“Irregular Periods” – with Dr. Aren Gottlieb

Dr. Aren Gottlieb talks about regular periods, which she defines as a period that is consistent over time, whether it be every 20 days, every 40 days, or somewhere in between. She and Dr. Fox explain Oligomenorrhea, the medical definition of irregular or inconsistent periods, and common causes and treatments for this issue.

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Dr. Fox: Welcome to today’s episode of “Healthful Woman.” A podcast designed to explore topics in women’s health at all stages of life. I’m your host, Dr. Nathan Fox, an OB-GYN and maternal-fetal medicine specialist practicing in New York City. At “Healthful Woman” I speak with leaders in the field to help you learn more about women’s health, pregnancy, and wellness. 


All right, Aren Gottlieb, welcome to the “Healthful Woman,” podcast. I’m so glad we finally wrestled you into coming on. 


Dr. Gottlieb: I know. It’s been a long time. Thanks so much for having me. 


Dr. Fox: You’re an OB-GYN and you practice here at Carnegie Women’s Health. And we go way back, obviously. 


Dr. Gottlieb: Yes. Way back. 


Dr. Fox: Way back. Aren was one of my chief residents. As I started my career in OB-GYN you taught me, and then we practiced… 


Dr. Gottlieb: You were also my student, when I was a resident and you were a medical student. 


Dr. Fox: It’s a good point. 


Dr. Gottlieb: I had to prepare for you. You were like super ready, eager to learn. And I had these other students who weren’t so eager to learn and you were like, on the ball. 


Dr. Fox: That’s code word in resident for I was the annoying one. 


Dr. Gottlieb: No, no, no. Like, I was like, “Oh, my goodness, I have to prepare for Dr. Fox.” 


Dr. Fox: Well, Aren did win a massive teaching award as a resident. So it all worked out. It’s all good. So just so our listeners know more about you just briefly, like, where are you from? How’d you get into medicine? How did you choose OB, you know, open ended question. 


Dr. Gottlieb: Open ended question. Okay, I grew up in Baltimore, Maryland. And then I never thought I would go into medicine. But if I look back, I probably had little things of, sparks of going into medicine or some sort of science field, because in college, I actually…one of my jobs, summer jobs was to…I worked in a hospital because it paid well, but it was taking dead bodies to the morgue. 


Dr. Fox: Oh, dear. All right. 


Dr. Gottlieb: Lovely. Also those some other fun things that I had to do. But in college, there was a flyer, this is like pre-cell phone day, pre-computer… 


Dr. Fox: Right. Prehistoric. 


Dr. Gottlieb: Prehistoric, right? Like, so there was a flyer saying, “Are you interested in going to medical school in New York City, spend the summer and we will pay you to learn about medical school?” 


Dr. Fox: Wow, that’s a good deal. 


Dr. Gottlieb: Yeah. And so I applied because I was like, “Who doesn’t wanna live in New York City for a summer?” 


Dr. Fox: Right, who was paying people to learn about medical school? 


Dr. Gottlieb: Mount Sinai had a program called The Humanities and Medicine Program. 


Dr. Fox: Right. 


Dr. Gottlieb: I applied. And it was for people who were not majoring in pre-med. And I got to spend the summer in New York. I got to hang out and see what being in the medical field was like. And I took classes during the day, explored New York City in the afternoon and evenings. And I was like, “This is something I really like,” the constant changing environment of medicine, right? So you get to go in, you get to see patients. You get to learn about them, research them. And there are many different things that you can do clinically. And I thought that was really neat and fun. So then I was like, “Well, I’ll try it and see, and I’ll go to medical school for one year.” And then I was like, “Oh, I like it, and I’ll go again.” 


Dr. Fox: I’ll come back. I’ll come back. 


Dr. Gottlieb: And I just kept going. I like never kind of just said I would do this, but somehow I just did. 


Dr. Fox: Then you’re graduating. 


Dr. Gottlieb: And then I was like, “Oh, my goodness, now what am I gonna do, I have to pick a residency?” And I really liked a lot of things. So I thought, well, I like surgery. I like the constant moving and different types of patients. But I didn’t like the one and done kind of aspect of surgery where you meet a patient once and then they’re…you fix them or you do something and then they’re gone. And in OB-GYN, you get to have long-term relationships with your patients, but you can also do lots of procedure oriented things. And to me that worked out beautifully. 


Dr. Fox: Yeah. And then stayed at Mount Sinai all the way through. 


Dr. Gottlieb: Stayed at Mount Sinai all the way through. 


Dr. Fox: True and true. Yeah, I mean, a lot of people have that experience that OB-GYN gives them that opportunity people like to operate, but they don’t wanna really be general surgeons. And just because it’s a different flavor. It’s a different relationship you have with the patients. And some people love that I come, I fix a problem, and I leave. It’s the most satisfying thing for them. And others are like, “I wanna fix problems. I wanna operate. But I wanna stay with this person for many, many years.” And a lot of them gravitate towards fields like OB-GYN. 


All right, excellent. Well, here we are. And we’re gonna be talking today about irregular bleeding or irregular periods. Everyone’s different. So what do we put in the brackets of regular just so we understand what’s outside of regular or irregular. 


Dr. Gottlieb: Most girls and young women start menstruating around the age of 12. It can be a little bit earlier, it can be a little bit later. And the first couple years, they may not have a “regular period.” But when you read a book or a textbook, it says, “Every 28 days,” well, 28 days it really could be somewhere in the average that they’re getting a cycle that is consistent, so maybe 20-something to 40-something days. And if it’s consistent over a time, that’s considered a normal period, and that would be regular. 


Dr. Fox: And then, irregular, there’s also a lot of terminology that’s out there. And it is somewhat confusing. For example, irregular period, people mean different things by that. So then there’s something called Oligomenorrhea. And these are really weird terms, because no one understands them except doctors, but Oligomenorrhea sort of means irregular, inconsistent, sort of all over the place, or fewer, mostly in the fewer side, when we say irregular, not too many, but not enough. 


Dr. Gottlieb: Most people think of Oligomenorrhea as if they’re menstruating less than, I guess, six to eight times a year, or if it’s something’s changed. So I think a lot of it is, what is your normal period? And then what caused it to change? Is it something that we should investigate? Or is it, hey, you stopped menstruating because you’re pregnant, and you want it to be, or you didn’t want to be? There are a lot of things to check off in terms of in evaluating, is something out of the ordinary? 


Dr. Fox: Right. And it seems to me that there’s really like three categories for why someone would be concerned or wanna look into irregular, unusual sort of patterns of bleeding. And the first simply just for many women, it’s annoying, right? It’s just annoying. It’s not predictable. They don’t know what’s going on. And it’s not something that they want. And so just that reason alone is worthy of investigation. The second is, if someone’s trying to get pregnant, then it makes it very difficult to time, you know, “Am I ovulating? When I am ovulating? Can I get pregnant? Can I not get pregnant?” And that’s sort of maybe a little more serious of a concern. 


And the third is, occasionally, it’ll indicate a real problem that needs to be addressed. Obviously, not always, sometimes it’s nothing but in that, it could be that. And when you see women who have irregular periods, what are most women complaining about, is it the first that they’re just annoyed. The second that they’re trying to get pregnant. Or the third that they’re worried that there’s like a real problem going on? 


Dr. Gottlieb: I think most people just wanna know that it’s okay. 


Dr. Fox: Right. That it’s not number three. 


Dr. Gottlieb: It’s not number three, right? So they come in. And once you kind of realize that it’s not number three, and you take…the most important thing to do is really just take a full history, you want to see what they were calling normal, and now what they’re not calling normal. And you wanna investigate what changed in their life, did they start taking a birth control, and somebody didn’t tell them that, “Hey, you know what? A lot of times, you can take birth control, and you can have irregular bleeding just from being on a birth control pill,” or, “that you may not bleed at all when you’re on a birth control pill, depending on what type of birth control you’re taking.” Or, you have to make sure they’re not pregnant, you need to make sure that they haven’t lost a lot of weight or gained a lot of weight. And did that throw them off? Have they been sick? So, many different things. And then you can kind of tweak out and do a physical exam as well to see if there’s anything that’s causing…that structurally could be causing irregular bleeding. 


Dr. Fox: Right. I think what you said before also makes so much sense about what was regular for them. And how is it different because for example, some women will have a period every, let’s say, 30 days, every month or so. And then if they say, “I’m having irregular bleeding,” what they mean by that is, “I’m bleeding in between my period,” like it’s a 13, 14, 15, 16. And for them that’s irregular, but they’re still getting their, “regular periods.” It’s just additional bleeding. And for other women, we actually call that Metrorrhagia, which is a horrible word, but that’s what it is. And there’s other women who they’re like, “All right, I still get my period every 30 days, but now they’re really heavy, compared to before,” which we call Menorrhagia. 


Dr. Gottlieb: Where they last long. 


Dr. Fox: Right. They last longer. And we basically use these terms just to confuse people and make us sound smarter than we are. But that’s another way some people will refer to irregular but as doctors, we think of that much differently, right? If someone says their period is irregular, but what it means is they’re spotting between their periods, we sort of look at that very different from someone who says, “I used to get a period every 30 days, and now it’s every 40 to 90 days,” which is just totally separate issues. And so that history of what exactly we’re talking about and mapping it out is so relevant and so important. And so for women who are concerned about their periods, it’s really important to keep track of it, whether actually on paper, like write down exactly what’s going. 


Dr. Gottlieb: Right. Now there are lot of apps. 


Dr. Fox: Yeah. Or an app, right. Now that we are…we’re not pre-historic anymore. 


Dr. Gottlieb: Pre-historic, right. So it’s all about the app. And I think the app, really, the app is great, but people actually have to write down what they mean. So you can’t just write bleeding, you have to be specific and say, spotting or bleeding out of sync to their, what they were calling regular period, and how much, and any other associated symptoms that they were having. 


Dr. Fox: Let’s address each of those separately. So let’s say a woman comes to you… Let’s say someone comes to you and they’re having regular periods, the same frequency interval between them, but now they’re heavier and lasting longer. So what we said before is like menorrhagia or heavier periods. So what would you be thinking in terms of that? Like, what’s likely going on? Or what kind of tests would you do, or what would you be concerned about potentially? 


Dr. Gottlieb: So, one of the things you think about is, is there a…first of all, I think age is really important, and we’re gonna discuss that. 


Dr. Fox: As you and I get older, we’re like age is really important, age is critical. 


Dr. Gottlieb: Age is very important. When you’re talking to a younger person, and every day everybody’s getting younger than I am. So a younger person, it’s more common to have hormonal fluctuations, that can cause a disruption in your cycle that can cause you to bleed longer, and then you’ll just regulate. And so someone, a teenager, or someone who is probably under 35, it’s not as worrisome if they’re having a longer cycle once in a while, or if they changed a medication and that can cause them to have a change in their cycle. But routinely, when somebody is having menorrhagia, one of the things that you want to look at is the structural problems, are they having any fibroids, or polyps, or you also wanna think about any hormonal problems, but for the most part, structural in a younger person. 


Dr. Fox: You suspect someone might have something structural, like a fibroid or a polyp. How do we assess that? 


Dr. Gottlieb: So again, you’ve taken a history and you find out many people have fibroids are a structural problem, but you want to find out if it’s actually significant to them. So you can ask a family history because fibroids tend to run in families. You could do a bimanual exam and to feel the size of the uterus, is it increasing in size from what you would expect? And we can do an ultrasound. And here at Carnegie Women’s Health, we have a technician and sonographers here all the time. So that’s fantastic. And it’s easy. And then from there, if we do detect something structural, we can assess, is it impacting the lining of the uterus, which can cause the bleeding. And so we can offer patients either a saline ultrasound where we infuse a little bit of saline into the cervix into the uterus, it kind of blows up the uterus like a little balloon. And we can see if there’s a polyp or there’s a fibroid abutting the lining of the uterus. The other option will be to do something like a hysteroscopy, where we put a camera inside the cervix that allows us to look inside the uterus and take a look and see if we see a polyp or a fibroid. And we can also remove, at that point, we can remove the polyp and we can do a biopsy of the uterus as well. 


Dr. Fox: Yeah, I mean, for women who have just heavier cycles, it’s rarely anything dangerous. I mean, unless they bleed so much that they become anemic, but it could be troubling to them or annoying. And it really breaks down either they have something there structural, in which case it’s quite satisfying, because you see it and then you can easily remove it and then they’re cured. And it’s not a complicated operation. Everything is through the hysteroscope, which is from below so there’s no incisions, no stitches. 


Dr. Gottlieb: Right, down time is really pretty insignificant. 


Dr. Fox: Right. I mean, you’re talking the day of, or a half day, and you’re basically at work the next day. And if there’s nothing there structural, then either it’s gonna, like you said, either just get better on its own or potentially someone can…there’s hormonal birth control pills or whatever. That’s the majority of it for heavy periods. Occasionally, there’s something that we see that could be concerning, that’s really the exception. What about women who bleed in between their periods? So they have regular cycles, so to speak, every month or so. But in between they get light spotting or a little bit of bleeding, is it the same type of issues or is it tends to be a little bit different? 


Dr. Gottlieb: You still wanna do the same things. You wanna take a look. Do you wanna inspect the cervix? Is there a little polyp on the cervix that’s causing an issue? Again, you would do an ultrasound, or a hysteroscopy, or a saline ultrasound, to look for something inside. But a lot of times, again, it can be…it’s either structural, or it can be just some hormonal or nothing. I mean, a lot of women tend to spot around the time they’re ovulating. And that’s normal. And so we have to differentiate, we just need to make…a lot of times what we do is make people feel comfortable with what’s normal for their own bodies. 


Dr. Fox: Right. No, and that’s really important. Because sometimes, you’ll check and just to make sure there isn’t a polyp on the cervix. Again, those aren’t dangerous, but okay, if that’s what it is, we could remove it. 


Dr. Gottlieb: We can remove it. 


Dr. Fox: And then you won’t have that anymore. Or maybe there is a polyp inside the uterus and the same thing, all right, so we can remove it, and you won’t have it anymore. But it’s, just to reassure if there’s something else, if they’re due for a pap smear, should have a pap smear. And these are just sort of basic things. But it’s unusual that when women come to us with these concerns that we’re worried that there’s something terrible going on. You’re just like, “All right, let’s just make sure there’s nothing unusual.” And if there’s something that’s “fixable,” then we’ll take care of it. And that’s really it. Obviously, and we had this discussion on a different podcast, but we’re talking about younger women. For postmenopausal women who aren’t getting their periods at all, totally different concern, right? 


Dr. Gottlieb: That’s a different concern. Right. 


Dr. Fox: Because they shouldn’t have any bleeding and so that’s a different concern. 


Dr. Gottlieb: And that needs to be seen. Patients should be seen immediately, and have a workup and still most of the time, thank goodness, it actually isn’t anything serious. But we wanna make sure. 


Dr. Fox: Right. Exactly, because sort of the list starts to include things that could be more concerning… 


Dr. Gottlieb: Right, you wanna rule out your endometrial cancers first, and then… 


Dr. Fox: Right, exactly. Okay. So now let’s talk about women who have truly irregular cycles, meaning it’s not every 28 days, they’re now coming sort of irregularly irregular. One month, it’s 30 days, then it’s 50 days, then it’s 40 days, then it’s 72 days, and then it’s 3 months. And so those women. 


Dr. Gottlieb: So those women, most likely, it’s something that’s off in their hormonal pathway, okay. And so we can try to figure out what that is. And we can do some blood work and we make sure that everything still is right, so their pituitary can be off and they could have a high prolactin, their thyroid could be off. And then of course, we’re talking about even higher up in the hormonal pathway, their hypothalamus could not be secreting the GnRH, appropriately. And so there are many different ways and many different treatment options. So if someone’s GnRH, or their hypothalamus isn’t working properly, that could be because of stress, it could be because of anorexia, because even if they’re not anorexic, and really trying to lose weight, they’re very thin, and they just can’t gain the weight. And that could cause them to have irregular periods. 


Dr. Fox: Right. This is a traditional like the gymnast, or the track runners or people maybe are exercising. 


Dr. Gottlieb: They are eating, and they’re doing all the things they’re supposed to, they’re just exercising too much for them, I could exercise a little more. 


Dr. Fox: And it’s not necessarily unhealthy to exercise to the point, but for some women, their body’s just more sensitive to it. 


Dr. Gottlieb: Correct. So in that scenario, you either if they have an eating disorder or if they don’t they, maybe working with a nutritionist or exercising a little bit less, or working with a specialist in terms of eating disorders, if that’s what’s going on. So there are ways to fix that. And then, do they have a prolactinoma, and do we need to do imaging of their brain and see if they have a mind mass that’s there that could be causing them, we can treat them to decrease their prolactin. The other thing is, are their ovaries not producing the estrogen or progesterone that it needs to? Or are they producing too much testosterone? I mean, those are the things that we all kind of look at. And then in terms of treating, if it’s something that we can fix hormonally or even if they’re…we have to figure out also what the goal is, is it to give the patient regular periods or is it to try to help them conceive? And those are two different pathways. 


Dr. Fox: Right, the fact that women get, or most women get regular cycles is a complex process that involves a lot of hormones and feedback loops and regulation in the body. It involves various parts of the brain and the ovaries, and there’s all this that gets included. And if there’s anything that goes off, it can affect your cycles. And it’s like you said, it sort of depends, like, what is going off and what might fix it. For some women, they’re gonna have irregular periods and low estrogen. Other women will have irregular periods and high estrogen. It could sort of be all the above. And so there is an evaluation you do either by history, by hormone levels, and then the treatment, okay. But again, there really is…we have to ask her, “What are we trying to do here?” Because if someone is perfectly healthy, and everything is fine, and she just has irregular periods, and it doesn’t bother her, and we think she’s ovulating. Then fine, okay. Unless she wants regular periods, but if she’s trying to get pregnant, it might be difficult. And I think that that’s one of the main sort of breakpoints, right? Because if she’s not trying to get pregnant, and she wants regular periods, very easy… 


Dr. Gottlieb: Very easy. 


Dr. Fox: There are certain hormonal treatments, or just put her on a birth control pill, and she’ll get regular periods. And there is some advantage to getting regular periods, aside from the sort of, regularity and the convenience of it, that if women are not getting their period regularly, for a specific reason, where they’re not ovulating, there actually is some risk associated with that. 


Dr. Gottlieb: There’s some risk to it. And it also can, at some point, when they do end up having a period, we tend to see it go into a lot longer, or a lot heavier periods, so back to that menorrhagia that we were talking about. 


Dr. Fox: Right. And that’s interesting, because when women have, “their period,” what that means to them is they’re having bleeding, right? But there’s actually different reasons the uterus is gonna bleed, one of which, like in a typical cycle, so to speak, which happens with the correct hormones doing the right things at the right time, sort of the lining builds up with estrogen, then progesterone comes and it all goes away, and then all that comes off, and that’s what’s sort of predictable. But if they’re not ovulating, they just have estrogen, estrogen, estrogen, estrogen, without progesterone and then when they bleed, it’s not because the whole lining comes off. It’s usually because various parts of it start to bleed and that’s why it’s so irregular, but those are the women who sometimes come to the emergency room like with crazy heavy bleeding, which is actually dangerous. And on top of that, some of those women are at increased risk of developing sort of a pre-cancer of the uterus, because it’s always building up and never breaking off. So that’s like what we’re thinking in our end. You know, we’re not thinking… 


Dr. Gottlieb: Right. Again, we wanna always make sure that we rule out the most dangerous things. And even though they’re very uncommon, we like to just take care of that. 


Dr. Fox: Right. So for us, we’re like, “All right, I gotta make sure that that’s not going on.” And if it is, it’s still very easy to…it’s easy to treat. 


Dr. Gottlieb: It’s easy to treat. 


Dr. Fox: But that’s sort of like one way. But if it’s not going on then, okay, let’s just, you know, “Does this bother you? Does it not bother you?” We’ll go there. And that’s, again, for someone who is not trying to get pregnant. For someone who is trying to get pregnant, it’s a little bit different. And how is that? 


Dr. Gottlieb: You cannot control them with hormones that will inhibit them from ovulating, you wanna make them ovulate, and you wanna make them ovulate on a regular cycle so that they can conceive. You still may need to use hormones to induce ovulation, but we’ll need to do a full workup as to what is causing their irregular bleeding. 


Dr. Fox: It’s really interesting, because the easiest treatment for all this is a birth control pill, because that’ll basically, almost whatever the issue is, that’s gonna “fix it” because her cycles become regular. If she doesn’t have enough estrogen, it’ll give her estrogen. If she has too much estrogen, it’ll actually ironically, make it better, right? So it really works, wonderfully, but the one thing you can’t do is you can’t get pregnant. And so if someone does wanna get pregnant, that’s when it gets, not tricky, because there’s things we can do. But there are medications you can use to induce ovulation, which will make her ovulate, and there’s different kinds, and there’s different, you know, pluses and minuses to them, and not so much risks, but sort of consequences. The risk of twins or triplets if she does ovulate, but that’s an important thing when you’re coming to the doctor with irregular periods, you should sort of think in advance, “Well, what am I trying to do here?” Right? “Do I wanna get pregnant? Do I not wanna get pregnant?” Because that will greatly change the direction this might go. And also, maybe, if you wanna get pregnant, sometimes it even involves going like, to a specific endocrinologist or reproductive endocrinologist to start doing these things in a way that’s safe, and that you don’t end up with triplets, or something like that. In terms of women who are not ovulating, right? And then they go on birth control pills. And so now their periods are regular. How do you prepare them for when they’re gonna come off the pill? Like, let’s say, “Okay, now I wanna start getting pregnant?” Do you just stop it and see what happens? Or are there things you do beforehand? How do you figure that out? 


Dr. Gottlieb: Well, I think you need to know where your patient is coming from, right? If they’re 20-years-old, and you put them on a birth control pill, because their periods were irregular, and they didn’t wanna get pregnant, then I think it’s reasonable. And now they wanna conceive, you take them off and you what happens. Sometimes just with age maturation, their bodies will reset and start menstruating regularly. I think if you are 35, or whatever works for that patient. I mean, you have to know about the patient. But I think if they’re older and they’re anxious to conceive immediately, and they’ve had a long history where they’ve never ovulated regularly, then they may wanna just jump right in and go see a specialist to help them ovulate and conceive. 


Dr. Fox: One unique population is teens. You’re seeing someone she’s 13, 15, 18, whatever it is, and she’s having irregular periods. Do you even treat that? Or do you wait? Or how do you make that decision? Because you said it’s pretty common. 


Dr. Gottlieb: So I think the first thing, especially with teens is just explaining to them what’s normal and what’s not. And that their normal can be different than their friend’s normal. And then I think we need to have a conversation of what if they really want to have some structure, because teens, even though we like to think they’re not structured, and they wanna be all over the place, I think that having an understanding of their body is really helpful to them. And so if you have a teen who needs to know, when her period’s gonna come, and feels more comfortable and relaxed with that, then you can offer them a birth control pill. I always even though they came in for specifically for regular periods when you’re handing someone a birth control pill, and that’s what it’s called, I always go back and explain to them that it is used for cycle control as well. And that if they are trying…if they’re thinking about having sex, then they need to remember to use condoms for there to prevent sexually transmitted infections. And then I get into these parents look at me with, [vocalization] but it is really important and also just to make everything normal and healthy. It’s really important. And so then we talk about what they want and what they wanna get out of their cycles. 


And then when they decide to stop or they wanna conceive later on or they’ve just been on it throughout college, and then they’re going and then they finally come to a doctor again, to actually have a full checkup and a real kind of regular routine GYN exam not because they had irregular periods. We can talk about, do they still need to be on it and what value that has? And I wouldn’t say that they need to then go see a fertility specialist to help them conceive, I would say, “Just go off of it. Let’s see what’s happened. Has your body matured enough that you’re gonna have regular cycles now?” 


Dr. Fox: Yeah, these endocrine loops develop and change over time. And it happens in both directions. I’ll see people who say, “Oh, my periods were so regular. And then I went on the pill, and it totally messed up my periods when I came off.” And I’d be like, “Well, how long were you on the pill?” They’re like, “15 years?” I’m like, “Well, it could just be 15 years…” [crosstalk 00:25:39] yeah, it could be just 15 years to change it. It’s probably not the pill. And on the flip side some people say, “Oh, I had such irregular periods, then I went on the pill and now they’re regular again.” I’m like, “Well, you’re on the pill.” They’re like, “No, no, I went off.” I was like, “Well, how long were you on it?” “10 years,” like, well, yeah, maybe they just got regular. And that’s the idea that the birth control pill does not sort of solve the underlying issue. 


Dr. Gottlieb: Correct. 


Dr. Fox: It just solves like the manifestations. And so it’s not gonna actually, like change how your body would do things when you stop the pill. And it’s just sort of, time, and it just gets you from point A to point B without having to deal with the irregularity of it. And that’s why it’s good. But yes, we have to remind everyone, it only protects against pregnancy, not against infections. Excellent. 


And finally, when you were mentioning before about the hysteroscopy, which is a procedure you can do to look at the lining, is that something that would need to be done for someone with irregular periods like we’ve been describing where they just get longer, and not as frequent to sort of more irregular. Is that only in the situations where you suspect something is structurally there. 


Dr. Gottlieb: So for sure, when we suspect something structurally, but also, I think, when we are concerned when we wanna rule out, as we had discussed before, these precancerous lesions, we can do it in that scenario, where we take a look, we wanna see what the lining looks like. And we can do a biopsy at the same time. 


Dr. Fox: Right. And again, that’s very straightforward. That’s not… 


Dr. Gottlieb: We do them in the office. 


Dr. Fox: Right, exactly. You do the hysteroscopy in the office, you do the biopsy in the office. And people can go back to work right after. I mean, because there’s no anesthesia. The issue with the hysteroscopy is not the procedure. It’s if you need anesthesia for it. 


Dr. Gottlieb: Correct. 


Dr. Fox: That’s really the thing that will keep you out of work. It’s not the actual procedure. Excellent. Well, Aren, this was great. 


Dr. Gottlieb: Well, thanks for having me. 


Dr. Fox: What a good review of irregular bleeding. Thank you for coming on. And now that you’ve done this, we’re gonna rope you in many more times. 


Dr. Gottlieb: Happy to. 


Dr. Fox: Excellent. All right. Have a good day. 


Dr. Gottlieb: You too. 


Dr. Fox: Thank you for listening to the “Healthful Woman,” podcast. To learn more about our podcast, please visit our website at www.healthfulwoman.com. That’s H-E-A-L-T-H-F-U-L-W-O-M-A-N.com. If you have any questions about this podcast or any other topic you would like us to address, please feel free to email us at hw@healthfulwoman.com. Have a great day. 


The information discussed in “Healthful Woman” is intended for educational uses only. It does not replace medical care from your physician. “Healthful Woman” is meant to expand your knowledge of women’s health and does not replace ongoing care from your regular physician or gynecologist. We encourage you to speak with your doctor about specific diagnoses and treatment options for an effective treatment plan.