How
do I know if and when I am
ovulating --what are the
signs, and on what day of my
cycle should that be
happening?I have a right sided
pain today, and I am on day
11 of my cycle. Does that
sound about right??
I
also had my right fallopian
tube removed about 18 years
ago due to a cyst that
developed when I was 6
months pregnant, but the
ovary was left behind. Is
this likely to affect when I
will begin perimenopause?I am 42 years old.
Thanks
Dr Judy.
Caroline
G.
Hi
Caroline,
Ovulation
generally occurs 14 days
before your next cycle.As cycle lengths may
vary some month to month, it
is hard to predict exactly
when this will be when
counting from day 1 which is
the first day of your cycle.In a 28 day cycle,
you would ovulate on day 14,
in a 30 day one, day 16.
That
said, the pains of
ovulation, which are not
consistently present every
month in every woman, can
start several days before
ovulation as they come from
the stretching of the pain
sensitive ovarian capsule as
the egg follicle swells in
preparation for ovulation.The actual release of
the egg can be very painful,
particularly if the egg
follicle has become a large
cystic sac.Other signs of
ovulation include: tender
breasts, an increase in
sexual interest, and a
clear, egg-white type
vaginal discharge.Some women have not a
clue when they ovulate.
Ovulation
can become more intense
during early perimenopause
as your ovaries are digging
deeper to find viable
follicles, and these deeper
eggs can stretch the ovarian
surface more.In addition, the
pituitary may be putting out
more follicle stimulating
hormone (FSH) to get the
ovaries to respond to the
call to ovulate, and the
hyperstimulated ovaries are
more likely to form a big
follicular cyst at
ovulation.
The
loss of a fallopian tube
will not affect the age of
perimenopause.Women with one ovary
seem to experience an
earlier and/or more
prolonged perimenopause, but
the age of menopause does
not seem to change.
Best,
Dr.
Judy
QUESTION:
Dear
Dr Judy,
I am
56 years old. My doctor
insisted that I come off HRT
last year as he says the
risks outweigh the benefits.I am scared to
contradict him as I know he
will poo poo me and say he's
the doctor and knows best.But during the 15
years that I took hormones,
I had a good quality of life
and now things are not so
good..
I'm
crying, I'm anxious, and I
feel like I've lost my mind.I can't think of what
I want to say and I have to
think hard before I spell a
word.Worse yet, within
weeks of stopping the
therapy,I was suffering joint
pains, mainly knees, hips
and hands. I wondered if
this pain and stiffness is
related to coming off HRT.What do you think?
Thanks,
Cheri
Dear
Cheri,
I
think that some doctors are
underinformed on the 'pro'
side of the pros and cons of
hormone therapy. The
headline news that came out
of the 2002 termination of
the Women's Health
Initiative Study certainly
informed us about the cons.
We know now that HRT should
not be given to older women
decades past menopause who
are at high risk for heart
disease, stroke, and
dementia. And we also know
(which we've always known)
that ongoing use of HRT does
slightly increase the risk
of breast cancer.
That
said, studies on cells,
animals, and large
epidemiological studies such
as the Nurses Health Study
that recorded outcome data
on women who started taking
hormones right after
menopause give a very
different picture. Rather
than writing on book right
here, I'll just note that
healthy cells thrive on
estrogen. In particular, the
cells that support verbal
memory and their neighbors,
the cells that support
executive functioning, work
better in the presence of
estrogen both with respect
to maintaining contact with
other cells and repairing
any age-related damage. So
the ability to find the
right word and spell it
correctly plus the ability
to start a complex task and
carry it through to
completion is best
maintained with hormones.
And some women are much more
susceptible to estrogen
depletion than others.Estrogen also supports those brain cells in charge of
mood--the times in a woman's
life when estrogen levels
plummet such as
premenstrually, post-partum
and perimenopause are
frequently associated with
depression, anxiety, and
panic attacks.
The
problem of 'menopausal
arthritis' seems to be
little appreciated. Some
women, including myself,
stiffen up terribly without
estrogen. This joint pain
and stiffness is one of the
worst side effects of some
of the anti-estrogen
medications such as Femara
used to treat breast cancer.
The
risk/benefit analysis of
using HRT varies for each
woman. As my family history
includes osteoporosis and
Alzheimer's disease, and my
personal history includes
joint pains, fuzzy thinking,
and terrible anxiety and
insomnia off estrogen, I
have chosen to use it at
this time. Other women who
feel well without HRT or
worry about breast cancer
due to a family history of
that may well choose not to
use it.
That,
briefly, is what I think.
I'm sorry that you are
partnered with a doctor who
intimidates you, but I
applaud your efforts to
inform yourself and act as
your own health advocate. I
hope that you are able to
work out a solution that
restores your previous
quality of life.
Best
wishes,
Dr.
Judy
QUESTION:
Dr.
Judy~
Can
you please explain estrogen
dominance. I have read that
a woman with estrogen
dominance may have PMS like
symptoms throughout her
cycle versus just the two
weeks before the start of
her period.
I
find that I do have some PMS
symptoms a couple of days
prior to my period, but the
symptoms tend to continue
about 7-10 days into my
period. The symptoms that
tend to hang on are a
headache and an edgy
feeling. My best days of the
month tend to be from about
14-24 days of my cycle.
Any
thoughts? I am frustrated.
SJ
Dear
SJ,
Trying
to sort out what's what in
the complicated rise and
fall of hormones through the
menstrual cycle certainly
can be frustrating.In addition, there is
an abundance of information,
much of it conflicting,
about what lies at the root
of PMS.I've been reviewing several web-sites on the subject as I
think about your question,
and even I feel like lying
down with a cold cloth on my
forehead!
The
term estrogen dominance
refers to an imbalance
between a woman's levels of
her two main reproductive
hormones--estrogen and
progesterone--as they rise
and fall through each
monthly cycle.Estrogen levels rise
during the first half of our
cycles from day 1 of the
menstrual flow until
mid-cycle when levels tend
to drift downwards.Progesterone, on the
other hand, is mainly
produced by the ovary
post-ovulation; if we do not
ovulate as occurs with
increasing frequency in our
30s and 40s on the road to
menopause, we do not make
much progesterone.As a result, the
normal ratio of progesterone
to estrogen in the last half
of the month is disturbed,
and the effects of estrogen
dominate.
Estrogen
has a host of characteristic
effects on our bodies,
including brain effects that
make us social and assertive
(perhaps these traits are
good ones to find an
eligible male in time for
ovulation).Progesterone causes a
calmness and inward
focus--in high doses it
actually acts like a
sedative and promotes sleep.Too much estrogen transforms outgoing into aggressive, and no
progesterone means no 'chill
pill' to balance the
irritability.
In
addition, estrogen promotes
salt and water retention in
contrast to progesterone's
diuretic effect.Estrogen promotes
cellular division in the
uterus and breasts leading
to heavier periods and
tender, lumpy breasts
whereas progesterone opposes
these actions.
Without
ovulation, the brain never
gets the signal that the
proper events in the
reproductive cycle have
occurred, and the pituitary
gland at the base of the
brain continues to send out
frantic messages to the
ovaries to get with the
program.This chemical
messenger, known as follicle
stimulating hormone or FSH,
causes the ovaries and other
estrogen-producing tissues
in the body to make more
estrogen which makes the
situation worse.
In
your case, you may be
ovulating (those good days
from 14-24).Once you've released
the egg, however, the
residual egg-producing site
in the ovary known as the
corpus luteum may not be
very efficient at making
progesterone.As progesterone
levels flag in the second
half of the cycle, poof!
you're into that estrogen
dominance thing again.
What
to do?You might speak with
your doctor about a trial of
natural progesterone in the
second half of the cycle.This would not only
boost your levels of
progesterone but also send
the message to your
pituitary gland to cut it
out with the FSH already,
everything is under control.Using birth control pills that contain progestogen
(synthetically altered
progesterone) can be
helpful, but some women find
the pill makes matters
worse.
The
late Dr. John Lee wrote
extensively about estrogen
dominance in his
well-written books including
"What Your Doctor May
Not Tell You About
Menopause."He and others believe
that progesterone cream
provides even levels of
progesterone that can turn
this situation around.My experience with
the cream has been variable
with respect to successfully
re-balancing these disrupted
cycles.
Best
wishes for relief,
Dr.
Judy
QUESTION:
Dear Dr. Judy,
I take lots of vitamins, C,
E, B complex and my
estrogen. I don't take any
calcium. I'm 59 and
wondering just how often you
should go for a bone density
test? My last one was
several years ago and it was
fine. Any advice?
Thanks,
J. in Georgia
Dear J in G,
Before we discuss
the appropriate frequency of
bone density tests, I'd like
to wonder aloud why you're
not taking calcium.Your use of supplements indicates that you take an active
interest in a healthy
lifestyle, yet you've chosen
to pass on two of the most
important ones--calcium and
vitamin D.
I'll admit there has
been some recent confusion
regarding calcium
supplements.A recent issue of The
New England Journal of
Medicine reported recently
on a sub-study from the
Women's Health Initiative.They looked at bone
health in over 36,000
postmenopausal women as it
related to intake of calcium
and vitamin D.Their conclusion,
widely reported in the
popular press, stated that
these supplements did not
significantly reduce the
risk of hip fracture.In fact, analysis of
the results shows that some
of these women were already
on osteoporosis therapy,
many were non-compliant with
the program, and many were
taking less than optimal
doses of vitamin D.And despite all these
factors that would decrease
the apparent usefulness of
taking the supplements, the
risk of hip fracture was
reduced by 12%.
An endocrinologist
from Massachusetts General
Hospital concludes,
“Calcium with vitamin D
supplementation isakin
to the ante for a poker
game: it is where everyone
starts."In other words,
calcium and D are necessary
but not necessarily
sufficient to prevent
osteoporosis and fractures.But
if a particular woman's
situation suggests that her
risk of fracture is
significant, she probably
needs additional preventive
treatment.
Vitamin D experts
uniformly agree that the
current recommended
allowance for D of 400 units
daily is insufficient,
particularly in cancer
prevention.They all endorse at
least 1,000 units daily.Most multivitamins
have 400 units per tablet;
it is extremely difficult to
get more without
specifically taking an
additional supplement.Many people who live
in cloudy climates, use
sunblock, or are
dark-skinned to not get
enough D through sunshine or
diet.
You are at an age
when accelerated bone loss
occurs. We all breakdown
bone to release needed
calcium or to remodel bone
in response to injury and
exercise.Since you are taking
estrogen, you hopefully are
preventing the increased
bone breakdown that occurs
after menopause.I'm glad you have had
a baseline measurement.The National
Osteoporosis Foundation
recommends that all women
over 65 get a DEXA scan, and
younger women get one if
they are in a high risk
group such as early
menopause, thin body frame,
family history of
osteoporosis, or a smoker.I agree with your
doctors, however, that
getting the first scan at an
earlier age is a better way
to plan for future bone
health.*
I do think that now
would be a great time to
repeat the scan to see if
your current strategy of
estrogen and dietary calcium
alone is preserving your
previously normal bone mass.If your bone mass has
remained normal, I'd
recommend talking to your
doctor about repeating the
scan again in another 2-3
years.If it is not normal,
your doctor may recommend
further testing, including
vitamin D levels, to see why
you have lost bone density.
Best wishes,
Dr. Judy
*Dr.
Paul Miller, an osteoporosis
specialist in Denver says
this about waiting until age
65 to deal with low bone
density:“I can tell
you right now, from a
clinician’s point of view,
that when you have an
individual patient in your
examining room who is 55
years of age, whose mother
had a hip fracture, whose T
score is now -1.8, and who
is concerned and wants to be
proactive about prevention,
you can’t tell her to come
back in 10 years.”
QUESTION:
Dear Dr. Judy,
I've been having a period now
for nearly 6 weeks. It seems
to be slowing down some but
was wondering if this is
sometimes normal? I just
turned 30 not to long ago and
my periods aren't always
regular. I've been know to
skip some now and then. I've
never been pregnant as yet but
hope to one day soon. It this
something I should be very
concerned about?
Thanks for any suggestions or
advice,
Jen in Florida
FROM
DR. JUDY:
Dear Jen,
Prolonged periods aren't
'normal' but they certainly
are common. In order to have a
normal period with proper
timing (about one month since
the previous bleed) and length
(3-7 days), certain hormonal
events must take place.
Early in an ideal cycle,
rising levels of estrogen
released by the ovaries as
they get ready to produce an
egg cause healing and
resurfacing of the uterine
lining . Menstrual flow
ceases, and a spongy lining of
blood vessels and glands
starts to thicken inside the
uterus in anticipation of the
next period.
Approximately two weeks after
the first day of the last
period, the ovaries release an
egg. Estrogen levels hold
steady, but now rising levels
of progesterone produced the
ovary causes the inner
endometrial lining to
specialize into a functional
layer ready for implantation
of a fertilized egg. If
fertilization does not occur,
estrogen and progesterone
levels drop off, and the
uterus sheds its lining as
another cycle starts.
The most common reason why
cycles become irregular or
abnormal is a lack of
ovulation. If no ovulation
occurs due to stress or other
issues, estrogen continues to
influence the uterine lining
but no progesterone is
produced to coordinate the
entire inside of the uterus
into one smooth tissue ready
for pregnancy. The lining then
begins to break down in areas,
causing a menstrual flow that
may be uneven, and heavier,
redder, or more clot-filled.
This 'anovulatory' period may
come early or late, and may go
on and on if no new follicle
begins to develop to put a
stop to it.
Women can miss ovulation under
times of stress, including
changes such as illness,
weight loss, moving, or change
in work or sleep habits. You
mentioned, however, that you
occasionally skip periods, and
that you plan to become
pregnant soon. You may wish to
consult your physician about
other reasons for irregular
periods that could interfere
with conception, such as
thyroid abnormalities,
autoimmune problems, or
polycystic ovary syndrome.
PCOS is a fairly common
condition that is more about
hormone imbalance than ovarian
cysts. It often is associated
with extra weight, acne, and
excessive hair growth on
places like the abdomen and
arms. Often, though, women
with PCOS have no indication
of the condition except
irregular periods. This
condition can be treated
leading to normal pregnancies.
If you haven't discussed your
irregular periods with your
doctor, please do soon so you
can undertake any tests or
treatments that might enhance
your chances of pregnancy.
