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Blood Clotting Disorder and Painful Cramps during Period
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Katie763 posted:
I don't usually post on these boards, but I am so discouraged I'm not sure what else to do. I'm in the process of finding a new OB/GYN, but for now I thought I would try this.

I have had severe, painful cramps my entire life. I'm 23 now, and I just found out maybe two months ago that I have uterine fibroids and those are the cause of my painful cramps. It's nice to have an answer, but I don't know where to go from here.

I miss a day of work every month (I have a full-time job) and I am student teaching in February. It's unprofessional to miss so much work, but for 12 hours a month I cannot function with painful cramping and diarrhea all day. I don't want to miss days of student teaching (we're allowed to be sick/gone twice), but I can't be at school with my cramps!

So why not birth control, you ask? I have a blood clotting disorder (Factor II Mutation) that raises my risk of developing blood clots significantly. I cannot take any kind of birth control to help the cramps with estrogen. I tried the mini-pill (progestin only) and gain 15 lbs within a month and half (NONE of my clothes fit me after that) and I had constant headaches and was exhausted all day. It really affected me physically and emotionally (being 15 lbs heavier so quickly) that I stopped taking it. To boot, it did nothing for cramps but made my husband happy lol.

I am wondering if anyone has experienced this before and if anyone has suggestions. I'm worried I won't be viewed as a professional having to take so many days off.

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Jane Harrison Hohner, RN, RNP responded:
Dear Katie: You are correct, fibroids can increase both uterine cramping and trigger a heavier flow. In addition to the painful cramps you also mentioned accompanying diarrhea. Both cramps and diarrhea can be linked to excessive production of prostaglandins.

Common menstrual cramps are caused by the release of prostaglandins from the lining of the uterus. Prostaglandins create both the cramps of labor and menstrual cramps by making the uterus contract. Common cramps may start prior to the onset of flow and usually last 72 hours. There are also receptor sites for prostaglandins in the bowel and central nervous system. Thus prostaglandins can produce not just cramps but also nausea/vomiting, diarrhea, headaches, and other "flu-like" symptoms.

Ways to block prostaglandins can include birth control pills (not an option for you), or anti-prostaglandin drugs (eg ibuprofen, naproxen sodium, ketoprofen, etc.). Some alternative healthcare providers such as naturopaths stress using of Omega 6 fatty acids in dietary choices, and cramp bark.

Katie, if the fibroids are the sole culprit here is the best summary citation on treatment found at the National Library of Medicine site:

Eur J Obstet Gynecol Reprod Biol. 2012 Dec;165(2):156-64. doi: 10.1016/j.ejogrb.2012.07.030. Epub 2012 Aug 29.
Therapeutic management of uterine fibroid tumors: updated French guidelines.
Marret H, Fritel X, Ouldamer L, Bendifallah S, Brun JL, De Jesus I, Derrien J, Giraudet G, Kahn V, Koskas M, Legendre G, Lucot JP, Niro J, Panel P, Pelage JP, Fernandez H.
Source

Service de gyn?cologie, Centre Hospitalier R?gional Universitaire de Tours, H?pital Bretonneau, 2 boulevard Tonnel?, 37044 Tours, France. Electronic address: marret@med.univ-tours.fr.
Abstract

The medical management of symptomatic non-submucosal uterine fibroid tumors (leiomyomas or myomas) is based on the treatment of abnormal uterine bleeding by any of the following: progestogens, a levonorgestrel-releasing intrauterine device, tranexamic acid, nonsteroidal anti-inflammatory drugs, or GnRH analogs. Selective progesterone receptor modulators are currently being evaluated and have recently been approved for fibroid treatment. Neither combined estrogen-progestogen contraception nor hormone treatment of the menopause is contraindicated in women with fibroids. When pregnancy is desired, whether or not infertility is being treated by assisted reproductive technology, hysteroscopic resection in one or two separate procedures of submucosal fibroids less than 4cm in length is recommended, regardless of whether they are symptomatic. Interstitial, also known as intramural, fibroids have a negative effect on fertility but treating them does not improve fertility. Myomectomy is therefore indicated only for symptomatic fibroids; depending on their size and number, and may be performed by laparoscopy or laparotomy. Physicians must explain to women the potential consequences of myomas and myomectomy on future pregnancy. .......

Yours,
Jane


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