How To Get The Care You Need
In 2015, the American College of Obstetricians and Gynecologists decided that your menstrual cycle is a fifth vital sign that can be used to assess your health. Your period is as important to measure your health as your temperature, respiratory rate, pulse and blood pressure.
From the time we are little girls, we are encouraged not to complain or ask difficult questions about our health. This mindset carries into our OB/GYN offices as adults. We convince ourselves that our symptoms are not important, so we then become silent about them. As a registered nurse and psychotherapeutic coach using food to heal hormonal imbalances, I find most women who come to see me have had feelings of being ignored, condescended, and disregarded by the medical structure.
Why We Must Advocate For Ourselves
The first step in receiving proper healthcare is paying attention to the one expert that most of us forget to turn to: our own body. Our bodies usually are our best source of information. Yet, at some point most of us stop listening to our bodies. The root of mistrust in women’s bodies began with the cultural narrative that women’s intuition was considered irrelevant and unscientific.
From our first visits to the doctor’s office, we are taught that we are not the experts on our own bodies and to hand our care over to the medical profession. When we go to the doctor, we are not asked what we think might be causing our heavy bleeds, chronic pain, and recurrent urinary tract infections. Going to the doctor’s office is a conversation between you and a professional with experience in specific skill-sets—not a one-sided evaluation. As women, we have so much data and experience with our bodies and it’s up to us to relay to this data to the doctor. Reproductive health is a team effort and you are at the center of it.
How To Set Up A Successful OBGYN Appointment
If you think something is up, trust yourself enough to believe it and speak up. Nobody can use your voice for you, so you have to be comfortable making yourself heard. Being prepared helps in feeling confident to discuss your menstrual health concerns with a medical professional. Do your own homework by speaking to trusted sources who have training and certifications.
Then, schedule an appointment to discuss your specific concerns with your medical provider. Making an appointment to only discuss your concerns rather than squeezing in the time while having a full physical will give the medical professionals the proper time to speak with you. Arrive at the appointment with a list of things you would like to discuss with your doctor.
Symptoms & Possible Tests to Mention
1. Pain Before, During, Or After Your Period
Intense menstrual cramps usually begin before menses and last for an average of three days—but pain is incorrectly normalized as a part of menstruation and PMS. At a doctor’s appointment, many concerned women are often dismissed about their pain levels and concerns. It’s important to discuss discomfort, because painful periods can be a sign of endometriosis, fibroids, infection, or ovarian cysts. Some suggested points to tell your physician are the amount of painkillers you are taking per month, if you experience pain between periods or deep, sustained pain during sex, and to ask about the possibility of endometriosis.
If period pain is new for you, then ask if you need a complete blood count (CBC) to test for infection. To understand the cause of your pain, your doctor might even do a transvaginal ultrasound. With my clients, I investigate for underlying causes of nutrient imbalances, inflammation like gut or chronic infection, and other stressors.
2. Heavy or Long Periods
Are you having very long periods (more than seven days) or heavy periods (carrying a change of clothes and changing your pad every hour for three or more hours in a day)? When visiting a doctor, begin discussing possibilities of insulin resistance, fibroids and endometriosis.
When working with clients, the most common causes I see of heavy or long periods are estrogen dominance and low thyroid levels. Hormone testing is a must with this amount of bleeding. Having a complete thyroid panel, along with estrogen and progesterone testing can help determine if hormonal imbalance contributes to your symptoms. Testing iron deficiency anemia can also be important for your health.
3. Short or Light Periods
If your period lasts for less than three days or you don’t feel the need to change your pad during the day, then your estrogen might be low. During your doctor’s visit, discuss if you are eating enough or over-exercising, if medication is interfering with your hormonal levels, or if you are a vegetarian (you might need to take supplements). Testing estrogen and progesterone during your menstrual cycle can help determine your levels and needed hormonal support. If you do the test at home, I suggest DUTCH Cycle Mapping test.
4. Short Menstrual Cycles
Cycles shorter than twenty-one days might be considered luteal phase defect. This might have been since the corpus luteum didn’t form correctly, or that there is a lack of ovulation. Both can lead to low levels of progesterone.
I suggest tracking your basal body temperature to provide insight into potential ovulation. When visiting your doctor, begin sharing that you are having periods but you don’t think you are ovulating. Ask about a possibility of PCOS, and to test progesterone levels and thyroid levels. In this case, dependent on the person, it can be suggested to conduct a DUTCH test (estradiol, FSH, LH, and progesterone), a thyroid panel (TSH, total T4, total T3, free T4, free T3, reverse T3, anti-TPO, and anti-thyroglobulin antibodies), and vitamin D.
The human body is complex and unique to each individual, so if you have any of these symptoms, speak with a medical provider. The points in this article are not tools to diagnosis yourself—they’re meant to help you start asking questions, learn, and have a conversation with your doctor.
Our menstrual cycle is one aspect of being a woman that has been most denied, hidden, and devalued around the world. Healing from hormonal imbalances calls for a new way of relating to our female bodies, one that honors and values what it means to be in the body of a woman.
Nicole Ohebshalom began her career as a registered nurse in an infertility and endocrinology center and brought functional nutrition and meditation to the center. Currently, she is a psychotherapist and women's health specialist. She works with women to heal hormonal imbalances, infertility issues and trauma using psychotherapy, functional nutrition and kundalini yoga. Her intention is for each woman to have the education to understand herself better so she can have the tools to be her own healer.