Dear sincereM: Both the medications you mention work to relax spams in the bowel. They may even be prescribed to runners experiencing gut cramps/spasms. I have even seen them used to try and differentiate bowel pain from GYN type pain--a tough call given the proximity of the two organ systems. Thus, if your pain is bowel spasm related (as diagnosed by the GI MD) then you are on an appropriate medication.
So why might these spams be linked to your menstruation? Here are a couple of POSSIBILITIES:
1. Endometriosis of the descending colon---Endometriosis ("endo") is related to the tissue lining the inside of the uterine cavity. These little implants of endo can be found throughout the abdomen attaching to both the gut and uterus/tubes/ovaries, and even the bladder. Every month at the time of flow these implants also bleed leading to pain and irritation at the site(s). If this were the case, an antispasmotic medication would not improve the pain.
2. Prostaglandins---Common menstrual cramps are caused by the release of prostaglandins from the lining of the uterus. Prostaglandins create both the cramps of labor and menstrual cramps by making the uterus contract. Common cramps may start prior to the onset of flow and usually last 72 hours. There are also receptor sites for prostaglandins in the bowel and central nervous system. Thus prostaglandins can produce not just cramps but also nausea/vomiting, diarrhea, headaches, and other "flu-like" symptoms. Ways to block prostaglandins can include anti-prostaglandin drugs (eg ibuprofen, naproxen sodium, ketoprofen, etc.), or birth control pills.
Bottom line, given what your GI MD stated you may well be having some type of bowel spasm--and it might be triggered by prostaglandins which are known to cause muscles in the uterus to contract. For the most "for sure" answer you may have to work with both a GYN and a GI MD. You can surely ask about the conditions mentioned above and see what your own healthcare providers believe.
Dear An: If a yeast infection is severe enough for the yeast to have reached the clitoral area often there is pronounced vaginal itching and burning as well. So if you have itching and burning throughout the area then yeast would be a common culprit.
It would be less likely for it to be the Head & Shoulders shampoo--unless you were shampooing your pubic hair as well. Truly, if your symptoms are not improving it would be preferable to have a GYN trained person do a brief exam. They can test for yeast at the same time. It's OK to discuss any masturbation concerns. In fact, if you use saliva as a lubricant, there are studies which link saliva contact to genital yeast infections (yeast is a common flora from the mouth through the entire gut).
Dear smjpain: Those tears or splits in the skin around the vaginal opening can be very painful and really interfere with intercourse. Some POSSIBLE causes for this to occur might be:
1. Lichen sclerosus--This is purported to be an autoimmune disorder which causes the skin on the vulva (especially the area between the vagina and anus, or "perineum") to get like parchment. It becomes thin, dry and fragile. Usually LS also itches. It is treated with prescription steroid creams. While once thought to be common only in elderly women, it can be found in adolescents and even children. In your specific case you have a known diagnosis of LS.
2. Vulvar yeast infection--This can cause small red "lines" in skin folds. These lines can be tender and even bleed if friction is present. It is treated with antifungal medications. Also in your case smjpain, you have a known super bad yeast infection with an typical subtype of yeast/candida.
3. Low estrogen--If you are breast feeding or even using hormonal forms of birth control (eg DepoProvera), you may have lowered systemic estrogen levels. This can manifest in the thinning and drying of vaginal tissues. In some cases the vaginal opening may seem tighter; lubrication is reduced.
4. Genital Herpes--This would be the most remote cause, but some herpes outbreaks can look like splits in the skin. Doubt this in your case smjpain, given your GYN history.
Thank goodness you have both a vulvar pain specialist and a pelvic floor PT on your side. Vulvar pain can be a slow to treat process, but reassure your boyfriend, that a return to full function is very possible.
Dear Mish: We appreciate your reading the questions of others to see if your situation was similar. Now, because your regimen is different, YOUR specific information may be useful to someone else.
As you have read, the consistent exposure of the lining of the uterus to progesterone (either natural from the ovary of synthetic) causes the lining to decrease in thickness. Simply stated, if the uterine lining is like grass or lawn, estrogen is like the fertilizer (causes a thickening of the lining), and progesterone is like the lawnmower (keeps the lining thin by three different mechanisms). This is why DepoProvera (high dose synthetic progesterone) brings about a thin lining, and why birth control pills (relatively progesterone dominant) bring about shorter, lighter periods. It is also why women who miss ovulations (no progesterone produced) are at a greater risk for too thick lining, heavy/prolonged flows and if untreated, endometrial cancer.
So in your case Mish, taking the Provera pills every day except for the last four days of the month gives you a dose and effect similar to getting the DepoProvera injection. After four days without the Provera pills your progesterone blood level drops enough to trigger any lining to be shed--if needed. That you don't have a withdrawal bleed suggests that your lining is being kept thin enough that there is not much that needs to be shed.
In terms of the TTC issues, Provera will not prompt an established pregnancy to be lost. While on DepoProvera shots for birth control one is exposed to the equivalent of Provera 20-25 mg daily for 90 days. That dose does suppress ovulations so conception should not occur. I do not know whether your dose of Provera 10 mg x 24 days will suppress ovulations as well. With your known history of PCOS, ovulations are classically fewer than monthly.
Mish, your GYN can give you the most "for sure" answer. You are definitely asking all the right questions. In my OPINION, it sounds like your GYN is first attempting to get your lining to a healthy level so you don't have to be hospitalized. In terms of TTC, you might be a candidate for ovulation induction medications.
Dear WorriedNow: Gosh, thank YOU for taking your story to the end, including the GI procedures. I know this will be helpful to other women with similar concerns, and will help them frame additional questions when it comes to a work up.
Dear An: There are a variety of causes for clitoral enlargement:
1. Increased levels of male hormones--I rather doubt this is your culprit as your symptoms appeared suddenly. Increased levels of male hormones tend to progress over time and can be caused by a tumor of the ovary or adrenal gland (there would likely be other symptoms beyond clitoral).
2. Swelling secondary to infection, yet you have no open sores or lesions.
3. Swelling secondary to trauma, for example a bike seat.
There are a variety of reasons for clitoral pain or tenderness:
1. Infections such as herpes, yeast, or even a localized infection from skin bacteria.
2. Dermatology problems which can appear in the genital area such as lichen sclerosus, lichen planus, psoriasis, or a contact dermatitis from detergent/bath products/genital cosmetics.
3. Nerve issue where the surrounding nerves (and the clitoris has lots of nerve tissue) begin to fire inappropriately leading to a sensation of pain. Sometimes this problem can be initiated by an irritant such as herpes, yeast, or trauma to the site (eg bike seat).
4. Persisting genital arousal syndrome--see recent citation: J Sex Med. 2009 Oct;6(10):2778-87. New insights into restless genital syndrome: static mechanical hyperesthesia and neuropathy of the nervus dorsalis clitoridis. Waldinger MD, Venema PL, van Gils AP, Schweitzer DH.
Department of Psychiatry and Neurosexology, HagaHospital Leyenburg, Leyweg 275, The Hague2545 CH, The Netherlands. firstname.lastname@example.org
INTRODUCTION: Systematic study of dysesthetic and paresthetic regions contributing to persistent genital arousal in women with restless genital syndrome (ReGS) is needed for its clinical management. AIM: To investigate distinct localizations of ReGS. METHODS: Twenty-three women, fulfilling all five criteria of persistent genital arousal disorder were included into the study. In-depth interviews, routine and hormonal investigations, electroencephalographs, and magnetic resonance imaging (MRI) of brain and pelvis were performed in all women. The localizations of genital sensations were investigated by physical examination of the ramus inferior of the pubic bone (RIPB) and by sensory testing of the skin of the genital area with a cotton swab (genital tactile mapping test or GTM test). MAIN OUTCOME MEASURES: Sensitivity of RIPB, GTM test. RESULTS: Of 23 women included in the study, 18(78%), 16(69%), and 12(52%) reported restless legs syndrome, overactive bladder syndrome, and urethra hypersensitivity. Intolerance of tight clothes and underwear (allodynia or hyperpathia) was reported by 19 (83%) women. All women were diagnosed with ReGS. Sitting aggravated ReGS in 20(87%) women. In all women, MRI showed pelvic varices of different degree in the vagina (91%), labia minora and/or majora (35%), and uterus (30%). Finger touch investigation of the dorsal nerve of the clitoris (DNC) along the RIPB provoked ReGS in all women. Sensory testing showed unilateral and bilateral static mechanical Hyperesthesia on various trigger points in the dermatome of the pudendal nerve, particularly in the part innervated by DNC, including pelvic bone. In three women, sensory testing induced an uninhibited orgasm during physical examination. CONCLUSIONS: ReGS is highly associated with pelvic varices [VARICOSE VEINS OF THE GENITALS--JHH> and with sensory neuropathy of the pudendal nerve and DNC, whose symptoms are suggestive for small fiber neuropathy (SFN). Physical examination for static mechanical Hyperesthesia is a diagnostic test for ReGS and is recommended for all individuals with complaints of persistent restless genital arousal in absence of sexual desire.
If your clitoral pain or enlargement persists please see a GYN for a more "for sure" answer. You could even start with your local county family planning clinic.
Dear Meg: Wow, living in Italy. I envy you as I love Italy. But I'm sorry that you are having these GYN issues with a 16 month old, having recently moved.
The most common reason for a menstrual pattern like you have described is not having an ovulation every month. In a normal cycle, estrogen is produced all month. Estrogen is responsible for building up the lining of your uterus so you have something to shed each month. The good news is that you have enough estrogen to make a lining that does shed.
In a normal cycle, progesterone production increases following ovulation and release of an egg.. Progesterone "stabilizes" the uterine lining in preparation for a possible implantation of a new pregnancy. If you are not pregnant that month the levels of estrogen and progesterone fall, triggering the release of the uterine lining—your period.
So, if you do not ovulate, the estrogen build up of the lining continues, but without the usual ovulation associated progesterone. Thus, the hormone levels don't decline, and the lining stays up inside the uterus—as a missed/late period. Alternatively, the built up lining can begin to shed on its own creating erratic bleeding patterns which are usually "too-light" or super heavy and prolonged.
As you may have read, causes for not ovulating are many: low thyroid (ruled out in your case), pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (problems with partners/family, money), increased body weight, anorexia, rotating shifts at work, etc. In your specific case there are several possible culprits: recently stopping regular birth control pills, and moving to a different country. You also have a known history of irregular ovulations.
Yes, bilateral breast tenderness can be a very early sign of pregnancy, appearing as early as two weeks after conception. This is thought to be related to increasing levels of hormones such as estrogen. In a month without an ovulation, not only can a menstrual period be missed, but there can be breast tenderness as well. This is similar to the increased breast tenderness experienced by some women when first taking postmenopausal hormone therapy.
I would urge you to establish care with a GYN by getting another pregnancy test done just to definitely rule out an undetected pregnancy. That way, if you do develop prolonged or heavy bleeding you have a place to receive care. I would hope that your cycles reset themselves naturally. Your daughter's birth confirms that you do ovulate--even if it is not always super predictable.
Dear justbe: Thanks for taking the time to write about your experience with the Novasure type of endometrial ablation (EA). I would concur with you. It's very unlikely that an EA would prompt weight gain. It's also unlikely that an EA device would create a problem with the appendix since the EA instruments stay contained within the uterine cavity, unless there is a rare perforation during the procedure. Perforations are usually detected right away and the procedure is stopped.
In terms of the sudden onset of urge-type incontinence one would hope that was an isolated incident. It's not uncommon to occasionally dream about voiding then to wake up having to really go to the bathroom. As you have read above, I was unable to find evidence that linked EA to incontinence issues.
Dear bg: My best GUESS would be that you are experiencing breakthrough bleed or spotting due to the hormones in your NuvaRing. Alas, breakthrough bleeding (BTB) can be a common side effect of most types of hormonal birth control (eg pills/patch/ring/shot/Mirena IUD). More remotely, BTB in a pill user can arise if she has gotten a chlamydia infection. Yet, if you both are monogamous this is not going to apply.
When a woman uses hormonal birth control it can make the lining of the uterus more unstable--so it is easier to have some of it begin to shed. Sometimes the lining is less stable because the hormones make the lining much thinner (actually this is good as a thin lining is a healthy lining). This is the more common reason in longer term users like yourself. Sometimes the lining is unstable because the hormones can make parts of the lining out of synch. This is more likely to occur in the initial months of use.
Abdominal cramping can arise if there is a pelvic infection (eg chlamydia). Again this would be unlikely if you have no risks for a sexually transmitted infection. Cramping can occur if there is spotting or flow---this would be my best GUESS in your case. Finally cramping can come from the bowel as well as GYN conditions.
Bottom line, BTB on hormonal methods of birth control is a nuisance side effect. The protection from pregnancy is still in effect. If your poor cycle control persists or worsens you should return to your GYN or clinic.
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