Ask Dr. Sally: What Can I Take For Painful Periods?

We received another great question and here’s our response…

I have fibroids in my uterus and they make my periods really painful.  I’m looking for something I can take for relief from the pain and I prefer natural therapies. What do you recommend?

(photo credit: TipsTimes via Flickr)

Many women suffer from painful periods.  There could be different reasons for painful periods and fibroids are a common cause.  Fibroids are benign tumors that grow in the walls of the uterus.  As a result, women with fibroids may have heavier and more painful periods.  They may also feel bloated, have lower back pain, have pain with defacation, or feel the urge to urinate.  If there are no symptoms, there is no need to treat and the fibroids will shrink on their own over time, especially after menopause when the body stops producing estrogen. If there are bothersome symptoms, then these are the treatment options that can be considered first:

  • The birth control pill.  The combination birth control pills (estrogen plus progestin hormones) work really well to have lighter and more predictable periods.  The birth control pills can also be used to suppress the period altogether.  In fact, the bleeding that women experience when they are on the birth control pill is not a natural period.  It is actually the body’s response to withdrawing from the hormones in the birth control pills during the hormone-free or placebo pills.  There is no medical or health benefit to this withdrawal bleeding and it’s safe to skip it, though some women like the reassurance of a monthly period.  If interested in skipping periods, the same pills can be taken on an extended cycle to reduce the frequency of periods to once every few months or they can be taken on a continuous cycle to skip periods for as long as desired.  Using birth control pills to reduce pain from fibroids has the added benefit of preventing pregnancy in women who are looking for that.  The birth control ring and patch work the same way as the pill.
  • Mirena intrauterine device.  This device is placed in the uterus and releases a progestin hormone for 5 years.  It helps women have lighter and less painful periods.  Up to 20% of women with a Mirena will stop having periods altogether.
  • Ibuprofen. This is the most popular medication from a class known as non-steroidal anti-inflammatory agents (or NSAIDs for short). Another option is naproxen. These medications help reduce cramping and heavy bleeding. Most women have one of these in their medicine cabinet, so it is readily accessible if needed. Ibuprofen can be taken in high doses several times a day for the first few days of menses. There are risks with taking these medications, so please consult with your healthcare provider before taking ibuprofen or another NSAID regularly. Aspirin should not be used for this purpose and can actually increase blood loss.
  • Lysteda.  This is the brand name for tranexamic acid and prevents blood loss.  It is an oral medication taken 3 times a day for up to 5 days at the beginning of menses.  Fewer doses are needed in women who have kidney problems.
  • The birth control shot. Also known as Depo-Provera.  The progestin helps counteract the estrogen and may help the fibroids shrink.  Prevents pregnancy too.
  • Oral progestin.  If a woman cannot take estrogen because of a medical contraindication, then a high-dose progestin is still an option.  Options include medroxyprogesterone and norethindrone taken on a daily basis.

If there are still bothersome symptoms after trying those medications, then these are the more aggressive treatments to consider:

  • Lupron or Zoladex.  These medications actually help shrink the fibroids that are causing the problems.  They are injections and work by reducing estrogen production.  For this reason, they can cause side effects that mimic menopause.  They are generally only used for a few months before surgery due to cost and side effects.
  • Surgery.  The fibroids can be surgically removed (myomectomy) or the entire uterus can be surgically removed (hysterectomy).  As with all other treatment options, it will be important to weigh the risks of these surgeries against the benefits.
  • Non-surgical procedures.  These procedures are an alternative to surgery.  Options are blocking uterine arterines (uterine artery embolization), removing the endometrial lining (endometrial ablation or hysteroscopic resection).

For those who prefer natural approaches to managing the discomfort, you’ll be happy to hear there are options for you.  Natural remedies may not be as effective for painful periods caused by fibroids.  Especially if the heavy periods are causing other health problems like anemia or infertility, which would have their own treatment options.  Some of the natural remedies that may generally help with menstrual cramps and pain include:

  • Heat pad.  The heat and pressure applied with a heat pad are very comforting.  Check out our handmade TheraPillow with natural contents.
  • Hot bath.  Again heat helps.
  • Magnesium.  This is essentially a salt that helps relax muscles.  You can take tablets, drink it, or soak in it.  Check out our handmade Soothing Salt satchels that can be placed in a bath.
  • Exercise.  Gets the blood flowing and brings oxygen to the muscles in your uterus to help provide some relief.  Yoga may be a good option.
  • Massage.  When doesn’t a massage help?
  • Acupuncture.  Not a lot of science behind this one either but it’s low-risk and may help.
  • Eat fruits and vegetables.  Women who eat a few servings of fruit and vegetables a day have lower rates of fibroids than women who eat one or no servings.  This finding is just an association and we can’t make any conclusions about causation.
  • Plants.  Maca root is used for many sexual and reproductive health issues, including menstrual cramps.
  • Avoid soy.  Soy products, like tofu, have phytoestrogens in them.  These compounds act like weak estrogens in the body and can theoretically contribute to fibroid growth and cramps.

I hope this information is a good start.  I’m always happy to discuss any of these treatment options further and help you make a decision.

Got a question? Send it to us.

— Dr. Sally Rafie

Pill Supply…The Pharmacy is On Your Side

Birth control pills are the most popular form of hormonal birth control and one of the most popular forms among all birth control methods.Birth Control Pill Supply Choose Control Sally Rafie

What’s the problem?

One of the biggest barriers to using birth control pills correctly and consistently is the lack of supply. Many women find themselves out of birth control pills when they go to take their next pill.  And because birth control pills currently require a prescription from a doctor or clinic, this could lead to delays.  Catastrophic delays.  Missing a couple birth control pills is very different than missing a couple of cholesterol pills.  It could mean pregnancy.  Especially because the first few pills in each pack are the most important to take on time to be sure ovulation is prevented (and no egg is released).  So that explains the problem.

What’s the solution? 

Giving women larger supplies of their birth control pills!  This mean less trips to the pharmacy, fewer missed pills, and fewer unplanned pregnancies.  It’s all very logical.  The hang up?  Health insurance plans don’t want to pay for larger supplies up front.  From their perspective, you may be a customer this month, but may not be a few months from now.  More and more plans are restricting the supply that can be dispensed at the pharmacy.  So even if your prescription is written for a 3-month supply at a time, the pharmacy may only be able to give you 1 pack for no/low co-pay.  Of course, women can choose to ditch the reimbursement from their health insurance plan and pay cash for multiple packs at once, but few will choose to do that and they certainly shouldn’t have to.

What does the research tell us?

All the research supports larger supplies.  It helps women stick to their birth control method and we know that’s what it takes to prevent unplanned pregnancies.  A systematic review of four research studies found that prescribing and dispensing more pill packs led to a handful of benefits:

  1. Increased birth control method continuation
  2. Fewer pregnancy tests
  3. Fewer pregnancies
  4. Fewer abortions
  5. Lower cost per patient

The only downside?  Some pill packs were wasted.  The wastage was a result of some women who stopped using birth control pills before they ran out of supplies.  But that was a small price to pay to reap all the other rewards.  There was an overall financial savings to providing more pill packs.

How do we get women the supplies they need?

Oregon lawmakers are proposing a new bill that would require health plans to allow up to a 12-month supply of birth control pills to be dispensed at once.  If you’re in the area and want to get involved, you can participate in a local lobby day on March 25th.  Hopefully this Comprehensive Women’s Health Bill passes and serves as a precendent for other states. For now, it is up to each health insurance plan to determine how many packs they will allow women to receive at a once.

Women always have the option to self-pay to get around plan restrictions.  Some pharmacies offer auto-refill programs to help patients stay on track with their medications, so ask if your pharmacy offers this.

Ask Dr. Sally: Forgot to Take My Pill

We welcome questions from readers.  Here’s a question we got this week and our response…

I take my pill like clockwork around 7 am when I get ready. Today I stayed in sweats and just remembered to take it now!  What should I do now?

Late Birth Control Pill(photo credit: Evan via Flickr)

This happens all too frequently, so do not panic!  Before answering this question, it’s important to clarify that you are taking a combined birth control pill.  Another important piece of information is that you realized you missed your morning pill in the early afternoon, so it is only a few hours late.

If a pill is late (it has been less than 24 hours since the last dose was due), the late pill can be taken right away and the daily regimen continued afterwards.  So go ahead and take your late pill now.  You will then continue taking the rest of your pills at the regular time.  In your case this means take the late pill today (a few hours late) and the next pill tomorrow morning.  In other cases, it may mean taking the late pill and the next pill in the same day.  For example, if a woman usually takes her pill every night before bed but forgets a pill and remembers the following morning, she can take the late pill in the morning and the next pill at the usual time at night.

Being a few hours late will not affect the effectiveness of your birth control.  So you don’t need emergency contraception (also known as the morning-after pill) unless you missed other pills recently.  A pill is considered missed if it has been more than 24 hours since it should have been taken.  You could consider taking emergency contraception IF you had missed active pills (pills with hormones) either in the last week of your last pill pack or earlier in this pill pack.  You don’t need to use another form of birth control either since your birth control pills should prevent pregnancy.

I hope this information alleviates your concerns.  It sounds like you’re generally able to stick to your schedule.  If that changes, you can either change your regular pill schedule to a different time of day or think about changing to an easier method.

Ask Dr. Sally: Taking My Pill After a Blood Clot

We received another important question from a reader…

If your blood clot symptoms (pain in legs and arms) go away, does that mean it’s OK to keep taking your birth control pills?

Birth Control Pills and Blood Clot

(photo credit: eflon via Flickr)

One of the potential side effects of birth control methods that have estrogen is a blood clot.  This is a serious side effect.  When blood clots form in the deep veins in your body, usually the legs, that’s called deep vein thrombosis.  These clots can lead to leg pain and swelling.  If you are having these symptoms, contact your doctor for evaluation.

If a clot dislodges from your leg, it can potentially travel to your lungs.  A clot in the lung is called a pulmonary embolism and will cause difficulty breathing.  If you are having unexplained shortness of breath (not after exercise or other activity that would cause this normally), chest pain when you take a deep breath or cough, lightheadedness, or coughing up blood, seek medical attention immediately.

If you are diagnosed with blood clots, you can no longer use any birth control method with estrogen in it.  This means no OrthoEvra patch, no NuvaRing vaginal ring, and no combination birth control pills (like OrthoTriCyclen, Loestrin, Yaz, etc) ever again.

Birth control pills with progestin only would be safe to use if you’ve had a blood clot.  Any other methods that have progestin only, like the DepoProvera injection, Nexplanon implant, Skyla IUD, or Mirena IUD are safe.  The copper IUD is safe to use, as well as any barrier methods like condoms.  So you still have a lot of great options available to you.

It will be important to let your healthcare providers, including your pharmacist, know about this new medical condition or medical history.  Your providers will help make sure you don’t receive an estrogen-containing birth control method in the future.  Your providers can help advise you of other medications or situations that may increase your risk of another blood clot, like being pregnant, and provide prevention when appropriate.

Thanks for sending us your question.  Don’t be shy to ask your pharmacist any questions about your birth control pills or other birth control methods.  We look forward to answering many more questions!

Ask Dr. Sally: Took the Wrong Pill

We received our first question from a reader today!

Just realized I took my pill today (Wednesday) but I took the wrong day’s pill (Friday).  What now?  Are they pretty interchangeable at that part of the month?  I take a generic version of Yaz.WrongBirthControlPill

Let me alleviate your concerns!  Yaz is a combination birth control pill, which means there is a combination of both estrogen and progestin hormones.  This is the most popular type of birth control pill and a minority of women use progestin-only pills.  Among the combination birth control pills, there are many different formulations.

Yaz has 24 “active” pills, all with the same doses of both hormones, and 4 hormone-free or “placebo” pills at the end of the pack.  The two active pills are the exact same.  So in this case, the fact that the wrong day was punched out and taken does not make any difference.  It’s just important to remember this and continue taking one active pill a day until you are back on track later this week.

For women taking other birth control pills, the response to this question would depend on the formulation.  Some pills have different doses of hormones every week or sometimes the dose changes after just a couple days.  Your pharmacy, doctor’s office, and community or family planning clinic are resources if you find yourself with a contraceptive mishap.  When asking a question, be sure to let your pharmacist, doctor, or other clinician know which birth control pill or other method you are on…know the medication name!  This way, you’ll get an answer specific to the medication you are on…and this goes for all medications, not just birth control.

Thanks for sending us your question.  Don’t be shy to ask your pharmacist any questions about your birth control pills or other birth control methods.  We look forward to answering many more questions!