Can Pills also shorten My Period?
January
31 ,
2009
So Megan, Ashley and their friends get together for some pizza and American Idol. A commercial pops up for the latest birth control pill.
"Get shorter, lighter periods with these pills!"
Then a commercial for another pill:
"Have your period for three days or less!"
"Hey that would be cool" says Megan, "I should have asked my doctor for THAT pill!"
What are these pills, and how do they work?
There are two pills on the market today that are designed to give you shorter and lighter periods. Those pills are Loestrin 24 and Yaz. When they designed these pills, they did a neat little trick. Most other pills give you medicine for three weeks, and then they give you placebo for one whole week. This means you have your period for a whole week.
Wrll, Loestrin and Yaz will give you medcine for three weeks plus three days. This leaves only four days without hormones. This means you have shorter periods, and usually lighter as well.
So is this a good idea for Megan? I don't see any reason it shouldn't be a good idea, why not! Megan is absolutely right, her doctor probably should have told her about these choices.
Birth Control Pills and Period Pain
January
30 ,
2009
Megan called her friend, Ashley Knowsitall, who happens to be the star first baseman of the softball team.
"There's no way I can make it to the game today, I'm having my period, and the pain is terrible", she says.
Ashley is appalled, "I can't believe you still have such bad periods! My doctor put me on these birth control pills and my periods are so light now, I hardly feel any pain at all!"
"But I am still a virgin, what do I need birth control for?"
"I started these pills two years ago, even before I started sleeping with my boyfriend. My doctor told me I should take it just to make my periods lighter. Don't you remember how I used to miss school every few weeks because I had a virus? Did you really think I got a monthly virus? It was my periods that were making me crazy! You should really see your doctor about this problem."
Is it really so common for women to have so much pain with their periods? Does this happen to everyone, or only if you have some kind of problem?
According to many studies, up to 90% of women complain of periods that are so painful that they interrupt their regular lifestyle. They ruin school, work, or whatever it is that you are trying to accomplish with your day. Consistently, scientific studies have demonstrated that women who use birth control pills have period that are lighter and less painful than women who are not using pills.
Why do Birth Control Pills make your periods lighter? There are many types of pills out there, and I promise you that I will make this simple and easy to understand. We will start by discussing the "traditional" birth control pills. These are pills that are designed to give you a period every month, and of course, to prevent pregnancy.
Traditional birth control pills contain two active medications. The first is a synthetic form of the natural hormone progesterone. Progesterone is designed to prevent pregnancy, because it blocks your ovary from making an egg (ovulating) every month. The second is a synthetic form of the natural hormone estrogen. This is designed to make your periods regular and to control bleeding when you are on the pill.
There are different forms of each of these hormones that are used in different pills, but we do not need to discuss these differences at this time. We'll discuss that a little bit later on.
With "traditional" pills you take the pills with the medicine in them for three weeks. Then you take a sugar pill called a placebo for one week. During the three weeks on the active pills, the lining of the uterus, called the endometrium will grow and develop because of the hormones in the pill. However, the lining will grow much less then it would have if you were getting the natural hormones that your own body makes. Therefore, the lining is much thinner when you get to the week of placebo pills.
As soon as you start the placebo pills, the lining of the uterus has no more hormones making it grow, so it "withdraws" and bleeds. But it bleeds much less than it would have if you were having natural cycles.
Remember when we explained where the pain of your period comes from? We said that your uterus releases substances called prostaglandins and leukotrienes that cause cramping, decreased blood flow to the muscle, and PAIN.
Well, it is the lining of the uterus that causes the release of these substances. So if you are on pills, the lining is thinner, and the pain is therefore less.
So Megan followed Ashley's advice and called her doctor. She got her prescription for birth control pills, and now hopes her periods will be easier for her.
"Hey, Megan, do you want to come over and watch American Idol tonight? They're down to the final four tonight!" asked Ashley.
"Sure, that'll be great, I'll pick up some pizza on my way over."
The fact is, that women suffer with their periods. The fact is that there have been so many advances in medical care in the last decade, that there is no reason why any woman should have to suffer with her periods anymore. I guarantee, that if you follow along with this blog every day, you will find out why you should be able to tell your periods that they should go to hell.
If you are one of those lucky women who have a regular normal period every month, and you actually don't find it to be particularly bothersome, these blog posts may not be for you. But if you are one of the thousands of women who hate their periods, then read on. The battle lines have been drawn, so let me tell you our strategy.
We will start each post with a scenario, and then propose a solution. If you find yourself saying, "hey, that sounds just like me!" then maybe you should consider the solutions I will propose.
I don't want to keep you in so much suspense, so let's start right away. We will begin with the following scenario. All of these patients are based on real women that I have seen in my office, but their names and identifying information have been changed beyond recognition in order to preserve their privacy.
Megan Crampsalot
Megan is 17 years old and is in her final year of high school. She has a 3.9 GPA and is looking forward to her freshman year at the State University. She has always wanted to be a lawyer, and is a talented softball player. Unfortunately, it is the day of the final game of the high school softball championships, and she is just starting her period. The cramping was this time is just unbearable. Ibuprofen usually helps a little, but she just could not function anymore. Her family doctor wrote her a prescription for a higher strength of Ibuprofen, but she was still in pain. This period was simply hell, and the softball team needed her to be in top shape.
What should Megan do?
This is a great opportunity to talk about the various options for treating the pain associated with periods. Although this blog series is dedicated to telling your periods to go to hell, I still think it is necessary to discuss what things can be done to relieve the pain associated with your periods.
What causes the cramping associated with a period?
A cramp is the sensation one feels when a muscle tightens. The uterus is basically just one big muscle. Every muscle has a job. Fort example, the muscles in your arm are designed to lift things, and the muscles in you heart are designed to pump blood. Well, the uterine muscle is designed to squeeze things out. This could be to squeeze out a baby, or to squeeze out the blood of your period. That is why you have cramping when you have a period. Your uterus is trying to squeeze the blood out.
OK, so that is why I have cramping, but why does is hurt so much?
Let's makes this as simple and straightforward as possible. When you have your period, the muscle fibers of your uterus, called the myometrial fibers, release a substance called arachidonic acid. Arachidonic acid is broken down by your body to make things called prostaglandins and leukotrienes. The prostaglandins and leukotrienes cause the muscles of the uterus to causes the release of various substances which make the muscles contract and become very tight. The more the muscle fibers contract, the more the blood vessels in the muscle become squeezed. When the blood flow to the muscles decrease, they are deprived of oxygen, this causes PAIN.
So if you were designing a medication for the pain of the period, how would you design it? Would;t you try to find a drug that blocks the breakdown of arachidonic acid into prostaglandins and leukotrienes?
Well that's exactly what the anti-inflammatory medications that are used for period cramps are designed to do. There are several categories of these medications, but they include many of the prescription and over the counter drugs that you are familiar with. Aspirin, Ibuprofen, Naprosyn and many other medications are designed to do just that. These medicines are often called "NSAIDs" by health care professionals. This stands for Non-steroidal anti inflammatory drugs.
In fact, when scientists measured the "tightness" of the uterine muscle (by measuring the pressure buildup within the uterus) during the period of women on these medications and compared it with women not on these medications, they found that the uterine muscle was more relaxed in women on anti-inflammatory medication. Less pressure means less restriction of blood flow, more oxygen, and LESS PAIN!
Here is a list of the available anti-inflammatory medications that work this way to reduce period pain:
Class
Brand Name
Generic Name
Usual Regimen (mg q6–8h)
Propronic Acids
Motrin
Ibuprofen
400–800
Naprosyn
Naproxen
250–500 (bid)
Anaprox
Naproxen sodium
275–550 (bid)
N/A
Ketoprofen
25–50
Fenamic Acids
Ponstel
Mefenamic acid
250–500
Cyclooxygenase-2 Inhibitors
Celebrex
Celecoxib
200 (bid)
But what about Megan? She's already tried Ibuprofen and it didn't work! Should she try one of the other anti-inflammatory medications? Do they work better?
You may be surprised to learn, that there is no clear evidence that any one of the NSAIDs are better than the others for period pain. There is nothing wrong with trying another one, but the chances are that if one didn't work, neither will the others, so I think Megan is going to have to find another solution to her problem. Stay tuned until tomorrow to find out some other solutions for Megan.
After lots of discussions with my patients, after reviewing the medical literature over and over again, I have come to the realization that it is time for women to really know the scoop on the "monthly period". You don;t need me to tell you about what the period is like, as you experience it every month, and obviously, I don't. But I can tell you a lot about why you should not be suffering through this monthly ordeal, and how many ways there are available to you today to avoid this monthly visitor.
I think it is SO unfortunate that so many women suffer every month with pain, heavy bleeding, headaches, bloating, and all sorts of things. All this when there are so many things that can be safely and easily do to help eliminate this problem. there is virtually no person who cannot benefit from at least one of the many medications, procedures and devices that have been invented and recently made available to women in this day and age.
For this reason, I am now going to dedicate this blog to this topic: "To HELL with my Periods!"
