Thursday, October 6, 2011

When Your Period Signals a Problem

Heavy periods, no periods, painful periods, spotting -- find out when it's time to call your doctor.



By Stephanie Watson


Reviewed by Mikio A. Nihira, MD


As you probably learned back in middle school, menstruation is the monthly shedding of your uterine lining. Though it can be uncomfortable and sometimes inconvenient, your period is your body's way of telling you that your reproductive system is working properly.



Just as every woman is unique, every woman's period has its own personality. Some periods are short, others are long. Some are heavy, others are light.


After a few years' worth of monthly bleeding, most women start to get a feel for their period's frequency, duration, and flow. When something out of the ordinary happens -- such as spotting between periods or an exceptionally heavy flow -- it's natural to wonder what's going on.


Is There Such a Thing as a Normal Period?


Not really. The average woman's menstrual cycle is 28 days long, and the average period lasts for three to five days, but there can be huge menstrual cycle variations from woman to woman.


"Three days is normal for some women, seven days is normal for others," says Franklin Loffer, MD, executive vice president and medical director of AAGL (formerly known as the American Association of Gynecologic Laparoscopists). Similarly, the normal period flow can be heavier in some women than in others.


Rather than worrying about the length or frequency of your period, you need to consider whether anything has changed.


"A woman should really be tracking her own menstrual cycle, because it provides huge numbers of clues about whether something's not right," says Frances Ginsburg, MD, director of reproductive endocrinology at Stamford Hospital in Stamford, Conn., and assistant professor of clinical obstetrics/gynecology in the Columbia University College of Physicians and Surgeons.


Here are some common menstrual period changes, and what they might mean.


Your Period Has Slowed or Stopped


The big question if you're not getting your period is -- how old are you?


The cause of a missing menstrual period (called amenorrhea) varies by age. "To quit having periods at age 25 is a significantly different issue than quitting at age 50," Loffer says.


For a woman in her 20s or 30s who is sexually active, pregnancy is always a possibility. "Even if a woman thinks she's protected, that's not an absolute guarantee," Loffer says.


On the other hand, women in their 40s or 50s could be in perimenopause -- the period surrounding menopause. As your ovaries slow their estrogen production, periods become less frequent. Periods also can get shorter or lighter during perimenopause. Once your periods stop for a full 12 months in a row, you're in menopause. The average age for menopause is 51.


Another possible cause of missed periods is excessive exercise. Anywhere from 5% to 25% of female athletes work out so hard that they stop getting their periods. Called exercise-induced amenorrhea, this phenomenon is particularly common among ballet dancers and runners. Intense exercise affects the production and regulation of reproductive hormones involved in the menstrual cycle.










Your Period Has Slowed or Stopped continued...


For similar reasons, women who have eating disorders such as anorexia nervosa can also stop getting their period. Severely restricting the amount of calories you eat suppresses the release of hormones your body needs for ovulation.


Other possible causes of missed periods include:


• Thyroid or pituitary gland disorders


• Disorder of the hypothalamus (brain area that assists with reproductive hormone regulation)


• Breastfeeding


• Obesity


• Oral contraceptives (although birth control pills will usually just make the periods lighter, rather than stopping them entirely)


• Stress


• Polycystic ovarian syndrome and other hormone imbalances


• Ovarian failure (the loss of normal ovarian function before age 40)


• Disease of the uterus (womb)


Your Period Is Heavier Than Normal


Most women only shed about 2 or 3 tablespoons of blood each month. Those with heavy periods (menorrhagia) can lose 5 or more tablespoons of blood monthly.


When you bleed excessively, you lose iron. Your body needs iron to produce hemoglobin, the molecule that helps your red blood cells transport oxygen throughout your body. Without enough iron, your red blood cell count will drop, leading to anemia. Signs of anemia include shortness of breath, unusually pale skin, and fatigue.


If you have a persistently heavy flow, see your doctor for a blood count to make sure you're not iron deficient, Ginsburg advises. If so, you might need to take a supplement.


A number of conditions can increase your period flow, including:


• Uterine fibroids or polyps (noncancerous growths in the uterine lining)


• Miscarriage or ectopic pregnancy


• Use of certain drugs (including blood thinners or steroids)


• A change in your birth control pills


• Clotting disorders, such as von Willebrand's disease


• Cancer of the uterus


You can gauge how heavy your period is by how many tampons or pads you're using. Soaking through one or more sanitary pads or tampons every hour for a few hours in a row is a sign that you're bleeding abnormally heavily.


Taking oral contraceptives can help regulate your menstrual cycle and reduce bleeding. If you use an IUD for contraception, your doctor may choose to insert a specific type of hormone-releasing IUD called Mirena to help reduce bleeding. Another option is a medicine called Lysteda, a pill that helps stop bleeding by increasing blood clotting.


If the bleeding continues, your ob/gyn might recommend that you have an ultrasound or other test to identify the source of the problem.






You're Bleeding In Between Periods


This is one period problem you shouldn’t ignore. "If you're bleeding between periods, it should be investigated," Loffer says.


Causes can range from something benign -- such as having an irritated sore in the vaginal area or forgetting to take your birth control pill -- to something as serious as an ectopic pregnancy or cancer. Visit your doctor for an exam.


You're Experiencing a Lot of Pain with Your Period


Your period generally isn't the most comfortable time of the month. Most women have cramps as the uterus contracts to shed its lining. Usually the discomfort is mild and it subsides in a day or two.


But for some women, the pain is so intense that they can't get out of bed.


Painful periods are called dysmenorrhea. They can be accompanied by other symptoms, including diarrhea, nausea, vomiting, headache, or discomfort in the lower back.


Sometimes the pain is from the period itself, but it also can be caused by conditions like endometriosis and fibroids. To find the source of the problem, your doctor can do a pelvic exam and Pap test, as well as other diagnostic tests such as an ultrasound or laparoscopy.


Nonsteroidal anti-inflammatory drugs (NSAIDs) can help because they not only relieve pain, they also prevent the body from making prostaglandins -- the chemicals that stimulate your uterus to contract during your period. Your doctor might recommend that you go on the pill or get an IUD, which can also reduce period pain. Fibroids and endometriosis are sometimes treated with surgery.


When to See Your Doctor


Any period issue that is out of the ordinary for you warrants a call to your doctor, especially if it makes you uncomfortable or keeps you from doing your normal activities. "If a woman feels that it's interfering with her lifestyle, then she needs to address it," Loffer says.


Definitely call your doctor if:


• Your periods used to be regular, but they've become irregular.


• Your period comes more often than every 21 days, or less often than every 35 days, for several cycles.


• You bleed for more than seven days straight.


• You stopped bleeding for 12 months in a row (menopause) and are now bleeding again.


• You are soaking through one or more pads or tampons each hour for several hours in a row.


• You have bleeding between periods.


• Your periods are very painful.


(Culled from WebMD.com)


Wednesday, October 5, 2011

Random Thoughts on Fertility

I listened to a radio call-in programme last night on IVF and 70% of the people who called in said they had the procedure and didn't receive post-procedure counselling after their cycles failed. This confirms to me that most fertility clinics are merely concerned about the money and not necessarily the emotional condition of their patients.

A woman called in and said she is over 50, and had IVF only to be told her ovum was not producing eggs! I believe someone like that need not have waited till her 50s to attempt IVF and also that the doctors should have done their investigative tests to ascertain her suitability for the procedure instead of allowing such a couple go through the emotional, and financial stress of the procedure.

It is common knowledge that if you are in your 20s and you have had unprotected sex for 1 year without conception you need to see a doctor and if you are in your 30s and has had unprotected sex for 6months without conception you are a candidate for fertility reviews. We should not wait until the 50s to seek help. One major factor leading to the high incidence of infertility in Nigeria as I have observed is late marriages. After spending all our productive years in school, we find out guys are afraid of commitment and ladies are getting married in their 30s. However, this does not stop anyone from getting to know your body while you are still single.

Ladies should review the changes in their monthly cycles. How long? How much? What changes? Seek healthy options to your favorites habits by eating well, avoid sinful relationships, don't do drugs and never take a drug without prescription. Do you know some prescription drugs causes infertility? if you have painful unexplained cramps, clots or irregular periods, they could be a pointer to deeper reproductive issues later in life. Knowledge is power and the earlier these are tackled the better.

Having a prayer network and receiving counsel goes a long way in calming nerves and knowing that someone has gone through the same path can go a long way in providing the succour and help that may be absent in the impersonal doctor's examination room. I can assure you that the feeling of being violated while on the examination table is not peculiar and any woman who has had to go through an examination knows what it feels like.

What am I rambling about? Reach out! Talk to someone!! It may not necessarily be easy to tell your friends and family what it is but in a personalised counselling you get to pour out your heart knowing the information will not be used against you.

 I strongly believe that any family going through infertility and considering treatment should seek out personalised counselling. It is a long road most of the time, and you need your support system. Please don't hesitate to reach out. Call 08121716955 today or add 2A38E9E7 on bbm. It could be the best decision you ever made on your journey through the waiting room.