My Vote Doesn’t Matter, Anyway: Why Not Caring About Your Reproductive Health Is The Worst Thing You Can Do!

Apathy stinks. No matter what you are apathetic about: your job, your partner, your country’s politics, or your body, it is a major bummer. And while it may seem a long way away, you should not only care about things that affect your world but also things that affect your womb. Unprotected sex can lead to some pretty unpleasant things (a.k.a. sexually transmitted infections—think gonorrhea, chlamydia, syphilis, HIV, and herpes), which can cause some pretty serious damage to your fertility (specifically, your fallopian tubes) down the road.

So, here’s why your vote matters.

Sexually transmitted infections are no fun. But unfortunately, they are sort of frequent. Approximately one in four women will be diagnosed with an STD during their lifetime—and given that many who contract an STD never seek treatment, this number is likely a lot larger. In fact, there are about 19 million new cases reported every year in the United States.

The problem with STDs is not only the possible itching, burning, and oh-so unpleasant discharge but also the long-term effects like chronic pelvic pain, scar tissue, and infertility. Infections like gonorrhea and chlamydia can leave a mark that even the best of treatments can’t erase. However, the earlier you seek treatment, the less the negative impact will be. Therefore, don’t be shy about sharing your secrets with your doctor. We never judge!

While prevention is the key (think condoms), sometimes the door has already been opened—think sex without condoms. In this case, curtailing what could potentially happen next is the goal.

Lesson 1, share everything with your doctor. Make sure we know what you are doing and whom you are doing it with.

Lesson 2, if it is a new partner or one that you are not in a monogamous relationship with, you should undergo STD testing.

Lesson 3, while many sexually transmitted infections don’t announce themselves: “Hello, my name is Chlamydia, and I am here to annoy you,” if you are experiencing atypical symptoms (abnormal vaginal discharge, abdominal/pelvic pain, vaginal itching, or burning and fever), you need to go and get things checked out.

Lesson 4, use your voice to effect change. If you test positive for an STD, make sure to share this with your partner(s). They too will need treatment; you don’t want go into the ballot box on this decision alone. Be vocal about what’s going on with anyone who too is at risk.

Lesson 5, don’t take shortcuts when it comes to your course of treatment. Some antibiotic regimens can be lengthy and can require commitment in the form of a couple of weeks. Finishing what you started in terms of medication is mandatory to make sure you have rid yourself of these unwanted guests.

Lesson 6, while STDs come and go, even those that are treated can leave their mark in the form of scar tissue and tubal damage. Therefore, while we don’t recommend you wake up each day remembering the STD you contracted five years ago, when you start thinking about starting a family, you should consider seeking fertility assistance early in your fertility journey. Making the acquaintance of a fertility doctor early can make the path from potential parent to parent much shorter and smoother.

Not caring about what happens is a bad thing. Your voice and your vagina matter (spoken like true gynecologists!). The decision you make today can affect your health and your fertility in the future. While you may not walk out of the GYN’s office with a sticker that says, “I got tested for STDs,” you will get a clean bill of health.

And although this does not ensure that when you are ready to have a baby it’s smooth sailing, it does increase the chances that things get off to a good start. Giving up on yourself, particularly your health, is not an option. So, get out, and vote for your future. In this election, it’s a victory either way!

No Period, No Problem?

For many of us, that time of the month is filled with moods, monster breakouts, and mounds of chocolate. We dread its arrival and plan our white pants-wearing days around it. However, if you ever or are now missing periods, this “period piece” is timely. Your period (while off hormonal contraception, remember that no period on the pill is a totally different non-alarming situation) is sort of like the sixth vital sign; it provides a lot of information about the health of your reproductive system.

The arrival of a girl’s first period is sort of a big deal. In many cultures, for many centuries, it has marked the transition from girlhood to womanhood. Historically, it indicated the promise of life, new beginnings, and the start of something. While today the pomp and circumstance around this event are much more hush hush, it is still a very intimate moment shared by mothers and daughters.

And despite the unpleasant cramps and cravings, menses does mark the culmination of puberty and the commencement of the reproductive years. So (playing off the graduation theme), when do you order your cap and gown? When will this process begin? The answer, while seemingly simple, is really somewhat complicated.

Your ethnicity, your family history, your genetics, your weight, your living environment (urban versus suburban), your fitness level, and your stress level all play a role regarding when you go through puberty. In fact, even the century that you live in plays a role in the timing of this event. (In the past 60 years, we have seen a decrease in the age at which girls get their periods.) While the arrival of a period is usually abrupt (wow, what is that?!?), the process that brought this to you actually took years. A period marks the end of the process of puberty.

Puberty encompasses many physical changes (breast development, pubic/underarm hair) as well as cognitive and psychosocial changes (sorry, Mom, for all those wild emotional tirades!). While all these things seem to occur at once, there is actually an orderly transition to this process; increases in a hormone called LH and FSH lead to the production of estrogen. Estrogen stimulates the development of breasts. Androgens from your adrenal glands stimulate the production of pubic and underarm hair (oh joy…get out the razor!). Somewhere in the midst of this, all you have a growth spurt, and then ultimately, your period arrives.

For most girls, puberty begins with the development of breasts at around 10 years (range 8–12). On average, from start to finish, the process takes between 1 and 4 years. African-American and Hispanic females, girls who live closer to the equator and in urban areas, girls who are overweight, and girls whose female family members went through puberty early are more likely to start the process at an earlier age. On the contrary, Asian and Caucasian girls, girls who are underweight, girls who are athletic, and girls whose female family members went through puberty late are more likely to start the process at a later age.

Although that first period marks the beginning of a brave new world, one period does not write the entire story. It suggests that the system has been primed but does not mean it is ready to run on autopilot. Now, while it is quite common for periods in the first two years to be irregular (many cycles during this time period occur without ovulation), after this point, they should start to follow some order. This pattern is not only good for wardrobe planning but also for demonstrating the system has matured.

Regular periods offer a visual that the following systems are a go:

1) About two weeks before the period, ovulation (egg release) has occurred (ovaries: check!)

2) A uterus with an open path for the blood to exist is present (uterus: check!)

3) The signal from the brain to the ovaries has been activated (hypothalamus / pituitary: check!)

Medically speaking, the lack of a period is called amenorrhea (for all you Latin buffs, a- in Latin means without, and menorrhea is menses). When a girl has not gotten her period by age 14 without evidence of breast development or by 16 with evidence of breast development, this is called primary amenorrhea (primary because there has never been a period). When a female has had a period(s) and then they stop for whatever reason, this is called secondary amenorrhea. While some processes can cause both, the causes of the two are usually different.

Primary amenorrhea cases require more detective work and are much less common. They are more likely to be genetic in origin, a sign of poor ovarian development, or a uterine-vaginal blockage (septum)…basically, the rarities of medicine.

Secondary amenorrhea is something that GYNs deal with almost on a daily basis. (Trivia question: what is the most common cause of secondary amenorrhea? Answer: pregnancy!) But aside from pregnancy, common causes are polycystic ovarian syndrome (PCOS), thyroid disease, over-exercise, and stress. Although a few months off from Ibuprofen and tampons feels good, you shouldn’t let this go on for very long without contacting your GYN.

Even though the arrival of Aunt Flo just in time for that weekend beach party is no one’s idea of pleasant, it isn’t all negative. Getting regular periods, while sometimes a pain, can be a plus. It shows us that the system is functioning. While there is absolutely no problem with going on some form of hormonal contraception (pill, patch, ring, IUD) and keeping your periods at bay for a vacation or big work deadline, this is VERY different than not getting period while off hormonal contraception.

Think of the reproductive system as an orchestra. The conductor is the brain, and the ovaries, the uterus, and the fallopian tubes are the instruments. So if the periods abruptly stop or never start, the conductor called off sick, or one of the instrument players have gone on strike, it is our job as GYNs to find out who is sleeping on the job and try to fix it! Although it might be easier to play over the group who’s gone, the music won’t sound or come out right. Periods mean something, and if they stop, someone needs to hear about it.

Contraception: When You Just Can’t Comprehend Conceiving

For many, the birds and the bees are as simple as the As, Bs, and Cs. If you have unprotected sex, you are putting yourself at risk for pregnancy (as well as a plethora of some pretty nasty infections). While there will likely come a day and time that seeing a smiley face on the pregnancy stick brings a smile to your face, now is probably not that time. You are career focused. You are education focused; you are you focused (at least for now). We totally get that.

But while you are not ready today, you don’t necessarily want to give that option up in the future and commit yourself to abstinence. We are here to review with you the many reversible forms of contraception that are available, effective, and reliable. (Note that reversible is bolded. We will not be addressing irreversible forms of contraception, a.k.a. tying anyone’s tubes  LINK: Done and Done).  

When you think birth control, two options probably come to your mind first—condoms and pills. And while these are very popular methods, they are not the only ones out there. They require some brainpower and even willpower and therefore are not right for everyone. So here is a list, with the pros, cons, and everything in between on what’s out there (in as few words as possible!). 

  1. Male Condoms:
    • Pros: Cheap, easily available, minimal planning, reversible, protect against STDs
    • Cons: Must be used consistently; applied correctly, can break…
  2. Female Condoms:
    • Pros: You are in the driver seat, no need for a prescription, does not require a fitting, can be placed before intercourse starts
    • Cons: Cumbersome, hard to find, can’t be reused
  3. Oral Contraceptive Pills (OCPs) (known by most of us as “the pill”)
    • Pros: Highly effective when taken correctly, other positive bodily features (decreased risk for ovarian and uterine cancer, goodbye to acne and unwanted hair growth, shorter/lighter periods, less cramps), when stopped periods/regular cycles return pretty quickly
    • Cons: Not highly effective when not taken correctly, many reasons why women can’t take the pill (headache variants, high blood pressure, etc.), does not protect against STDs
  4. Hormonal Patch
    • Pros: Does not have to be swallowed (for all of you who have trouble with pills), does not require daily administration (patch is changed once/week), reversible
    • Cons: Must “make weight” to use this option (women heavier than 195 pounds have decreased efficacy with this option), not ideal in women with sensitive skin or dermatologic conditions, slightly higher risk of blood clots (versus the oral route)
  5. Hormonal Ring
    • Pros: Can be placed in the comfort of your home (and does not need to be sized), more private (not worn like a patch or taken like a pill), offers all the benefits of the pill (decreased cancer risk, shorter/lighter periods, less cramping with your period)
    • Cons: Higher rates of vaginitis/vaginal wetness, requires a prescription, some report feeling it
  6. IUD (non-hormonal = Copper T, hormonal = Mirena, Skyla, Liletta)
    • Pros: Most effective form of reversible contraception, once it’s properly placed in the uterus, it’s pretty much smooth sailing for five to 10 years, does not interfere with the spontaneity of sex, can be used in women who need to avoid estrogen
    • Cons: Must be placed by a medical professional, can be expulsed, “mal-placed,” or broken, strings can get lost and require surgical removal, placement can (in very rare cases) cause pelvic inflammatory disease
  7. Depo-Provera (aka “depo”)
    • Pros: Is taken every three months (does not require daily administration), eliminates monthly menses, can be taken by women who can’t take estrogen (Depo-Provera contains only progesterone), reduces the risk of migraines
    • Cons: It’s a shot, can cause weight gain, can lower bone mineral density, menses can take many months to return
  8. Implantable Devices (Implanon, Nexplanon)
    • Pros: Effective for several years after placement, can be used in women who can’t take estrogen, does not need to be placed before intercourse
    • Cons: Must be placed and removed by a medical professional, often causes irregular bleeding, discomfort/pain at site of implant
  9. Diaphragm/Cervical Cap
    • Pros: Provides contraception without delivering hormones, can be carried in even the smallest of purses! Can be used while breastfeeding, cannot be felt by you or your partner
    • Cons: Requires a fitting, can be difficult for some women to place/insert, can be pushed out by certain sexual positions, not as effective as hormonal contraception
  10. Withdrawal
    • Pros: Can be used in a real bind (requires nothing but commitment!), no medical/hormonal side effects, free, no prescription required
    • Cons: Not really a reliable method for contraception. Simply stated, it’s an ineffective way to prevent pregnancy, requires trust, and is not good for men with premature ejaculation or men who are not sure when to “pull out”
  11.  Rhythm Method (Fertility Awareness-Based Methods = FAMs)
    • Pros: Minimal cost, no medication required, safe, can be stopped at any time
    • Cons: Timing is key (you must be really in sync with your body and know when you are ovulating), not the most effective way to go about preventing pregnancy, there are several days in the month where sex is off (requires a committed partner), no protection from STDs

Birth control, like those who use it, comes in many shapes and sizes. And in almost all cases, one of the shoes fits. While you may never, ever choose to wear a diaphragm or test out the female condom, at least you know what’s out there. Unwanted and unplanned pregnancies happen, sometimes even while using contraception. But by utilizing a form of birth control that works for you, you can dramatically reduce the chance that it will happen to you. While we fully support a night out at the casino, we do not recommend gambling on the possibility of pregnancy. Unlike the blackjack table, here, the risk is not worth it.

Will the Eggs I Freeze Make a Baby?

Of all the questions we wish we had the answer to, “Doctor, will these eggs make a baby one day?” is at the very top of that list. But despite our white coats, our medical degrees, and our fancy instruments, we don’t know it all. We actually aren’t even close to knowing it all, especially when it comes to egg quality. Currently, we have really no way of looking at an egg, even under a microscope on high-power magnification, and knowing its potential.

Will it make an embryo that will be ready for transfer (ET), or will it barely survive the subsequent thaw? Will it result in a baby, or will it barely make it past the fertilization stage? Unfortunately, we still have no good way of predicting this. Therefore, while we can give you percentages based on your age, your fertility history, your family history, and your ovarian reserve, we can’t give you definites.

If you choose to egg freeze, you should be aware of this. You should be comfortable with the notion of possibilities, potentials, and perhaps—because in reality, this is all that any fertility MD can really give you.

Before a woman chooses to egg freeze, she will most likely meet with a fertility specialist to talk about the procedure, both in generalities and in particulars. What the overall process is like, what to expect on a day-to-day basis, and what the recovery period is like: these are the “generals.” As a result, you will get a lot of general answers.

Following this, your doctor will probably personalize the generals and add the specifics based on you, your medical/GYN history, your family history, and your ovarian reserve. Based on all of these factors, we can give you a projected response to the medications (a.k.a. how many eggs will you get). And this is the important stuff, the info you really need to know. Speaking in broad terms is nice, but it isn’t super helpful. You want to know how you will feel, how you will react to the medicine, and how this will determine your chances of having a baby in the future. Make sure you get this. Even if it’s speculative, it’s better than simplifications.

So if we can’t answer your burning fertility questions, what does egg freezing teach you? Is it even worth doing? (You could do a lot of good online shopping with that money!) So here’s what it for sure teaches you:

  • You have eggs.
  • How you will respond to fertility medications.
  • Your ovarian reserve (we measure hormones like FSH and AMH to get an idea on how to dose the hormones).
  • You are a tough cookie to take shots every day for several days—and you are a proactive, no-nonsense woman in the know for even asking these questions about your fertility future.

But with all the good it does, what it won’t tell you is if those eggs that you made will make a baby or the answer to your huge question: am I fertile? Fertility is one’s ability to conceive. And unless you are out there trying, we can’t really tell if you are fertile or infertile. Even women who respond poorly to fertility medications, make only a few eggs, and have abnormal ovarian reserve testing (low AMH or high FSH) can be fertile. We’ve seen it many times!

Don’t let the number of eggs you make in an egg-freezing cycle make or break your baby-making future. It could mean very little.

So while your eggs are a potential insurance policy, they are not your guarantee. Don’t look at eggs like babies because they are not; they are only just the beginning. We promise we aren’t Nelly Negatives or Debbie Downers. There are no bigger fans of egg freezing and reproductive choice then us at Truly, MD. We believe women should have options when it comes to their bodies, particularly their gametes (a fancy word for eggs).

But we are also big fans of honesty, transparency, and truth. You should know the truth about what egg freezing can tell you and what it can’t. It can’t give you complete clarity about your reproductive future, but it can give you choice. It can’t give you answers, but it can give you options. It can’t give you a slam dunk, but it can give you a shot. And even one shot can be the winning point.

Does Breast Pain Always Mean Something Bad?

Although there isn’t a moment in our lives that “the girls” aren’t by our side (or rather on our front), on most days we are unaware of their presence. Sure, we have the daily AM bra conversation with ourselves…what color, what material, strapless vs. racer-back, but in reality we spend a very modest amount of time paying attention to our breasts. This is except when one or both starts to hurt.

Breast pain makes us say, hmm, what could that be? And while most of the time our mind goes to that scary place, the majority of breast pain is totally benign. Let us unveil the A, B, C, and Ds (and maybe even the double A or double Ds) of breast pain with these basic facts.

A: Breast pain is one of the most common reasons women visit their GYNs.

B: The medical term for breast pain is mastalgia.

C: The easiest way to figure out what is bothering your breasts is to break out your calendar. Pain that moves with your menses (a.k.a. changes throughout the menstrual cycle) is considered cyclic. Cyclic breast pain is almost always caused by hormonal changes. Pain that comes on any calendar day (a.k.a. is constant) is considered noncyclic. Noncyclic breast pain is almost never caused by hormonal changes.

D: There are other structures (think of your muscles and your ribs) that are “roomies” with your breasts. Their close proximity to the breast can often masquerade as breast pain. So problems such as trauma to the chest, a fracture of the ribs, herpes, reflux, inflammation of the cartilage connecting the ribs, and angina make one think one’s breasts are in big-time trouble—when in reality they are nothing more than innocent bystanders!

Getting into the nitty gritty of it (or the double As and Ds as we like to say), hormonal or cyclic breast pain can occur from any medication that is either made from or modifies your hormones. Think OCPs (or any form of hormonal contraception), fertility medications, and medications used to treat abnormal vaginal bleeding.

When it comes to noncyclic breast pain, hormones are not the issue. While the breast is involved, the pain has nothing to do with your period. Think of things like trauma, infection, cysts, tumors, and cancers. Therefore, non-cyclic breast pain, specifically when it is in one breast, is intense, and is getting worse, makes us a bit more nervous. It definitely needs to be checked out.

In most cases, pain prompts a physical exam and an in-person chat: when did the pain start, what makes it better or worse, how often does it occur, and what where you doing when you felt it first? Depending on what these initial evaluations show, your doctor may decide to send you for a mammogram, a breast ultrasound, and/or an MRI. But because most breast pain winds up being no big deal (not cancer), the best thing to do is take a deep breath: it will very likely be okay. After this, it is not a bad idea to consider changing your bra (more supportive, better fitting) and changing your diet (less salt, caffeine, and fat). These modifications might just do the trick.

When nothing works, you may need to move on to medications. Starting an OCP or changing your OCP can help alleviate cyclic breast pain. Additionally, lowering the dose of a hormonal medication can also be helpful. Last, if the pain is non-cyclic and related to the muscles of the chest, an anti-inflammatory like Ibuprofen or Advil can certainly do the trick.  

Your breasts are sort of a big deal, no matter what size you are. And when they don’t feel right, you want to look into what’s making them hurt. While the pain is most likely from normal hormonal ebbs and flows, this is not a tide you should just watch roll in and roll out. Go looking for the lifeguard (your GYN) to make sure you weather this storm safely. It may be a pain (no pun intended), but it will keep you and your breasts protected.

Forever Young? Egg Freezing

How many of you can remember playing superheroes when you were a kid? Running around with your friends zapping, ka-powing, and bamming the bad guys was a fairly typical afternoon in the life of a child. Whether you were Wonder Woman or Super Girl, you probably kicked butt (and was pretty good at concocting the most awesome of superpowers).

Fast-forward nearly 30 years. Although you probably don’t play superheroes anymore (although we wouldn’t judge if you did!), if given the chance to have a superpower, we bet you could come up with a pretty long list. As fertility specialists and women who know how hard it can be to fit in careers and baby making, our greatest superpower would be to stop the inevitable biological clock: the decline in egg quality and quantity that happens as you age.

From the moment you make your debut into this world, it’s a downhill process. And for years, there was nothing anyone could do about it. Your ovaries didn’t really care what you ate, where you lived, and if you exercised—they were like a typical teenager (headstrong and independent). They just kept on going in a downhill fashion. And while they still don’t care, we have found a way to instill some discipline into them.

Cue egg freezing. While egg freezing has been around for nearly 30 years, it didn’t become mainstream until about five years ago. Around this time, it gained serious popularity and notoriety. With research, data, and the American Society of Reproductive Medicine (ASRM) removing the experimental label from egg freezing, more and more women signed up for the procedure. Nowadays, the press and social media are all over egg freezing. And taking it one step further, some companies now even cover the cost of egg freezing (e.g., Facebook, Apple)—its become pretty prevalent.

Why, you may ask, are women electively shooting themselves up with hormones, waking up at the crack of dawn for vaginal ultrasounds, and having a needle put in their vagina? All good questions…and here’s why. Because egg freezing may save your fertility and your chance of having a genetic child. The eggs you store today may make you a mother in the future when egg quality and egg quantity have taken a serious downturn. Nothing, with the exception of egg freezing, can halt the decline of ovarian reserve that occurs over time.

Although pregnancy, polycystic ovarian syndrome (PCOS), thyroid disease, too much exercise, eating disorders, and the pill may show your periods the red light, they will do nothing in terms of stopping the loss of eggs. The only thing that can show this process the yellow light is egg freezing.

If you want to freeze your eggs, don’t let fear about how long it will take you and what the process will do to your body and mind hold you back. All in all, egg freezing is a pretty quick and painless process (we need no more than about two weeks of your life before we can get those eggs into the freezer). Yes, you will need to give yourself shots. Yes, you will need to cut back on your exercise. Yes, you will have some transient weight gain, and yes, you will need to set your alarm an hour or so earlier than usual. Overall, though, it’s pretty tolerable.

Most women start the injectable fertility medications on day two or three of their period. The shots are administered twice a day for usually about 10 days; their primary job is supposed to help your body produce multiple follicles (a.k.a. eggs). Think of the shots as the gas fueling the development of the eggs present in your ovaries at the start of the menstrual cycle. They get them all going. But we can only put in as much gas as the tank will allow; if your starting antral follicle count (a.k.a. AFC) is 10, more medication will not make more eggs.  Your baseline, or AFC, is a measurement of your underlying reserve. Simply stated, those with more will have more eggs retrieved; those with less will have less retrieved. Here, there is no funny math.

However, while a car needs fuel to get going, we don’t want to overfill the tank. The same goes for the ovaries and the dose of fertility hormones. Too high of a dose can be dangerous and can result in overstimulation. Too low of dose will keep you idling in the parking lot. For this reason, your doctor will probably want to see you every other day for ultrasound exams or blood checks to make sure that your ovaries are running but not racing.

Once the follicles reach a certain size (usually about 17–19 mm), and the estrogen level is at a specific peak (we like to see about 150–200 pg/mL of estrogen/follicle), you will likely be instructed to take your “trigger” shot. This shot is either human chorionic gonadotropin (hCG ) (brand names: Novarel or Ovidrel) or Lupron (or a combo of both). It will prepare the follicles/eggs for the final stages of development needed to achieve maturity (remember only mature eggs can be fertilized in the future). The eggs will be extracted (a.k.a. retrieved) vaginally. That means a needle will puncture the vaginal wall, enter the ovary/follicle, and out comes the egg within the follicular fluid. The whole procedure takes no more than 20–30 minutes, although to you it will feel like seconds (this is the part you will be sleeping for). When you open your eyes, most will be relaxing in the recovery room snacking on graham crackers and apple juice. On occasion, the pain can be severe, but this is definitely not the norm!

Unlike most things that sit in your freezer, your eggs never really go bad. They can remain frozen until you are ready to defrost them; there is no expiration date. And while their Ice Age can be long, it’s important to remember that at some point you may no longer want to be pregnant. While women can carry pregnancies well into their forties and even fifties, the complications do increase as women age. This doesn’t mean that you have to freeze and thaw ASAP, but it does mean you need to make a personal timeline about when they will be used.

Although the sperm thing may seem like a problem, don’t let this part stand in your way.  Your eggs can be fertilized with partnered sperm or donor sperm—it’s totally up to you. In either case, the eggs will be thawed and inseminated in a process called ICSI (intracytoplasmic sperm injection). The resulting embryos will be grown in the laboratory, and the best embryo (s) will be selected for transfer about five days later. Any remaining high quality embryos can be frozen for future use.

Although egg freezing is good, it’s most certainly not perfect and is in no way a guarantee. It is not even a really good insurance policy. The success rates after egg freezing are never better than about 50–55% (and this is in women less than 35 years old). In the over-40 age group, it’s really no greater than about 15%. We say this not to bum you out but to bring reality to the situation. Egg freezing is expensive and a commitment. So before you drop some serious dough and time, you should know what you are doing and how much it can do for you. Egg freezing is a big decision—your doctor should go through it in detail before you sign on the dotted line.

While we may still lose to villains, we are getting stronger and stronger each day. Not only are more women choosing to freeze their eggs, but even more importantly, more women are also becoming aware of what will happen to their fertility, particularly their eggs, over time. Beating the “bad guys” is way more about brain power than muscle power—if you know what you are fighting, you will be able to devise a pretty awesome plan to beat them. Freezing your eggs may not be one of your weapons, but knowing about the process and the process of egg loss will ensure that you are not a victim of a surprise attack.

Mother Knows Best: Your Reproductive History

As much as we hate to admit it, it’s hard to find many things that our moms were wrong about. From the most basic (eat your veggies!) to the most complex (bad boys will always break your heart!), their words of advice were thoughtful, poignant, and basically spot on. But it’s funny that, no matter how much we talked and shared with the woman who gave us life, the sordid details of her menstrual cycle, her fertility, and her menopause are all too often taboo subjects. When did you get your first period, did you have trouble getting pregnant, did you suffer multiple miscarriages, and when did you go through menopause are questions that over half of our patients have never discussed with their mothers. When asked, they stare back blankly, and together we attempt to piece together a timeline of events based on when their mother was shouting, “I’m too hot, I’m too cold” multiple times a day.

Much of what dictates the timeline of reproductive life (first period to the last period) is unknown. Why some women go through menopause at 30 and others at 60 remains in many ways a mystery. Sure, women who are given certain types of chemotherapy or have multiple surgeries on their ovaries will frequently have a shortened “reproductive life,” but for most women who experience the premature stop, we don’t have good answers to the question of why. As frustrating as this is for the patient, it can be in many ways equally as frustrating for us as doctors. We, like you, want answers. Not knowing why something happened can often make the experience even harder to deal with.

Here’s what we do know. We know that a large piece of the reproductive life timeline puzzle can be answered by genetics. Genes inherited from your mother will frequently dictate your personal reproductive path. Because of this, when we see a girl who is late to have her first period or a woman who appears to be going through an early menopause, we ask detailed questions about the family history, specifically the female members of the family. We can often find reassurance (in a girl who is late to get her first period) or an answer (in a woman who is having an early menopause) when we put a microscope to the women on your family tree.

Despite major strides in genetic testing, most of the genes that make us who we are, particularly our ability to reproduce, still elude us. But while we may not know exactly what genes are controlling how fast our eggs disappear, we do know that how it all went down for your mom, your grandmother, and your older sisters is important. Simply stated, if your mom had menopause before the average age (~51), you should know about it, and you should consider doing something about it. In fact, research has shown us that we tend to have a pretty hard time getting pregnant about 10 years before our mom went through menopause.

So let’s do some math; if your mom had an early menopause at 45, you may have some serious fertility issues at 35! (Remember, menopause is defined as one year without a period.) If you ask your mom and she remembers mood changes, irregular cycles, and hot flashes starting at 45 but her last period was at 50, her menopause was at 51 (get it?). The fun and wonderful changes associated with menopause (aka the peri-menopause or menopausal transition) can actually go on for several years before the real hammer (menopause) is dropped.

It’s safe to say that, in 10 years, our knowledge about the genes that code for reproduction will be vastly different from what we know today. Genetics is the fastest growing field in medicine; long gone are the days of Mendel and his fruit flies! Pretty soon, you might know more about yourself (and your future children) than you even dreamed (or desired) possible. We don’t want to go all Pandora and her box on you, but remember that, with discovery can come disappointment. So while we all wish to know more about ourselves, some information can be hard to swallow.  

But here’s the simple take-home message: we can’t predict a whole lot about what will happen to your ovaries just by looking at you. But we can predict a lot by talking to you. Start the conversation with your mom, your sister, and your gynecologist early. Know your own body as well as what happened to your mom and grandmother’s body. Whether you look like your mom or not does not dictate whether your insides do. If you want to plan for your reproductive future, the best person to seek advice from is your mom. Once again, she knows best.

While much of what dictates the timeline of a woman’s “reproductive life” (first period to the last period) and a woman’s fertility is unknown, many of these answers are in our genes (aka what happened to your mom or your grandmother may very well happen to you).  What we don’t know today about the genes that dictate fertility (specifically egg quantity and quality), we will likely know in a few tomorrows. Genetics is the fastest-growing field in medicine.