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Season 4 Episode 2 – Pandemic Periods

Pandemic Periods Description

Drs. Williams, Guthrie, and Greene discuss the correlation between the COVID-19 pandemic and periods.

Pandemic Periods Transcription

Dr. Mironda Williams:

Welcome to another episode of Take Good Care podcast. I’m Dr. Mironda Williams.

Dr. Deanna Guthrie:

I’m Dr. Deanna Guthrie.

Dr. Karen Greene:

And I’m Dr. Karen Greene.

Dr. Mironda Williams:

With Peachtree City Obstetrics and Gynecology this season with the podcast, we really are endeavoring to provide even more information in different ways than we have ever done before. So on our social media platforms as well as on our website, we are posting articles and blog posts about various different topical issues that may be coming about. And recently we’ve put a post on our Facebook and other social media regarding I think pandemic and menstrual cycles. So Dr. Greene, can you tell us what that post showed?

Dr. Karen Greene:

So the post was basically about did the pandemic cause a change in women’s cycle? Many women experienced high levels of stress during the pandemic as they took on various taxing matters. Now, a new study suggested this extra stress may have changed the menstrual cycles in a variety of ways. And so the article goes on to talk about what those ways were.

Dr. Mironda Williams:

The pandemic, we’re living with it now, it’s not over, but it’s just moving into a different phase. Everyone’s got to get back to life. And so we’re beginning to find out even more information about COVID-19 and how it may have impacted all of us in ways that we never would’ve thought of. So again, with this episode, we want to do a little discussion about menstrual cycles in general and talk about has there been any impact with COVID-19 and the pandemic and stresses and women’s menstrual cycle? So by way of introduction, again, I’m Dr. Mironda Williams.

Dr. Deanna Guthrie:

I’m Dr. Deanna Guthrie.

Dr. Karen Greene:

And I’m Dr. Karen Greene.

Dr. Mironda Williams:

Hey, Dr. Guthrie, I think you’re going to get us started by talking about what are normal cycles and just give us some information that you were able to find?

Dr. Deanna Guthrie:

So menses, the term also used is periods or cycles. The menstrual cycle is a central part of a woman’s life. It’s what differentiates us from men, other than our body parts. And for a lot of women, it defines our womanhood. This menstrual cycle is a sequence of events that occur in a woman’s body every month as it prepares for the possibility of pregnancy. So there’s a possibility every month of a pregnancy, put that in the back of your head.

Dr. Mironda Williams:

Every month.

Dr. Deanna Guthrie:

Every month there’s a possibility of a pregnancy.

Dr. Mironda Williams:

Unless you do something to prevent it.

Dr. Deanna Guthrie:

Exactly. So we have hormones, and these are chemicals in our body. They’re chemical messengers in the body, and they drive specific changes that run a complex series of events on a regular basis. So your period or menstruation is the shedding of the lining of your uterus. Every month, these chemical messengers from the brain to the ovary and the ovary to the uterus tell the body to prepare for a pregnancy. And part of that preparation is building a lining where a pregnancy will implant and grow. Other changes that occur are that the ovaries get a message from the brain to start developing what’s called follicles. And follicles are what house the egg, or the technical term is the ovum, and the egg is what gets fertilized by sperm to become a little baby.

And so every month your body goes through these series of changes to prepare for a pregnancy. Now periods, we did a episode on names for the vagina. So they have several names for menstrual periods all throughout the world. Okay. So the one that everybody probably knows is Flo or Aunt Flo. People call it their friend, the curse.

Dr. Mironda Williams:

One end of the other. Friend. Curse.

Dr. Deanna Guthrie:

That time of the month, the Rag Belly Devil.

Dr. Mironda Williams:

Oh, never heard that one. That’s the new one.

Dr. Deanna Guthrie:

I like this one. That one though. I like this one. The girl flu.

Dr. Mironda Williams:

The girl flu.

Dr. Karen Greene:

If that’s how you feel.

Dr. Deanna Guthrie:

So then you have some other strange ones. There’s Dracula, teabag.

Dr. Mironda Williams:

Oh Lordy.

Dr. Karen Greene:

Oh my.

Dr. Deanna Guthrie:

Lady days.

Dr. Mironda Williams:

Lady days. Okay.

Dr. Deanna Guthrie:

Leak week.

Dr. Mironda Williams:

Leak week. I’ve never heard these Doctor Guthrie. Where did you find these?

Dr. Deanna Guthrie:

And then you can look up the whole list there. Yes.

Dr. Karen Greene:

Google University.

Dr. Deanna Guthrie:

Lucifer’s waterfall.

Dr. Mironda Williams:

Oh wow. Okay.

Dr. Karen Greene:

Oh my.

Dr. Mironda Williams:

Shark Week.

Dr. Karen Greene:

Okay. Yeah, yeah. Cause you go swimming. You going to attract sharks.

Dr. Mironda Williams:

Oh okay, duh. All right. All right.

Dr. Karen Greene:

Yeah, so you don’t go swimming.

Dr. Mironda Williams:

Okay, gotcha.

Dr. Deanna Guthrie:

Riding the Cotton Pony. Red wedding, for those who watched Game of Thrones.

Dr. Karen Greene:

That’s is not the red wedding I was thinking of at all.

Dr. Deanna Guthrie:

I said it. Comes from that. There’s Carrie, which if you know the story about her and then lining the drawers, but then I think there were 5,000 different names. I just kind of picked some that-

Dr. Mironda Williams:

Those are interesting. That’s a [inaudible 00:05:06].

Dr. Deanna Guthrie:

But a normal cycle is, it ranges over a 28-day period for the ideal cycle. But there’s a wide range anywhere from 21 to 35 days.

The first part of the cycle is where you’re building that lining and then the middle part of the cycle is ovulation and then the last part of the cycle is called a luteal phase where if you don’t get pregnant, you start to shed that… the hormones start to change in order to shed that lining.

Most women start periods anywhere between the ages of 12 to 16, and it usually starts within a year of developing breasts and hair, pubic hair or axillary hair, but mainly pubic hair.

The end of the lifetime of cycles is called menopause. And the average age in the United States is age 51 and that’s when you have gone a whole year without having a menstrual cycle and then you’re officially and you’re officially menopausal. Exactly.

Blood loss, they say a typical cycle is two to three tablespoons of loss. So anything heavier than that can be considered abnormal. There are a lot of women out there who have much heavier periods than this and still consider themselves normal. But a normal cycle, you should lose no more than two to three tablespoons of blood. So if you’re having heavier periods than that, you may need to contact a healthcare provider or a gynecologist. But that’s basically the menstrual.

Dr. Mironda Williams:

And we get questions a lot from patients because everyone’s hyped up about COVID pandemic and some people concerned that did the pandemic cause any issues or changes with people’s cycles? What information did you find Dr. Greene?

Dr. Karen Greene:

So when the pandemic occurred, a lot of women were coming in with changes. And sadly, for the most part, some doctors just kind of ignored. It was one of those, well, it’s okay, there’s no big deal. But they actually did a study in obstetrics and gynecology that there really was the effects on the cycle when they look back at the pandemic and what happened. So patients had noticed early cycles, delayed cycle, heavier flow, increased spotting. For people that were trying to get pregnant, they were having irregular bleeding and that could affect their fertility as well as their mental health. You don’t know if you’re trying to get pregnant, your cycles aren’t coming, but you’re not pregnant, that’s stressful on top of everything else. If you are not wanting to get pregnant and your cycles were all over the place, that could be stressful and that can affect your mental health.

So it was a self-report of 354 women between the ages of 18 and 45. And what this professor, an assistant professor at the University of Pittsburgh found was that more than half of the women surveyed reported changes in the menstrual cycle length, period duration, menstrual flow or spotting. And 12% reported change in all four measures. And sadly, younger women with mental illness were more susceptible to the change. So the thought was, okay, why is this really happening? What she said as her final statement was, until we get some data to show that women, that what’s in women’s head is actually the truth, the medical society turns away and doesn’t believe it. And so this was her first thing to say, okay, here’s the data. Where actually, this is self-reported, is what’s going on. Now we need to know why.

The thought is that it’s stress production of cortisol. And so cortisol, if it’s increased is going to affect the body’s production of estrogen and progesterone, which are the hormones that are important to have a normal cycle. So if your cortisol levels are high because of all the stress, you’re probably not going to produce as much, and that may cause your period to be heavier or lighter, or you may not have a period altogether. We know that stress can affect the periods and as gynecologists, people will come in all the time and say, do you think it could be stress related? My father died, my dog ran away, I lost my job probably, and it’s cortisol. And with the pandemic, it was not only the stress of actually having the pandemic, but it was now kids are home from school, you’re having to take care of them. You can’t take them to childcare, you may be the one that can’t go to work because you’ve got to take care of the kids. And so it’s all that added stress. And as women, as we talk about all the time, we don’t really think about how stress affects us because we just do do do.

But when you’re looking at something that’s actually objective, that weight, my periods are different, that’s really a way we can measure and say, okay, it’s probably something going on. There was another smaller study that was online of about 210 women also suggested that the pandemic affected women’s stress levels and menstrual cycle over a long period of time. So this isn’t something that just happened in 2020 or 2021 because the level of cortisol was so heightened because of the added stress. It actually affected them for a longer period of time. And so it’s just recognizing that it’s not just in their heads, it’s not just, I think something’s wrong as we always say, you know your body. And if you think that maybe something’s different, it probably is. And so the next step is really to say, okay, so what do we do about it? What is really the answer here?

A prolonged, of course, irregular menstrual cycle, may be a sign of something that is more worrying change. And we always tell patients that, okay, if you’re concerned, yes, you can chalk it up to stress initially, but if you’re really concerned, come in and see your healthcare provider. Find out to make sure that nothing else is going on. As Dr. Guthrie just said, that when you have heavier periods that you think are normal and they actually might not be, you probably should see someone about it. You don’t want to put that on your list of, well, I’ll just take care of that later because I’ve got all this other stuff to do.

Which goes along with when you’re stressed and you’ve got things to do, you tend to put yourself at the bottom of the list. But of course, more research is needed to inform women if these stress related changes will have any lasting effects. Because that’s the bottom line. That if you have an entire year of no cycle because you’re stressed, does that mean I’m going to go through menopause earlier? Does that mean I can’t get pregnant? What does this really mean? And that’s really what the research is pointing to that, okay, we now see based on the fact that the pandemic was probably the worst stress we’ve ever had, that is changing women’s cycle. It’s not in their head, what do we want to do next? What do we look at long term?

Dr. Mironda Williams:

And I think that’s been a lot of the frustration among practitioners such as ourselves, but as well as patients with information and the factual information that we can provide as it relates to the pandemic or pandemic changes. Again, this was a new virus. How it impacted everything. Not just things like menstrual periods and things like that. It’s ever evolving. Yes, we’re still finding this information out. And so it’s going to take some time. It’s going to take some additional research to determine if these changes that we know are probably happening to a woman’s menstrual cycles, how long-lasting may they be? Will there be any other consequences health-wise that may persist? So that information is still yet to be found. One of the other things that a lot of patients have had concern about is what about the COVID-19 vaccines? Because of course we know there’s a lot of hesitancy about obtaining vaccines for a number of reasons.

Women in particular, especially women who are considering pregnancy, have been concerned about, will this in any way impact my fertility? Will it impact my menstrual cycle? What kinds of things may be an unknown consequence or side effect of the COVID-19 vaccination? So there was an NIH study, an article that was printed, published not too long ago that did look at the possible issues of COVID-19 vaccination and any temporary increase in menstrual cycle length. And along with the studies that Dr. Greene mentioned, the bottom line of that study was, yeah, we are starting to notice that there were some changes in menstrual cycles and lengths, but they are temporary. And I think that’s the thing that at least as it relates to the COVID-19 vaccination piece, the initial information and research that we’re seeing is saying that there may be some change in your menstrual cycle, but it’s a temporary change in that eventually you go back to whatever your normal cycle had been.

And again, that’s the whole thing when we talked about vaccines in some of the other seasons about the mechanics of vaccinations and what they do. They’re not changing your DNA, they’re not altering you as a human. They are providing your body a boost in an immune response. But unfortunately, that’s why vaccines aren’t lifelong. A lot of them, you have to come back and get boosters and different things because the immunization improvement that you… the effect on your immune system, the improvement of that doesn’t last. It will eventually slack off. And so that’s what they’re seeing as well with the impact on a woman’s menstrual cycle, that there may be some temporary changes, but they’re minor. They’re not anything that’s going to affect your health long term and they will eventually go back to your normal pattern.

But again, I think that’s one of the reasons why we wanted to put this article out on our social media platforms, but also to have a little bit of time on our podcast to just give some information about menstrual cycles, what’s considered normal. Yes, we realize that any kind of stress, particularly a pandemic stress and all the stresses related with that may cause changes in your menstrual cycle. So it’s not in your head. If you think that something has changed, if you feel like something is different, it possibly is. That doesn’t mean that it’s something that’s going to detrimentally impact your health long term. Come talk to your healthcare provider and let us evaluate it together.

We’re finding out, we’re always reading, trying to see what the latest research is, what the latest science-based data-driven information is so that we can advise our patients in terms of what things we need to be concerned about and what things we can probably just watch and see how things will resolve on their own down the line. So we always want to make sure that we provide as much factual information as we can about your body’s normal function. Which is why whenever we do these podcasts, we like to start off with what’s normal because so many young girls and women don’t know what is a normal period. They know what’s normal for them or what they think is normal. That’s just what their pattern is or pattern as my grandmother would say. But that doesn’t mean that that’s normal in terms of health and science and what menstrual cycles should be. So if you don’t know what a normal menstrual cycle or the amount of flow, then you don’t know when you should seek attention from your healthcare provider. So we always want to provide that kind of education.

Dr. Karen Greene:

And don’t be embarrassed to ask because if you don’t know, I’d rather you ask and me tell you it is normal or it’s not normal than to walk around wondering.

Dr. Mironda Williams:

Because there are times we don’t know, right? For instance, when we’ve had patients ask us information about the pandemic or vaccines and it’s going to hurt-

Dr. Karen Greene:

Vaccines and cycles.

Dr. Mironda Williams:

… We would say, well, the information that we have currently may say one thing. As more information is provided and found out through research, then we may have to change what those recommendations are.

Dr. Deanna Guthrie:

And a good place to start is tracking your periods. A lot of women come in and it’s because it’s been a part of your life and you just, it happens and you just go through it every month. There’s several apps that you can use to track your periods because I’ve had some women who come in thinking that their periods were abnormal, but when you actually count out the days, it was actually in a normal variation and just to even get that reassurance. Otherwise you would just keep on thinking that your periods are abnormal.

So first place to start is tracking your periods, knowing how many days between your cycles, that sort of thing. Rather than, a lot of women say it’s always at the first of the month. Well, not every month has 28 days and then it changes. And so your dates are going to move because of the change in the number of days per month. So again, tracking your period is a good place to start.

Dr. Mironda Williams:

We always advocate empowering our patients and for women to know their bodies, to know what’s normal, to ask questions, to seek care with your healthcare providers. We understand that access to healthcare is a big deal now and looking at health equity and women’s reproductive rights and all the things that are going on now in today’s world. And so if you don’t have a healthcare provider that you can see in person, there are certain online entities that you can look into just to provide information, to get answers to your questions. But we cannot stress enough how important it is to establish care with a healthcare provider through health departments, through private practice physicians or even some medical schools and training institutions offer clinics where you can be seen at a nominal or decreased rate.

So there are other options for you to get healthcare and to get good information that you can trust that is science and data driven, where we have no other in agendas other than your health and your wellbeing. So please, please reach out to us if you desire to come see us at ptcobgyn.com or anyone else that you may feel more comfortable with in getting answers to your questions.

So when we talk about pandemic stress, menstrual cycles, COVID-19 vaccines, have there been impact? Yes. What the long term impact that may be is still to be decided. At this point, we don’t see anything that has been determined that is detrimental or long-lasting, longstanding. And that the changes that you may experience should be temporary and self-limiting that don’t require treatment. Just observation for us to make sure that they do resolve. But if not being connected with the healthcare provider can help you figure all that out as we figure it out so that we can make sure that your health is the best that it can possibly be. Cause that’s what we’re about on Take Good Care.

We want you to take good care of all of your life. Any other thoughts you would like to share before we close up?

Dr. Karen Greene:

No.

Dr. Mironda Williams:

So this was a brief episode. Again, we just wanted to piggyback on the article that we posted on our social media platforms not too long ago about pandemic stress, menstrual cycles and COVID-19 vaccines. And so we wanted to give you a little bit more information just to elucidate what is a normal cycle, as well as talking about those potential changes that you may see. So always check us out on our social media platforms. You can always look to us at ptcobgyn.com for other information. And until we meet again, this is Dr. Mironda Williams.

Dr. Deanna Guthrie:

I’m Dr. Deanna Guthrie.

Dr. Karen Greene:

And I’m Dr. Karen Greene. Take Good Care.

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