Gynecologic Health Concerns

"What can I do about my facial hair?"
Levels of androgen excess produce some increased facial hair and this can often be managed with hormonal manipulation in the form of birth control pills and close follow up. Electrolysis is an option if facial hair is noticeable. Management of PCOS should be done through your gynecologist or family doctor at home and not undertaken while at school.

"My periods are all over the place since I am living away from home. This is driving me crazy!"
It is well documented that some women have menstrual cycles which change when they are in a new or stressful environment. Late nights, different diets, different exercise routines or class related stress can all affect a woman's menstrual cycle. It has been documented that women who live together in close proximity such as a dorm will sometimes begin to cycle at the same time even if this was not a usual pattern for them prior to living in close quarters.

"If I miss my menstrual period, how can I tell if I am pregnant or not?"
In the office when a physician asks a woman if she is pregnant or not and she is on birth control pills or some regular form of birth control and is 100% consistent with this method and is using it correctly every time, this is considered a low risk person for unintended pregnancy and the physician will proceed with the treatment. For women who do not practice effective contraception all the time perfectly, this does leave open the question as you are approaching the end of your cycle and there are no signs of your period beginning. In the medical office, if a medication therapy were being considered, a woman who is not completely compliant with birth control would receive either a urine or blood test for early pregnancy. The answer to the question is that if you are 100% compliant with your pills or other methods, then it may just be one of the many non-pregnancy related causes for a late or missed period.

"I bleed through 6 pads a day for about five days during my period, is this too much?"
Abnormal bleeding is due to one of two reasons;

1. The woman has bleeding from the lining of her otherwise normal uterus.
2. There is some condition affecting the reproductive tract (such as a fibroid uterus) or some systemic disease (such as liver or kidney disease).

"When do I get concerned that my periods are too heavy?"
Normal blood loss for women during a normal cycle is between 25 and 80 ml (milliliters) of blood. The normal duration of menses is 3 to 7 days. If you are alarmed about the amount or the pattern of pad use and especially if there seems a sudden inordinate amount of blood, let a health care provider help evaluate you. Blood loss can contribute to iron deficiency anemia and may need to be addressed by a health care professional.

"What do douches do?"
The original douche is a vinegar and water which is meant to irrigate the vaginal vault and leave the woman feeling cleansed and refreshed. These are sold pre mixed now and apart from irrigation, these substances change the acid base balance in the vagina for a time and are thought to slow the return of some colonizing bacteria.

"I get cramping pain in the middle of my cycle sometimes. What can that be?"
Mid cycle cramping is sometimes called 'mittelschmerz' pain and is associated with ovulation.

"I have really painful period cramping, what is out there for me to take?"
According to one reference only non steroidal anti inflammatory medications are documented to be truly effective to relieve painful cramping. These medications include ibuprofen and naproxyn and can be purchased over the counter. An older medication in this family called Ponstel can also be effective but must be prescribed. Other medications and substances investigated and shown to have given at least a small benefit even if after months of use include; magnesium, thiamine, toki-shakuyaku-san (an herbal remedy), tropical heat, transcutaneous electrical nerve stimulation, vitamin E. The following have an unknown effect on relieving menstrual cramping; combined oral contraceptives, acupuncture, behavioral modification, fish oil, B12 and surgical interruption of nerve pathways. Spinal manipulation was not shown to have any relief of menstrual cramping in controlled studies.
Clinical Evidence Concise 2004: 11:446-448.

"I heard that smokers have more painful periods. Is that true?"
This is true. Reasons for this may be that the sympathetic nervous system is heightened in smokers and so the pain threshold is lower. Circulation in the smaller vessels in smokers is poorer than in non smokers. Smokers experience more pain than non smokers in almost any injury or condition and recovery from pain is more difficult.

"What is endometriosis?"
The uterus is lined with endometrial tissue. In some women, this tissue develops outside of the uterus in the pelvic cavity where it is not supposed to. When women menstruate this tissue bleeds and tries to shed the same as the tissue in the uterus since it responds to the same hormonal cues. When that tissue bleeds, the blood is irritating to the tissues in the rest of the pelvis and this causes excessive pain and cramping beyond what a woman would experience during a normal period.

"How common is endometriosis?"
It is thought to affect 10% of women of reproductive age in the 25-29 year age range.

"I have a lot of pain when I have intercourse. What could that be from?"
'Dyspareunia' means painful intercourse and can be caused by many conditions including; inadequate lubrication, inadequate stimulation, endometriosis, an inflamed cervix, a shallow vaginal vault, a narrow vaginal vault, an inflamed urethra and other conditions.