View Full Version : Lupus or menopause
12-04-2006, 03:31 PM
I have just dropped from 10mg of Prednisone to 5mg and also taking 400mg of Plaquenil. I started my menstrual cycle 3weeks ago and still bleeding and clotting. I went to my PCP and she just prescribed birth control pills to regulate the cycle. I haven't taken them yet I'm waiting to see my rheumatolgist tomorrow. I have never experienced an irregular period and can't help wondering whether this is Lupus related. Has anyone experienced this?
12-04-2006, 04:10 PM
Lupus has been known to cause menstral irregularity, such as menorrhagia (heavy bleeding), amenorrhea (no menstrual bleeding), bleeding between periods, and missed cycles. The exact mechanism for this is not known. Also, many women report that their symptoms of Lupus get worse during their menstral cycle. So, to answer your question, yes, it could be due to your Lupus.
There are other reasons that could cause this irregularity, here is a web site that gives explanations for some of the other reasons:
Peace and Blessings
12-04-2006, 04:17 PM
Thank you sooo much! I have to go to the doctors with the facts or else you will get shrugged of as "no big deal". That site was very helpful.
12-04-2006, 04:22 PM
I forgot to add, after I did a web-search there were many articles related to Lupus and menstrual irregularities. I hope this helps others.
12-04-2006, 04:34 PM
Anicnan, birth control pills can be a problem for some patients with lupus, especially if you have phospholipid antibodies (includiing cardiolipin antibodies and lupus anticoagulant), have any history of blood clots, or if you are a smoker. Any of those things can increase your risk of developing blood clots while taking birth control pills. So it's a good idea to discuss it with your rheumie to make sure you don't have any risk factors for clots.
12-06-2006, 04:46 PM
I am so thankful for this web-site. I went to my rheumotologist armed with information regarding heavy bleeding and Lupus. He had never heard of the correlation. He told me to take the birth control and see a gynecologist. He didn't deal with the dizziness I'm having at all. He said continue taking 5 mg. of prednisone and the plaquenil. Even when I told him that the bleeding started when I reduced the prednisone from 10mg to 5. He said it was no relationship. I'm still bleeding, afraid to take the birth controls because I'm clotting and can't get a gynie appt. until tuesday. I am soooo frustrated and angry. I get more information on the internet than I do at the doctors.
12-06-2006, 06:10 PM
Anicnan, I do not want to frighten you, but heavy or prolonged menstrual bleeding and resulting blood loss can cause anemia, which can cause fatigue, dizziness, shortness or breath, and even fainting. So if you are having new onset dizziness, this might mean that your blood count is getting too low. Did your rheumatologist check your blood count when you went to see him? If your period lasts longer than seven days, or you are saturating a pad or tampon per hour for more than six hours - this is considered "heavy" bleeding.
I know your PCP prescribed the birth control pills, but did she do an exam or any type of labwork first, or just write the prescription? Is there any possibility that you could be pregnant? Because if so, you need to see a doctor right away, not next Tuesday. If there is any way possible to move your appointment up - you need to do so. You might try calling the GYN and asking if a nurse practioner or physician's assistant can see you on an emergency basis - many offices have them and it is often easier to get an appointment that way. And if you are having abdominal pain that feels different from your normal menstrual cramps, or you feel dizzy or weak when you stand, please go to the emergency room. If there is any possibility of pregnancy, an ectopic pregnancy needs to be ruled out. You also need an ultrasound exam to rule out an ovarian cyst or uterine fibroids (benign growths in the uterus), which can cause heavy or prolonged bleeding. And you most certainly need your blood count checked. Lupus can cause low platelet counts, which can also cause prolonged menstrual bleeding.
What can also happen with steroids is a condition called anoovulation, or failure to ovulate. The ovulation process is complex, and failure to ovulate one month can cause you to have an extremely long, heavy period the next month. Steroids like prednisone can cause this, so can thyroid deficiency, and a condition called polycystic ovarian syndrome. So all possible causes for your abnormal bleeding need to be ruled out.
Be sure you aren't taking any aspirin or medicines that contain salicylates (the OTC medicine Pepto-Bismol, and herbal medicines that contain white willow bark are salicylates) - these can also prolong bleeding time.
To try to reduce the bleeding until you can get into the doctor, you need to stay off your feet as much as possible and rest with your legs elevated. Ibuprofen is a prostaglandin inhibitor which will slow the bleeding some, so you can try taking this. It is available as a generic over the counter medicine, or as advil or motrin. Most OTC ibuprofen is a 200 mg. tablet or capsule, so take 200 mg. every four to six hours - this will reduce the amount of menstrual flow. Even if you feel bloated, it's important to replace the fluids you are losing through your period because low blood volume can cause dizziness. So drink extra fluids, but be sure to get some salt as well so your sodium levels don't get too low. A cup of bouillon or tomato juice will provide fluids and salt. Extra vitamin K and vitamin c may also help stop or slow the bleeding - you can get these through food or supplements (vitamin C, 250-500 mg and vitamin K, 100-250 mcgm should be safe and may be worth trying).
You also need to replace the iron you are losing through your constant blood loss - good food sources of iron are red meat, egg yolks, dark green vegetables, and dried fruit like raisins. This will reduce your risk of developing iron defieincy anemia.
Please contact the gyn. tomorrow and try to get your appt. moved up, and don't be embarrassed to go to the ER if you feel worse. And REST!
12-07-2006, 03:18 PM
Great information as usual, but I have a bit of a correction today. Ibuprofen should NOT be used to help reduce bleeding. Ibuprofen is a non-steroidal anti-inflammatory drug (NSAID). This entire group of drugs can prolong bleeding times. It is true that ibuprofen is an effective inhibitor of the biosynthesis of prostaglandin as is aspirin and in fact they are roughly equipotent in this action. Because of this they both alter platelet function and prolong bleeding time. In addition, NSAIDs can cause gastrio-intestinal erosions (ulcers) which would obviously cause more bleeding. Ibuprofen is generally better tolerated than some of the other NSAIDs, but should definitely be avoided if you are having bleeding problems. If you are already taking a prescription NSAID, avoid taking over the counter NSAIDs because the risk of ulcers and bleeding increases dramatically. OTC NSAIDs include ibuprofen (Motrin or Advil) and naproxen (Aleve). *both of these products are in the propionic acid derivative group of analgesic-antipyretic and anti-inflammatory drugs if anyone wants to research them in more depth* Acetaminophen (Tylenol) is completely unrelated to aspirin and the NSAIDs and can be safely taken for fever or pain without affecting bleeding. Acetaminophen should not be taken at doses greater than 4000mg / day as it can be toxic to the liver at higher doses.
Again, thanks to Marycain for provideing such a wealth of wonderful information.
12-07-2006, 04:16 PM
Actually, my gynecologist is the one who told me to take ibuprofen to reduce my menstrual bleeding, which used to be very heavy and prolonged because of endometriosis, but only the 200 mg. dose. Because my mother had a history of stroke, she told me that birth control pills were a high risk, and that ibuprofen was the first line treatment for menstrual bleeding when non-hormonal treatments are preferred. My PCP said essentially the same thing. That's why I suggested it as a stop-gap until Anicnan could get into her doctor. Obviously as a pharmacist, you are much more aware of the safety considerations, probably more so than the doctors, but ibuprofen is a recognized drug treatment for menorrhagia. You're certainly right about the dangers of long term use - I think when I wrote the post I was more concerned about the menstrual bleeding since I'd had similar problems with endo. And I should have asked if she was already taking prescription NSAIDS because of the potential for double-dosing.
I cut and pasted the information below from the University Of Maryland Medical Center Patient Education handout on heavy menstrual bleeding, because their site is usually well-researched.
Nonhormonal Agents. The use of nonhormonal agents is an appropriate first choice when the menstrual cycle is regular.
The first options are nonsteroidal anti-inflammatory drugs (NSAIDs), with reported reductions in menstrual blood loss of 25% to 35%....
Nonsteroidal Anti-inflammatory Drugs (NSAIDs). Nonsteroidal anti-inflammatory drugs (NSAIDs) block prostaglandins (the substances that increase uterine contractions). They are effective painkillers and also have other properties that act against inflammatory factors that may be responsible for heavy menstrual bleeding. Studies suggest that they reduce bleeding by 30% to 50% and are the first choice for most women who experience heavy menstrual bleeding. Aspirin is the most common NSAID, but there are dozens of others available over the counter or by prescription. Among the most effective NSAIDs for menstrual disorders are ibuprofen (Advil, Motrin, Midol PMS), naproxen (Aleve, Naprosyn, Naprelan, Anaprox), and mefenamic acid (Ponstel).
In one major 2002 analysis, NSAIDs were equally or more effective than oral contraceptives or progestins. (They weren't as effective as tranexamic acid or danazol.) For maximum benefit, they should be taken seven to 10 days before a period is expected. It should be noted, however, that long-term use of any NSAID can increase the risk for gastrointestinal bleeding and ulcers. In fact, one 2001 study of women with iron deficiency anemia reported that overuse of NSAIDs for menstrual disorders contributed to the anemia.
According to MedLine Plus, the NIH patient information site, "...Ibuprofen or another prostaglandin inhibitor is often prescribed. Ibuprofen is also available in lower dosages (Advil, Nuprin) without prescription."
Anicnan. I hooe you are doing better today.
12-07-2006, 09:05 PM
Yes, I see now why you recommended it. In that context it does make sense. Hope we have not confused any of ya all in the whole scheme of things. Thanks again!
12-07-2006, 10:23 PM
That's why it's so great you're a pharmacist - many of the doctors I deal with on the job are remarkably UNinformed about drugs, even the ones they are prescribing. I'd say at least 40% of the malpractice cases I evaluate are medication -related. Some are honest errors or unpredictable reactions - others are just unforgivably stupid and careless, like an ER doc giving a demerol injection to a patient taking parnate, then compounding the error by not recognizing a life threatening drug interaction. It's hard to believe any doctor could make this mistake, but I guess they don't teach the Libby Zion case in med school. And too many doctors are reluctant to open a PDR in front of a patient. As patients, we're so desperate to relieve the symptoms that we are willing to risk the chance of side effects just to get relief. So it's a good thing the pharmacists know their stuff - sometimes they are the only protection a patient has got! :)
12-13-2006, 12:07 PM
Since my initial post I have seen three doctors. All giving me different information. MY PCP gave me birth control fto regulate the bleeding, my rheumie told me to see a gynecologist because it was not lupus related. The gynecologist prescribe progestrone for 10 day and gave me a vaginal biopsy which was very painful. He stated that steroids could cause the irregular bleeding and doesnot work well with birth control. I was also anemic from all the loss of blood and taking iron pills. The good news is after 32 days of bleeding, I have finally stopped. The disconcerting part is who do you trust with your health. I t seems as if no one really knows what is going on.