Period Problems? Why It's Important To Find The Underlying Cause
In most medical specialties, we have developed very sophisticated ways of determining the underlying causes of disease. When we know the cause(s) of the problem, we are better able to offer the proper treatment, if not the cure, for the disease. For example, in a patient with Type 2 Diabetes, we know that there is a genetic predisposition to develop the disease PLUS environmental factors (diet) that work together to bring about the disease. Any treatment for this type of diabetes that does not help the patient to address the problems in the diet is simply not going to be effective in the long term. There is no “quick fix” for this disease. The patients with Type 2 Diabetes that follow a healthy diet and exercise program are most likely to reverse the course of their disease and may no longer need further treatment with prescription medications.
When it comes to irregularities in the periods of women, we have not been so sophisticated. In fact, very little research has been done in this area in recent decades due to the fact that doctors are taught that no cause needs to be sought. Why would we look for the cause of the problem when the “solution” has already been found?
Periods too often? Birth Control
Periods too far apart? Birth Control
Painful periods? Birth Control
Acne? Birth Control
Bleeding in between periods? Birth Control
Heavy periods? Birth Control
The problems with this approach are too numerous to list, but here are a few:
· Women who are treated this way feel that they are not being heard when after just a few minutes of explaining their symptoms to the doctor, they are handed a prescription for birth control to “regulate” their periods.
· Many times the birth control pill/shot/patch/ring causes a new set of problems that may lead to additional prescriptions.
· The artificial hormones in birth control suppress healthy ovulation and healthy ovulation is necessary for the overall health of a premenopausal woman.
· Women are not being taught about their signs of fertility so that they can make informed decisions about their own health.
A Different Approach
1. LISTEN: First, we should take some time to listen to our patients. In medical school, we were taught to take a good medical history from our patients. In practice, we quickly learn to take shortcuts in order to be more efficient with our time.
There are significant clues to look for that will help us to make the proper diagnosis, such as:
*Age of the patient – when women are in their teens and/or in the peri-menopausal years, many cycles will naturally be anovulatory. Anovulation happens when a woman does not ovulate normally in a cycle. This causes abnormal levels of progesterone and estradiol, which can adversely affect her period. Anovulation can cause heavy periods, irregular periods, and infrequent periods or too frequent periods. The good news is that ovulation can be supported and/or restored with natural progesterone in the form of an oral or vaginal capsule.
*Signs and symptoms of other diseases – thyroid disease can cause irregular periods. Polycystic ovarian syndrome can cause irregular periods. Bleeding disorders can cause heavy periods. During the visit, the patient should be asked about the health of other body systems such as their digestion, weight problems, bowel movements, acne, hair on the face/chest.
*Diet/nutrition – this is a HUGE disruptor of periods. When women eat too many sugars, they may not ovulate. When women don’t eat enough calories/carbs, they may not ovulate. For example, many women have Hypothalamic Amenorrhea. This is a condition where the master gland in the brain (the hypothalamus) has surveyed the overall health of the person and has sensed that the person is not healthy enough to be fertile at any given time. This could be due to poor diet, too much exercise, too much stress, not enough sleep or another illness.
*Medications – the number 1 offender here is (you guessed it) artificial birth control! Birth control suppresses healthy ovulation and once the medication is stopped, it can take up to one year to resume healthy ovulation.
2. TESTING: Not everyone needs lab tests. Sometimes after listening, it is clear that the patient might only need more sleep, some vitamins or just time for her brain and ovaries to learn to communicate. If testing is deemed necessary, it should be done selectively based on the suspected diagnosis.
For example, if I suspect polycystic ovarian syndrome and the patient has long cycles, I order the following:
pelvic ultrasound to assess uterine lining (if thick, she’s making enough or a lot of estrogen; if thin, her ovaries are “sleeping” and not making estrogen)
fasting labs on cycle day 3 – may include FSH, LH, fasting insulin, androgen levels, 17 hydroxyprogesterone, prolactin, vitamin D, thyroid tests, ferritin level
I may prescribe a 10 day course of prometrium (natural progesterone) that causes a withdrawal bleed and stimulates the hypothalamus to initiate a new, healthier cycle. (Note: using artificial progesterone does not have the same beneficial effect.)
3. TREATMENT/RESTORATION: After the data is gathered and reviewed, I meet with the patient again to discuss the results and her treatment plan. I give her advice about her diet/nutrition, continue to educate her about what is normal/abnormal about her cycle, ask her to keep track of her cycle in the best way possible for her, and sometimes I prescribe progesterone to be taken in every cycle to assist the HPO axis to assist healthy ovulation. In the ideal situation, patients are charting their cycle using an advanced system such as Creighton Model Fertilitycare System. In this system, patients are able to identify the actual day of ovulation. When this is done, we can gather more information about hormone levels before and after ovulation. This allows for more precise diagnosis and treatment of hormonal dysfunction so that we can achieve more authentic restoration of cycles.
As a physician, this personalized approach is much more satisfying because I know that I am providing the best diagnosis and treatment for each woman. Patients are satisfied too when they feel that they are being listened to and valued as individuals. When doctors and patients work together by finding and treating the cause of the problem, everyone benefits.
Please share this information with doctors and women who may be interested in this approach!