The Gynae Geek. Dr Anita Mitra

not on the COCP In this case, your GP can prescribe Norethisterone, a synthetic progestogen tablet that you take three times per day, starting about ten days before your period is due and continuing for the duration of your trip/the time for which you want to stop your period. Your period will usually start about two days after stopping the tablets. Again, they can cause cramping and spotting and your period might be heavier than normal.

      There isn’t a ‘non-hormonal’ way of stopping/delaying your period.

      THE GYNAE GEEK’S KNOWLEDGE BOMBS

      I love a good ol’ period chat. I always find that it’s something everyone wants to talk about, but no one wants to be the first to bring it up, whether in clinic or socially. One of my biggest missions is to help start this conversation, so that you can understand what’s normal and when something might need medical attention. Here are the five key points that I’ve covered in this chapter that I find myself repeating over and over:

       A period is what happens when the lining of the uterus falls away, containing blood, mucus and old cells. It’s not your body detoxing itself, it just means you didn’t get pregnant.

       Your period blood can be like a rainbow – pinks, reds, browns, blacks; they’re all normal.

       It’s common to have irregular, often quite long cycles at the extremes of your menstrual life – as a teenager and before the menopause.

       Menstrual cups, tampons, pads – there isn’t one outstanding product. Use what makes you feel comfortable.

       Toxic-shock syndrome is exceedingly rare, so again, use whichever product you prefer.

CHAPTER 4

       Irregular and absent periods

       I used to dread the time when my period arrived, but now I’m desperate to have one … what can I do?

      Irregular periods are something I hear about frequently in clinic and get a lot of messages about online. Sometimes absent for months on end, they can cause a lot of stress, often because women worry they’re going to struggle to get pregnant eventually. There’s been a lot of media interest in polycystic ovarian syndrome (PCOS) lately, and while it’s a common cause of a disrupted cycle, many people don’t realise the impact that our hectic lifestyles can also have on periods. Most women tell me that they always had a regular cycle right from the word go, but that more recently they’ve gone completely haywire.

      This is something that happened to me, and I had absolutely no idea of why. I’d thought my body was normal, so why had it started misbehaving? What I didn’t appreciate (and was never taught in medical school) was that my body was warning me that my intense exercise regime, lack of sleep and through-the-roof stress levels were putting it under incredible strain and destroying any hope of a normal menstrual cycle. Let me explain how and why these things alter your period and, while I’m at it, I will also give you a good rundown of PCOS.

       How irregular is irregular?

      Many people believe that anything that is not a twenty-eight-day cycle is irregular, but if your period comes, for example, every twenty-six to thirty days, that’s regular for you. As doctors, when we use the term ‘irregular’, we are talking about a cycle that has no rhyme or reason. This means you generally cannot predict when your period is going to come, and the variation in cycle length is usually more than ten days (i.e. If your shortest cycle is twenty-five days and the longest is sixty, the variation is thirty-five days). ‘Amenorrhoea’ is the term used when you don’t have a period for at least three or six months (depending on your source). It is also very common and something that causes a great deal of anxiety.

       ‘Lazy ovaries’ are not ‘a thing’

      I’ve heard of people being told they are not having periods because of ‘lazy ovaries’, which is a bit unfair, as those poor little ovaries are trying their hardest to ‘keep calm and carry on’. Your menstrual cycle is not just controlled by your ovaries; they rely on getting the appropriate signals from the brain – the hypothalamus and anterior pituitary gland being the two areas that make the hormones that communicate with the ovaries to stimulate oestrogen and progesterone production. Many things can interfere with this communication, changing your menstrual cycle as a result.

       Causes of irregular or absent periods

      I’m sure a number of the issues outlined below will resonate with a lot of you, and if they do, I suggest you hotfoot it to Part Five for a more thorough insight into these factors.

Note: it may sound obvious but the first thing you need to check for when you’re not having a period is … pregnancy.

       Hypothalamic amenorrhoea (HA)

      Also called functional amenorrhoea, this is one of the most common topics I am contacted about via email and social media, usually by women who say things like; ‘I haven’t had a period for over a year and I just can’t understand why. I exercise five times a week and I’m on a really healthy diet.’ Although I have no statistics to back this up, I would estimate that it is more common in young, fit women heavily invested in a healthy lifestyle. Unfortunately, the current fashion for an athletic physique, combined with the ‘more-is-more’ attitude of society and our hectic lifestyles leave little room for the simple things in life – like hormone production. That is why women get HA; and I can usually tell this straight away from the Instagram profiles of the many women who message me about this problem – their bodies have quite simply run out of steam.

      While we may not be very good at consciously prioritising the essentials, our bodies do this automatically as a way of helping us to survive. As over-the-top as it sounds, your body would prefer to keep your heart beating, rather than give you a period, so your brain shuts off production of the hormones that stimulate your ovaries, which stops ovulation. And since the entire purpose of your menstrual cycle is for you to get pregnant, Mother Nature is particularly clever, recognising that a stressed-out woman does not need the added stress of having a baby. From an evolutionary point of view, this is a survival tactic for both mother and baby.

      The main triggers for hypothalamic amenorrhoea that I see on a recurrent basis are stress, diet and overexercising – or, usually, a combination of all three.

       Stress

      You’ve probably heard of cortisol, the stress hormone. It influences production of female hormones by telling your brain that you’re under stress (even if you don’t realise it) and to halt ovulation until you’ve overcome it. Unfortunately, we are so used to living our lives in ‘turbo-power mode’ that we’ve forgotten what it’s really like to press the pause button, or even that it exists. I frequently meet real-life superwomen. They typically have several children, a zoo-worth of animals and a husband who isn’t very domesticated. And often an irregular cycle. Recently, I called one of these superwomen into my room and apologised that the clinic was running late. She said, ‘Oh, don’t worry; it’s been lovely to sit and read a magazine and have some time to myself …’ So before she’d even sat down I was pretty certain of what the problem was, although it can be a tricky one to solve because so many women have lost sight of how important it is to take that critical time for themselves.

       Dietary factors

      If you’re not eating enough to be able to provide the energy requirements of your own body, you’re not going to be able to sustain a healthy pregnancy. So here again, your brain shuts the system down, saving the energy and nutrients that would otherwise be used on ovulation. Fat tissue is one of the sites of oestrogen production, so women with very low body fat may not produce enough oestrogen, which is made from a specific type of fat called cholesterol. Fat tissue is also able to send signals to the brain to tell it whether