Rhode Island Monthly Whole Woman 2016 : Page 3

WHOLE WOMAN GENERAL HEALTH Though our periods begin early in life, women experience a menstruation evolution throughout their 20s, 30s and 40s. Women tend to consult friends with minor — or major — questions about these experiences but no one woman’s cycle is exactly the same. Dr. Kathleen Bowling of Bayside OBGYN in Providence provided answers to our nagging questions. 1. What factors contribute to irregular menstrual cycles? Irregular menstrual cycles occur for a number of rea-sons. Some women have irregular cycles because they are not ovulating consistently, and without ovulation the hormones from the ovaries don’t trigger the coor-dinated shedding of the uterine lining. This can happen in women with polycystic ovarian syndrome, thyroid disease, benign adenomas in the pituitary or those who are underweight. It also happens when women start approaching menopause, because ovulation becomes less consistent. With any irregularity in menstrual cy-cles, pregnancy should first be ruled out as the cause. 2. Is it normal to bleed or spot between periods? Spotting and bleeding between periods requires evaluation by a healthcare provider to determine the cause. Once it has been determined that a woman is having regular cyclic bleeding, spotting in between periods may be due to: polyps in the cervix or within the uterus, infection, fibroids, endometrial hyperpla-sia (overgrowth of the uterine lining usually due to too much estrogen) or cancer. Some women may have spotting at the time of ovulation, this is normal. A detailed medical and menstrual history will help narrow down the cause of the inter-menstrual bleeding and testing — based on the woman’s history — will help determine the cause. Appropriate treatment is based on the cause of the bleeding. 3. Should I be concerned if I skip a cycle? If you have taken a pregnancy test and are not pregnant, it is pos-sible that you will resume regular cycles over the next few months. If periods continue to be irregular, you should see a healthcare provider to help determine the cause and appropriate evaluation. Not ovulating regularly puts women at risk for endometrial hyper-plasia and cancer. As a woman approaches the age of menopause, fifty-one being the average, it is common to skip one cycle or many. However, in women with longstanding irregular bleeding as well as women over forty-five, endometrial hyperplasia and cancer should be ruled out as its cause. Another cause of skipped cycles is ovarian insufficiency. About 10 percent of women who stop having periods before the age of forty do so because of primary ovarian insuffi-ciency, which is formerly known as premature menopause. 4. If I’m experiencing more painful cramps than normal, could it be a sign of a larger issue? Pain with periods vary from one woman to the next. If the pain becomes worse, it could be a sign of endome-triosis (cells normally lining the uterus are found in the abdomen, on the ovaries and fallopian tubes and on the bladder) or adenomyosis (cells normally lining the uterus burrows into the muscle of the uterus). Pain is multifactorial, as cramping can vary from cycle to cycle for the same woman and change over time. Therefore more painful cramps may not be a sign of a problem at all. But if you are concerned and/or the pain is unbearable, consult your gynecologist. 5. What exactly is PMS and how do I know I have it? Premenstrual Syndrome consists of changes in a wom-an’s mood (e.g. irritability, anxiety, difficulty concentrating) and body (e.g. bloating, weight gain, breast tenderness) that happen before her period and interfere with her quality of life. There is no specific “test” for PMS, but keeping a symptom diary for a few months can help the woman’s healthcare provider make the diagnosis (as symptoms vary from month to month). This helps determine that the symptoms are actually related to the menstrual cycle because PMS symptoms are present within five days before the start of the period, and end within four days after the period starts. If symptoms do not follow this pattern, PMS is probably not the cause. 6. How often should I be seeing my gynecologist? Women should have a well-woman evaluation every year, which can be done by your gynecologist or other healthcare provider. The annual well-woman examination provides an opportunity to promote health and wellness. The American College of Obstetri-cians and Gynecologists recommends the well-woman evaluation as a time for a woman to discuss birth control, cancer screening, vaccinations, depression screening, sexually transmitted infection screening, concerns about your sexual health and weight control. Pap smear screenings for cervical dysplasia and cervical cancer should have begun at the age of twenty-one. After twenty-one, ask your healthcare provider how frequently to have these screenings, as guidelines have changed. WW WHAT’S NORMAL? Are off-schedule, heavy or painful periods normal? We spoke with a local gynecologist to get some answers. EDITED BY viki paNteleakis AND keRRi RUBiNO Expert: Dr. Kathleen Bowling, Obstetrician/Gynecologist at Bayside OB/GYN; Assistant Clinical Professor of OB/GYN at Warren Alpert Medical School at Brown; Assistant Chief of Dept of OB/GYN at Women & Infants WHOLE WOMAN l RHODE ISLAND MONTHLY 2016 99

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