Late period after taking prednisone: Medication That May Affect Your Menstrual Cycle

Medication That May Affect Your Menstrual Cycle

Many different medications can affect the menstrual cycle. In this article Consultant Gynaecologist Mr Pisal explains how medications can effect cycle regularity, period pain and stop periods altogether. However, it is always important to consider other causes of menstrual irregularities such as pregnancy or polyp. So if your symptoms are unexpected or troublesome, please see your GP or gynaecologist for an assessment.

Oral Contraceptive Pills:
The ‘pill’ usually has a positive effect on the menstrual cycle. It makes the cycle regular and periods less heavy and less painful. Hence, the pill is often used as a therapeutic intervention for conditions such as endometriosis, heavy or painful periods. Occasionally taking the contraceptive pill can lead to break-through-bleeding between periods.

Aspirin:
Aspirin in theory can increase the amount of bleeding during a period, but in practice this effect is minimal. It is also not particularly effective at reducing the period pain.

Ibuprofen:
Ibuprofen is excellent for reducing period-related pain and does not affect the amount of bleeding.

Antipsychotic and Anti-Depressant Medication:
This type of medication can sometimes lead to absent periods or infrequent periods with longer a menstrual cycle (35 days instead of 21 days for example).

Weight Loss Pill:
A sudden change in weight can also affect menstrual cycle. Diet pills are known to cause irregular periods. A body fat percentage less than 17% can also affect menstrual cycle and lead to a lack of periods (as in many Olympic athletes).

Chemotherapy:
Chemotherapy can lead to premature menopause and hence no periods. But sometimes the ovaries can recover and periods can resume normally. Your doctor will often recommend that you see a fertility specialist before starting chemotherapy if you wish to preserve your fertility.

Steroids:
Steroid medications such as prednisolone can affect periods and make them irregular, prolonged and sometimes heavier. This is usually after long-term use of steroids.

Other forms of Contraceptives:
Contraceptives other than the oral pill can also affect the menstrual cycle. The non-hormonal intrauterine devices (IUD, Copper-T) can lead to bleeding between periods. Whereas hormonal IUDs (Mirena or Jaydess) secrete a small amount of progesterone within the uterine cavity and will often lead to lighter and less painful periods. Sometimes the periods are completely blocked. Irregular bleeding in the first few months is also a common side effect. The injection pill, implant and minipill all contain progesterone and often lead to absence of periods. Irregular unpredictable bleeding is a known side-effect.

Make an appointment

Although different kinds of medication have been found to affect the menstrual cycle, if you are experiencing any symptoms or abnormalities which you are worried about, don’t hesitate to contact your GP or gynaecologist, or give us a call on 0207 10 11 700.  At London Gynaecology, we have locations at The Portland Hospital and at our new opening in the City of London.  To book a consultation please email our team on [email protected] or call the number above.

Prednisone Side Effects in Women – Adverse Effects in Females

Sometimes it feels like we have too much progesterone or too much estrogen or too much testosterone than it normally would. That is the foundation for understanding all of the other things that happen throughout the rest of this article.

How Does Prednisone Affect Women?

 As a woman, you might be wondering how will prednisone affect me? Prednisone affects women differently than men in these ways:

• The side effects can be on female-specific issues.
• Women get different mood issues than men.
• Women have different effects on their hair.
• Women’s bones affected more than men

What are the prednisone side effects in women?

We’ll start with the female issues. Females are the only ones who menstruate and who can get pregnant or do breastfeeding. We’ll go into each of those in depth next:

• Changes in Breasts: bigger, smaller or tender
• Menstrual Changes
• Pregnancy
• Breastfeeding
• Hair
• Mood Swings
• Changes in Female Hormones
• Bone Loss

Changes in Breasts

Women that report when they’re gaining weight because of prednisone that it makes their breasts get bigger. Other women find that their breasts shrink while on prednisone. Even other women report having more tender breasts than usual.

Menstrual Changes While on Prednisone

• Dysmenorrhea
• Amenorrhea
• Postmenopausal Bleeding

Essentially anything can happen to your period while on prednisone. You can have dysmenorrhea, which is when you have painful or extra bleeding, or longer periods than usual.

You can have amenorrhea, which means you go without having a period.

Can I have Postmenopausal Bleeding on Prednisone?

Finally, you thought you were done. You thought you were out of the woods, that you were in menopause and then prednisone gives you postmenopausal bleeding!

Now with everything I say in this article, clearly you can’t have all of these happen to you. You can’t have dysmenorrhea and amenorrhea at the same time. This doesn’t happen to everyone. None of these happen to everyone. And they’re not that common.

All of these female-specific prednisone side effects in women mentioned are relatively rare side effects that people experience. My purpose in this article is for you to understand that you’re not alone, that these adverse effects to prednisone are possible as a female. You’re not going crazy. You’re not suddenly going back into perimenopausal bleeding. It’s just the prednisone!

Does Prednisone Cause Menopause?

Feeling like you’re going through menopause, even if you’re not, is possible. I am clearly not in menopause (way too young!), but I felt like I was going through that change because I had hot flashes, sweats, and mood swings. I had that beautiful red flushing of my cheeks and chin.

Check out this picture of me with no make up, no filter or editing so that you can see my red hot flashes from prednisone!

As you can tell, I have no makeup on, I’m not using a filter of any kind. That’s me, the real deal with nothing else.

I was clearly having hot flashes and it was no fun!

Is Prednisone Safe During Pregnancy?

Another female issue: pregnancy. So a lot of women are worried, “Can I take prednisone while I’m pregnant?”

The drug companies have this tiny little asterisk saying that there’s a slight risk of cleft palate in the first trimester.

While this is true, usually if somebody is taking prednisone, the benefit of taking prednisone far outweighs the tiny, tiny, tiny risk of cleft palate. And because of that, the doctors who take care of pregnant women, the American College of Gynecologists (ACOG) say that “Prednisone is the recommended drug to treat certain diseases in pregnant women. ” So if they think it’s worth it, then I agree with them. They’re the experts.

This is from the ACOG Clinical Guidance, in which they call prednisone a “Low-Risk Medication:”

Low-risk medications typically are continued in pregnancy, or initiated during pregnancy as needed, because the benefits of therapy and disease control far outweigh any theoretic risks associated with the medication.

Glucocorticoids

Glucocorticoid preparations are commonly given during pregnancy, both as maintenance therapy and in short “bursts” to treat disease exacerbation. Oral corticosteroids, such as prednisone, prednisolone, or methylprednisolone, are recommended during pregnancy because of their conversion to relatively inactive forms by the abundance of 11β-hydroxysteroid dehydrogenase found in the human placenta 7. Long-term glucocorticoid treatment during pregnancy may increase the risk of hypertension, preeclampsia, weight gain, hyperglycemia, immunosuppression, gastrointestinal ulceration, prelabor rupture of membranes (also referred to as premature rupture of membranes), and intrauterine growth restriction, but if these risks exist the magnitude is not known 8 9 10 11 12. Early data suggested that first trimester exposure to glucocorticoids may be associated with an increased risk of fetal oral clefts 13, but more recent data have failed to demonstrate an association 14 15.

There might not even be a risk of cleft palate according to this!

Is Prednisone Safe While Breastfeeding?

What about breastfeeding while on prednisone? I actually had to deal with this when I was prescribed high-dose prednisone. I was nine months into feeding my fourth child. And I was surprised that I was being prescribed prednisone. So I actually had to look it up to make sure prednisone was safe while nursing my baby.

I recommend that every woman who is breastfeeding and is questioning whether their drug is safe while they’re pregnant, download the LactMed app. It’s written by the United States National Institutes of Health (NIH). It gives really great information about what drugs do, what has been reported about the drugs in lactation. LactMed said that:

Amounts of prednisone in breastmilk are very low. No adverse effect have been reported in breastfed infants with maternal use of any corticosteroid during breastfeeding. With high maternal doses, the use of prednisolone instead of prednisone and avoiding breastfeeding for 4 hours after a dose theoretically should decrease the dose received by the infant. However, these maneuvers are not necessary with short-term use. High doses might occasionally cause temporary loss of milk supply.

And so I said to myself, “Great! I will take that prednisone so that I will not bleed to death.”

They had me staying in the hospital and I was away from my baby. It was really rough trying to figure out how to get that milk to my baby. The nurses were fantastic and they helped me succeed in continuing to breastfeed, even though I was hospitalized. What I didn’t realize was that next bullet right there, I kind of skimmed over that a little too fast, where it said:

High doses might occasionally cause temporary loss of milk supply.

So the first time I was on prednisone, I was on a high dose. The following week I was on a drug very similar to prednisone called dexamethasone. And I was on incredibly high doses. I’m talking 10 pills a day of the highest strength for four days (40 mg of dexamethasone). That’s like 267 milligrams of prednisone! I was on that for four days and it completely shut down my milk supply. I was surprised that I couldn’t give my baby any milk.

It shut it down! I had to stop breastfeeding. It was very sad.

Will Prednisone Harm my Baby if I Take it?

The American Academy of Pediatrics says that prednisone is compatible with breastfeeding.

So the doctors who take care of the babies say that mamas can be taking prednisone while they’re breastfeeding. So I feel pretty good about that. If the doctors that take care of the babies say it’s okay for breastfeeding and the doctors that cake take care of the mamas say, it’s okay for pregnancy, then I agree with both of them.

Moving on to other prednisone side effects in women and how it differently affect us differently than men.

Mood Swings

Psychiatric Side Effects of Prednisone in Women

• Female > Male
• Females > depression
• Males > mania, delirium

So they’ve noticed with mood side effects, things that are psychiatric, that women tend to have more depression.

Men might have more mania or delirium. Women generally have more psychiatric side effects than men.

So men might take prednisone and be like, “eh, it wasn’t that bad.”

Then a woman takes it and feels like she’s going crazy! But it’s not her; it’s the medicine. So you are not going crazy. The medicine is giving you a side effect.

Hair

This question comes up tons “can prednisone cause hair loss?”

And it seems rather controversial because there’s not a lot of evidence in the literature about this, but essentially yes, prednisone can cause hair loss. For me, personally, I lost a third of my hair after I stopped taking prednisone. I finished prednisone in June. Then from August to September, every time I washed my hair I would lose an entire brushful of hair.

It was amazing; shocking to me. It’s been a year since then, and now my hair is growing back. There’s this strange thickness at the top and then where it’s thinner at the bottom.

So yes, alopecia or hair loss can happen from prednisone. It doesn’t tend to be bald spots like when you cure with chemotherapy or an entire lock of hair falls out, it’s more like thinning.

It’s more, you lose the thickness of your hair, but the thickness will come back.

All right, then hirsutism, that’s a fancy word. That means facial hair. Women will talk about peach fuzz or bigger sideburns than usual or having to shave their face for the first time ever. And that is related to that testosterone. Both of those, both of these hair issues are related to the testosterone hormone changes because of prednisone.

Female Hormones

Another person posted recently on the Facebook support group, asking if prednisone could cause testosterone levels of zero, and yes, that is possible. If things like that are happening, you can supplement; your doctor can prescribe hormone replacement. You can give back testosterone as a cream, injection, or pill.

You can also give back female hormones if they’re too low. So you could go on birth control pills or female hormone replacement if they are being lowered by the prednisone.

Bones

All right, finally bones. This is by far the most important side effect in women to me.

Prednisone is leaching calcium from bones. Everyone on prednisone should worry about this, but the people who should worry about it the very most are postmenopausal women. Women who have gone through menopause and are taking prednisone have a much higher risk of osteoporosis than any other population.

That’s why every single postmenopausal woman on prednisone taking over 7. 5 mg should be taking calcium and vitamin D daily.

It’s because it can lead to osteoporosis! The most terrible form of bone destruction from prednisone is avascular necrosis, which is bone death! And this person’s x-rays, you can see here, they had to have their hip joint replaced because of avascular necrosis, which is terrible!

Prednisolone – what you need to know about taking this drug

Most often in non-medical circles it is called a steroid or glucocorticoid, many people think that this is a very dangerous drug and are very reluctant to agree to treatment with this drug.

But for certain diseases, it is prednisolone that is considered an obligatory and necessary drug of first choice in the treatment of a disease (for example, nephrotic syndrome, which you can read about here).

We are not talking about the drug itself and for what diseases it should be prescribed, but our information block about what doctors usually forget when they prescribe prednisolone. Usually, children come for a consultation while taking prednisolone in combination with asparkam. Believe me, hypokalemia (decrease in the level of potassium in the blood), in connection with which asparks are prescribed, is not the most common complication when prescribing prednisolone.

In our practice, almost 90% of patients receiving this drug are diagnosed with nephrotic syndrome.

Prednisolone is prescribed for a long period of time (the full course of therapy before the drug is discontinued may last 6-12 months), additional drugs must be prescribed to prevent the side effects of prednisolone. They are:

1. In order to protect the mucosa of the upper gastrointestinal tract (esophagus, stomach, duodenum), prednisolone may cause indigestion, nausea, vomiting and more serious complications such as steroid ulcers. However, all this can be avoided by taking the so-called – gastroprotective drugs (i.e. Protection of the stomach in literal translation). These are antacids (eg Maalox, phosphalugel, etc.), H+ pump blockers (eg Omeprazole), drugs that improve the motility of the gastrointestinal tract. All doses of drugs are selected individually according to age and body weight.
2. Bone protection. Long-term use of steroids can cause a decrease in bone mass, so-called steroid osteoporosis (bone thinning) can develop, which ultimately leads to bone fractures. But this condition can also be prevented, it is necessary to take calcium and vitamin D preparations . The dose of drugs is also selected individually.

Other things to watch out for:

1. Mandatory blood pressure monitoring
2. Observation of an ophthalmologist: control of vision, the state of intraocular pressure and the lens of the eye.
3. When taking prednisolone for a very long time, check blood glucose levels.
4. State of mental health. Children very often become capricious, sometimes even aggressive. This condition resolves on its own after discontinuation of the drug.
5. Watch your weight and diet. Against the background of taking prednisolone, the appetite increases very much. However, you, as a parent, can control the nutrition of your child, it is necessary to limit the intake of easily digestible carbohydrates.
6. In order to monitor and evaluate the effectiveness of gastroprotective therapy, the mucous membrane of the upper gastrointestinal tract is assessed by – EGDS (gastroscopy).

This information has been prepared by an employee of the department (pediatrician) for informational purposes only. It is necessary to consult with your doctor.

If you have any questions or suggestions about this topic, we are happy to answer questions and accept your suggestions.

Side effects of steroids

Side effects of steroids

Listed below are some of the most common long-term side effects of high-dose steroids in growing children. It is important to note that different patients may have different reactions to steroids. The key to successful steroid treatment is being aware of the potential side effects and working to prevent them. Reducing the dosage of steroids is necessary when the development of side effects is intolerable for the patient and inspires concern in the doctor. If the development of side effects cannot be corrected by reducing the dose or changing the regimen of taking the drug, then it is recommended to abandon the course of steroid treatment as a whole.

• Side effects of taking steroids
• Comments and recommended observation
• Questions to address and discuss with your therapist

• General and external, Weight gain, Obesity
• Dietary advice should be given to all families before starting steroid therapy. It should be noted that steroids increase appetite.
• Nutrition must be balanced to prevent weight gain. Follow diet and nutrition recommendations for the whole family.

• Cushingoid signs (moon face)
• The fullness of the face and cheeks becomes more noticeable over time.
• Careful adherence to a dietary regimen, limiting sugar and salt intake should help control weight gain and minimize cushingoid symptoms.

• Increased hairiness (hirsutism)
• Medical examination.
• The occurrence of this effect is not a sufficiently serious reason to refuse a course of steroid treatment.

• Acne, ringworm, papillomas
• More common in adolescents.
• Get a special treatment (temporary treatment) and do not rush to change your steroid regimen.

• Slow growth
• Monitor the patient’s growth at least every six months (usually DMD patients are not tall, even those who are not on steroid therapy).
• Ask your son if he is worried about his short stature. If you are worried, discuss with your doctor the need for an examination by an endocrinologist.

• Delayed puberty
• Development monitoring. Find out about a family history of late puberty.
• Discuss the issue of puberty. Ask your son if he is worried about delayed puberty. If your son is concerned, discuss with the doctor the issue of examination by an endocrinologist.

• Adverse behavioral disorders (here you will find many recommendations on this topic)
• Determine initially: general mood, temperament, attention deficit hyperactivity disorder. Keep in mind that all of these parameters may experience deterioration temporarily for the first 6 weeks of steroid therapy.
• Consult a psychologist before starting steroid treatment if the child has behavioral problems. Changing your prednisolone regimen later in the day may help. Discuss this issue with your doctor.

• Immunosuppression / adrenocorticosteroid deficiency
• Be aware of the increased risk of infectious diseases and the need for timely treatment. Inform all medical personnel that the child is taking steroids and carry an individual patient record with you. Make sure you don’t stop taking steroids. It is very important that a patient on permanent steroid treatment does not allow pauses in taking the drug for a period of more than 24 hours.
• Get vaccinated against varicella before starting steroid therapy; If vaccination is not performed, in case of accidental contact of the patient with patients with chickenpox, you should immediately consult a doctor. If there is a threat of contracting tuberculosis, special monitoring may be necessary. Discuss with your doctor what to do if you have to stop taking steroids, such as replacing prednisone with an equivalent if deflazacort is temporarily unavailable, or whether you need an IV during an illness or nutritional deficiency. Discuss intravenous loading of methylprednisolone for surgery or underlying disease. Use droppers for parenteral nutrition.

• High blood pressure
• Blood pressure measurement at every clinic visit.
• If you have high blood pressure, limit your salt intake and aim for weight loss. If this does not lead to the desired result, then the doctor should prescribe ACE inhibitors or beta-blockers.

• Impaired glucose tolerance
• Urinalysis for glucose with rapid test with impregnated substrate. Consult a specialist for frequent urination or increased thirst.
• Blood tests may be needed if urine glucose levels increase.

• Gastritis / gastroesophageal reflux
• Watch out for reflux symptoms (heartburn).
• Avoid non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, naproxen. To eliminate the symptoms, you can take specific medications and antacids.

• Peptic ulcer
• Abdominal pain may be due to damage to the gastric mucosa. Get a fecal occult blood test if you have anemia or a history of aggravation.
• Avoid NSAIDs (aspirin, ibuprofen, naproxen). Medications and antacids should be taken symptomatically. Seek advice from a gastroenterologist.

• Cataract
• Annual eye examination.
• If cataract develops and affects vision, consider switching from deflazacort to prednisolone. Seek advice from an ophthalmologist. Cataracts should only be treated if there is visual impairment.

• Osteoporosis (bone demineralization) and increased risk of fractures
• Note any history of fractures. An annual bone density test (DEXA) is recommended. Annual analysis of the level of vitamin D in the blood (ideally at the end of winter). With a decrease in its level, add vitamin D3. The doctor should assess the intake of calcium and vitamin D.
• Vitamin D supplements may be required depending on blood levels. After 3 months of treatment with vitamin D, recheck the level of vitamin D in the blood. Aerobic exercise may help. Make sure you get enough calcium in your diet, otherwise special supplements may be needed.

• Myoglobinuria (Urine color is brown, because it contains breakdown products of muscle proteins.