Reproductive System & Birth Control

I have irregular periods. Is this normal?

Irregular periods and the normality of it ; that's actually a very good question. So I actually see a lot of patients who think, you know, deviation of one or two days, something's wrong with themselves.

Irregular periods are expected in the first couple years, right after having your menstrual cycle. And of course, as we all know, when we get to that peri-menopausal area, they do whatever they want to do. But if you have periods that are consistently irregular for a six month period, six months length of time, then we have a problem. I have [an article that explains] per age group, what that range should be. But if it's not in that range and it's not consistently in that range, like my day is 38, then there's something going on.

Now we look at well, what could that be? It could be purely a hormonal issues that we have to address. It could be there's something in the uterus, such as uterine fibroids, polyps, and infection. And I will get into these habits a little further later on. And there's treatments for all of this. And unfortunately, some people are a little hesitant to take hormones, but I'll be honest - half of hormones I prescribe are not for birth control. They are for getting these periods regular. You don't want to live with an imbalance because that affects your entire body and can have long-term consequences

My mood swings are severe during each cycle. Is this normal, or could it be a sign that my estrogen level is off?

So when they think of mood swings, we think of PMS. And then there is a less known title called PMDD (premenstrual dysphoric disorder). Symptoms - I think most of us are familiar with them because 75% of all the population of women experience these – crying, irritability, more fatigue, more sleeping. You're just not yourself. And in this can start a week before your period and last a little longer. It is caused by, and of course we are not a hundred percent sure, but we believe it is caused by the drop in the hormones in our body. And then we're withdrawing from those hormones, and as we're doing that, it's triggering symptoms. Now, PMDD is a much rare form of this. This is only in about max 8% of women that have this.

And this is when it gets to a point where yes, a lot of us have pain, that’s what it is and we keep on going. We know this it is what it is. It doesn't affect your life.

PMDD is affecting your life. You cannot go on because these symptoms have taken over and literally wipes out a week of your life because you're just not yourself. And essentially they're so severe that you can't do your normal activities.

With just PMS, there are some natural treatments. Like increasing your calcium, your B6. There are some herbal treatments over the counter. And of course we can treat them hormonally as well. So if this becomes an issue in your life, please come to the one of the three of us. And we would like to talk to you about that and see if we can help you. The belief is – and this is because can get inside someone's brain. So we're going to come up with our theories and the theory makes sense so let me explain it to you. When the estrogen level of progesterone level drop, what it does is it goes to our brain and because these are all hormones and it goes to our brain and it drops a level of something called serotonin.

Now, serotonin may be familiar and you may have heard that word before. What it is, it's the hormone in antidepressants. Because if you think about it, the symptoms you're experiencing are similar to depression symptoms. And so by dropping off those hormones, you are dropping off this amount of serotonin. So we have treatments beyond birth control pills, which just knocks out your period and knocks out a drop off of hormones, to putting you on antidepressant. Sarafem is probably the most popular and has been for quite a while. Sarafem is really just Prozac renamed. I always like to go with the generic form. We have Zoloft, we have Paxil, we have Celexa, all of which are serotonin boosters, so they can help during that time period if that’s something you choose.

What are signs that my estrogen level might be too low?

Let's point out the obviously two most common times when your estrogen level drops. First is perimenopause. This is when ovaries work one day, don't work the other and then work a little bit. It's our way of our body's slowing down to enter menopause. So that's when you get these crazy cycles, that's when you get periods coming or disappearing for months, and then coming every two weeks. So that's because the ovaries are doing what they want. They're not quite shut down, but they're getting there. And that is signs of low estrogen, which would come the symptoms of hot flashes, mood changes, irritability, night sweats. And that goes on to day sweats. There's no time, there's no guarantee that it’s going to be one time or another. Sometimes you will even experience a little fatigue and a little bit of brain fogginess and that's the perimenopausal agent.

So then in younger girls, we have to worry about low estrogen as well. Because the whole access from the brain down to the uterus has not been fully established. And that may take years. So they may have irregular cycles. They may have no cycles at all. In that age group and in other age groups, a concern for me is a person who is a very strong exerciser or runner, someone who has a very low body mass index. Because again, estrogen is stored in our fat cells. If you don't have enough of those, you're not getting a period. But what that means to me also is that you're not providing enough estrogen to make your bones strong. So I don't want you at 20, going years without period, and finding out at 45 you already have osteopenia because your body has not had that time to build up your bone strength because you haven't had hormones.

Sex is often painful. Is this normal?

This is a big topic, but one that most people don't want to talk about.

So it is actually part of my standard question with anybody post-menopauseal. Because that tends to be the biggest group. With perimenopause we're having that drop of estrogen and that estrogen not only effects our symptoms. It also effects a good part of our body. It is associated with issues in the vaginal region. The whole vaginal region is affected by estrogen. So you're having your vagina, your vulva, your external vaginal tissue. Even the urethra are starting to lose estrogen, they're getting smaller. The tissues getting thinner, it's losing its normal vaginal discharge, and that leads to terribly painful sex. But the good thing about this is usually treated with a non-oral, which means all those risk factors that women are often scared to death about, don't exist. With a topical treatment, I'd like to describe it as, having eczema and you're putting cream on your skin.

You're going to put estrogen back to those areas because literally the vagina will shrink and that shrinking will actually cause the urethra to open. That increases your risk of urinary tract infections. Other issues that can cause painful sex are vaginal infections - STDs, UTIs and even IUDs if it is not quite what your body likes. Even if it’s in the perfect position, people will have sex with a pain with an IUD. So if you're experiencing painful sex, it's not you. And that's problem is most people would think “This is my fault. This is something I have to deal with”. No, this is something that we encourage you to come to us and we'll help you with it.

What are potential signs of having an STI, and what should I do if I think I might have an infection?

So these can cause a discharging, pain with urination, pain with intercourse and irregular bleeding. And a lot of times, unfortunately there may be no symptoms at all. So my recommendation -  if you're changing partners or if there's any question about your last partner or you just want to make sure you're okay, just get checked. And we do this routinely on girls at young ages just because we don't want you to have a sexually transmitted infection and not know about it. So anything that seems out of ordinary for you, you have someone that's not, you know, a regular partner or a new partner, come on in. It's an easy check. Let's just make sure you're okay.

What types of birth control are available? And what is most recommended?

Types of birth control