Menstruation question?

  1. Hi all, I have a question for you nurses. I am doing my prerequisites for nursing school. I am 34, 300 lb. woman with no children. For the last six months or so my periods have been screwed up, before this I was regular every 28 days. I was 21 days late in Dec. then bled for three weeks HEAVY, then nothing again till Feb. 3 and then I just spotted untill three days ago and now it is very heavy again. This time I've been bleeding for 23 days. I can't tell you how sick I am of it. I've had an ultrasound checking for fibroids, and they didn't find any. I have another dr's appointment on Friday, but I just thought I"d get a nurse's opinion. My dr's nurse told me it could be early menopause, which scares me to death since I do want children when I get out of school. Hopefully Dr. will refer me to an obgyn on friday. I know you all aren't doctors but my Mom always says that nurses know about as much as doctors anyway.
    THanks for any advice.
    Lee
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  2. 10 Comments

  3. by   VivaLasViejas
    I too am very overweight, leelee, and I've been going through this since I was in my late 30s (I'm in my mid-40s now, and am currently going through perimenopause.) The cause is probably an overabundance of estrogen, which is very common in women like ourselves because excess fat deposits contribute to overproduction of the hormone.

    I had it all too---endless periods, extremely heavy flow, and so on. Just a couple of weeks ago I had a D & C with endometrial ablation, which destroys the uterine lining and supposedly puts an end to, or at least reduces, the bleeding. This procedure would not be appropriate for you since you indicated you still want to have children, but it's only one of many things that can be done to help regulate your cycles. You might want to ask your doc about a trial of progesterone, which is taken for part of the month; it helps regulate and reduce the amount of bleeding. You could also try birth control pills, but because you are already overproducing estrogen, this could be somewhat risky for your uterus and breasts.

    You *could* be in early menopause, but at your age it's really rare, and in an obese woman it's the least likely reason for messed-up cycles. Our bodies do start going through some preliminary changes in our 30s in preparation for menopause, but only your doctor can determine whether that's happening.

    Good luck to you. I hope this helps you.
  4. by   SmilingBluEyes
    Had your ovarian function checked lately? You could be in premature ovarian failure. I would look into it.
  5. by   leelee33
    Thank you all for the info. I wondered if it didn't have to do with my weight. My appt. is today so hopefully I'll find something out.
    Lisa
  6. by   CMTMom
    I'd suggest also having your thyroid checked - not just TSH but also FREE T3 and FREE T4 - hypothyroidism can cause slow metabolism leading to obesity and can also seriously screw up your cycle, even causing infertility and repeated miscarriage.

    It's a simple blood test and certainly worth a shot.
  7. by   leelee33
    I had my thyroid checked about a month ago the first time I went to the Dr. about this problem and it was normal. I thought for sure that was it because I'm so tired all the time, but he said it was normal. When I went for my appt. yesterday he put me on a birthcontrol pill for three months to get my cycle back in sync. I have almost stopped bleeding already. I'm so happy! If the problem reoccurs I may get a second opinion. Hopefully it won't though.
    THanks again for all your help and concern.
    Lee
  8. by   LilgirlRN
    Being underweight or overweight can effect your menstrual cycle, I would vote for weight versus early menopause. I'd ask my mom when she went through it, if she went through it early perhaps you are too.
  9. by   CMTMom
    just wanted to pop back in and say again, if your doc only tested TSH it may well still be your thyroid even though you number was "normal." We haven't figured out why yet, but my TSH was always normal, yet my Free T3 and Free T4 was way off and indicated a definite problem. Unfortunately I got pregnant before we could complete the testing to decide if I have a pituitary problem that was causing the abnormally "normal" TSH numbers, or what.

    Also the NACB has recently significantly lowered the range of "normal" for hypothyroid TSH readings, from 5.5 to 2.5. Your doc may not be aware of that change as of yet.

    Finally there's something called subclinical hypothyroidism in which your TSH is right on the brink of being abnormally high but is still technically "normal," however you also have many other thyroid symptoms. This is often successfully treated.

    I'd suggest you do some reading at http://thyroid.about.com specifically T3 and T4 normal ranges, and subclinical hypothyroidism.

    Sorry to be pushy about this I had to fight with my docs for 10 years before someone finally thought to draw T3 and T4 numbers and treat me based on symptoms instead of numbers alone.
  10. by   leelee33
    CMTMOM,
    thank you so much for the info. I'll call my Doc Monday and ask about it. I'm also worried because he put me on birth control knowing that I am a heavy smoker and I"ll be 35 this month. Maybe he forgot that I'm a smoker. I'll ask him about that too.
    THanks again.
    Lee
  11. by   LilgirlRN
    EEEEEK! If you have any trouble breathing or pain in your calves get to the ER right away!!
  12. by   GailWHNP
    Hi, Leelee . . .
    Most dysfunctional uterine bleeding (90%) is due to estrogen breakthrough bleeding, a result of anovulation. Since ovulation has not occurred, progesterone is not available in sufficient quantities to stabalize the endometrial structure. Due to this lack of progesterone, the lining continues to grow under estrogen influence, but it is not mature and is very fragile. A small decrease in estrogen level results in bleeding, usually heavy. As one site heals, new sites break down in an asynchronous manner. The amount of bleeding depends upon the height of the endometrium and in the drop in estrogen. There is no rhythmic vasoconstriction or orderly colapse present to induce stasis and clotting. Signs of anovulation are sudden onset of excessive bleeding, too frequent flow, too heavy flow, too prolonged flow, occasional clots, lack of premenstrual symptoms, and, of course, absence of pelvic abnormalities.

    Identified causes of anovulatory dysfunctional bleeding are: CNS dysfunction (ie, stress, chronic fatigue, obesity [due to more free testosterone], malnutrition, perimenopausal), ovarian dysfunction (ie post tubal ligation), follicular phase defect (ie, immature folicle formation or persistent unruptured follicles), luteal phase defect (ie, premature corpus luteum degeneration or persistent corpus luteum), temporary estrogen withdrawal at ovulation, endocrinopathies (ie, thyroid, diabetes, adrenal) and high prostaglandins.


    OK, so this is more than you probably cared about knowing. Take what's useful and dump the rest.

    I also would be very concerned about your being on OCs and smoking, although it is a common treatment for dysfunctional bleeding, but usually only short term (3 months or so).

    I hope you find answers at your doc's appt.
    Gail

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