Suffering From Hot Flushes at 24. Is This Normal?

Hello to you all. I hope you have all had a wonderful week do far. It is hard to believe that summer is half over now!

I have had a run of patients lately that are concerned because they feel an increase in their hot flashes/flushes this time of year. Of course, with the heat, this is common, especially among perimenopausal and menopausal patients. Those of you with other illnesses like diabetes, thyroid disorders and other chronic illness can have an increase amount of sweating and hot flashes. Also, some medications can even cause hot flashes and increased sweating.

That all seems natural, but what about those of you in your late teens, twenties and thirties who are nowhere near menopause? Many of you come in because you are experiencing hot flushes that come the week prior to and during your menstrual cycles. Is this normal or should you see your doctor to check for some other medical problem?

I can tell you that it is normal for women of any age, from early teens to late thirties, to experience hot flushes a week before and during their periods. They actually put a birth control pill on the market 15 years ago called Mircette, that was designed to address this problem. [Side note: The pill is designed to mimic our cycles with the rise and fall of hormones, but is balanced in a way to prevent ovulation of an egg.]

Mircette is a mono-phasic pill that has the same amounts of hormone in each tablet for 21 days, then starting with the 22nd day (which is day #1 of the last week in the package), normally all birth control pills in the last week are placebo (sugar pills) plus Mircette. Each pill in the last week also contains a low dose of estrogen to help prevent hot flushes. It is the sudden drop in estrogen during normal cycles and when taking birth control that causes these hot flushes. After our period ends the estrogen and hormone levels begin to rise again and hot flushes go away, and it all starts over again.

The same can be accomplished by giving women a low dose estrogen pill (0.3mg) or a low dose patch of the same strength. This can also help with dizziness, nausea, migraines, mood changes and breast tenderness. A woman's body is so sensitive to estrogen fluctuations and this is what causes the symptoms to come on.

So what does a hot flush feel like? First you feel flush, then a sensation of warmth crawls down your body. Soon you begin perspiring. Some women feel that the flushes begin in their face with perspiration running down their neck and gently moving to the chest and upper back, causing beads of sweat between the breasts. Most stop there. Only a few feel the flushes lower than the chest. Some young girls and women say that their skin can be cold from the outside temperature, while their internal body temperature feels hot.

So, the answer to the question, "Is it normal for me to have hot flushes around my period even though I'm only 24 years old?"…..is yes.

I hope that if you are having this problem that you will visit your doctor and let him/her know, so you can get relief and be evaluated for any other medical problems.

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My Periods Are Very Heavy. Should I Be Concerned?

If your menstrual blood varies in color and consistency throughout your monthly period, it's likely that it's perfectly normal. There are times, however, when changes in color, thickness, or clotting may indicate a problem.

During your menstrual cycle, the lining of your uterus thickens to get ready for pregnancy. Then, if you do not become pregnant, your body sheds the uterine lining - causing the bleeding. The amount of blood and fluid lost is usually between 4 and 12 teaspoons each cycle. The average menstrual cycle lasts 28 days, but cycles can be as short as 21 days or as long as 35 days. A normal period lasts between two and seven days.

Many women have clots in their menstrual blood from time to time and the clots may be bright red or dark in color. Often, these clots are shed on the heaviest days of bleeding. The presence of multiple clots in your flow may make your menstrual blood seem thick or denser than usual. If you have excessive clotting or clots larger than a quarter, you should let your doctor know, to rule out any conditions that might be causing an abnormal period.

Sometimes you may notice that your menstrual blood becomes dark brown or almost black as you near the end of your period. This is a normal color change. I t happens when the blood is older and not being expelled from the body quickly.

On a short-term basis, thick, heavy flow isn't necessarily cause for concern. But many women become accustomed to heavy periods, considering them to be normal. Then, over time, excess monthly blood loss leads to anemia, and can potentially cause weakness or fatigue. If you ever feel something is not right with your period, it's important to see your doctor.

Changes in the color and thickness of menstrual blood are often normal. But there are a number of problems that might cause abnormal clots to form in your menstrual blood or lead to changes in color or thickness during your period.

There are many things that could be the cause of your heavy bleeding and it is important to get into your doctor and get tests taken. Irregular, late and heavy periods can be a sign of miscarriage. You may pass blood clots or gray clumps of tissue from the vagina. Miscarriage can cause severely heavy bleeding and this can lead to anemia.

Uterine fibroids (also called leiomyomas) are noncancerous tumors that form in the uterus. Fibroids do not always cause symptoms. But, women with fibroids may have greater than normal amounts of menstrual blood. If you have fibroids, you may have more clots in your period than you had in the past. Another possible cause of irregular, heavy cycles is sudden or gradual hormone changes in the body. Your body relies on a delicate balance of progesterone and estrogen. These hormones regulate the production and shedding of the uterine lining. When this balance is disturbed, it can lead to the development of an excessively thick uterine lining. This thickness can contribute to more bleeding than usual. It can also cause clots in the menstrual blood when the lining is shed.

Also, dramatic weight changes can cause hormone imbalance and cause problems with abnormally heavy menstrual cycles. So can side effects from medications like steroids and antibiotics. Adenomyosis or endometriosis are also common causes of heavy and painful menstrual cycles. These related conditions occur when the tissue that forms the uterine lining is found in the wrong place. In endometriosis, this tissue implants itself outside the uterus by what is called retrograde menses. That is where the blood flow out through the fallopian tubes and the endometrial lining in the blood implants itself on the ovaries, bladder, uterus and even in the lungs. Adenomyosis is where the uterine lining grows into the uterine wall, causing the uterus to enlarge and become boggy. Like endometriosis, this can cause exceptionally heavy menstrual cycles and severe cramps. Endometriosis is more common in younger women, and Adenomyosis is seen more often in older women.

Depending on your symptoms, your doctor may order a variety of tests to determine the reason for all of the bleeding problems. These may include a vaginal ultrasound - which can see Uterine fibroids and measure the size of the uterus. Also, lab work may be ordered to check your blood for anemia, clotting/bleeding disorders or hormone imbalance.

Another test is done in the operating room which allows your doctor to get a biopsy of your uterine lining for pathological analysis. This also allows your doctor to look inside your uterus with a hysteroscopic camera.

Symptoms to watch out for (as they can be a sign that your bleeding problems are worsening) are: fatigue with normal activity, lightheadedness, pale complexion, ashen skin, fingernail beds that are pale, not pink, irregular periods, or frequent bleeding between periods. Anemia can be diagnosed with a simple blood test. Iron supplements result in improvement in most women.

It's important to see your doctor for bleeding problems, as they can lead to severe anemia and other issues that are not worth sacrificing your health for.

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Beside Pregnancy, What Could Cause Me to Miss a Period?

Most of us feel that if our menstrual cycles are normal and regular then our health must be OK, right? All it takes is to miss a period, or for them to become very irregular, for an alarm to go off. Then, we hurry to our gynecologist. It's truly amazing to me how regular most women are. So, suddenly missing a period or having a big change in frequency should not be ignored. Judging by the tears and anxiety in your voices, it can be a significant event.

Most women have between 11 and 13 periods a year. You may be different as you may have more or fewer cycles. Every woman is a little different. Menstrual periods are often irregular in puberty, when our cycles first begin. It may take several years for a woman's hormones to balance, so that ovulation and cycles become regular. Hormone imbalance is what also causes menstrual irregularities when peri-menopause and menopause occur. What surprises many women is that, with menopause, our cycles can become less frequent with less bleeding or more frequent with heavy bleeding and passage of blood clots.

If menopause comes before age 40, it is known as premature ovarian failure. This needs to be checked by your doctor because a special test called an FSH can be done to confirm early menopause. Early menopause can cause many health problems including osteoporosis, strokes, heart disease and emotional and cognitive deficits. It should not be taken lightly.

But, of the many reasons for menstrual irregularities and missed periods, the most common is pregnancy. If you might be pregnant, you are naturally excited, and you should treat yourself as if you are pregnant until you see your doctor and have a pregnancy test. There are several symptoms that are suggestive of pregnancy. These include breast tenderness, nausea and bloating.

But, since these can also be premenstrual symptoms, it can still be confusing until a pregnancy test or an ultrasound are done. If you recently went off the Pill, Depo-Provera injections or just stopped breast-feeding and want to get pregnant, it can take a few months for your periods to return to normal. You will not be able to get pregnant until you start ovulating again. A good sign that you are ovulating again (and are fertile) is when your cycles return and are regular.

Pregnancy is detected by a missed period and through taking a home pregnancy test. Sometimes tests will show up negative if they are done too soon. Home pregnancy tests check for the HCG hormone in our urine, so it is important that they are not done until you miss a period. Only certain kinds of blood tests called Quantitative not Qualitative Beta-HCG can test accurately before a missed period.

It is a good habit to track your cycles, so you know when to expect them, because miscalculation is a common reason for women to think they have a delayed or missed period. Tracking makes it easy to look back and see if you had sex during your fertile time, and it helps keep track of ovulation too. This is beneficial whether you are or are not trying to get pregnant right now. Nothing strikes fear into the heart of any woman like a missed period, and if you are not pregnant, there are other possible causes for missed or irregular periods that need to be looked into.

• Stress can affect all the messages to our female organs - like GnRh rhythms and hormone balance that can cause menstrual irregularities.
• Any sudden or chronic illness can also temporarily cause cycle irregularities.
• Even the stress of traveling is enough to throw off our bodies’ delicate cycles and messenger systems.
• Problems with our female organs or genitalia, such as a hymen that is closed off or imperforate (which closes the opening of the vagina and prevents the blood from coming out).
• Asherman's syndrome is a complication that occurs after having surgery in the uterus like a D & C (dilation and curette) which is done in pregnancy terminations. Asherman's syndrome can leave severe intra-uterine scarring, which prevents the uterine lining from thickening each month and causes little or no period.
• Changing schedules can really throw off your body clock. This is particularly true if you go from days to nights at work or vice versa. If you frequently change shifts, then this may be the reason. Isn't that amazing how sensitive our bodies are?
• Perhaps you're trying a new medication and realize it is having an effect on your cycles. Then it's important to let your doctor know how it is affecting you. We see the same with women who abuse illegal drugs.
• Carrying around too much weight can hormonally shift your cycles and even stop them. Most women will see a big change and a return to regular cycles with ovulation even with a 5-10 pound weight loss - even if they are still overweight.
• Being underweight can cause just as many problems with your cycles. If you do not have enough body fat you will not have regular periods, and sometimes you can even cause your periods to stop altogether. This is called amenorrhea. This is a frequent cause of a missed period in women who work out to an extreme or who are professional athletes. Typically a little weight gain will bring back your periods.

It is a good idea to relax and try to reduce worry and stress. This will help your body recover.

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Painful Period Cramps (Dysmenorrhea) - Causes and How to Alleviate Pain

I know sometimes the health issues many of you have - that cause so much pain in our bodies - can interfere with summer fun and getting together with your loved ones to relax and enjoy life. Many of you have contacted me or have come to my office concerned because of the pain with your periods.

Some of you have had severe menstrual cramps since your periods first began, and they seem to be getting worse. For the rest of you, you cannot understand why there has been so much change over the years.  Now, your periods are lasting longer and becoming much more painful.  "Wasn't all that supposed to get better, especially after having babies?"  It’s time for a 'Pow Wow' about this topic!  

Dysmenorrhea is the medical term for painful period cramps. There are two types of dysmenorrhea: primary dysmenorrhea and secondary dysmenorrhea. 

Primary dysmenorrhea is named for cramps that begin with the onset of the menstrual cycle.  It's the type of dysmenorrhea that we all remember as teenagers that just got better after a couple years - if we were among the lucky ones.  

Menstrual cramps are caused by contractions in the uterus, which is a muscular organ. The uterine walls are made up of muscle fibers which are wrapped and formed together in layers, with each layer lying slightly differently (horizontal, diagonal, etc.), which allows the uterus to contract powerfully. It is a hollow, pear-shaped organ where a baby grows. It contracts during a woman's menstrual cycle.  But, if the uterus contracts too strongly, it can press against nearby blood vessels, cutting off the supply of oxygen to the muscle tissue of the uterus.  Pain results when part of a muscle briefly loses its supply of oxygen.  We all experience the same thing when we exercise, run, or do too many sit ups without stopping and begin to feel our muscles cramp up.  These cramps happen for the same reason.   

Secondary dysmenorrhea is caused by some type of abnormality that has developed in the woman's reproductive organs. Pain from secondary dysmenorrhea usually begins earlier in the menstrual cycle and lasts longer than common menstrual cramps.  Often, it is associated with a feeling of pressure in the abdomen, pain in the hips, lower back, and inner thighs.  As cramps become more severe, some women experience upset stomach, sometimes with vomiting and loose stools, and even diarrhea.

For menstrual pain, women can take aspirin or another pain reliever, such as Tylenol (acetaminophen), Motrin (ibuprofen) or Aleve (naproxen).  For best relief, you must take these medications as soon as bleeding or cramping starts. Placing a heating pad or hot water bottle on your lower back or abdomen and taking a warm bath may also provide some relief.  Getting plenty of rest is essential to feeling well mentally and physically.  Diet can also play a part, and some women may need to avoid caffeine and/or alcohol.   And if you smoke, begin a regimen to help yourself to quit. 

There are prescription medications that can be used, such as: birth control pills; prescription strength pain relievers like Motrin 800mg;  many forms of naproxen; and some muscle relaxers.  These may work well with all forms of dysmenorrhea, but if it is secondary dysmenorrhea, it is extremely important to visit your doctor because you may need further testing.  The pain medications or birth control may help relieve symptoms, but could be covering up a more serious problem or infection.

Endometriosis is something else to be aware of.  It is a condition in which the tissue lining the uterus (the endometrium) is found outside of the uterus, and can implant on the ovaries, uterus, bladder and has even been found in the lungs of some women with severe disease. 

Here’s another issue to understand.  Pelvic inflammatory disease is an infection caused by bacteria that starts in the uterus and can spread to other reproductive organs.  The bacteria can be from sexually transmitted disease, but often is caused from transfer of bacteria from our own body, or rectal area during intercourse.  Even after the infection is resolved, the remaining damage left from scarring from the previous infection can leave anyone experiencing pain. 

Stenosis (narrowing) of the cervix, the lower part of the uterus, is one form of damage that can be caused from infection or menopause.  If stenosis happens while we are still menstruating it can trap the blood inside the uterus.  This is called hematacolpos and this can cause horrible pain. 

Finally, fibroid tumors (benign growths on the inner wall of the uterus), are another example of what can go wrong that needs evaluation and possible treatment by your doctor.

So it looks like we have a lot of work to do before we can get to the bottom of all this pain and discomfort so you are not controlled by your monthly period.  Please talk to your doctor.

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