I get a lot of questions about how the menstrual cycle works, what is a normal cycle, what causes irregular cycles and how birth control pills work. The next few posts will tackle these questions. Today: The normal menstrual cycle. As you will see, normal has significant variations.
The menstrual cycle is the basis of our ability to reproduce. Just as it is so easy to forget that eating exists primarily to provide nutrients for our body’s health and survival, so too is it easy to forget that our* menstrual cycles exist in order to make an egg ready to join with a sperm and prepare the uterine lining to accept the fertilized egg.
Menses begin with puberty and menarche (the medical term for the onset of menses) and continues until menopause (beginning one year after your last menses). Most women have many, many menstrual cycles in our lives. For many women, much of our reproductive lives are focused on how we can safely control our fertility and have our children when and if we want. Understanding the menstrual cycle is a key to understanding how our bodies work, how contraception works and how pregnancy is achieved.
Bacterial Vaginosis or BV is characterized by a unique and offensive vaginal odor commonly described as “fishy” or “sour”. The smell is often worse at the end of your menses and right after sex with a man, if no condom is used. The smell can be embarrassingly strong, and the condition can be annoyingly recurrent for some women.
BV is not an infection, rather it is an imbalance of normal vaginal flora –I love that we refer to the vaginal ecology as flora.
It is called a vaginal yeast or candida infection, but that is a misnomer. What is really happening is an overgrowth of yeast in the vagina. Yeast commonly exists in small amounts in the vagina, it is kept in check by, among other things, the healthy lactobacilli which also live there. So when we have a yeast infection what we have is an overgrowth of this one element. Candida albicans is the most common strain of yeast, though others exist, this is important to remember if you are having a treatment failure: you could have a different strain.
Where does yeast grow?
Anywhere where it is warm and moist is a lovely home for yeast—skin folds anywhere, under breasts and under arms, anywhere around the genitals, inner thighs and buttock where air does not circulate. It can occur in the mouth and digestive tract, typically this is not seen unless you have a weakened immune system.
It is one of those things just not talked about—caring for your vagina. We get messages from the media and folks selling product, we need to sanitize ourselves. We should “freshen” with a douche or “organic wash” or “odor blocker”. The truth is, the more product you put in your vagina, the more likely you will get an imbalance in your natural flora. This is the healthy bacteria which we need for vaginal health. This imbalance can lead to vaginitis –an inflammation of the vagina. This can be mildly uncomfortable or can lead to yeast infections or bacterial vaginosis—stay tuned for posts on these.
So you now know what not to do. So what DO you do?
I am often asked about my thoughts on mammography. There is controversy in terms of it’s use as a screening tool and when used, how often and at what age to begin screening. There is no doubt as a diagnostic tool—when a mass is found and needs to be evaluated, it is effective. The question is how effective is it as a screening tool with the goal of early cancer detection with the subsequent assumption of a resultant longer lifespan.
In October 2015 the Journal of the American Medical Association published a large meta analysis of research. This was not a new study, rather an analysis of existing research-a study of studies. It shows an association of mammography (MMG) with a decrease in breast cancer mortality. The decreases in mortality increase with the age of the women screened, the largest decrease of breast cancer related mortality is with women aged 60-69 (because breast cancer frequency increases as you get older). The article acknowledges the issues of over diagnosis but unfortunately notes there are no studies with reliable data on this, nor on the impact of treatment for the over diagnosed. So this very important variable is still unclear.