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Doctors' Answers to "Frequently Asked Questions" - Menstrual Cycle

These comments are made for the purpose of discussion and should NOT be used as recommendations for or against therapies or other treatments. An individual patient is always advised to consult their own physician.

[posted 03/12/2000]
Question: Hello, I'm taking Triphasil-28 and am going on a vacation in late June. As it happens, my period will occur right smack in the middle if I keep on my regular schedule. I've looked at it both ways, if I should skip the placebo pills of this packet and continue onto the next, or if I should take the second week twice in two packets and delay my period by a week. As I see it, I would rather have my period a week early than a week late- is this wise to do? Thanks for you help.

Answer: Either way will work, but you should use an additional method of birth control(condoms, spermicidal jelly, or both) while you are juggling. The taking a 2nd week is more likely to delay your period over the vacation.

[posted 08/10/1999]
Question: My boyfriend and I were having oral sex and his seman was on my hand. I wiped it off and some time later, I used the same hand to wash my vagina. Can I be pregnant through this? Can sperms survived in the open air? Also, recently, I started exercising regularly and has be keeping to it for 1-2 months. I didn't exercise for about 2 years. Then, last month, my mentrual flow decreases and ended 1 day early. For this month, it came 2 days early and stopped. All my periods have been regular until recently. What is the cause of this. I have heard that intensive training can result in this. How true is this?

Answer: Pretty unlikely but not absolutely impossible. Extensive exercise can change a woman's period probably by decreasing the fat which metabolizes estrogen. There also appears to be some type of limit on getting pregnant below a certain body weight-this seems set by your pituitary gland. If you are concerned about sperm in the future use a vaginal spermical suppository(available over the counter in any pharmacy) before you go out with your boyfriend. This creates a little vaginal discharge as the suppository melts but, gives some protection.

PMS and Hormones [posted 1/13/99]
Question: Exactly what happens to your hormones during PMS? What triggers the onset of PMS as related to hormones? Also, what role does serotonin play in relation?

Answer: Well, we really don't know. You would think that we would have some idea, but we're pretty clueless as to the cause of PMS, except that it is obviously hormonal in some way.

Hypertension in Menopause [posted 1/13/99]
Question: On Aug 18,1998 I started bleeding heavily I was finally able to see a doctor. He prescribed medroxyprogesterone to stop the bleeding and then prescribed iron supplement with B-12 and folic acid. My regular doctor was concerned for my hypertension (180/110). I have not had a problem with this before until August. He told me that in some cases with the onset of menopause some women start having hypertension. My main concern is that in taking the hydrodiuril that my potassium levels will drop and I'll just start taking one pill after another for subsequent problems. I am not sure I can really trust this doctor.

Answer: Most women have elevated blood pressure in the presence of estrogen withdrawal. The restarting of estrogen usually fixes this problem. I'd focus on estrogen replacement, not bp treatment. If you have decided not to replace the estrogen, clonidine is an excellent bp medication during the withdrawal months.

Early Menopause [posted 1/11/99]
Question: I have been going through menopause since I was 16. Is this normal?

Answer: No. See your doctor or get a second opinion.

Period Stoppage [posted 1/8/99]
Question: In January of last year, I gained a total of 12 pounds. This, during a time when I was exercising at least 4 times a week for at least 40 minutes. Also, during this time my period stopped. I am not pregnant. I stopped eating red meats in February and eat very little pork. I am taking ziac for hypertension. My doctor prescribed provera for the cessation of menses, which I take 5 mg a day for the first 12 days of the month. I have gained an additional 5 pounds in the last two weeks. Is it possible that the combination of these two drugs is slowing my metabolism? My doctor also said that my body wasn't producing the progesterone because of my weight. Is this possible? What are other causes for one's period to stop? I currently weigh 185 pounds and I am 5'4". I have a medium build.

Answer: Most common would be menopause. However, if you aren't the correct age, there is a long list and it needs to be evaluated by an endocrinologist or gyn-endo specialist. The weight gain can cause period abnormalities, but sounds like its a chicken egg argument.

Non-stop Menstruation Concerns [posted 11/13/98]
Question: I started the pill (Ortho-Tricyclen) last month and I haven't stopped bleeding. I've now gone through an entire cycle while persistently bleeding. I am getting married in three weeks and I'm scared that the bleeding will not stop by then. On Sunday I will have finished my spacer pills and will be starting the whole process over again. Is this side effect normal? I've talked to one gynecologist here in town about the problem but she wasn't much help. She just told me to stick it out? If someone could please let me know what is going on with my body and when this will stop I would really appreciate it! I'm desperate not to spend my honeymoon or first months of my marriage with this problem. Thank you for your help!

Answer: Well, I'd try a big dose of progesterone to ensure that the lining of your uterus is sloughed. Common problem with low dosage birth control pills.

Relieving PMS Symptoms [posted 11/13/98]
Question: I have read that to relieve symptoms of PMS, diet and excercise are important,and it is recommended that you take vitamins B complex and eat heavy carbohydrates. Can you suggest proper foods that would be helpful and what is the best way to increase serotonin in the body during the premenstrual period? What is the dosage of B complex that I should take? I am 40 yrs old and weigh 120 lbs. Thank you.

Answer: Possible, but, unlikely. PMS is one of those problems for which we really don't have good treatments. But, shouldn't do any harm(except weight gain with the carbs). Take 2 B complex vitamins from the pharmacist, this would be more than enough.

Lengthy Menstrual Cycle [posted 11/11/98]
Question: Hi, I am sixteen years old and a year round swimmer. My menstural cycle has never been regular because of swimming, but it lasts no more then 7 days. Well, my period came two Sunday's ago and has gone on all that week and all this week. Could you please tell me what's wrong (if anything)? Thank you .

Answer: Probably nothing. Occasionally, you may need an extra dosage of progesterone to slough the lining. This is pretty common in thin, athletic women.

Missed Periods [posted 11/05/98]
Question: I have missed my periods for 2 months now and the last one i did have only lasted one day. I am currently taking bcp- Dimulen. I have taken 2 preg. tests, which are neg.One only last week. I have been feeling awful. terrible headaches, vomiting, after eating I almost always feel nasiated, like my food is stuck in my upper chest. Like a big wad siting there . I feel as if I should throw up to rid myself, although when I do it not always helps. My dr. says not having a period is normal while on bcp. Is it? Should I have some other tests ran? Some advice will be much appreciated. Thanks

Answer: Missing a period here and there can occur on the pill;but, missing two would be unusual. However, if you have some metabolic problem or are ill that can happen.

Does an Extended Period Mean Pregnancy or Another Problem [posted 11/04/98]
Question: Ok...I guess I'll start in the beginning... my ex-boyfriend and I one night had sex, but not technically had sex. See he tried to go inside but could never get in. He also had no condom. Ok, about 3 weeks after that night I got my period, but it hasn't stopped. I have had it for about 4 weeks and its still going. My mom called the doctor and they said I might be pregnant. Could that be? And if not then what is wrong with me?

Answer: Well, you could be - but probably not. We always check this first since the treatment is so different. Usually, a protracted period will call for progesterone for a week or two to slough the lining of the uterus. This is pretty common.

Went Off Pill months Ago, But Menstrual Cycle Has Yet to Start [posted 10/23/98]
Question: I am a healthy active 24 year old woman. About 10 months ago I went off the birth control pill Nordette. I took Nordette for a year with no problems except I gained 7 extra pounds. I did lose the 7 lbs but since going off I haven't had a period. I have been to my OBGYN numerous times. Each time the nurse gives me a pregnancy test and a progesterone shot. The shots have failed to bring on my period so about 4 months ago I had blood drawn. All the hormone tests came back normal and the nurse said I could get another shot of progesterone or do nothing. I am 5'6" and weigh 114 lbs. For exercise I walk 4 miles 4-5 times a week with 7lb weights., I do not eat dairy products (I take a calcium citrate vitamin) and only rarely do I eat any meat. I try to keep my fat intake extremely low. My health is excellent otherwise, my husband and I want to have children someday and I am starting to become worried. My OBGYN annual is in a month. Should I just wait until then?

Answer: Yeah, you probably need a D&C to remove the hypertrophy of the uterus, usually responsive to progesterone.

Pain & Irregular Cycle [posted 10/21/98]
Question: I am a 32 year old female. I have had 4 children. As long as I have had a period I have charted it and have been as regular as the sun rising and setting (28 -31 days/cycle). In May, 15 days after the first day of my last period I had some bleeding accompainied with menstrual cramps, and a more defined pain in my lower right abdominal area near my right hip. This alarmed me and I visited my OBGYN, who gave me a pelvic exam, took a pap smear, which came back as no sign of cancer for my cervic or vagina and was told that the bleeding was "normal", they also gave me a urine pregnancy test that came back negative. As my pain continued to be constant and I did not have period as of day 35 when I had another pelvic exam, & blood pregnancy test, both were negative; and the following day my cycle began. I have also had my blood count tested for white cells, red cells, hemoglobin, hematocrit, MCV, platelets, granulocytes, lymphocytes, monocyte, eosinophil, basophil, and beta-HCG.

Every result was within their normal range, my pain persisted I was scheduled for an ultrasound of my pelvic area. My pain increased sharply, so I was prescripbed hydrocodone/apap 5/500. I have taken this and while on this medicine I still have the pain. Since then I had my ultrasound, which was evaluated as "entirely normal". I was told that they do not know what is causing my pain. I am very bothered by my pain, it is constant lasting 24 hrs a day, and I have no other noticeable symptoms. Do you have any ideas what could be going on and any suggestions to what steps I should take next to get to the bottom of this. Please help me as I am very concerned about why I have the pain.

Answer: I would see a general surgeon for an evaluation if the ultrasound is normal. However, it sounds like you had a ruptured ovarian cyst. This occurs in the mid cycle and can be quite painful. Especially so if there is a lot of blood released to the pelvic area from the rupture. These happen every month with ovulation;but, occasional ones are large and bloody.

Menstrual Side Effects on Arthrotec [posted 10/13/98]
Question: For two consecutive months I have experienced severe mid-cycle pain with some bleeding. Concurrent with these episodes were nausea and projectile vomiting. I suspect this may be related to the use of Arthrotec which I have been prescribed for joint inflammation. Is this a recorded side effect and what effect might the drug have on normal menstruation?

Answer: Usually nothing on menstruation, except sometimes changing the duration or severity of the period-stumped on this one, check with your md.

Menstrual Cycle [posted 10/13/98]
Question: I had a termination of pregnacy beofre than my periods were Always regular, about 3 months after the termination my periods were on for about 2 months. My gyn gave me loestrin(bcp) for 3 months. My per became regular for about 6months. Now I haven't seen My period for 4 months now. I've been having intercourse without protection, for about 4 months -nothing Is going on. My periods are delayed- and i don't want (bcp) to regulate. Please help - i'm stressed. I'm trying now to make plans to see an endocrinologist.

Answer: Sounds like you need a pulse of progesterone to completely slough the lining of your uterus. If this does not work, most would recommend a d&c to ensure that the lining is completely back to normal. However, stress can also do this.

Painful Menstrual Cycle [posted 10/10/98]
Question: My doctor has recently prescribed Megace for me so I will no longer have such painful periods. I have only seen reference to this drug for cancer patients. Is there any information available concerning my use of Megace? Any long term side effects? It has worked well and I feel fine and appreciate not having to go through a hysterectomy. Any information would be appreciated. Thank you.

Answer: Well, it is a potent steroid, usually used to increase energy, appetite etc. in cancer and HIV patients. Long term side effects center on its progesterone like effects. Also, there are reports of adrenal problems, insufficiency, Cushings Disease ,etc. Short term effects are nausea, vomiting etc.

Hormone Replacement Therapy [posted 10/10/98]
Question: I have been going to the V.A. outpatient clinic, because I am a veteran, at which time they started me on HRT because I have been going through menopause since I was 37. The Hormones caused my blood pressure to shoot up to approximately 146-154/102-112. They decided with that, that they did not want to stop the hormone therapy, so they put me on hydrochlorothiazide, to decrease my blood pressure. I went back after app. 1 month, and my blood pressure is still high. They increased the dosage to a whole tablet of hdrothzd, which is 25 mg. I started waking up with splitting headaches, I was confused, etc. I stopped taking the hormones yesterday, but today went back to taking a half of tablet of hydchlotzd. What should I do now, I am at a loss? Do you have any suggestions for me. Is there other types of hormone replacements that are better for me? Are there an4d side-effects with taking this medicines together?

Answer: Well, what were they giving you? There are several different types of estrogen replacement regimens and several doses possible. Try a different regimen. Also, some women tend to elevate their bp on estrogen withdrawal. Clonidine is very effective in this situation.

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