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Yeast infections triggers a period or BTB?
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An_142427 posted:
Background info: 28 year old married female who has had periodic vag yeast infections for 10 years, ranging from mild to excruciating. I've experienced light streaking/ pink tinged discharge during these infections sometimes, which one deduces is some mild bleeding due to irritation. During my last infection about 18 months ago, I used the OTC 1day ovule and experienced what seemed like a chemical burn: severe pain, burning and red tinged discharge lined with bits of skin. I saw a NP a few days later who said I was very inflamed, swollen, and by then neg for yeast/bv but it looked like I was healing and perhaps I just had break-through bleeding or starting my period (it was mid cycle for me then). I healed and went these 18 months with no infection. About 10 days ago, started feeling the same old symptoms of a YI, so wanted to be pro-active and to also try a more natural approach. So for a week I first tried tea tree oil suppositories and when those were gone, a natural probiotic douche. After 2 of those the symptoms were somewhat reduced but I still had the YI and I started bleeding; what I would term heavy spotting. Not simple streaking/tinges, but enough that I need panty liners and need to change them about about 3 times a day. This has been for about 4 days now. I've now had 2 nights of a 3 night clotrimazole cream. The yeast itching, irritation, discharge was almost completely gone after the 1 night's dose but I'm still having heavy spotting. Do you think it's from the irritation or does yeast or clotrimazole cause break through bleeding or even another period? First day of last period was about 11/10, cycle is usually 25-28 days. Could that bleeding last time have been something similar? It really seemed different from any menstrual bleeding last time. This clotrimazole has not given me any pain, burning so I don't feel like I am injured to the point of bleeding in there. Thanks!
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Jane Harrison Hohner, RN, RNP responded:
Dear An: My clinical experience agrees with your assessment that there can be more irritation when the one dose regimen is used. Whether one uses a one day, three day, or seven day regimen you get the same number of total milligrams of active ingredient for the course of treatment. I'm glad to hear that the three day regimen did not prompt the same type of burning and irritation as the prior one day suppository.

While some women can have such severe inflammation that there can be tiny breaks in the vaginal tissues, yeast does not usually cause overt spotting/bleeding. Enough spotting to soil three panti-liners/day is not likely to have yeast as a culprit. Moreover there is nothing about clotrimazole which would interfere with hormone levels. The more likely explanation would be spotting/bleeding from the lining of the uterus. Some possible cause would include: new chlamydia infection, midcycle spotting due to ovulation (cycle day 11-14 in your specific case), or late luteral phase spotting (occurs in the week prior to actual onset of flow). Coincidentally, women with recurrent yeast seem to have more infections in the week prior to flow.

If the erratic spotting persists or escalates your best bet is to see your GYN or clinic. I never say "impossible" to any pattern a woman notices. Perhaps you are a unique individual for whom vaginal yeast will be linked to spotting.

Yours,
Jane
 
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An_142427 replied to Jane Harrison Hohner, RN, RNP's response:
Dear Jane, Thank you so much for your response! But now, I am more confused then ever. After our posts, the bleeding stopped a couple of days later and everything seemed back to normal. I agreed that this was probably mid or late cycle bleeding and the infection was gone. I have actually had some mid and late cycle spotting in the past, not always, but never like the heavy spotting i described to you. But I've not gotten my Dec period at all! Ive been very regular the last several years. As I said before, I've had many YIs and they've never affected my actual flow, just the slight streaking. So my last period was 11/10/12. I've taken a couple of home pregnancy tests - negative. Hubby and I use condoms only as contraception. Usual cycle 25-28 days, was expecting period in the first week of Dec. Around 12/13 I had this little 'whoosh' of light bleeding and clear discharge so thought it was my (late) flow arriving, put in a tampon, but took it out a few hours later and the whoosh was it...no bleeding at all since then. Not even the tiniest spotting. I'm more confused than concerned. No pain or other problems. From about 12/9-12/19 I had very mild cramping every day, felt nauseous off and on and a little dizzy sometimes. But the last few days, since 12/19 am back to feeling completely normal. The only other thing I can think to mention is this month, I've felt a brief, jabbing sharp pain in my right abdomen several times. Just like a momentary poke and then gone. But it's more GI area, maybe 6 inches in a straight line to the right of my belly button. We just moved so next week I'm going to try to make an appointment with an ob/gyn but not sure how fast it'll be as a new patient. Any thoughts would be appreciated Jane! Thanks.
 
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Jane Harrison Hohner, RN, RNP replied to An_142427's response:
Dear An: The most common reason for a menstrual pattern like you have described is not having an ovulation every month. In a normal cycle, estrogen is produced all month. Estrogen is responsible for building up the lining of your uterus so you have something to shed each month.

In a normal cycle, progesterone production increases following ovulation and release of an egg.. Progesterone "stabilizes" the uterine lining in preparation for a possible implantation of a new pregnancy. If you are not pregnant that month the levels of estrogen and progesterone fall, triggering the release of the uterine lining—your period.

So, if you do not ovulate, the estrogen build up of the lining continues, but without the usual ovulation associated progesterone. Thus, the hormone levels don't decline, and the lining stays up inside the uterus—your missed/late period. Alternatively, the built up lining can begin to shed on its own creating erratic bleeding patterns which are usually "too-light" or super heavy and prolonged.

There can be many causes for not ovulating:low thyroid problems, pituitary problems, ovarian cysts, physical stressors (eg sudden increases in exercise, crash dieting), emotional stressors (problems with partner, finances, recent move), increased body weight, anorexia, rotating shifts at work, etc. You mentioned both a possible stressor (recent move), and some right abdominal pain (could be an ovarian cyst, but you are correct ovary is usually closer to the pubic hair line than the bellybutton).

I agree, it can take a while to get in as a new patient so make an appointment now. You can always cancel if your cycle returns to normal--or keep it as a follow up on the menstrual changes.

Yours,
Jane
 
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noodle202 replied to Jane Harrison Hohner, RN, RNP's response:
Hi again Jane! I certainly appreciate your input. I was hoping to get your advice one more time? So I had the on/gyn appointment and I liked the doc. She said everything physically looked and felt normal. We did hormone levels (DHEA, free/total testosterone, progesterone, and estradiol) and her nurse just told me everything came back normal. So no answers. I had brighter, heavier bleeding the week leading up to my period this month instead of the brown spotting I'm used to. But my cycle timing/length does seem normal again. So maybe Dec was a fluke? It is normal and predictable for me to have some bleeding between and leading up to periods, so should I just leave well enough alone? Unless I experience any pain or excessively heavy bleeding should I just deal with it? I think at some point soon, I may try to see an endocrinologist. I want to find out what this TSH level came up as because I have my labs from several years ago(I worked in a lab for 7 years) and my tsh came up 2.5, then 1.8, then 3.5 in an 18 mon period. I've known a few docs who do further testing when it's above 2 as that often indicates a problem. I've never had a t3 or t4. But I just wanted your input. We were hoping to start trying to conceive this spring or summer, so I'm wondering if you think I should give it a try and not worry or If I should try to find the culprit before possibly getting pregnant? Thanks so much Jane!
 
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An_142427 replied to noodle202's response:
Oh I forgot to do anonymous so that's me still lol. Noodle202. Thanks!
 
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Jane Harrison Hohner, RN, RNP replied to noodle202's response:
Dear noodle202 (love your screen name!): I sounds like your new GYN was trying to rule out polycystic ovarian syndrome (PCOS) as a cause for possible missed ovulations leading to erratic bleeding. It's good that the labs were returned a within normal limits (WNL). Before waiting to see an endocrinologist you might even ask your GYN to rule out hypothyroid with both a TSH and free T4.

If all your labs return as WNL then your MIGHT have just had an aberrant cycle in December. If you have been unable to conceive after 12 months of unprotected sex, or you have erratic bleeding patterns return, then the search for a cause needs to be widened.

Best wishes for conceiving when you desire.

Yours,
Jane


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