Dr Flo, I had a miscarriage during my fifth week of pregnancy. It started with spots of blood, followed by abdominal pains. I went to my gynaecolist, who gave me medicine, but the spotting didn’t stop. After two days, I felt sharp pains and started bleeding, so I went back to hospital and the doctor told me that the pregnancy was coming out, so he had to complete the process. I want to know what is wrong with me because I have a problem with my hormones. Sometimes I have my period normally, and sometimes I don’t. I want to have a baby and every time I go to hospital, I am told my problem is hormonal imbalance. Please help. Rose.
Dr Flo, my wife suffers from hormonal imbalance. She has irregular periods which make conception difficult. A gynaecologist prescribed some medication and her period came once and then stopped. Which is the best treatment and medication for this condition? Thanks. Gikundi
Dear Rose and Gikundi,
Hormones are chemical messengers that are produced by organs and glands and they influence specific cells, causing an effect on many processes in the body. The level of the hormones can be affected by other hormones, by glands and organs, and by feedback loops.
The menstrual cycle occurs due to changes in the levels of the hormones oestrogen and progesterone, causing the different phases of the cycle. If something causes a problem with these hormones, then there is a hormonal imbalance and the cycle is disturbed.
Hormonal imbalance means that there is too little or too much of one or several hormones.
The menstrual cycle is different for every woman, but menses can occur every 21 to 42 days, and can last from two to eight days. Menses are considered irregular if the time between one period and the next changes significantly, if the number of days when you are on your period changes a lot or if the amount of bleeding changes a lot.
Irregular periods usually mean that there is no ovulation. Hormonal changes affecting the menstrual cycle can happen due to pregnancy, breastfeeding, menopause, using hormonal medication, stress, too much exercise, severe weight change (losing or adding a lot of weight), thyroid disease, polycystic ovarian syndrome, diabetes, diseases of the adrenal or pituitary glands, and tumours.
In some cases, the problem can be rectified permanently, but in many cases, there is no permanent solution. In most women, the cause of imbalance is polycystic ovarian syndrome, which cannot be cured completely.
You need to visit a gynaecologist so that you can be examined. Some tests will be done to check the levels of different hormones. These will help to figure out the exact cause of the imbalance so that you can be treated appropriately.
You may be given some hormonal medication to try and make the cycle regular. The medication usually works only during the cycle it is used (it does not affect future cycles). That means, for example, if you use the drugs for three months, you may have regular periods for three months, and then after that the cycle goes back to being irregular.
Let the gynaecologist know that your goal is to get pregnant, so you can work together on a long-term plan to achieve this. This will begin by identifying the exact cause of the imbalance and tackling it. You may possibly be put on ovulation induction medication and started on a schedule to help achieve a pregnancy.
This calls for patience because you may not conceive immediately, and you may need to go through several cycles to achieve a pregnancy, just the same way that those who do not have hormonal imbalance may go for some time without getting pregnant even though they are trying.
If after several attempts (usually around six) there is still no pregnancy, you may benefit from other forms of assisted reproduction like IVF.
Dr Flo, there is pain in my knee and the area around it is swollen. What might be causing this? DM
Knee pain and swelling could be due to injury or overuse of the joint. It may also be caused by inflammation or wear and tear of the tissues in the joint. This can be due to conditions like arthritis, gout, tendinitis, bursitis, cysts, dislocation or even infection in the joint. You are more likely to develop these symptoms as you advance in age, if you have obesity or if you are involved in some types of sports.
It is advisable for you to visit a doctor so that the exact cause of the problem can be identified. This may involve some blood tests, X-rays and/or scans. The doctor may also take some fluid from your joint to test it.
To manage it, rest the joint and place a pillow under it when sitting or sleeping; use alternating cold packs and hot packs; gently massage; use a crepe bandage or a knee support to stabilise and compress the knee. You can also use a crutch or a cane to reduce stress on the knee if it is very painful. Pain and anti-inflammatory medication will help to manage the pain and swelling. Physical therapy and some exercise can also help to manage the pain.
Depending on the cause and severity of the problem, surgery may also be an option to remove the fluid and repair the joint.
Send your medical questions to firstname.lastname@example.org for absolutely free expert advice