Menstrual Cycle Normalities and Abnormalities
Interview with Yvette M. Gentry, M.D.
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Dr. Yvette Gentry: I'm Dr. Yvette Gentry. I'm an OB/GYN in Oakland, California and I have been practicing in the East Bay community for ten years.
Male Interviewer: And what are we going to talk about today?
Dr. Gentry: Today we're going to talk about menstrual cycles and many people ask what's considered normal and what's abnormal and is something wrong with me.
Interviewer: What is normal?
Dr. Gentry: A normal cycle, it can bring — it can vary. It may come every 28 to 32 days and some patients worry if they're not exactly on schedule, but it's okay to have some variation of a few days. And typically they last from three to five days and people ask me what's considered heavy, you know, because we all have our own experiences and that's not something typically that women discuss with each other. In a normal cycle, generally you may change your sanitary product on the heaviest days every couple of hours. And maybe for one day of a cycle and then after that it should start to lighten up. And so some ladies, when they have problems, it gradually gets worse and they think that everyone is that way and that's just the way their family is because there probably is some genetic predisposition for some problems. But typically that's how long the duration of a period should be and that's the inteeval you should have.
Interviewer: What's a warning sign if you really do have a problem?
Dr. Gentry: If you notice that if you are every 28 to 32 days and then abruptly your cycles change quickly. You know, sometimes if we travel or get stressed, weight loss, weight gain, medications, your cycle may be off once and that's okay. But if you consistently have a problem bleeding in between cycles, periods every two weeks, then that would be the time to go in and get checked out.
Interviewer: What are the steps that you would typically recommend or what in general would you typically recommend for women who are having difficulties with their menstrual cycle?
Dr. Gentry: I think that the first thing to do is to look at what medicines you're taking — if you're taking any - if you've had any big lifestyle changes. Sometimes, particularly women in college years, at times of their final exams when they're more stressed, typically that's more visits to the clinic for checking pregnancy tests because they're stressed and they're skipping cycles. So I think that looking at overall, your overall health as far as are you stressed, have you gained a significant amount of weight; people with weight gain, sometimes their cycles will start to skip or they'll miss cycles from the hormonal changes that result in weight gain. If they're traveling, they may have a thyroid abnormality, a prolactin abnormality, some hormonal changes, so I think that you need to first evaluate what you're doing, what's going on, go and get checked out. There's some blood tests we can do, an exam, and perhaps if necessary, an ultrasound to look for any other pathology.
Interviewer: Are there any very common myths, legends, misconceptions that women have about their cycles?
Dr. Gentry: One misconception is about the onset of menopause with the menstrual cycle. People will think that if your periods started earlier, if you are younger when your periods start, that subsequently your menopause will be earlier and that's not the case. The time when your periods stop at menopause and the definition of menopause is no menstrual period for a year. That's usually genetically predispositioned, so the best indication of when your periods will stop is your mother or your sister or your aunts, not when your first period was or how many periods you have had.
Interviewer: What's the most common problem that you treat?
Dr. Gentry: I'd say one of the most common problems that I treat is patients who have uterine fibroids.
Interviewer: We have a lot of women who are seeking treatment for uterine fibroids. What should they know that they might not know?
Dr. Gentry: What they need to know is that there are alternatives to hysterectomies and that there are ways to treat uterine fibroids that are not surgical, that involve medication and there's a more innovative treatment that's actually performed at Alta Bates Summit Medical Center called uterine artery embolization where an inteeventional radiologist does a procedure that places pellets inside adjacent to the uterine arteries that decreases the blood flow to the uterus. And subsequently over six months to a year, the fibroids gradually shrink.
Interviewer: So that's not an invasive procedure at all?
Dr. Gentry: No, it's not. I mean, it's a procedure, but it's not a surgical procedure. The recovery time is a couple of weeks and it's not for people who need immediate results, but for those who can tolerate their symptoms and can wait that six months to a year for their symptoms to decrease. However, it's not for patients who would like to get pregnant because it has been shown that it may affect their ovarian blood flow, so you may get early menopause or some menopausal symptoms, so we don't want people who are thinking of having a baby to have that procedure. But if you're past childbearing and you can wait and you're not bleeding so heavily that you're anemic or other organs are involved with compression like your ureters, then it's a really good alternative that I think people need to know about, that it's offered at our hospital. I had a patient come to me who was very distraught because she had had an emergency cholecystectomy (emergency gall bladder surgery). And at the surgery the doctor looked down in her pelvis and saw uterine fibroids and when she came to and in the recovery room, the surgeon told her, oh, that uterus has to come out. And this woman was in her early thirties and she was devastated because she thought that the surgeon must know what he's talking about and he says I have to have a hysterectomy. So she came to me with large fibroids, tearful and upset because she had not had any children and thought that she had no options.
Interviewer: Which might have been the case ten years ago.
Dr. Gentry: Absolutely.Absolutely. And so now, so I was able to give her medications to help the fibroids shrink temporarily and this medication, it's called Lupron and I gave her this injection for six months and it helped the fibroids to shrink and I was able to do a surgery called abdominal myomectomy, in which I removed the fibroids and soon after that she had a child.
Interviewer: Well, that's really great.
Dr. Gentry: And then actually, she's had two children and it went fine, her pregnancies were uneventful and they're healthy and happy and it's great because when she came to me, she thought she had no options and now she has a family and she's happy.
(Recording Ends)
- INTERVIEW CONCLUDED -Go to the Women's Health Audio Web Page
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