When Period Pains Cramp Your Daughters Style


by Lauren Streicher, MD

While it may seem like your menstruating teen is being a drama queen, menstrual cramps can be really painful. Roughly 50% of teens suffer from menstrual cramps and in 15% the pain is severe enough to interfere with normal activities. Since the average girl today starts menstruating at age 10, an adolescent with difficult periods can expect a minimum of 240 days, or over 8 months, of pain before she even leaves her teens

While endometriosis or another gynecologic issue is possible, most teen cramps are not an indication of a serious problem. The culprit is usually increased production of prostaglandins, a hormone-like substance that can cause intense uterine contractions. Some teens also experience monthly diarrhea, nausea and vomiting.

While crawling into bed, lying in the fetal position and wishing for a hysterectomy is one strategy, there are other solutions. The heating pad, an old standby, is actually a good idea. A study released in 2004 confirmed that continuous low level heat on the lower abdomen combined with ibuprofen dramatically reduced, or even eliminated, menstrual pain. Thermacare Menstrual Patches or any disposable heatingpad thatadheres to the lower abdomen, can be worn discreetly under clothes, and emit continuous heat for 8 hours. Over the counter NSAIDS (non-steroidal anti-inflammatory drugs) such as ibuprofen or naproxen dramatically reduce the formation of prostaglandins and decrease cramping and bleeding. The key is to take them the day before menstruation starts and prostaglandin activity kicks in. That’s no problem if your daughter has regular periods, but if her cycles are unpredictable, the medication should be taken at the first sign of bleeding or discomfort.  Once the period is fully flowing and the cramps excruciating, it’s too late to get the maximum benefit.

Of course, there is no better way to eliminate menstrual cramps than by eliminating menstruation. Using hormonal contraception like birth control pills to eliminate or drastically shorten bleeding (even when contraception is not needed) can change the life of a teen who has a major meltdown every time she realizes her period is going to interfere with an important social or sporting event. Many parents are concerned that giving hormonal contraception to teens will negatively affect future fertility or increase the chance of developing cancer down the road.  Fortunately, all evidence indicates that this is not the case. As an extra bonus, eliminating menses not only gets rid of cramps, but also reduces hormonal headaches, anemia, ovarian cysts, PMS and endometriosis. And any mother of an adolescent girl during a pre-menstrual meltdown can attest that the reduction in PMS alone makes it worthwhile. Not to mention the hundreds of dollars you will save every year by not buying pads, tampons and pain medication. And being the parent of a cramp-free teen ... priceless.

10/27/2010 doctoroz.com

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

5 Myths About Endometriosis and Why They’re So Wrong

By Lauren Streicher, MD


When I mention the possibility of endometriosis to a patient, it’s pretty rare that she hasn’t at least heard of it, even if she’s not sure exactly what it is. The simple description is that endometriosis is a condition in which the glandular tissue that normally lines the uterine cavity appears in other places, such as the lining of the pelvis, fallopian tubes, ovaries, or bowel.

Rarely the uterine glands can end up in really weird places, like the lung, bladder or kidney. Each month during menstruation, this tissue responds to hormonal changes, just like the tissue that lines the uterine cavity. And yes, women with lung endometriosis cough up blood once a month. Since the tissue is not where it’s supposed to be, various problems can ensue, such as scar tissue, inflammation, ovarian cysts, painful intercourse, and the most commonly appreciated symptom, excruciatingly painful periods that get worse with time. The degree of pain is not necessarily related to the severity of endometriosis. Women who appear to have minimal endometriosis sometimes suffer the most.

Like many medical conditions, there are a lot of misconceptions floating around, so I would like to bust a few of the myths I regularly hear.

Myth No. 1: Endometriosis is most common in Caucasian women in their the twenties or thirties.

In the 1970s and 80s, the accepted medical belief was that Caucasian career women were the only ones at risk for endometriosis. Looking back, it’s not that those women were more likely to have endometriosis, but simply more likely to be taken seriously when they complained. It wasn’t until the 1980s that it was recognized that African American women and teens are just as much as risk. Any menstruating woman can have endometriosis, weather she is 16 years old or heading toward her last tampons. It is unknown how many women have endometriosis since not everyone has symptoms and the diagnosis can’t be made definitively without surgery. What we do know is that it is diagnosed in up to 30 percent of menstruating women who have menstrual pain severe enough to warrant surgery.

Myth No. 2: Women with endometriosis only have pain during their period

Scarring and inflammation from endometriosis can result in all day every day pelvic pain for many women. In one study of women with known endometriosis, 45 percent had pain with intercourse, 29% had bowel pain, and 69 percent had pelvic pain even when not menstruating. This isn’t just about bad period cramps.

Myth No. 3: Women with endometriosis can’t take estrogen after menopause or after a hysterectomy

Not true! Women who have suffered for years from painful periods do not need to suffer formhot flashes and vaginal dryness once the agony of endometriosis is finally over. Taking estrogen for relief of menopause symptoms will not reactivate endometriosis.

Myth No.  4: Women with endometriosis always have heavy periods.

Actually, heavy periods are more commonly associated with adenomyosis, a cousin to endometriosis that sometimes goes hand in hand. In adenomyosis, the glands infiltrate into the wall of the uterus instead of getting outside the uterus. Women with endo might have heavy periods, but they also might have very light periods.

Myth No. 5: Women with endometriosis are usually infertile.

It is true that women with endometriosis are at risk for infertility however, many women with endometriosis have no difficulty getting pregnant. In fact, many women with endometriosis don’t even know they have it. Having said that, if you know you have endometriosis, the best way to minimize the chance of endometriosis related infertility is to suppress periods until you are ready to conceive. That may mean taking hormonal contraception continuously (no placebo pills) or using a levonorgestrol IUD. Don’t stop your contraception until just before you are ready to get pregnant. And if not pregnant within a few months, see a specialist sooner rather than later.

Originally Published Mar 10, 2014 Everyday Health

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.