Missed Your Period But You're Not Pregnant?

In addition to posting updates about important breakthroughs in women's health, there are some questions that many women ask on my message board. From time to time, I'll going to post some of the information I share with those women in the hope that it will help others who visit WebMD with similar questions.

A very common cause of a missed period is not having ovulated that cycle. In a normal cycle, estrogen is produced all month. Estrogen is responsible for building up the lining of your uterus so you have something to shed each month. In a normal cycle, progesterone production increases following ovulation.

Progesterone "stabilizes" the uterine lining in preparation for a possible implantation of a new pregnancy. If you are not pregnant that month the levels of estrogen and progesterone fall, triggering the release of the uterine lining - your period. So, if you do not ovulate, the estrogen build up of the lining continues, but without the usual ovulation-associated progesterone. Thus, the hormone levels don't decline, and the lining stays up inside the uterus - your missed period.

If you have been several months without a period, a gynecologist may give you some progesterone in a pill form (eg Provera 10 mg for 5 days). Within 48-72 hours after stopping the progesterone your "progesterone blood level" will fall, triggering the release of the lining that has been building up. Alternatively, the built-up lining may begin to shed under its own weight. Either way, women report that these periods are very heavy - as though several months of lining are shed.

Such flows can also be prolonged or have a stop and start pattern. The reason for this erratic or prolonged bleeding is this: without the progesterone the lining does not have a clean shed down to the base layer.

Causes for not ovulating are multifold: thyroid problems, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (problems with parents or boyfriends/girlfriends, exams), increased body weight, anorexia, rotating shifts at work, etc.

If the bleeding persists you should contact your GYN or clinic. The bleeding can be stopped with hormones, and any possible causes of not ovulating assessed. Hopefully your cycle will reset itself.

Related Topics:

• FDA OKs 'No Period' Birth Control Pill
• Treating Fibroids Without Surgery

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Pelvic Muscle Twitches

Amazingly, questions arise on the Women's Health Board about vibrating sensations in the vagina or pelvic floor at least once a month. I have done MULTIPLE literature searches at the National Library of Medicine site, and other search engines - none of which have ever yielded a conclusive answer. My best GUESS is fasciculations - small nerve twitches which induce small muscle twitches. This would be analogous to twitches of the muscles of the eye lid.

Most of us have had these uncontrollable eye lid spasms ("blepharospasms") at one time or another. The triggers for eye lid spasms are fatigue, caffeine use, stress. Some treatments are pressure applied near to the twitching muscle, or even Botox.

There is another name for involuntary sustained muscle contractions which can lead to abnormal movements. They are called focal dystonias. Most of the focal dystonias include the neck, eye lid, mouth/jawbone, even writer's cramp. The start of such conditions can be after a trauma to the body part - or they can arise without apparent cause. There may be a genetic predisposition. The exact cause is not well understood, but the area can be injected with botox which causes the affected muscle to relax.

For more information on the more severe forms of focal dystonias, the Dystonia Society website offers a good overview.

Related Topics:

• The Pelvic Exam
• Vaginal Problems

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Fighting Midlife "Weight Creep"

The Pelvis Queen's Guide to Fighting the Effects of a "Permissive Environment"

Weight Loss Pills

There are pharmaceutical options, most of which are by prescription. For short term use phentermine can be prescribed as an appetite suppressant. It is related to amphetamine type medications so it can increase heart rate, and in some women worsen symptoms of anxiety and insomnia. For longer term use the US FDA has approved subtramine which works via serotonin signals from the gut to the brain creating a feeling of satiety.

Orlistat, formerly a prescription drug has been approved for over the counter sale in the US. When taken with a high fat meal it causes some of the fat to move rapidly through the gut so it cannot be absorbed. The side effects, if one eats a high fat diet can include oily stools and some rectal leakage. With most of the prescription drug treatments a weight loss of 5-10% of original body weight is considered a good result.

But is weight loss really as simple as taking a pill?

Women often ask on my message board if there are "natural" or alternative treatments to pharmaceutical approaches. There have been two recent reviews of the alternative medicine literature concerning weight loss. All proposed treatments were studied in combination with a placebo. These reviews found the best outcomes for ephedra, conjugated linoleic acid, pyruvate, and hypnotherapy.

In terms of diets, a meta-analysis of many diet studies (Nordman, Archives of Internal Medicine, 2006) identified that both low carbohydrate and low fat diets were equally effective for inducing weight loss for up to one year. The "A to Z Weight Loss Study" (Gardner, JAMA, 2007) showed that the Atkins diet (very low carbohydrate) produced the most weight loss. In this group the mean loss was 9.2 pounds. But the differences between the Atkins, Ornish, Zone and LEARN (traditional 60% carbohydrate + calorie restriction) would likely have diminished over a longer follow up time according to the authors.

Even small improvements in diet can stop "weight creep". While there were no differences in the incidence of heart attacks and strokes, participants in the Women' Health Initiative diet study did not gain weight compared to a control group (Howard, JAMA, 2006). Both groups were followed for three years. The "winning" women ate one serving more of a fruit or vegetable, ate ½ more serving of whole grains, and decreased their intake of saturated fat.

How Much Weight Loss Is Really Feasible, or Will I Ever Be a Size 4 Again?

If midlife women are enrolled in an intensive four-month program that encompasses a 400 calorie deficit and 150 calorie increase in exercise (eg waking two miles/day) what could one expect as a result? This intervention was done with 136 women where the average age was 48 years old (Teixeira, Medicine and Science in Sports & Exercise, 2006). After 4 months there was an average loss of 6% of initial body weight. By 16 months the mean loss was 5.5% of their initial body weight. Individual variation was large at every assessment. That means that some women had much better results than others. Yet it was noted that exercise was one of the strongest predictors of success.

How Much Exercise Is Needed?

The Centers for Disease Control (CDC) suggests a "minimum of 30 minutes most days to improve health." That would be about 150 minutes/week. The Institute of Medicine in the USA specifically addresses weight issues: "Minimum of 60 minutes per day on most days per week to control weight." That would be 300 minutes of some type of exercise per week. If one walked a mile in 20 minutes, whether at the mall, pushing a stroller, or taking with a friend, walking two miles per day would fulfill this "exercise prescription."

If exercise is combined with decreased calories the outcome is enhanced. Among 200 subjects taking about 1500 calories per day, those that exercised 200 or more minutes per week had an average 13% loss from their baseline weight. Those that exercised less than 150 minutes per week the average loss was about 5% (Jakicic, JAMA, 2003).

But I Have a BUSY Family Life, You Say...

Ok, it is true that women have way too much to do and never much time for themselves. It is a gift to have a few minutes of alone time at night. So what can one do? A registered dietitian (C. Nonas, NAMS, 2006) got straight to the point in a recent presentation. She asserted that women have a harder time losing weight as they move into middle age - if they can just maintain they are doing well. She suggested starting early in the cycle of "weight creep." If your body mass index (BMI) is less than 25 lose 3-5 pounds by age 40. If your BMI is more than 25 consider losing 5-10 pounds.

Given that most diets show similar results over the long haul, choose one that is workable for your preferences. Since the secret of many commercial diets is portion control or decreased calories by eliminating certain types of foods, you could try something even simpler. Ms. Nonas suggested a 1200 calorie meal plan which utilizes easily obtained meal replacements such as bars or shakes. For example: Breakfast is a shake plus a fruit, Snack is one fruit or protein serving, Lunch is a bar and a vegetable serving, Dinner is a reasonable portion of what you have fixed for others in the family.

Say you don't have time to do 30-60 minutes of exercise on most days. It is an option to break that time up into smaller segments. Keep track of the walks across campus, walking at work, walking kids to school and back home. All those trips up and own stairs, yard work--all those minutes count. And it's never too late to learn a new physical skill. For me it was cross-county skiing, and backpacking in my 30's. I took up running in my early 40's, and began weight lifting at 50. This was a departure for a person who was always last to be chosen for a team because I was so uncoordinated (I still am).

In Conclusion...

What I learned can be summarized in a few words. While becoming menopausal may impact weight and fat distribution, the effect of menopause is smaller than that of general aging and lifestyle choices. Genes do play a role but their impact is modulated by age and how we eat and exercise. ...Thanks for all the good questions which pushed me to make this investigation.

Yours,

Jane

Related Blogs:

• It's Not Easy: Midlife Weight Gain in Women
• Is Age Responsible for Midlife Weight Gain?
• Is Menopause Responsible for Midlife Weight Gain?
• Are Our Genes Responsible for Midlife Weight Gain?

Related Topics:

• WebMD Video: Getting In Shape: Which Workout Plan Works?
• WebMD Video: Eating by the Numbers

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Are Our Genes Responsible for Midlife Weight Gain?

This was an area where I received my biggest change in attitude. This is also an area where there has been a recent explosion in knowledge. One review on this subject studied family, twin and adoption research trials. Within this broad section of groups the suggested heritability of obesity ranged from 10-80%! Within my reading the number 20% of overweight is due to genes kept appearing. Remember that single gene defects are relatively rare. More common is a multitude of genetic changes which make one susceptible to weight gain - especially in a permissive environment.

One study which illustrates this point was performed in the Framingham Offspring Study (Corella, Journal of Molecular Medicine, 2007). Of the 1207 women tested, 13% had single neucleotide polymorphism called APOA5-1131T>C. Those that were genetically at risk for obesity by this trait had increased body mass index when their diet contained more than 30% of its calories from fat. In those with the "obesity gene" who followed a low fat diet there was no increase in body mass index.

Now that you know what age, genes and menopause have to do (or not) with midlife weight gain, my next post will deal with how to prevent it.

Related Blogs:

• It's Not Easy: Midlife Weight Gain in Women
• Is Age Responsible for Midlife Weight Gain?
• Is Menopause Responsible for Midlife Weight Gain?

Related Topics:

• WebMD Video: The Role of Genes in Weight Loss
• Obesity in the Genes?

Technorati Tags: women's health, weight, obesity, menopause, age, health and wellness

Is Menopause Responsible for Midlife Weight Gain?

There have been many studies which have identified increases in body weight, general body fat and increased abdominal fat during the decade after menopause. Surprisingly, other studies have not found such changes. For example, in a racially diverse group of 3,000 women in the USA, there was a mean weight increase of about 4.5 pounds over three years. However their transition into menopause was not associated with weight or abdominal fat acquisition (Sternfeld, American Journal of Epidemiology, 2004).

Perhaps one of the best ways to examine whether the loss of estrogen after menopause made women fat would be to see if giving estrogen helped blunt weight gain. One very large review of such studies (Norman, Cochrane Database Systematic Review, 2000) concluded the following. Neither estrogen nor estrogen plus progestin/progesterone therapy use effected weight gain compared to nonusers.

Coming Next: Is weight gain genetically determined?

Related Blogs:

• It's Not Easy: Midlife Weight Gain in Women
• Is Age Responsible for Midlife Weight Gain?

Related Topics:

• WebMD Video: HRT Controversy - Making the Right Choice for You
• Managing Menopause Naturally

Technorati Tags: women's health, weight, obesity, menopause, age, health and wellness

Is Age Responsible for Midlife Weight Gain?

While we tend to think of the time around and before menopause as the "prime time" for weight gain, that may not be accurate. One four year study of 336 African American and Caucasian women aged 35-47 found that women aged 45-47 were less likely to gain ten or more pounds than the 35-39 year olds (Samuel, Family Practice, 2003)! Thus, we may need to be focusing on women in their thirties to stop "weight creep."

There are studies which have looked at what is the "usual" amount of weight gained as women age. Among women in the "Nurses Health Study," monitored for up to 24 years, the average weight gain since age 18 was 26.5 pounds. Of that, only 6.6 pounds had been gained after menopause. Again you can see that there was not a big jump in weight gain after age 50.

Another thing which may not be apparent is that, according to one large study of over 8,000 women, over 1/3 of women followed for two years actually lost weight over a two year period. About one third of women gained, and about one quarter stayed the same (Williams, International Journal of Obesity, 2006). Yet the average or "mean" weight gain was about a pound a year. So sometimes the actual spectrum of personal weight changes can be hidden inside a quote for an "average" weight gain. The take home message here is that at least one third of women will gain up to or over 5 pounds in two years during late midlife.

Coming next: Is Menopause Responsible for Midlife Weight Gain?

Related Blogs:

• It's Not Easy: Midlife Weight Gain in Women

Related Topics:

• WebMD Video: Simple Tips to Cut Calories
• WebMD Video: Tracking Nutrition Trends

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