This post is sponsored by Olmsted Medical Center
We’re pleased to have been able to sit down with Dr. Richards again to find out some questions about women’s bodies and how the function…and what is normal and what is not normal. To see the full interview, click the video below. Want to submit a question? Drop them in the comments, or send an email to Becky (email@example.com)!
Don’t miss our first post in our series with Dr. Richards: Questions You Might be Embarrassed to Ask a Gynecologist. To see the full interview, click below. Want to submit a question? Drop them in the comments, or send an email to Becky (firstname.lastname@example.org)!
Q: What is a “normal” period?
A normal period is from the first day of bleeding of your last period to your first day of bleeding of your current period to be 28 days, plus or minus 7 days. This means it can be normal for your periods 21 days apart, up to 35 days apart. Most people run between 28-30 days. Regarding the amount of bleeding, there is a lot of data surrounding measuring the physical amount of blood- milliliters, etc. But in my mind, normal periods are periods that don’t interfere with your normal activities. So if you are making decisions based on the amount of bleeding that you’re having, that’s really not normal. If you are having medical issues from the amount of bleeding, such as anemia (your hemoglobin is down), they probably are not normal. And bleeding should not last more than 7-10 days. And ten is on the very high end.
Q: When do I need to see my provider about my period?
If you are making decisions around your period, please see your provider. If you are scheduling vacations, avoiding exercise, changing plans based on your period, or packing extra supplies because you’re worried about leaking accidents, we can help with this! Your period should not control your life. If your period are greater than 35 days or less than 21 days, that should be evaluated. It can be a thyroid, hormonal imbalance, or bleeding issue that can cause this, and these can have bigger health implications than just the annoyance of never knowing when you’re going to get your period. It’s also important from a fertility standpoint. Very irregular periods can make it trickier to get pregnant for a lot of people. That’s another reason to come in to be seen. Bottom line: if you have questions about your period, you should come in.
Q: Will my period get worse as I get older? Or will it get worse after having children?
It’s not uncommon for periods to change and get ‘worse’ as we move through childbearing years and then moving into our 40s. Some of this is an increase in things like uterine fibroids, which are benign little muscle bundles that can be found in the uterus. 80% of women have uterine fibroids by their 40s, and can cause heavier periods. As we get closer to the average age of menopause, which is 51 (high variation), we can see periods becoming more irregular. The longer stretch between periods can bring heavier bleeding.
Q: How can I manage my periods to make myself comfortable?
For many of us in our 30s and 40s, when we first started having our periods, the only products out there to use were pads or tampons. Now the market has opened up with all sorts of new products, from period absorbing underwear to menstrual cups. This gives women many more options. Menstrual cups can help women who have heavier flows, and period underwear is a great option for those concerned about leaks. These options are a lot more discreet than carrying around pads and tampons, and many are reusable. Another great thing about these new products is that women and OB/GYNs were consulted in the research surrounding some of these products. Don’t be afraid to try something new, and to see what works best for you and your lifestyle. Another thing we haven’t discussed at length yet is that as medical providers, we can help with heavy periods, irregular periods, period pain, and other issues you may be having. Please contact your healthcare provider to see what we can do to help. The bottom line is that there are so many more options today than there were when we were younger, for managing periods and having them be as easy and nonintrusive in your life as possible.
Q: Let’s talk about menopause. What’s menopause? What’s pre-menopause? When do you start menopause? How long do you stay in menopause?
This is a huge area, something we can’t cover everything in this short interview. But in short, we divide into three buckets. Pre-menopause: normal fertility, normal periods. Menopause (assuming the person still has a uterus and at least 1 ovary): When a person goes at least 12 months without having a period. Gray area in between: Periods are more irregular, skip a month, hot flashes, mood changes, night sweats. With the average age of menopause being 51, some women will hit this gray area in their 40s.
My job as the provider is to have some nice honest conversations with patients, as this affects not just you personally, but the people around us. How do we manage this? How can we help you through this time?
Red flags: Gone 1 year without a period, then start bleeding again, or have brown or pink discharge, that warrants a phone call to your provider or a visit to women’s health. The other red flag is if you have been having more irregular periods, and then have bleeding that lasts more than 7-10 days. If you experience either of these things, we want to hear from you.
Q: What do I need to know about birth control in menopause?
This is where education is really important for people to understand how birth control actually works. Different kinds of birth controls work in different ways. Some birth controls (specifically the classic estrogen/progesterone 3 weeks active tablets, 1 week placebo tablets) actually mimic their cycle, and it tricks people into thinking they’re having a menstrual cycle every month. But it’s the pill giving them a withdrawal bleed every month, not an actual period. So for a woman in her 50s who is still taking this, she may think she is still getting a period every month, but it may be a withdrawal bleed, not an actual menstrual cycle. This is why education surrounding birth control and how it really works is so important, and something we as providers spend a lot of time on. So for a woman who is 53 for example, we may take her off her birth control for a month or so, with education for other non-hormonal methods of birth control, and then after a month test her hormone levels to see where she is, fertility-wise, and whether or not she is in menopause.
Q: There are so many different types of birth control! What kind is best for me?
Yes, there are so many different kinds. Years ago, there were basically four options: don’t have sex, use condoms, take this one kind of birth control pill, or have your tubes tied. Today, the list is long. What is great about this, is we get to figure out what makes the best sense for you. Again, this comes back to the education piece, to learn how each one works, and how to choose what would be best for you. This also helps with knowing how to look out for side effects.
Non-hormonal options: Natural family planning, which tracks your cycle and avoids sex during your most fertile time of the month. We do have patients who are very successful with this method, and have an OB/GYN here at OMC who is very knowledgeable and helps patients to be successful with this method. Condoms are a barrier method that is successful in preventing pregnancy and sexually transmitted diseases. Condoms are not always the strongest method in preventing pregnancy, because you need to use it in order for it to work. “Pulling out” is another method that is sometimes used, but is not a reliable method for preventing pregnancy. Sperm can still often find an egg. Diaphragms are another method, but not commonly used anymore. I’ve been in practice for 10 years, and have yet to fit a diaphragm. If you are done having babies, there are methods of permanent sterilization, via removing the fallopian tubes entirely, or “tying” the fallopian tubes by removing a segment of the tubes, or putting clips on them. These are same-day procedures, and you can go home immediately after. Vasectomy (performed on male) is another procedure that has been around for a while and is extremely reliable and effective. It’s done in the office, and is great option for couples who are finished having babies.
Hormonal options: The Pill (oral contraceptive), estrogen/progesterone- get a withdrawal bleed every month. Can also choose to skip that withdrawal bleed and have one every three months, or even none at all. The Mini-pill is often taken by breastfeeding moms or those who cannot have estrogen-based birth controls. Pill options are great, as long as you take it. You have to be good at taking the pill every day in order for it to be the most effective. Average usage typically puts the pill at about 80% effective rate. We are busy people, and sometimes we forget! One non-pill hormonal options is the patch. Another that works very well is Nuvaring®, a ring that is placed in the vagina and left in place for 3 weeks, then you take it out for a week and get a withdrawal bleed, and then put a new one in.
Long Acting Hormonal options: Depo-Provera® shot, which is a shot every 3 months. Nexplanon®, which is a little implant that goes in the arm that stay in place for 3-4 years to prevent pregnancy. Here at OMC we have 3 versions of IUDs that we use. Mirena® (probably the most common) that is used for both preventing pregnancy and reducing periods by 75-99%, which is pretty awesome. Sidenote: I personally use the Mirena! We can also use it for pelvic pain, treat pre-cancerous cells in the uterus, and we can also use it for women who have uterine cancer, but don’t want a hysterectomy. Then there is Kyleena® a smaller IUD that is the lowest-level hormonal option that we have. It is smaller and made to fit every uterus. Most women do get a very light period. The third IUD is actually not hormonal: the Paragard® IUD. It is a copper IUD, and is good for 10-12 years. This is a great option for someone who wants very good birth control that is not permanent, and not hormonal.
Everyone needs to figure out what works best for them. Our job is to make sure that you are well-educated about your options, and help you to make the decision that fits your situation best, whether your goal is pregnancy prevention, lighter periods, or something else.
Q: What is cervical fluid? What is normal?
This all falls under the umbrella of vaginal discharge, which is something normal that all women have, and there should be no shame attached to it. The vagina and cervix are amazing, and vaginal discharge is part of a healthy vagina. We see women in the clinic for this, but a lot of the time, they don’t talk about it unless we ask. From an anatomical standpoint, the bottom 1 to 2 inches of the uterus is called the cervix, and it opens into the vagina. Both the cervix and vagina produce discharge. The amount and texture of the discharge and vaginal mucus changes over the course of the menstrual cycle, which is how women who do natural family planning and those who are trying to get pregnant can tell when they are ovulating. This is normal.
Things that make me concerned about vaginal discharge are any associated symptoms. So if it has a bad odor, that may be concerning. One note about odor that I want to say, because no one wants to talk about it, but is a question that so many women have: if you have sex without a condom, afterwards, the discharge can often smell a little “fishy.” This is normal. If you have no other symptoms with it, then there is nothing to worry about. However, a stronger fishy odor with itching that is not associated with sex, should be seen. Any itching, burning, or weird bleeding that is associated with vaginal discharge should be seen. These can be a symptom of sexually-transmitted infections (STIs). This is a great time to remind everyone that if you are having sex with someone and you and your partner have not been tested for sexually-transmitted diseases or infections, to get tested. These are really out there. For gonorrhea and chlamydia, sometimes the only symptom is a change in vaginal discharge.
Q: What are some other reasons that someone would want to come in to see an OB/GYN?
First, I want to say that women’s health is so much bigger than OB/GYN. It includes primary care physicians, internal medicine, family medicine, nurse practitioners and physician assistants, and so many more that all work collaboratively in the care of women’s health. I want everyone to feel comfortable going to any of their providers with any of these questions, and their provider can link with us to help in any way needed.
We see a lot of patients coming in with fertility questions and concerns. For those with irregular periods or if they’ve been trying to get pregnant for 6-12 months with no success, we want you to come see us. Or if you just have questions about how to get pregnant, we are happy to meet with you.
Urinary incontinence is another reason we frequently see patients for, as we talked about last time. It’s so normal, and we can help! We see patients for prolapsing symptoms (feeling like your uterus is dropping/going to fall out of you). Pelvic pain is another area that we see patients for. We can help with all of these! We have women who have struggled with pain or issues for years, and we develop a good plan and 6 months later, they are so happy they came in.
Thank you again to Dr. Richards for sharing her knowledge and expertise! OMC providers are dedicated and passionate about educating, encouraging, and empowering women to know their bodies. This is so clear in our interviews with Dr. Richards, and the entire OB/GYN team of providers at OMC.
Phone: (507) 529-6605