Your opinion

[Guest guest]

A new NFP client recently presented her 19-yr old daughter's situation and asked for suggestions.

The daughter begin menstruating at 12 1/2 with some slight irregularity, but after about one year of some variation, cycling became more regular, about once/month.

Cycles continued monthly for about 3-1/2 to 4 years and then cycling became irregular. Unfortunately the daughter has not been interested in charting, so there are no symptoms nor temperature to report, but in the last 1-1/2 to 2 years (she couldn't be more specific), bleeding has become sporadic, sometimes once/month and sometimes every two weeks. All bleeding is as heavy as what she considers to be typical for a period and is always accompanied by very painful cramping. She had trouble with cramps since menarche.

She says that her thyroid has been checked and is normal. Her mom had a copy of Fertility, Cycles and Nutrition, and she has implemented some of the nutritional strategies recommended -- PMS nutritional plan, magnesium, particularly, but this has not helped.

This young woman has seen two physicians who recommend that she start taking the pill to decrease the bleeding and to eliminate cramping. She has declined thus far. She has not been offered any diagnostic tests or treatments.

She and her mother are wondering if there are any tests or treatments she should ask for.

I have suggested chart to to help establish if any of the bleeding is associated with PK + temp rise or temp drop...as well as having an eye to establish her typical luteal phase so that at least in cycles demonstrating a PK + temp rise she would be able to begin "300 mg aspirin q 6h 24 hours before her period is due. It is a prostaglandin synthetase antagonist. Otherwise use ibuprofen." per Dr. Klaus's email of 2/9/01. Of course, while that might help with some of the pain, the bleeding issue will continue.

Any suggestions/recommendations would be appreciated.

Janet McLaughlin

Northwest Family Services

[Guest guest]

Janet,

She needs a workup for " dysfunctional uterine

bleeding " which includes a complete blood count and

PT/PTT to make sure she does not have a bleeding

disorder (less likely with no hx of easy bruising in

the family or herself prior to this)but still needs to

be checked. This also checks for anemia to give an

idea of the severity of the bleeding. She should also

have a pelvic exam and rule out any sexually

transmitted disease, not to mention pregnancy test

(she needs a pelvic even if not sexually active).An

ultrasound should also be considered to rule out

endometriosis (can still be seen in teen girls)or

other abormalities. Treatment with ocps for a few

months is the norm, however this list may have other

treatment ideas. And if the anemia is severe, then

in-patient management with iv premarin or high dose

combination ocp's may be indicated. Also, if anemic,

make sure she is taking iron. Girls who are

overweight, have any hirsutism, may have polycystic

ovarian/insulin resistance and metformin can help this

girls to become regulated.

Anovulation b/c of stress or illness can occur even in

adolescents who have previously had normal periods.

Then the endometrium sloughs incompleletly during

periods and then soon again, causing this problem (as

long as the above things have been ruled out).

Hope this helps.

Meyers, M.D.

Pediatrician

__________________________________

Yahoo! Mail Mobile

Take Yahoo! Mail with you! Check email on your mobile phone.

http://mobile.yahoo.com/learn/mail

[Guest guest]

I would be concerned with hormonal irregularities

causing endometriosis or some other “cause” of heavy, frequent,

painful bleeding. Is it possible she is sexually active and has an STD?

If there is a pro-life OBGYN in the area,

they would likely be willing to find the root cause rather than treat the

symptoms with the pill. If not, I’d also recommend seeing an endocrinologist,

rather than an OBGYN, and request any hormonal tests necessary to find the root cause. I was finally

successful with an endocrinologist after several OB’s said they would

only put me on the pill for having periods only every 4 months.

Your

opinion

A new NFP client recently

presented her 19-yr old daughter's situation and asked for suggestions.

The daughter begin

menstruating at 12 1/2 with some slight irregularity, but after about one year

of some variation, cycling became more regular, about once/month.

Cycles continued monthly

for about 3-1/2 to 4 years and then cycling became irregular.

Unfortunately the daughter has not been interested in charting, so there are no

symptoms nor temperature to report, but in the last 1-1/2 to 2 years (she

couldn't be more specific), bleeding has become sporadic, sometimes once/month

and sometimes every two weeks. All bleeding is as heavy as what she

considers to be typical for a period and is always accompanied by very painful

cramping. She had trouble with cramps since menarche.

She says that her thyroid

has been checked and is normal. Her mom had a copy of Fertility, Cycles and Nutrition, and

she has implemented some of the nutritional strategies recommended -- PMS

nutritional plan, magnesium, particularly, but this has not helped.

This young woman has seen

two physicians who recommend that she start taking the pill to decrease the

bleeding and to eliminate cramping. She has declined thus far. She

has not been offered any diagnostic tests or treatments.

She and her mother are

wondering if there are any tests or treatments she should ask for.

I have suggested chart to

to help establish if any of the bleeding is associated with PK + temp rise or

temp drop...as well as having an eye to establish her typical luteal phase so

that at least in cycles demonstrating a PK + temp rise she would be able to

begin " 300 mg aspirin q 6h 24 hours before her period is

due. It is a prostaglandin synthetase antagonist. Otherwise use

ibuprofen. " per Dr. Klaus's email of 2/9/01. Of course,

while that might help with some of the pain, the bleeding issue will continue.

Any suggestions/recommendations

would be appreciated.

Janet McLaughlin

Northwest Family Services