Barb's Daily Dose

No Periods?

Yes, that's right, women who are on birth control do not need to have a period every month. 

How is this possible, you wonder? Well, as long as there is balance in hormones, then there is no risk of problems. I'll explain a little further.

The menstrual cycle 

If you click on the link above you can learn more about the menstrual cycle, which will make this easier to understand.

Why heavy periods happen

A few days ago, I talked about heavy periods.  Now there's lots of reasons that this could happen, so it's important to find out why it's occurring and then provide treatment options.

Diagnostic Tests

Depending on the woman's age and her history of heavy bleeding one or more of the following may be ordered:

Your Menstrual Cycle

The menstrual cycle is my life. I know, it's crazy, but without knowing how it works, it's impossible to do my job.  If you understand this, then you will understand these important issues that most women face at some time in their lives:

• Why the pill works
• What happens when you can't get pregnant
• How you can get pregnant
• What happens in menopause
• What happens with PCOS
• What makes the world go around - sorry, couldn't resist  

The Typical Menstrual Cycle
This is a fast, quick explanation: 

The Typical Menstrual Cycle
This is a fast, quick explanation: 

Heavy Periods

"I decided to stay in the shower, because I was bleeding so heavily that it was just easier that way."

Did you know that 1 in 5 women suffer from heavy periods?  That's a lot of pads and tampons. Some women have heavy periods their entire lives and some only experience this particularly feminine challenge with perimenopause.

The quote above is from my friend J. She lives on the east coast and called to say that she was really worried, because her bleeding had become so bad that she couldn't leave the bathroom. 

She said, that she since was the only one at home and was bleeding so heavily that she decided to get into the shower because as she says, "I figured if bled to death in the shower, it would be easier to clean up."

This floored me. Always thinking of others first, putting ourselves last.  Really, she was doing the best she could at the time.  She also said that she was afraid that she couldn't drive to the doctors office 20 minutes away. 

No Periods?

Yes, that's right, women who are on birth control do not need to have a period every month.

How is this possible, you wonder? Well, as long as there is balance in hormones, then there is no risk of problems. I'll explain a little further.

The menstrual cycle

There are 2 main hormones involved, Estrogen and Progesterone. Estrogen is the hormone that is responsible for many things including building up the lining of the uterus also known as the endometrium. Progesterone is the hormone that causes the endometrium to be thicker and more glandular to help support a fertilized egg.

Every month a woman's ovaries produce levels of Estrogen & Progesterone in a delicate balance that results in ovulation, the release of an egg. The Period happens when the Estrogen and Progesterone levels decrease. If the hormone levels remained higher, and there was no decrease, there would be no period.

The hormone balance
The birth control not only prevents ovulation, it also provides a different balance of Estrogen and Progesterone, which also decreases acne. With this different balance in hormones, the lining of the uterus also doesn't grow as much as it would, so for most women, there is less blood. That's why many women have shorter lighter periods, and much less cramping. What we've found is that by giving the hormones without a break, there is NO decrease in their levels and so no periods.

If you're interested in a more thorough explanation of the menstrual cycle, see my 3 part series on PCOS.

PCOS Part 3

A few weeks ago I posted Part 1 of PCOS.

Last week I posted the 2nd part of our series on PCOS.

Today, we'll talk about how PCOS manifests in women's lives and what they should watch out for.

Quick Review

Women with PCOS often do not ovulate and they have an imbalance in their hormones. Many will have long intervals between periods and some may only have 1 period a year. When this happens, these women are at risk too much estrogen stimulation on the lining of the uterus, without the balance of progesterone.

Heavy Bleeding
With PCOS, because of the imbalance of estrogen and progesterone, the lining of the uterus, known as the (endometrium) may grow too much and a woman may experience heavy and prolonged bleeding. There are many terms for this, and what's important to know is when to be concerned. Check in with your health care provider if:
• You have been bleeding for more than 10 days in a row
• You are soaking through a pad and/or a tampon in less than 1 hour for more than 3-4 hours
• Your periods come more often than every 21 days.

Abnormal bleeding
With PCOS, women are more at risk to have abnormally heavy bleeding that may be a sign of abnormal, pre-cancerous or cancerous cells within the endometrium.

PCOS part 2

This is part 2 in our series on PCOS. Here's a link for Part 1.

Most women with PCOS see a health care provider for a few common reasons. Either they aren't having periods, their periods come infrequently, or they have heavy bleeding.

This is what PCOS looks like with an ultrasound

Poly = Many

Notice that there are many small black areas within the ovary.
Each of these black appearing areas are cysts that are filled with fluid.
It's not unusual to see 10 - 12 cysts on each side.
Each month more cysts begin as others regress.
Most women do not feel these cysts.
These cysts are usually small and rarely burst causing pain.

Is there a cause for PCOS?

Can it be prevented?

Can PCOS ever go away on it's own?

Review
In order to understand what happens with PCOS, let's briefly review what happens in a typical menstrual cycle.

• When a woman starts her period, the ovary is also active. Several follicles, which are where the eggs develop begin to grow under the influence of FSH (follicle stimulating hormone).
• These follicles produce the hormone Estrogen.
• One of the follicles really grows fast, producing the most Estrogen and it becomes known as the dominant follicle, which will ultimately be the one that releases the egg.
• This high level of Estrogen triggers the release of LH (luteinizing hormone).
• About midway through the cycle, there is a surge in LH which causes the egg to be released about 24-36 hours later.

PCOS

Poly Cystic Ovarian Syndrome

This is the first part in a multi-part series on PCOS. I care for many women with PCOS and they've told me that there isn't a lot of information that's easily understood available.

What women with PCOS may notice:

• Too much hair in places you don't want it, like the upper lip, chin, around the breasts and tummy

• Difficulty losing weight

• No periods, irregular periods or 1 -2 each year

• Acne

• Darkened skin around the neck and/or armpits

• Inability to become pregnant

What your provider may notice

• Elevated levels of LH (Luteinizing hormone)

• Lowered FSH (Follicle Stimulating hormone)

• On an ultrasound, 10 or more cysts on one or both ovaries. This is how PCOS got it's name. Poly means many. When there are many cysts, there are Poly Cysts.

Questions and Answers about Heavy Periods

How do I know if I have heavy periods?

Although many women may feel as though they are the only ones experiencing heavy periods, women of all ages have heavy periods that interfere with their day-to-day lives. You may have heavy periods if your period:
• Lasts a long time
• Is so heavy that you need to change pads or tampons every 1 to 2 hours
• Is so heavy that you often have a tampon AND a pad for more protection
• Is so heavy that you have to change pads at night

Is it normal to miss work or other activities once in a while because of heavy bleeding?

Many women are surprised to learn that it’s not considered normal for periods to disrupt their normal activities and life. Heavy periods may be interfering with the quality of your life if you:
• Wear dark clothing because you worry about “accidents” during your period
• Miss work or social activities because of heavy periods
• Find that your moods are affected by your heavy periods
• Have had to significantly alter sexual relationships because of heavy periods
• Feel that your life would be much better without your periods

Who is likely to experience heavy bleeding?

Women of all ages may experience heavy bleeding, yet many women in their 30’s and 40’s may develop heavy bleeding for the first time. Women who have stopped taking birth control pills, those who have had their tubes tied (tubal ligation) and women who are pre-menopause are especially likely.

Losing Sleep Over Heavy Periods--A True Story

I'll tell you a true story about a patient of mine, since we received so much great feedback on the DareToWearWhite Website. This amazing woman came to see me because she wanted sleeping pills. When I asked her what was interfering with her sleep, she said that when she rolled over, the noise from the plastic sheet woke her up. Well, I felt like a CSI detective, as I asked more and more questions to figure out what the heck she was doing, sleeping on a plastic sheet.

As it turned out, during her heavy, heavy periods, she didn't sleep in bed with her husband anymore because she had bled through so many nightgowns, towels, sheets, and mattresses that she didn't want to ruin anything else. So she was sleeping ON THE FLOOR on a plastic sheet! No wonder she was tired! She never brought it up with any health care provider, because she was afraid that the only option was hysterectomy (her mom had one) and she didn't want that. Well, long story, getting longer.....she had NovaSure procedure and then she, on her own, called the company to offer herself as a testimonial as it changed her life!

I encourage you to go to the DareToWearWhite.com website to learn more. For more information please check out www.NovaSure.com