The Mysteries of Being Female – Your 5 Common Questions Answered

Sometimes being a woman can be challenging.  Hormones go up and down then come and go.  We have this amazing ability to become pregnant and deliver a baby out of an area that starts small and grows to 10 centimeters when fully dilated.  We crave, we cry, we cramp, we clean and we console often all in the same day (sometimes in the same hour). We can carry on four conversations at once while updating our Facebook status, cooking dinner and prepping tomorrow’s suit which makes us wonder why we are tired at the end of the day.  We do all this and yet there are times when our body just does not seem to want to cooperate or suddenly veers off course.  Here are some answers to 5 common medical mystery questions about the female body.

1.       Why do I have vaginal dryness (sometimes or all the time)? There are many reasons to consider but the big ones include: not fully aroused, stressed, other things on your mind, on the birth control pill, on clomid (or other fertility medications known to dry up mucus), history of a LEEP procedure on the cervix due to an abnormal pap smear, decongestants (they do not just dry up the nose), dehydration, and hormone changes.

2.       Why are some periods unlike other periods?  Some women have the “fluke” where their period comes early or late (not pregnant), is really heavy, really light, no cramps, severe cramps…etc and this is different from the normal.  Some women alternate months in that one month is an easier period then the next month is a more symptom heavy period. Remember (as I tell my patient’s), your ovaries are sisters not twins therefore “righty” and “lefty” may produce different hormone levels and create different symptoms. Some months may be a “righty” month and others a “lefty” month.  In addition, high stress, grief, flying, major transition, heavy exercise, weight loss, and hormone changes can all affect how your cycle rolls. 

3.       Am I too young for hormone changes?  Nope.  Hormone changes and imbalance can occur at any age from puberty all the way through menopause.  You may be too young for menopause but that does not mean there are not issues with hormone production.  Women who do not ovulate do not make progesterone and progesterone is typically known as the calming, soothing, anti-PMS, pro-pregnancy hormone.   High estrogen contributes to more PMS-type symptoms, heavier periods, weight gain and tender breasts.  Higher testosterone or testosterone sensitivity may create more acne and increased hair growth on the chin, neck, and around the nipples.

4.       Why are my periods irregular or why do I spot and bleed more than seems normal?  First of all, if you are fully menopausal and have not had a period in 12 months and suddenly you start bleeding, please contact your health care provider as you will need additional work up.  If you are peri-menopausal then expect your once regular periods to become very erratic and unpredictable due to the nature of the ovaries changing.  Other reasons for most all ages include hormone imbalances, fibroids, polyps, pregnancy, thyroid problems, being low in iron, having Polycystic Ovarian Syndrome (PCOS) and being on the wrong birth control pill dose.

5.       Where did my sex drive go?  This is tricky.  Some women do not start out with a thriving sex drive and as they go through hormone changes it begins to wane even more.  Those who are used to a higher drive find themselves perplexed when their mojo is gone.  Sex drive for women is rather complicated as it takes into account hormone balance, arousal, stressors, how many things are on their brain, attraction, confidence…and more.  Certain medications are known to lower drive such as the birth control pill and anti-depressants.  Men typically have an “on/off” switch while women have an entire control panel.  Talk with your health care provider about testing for hormones, thyroid, and energy zappers like iron, Vitamin B12 and Vitamin D.  Focus on your stress response, eliminating what is not a priority, communicating with your partner about what you need (A dinner out? The laundry done? Compliments? Forplay?) and do not be afraid to explore and change things up within your comfort zone.  Perhaps this means new lingerie, the addition of sex toys, erotic readings (grey ties anyone?), more date nights, or a mini-couples vacation.

While being a woman is wonderful and empowering (empowher!), please talk to your health care provider if you recognize some of the symptoms above and suspect your particular symptom is more than just a “fluke.”  There may be some true imbalances that require a little tweaking in order to help you feel your healthiest.

References:

1)      Bachmnan, G., and Santen, R. Treatment of Vaginal Atrophy.  Web.  8 June, 2013.

http://www.uptodate.com/contents/treatment-of-vaginal-atrophy

2)      Shifren, J.  Sexual dysfunction in women: Epidemiology, risk factors, and evaluation.  Web. 8 June, 2013.

http://www.uptodate.com/contents/sexual-dysfunction-in-women-epidemiology-risk-factors-and-evaluation?detectedLanguage=en&source=search_result&search=libido&selectedTitle=3%7E131&provider=noProvider

3)      Welt, C.  Physiology of the Normal Menstrual Cycle.  Web.  8 June, 2013.

http://www.uptodate.com/contents/physiology-of-the-normal-menstrual-cycle?detectedLanguage=en&source=search_result&search=irregular+menstrual+cycle&selectedTitle=12%7E150&provider=noProvider

Birth Control Pills or IUD: Which Is Right For You?

There are several different types of birth control on the market now leaving women with many questions as to their effectiveness, side effects and long term consequences.  Unfortunately there is no perfect option that is ‘side effect –free’ (unless, of course, abstinence is counted however many opt not to make this choice) therefore it is important to combine your current health with your goals (true pregnancy prevention or other women’s health issues as well) and talk with your health care provider.  Here are some things to consider when looking at the two most common forms that might work for you.

First and most common is the birth control pill also known as the oral contraceptive pill.  This pill is taken daily for 3 weeks then stopped for 7 days to allow for a "period," or continued in some cases for 3 months straight or in rare cases done continuously without a bleed.  The pill is typically a combination of a synthetic estrogen and progestin that works to suppress ovulation therefore a woman cannot become pregnant if there is no egg release.  There are various forms of the pill and amounts of estrogen and progestin within. 

Typical side effects can include: change in menstrual cycle, mood changes, increased vaginal discharge, decreased libido, skin changes, weight changes, increased risk for gall stones, and increased risk for blood clots.  Women who smoke, have migraines with aura, have diabetes, or have a personal history of cardiovascular disease should not use the pill.  When used correctly (ie. taken at the same time every day) the effectiveness against pregnancy is 92-98% effective.  It does not protect against sexually transmitted infections such as gonorrhea, Chlamydia, HIV/AIDS, HPV or trichomonas. 

Next most common is the IUD or intrauterine device. This is a small T-shaped device that is inserted up into the uterus during an office procedure (only local anesthesia required).  There are two types of IUDs.  First is the Paragard that is also known as the copper-T as it does not have any hormone in it and instead relies on the copper wrapped around the T-frame causing local inflammation to create a non- hospitable environment for the egg and sperm.  This IUD lasts 10-12 years after insertion.  The Mirena and Skyla IUDs are hormonally based in that they both contain progestin, similarly to that found in the birth control pill.  They are inserted the same way as the Paragard however the Mirena lasts 5-7 years and Skyla (which is newer and has a smaller design for those women who have never been pregnant) lasts 3 years.  Their effectiveness is about 99% against pregnancy and can be removed relatively easily in office through a simple, quick procedure. 

The most common side effects for all three IUDs are pain with insertion, spotting or irregular cycles for the first 3-6 months during the adjustment period, and back pain.  There is the small risk for expulsion after insertion and perforation through the uterus.  The Paragard may increase menstrual cramps and increase menstrual flow.  The Mirena typically diminishes cramps and reduces flow however there is a risk for ovarian cysts and acne.  None of the IUDs prevent against sexually transmitted infections such as gonorrhea, Chlamydia, HIV/AIDs , HVP or trichomonas.

There are other forms of birth control such as barrier methods (condoms or diaphragm), the depo-provera injection, the implant, the patch, the ring, tubal sterilization, ablation and tubal blockers (essure).  Please talk with your health care provider about which form suits your needs and your health best.

Read more at www.empowher.com

References:

1)  Foster, D. (2009).  Optimizing the Use of Oral Contraceptives.  Web.  14 April, 2013.

http://www.medscape.com/viewarticle/588425

2)  Reuter’s Health Information (2013).  U.S. Approves First New IUD in 12 Years.  Web.  14 April, 2013.

http://www.medscape.com/viewarticle/777413

3)  Waknine, Y. (2009).  Levonorgestrel IUD Approved to Treat Heavy Menstrual Bleeding.  Web.  14 April, 2013.

http://www.medscape.com/viewarticle/709854

4)  Barclay, L.  (2011). IUDs, Implants Most Effective Reversible Contraceptive.  Web.  14 April, 2013.

http://www.medscape.com/viewarticle/745108