Our Gynecological Health – Part 2

Normal VS Abnormal Bleeding

Normal menstruation lasts about five days and usually will follow a pattern, here are two variations:

Light –> heavy –> medium –> light –> very light
Heavy –> heavy –> medium –> medium –> light

Also, some women may spot (ordinarily brownish) or bleed at other times in their cycle besides actual menstruation. Spotting is one of the most misunderstood aspects of a woman’s cycle. A common mistake is to assume any type of bleeding episode is menstruation. True menstruation occurs after ovulation, about 12 to 16 days after. Any other type of bleeding is either anovulatory bleeding, what is considered normal spotting, or is symptomatic of a problem.
Ovulatory Spotting

Light bleeding may occur right around ovulation in some women. It is not only normal, but an indicator for fertility, a sign that tells where the woman is in her cycle. It results from a sudden drop in estrogen, just before ovulation. It occurs more in long-cycles.

Anovulary Bleeding and Spotting

Once in a while an egg is not released. It could be due to the estrogen not reaching the level for the egg to release. When this happens the drop in estrogen will cause light bleeding.

For women over 40, the cause is a decreased sensitivity to FSH and LH hormones. This would result in these women not ovulating. The progesterone level is not able to sustain the lining and some spotting or bleeding may occur.

The way to know if actual ovulation did occur, is to chart the temperature. As a reminder: the temperature pattern is: low before ovulation, followed by the high temperature after.

Implantation Spotting

So when a woman notices spotting rather than bleeding a week after her temperature shifts she might want to consider a pregnancy test. This may be an indication of “implantation spotting”, because as the egg burrows into the lining of the uterus, a bit of spotting may occur. If temperatures remain high for another 18 days or more, this is an indication that the corpus luteum is viable.

Breastfeeding Spotting

After the initial flow of birth has stopped, some women may have some bleeding about six weeks postpartum. This is due to the withdrawal of hormones that were high during pregnancy.

Also there may be a fluctuation of hormones while breastfeeding because of the needs of the baby. The temporary imbalance of hormones may cause women who breastfeed a few anovulatory spotting.

Other times

• After office procedures
• While on the pill
• Or during postmenopausal hormone replacement therapy

Women with Disabilities -The Healthcare Team- Part 2

Interviewing the Doctor

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Here are some questions you may wish to ask:

What are the pros and cons of pregnancy for me?

If the doctor is opposed, ask why?

What do you know about my disability, and what access do you have regarding it?

Do you have experience with the pregnancy and delivery of babies with disabled women? How much?

In what way will you be working with my regular doctor?

If there are unusual symptoms that arise, who should I call if I am not sure if those symptoms are pregnancy or disability related?

How will labor and delivery be affected by my disability?

Will there be a need for treatments that differ from the usual types, due to my disability, and how will we get the cooperation of the hospital for those treatments?

Do you think I may need a caesarian section? Why? Would you set a date, or wait for labor to begin spontaneously?

Can I get a referral for genetic counseling?

The physical exam

Besides the questions suggested previously, the examination is also another time to decide on the doctor who will tend to your care. How the doctor behaves during the examination and time taken to let you know what he/she is doing in that exam will assist in your final decision.

Does the doctor ask you questions during the exam? Are you treated with sensitivety and consideration? Are the questions the doctor is asking relative to your level of sensation, mobility, and flexibility? Regarding your comfort?

The doctor’s partners

If the doctor has partners or a physician that they use when they are not available, you will need to schedule an appointment with them on one of your regular visits, as early as possible. See if they also are “on board” and will be responsive to your needs and care.

You will need to feel comfortable with any one of these doctors, in case they are the one in delivery with you. It would be much more comfortable to have a familiar face, and know if they also will support your needs.