A Top Doctor’s Advice on Heavy Bleeding ‘The Doctors’ Lisa Masterson Explains Your Menstrual Cycle

Worried about painful periods or PMS? Gynecologist and TV host Lisa Masterson, M.D., has the answers. From heavy bleeding to chocolate cravings, she tackles your tricky health questions… As the only female physician on daytime TV’s “The Doctors,” ob-gyn Lisa Masterson, M.D., talks about topics like childbirth and cancer and occasionally jumps atop desks to make a point. But off-camera, this energetic doctor is undeniably professional. A staffer at Los Angeles’ prestigious Cedars-Sinai Medical Center, she’s passionate about women’s reproductive health, especially when it comes to periods. “If your periods are so painful that you can’t do things you enjoy, tell your doctor,” she says. “That’s something we talk about a lot on ‘The Doctors.’ If something doesn’t feel right – if it’s a detour from your usual daily functions – communicate [that].” In this exclusive Lifescript interview, Masterson sheds light on several conditions that concern many of us – from painful periods and heavy bleeding to heart disease. How can we tell if something’s wrong with our periods? [You’ll know] if something’s different from what’s normal for you or affects your daily life. These are [red flags]: They’re so irregular that you’re running to the bathroom or having [overflow]. You sometimes wonder if you’re pregnant because your period doesn’t come as often as it should. Your doctor should ask about these things during your yearly exam, and if he or she doesn’t, speak up about these issues. How do you know if your menstrual flow is excessive? If you’re going through at least one large tampon and a pad an hour, or the flow results in anemia [a fatigue-causing decrease in healthy red blood cells], that’s considered heavy bleeding. What causes heavy bleeding? There are lots of possible reasons, depending on where you are in life. [They] include hormonal fluctuations, infection, thyroid disease or such factors as [excessive cell growth in the uterine lining], cervical polyps [growths on the cervix] or endometrial cancer. If you have a large uterus, it could be due to fibroids [benign lumps]. If you’re postmenopausal or on hormone therapy consisting of estrogen without progesterone, we’ll be looking more for cancer or hyperplasia [an abnormal increase in cells]. What tests do patients with heavy bleeding need? It often depends where you are in life. Tests to determine the root cause include a pelvic exam and a Pap smear with laboratory cultures. Because thyroid disease can cause heavy or irregular menstrual bleeding, we’ll often do a thyroid panel. (For more about this important gland, read A Woman’s Guide to Thyroid Health.) How do physicians treat the problem? We use oral contraceptives to take away the periods, or a progesterone IUD (intrauterine device) [to reduce bleeding]. Sometimes, just a non-steroidal anti-inflammatory drug like ibuprofen (Motrin) can help if taken before a period [by blocking an enzyme called prostaglandin]. If you’re postmenopausal or don’t want more kids, there’s also endometrial ablation [which removes the uterine lining]. Just about all women have premenstrual syndrome (PMS). But what can women with really bad symptoms do? About 80% of women suffer from PMS. It’s [pretty] normal given the change in hormone levels throughout your menstrual cycle. But some women have premenstrual dysphoric disorder (PMDD). It’s PMS to the nth degree. PMDD? What’s that like? With PMS, prior to your menstrual cycle you can have symptoms from nausea to bloating to headache to mood swings. The headaches go away with pain relievers. The mood swings are minor – you don’t suffer from [extreme] emotions or weeping spells. But with PMDD, you can’t cope – it affects your ability to perform in everyday life. You could have so much pain and cramping that you can’t get out of bed. You get into arguments with your loved ones or co-workers, and it can keep you from engaging in everyday activities that you normally enjoy. It usually lasts longer than regular PMS [more than 14 days]. And it often includes a severe form of depression. What treatments are available for PMDD? We can prescribe birth-control pills, because it’s really a hormonal imbalance that you’re experiencing. A mono- or biphasic oral contraceptive, or progestin, can stabilize those hormones. [Monophasic pills provide a steady level of estrogen and progestin throughout your menstrual cycle; biphasic pills have two different doses of those hormones; and progestin-only pills contain a single hormone.] If the pain is severe, sometimes [a contraceptive that takes] away periods will help. What if symptoms persist? Patients can also use antidepressants – like selective serotonin reuptake inhibitors (SSRIs) [such as Prozac and Zoloft], which have been shown to have really good success [in relieving symptoms of] PMDD. Most of the time, you don’t have to take antidepressants every day, just right before your menstrual cycle. Can a healthy diet minimize period issues? It helps. Obesity can affect your hormones, as well as your fertility. If I’m craving chocolate close to my menstrual cycle, is it OK to indulge? You can absolutely have a piece of chocolate when you’re PMS-ing. It’s not going to hurt [your body]. But if you eat a box of chocolates, you’re going to damage your health. That leaves you at risk for [poor health] conditions [like obesity] – and if you already have an underlying disorder, it’s common sense that you should do things in moderation. Women often believe they’re safe from heart problems if they’re still having menstrual cycles. Is that true? We have found that the body’s estrogen [protects hearts] for women. As you go through menopause [and estrogen declines], you’re going to have a higher risk. How do you protect your heart after menopause? There’s hormone-replacement therapy, but it comes with pluses and minuses. The question is whether the benefits outweigh risks. We know that it’s more beneficial over a short term and in lower dosages. But diet and exercise are important. Women also need to pay close attention to their weight and exercising – just as men do. We’ve become too sedentary. How can you tell if you have heart disease? You need to be aware of the symptoms, because they can be different than men’s. A lot of the time [heart disease] feels like fatigue. So if you’re overly tired, talk to a doctor about it. There’s no harm in calling your doctor to ask if that’s a problem or if a workup is necessary. I’ll often find cardiovascular disease when a patient has high blood pressure. It’s the silent killer. (Do you know the symptoms of heart disease in women? Check out Doctor-Recommended Tips for a Healthy Heart.) And for more with Masterson, read her top ways to stay fit.