It's Not Hysteria: Everything You Need to Know About Your Reproductive Health (But Were Never Told)

by Karen Tang

Lactobacillus species are the most common vaginal flora; they produce lactic acid and hydrogen peroxide, which give the vagina its normal acidic pH.

Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen (Motrin or Advil) and naproxen (Aleve) are the most effective over-the-counter medications for uterine pain. NSAIDs increase bleeding elsewhere in the body but actually decrease menstrual bleeding. In fact, NSAIDs are almost as effective as birth control methods in lightening uterine bleeding. Acetaminophen (Tylenol) may also improve pain but usually to a lesser extent than NSAIDs, and it does not have the same beneficial impact on bleeding.

Vitamin D supplementation was shown to improve pain scores in a randomized control trial, but the placebo group experienced almost the same improvement in pain as those who received the vitamin D.

Some endometriosis patients subjectively report improvement in symptoms with taking turmeric. There have been several studies showing that curcumin, the main active agent in turmeric, has anti-inflammatory and antioxidant activity, which in theory may address some of endometriosis pain and symptoms. Unfortunately, there are no direct studies on the use of turmeric for endometriosis.

Many people with endometriosis or adenomyosis also report subjective improvement in pain and bowel problems with avoidance of inflammatory foods su...

anxiety and depression have been shown to worsen pain, bowel symptoms, and muscle tension, so managing mood symptoms can also help break the cycle of pain experienced by so many people with endometriosis and adenomyosis.

The good news is that some studies have shown that cognitive behavioral therapy (talk therapy to identify patterns of thinking, improve coping skills, and relieve emotional distress) and practices such as mindfulness and meditation may improve endometriosis symptoms. Cognitive behavioral therapy in particular has been found to be effective in the management of several medical conditions that have a mind-body connection, including endometriosis. Anyone feeling significant depression, anxiety, or other mood symptoms should see a licensed mental health professional. Good mental health care should be prioritized as much as surgery or medication.

Bupropion (Wellbutrin) is an antidepressant that is FDA approved for depression and smoking cessation, and it’s been shown in small randomized studies to be effective in improving desire, arousal, and orgasm.

People can have PMS without experiencing period bleeding; for example, if they’ve had a hysterectomy or have a progesterone IUD that prevents periods. This is because the ovaries still function and cycles of ovulation and hormone production occur whether there is uterine bleeding or not.

many gynecologists will recommend transdermal patches rather than pills for several reasons: convenience of dosing (patches are applied once or twice a week rather than taken once daily like pills), more stable blood hormone levels, and less of an impact on cholesterol and lower risks of blood clots and strokes compared with oral pills.

There are FDA-approved bioidentical hormones, such as 17-beta-estradiol (Estrace) and micronized progesterone (Prometrium).

Postmenopausal hormone replacement therapy treatments that contain both estrogen and progesterone may slightly increase the risk of breast cancer, though studies suggest that short-term use of less than four to five years may not significantly affect risk, and breast cancer rates may go up only with prolonged use. Interestingly, estrogen-only hormone treatment, which is used for people who do not have a uterus, does not seem to affect breast cancer risk.

In the United States, if the cervix is removed with a hysterectomy and the patient did not have precancer of the cervix in the previous twenty years, the patient can stop getting Pap smears because these are just tests for cervical cancer.