Tampons after PID and difference between a period and withdrawal bleeding

[heatherette2.livejournal.com]

Hi All,

I recently saw a new OB/GYN who after finding out that I had PID (pelvic inflammatory disease) 10 years ago advised me not to use tampons anymore. I used tampons prior to having PID and have used them since without issue. Has anyone else been told to stop using tampons after PID? If I've been fine for 10 years post PID (my PID was NOT caused by an STI). Is there really any risk to continue?

Also, can someone please explain the difference between a period when not on HBC and a withdrawal bleed when on HBC? I was trying to explain it to my boyfriend only to realize part-way through my jumbled, semi-explanation that I didn't really know...

Thanks!!

Comments

[herloved-beauty.livejournal.com]

A period: The shedding of the lining of the uterus, brought on by a natural cycle of hormone levels decreasing, and then increasing again to stop it. Also, in a real period, there is an ovum (egg) present. The other difference is that you have ovulated.

A withdrawal bleed: The shedding of the lining of the uterus, brought on by a hormone drop by starting the placebo pills instead of continuing the hormone pills. There is no ovum present, you have not ovulated.

They are similar, but the pill uses the "drop in hormones" to mimic the body's period. It is not medically necessary to have a "withdrawal bleed"

[rikkitsune.livejournal.com]

Yes, this, that's pretty much perfect. I'll just add something I learned in high school biology which helped me a bit. Excuse my clunky language.

Your hormone levels increase during your cycle, and the lining of your uterus gets thick and juicy and cushiony, because if there is a baby, it needs something it can easily attach to.

Mid cycle, your ovaries release an egg, which travels down the fallopian tubes into your uterus where it sits and waits for sperm to come and fertilise it.

After a certain period of time and no fertilisation, the egg 'expires' and hormone levels decrease. The thick juicy cushion begins to break down. When you have your period, it it your uterus expelling the expired egg and the broken down uterine cushy stuff. The cramps are contractions of the uterus flushing everything out.

Then your cycle resets and it all starts again.

When you're on HBC, it releases hormones that trick your body into thinking it's pregnant. Therefore, you have thick cushy uterine walls all the time, and your ovaries don't release any eggs for ovulation, because they think there's a baby in your uterus.

When you have your HBC free week, the drop in hormone levels makes the cushiony stuff break down and flush out. The cramps aren't as bad because it isn't a natural period. If you go over seven days of placebo, your ovaries start waking up (as someone very clever here said) and realising that you're NOT pregnant.

Hope that helps!

[misspaigeb.livejournal.com]

"When you're on HBC, it releases hormones that trick your body into thinking it's pregnant."

That is not true at all. HBC makes your body think it is in the luteal phase (the phase after ovulation.) It does not make your body think it's pregnant. The ovaries do not release eggs because they think they already released one.

"The cramps aren't as bad because it isn't a natural period."

Where did you hear that? My cramps are very bad on HBC and off.

[rikkitsune.livejournal.com]

Well right-o, I shall bow to your superior knowledge. Just what I learnt in school.

And as for the cramps, I was speaking from my own experience, guess I should have been more specific.

[archangelbeth]

Mid cycle, your ovaries release an egg, which travels down the fallopian tubes into your uterus where it sits and waits for sperm to come and fertilise it.

Actually, no. The sperm travel up the fallopian tubes and -- usually -- wait for the egg to pop out. Sperm can live up to several days, especially in the fallopian tubes, and eggs only live 24 hours. (The possibility of a second ovulation a day later means the "fertile window" is 48 hours, if trying to avoid pregnancy.) If an egg isn't fertilized before it hits the uterus, it's probably going to disintegrate shortly after.

To elaborate on misspaigeb's thing about HBC/pregnancy... The whole HBC=fakepregnant thing is a confusing "simplification." The high levels of progesterone start just after ovulation, normally. Progesterone (also or alternatively spelled progestin; I have not yet tracked down a definitive distinction between the two spellings) keeps the uterus from shedding the lining, until the corpus luteum (the part of the ovary where the egg popped out that time) deteriorates. When pregnancy happens, hCG -- the true pregnancy hormone -- is produced, which tells the corpus luteum, "Keep making more progesterone!"

So while it's true that the high progesterone mimics the levels found in pregnancy, it's more true that it mimics the post-ovulation hormone levels, and "makes your ovaries think they just ovulated" means fewer questions about, "If I'm on HBC and my body thinks it's pregnant, then a pregnancy test won't work for me, right?" Because pregnancy tests look for hCG, and are not affected by HBC at all! (They are affected by certain fertility drugs that contain hCG, though.)

I suspect the "makes your body think it's pregnant" is what doctors said way back when because too many of them didn't want to explain ovulation and hormones to the Silly Little Wimmens. (Or possibly the Silly Mens Who Think Biology Is What Grows In Their Fridge, too.) O:p

[rikkitsune.livejournal.com]

Cool. Like I said, I'm happy to bow to superior knowledge on this topic. 8)

[kuradi8.livejournal.com]

If you "shouldn't" use tampons, can you use cups instead?
http://community.livejournal.com/menstrual_cups/1285963.html

[heatherette2.livejournal.com]

I've tried cups but haven't been able to find one that fits my body in a comfortable way.

[archangelbeth]

To add to the difference:

When you have a real period, the time you are bleeding is when you are least likely (as in, it's nearly impossible) to be ovulating.

When you have a withdrawal bleed, the same drop in hormones that triggers the uterus to bleed is letting the ovaries wake up. So don't go more than 7 days without those hormones, even if you are still bleeding, because there is the potential for ovulation if you do. (And you have to have had 21 days, or more, of active pills to make sure the ovaries will be hypnotized for that week.)


As for the tampons? I would seek a second opinion. It may indeed be a risk increase, but the amount of risk may be small enough that you're willing to take it. Or else ask the doctor to cite her research! I'm always up for looking stuff up online. *grin*

(*pause* HOLY CATFISH! Tampons have antibacterial properties?? http://www.ncbi.nlm.nih.gov/pubmed/6403199 , http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1046145/pdf/brjvendis00008-0020.pdf , http://www.ncbi.nlm.nih.gov/pmc/articles/PMC1046017/pdf/brjvendis00014-0035.pdf )

I did find some 1978 letters to the editor, for some doctors' magazine, that seem to believe that tampons serve as a "breeding ground" for bacteria, potentially, and that inserting them (or the strings? it's a little unclear in the letter) can get bacteria from the anal area into the vagina.

That's, um, 1978, and is the only place I'm seeing this particular theory.

[paraxeni.livejournal.com]

Yeah, I seem to remember something about a certain string+body composition that was a perfect storm for the development of nasties, but was rapidly discontinued. Using any modern tampon according to safety guidelines (clean hands, never in anticipation of bleeding, never for non-period/withdrawal bleeding, never to soak up discharge, following the time limit in inserts, as low an absorbency as possible) the chance of problems, regardless of past vaginal history, is very rare. I'd ask for a second opinion too OP.

[archangelbeth]

It was the wicking-of-bacteria-up-into-the-uterus string on the Dalkon Shield that, combined with its pointy, badly-designed "working" part (that could embed itself in the uterine lining), that pretty much single-handedly ruined the reputation of IUDs for a generation or two, I think.

Wouldn't be surprised if there were similar issues for tampons in the past!

[paraxeni.livejournal.com]

Oh yeah knew about that, but there was a type of tampon that was recalled for being unsafe too. I'll go through my archives!

ETA- here<s one http://en.wikipedia.org/wiki/Rely_(brand) I think it was KoTams (by kotex) that were connected with revised safety warnings due to cases of TSS involving them. They had no string, just a wrap made of gauzey netting that was a cover and pull-cord in one.

[archangelbeth]

The thought of a gauzy netting possibly scratching up the vagina, and very probably holding/wicking bacteria up into the scratched up parts, makes me cringe even more than most tampons make me cringe.

(Mmm, research! O:D )

[heatherette2.livejournal.com]

Antibacterial properties?! Who knew??

[helenkacan.livejournal.com]

And, yet, in ancient memory (um ... from the 1970s), I remember the theory being that wearing a pad was a sure highway for anal bacteria into the vagina. I guess they were promoting tampons as a more hygienic alternative.

[heatherette2.livejournal.com]

Thanks everyone for your help and clarifications! I think I will seek another doctor opinion re the post PID tampon thing.