Dr. Victoria J. Mondloch, M.D.

Irregular bleeding can happen more frequently at the beginning and end of our menstrual career; especially from age 40-50yo. Women also have larger swings in their female hormone levels with more months having very low Progesterone levels; this leads to an Estrogen dominance situation and can cause growth of ovarian cysts. These ovarian cysts can then grow to the point of torsion (or twisting on its own blood supply) or even ovarian cyst rupture which can be sudden and acute pain that can mimic an acute abdomen or even appendicitis. Light bleeding can happen whenever hormone levels are out of balance, especially when something like an ovarian cyst ruptures and hormone levels drop because of the rupture, triggering bleeding. Of course, any abnormal bleeding can also mean pregnancy, especially if you are not currently using a reliable contraception method. Use a home pregnancy test by urinating on a home test (can get at the Dollar Store for …$1) to be certain that you are or are not pregnant. If you are not pregnant, then I highly recommend getting your hormone levels checked on day 21 of your menstrual cycle (day 1 is 1st day of your bleed); you need to be certain that you are not Estrogen dominant as this can cause abnormal mammograms, ovarian cysts, uterine polyps, uterine fibroids and stimulation of endometriosis implants.

Realize that all children before the age of puberty have minimal sex hormones in their body. It is with the onset of puberty and the pituitary gland starting up in the head that the sex organs are stimulated to then make their hormones; testicles make Total/Free Testosterone and ovaries make Estradiol, Progesterone (with ovulation), Total/Free Testosterone. It is with the Estradiol stimulation of breast, uterus and ovaries that the sex organs will be stimulated to enlarge. Thus growth of breast buds and then the stimulation of breast tissue is triggered by puberty as the body needs to have female hormone production in order to stimulate breast development. Then it’s knowing that the female hormones are properly balanced (a Progesterone/Estradiol dominance) and that ovulation is actually occurring on a regular basis. For more in-depth answers to questions that you may have about adolescence and puberty, please check out my book on Amazon; Blossoming, Becoming a Woman. This book gives an easy to read account of how the female body works and has many examples of patients who ‘tell their story’ as case studies in the book. This is the first book that I know of that actually is written for the teen and her parent and is meant to answer any questions that you have.

Extreme vaginal discharge doesn’t just happen; it’s either infectious, or hormonal or possibly even pregnant. Sometimes, associated with bladder issues, this discharge can be caused by something mechanical or something pushing against the bladder/cervix area which are very close to each other. This kind of a sudden change usually means that you need to 1) do a home pregnancy test and 2) see your OB-GYN; it doesn’t sound like an infection but cultures will be part of a complete work-up. 3) And you’ll likely get a full pelvic exam (including a rectal) and then 4) a pelvic ultrasound to have a targeted look at your female organs. Sometimes a degenerating fibroid can become mucousy and this liquid will pass through the cervix into the vagina but this needs to be documented as there may be more fibroids in your uterus that you need to know how to manage. If you possibly are early pregnant, then this could be a rupture of a bag of waters and this could lead to hemorrhage as you would likely miscarry. And if this was possibly an ectopic pregnancy, then you may pass the bag of waters from the tube into the uterus and out your cervix but the tube can still cause sharp pain as the placenta continues to grow. In any of these circumstances, the best way to find out what’s going on is to see your doctor as this combination of symptoms means it’s time to go to your doctor, sooner than later!!! You don’t want an emergency ambulance ride or surprise surgery if this turns out to be a serious issue.

The artificial hormone of birth control pills or oral contraceptive pills (OCP’s) will build a thinner lining in your uterus. Over many consecutive months of taking OCP’s, the lining gets thinner and thinner and with many patients, you will not make enough of a lining to shed so there is no bleed. That effect is completely reversible and once you are off the pill, your ovaries will go ‘back to work’ and will increase production of Estradiol, Progesterone and Testosterone which will then resume building a lining (Estradiol), stabilizing and enriching a lining (Progesterone) and having systemic effects to the body (Testosterone); then it’s important to know if you will resume ovulation; this may lag behind vs happening at the same time as resuming production of hormone. Most doctors do not check hormone levels for any reason; but if you were placed on OCP’s for heavy bleeding or irregular bleeding, then OCP’s may help regulate these issues. However, these same issues are just ‘covered up’ and will likely resume once you stop OCP’s for any reason. So, if you make the decision to stop your OCP’s or if you had a medical reason to take OCP’s in the first place (besides contraception), then realize that the medical reason likely still exists and will need to be dealt with at a later date. If that medical reason could influence your ability to get pregnant down the road, then dealing with a medical reason sooner than later allows you the time to work out the issue vs having fewer options available to you or a time crunch of being too close to age 35 and the increased risk of Down’s Syndrome to deal with. Remember, if it seems too easy, there may be a catch; you may be dealing with a medical problem later. If you have any questions about whether you may have any medical reason that you were put on OCP’s, then ask your doctor to help you get the work-up that you need. If they tell you it’s because you have irregular periods, then make certain you do not have elevated Testosterone which could mean Polycystic Ovary (PCO) and this can mean higher infertility risk and probable need for infertility medication, delays in getting pregnant or perhaps even a surgical intervention to help you get pregnant; all things you would need to know sooner than later; knowing your hormone levels is one way to find out if you have this diagnosis.

Dr. Victoria J. Mondloch

The first question you need an answer to is could there be a sexually transmitted infection going on? Could your new partner be diabetic? Diabetic males can have a retrograde ejaculation with semen backflowing into the bladder; that mixes with the excess sugar in the urine and can cause a low grade irritation on penile skin which can transfer to your vagina, causing irritation and a low grade yeast infection in the female partner. I always ask my patients to have a new sexual partner get ‘checked out’ medically by a physical and STD cultures/bloodwork to be certain you know what you are getting exposure to. Unfortunately, women tend to carry the brunt of any STD exchange so being forewarned is being forearmed. And if the relationship is not monogamous, and if a 3rd party may be involved, then you really have much less control than you think. Don’t hesitate to ask a new partner to get checked; after all, it’s your health.

I don’t know what your app is telling you but I will always discourage a patient from having unprotected intercourse if they are not trying to get pregnant. Even though the ovaries switch off each month as to which one is going to ovulate, it doesn’t mean that you will ovulate on time or that you may not double ovulate (from each ovary) or that Estradiol hormone levels may be off 1month to the next month and ovulation may be early or delayed by a few days which would throw any pre-determined app off. The best rule to follow is ALWAYS COVER YOURSELF OR YOUR PARTNER by using a condom and always expect the unexpected.

Indeed if this blood clot was passed from your vaginal vault, then you need to be examined by a GYN and you may require a pelvic US of abdom/pelvic CT scan. Sometimes you can have a vaginal polyp at the top of the vagina where the cervix used to be; these polyps can bleed and even form small clots but polyps should be investigated and usually treated with Silver nitrate (AgNO3) in the office which is a liquid cautery. If you had a supracervical hysterectomy (uterus removed but cervix remains), then bleeding can happen from the cervix, usually the cervical canal so this also needs to be checked by a Pap smear and possible colposcopy with endocervical curettage or sampling of the tissues of the cervical canal. Rarely, but sometimes there can be a fibroid that is within the cervix and sometimes fibroids are found in the fallopian tubes; if they were scarred to the vaginal vault, then stimulation or growth of that tissue can occur and stress the vaginal cuff, possibly causing bleeding.

Another possible reason for vaginal bleeding can be from the prolapsed tissue of the urethra or caruncle (where your urine comes out) and that tissue can bleed; however, this is usually only spotting on toilet tissue with wiping but small polyps can form and cause heavier bleeding. Treatment for caruncles are usually with a topical Estradiol cream applied directly; this Estradiol is not absorbed into your bloodstream so you don’t need to worry about getting blood levels checked. However, sometimes topical cream alone may not solve the problem and taking oral bio-identical hormone as Estradiol + Progesterone. For further information about menopause and how to manage your health issues in menopause, check out my book, Full Bloom: Perimenopause, Menopause, Postmenopause and Beyond which is available on Amazon.

You are not alone; and you are likely anywhere from 1-5 years or so from going into menopause. Your female hormone levels yo-yo from 5% to 66th% in the 5 years leading up to your menopause and your Estradiol usually doesn’t track at the same percentiles as your Progesterone. FSH is actually not a helpful test because you will also yo-yo your FSH levels so it’s not helpful at all. Working with your Estradiol and Progesterone levels by taking bio-identical hormones and following your blood levels is your best option. Remember, Estradiol and Progesterone are prescription meds and are covered by your insurance, so just ask your healthcare provider to draw your blood levels so you can balance your levels. Check out what other hormone levels you should know about by reading my book: Full Bloom: Perimenopause, Menopause, Post-menopause and Beyond which is available on Amazon. This book walks you through the myths and tells you the truths about what women go through as they approach their ‘change of life’. It also walks you through the research and helps patients understand that hormone replacement is much safer than they are led to believe. And there’s a section in the book that walks you through how to talk to your doctor about the bloodwork that you’d like to have done.

Dr. Victoria J. Mondloch

Your issues are a little more complex than the average patient. First, endometriosis is a disorder or female hormone imbalance, with Estradiol (E) at a higher percentage than Progesterone (P4) with likely anovulation which further contributes to E/P4 dominance. To have a hysterectomy by age 26 is highly unusual and means that your case is severe enough that you were not diagnosed early enough to stop the progression of endometriosis implants. However, that cannot be undone but you still have to manage the E/P4 imbalance or your are at risk of ovarian cysts, ovarian cancer, growth of endometriosis implants that were left behind and even breast cancer! If you are wondering where the research to back-up these claims comes from, check out Full Bloom; Perimenopause, Menopause and Beyond and the research is laid out for readers. Full Bloom is available on Amazon for only $20.

Regarding the possibility of thalassemia, you really need to have a hemoglobin electrophoresis (a blood test) to help determine if that is going on; it’s something that should be covered by your insurance. Ferritin is the protein that carries your iron in your bloodstream so it’s quite a valuable test result to know about; high iron levels usually indicate tissue damage so it is not as helpful as ferritin levels. Interestingly, ferritin is actually a COVID test so be certain that a high ferritin is not due to a chronic viral illness such as Epstein-Barr, Lyme’s dz (tick-borne) or other significant viral disease, including COVID. Your nutritionist has made a great observation; now proper work-up with an internist or family practice practitioner or even a good OB-GYN who is interested in total body health is whom can do your blood work-up.

Despite being on birth control, whether pills or an IUD, your female hormone levels are still produced and are susceptible to imbalance. In addition, your adrenals are likely being stressed and that impacts your female hormone levels as well. Lastly, patients with polycystic ovary disease (PCO), despite being on birth control can have higher testosterone production which can also interfere with female hormones. In fact, patients with PCO typically will have irregular bleeding on birth control pills, even on higher dose birth control pills. The best way to manage your adrenal stress is to start Vitamin B Complex with METHYL B12 and METHYL folate for best adrenal support; then get your AM Cortisol, Total Testosterone and Free Testosterone levels checked if you are taking birth control pills. If you have an IUD in place, then check all of the above labs including Estradiol and Progesterone. Check out my books, Blossoming, Becoming a Woman and Full Bloom: Perimenopause, Menopause, Postmenopause and Beyond for a little more explanation; there is a section in the back of the book regarding the labs to order in the how to talk to your doctor chapter.

What many women are not aware of is that they are fertile for up to a week pre-ovulation and for 36 hours post-ovulation; so, if your period was on time and you had relations d7or d8 of your cycle, then you could indeed be pregnant. So a home pregnancy test to be certain; they are most affordable at the dollar store. If you are bleeding because you didn’t ovulate the cycle before, then you may have irregular bleeding off and on throughout the next month until you ovulate the next cycle. If you have any concern about a hard to read pregnancy stick test, then check with your doctor; you may wish to have bloodwork for hormones done as well as a blood HCG pregnancy.

Not all urinary frequency means an STD; it may actually mean low Estradiol from a low dose birth control pill, from ovarian suppression if you are athletic and not getting periods or if you have a tendency toward polycystic ovary disease when women make more male hormone and not enough female hormone; you need to know what your female and male hormone levels are so get day 21 bloodwork done Your symptoms may also represent a possible yeast infection; yeast can happen when you are taking an antibiotic, taking steroids (asthma inhaler or other oral steroid), are diabetic or even ingesting higher amounts of simple carbohydrates/sugars. And don’t forget that hot weather can also trigger yeast. Remember, one of the most common STD’s is BV or Bacterial vaginosis which is triggered by an alkaline pH of vaginal secretions and it has a rotten fish odor. And it’s important to realize that spotting or bleeding with breakdown in blood causes an alkaline environment; so does frequent intercourse as male semen is very alkaline. Lastly, don’t let your guard down about HPV or genital warts or even painless skin ulcers that may represent syphilis.

Yes you are protected. But let me be one of the only healthcare providers that is willing to tell you that the synthetic Progesterone in your new shot comes with an 8% increase in heart attack, 8% increase in stroke and 10% increase in breast cancer as well as an increase in appetite, increase in acne and significant increase in depression with increased incidence of needing medication. Provera or medroxyprogesterone acetate is the reason that the Women’s Health Initiative was called early and then stopped: it is a terrible chemical to put into the body and it contributes to multiple women’s health issues not to mention it causes infertility in women who take it. My suggestion is to restart your birth control pill once you have reached the end of your 3month timeframe and not get a 2nd Depo Provera shot. I also do not recommend the long acting reproductive contraceptives of LARC’s or what was formerly called IUD’s if they contain hormone; there are 2 types of LARC or IUD units: Mirena contains a Testosterone-like Progesterone and is associated with abnormal periods, spotting, PMS and acne so I do not recommend this IUD. The Paraguard IUD is made of copper and it protects women from pregnancy without disturbing your hormone production; it does not cause acne or PMS but can be associated with increased abnormal periods.

Most women will have a month when they don’t ovulate; that means they don’t make both of their female hormones, Estradiol (E) and Progesterone (P4). When you only make E, you are making a lining; then the P4 stabilizes the lining with the drop in P4 triggering your monthly bleed. When you do not ovulate, you continue to make a thicker lining and it has no ‘signal’ or ‘trigger’ of when to start or when to stop so it may bleed heavily or lightly of off and on until all of the old lining comes out or until you ovulate again which will stabilize the remaining lining for you then to ‘bleed’. This anovulatory bleeding can also be triggered by other hormones that are out of balance such as adrenal or thyroid; so get your healthcare provider to do your bloodwork to know what your body is telling you so that you take the right corrective measures.

That’s a great question that gets debated a lot. We do feel that your baby can hear in utero, so many patients read to their baby in their pregnant belly; whether it’s a children’s book or the Wall Street Journal, experts feel that the vibrations caused by speaking or singing are transferred through the amniotic fluid. But there are no vibrations that transfer through fluid with touch. Yet our brains put out ‘feel good’ hormones such as Serotonin that may chemically transfer through the bloodstream to the fetus but again, this is controversial as we cannot ask the fetus. We do know that when a pregnant mom is active, the baby will rest and when the mom rests, the baby will be active; which is why a baby is usually going to sleep during the day and be awake at night.

This is a common issue that many women have happen; what is usually means is hormone imbalance due to not ovulating the month before. It may also mean Estradiol dominance or ‘E’ dominance which means you are making more Estradiol than Progesterone which by definition is hormone imbalance. Many doctors are not aware that they can check your blood levels of these 2 hormones and then know exactly what is happening so that they can help guide you as to what to do about it; they will simply tell you to take pain medication for the cramps, prescribe anti-nausea medication and maybe even order a pelvic Ultrasound (lots of $). Now, a pelvic Ultrasound may tell you about an ovarian cyst (E dominance) or uterine fibroids (E dominance) pressing against other parts of your lower pelvis. Or you may be offered birth control pills to override your abnormal periods; but since you already have had a tubal ligation, you may not want the side effects of the birth control pills (depression, weight gain, acne). And know that you could have this occur again because you are heading toward your 40’s which is perimenopause time when hormone swings are more common and abnormal periods are more common than uncommon. But the only way to know how to manage this time is to check your hormone levels. Ask your doctor to check d21 bloodwork of your cycle (day 1 or d1 is the first day of your bleed) for Estradiol, Progesterone, Total and Free Testosterone. I also go into more detail about the bloodwork you need and more in my book, Full Bloom, Perimenopause, Menopause and Beyond which is available on Amazon. You need to understand what your body is telling you; and knowledge is power, so don’t be afraid to ask for blood testing to help you understand what your body is telling you.

Dr. Victoria J. Mondloch

The issue of how our period behaves for us hits every woman at some time or another over the course of their menstrual career from puberty approx. age 12yo to menopause approx. age 50.5yo. Periods that come early, late or last longer than they should usually means there is imbalance between the 2 female hormones (Estradiol and Progesterone). This imbalance is not uncommon both early or late in our menstrual career and usually means that you did not ovulate that cycle and there is no Progesterone on board to counter the function of growing a lining which happens based on our Estradiol level. Most of the time our body figures this out after 1 or 2 ‘off cycles’ and will do an automatic reset on its own and we get our cycles back on track. However, when it happens a lot or bleeding gets heavier or crampier, then this hormone imbalance has triggered something that could mean a recurring problem that needs to get investigated. What that means is getting your hormone levels checked by bloodwork; that is best done 1wk before you anticipate your period happening or d21 of your cycle with d1 being the first day of your period when a period usually lasts approx. 28 days from start of one period to the start of the next period. I recommend that patients ask their doctor to check their female and male bloodwork on d21; this means 4 blood tests which are your Estradiol, Progesterone, Total Testosterone and Free Testosterone. However, abnormal periods can also be from thyroid issues or from stress which comes from your adrenal. In other words, checking all of the hormone groups is actually the BEST way to approach an abnormal bleeding problem that persists to best determine what is causing the hormone imbalance. I recommend that you check out my book Blossoming, Becoming A Woman; this book is available on Amazon and helps clarify a lot more about the many issues that women go through as they go from puberty and into their 20’s. There is a section in the back of the book on how to talk to your doctor and it lists all of the blood tests that should be ordered and why. This is what you take into your doctor so that you don’t miss any of the tests that need to be done.

Dr. Victoria J. Mondloch

Severe cramps can be associated with a few things: 1) this may be a low Progesterone which means a n Estradiol/Progesterone female hormone imbalance; this causes more lining to have to be passed which means your cervix has to dilate in order to pass more blood and these cramps can be similar to labor pains. Severe cramps with minimal bleeding can also mean endometriosis which is blood and tissue passing through your tubes and into your abdomen causing a condition like peritonitis and scar tissue. Then if scar tissue involves the bowel, it can cause GI symptoms that are associated with when you have good travel through your GI tract. One of the easiest things to do is to have your blood levels for Estradiol, Progesterone, Total Testosterone and Free Testosterone checked on d21 of your cycle with d1 of your cycle being the first day of bleeding. Check out my book, Blossoming, Becoming a Woman on Amazon; there is a section in the back about how to talk to your doctor and it talks about the bloodwork to order and why I recommend it. If your doctor is not comfortable interpreting these values, then contact my office: 262-524-9116 and let us help you.

Dr. Victoria J. Mondloch

What you need is a good OB-GYN who will actually balance both your female/male hormones and then balance them with your thyroid hormones. You also need to know that there is an increased incidence of autoimmune thyroid dz as well as other autoimmune diseases when women have a drop in their Estradiol levels with menopause. My approach is outlined in my book, Full Bloom, Perimenopause, Menopause, Postmenopause and Beyond on Amazon. This book walks you through the research and outlines the approach of why bio-identical hormone replacement is recommended and how it actually protects your heart and protects you from all mortality, even cancer. Ask your GYN to check your bloodwork for your blood levels of your 4 hormone groups: 1) Estradiol, Progesterone, Total Testosterone and Free Testosterone, 2) TSH, Free T3, Free T4, Thyroglobulin Antibody and Thyroid peroxidase antibody, 3) Vitamin B12 and AM Cortisol (drawn 3hours after arising from overnight sleep) and 4) Fasting blood sugar and insulin (4hour fast). If your doctor is not comfortable interpreting these results, then contact my office as these lab results are the foundation of your health and it is extremely important that you understand these values and what they mean for you.

Dr. Victoria J Mondloch

Actually I am going to recommend that you start topical Estradiol to your vulva as estradiol increases blood supply per square inch to this also brings increased oxygen and nutrition to these same tissues. You cal also ask your doctor to prescribe viscous xylocaine and mix it with the topical Estradiol which will help decrease the pain in those tissues. Viscous xylocaine is quite inexpensive and lasts a long time so it’s easy to use and cost effective.