When No Period Is No Problem

 

By Lauren Streicher, MD

 

When the pill was first released for use as a contraceptive in 1960, it was prescribed to include a hormone-free week in order to ensure a normal menstrual period. The scientists that invented the pill felt that in spite of the nuisance factor, maintaining a normal menstrual cycle would make women comfortable taking this new form of contraception. The truth is, there is no medical benefit to that week off, and there are a number of advantages (beyond wearing white pants without fear) to skipping the pill-free days and instead take an active pill up to 365 days a year.

The obvious benefit is that no period means no cramps, no menstrual headaches,  and no making a midnight run to buy tampons! Women who are anemic from heavy periods may particularly benefit. Eliminating the hormone-free week also dramatically decreases the chance of an inadvertent pregnancy that can occur if a new pack of pills is started late. The idea of eliminating periods by taking pills continuously is not a new concept. For over 20 years gynecologists have recommended continuous rather than cyclic use of birth control pills to eliminate painful menses in women with endometriosis. What’s new is the notion that menstrual suppression is an option driven by patient preference and convenience rather than medical indication.

Many women, when asked, think it is unnatural and unsafe to not bleed monthly, which is why the majority of women who use hormonal contraception take three weeks of hormones followed by four to seven hormone free days to bring on a menstrual period. While a monthly period may seem “natural,” what nature really intended was for women to be pregnant or nursing as much as possible and have relatively few periods. Consider that prehistoric women experienced only 50 menstrual cycles in a lifetime (due to shorter lifetime and increased rate of pregnancy) as opposed to the approximately 450 menstrual periods experienced by most women today.

With the average woman spending over 2,000 days of her life bleeding, it’s no surprise that according to a Harris poll, a majority of women would eliminate or decrease the number of their menstrual periods if safe to do so.

Currently, many new forms of hormonal contraception are packaged this way, and the expectation is that this trend will continue. I predict our granddaughters will want to hear about the “olden days” when women who were not trying to get pregnant still got a period.

So if you take birth control pills, try skipping the hormone-free days. People who use a NuvaRing may also be able to skip the ring-free week and replace one ring with another after 3-4 weeks.

Buying those extra couple of packs every year can be expensive, but you can more than make up for it in the money saved in pads, tampons and pain medication!

Origianlly published Jan, 2014 DoctorOz.com

Adenomyosis: The Hidden Disease

By Lauren Streicher, MD

Published Oct 13, 2013 EveryDay Health

 

It’s beyond maddening to contend with monthly twelve-plus tampon a day bleeding and incapacitating cramps only to be told that it’s not due to fibroids, endometriosis, hormonal imbalance, or any other identifiable gynecological problem. One diagnosis that is overlooked far too often is adenomyosis, a condition in which the endometrial glands that usually line the cavity of the uterus infiltrate deep into the wall of the uterus resulting in menstrual periods that rival Niagara Falls in flow and appendicitis in pain.

Adenomyosis is essentially a cousin to endometriosis. Both conditions cause debilitating, painful periods, but while women with endometriosis have endometrial glands that live outside the uterus in locations such as the ovaries, tubes and lining of the pelvis, women with adenomyosis have glands that remain in the uterus, but have infiltrated deep into the muscular wall. And yes, you can have both adenomyosis and endometriosis.

The frustrating thing about adenomyosis is the difficulty in making a definitive diagnosis. Typically, nothing abnormal shows up on ultrasound, biopsies or blood tests.

A gynecologist can’t even see it during laparoscopy or hysteroscopy since the glands are microscopic and buried inside the wall of the uterus. Often a gynecologist will suspect adenomyosis if the uterus is enlarged, soft and tender, but the only way to absolutely know is to remove the uterus (hysterectomy) and have the pathologist cut open and look inside the uterine wall with a microscope. MRI (Magnetic Resonance Imaging) is the best non-invasive way to make the diagnosis, but is often not definitive or routinely done due to the expense.

When adenomyosis is suspected, symptoms can sometimes be adequately controlled with hormones or pain medication so that surgery is not necessary. Menstrual suppression protocols, such as continuous hormonal contraceptives, a progestin intrauterine device or GnRH, are often helpful. Endometrial ablation and uterine artery embolization have been used on a limited basis with variable results. The only definitive treatment for severe adenomyosis is hysterectomy. Symptoms do resolve with the onset of menopause, so waiting it out is also an option.

Why some women are vulnerable to adenomyosis is pretty much a mystery but a study just published in the Journal of Pathology may give some insight. A specific protein, beta-catenin, triggers changes in the cells of a woman’s uterus, which in turn cause adenomyosis to develop. This doesn’t mean the cure is around the corner, but research that leads to a solution is facilitated when the cause of a problem is better understood. So yes, hope is on the horizon for the many women with adenomyosis who schedule activities according to the calendar and live in dread of their next period.