Your period-what’s normal, what’s not

Abnormal menstrual bleeding is one of the most common problems that brings women to their physician. But what exactly is “normal”? When should you worry about your periods?

According to American Family Physician journal (Volume 99, Number 7)

“abnormal uterine bleeding falls outside population-based 5th to 95th percentile for menstrual regularity, frequency, duration, and volume.”

Or, you could say -“normal” is that periods vary widely for most women

How doctors talk about normal

Doctors sometimes use medical terms to describe abnormal bleeding-menorrhagia, metrorrhagia, even meno-metrorrhagia, which are imprecise and often misunderstood. In 2011 FIGO, the International Federation of Gynecology and Obstetrics developed standard definitions and descriptions of menstrual bleeding, also endorsed by the American College of Obstetricians and Gynecologists.

This post will outline the FIGO definitions. Anytime you are concerned about your bleeding you should talk to your doctor. This information may help you describe your concerns to your doctor and understand what is “normal” for you.

The frequency, regularity, duration, and volume of a period are all important to determine if they are normal.

What is Your Menstrual Cycle?

The Menstrual cycle is the length of time from the first day of a period until the next one starts; in other words, from day 1 to day minus 1. You can also think of this as the frequency-how often you have a period. Every 24 to 38 days is considered normal.

  • Infrequent->38 days
  • Normal 24-38 days
  • Frequent <24 days

The regularity of the menstrual cycle is how much the length varies over time, usually 12 months. Is it always 24 days, 28, 32? Or does it vary, sometimes 24, or sometimes 38? Either can be normal, but if your pattern suddenly changes, it may indicate something has happened.

  • Regular cycles vary by 2-20 days over 12 months
  • Irregular- cycles vary >20 days over 12 months

What is your menstrual period?

The duration or length of your menstrual period is how many days you bleed, no matter how much or how little. Again, what’s important is your usual pattern; for most women this stays consistent, so a change is usually noticed.

  • Short <4.5 days
  • Normal 4.5-8 days
  • Prolonged >8 days

How heavy is your period?

The amount, or volume of a period is how much blood you lose. From 5-80 ml , or for Americans 1 teaspoon to 3 ounces, is considered normal although most of us find counting pads or tampons per day is easier to understand.

  • Light <5 ml
  • Normal 5-80 ml
  • Heavy >80 ml

Amenorrhea means no bleeding for 90 or more days. Once a woman has not had bleeding for 12 months, this is menopause. (This does not apply if she stops bleeding because her uterus is removed, a hysterectomy. Menopause is defined differently in that case. )

What can change the cycle length or regularity, or the period length, duration, or amount of bleeding?

  • Using some form of hormonal birth control
  • Recent pregnancy
  • Breast feeding
  • Vigorous or intense physical activity
  • Serious illness, injury, or surgery
  • Starvation
  • Peri-menopause (the months prior to menopause)

If you doctor determines that your bleeding is “abnormal” she may evaluate you for the common causes-

  • complications of pregnancy-miscarriage, ectopic pregnancy
  • uterine fibroid tumors-leimyomata
  • cervical or uterine cancer
  • bleeding disorders
  • hormone dysfunction, including PCOS (polycystic ovarian syndrome)

Where to learn more about menstruation

Familydoctor.org offers this easy to understand outline of the causes and treatment of abnormal bleeding.

Abnormal uterine bleeding

Información en español – from the CDC

Sangrado menstrual abundante

Most cases of abnormal bleeding have a straight forward cause which can be determined by the history, examination, and appropriate testing. Most are treatable and not life threatening. However, since a few cases will be due to cancer, don’t ignore this important symptom.

Keeping track of your periods

You can use any blank paper or digital calendar to keep track of your periods but digital apps are a convenient way to keep track of your periods.

Flo Period & Ovulation Tracker

Flo Period Tracker, Ovulation & Fertility Calendar!

It’s a smart and simple female period tracker, helpful pregnancy week by week app, accurate ovulation and fertility calendar and PMS symptoms tracker for women all over the world. Flo Period Tracker not only tracks your period accurately, but it’s also a reliable pregnancy calculator, ovulation calendar, and true fertility friend for you. It’s the first period app, pregnancy calculator, fertility and ovulation calendar for women that uses machine learning (AI). All women, even those with irregular periods, can rely on this health tracker. Log your menstruation days in a handy period calendar, ovulation and fertility tracker, schedule menstrual cycle reminders, record moods and PMS symptoms, use a due date calculator, follow a pregnancy calendar and take full control of your health.

However you do it, take your menstrual record with you every time you visit your doctor.

photo from LIGHTSTOCK.COM, an affiliate link

sharing the HEART of health

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn, links are on the left side bar here and the Home page. Thanks so much.

                              Dr. Aletha 

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May timely topics-memories, memorials, and mothers

May is a month of celebrations and remembrances.

You’ll find several affiliate links in this post, to help me fund this blog and give extra value to you, my readers.

In the United States, we call the second Sunday in May Mothers’ Day to honor mothers. We may not be one, but we all have one, although like me, yours may be deceased.

You may have pleasant or not so pleasant memories of your mother, as nurturing may not come easily to some women, possibly because they did not receive it. Sometimes when that happens, other women step in to bridge the gap. They deserve to be honored also.

Other events that typically occur in May include proms, graduations, and weddings. I know because I married my husband in May; I almost share an anniversary with the Duchess of Sussex, the former American actress Meghan Markle. And now she and Prince Harry are new parents of a so cute baby boy, Archie. What a sweet family they make.

May timely topics include

  • parenting issues
  • spring and summer health concerns
  • Memorial Day, another U.S. national observance
  • women’s’ health
  • books about mothers

thanks for exploring with me

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn, links are on the left side bar here and the Home page. Thanks so much.

You will find links to the Timely Topics on the Home page and on the right sidebar on every post (you may need to scroll down to find them on a mobile or tablet)

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cheesy-free faith-focused stock photos

The featured image in this post is from Lightstock-quality photos and graphics site- get a free photo here. 

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Here are some other affiliate links you may find helpful. Thanks for considering.

                              Dr. Aletha 

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2019 women’s health update- new meds to control pain and prevent disease

In a previous post I gave you updates about hormones, the heart, and HPV. Here is the link-

Women’s health update, part 1

In this post I’ll review some new drugs that treat conditions exclusive to or common in women.

I’m illustrating this post with covers of books written by women; I have reviewed all of these books on my blog, so I’ll include those links also. Please note these are affiliate links, so if you do happen to use them for a purchase you will help me fund this blog.

Photo by rawpixel.com on Pexels.com

Relieving the pain of endometriosis

Women with endometriosis suffer infertility, excessive bleeding, painful periods and pelvic pain unrelated to periods. In endometriosis, uterine tissue grows outside the uterus. It can be difficult to diagnose, requiring invasive procedures to discover. Treatment depends on the goal, whether pregnancy, pain relief, or both. Short of surgery, hormonal therapy has been the mainstay of treatment.

A new hormonal drug released last year, elagolix, brand name Orilissa, is the first of its kind specifically developed and approved to treat “moderate to severe” endometriosis pain. It does not help with infertility. AbbVie, the pharmaceutical company which developed the drug, has priced it at $844 per month, or about $10000 per year, retail.( per Reuters report) Patients may pay less depending on insurance.

 

Stop bleeding fibroids

Researchers are studying elagolix and another hormonal drug ulipristal for treating uterine fibroids. Fibroids are growths within the uterine that can cause pain and excessive bleeding. Initial trials show both of these drugs can significantly decrease bleeding and pain. However, neither is currently FDA approved for treating fibroid.

Easing dyspareunia

After menopause many women develop atrophy of the vagina, making it thin, dry, and easily irritated, leading to painful sex, or dyspareunia. A new intravaginal medication, prasterone,brand name Intrarosa, can help relieve the discomfort. Studies show it may also help improve sexual desire and arousal, but it is not labeled for this.

Manufactured by AMAG Pharmaceuticals, it is for “moderate to severe” symptoms. Also known as DHEA, it is a steroid that transforms into estrogen in the vagina ,administered as a once daily vaginal insert at bedtime, applied with an applicator. According to goodrx.com,a 30 day supply costs about $213.

DHEA can be purchased as an over-the-counter, non-regulated product, whose effectiveness and safety are unknown. A one-month supply of 50 mg tablets may cost $5.

Other options for treating vaginal atrophy symptoms are oral or vaginal estrogen and/or vaginal lubricants.

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Prevention of migraine pain and disability

Migraine, although not exclusive to women,occurs much more frequently in them than men. For infrequent headaches,non opiate pain relievers are effective and recommended. But for severe, frequent, or persistent symptoms prevention is recommended to improve quality of life. Several oral meds are effective but two new injectable drugs show promise.

Botox, onabotulinumtoxin A, has been FDA approved for treating chronic migraine, meaning patients with frequent headaches and other migraine symptoms for at least 3 months.

Yes the same drug used to treat wrinkles,Botox, can prevent migraine

Manufactured by Allergan, a vial containing 200 units costs $1452, per goodrx.com. For migraine, the drug is injected in the upper facial muscles by a physician specifically trained in its use.

Another novel therapy uses the immune system to fight migraine. Monoclonal antibodies bind to a calcitonin gene-related peptide receptor which is responsible for transmitting migraine pain. The antibodies are produced in a laboratory but work like antibodies naturally produced by the body. They are being used to treat cancers and some forms of arthritis.

Three of these drugs are available

  • Erenumab-brand
  • Fremanezumab-Ajoovy
  • Galcanezumab-Emgality

 

They are administered as subcutaneous injections (under the skin) monthly. According to a Medscape, average cost is $600 per month.

You may want to review my previous post about non-drug ways to manage migraine.

Simple and effective ways to manage chronic pain

Preventing cervical cancer with the HPV vaccine

I mentioned this in my previous post about women’s health but it fits here also.

Infection with the HPV, human papillomavirus, causes genital warts and changes in the cervix called CIN which can lead to cervical cancer.

According to a review of clinical trials by Cochran, vaccination against this virus effectively prevents infection and thus fewer cases of CIN. Since a significant percentage of CIN progresses to cancer, we can expect fewer women will develop invasive cervical cancer, the 4th most common cancer in women worldwide.

The vaccine, Gardasail 9, originally approved for use in females ages 9 to 26 years,received FDA approval for use up to age 45 years.

Stopping shingles with the zoster vaccine

And speaking of vaccines, a new zoster (shingles) vaccine, Shingrix, prevents the painful rash much more effectively than the original vaccine Zostavax. It ranges in effectiveness from 91% to 97% at preventing shingles, depending on age. The first vaccine was 51% effective.

Zoster is a reactivation of the varicella virus that causes chickenpox. It causes a painful rash known as shingles;the pain may continue after the rash is gone. It can happen at any age, but symptoms tend to be worst in older persons.

exploring the HEART of health through books

Thanks for joining me to review new steps in women’s health and review some fine women authors. I hope you will follow the links to my reviews and read some or all of these books. When you do, I would love to know your reaction. I might use your comments in an update.

I appreciate all of you who follow this blog; there are numerous other blogs to choose from so I am honored you chose to spend some time here. A special welcome to all my new followers from this past month.

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

                              Dr. Aletha 

This blog may earn a commission if you use these affiliate links from Barnes & Noble , AvaCare Medical, and Aaptiv.
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2019 Women’s health update- hormones, the heart, and HPV

Multiple health issues impact women exclusively or differently than men, so new and updated information is important to share. The issues we women face vary with our age, stage of life and health status.

Let’s look at some medical news about women’s health issues, information I picked up recently from several medical journals I follow.

This is current, general medical information that helps a doctor and patient make decisions about what is right for her. Medical recommendations and practice changes as we learn new things.
If you deal with any of these issues , please discuss with your doctor before  taking any action.

I’m illustrating this post with photos of art featuring women. I’ll tell you more about the source at the end.

statue of a woman holding an infant

Human papillomavirus and cancer 

Infection with the human papillomavirus, HPV, can cause  genital warts and cervical cancer.

The percentage of young women with confirmed HPV (human papillomavirus) infection  in the United States fell significantly from 2006 to 2012. Women who had received the HPV vaccine showed the greatest decline in infection rates, compared to those who had not. Even one dose was effective, even though 2 or 3 are recommended.

A new study reported by the New England Journal of Medicine shows that women who become infected with the HPV strains 16 and 18 have a much higher risk of changes in their cervix called CIN-cervical intraepithelial neoplasia-which can be a precursor to cancer. These changes may not be picked up by a Papanicolaou (Pap) test.

Thus, protection against infection with HPV should also provide protection against cancers caused by HPV.

Human papillomavirus vaccine

Gardasil, a vaccine which targets the HPV has been available to females and males from 9 years old to 26 years old. Now the age has been extended through age 45 years for both genders.

Here is a link to detailed information about HPV vaccination from the National Cancer Institute.


Human Papillomavirus (HPV) Vaccines

statue of a pioneer woman with rifle and infant

Long-acting reversible contraception-LARC  

Two forms of long-acting reversible contraception are available to women in the United States.

Nexplanon, a contraceptive implant, slowly releases the hormone progestin and does not have estrogen. It can be used in women who cannot take estrogen, such as those with uterine fibroids or endometrial cancer.

Intrauterine devices, IUDs, containing copper only are appropriate for women with past or present breast cancer, ischemic heart disease, and women at risk for blood clots.

Use of LARCs accounts for 12% of all contraceptive use. Additional benefits include controlling excessive menstrual bleeding, potentially saving women from surgery.

Here is a link to Quick Fact about intrauterine devices and other forms of contraception from the Department of Health and Human Services

Intrauterine Device

statue of woman, holding infant, standing next to a child

Hormone therapy and prevention of heart disease

A 2015 Cochrane review of 40,410 postmenopausal women examined the use of oral hormone therapy (estrogen with or without progesterone) taken for at least six months, compared with placebo (no real drug), to determine the effect on death from any cause, and deaths caused by heart disease, stroke, and blood clot in a leg or lung.

The review found no benefits for preventing heart attack (fatal or nonfatal), or death due to any cause.

In women who took hormones they found

 
1 in 165 women had a stroke
1 in 118 women had a blood clot in the leg or lung
1 in 242 women had a blood clot in the lung

The women in this study were all older than 60 years old, so it is possible there might be benefit in younger women.

statue of woman with arm raised and holding an infant

Vaginal estrogen and heart health

While estrogen replacement after menopause is effective at controlling the undesirable effects of night sweats, hot flashes, and vaginal dryness, it potentially increases the risk of developing cardiovascular disease-heart attacks and stroke, and some cancers-breast and uterine.

However, results of the Nurses Health Study over 18 years shows no increase in incidence of these complications in women who used vaginal estrogen, suggesting this is a safe option for women who elect to use estrogen. (from the journal Menopause)

The photos- a tribute to women

I took these photos during a recent visit to Woolaroc ,a museum and wildlife preserve located in the Osage Hills of Northeastern Oklahoma. Woolaroc was established in 1925 as the ranch retreat of oilman Frank Phillips. 

These statues displayed there were all models considered for a larger project now known as the Pioneer Woman Statue in Ponca City, Oklahoma.

What do you think? Would you have chosen one of the other statues for the final version?

More women’s health info

To start following Watercress Words , use this form to get an email notification of new posts . Please find and follow me on Facebook, Pinterest and LinkedIn. Thanks so much.

                              Dr. Aletha 

a statue of a woman holding a child, "CROSSING THE PRAIRIE"
“CROSSING THE PRAIRIE” by Glenna Goodacre, Broken Arrow, Oklahoma
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