A pelvic pain that is usually less serious but which you might notice at some point in your life may be due to ovarian cysts. As you read in more detail in Chapter 8, you may experience either a nagging tug from the swelling, or an intense pain if it bursts, usually on one side.
You may only be able to eliminate the pain of a follicular cyst with a progesterone injection, though luteal cysts usually resolve on their own. In either case, it’s best to be checked on Day 5 of the following cycle to be sure the cyst is truly gone.
Symptoms of Ovarian Cancer
This is one of the most dreaded forms of cancer for women because, by the time it’s diagnosed, it has often spread. Now, however, researchers are discovering that there are in fact symptoms that women may notice if they are truly in tune with their bodies—another obvious benefit of charting.
If you experience any of the symptoms below for at least three consecutive weeks, especially the first three, you should consult your doctor.
•abdominal pain
•abdominal distension
•frequent urination
•a feeling of fullness, even after a light meal
•a change in bowel habit
•loss of appetite
•irregular bleeding
•bleeding with intercourse
•leg pain (due to ovarian pressure on your nerves)
The Three Vs: Vaginismus, Vulvodynia, and Vestibulitis
It’s normal for women to occasionally have vaginal pain or stinging. Perhaps you removed a tampon on a very light day and scraped your vagina while removing it. Or you have a vaginal infection, and the stinging reminds you why you should never douche simply to smell like a field of wildflowers. Or maybe you had sex several times within a couple hours, and it stings like crazy the first time you urinate afterward. That’s understandable.
But if you experience pain or stinging most of the time, or find it impossible to have sex without major discomfort, you’ll definitely want to see your gynecologist or natural health practitioner. What you may have is any of the three Vs: vaginismus, vulvodynia, or vestibulitis. Before describing them, just know that what you are experiencing is surprisingly common, and you should never hesitate to discuss any of them with your gynecologist. You can be sure that they see women all day with similar issues.
Vaginismus
This typically refers to vaginal issues specifically with sex, such as burning or pain, uncomfortable vaginal tightness or penetration problems, or even a complete inability to have intercourse. The vaginal tightness is due to the involuntary tightening of the pelvic floor (especially the PC muscles), but women are often unaware that this is the cause of their penetration or pain difficulties.
Vulvodynia
This is a regrettably common condition characterized by chronic pain around the vaginal opening for which there is no identifiable cause. The pain, burning, or irritation may be so uncomfortable that having sex or even sitting for a long time can become almost unbearable.
Vestibulitis
This is similar to vulvodynia, in that it causes discomfort and pain in the vaginal area, but more specifically, often manifests as severe pain in the vaginal opening. This area is sensitive and contains the urethra, as well as the Bartholin’s glands, which produce lubrication.
Unfortunately, all three of these conditions can become chronic if not treated, and there is no uniform approach that works for all women. However, clinicians have become more experienced in helping their patients successfully manage their symptoms, and there are, in fact, a wide array of possible treatments. They range from the use of topical gels and creams to the use of physical therapy and cortisone injections.
So, again, if you have the symptoms of any one of these, try to get over your embarrassment and see your gynecologist.
NORMAL CYSTIC BREASTS VERSUS CANCEROUS BREAST LUMPS
Normal Cystic Breasts
Charting your cycle can help you differentiate between normal cyclic breast changes and abnormal breast lumps. The texture of breasts in women with fibrocystic breasts tends to be fairly lumpy, becoming more so in the postovulatory phase of their cycle. By knowing when they have begun that phase, they can determine if their lumps are normal and cyclical, and make the necessary lifestyle adjustments to try to lessen the discomfort of fibrocystic breasts.
There is a lot of support in the natural health community for the use of progesterone cream during the luteal phase. But if the lump(s) remain throughout the cycle, charting can be beneficial in tracking whether further examination should be made by a health practitioner.
Charting is also an excellent way to remind you to do a monthly breast self-exam on Day 7 of your cycle. (Note the BSE symbol in the Notes row at the bottom of the master chart.) The reason that you should perform the exam on this day is because it is the hormonally optimal time, since your breasts are least susceptible to lumps or tenderness caused by progesterone. After completing your self-exam, circle the notation on the chart, as Molly did in the chart below.
The American Cancer Society recommends that most women should start having mammograms at age 40. As with your breast self-exam, you should ideally have it done in your preovulatory phase, when your breasts are not tender or possibly fibrocystic.
Molly’s chart. Recording breast self-exam. Molly performs a breast self-exam every cycle on Day 7, then records it by circling BSE on her chart.
Cancerous Breast Lumps
The prospect of breast cancer is extremely frightening to most women. However, you should know that most lumps are benign and that cancers of the reproductive system are curable if detected and treated early. You, yourself, can directly affect your chances of finding cancer early if you maintain a healthy lifestyle, get annual pelvic exams and Pap tests every 3 years, do monthly breast self-exams, and make a point to promptly attend to suspicious symptoms.
The following are warning signs to look for in your breasts. The important point is to notice whether they remain indefinitely, or disappear with the new cycle. Obviously, anything that persists should be examined by a clinician.
•breast lump or thickening (firm, nonmovable lumps are important to watch for, especially because they are usually painless)
•lump in underarm or above collarbone
•swelling under the arm
•puckering or dimpling in one area of the breast
•persistent skin irritation, flaking, redness, or tenderness of breast
•sudden change in nipple position (such as nipple inversion)
•bloody nipple discharge
SCHEDULING THE BEST TIME FOR PHYSICAL EXAMS, CONTRACEPTIVE FITTINGS, VACCINATIONS, AND SURGERY
Another benefit of charting is that it can help you identify the most effective time in your cycle to have physical exams, contraceptive fittings, vaccinations, and surgery. The best time to schedule a Pap test, for example, is about midcycle, when the cervix is naturally dilated. In the case of fitting for diaphragms or cervical caps, having it done at the wrong time can mean the difference between complete contraceptive protection and an unplanned pregnancy! Since the cervix clearly changes around ovulation, it only makes sense to get fitted at the time when the method is most likely to fail. Remember that when a woman is fertile, her cervix becomes soft, high, and open, so that is the best time to be fitted.
As mentioned earlier, you should do your breast self-exam on Day 7 of your cycle. For the same reason, you should schedule your routine mammogram around the same time, ideally about Day 7. This is because your breast tissue is less dense in the preovulatory phase. And, if you’re going to have two steel plates squish your breasts, it might as well be done when there is as little discomfort as possible!
A practical piece of advice would be to have a rubella vaccination performed just after your period. This would assure that you aren’t pregnant at the time. This is crucial for this particular vaccine, since the effects of the rubella virus on the fetus of pregnant women are potentially devastating.
> Some studies have suggested that having breast cancer surgery after ovulation may increase your chances of living longer without a recurrence of the disease. One theory for the difference in outcome is that estrogen in the first part of the cycle could stimulate the growth of cancer cells. You should be aware, however, that these findings do not reflect a general consensus. Finally, if you are having a laparoscopy to remove endometriosis, some believe that it’s best to have it done before ovulating in order to decrease the recurrence rate.
Since further research may prove that timing surgeries to a particular phase of your cycle increases the odds of a positive outcome, you should ask your physician about it. If it’s just minor surgery, it may not be so important. But if it involves something as serious as your survival, I would encourage you to do your homework and research the latest studies with a discriminating eye.
WOMAN HAVING BIMANUAL PELVIC EXAM AND PAP SMEAR
A pelvic exam typically includes a bimanual, as well as a Pap test every 3 years. A bimanual is when the clinician inserts a finger into the vagina to be able to stabilize the uterus from the inside while gently pressing down on the abdomen to palpate the uterus and ovaries from the outside. The Pap test is done primarily to detect the presence of pre-cancerous cells of the cervix.
STAYING HEALTHY AND KEEPING INFORMED
I wrote this chapter to help you distinguish between what is normal and what may require medical attention.
By accurately tracking your symptoms on your chart, you can help your doctor determine if you need further testing to diagnose the cause of any particular pain or issue. For this reason, you should learn to recognize what is considered normal, cyclical pain, as opposed to that which is more intense or occurs at unexpected times of the cycle, since that is more likely to indicate a potential health problem. (As mentioned earlier, click here to see the page in the color insert to view how different colors can be used to keep track of your various symptoms.)
The form in the Master Charts section at the back of the book can be used for your annual exams. You can either download it from tcoyf.com, or copy and enlarge it by 125%, then copy it onto the back of the chart of the cycle in which you get your yearly physical, taking it with you when you go. You’ll find it’s a practical way to keep track of your weight, blood pressure, and general gynecological health, including such things as breast exams, mammogram, Pap test, vaginal culture, or any possible STIs. You can use the back of the regular charts to record anything else worth remembering.
NORMAL VERSUS ABNORMAL BLEEDING
Finally, if you have a uterus, then you already know that this topic gets a chapter of its own!
CHAPTER 19
Causes of Unusual Bleeding
It’s quite likely that at some point in your life, you will experience unusual or abnormal bleeding, which is essentially any bleeding that is different from a true menstrual period. And, of course, as you know by now, a period is the bleeding that occurs about two weeks after ovulation.
Back to Sixth Grade! Reviewing the Basics of a Healthy Period
In order to understand unusual bleeding, you’ll want to remember what is normal as a point of reference: Menstrual cycles generally last from 21 to 35 days, while periods average from 3 to 5 days (though anything from 2 to 7 is still considered normal).
Menses typically follows a pattern similar to one of these two:
light → heavy → moderate → light → very light
or
heavy → heavy → moderate → moderate → light
In addition, a true period will often be associated with mild symptoms such as premenstrual breast tenderness, mild cramps, or a mild low backache.
NORMAL BLEEDING
As you already know, women may have spotting at other times in their cycle besides menstruation. In fact, one of the most misunderstood facets of the woman’s cycle is that of normal spotting, which is often brownish because the blood is exposed to more oxygen as it trickles out of the body. Also, a common mistake many women make is to assume that all bleeding episodes are periods. Of course, true menstruation is the bleeding that occurs about 12 to 16 days following the release of an egg. Any other type of bleeding is either anovulatory bleeding, normal spotting, or symptomatic of a problem.
Ovulatory Spotting
Simply stated, some women have a day or two of light bleeding right around ovulation. This spotting is not only normal, it’s a secondary fertility sign that can help identify where they are in their cycle. It’s usually the result of the sudden drop of estrogen just before ovulation and tends to occur more often in long cycles.
Gretchen’s chart. Ovulatory spotting. It is perfectly normal for women to have spotting around ovulation, in Gretchen’s case, on Day 24. (Ovulation is seen to have occurred by the thermal shift on Day 25.) Had the spotting occurred several days away from ovulation, it could have been a sign of abnormal bleeding.
A fellow FAM instructor once described her experience using a diaphragm before she learned a natural method of birth control. Every now and then, when she would remove it after making love, there would be a little blood and slippery secretions mixed in with the spermicide. She found this very confusing and wondered whether her partner had injured her cervix during intercourse. It wasn’t until years later that she realized that the blood she had seen periodically was merely ovulatory spotting collected in the diaphragm.
Anovulatory Bleeding and Spotting
Occasionally women don’t release an egg for several possible reasons. One of these is that estrogen doesn’t reach the threshold necessary for the egg to be released. When this happens, the drop in estrogen is enough to cause a slight shedding of the lining of the uterus. At other times, estrogen may continue to stimulate the growth of the uterine lining to such an extent that it can’t support itself sufficiently, and breakthrough bleeding occurs. In women over 40, the cause of anovulatory bleeding is often the result of a decreased sensitivity to the hormones FSH and LH. The result is that the woman may not ovulate, and without progesterone to sustain the lining, spotting or bleeding may occur. In all these cases, though, the bleeding is not technically menstruation.
The way to determine if a woman did indeed ovulate is through charting her temperature. Remember, ovulatory cycles usually reflect a classic temperature pattern of lows before ovulation, and highs after.
Implantation Spotting
Likewise, if a woman was trying to get pregnant and noticed spotting rather than bleeding anytime from about a week after her thermal shift, she should consider taking a pregnancy test because it may be “implantation spotting” rather than a period. When the egg burrows into the endometrial lining of the uterus, a little spotting may occur. She can also determine if she may be pregnant by noting if her temps continue to remain high beyond 18 days. This would indicate that the corpus luteum was staying alive to support a pregnancy.
Breastfeeding Spotting
Women who have just delivered a child may find that after the initial lochia (spotting following childbirth) has stopped, they have an episode of spotting at about 6 weeks postpartum. It’s usually due to the withdrawal of hormones that had been circulating at high levels when the woman was pregnant. In addition, while breastfeeding, hormone levels can fluctuate due to the varying needs of the baby. Because of this temporary hormonal imbalance, nursing women may experience a number of anovulatory spottings.
Spotting After Office Procedures
Women will often spot after office procedures such as Pap tests, cervical biopsies, cryosurgery, cautery, laser surgery, pelvic exams, and IUD insertions. This is normal.
Hormone Therapy
It’s normal to have some spotting or bleeding with HRT, especially in the first few months. Still, you may want to discuss it with your clinician to initially rule out an incorrect dosage or other potential problems.
Dark Brown or Blackish Spotting
This type of bleeding may occur in the days leading up to your period or at its tail end. T
he blood flows so slowly that by the time it reaches the outside of your body, it has been exposed to oxygen, which turns it from red to dark—think of the color of blood when you first cut yourself, before the darker scab forms. This old blood is only a potential concern if you have it for two or more days (as discussed in the Luteal Phase Insufficiency section later on).
Clotting During Menstruation
In some ways, clotting is the opposite of the dark spotting. Your body typically releases anticoagulants to keep menstrual blood from clotting. However, when your period is heavy and the blood is flowing quickly, there may not be enough time for anticoagulants to work, and thus clots form. They are common and usually not considered a concern. If they are bothersome, however, you may want to see your doctor to rule out anything serious.
UNUSUAL BLEEDING
You may be able to eliminate some of the types of bleeding below by following the suggestions in Chapter 9 on balancing your hormones. Of course, it should go without saying that if any of them are particularly severe or cause you serious problems, you should see your doctor.
Problems with Menstrual Bleeding
As you read above, your periods should typically follow a pattern of increasing and decreasing in flow, or just decreasing from a heavy flow on Day 1. You may occasionally have a thick, heavy flow, which can be normal. But if you regularly experience heavy periods, defined as soaking through a pad or tampon about once an hour, at a minimum, you should have your blood count checked to rule out anemia caused by excessive blood loss, since this can lead to weakness or fatigue. Regardless, if you ever think that something doesn’t feel right with your period, trust your gut and see your doctor.
Cervical Erosion
If you experience a continual whitish slightly bloody discharge, it could be a sign of cervical erosion. This condition is rarely serious and can have numerous causes, from tampon use to the physical impact of multiple childbirths.
Taking Charge of Your Fertility Page 29