Category Archives: Women’s Health

All, Women's Health

Is your menstrual pain “normal”?

Written by Mansi Patel

It can be argued that, in part under the influence of patriarchy, women may have felt the need to suppress their emotions and behave according to accepted gender norms (1,2). For instance, women may tend to default to an assumption that their level of menstrual pain is average and expected (2). This may limit the potential for women to benefit from helpful diagnoses and treatments to alleviate menstrual pain (1).

The diagnosis of dysmenorrhea is based on severe and frequent pain in the lower abdomen that may radiate to the inner thighs and back during the menstrual cycle (3). Other symptoms include vomiting, diarrhea, and even fainting (3). There is evidence that most women fitting these characteristics (up to 86%) in the U.S. do not seek care (1).

Reasons to consider seeking care include the potential for correctable pathophysiologies such as secondary dysmenorrhea or treatable associated conditions such as endometriosis or ovarian cysts (4). Endometrial ablation, destruction of the uterine lining, or hysterectomy (removal of the uterus) may be available treatment options to prevent further complications of any underlying conditions (3).

Given that most menstrual pain is not pathological, it can also be helpful for women to be aware of simple techniques they can use to alleviate menstrual pain. For instance, numerous randomized trials have demonstrated the effectiveness of relaxation exercises for alleviation of symptoms of primary dysmenorrhea, mostly within four weeks, compared to control groups receiving no intervention or regular care (5).Nonsteroidal medications can also help alleviate symptoms (3,5).

Accommodation and personal health agency are effective health strategies that are helpful no matter the diagnosis identified, and treatment selected. Women can be aware of the option of medical care to be sure specific treatable pathophysiologies are not overlooked. Beneath what may appear to be part of an expected monthly cycle that women accommodate, there is the option to seek care or try treatments at home. Before assuming nothing can be done for strong menstrual pain, think twice!

References:
1. Chen CX, Shieh C, Draucker CB, Carpenter JS. Reasons women do not seek health care for dysmenorrhea. J Clin Nurs. 2018; 27: e301–e308. https://doi.org/10.1111/jocn.13946

2. Getahun, S. B., Berhe, S., Mekonnen, B., & Melaku, G. (2023). Reasons for Not Seeking Healthcare Among Students with Dysmenorrhea: A Qualitative Study. International journal of women’s health, 15, 1733–1744. https://doi.org/10.2147/IJWH.S437233

3. John Hopkins Medicine. “Dysmenorrhea” https://www.hopkinsmedicine.org/health/conditions-and-diseases/dysmenorrhea

4. Coco A. S. (1999). Primary dysmenorrhea. American family physician, 60(2), 489–496.

5. Tsai, I. C., Hsu, C. W., Chang, C. H., Lei, W. T., Tseng, P. T., & Chang, K. V. (2024). Comparative Effectiveness of Different Exercises for Reducing Pain Intensity in Primary Dysmenorrhea: A Systematic Review and Network Meta-analysis of Randomized Controlled Trials. Sports medicine – open, 10(1), 63. https://doi.org/10.1186/s40798-024-00718-4

All, Women's Health

Does emergency contraception affect fertility?

Emergency contraception, better known by its brand name, Plan B, can be taken after unprotected sex to prevent pregnancy. It can be purchased over the counter at your local pharmacy. However, on social media, there is some sense of worry that emergency contraception will affect future fertility, especially if taken repeatedly. Let’s think twice: does emergency contraception affect fertility?

Emergency contraception typically consists of the hormone levonorgestrel, which is a synthetic form of the hormone progesterone (1). Progesterone is a natural hormone in the body that helps regulate the menstrual cycle and increases during pregnancy (2). Levonorgestrel delays ovulation to prevent pregnancy (3).

A 2022 systematic review of levonorgestrel emergency contraception analyzed 33 studies and found that it did not affect fallopian tube mobility, ectopic pregnancy, miscarriage, stillbirth, or subsequent menstruations (3). Another systematic review of 47 studies found that adverse outcomes like ectopic pregnancy and miscarriage were not significantly associated with taking levonorgestrel emergency contraception (4). Researchers reported that “the most common adverse effects of levonorgestrel were not serious.” Temporary side effects reported after emergency contraception use include nausea and vomiting, vaginal bleeding, and fatigue (7). In one observational study of 232 participants reported transient changes in their menstruation (6).

A 2014 systematic review of 22 studies evaluated the repeated use of emergency contraception as the primary source of contraception and reported that the most common side effect was menstrual irregularities (5). The researchers concluded that more investigation is required since the existing studies on repeated usage were not methodologically sound. Also, many menstrual cycles are irregular and pregnancy alone might alter them, making objective measurement of the cycle for several months before and after important, which is difficult and perhaps impossible.

Emergency contraception can reduce the probability of conception after unprotected sex (8) and is a safe and effective medication that does not impact future fertility.

Sources

Gillson, George. “Clarifying hormone terminology.” Canadian family physician Medecin de famille canadien vol. 53,1 (2007): 29-30.

Cable JK, Grider MH. Physiology, Progesterone. [Updated 2023 May 1]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2024 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK558960/

Endler, M et al. “Effect of levonorgestrel emergency contraception on implantation and fertility: A review.” Contraception vol. 109 (2022): 8-18. doi:10.1016/j.contraception.2022.01.006

Leelakanok, Nattawut, and Janthima Methaneethorn. “A Systematic Review and Meta-analysis of the Adverse Effects of Levonorgestrel Emergency Oral Contraceptive.” Clinical drug investigation vol. 40,5 (2020): 395-420. doi:10.1007/s40261-020-00901-x

Halpern, Vera et al. “Repeated use of pre- and postcoital hormonal contraception for prevention of pregnancy.” The Cochrane database of systematic reviews vol. 2014,9 CD007595. 26 Sep. 2014, doi:10.1002/14651858.CD007595.pub3

Gainer, Erin et al. “Menstrual bleeding patterns following levonorgestrel emergency contraception.” Contraception vol. 74,2 (2006): 118-24. doi:10.1016/j.contraception.2006.02.009

World Health Organization. “Emergency Contraception.” (2021). https://www.who.int/news-room/fact-sheets/detail/emergency-contraception#:~:text=Emergency%20contraception%20(EC)%20can%20prevent,assault%20if%20without%20contraception%20coverage.

All, Medicine, Recent posts, Women's Health

Does birth control cause infertility?

Birth Control

IMG via MedlinePlus

Women take birth control for a multitude of reasons, from preventing pregnancy to regulating the menstrual cycle and reducing acne. Taken correctly, the pill can prevent 99% of pregnancies. This has made birth control a staple for generations of women. However, some women may wonder, What happens if I stop taking the pill? One misconception about the pill is that taken for years, it can reduce the ability to have children. The possibility of future infertility would deter many women from considering birth control pills. So, let’s think twice about it.  

The combination pill works by supplying two hormones, estrogen and progesterone, that work together to stop the ovaries from releasing an egg each month during menstruation. Other pills provide only progesterone; progestin-only pills prevent pregnancy primarily by thickening the cervical mucus. When you stop taking the pill, the hormones it supplies leave your system in a matter of days, and your body reverts to its natural cycle. Additionally, your body begins to produce estrogen and progesterone again. Therefore, barring underlying health issues, women can become pregnant right away after stopping the pill. 

There are several reasons behind the misconception that birth control causes infertility. One is that taking birth control can conceal symptoms of conditions associated with infertility, such as endometriosis, PCOS, and uterine fibroids. Birth control is sometimes used to manage these conditions, so stopping birth control might mistakenly associated with infertility. Another reason for this misconception might be that historically, the side effects of the pill were not well-researched or disclosed to users, so it was not clear whether infertility was a risk. Women often felt dismissed by clinicians and pharmaceutical companies when they experienced side effects of the pill, even for conditions as serious as blood clots and strokes. In the 1960s, despite reports of deaths related to the pill, the FDA maintained that the pill was safe. Additionally, drug companies failed to inform healthcare providers of the pill’s more severe side effects. Since then, the dosage of hormones provided by the pill was adjusted to improve its safety, but mistrust of the pill persists and worries about infertility have continued to the present day.  

However, there is good evidence that birth control users need not worry about their fertility. A 2018 review of twenty-two birth control studies including over 14,000 women showed that 83% of women became pregnant within 12 months of discontinuing contraception. Furthermore, a 2013 study of 3,727 women found that although birth control use was associated with a short delay before conception, overall fertility was not impacted. Additionally, longer-term use of the pill was associated with higher fertility compared to short-term use (less than 2 years). Therefore, even long-term users of the pill should not be concerned. Overall, the evidence suggests that worries about infertility should not stop women from taking the pill.  

Links:

https://my.clevelandclinic.org/health/drugs/3977-birth-control-the-pill#:~:text=Birth%20control%20pills%20are%20a,improve%20acne%20and%20treat%20endometriosis. 

https://my.clevelandclinic.org/health/drugs/3977-birth-control-the-pill 

https://health.clevelandclinic.org/can-birth-control-make-you-infertile/ 

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6055351/ 

https://www.mayoclinic.org/healthy-lifestyle/birth-control/in-depth/birth-control-pill/art-20045136#:~:text=The%20pill%20prevents%20your%20body,you%20stop%20taking%20the%20pill. 

https://www.mayoclinic.org/healthy-lifestyle/birth-control/in-depth/best-birth-control-pill/art-20044807#:~:text=How%20do%20the%20different%20birth,sperm%20from%20joining%20the%20egg. 

https://health.clevelandclinic.org/6-things-that-can-happen-when-you-stop-taking-the-pill/ 

https://cham.org/HealthwiseArticle.aspx?id=te8132#:~:text=You%20can%20get%20pregnant%20right,months%20after%20stopping%20the%20pill. 

https://www.healthline.com/health/birth-control/can-birth-control-cause-infertility#misconceptions 

https://www.acog.org/womens-health/faqs/progestin-only-hormonal-birth-control-pill-and-injection#:~:text=It%20stops%20ovulation.,uterus%20and%20fertilize%20an%20egg. 

https://www.sciencedirect.com/science/article/pii/S0277953621005797#bib115 

https://medlineplus.gov/birthcontrol.html