In this chapter we look at the conditions and diseases that play a role in a woman's ability to get pregnant and give birth, the medications that are often prescribed to treat these health challenges, and how these medications may affect a woman's reproductive and overall health. (For your convenience, each medication entry in part two has a subheading titled "Of Special Interest to Women," where we note how a specific medication may affect a woman's reproductive health.) We also discuss the impact medications generally can have on a woman's health during pregnancy and after. These are times in a woman's life when her medication decisions affect not only her but her child as well.
Menstruation
Some women call it their period, others call it the curse. Perhaps you're at the stage in your life when you call it history! Whatever you call it, menstruation is central to a woman's reproductive health. Key elements of your reproductive health are hormones, and the hypothalamus and pituitary gland work together to control six of the main hormones necessary to keep your reproductive system functioning: estrogen, follicle-stimulating hormone (FSH), gonadotropin-releasing hormone (GnRH), luteinizing hormone (LH), progesterone, and testosterone.
This Is Your Period
Briefly, your menstrual cycle and these hormones work like this: Your hypothalamus releases GnRH, which triggers a chemical reaction in your pituitary gland to produce FSH and LH. In response to the release of FSH and LH, your ovaries produce estrogen, progesterone, and testosterone. The synchronization of all these hormones allows a normal menstrual cycle to occur.
Other substances involved with menstruation include prostaglandins, which cause your uterine muscles to contract so you can shed your menstrual blood. Women who have an excessive amount of prostaglandins in their uterus can experience very painful periods, a condition that is known as dysmenorrhea. Dysmenorrhea involves severe pelvic pain and often nausea and vomiting, back and thigh pain, headache, and other symptoms. An excess of prostaglandins is a cause of primary dysmenorrhea, while women who experience these symptoms as a side effect of other reproductive problems, such as endometriosis, pelvic inflammatory disease, uterine fibroids, or use of an IUD, are said to have secondary dysmenorrhea.
Treating Menstruation and Dysmenorrhea
If you still experience menstruation, chances are you also experience some annoying, uncomfortable, even distressing symptoms. While most women report mild to moderate symptoms of cramping, headache, breast tenderness, and bloating, others suffer more serious effects associated with dysmenorrhea. Statistics on how many women experience dysmenorrhea, range from 10% up to 90%, but the important thing is that if you are sufferingwith severe symptoms, the only statistic you care about is you, and you want relief.
For mild menstrual symptoms, a heating pad or a warm bath may be helpful. Some women report relief from natural remedies such as black cohosh or fish oil, and a limited number of scientific studies do back up their benefits. Effective over-the-counter or prescription nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen, mefenamic acid, or naproxen can alleviate cramps and muscle aches, and are also helpful if you have dysmenorrhea, as these drugs reduce the concentrations of prostaglandins.
The FDA has approved the NSAIDs diclofenac, ibuprofen, ketoprofen, meclofenamate, mefenamic acid, and naproxen for treatment of dysmenorrhea. Your health-care provider may also prescribe oral contraceptives along with NSAIDs to treat your primary dysmenorrhea symptoms. If your doctor has determined that your severe menstrual symptoms are associated with another reproductive condition, it is necessary to treat that health issue simultaneously with your dysmenorrheal symptoms.
Menstruation Red Flags: See a Doctor If ...
• Your period suddenly stops for more than 90 days (and you cannot attribute it to pregnancy or menopause).
• Your periods become very irregular after you have had regular cycles.
• Your period occurs more frequently than every 21 days or less often than every 45 days.
• You experience bleeding that is heavier than usual or you require one pad or tampon every 1-2 hours.
• You experience severe pain during your period.
• You bleed for more than 7 days.
• You experience fever and feel ill after using tampons.
Endometriosis
Between the start of menstruation and menopause, 10% of women can expect to experience endometriosis. If you are among this 10%, then you arelikely no stranger to the pelvic pain that often--but not always--correlates to your menstrual cycle. For some women the pain occurs at other times of the month, and it can be so intense and debilitating that their lives are turned upside down for days.
What Is Endometriosis?
Endometriosis occurs when endometrial tissue, which should grow only inside the uterus, grows outside the uterus. These endometrial deposits, referred to as endometriomas, can be found on the ovaries, the fallopian tubes, the pelvic sidewall, the rectal-vaginal septum, and cesarean scars. Less often they are found on the appendix, bladder, bowel, colon, intestines, and rectum. Sometimes endometriosis causes adhesions that alter a woman's internal anatomy, and in advanced cases the internal organs can fuse together, causing what is known as a "frozen pelvis."
One of the more disturbing consequences of endometriosis for some women is an inability to have children. It is estimated that 30-40% of women with endometriosis suffer from infertility. If you are having difficulty getting pregnant and you have or suspect you have endometriosis, consult a knowledgeable physician as soon as possible to get a diagnosis. Although currently there is no cure for endometriosis, there are treatments that can significantly improve your quality of life.
Treatments for Endometriosis
Medication, hormones, nutritional therapy, alternative therapies, surgery--women have a variety of treatment options when faced with endometriosis. We focus on medications and hormones, but it is important to mention that some women respond to a holistic...