PAGologist Profile picture
Aug 6 13 tweets 5 min read
”She's moody, probably because she's a teenage girl, but could it be the #BirthControl?”
"She's acting so hormonal."
"Her moods are crazy, she's PMSing all the time."
Moods have nothing to do with #gender and sex hormones! These #stereotypes only perpetuate #bias. 🧵 #MedTwitter
Let's start with #hormones. Hormones are chemicals released by certain organs that carry messages to other organs. Everyone has hormones. Changes in hormone levels can affect our moods but having hormones does not make someone moody.
The reproductive (and other) organs produce the sex hormones (#progesterone, #estrogen, and #testosterone) in all people, just in different quantities. These levels can vary throughout the day and over time.
The term 'hormonal' has been negatively used to describe people (mostly females) who are experiencing some difficult moods. Sure, teenage girls can be irritable, but this has more to do with being a teenager than with being a girl.
Women can be sad, grumpy, overwhelmed. It likely has more to do with everything else happening in life than hormones. Using #hormonal to refer to unwanted moods in specific groups only perpetuates the idea that they are somehow mentally weaker, irrational, prone to hysteria, etc
Everyone has hormones and everyone can be moody at times. It's ok to show and feel emotions. Most of the time checking hormone levels doesn't make any difference; there's a very wide range of normal.
But what about #PMS? It's true sex hormone levels can sometimes affect moods (and other body systems), which is what causes #PremenstrualSyndrome. After menarche (onset of periods), the brain usually stimulates the ovaries to produce estrogen and progesterone each month.
Depending on the time of the month and the cycle length, E+P levels will rise and fall each month. When hormone levels are at their lowest, this triggers a period. With PMS, the body is sensitive to these low levels of E+P, which can result in mood and other changes pre-period.
PMS is related to the cyclicity of the hormone levels so happens in a predictable pattern. If something is happening randomly or all the time, this is not PMS. A mental health specialist may be the most helpful for diagnosis and treatment in those cases.
By definition, this can only happen to people who are having periods. That's still not an excuse to attribute every bout of sadness, irritability, mood lability to being 'hormonal' and asking people if they're on their period.
Can't birth control cause mood issues? Yes, medication can affect different people in different ways, sometimes this means mood changes. On average, most people do fine without side effects, but they are hard to predict.
Usually mood side effects are noticeable soon after starting, and don't suddenly occur after several years. It's easy to blame the birth control if they do, but probably something else is going on.
Life is hard. Moods are allowed to change. It's ok to be happy, cranky, angry all in the same day. The language we use to describe these feelings matters and this doesn't just affect one gender. It's ok to not be ok sometimes.

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More from @yffei

Apr 28
Parent: Is it true birth control pills are made to have monthly periods just to appease the church?
Me (having just read Malcolm Gladwell's book about this): It seems so, yes. There's no reason your child needs to have periods.
Parent: 😡 Why didn't anyone tell me that sooner! 🧵
John Rock, a devout Catholic, was one of the inventors of the Pill, which was FDA-approved in 1960. The Catholic church bans any methods other than the rhythm method as 'mortal sin,' so the only acceptable way to avoid pregnancy is to not have sex during the fertile window.
Most hormonal birth control works by maintaining a thin uterine lining and preventing the cyclic changes of the hormones that trigger ovulation.
Read 6 tweets
Apr 13
Myth: "My periods are so painful that I miss a couple days of school each month. Sometimes I think about calling 911 because of the pain. My doctor said this was normal and I'd grow out of them." 😱😱😱
#MedTwitter #obgyntwitter #tweetorial
Severe period cramps are common but they are absolutely not normal. If someone is missing school or activities because of cramping or heavy bleeding, this is not normal. There are so many options to make periods better and no one needs to have a period if they don't want to.
It's reasonable to treat the painful periods first and see if things get better. Not everyone needs an ultrasound to evaluate heavy, irregular, or painful periods. If cramping remains persistent or progressive, a pelvic ultrasound can check for an obstruction.
Read 4 tweets
Apr 13
There's actually nothing special about Sunday. It doesn't matter what day your period starts and you don't have to start your #BirthControl the Sunday after your period starts. 🧵
#MedTwitter #tweetorial #obgyntwitter
Usually I tell people to start the first day of the period or as soon as they pick up the prescription. Starting during the period decreases risk of breakthrough bleeding and starting immediately gets them protected against pregnancy asap (and often makes next period lighter).
Pill packs come with these handy stickers so it's easy to change the labels to remember what day they're on.
Read 6 tweets
Mar 28
Ready for another #PAG mystery?
16yo with primary amenorrhea (never started periods).
What questions do you want to ask?
#MedTwitter #MedEd #tweetorial #OBGYNtwitter
There are many reasons someone might not have periods. I usually divide them into sections to make them easier to rule out:
- hormonal: either repro hormones not cycling normally and/or abnormal levels of other hormones
- structural: could be a blockage or underdeveloped organs
Things to think about:
- any evidence of puberty (breasts, pubic/axillary hair, growth spurt)?
- could she be pregnant?
- any other symptoms (acne, facial hair, breast discharge, hot flashes, night sweats)?
- any (cyclic/monthly) abdominal pain?
- exercise and eating habits?
Read 10 tweets
Feb 13
During each visit, I always try to talk about the #HPV vaccine if they need it. One mom said, "we don't need that yet, her PCP said she had until age 26 to get it." 🤦‍♀️
Please start as early as possible (age 11-12). I'll tell you why 🧵
#tweetorial #MedTwitter #MedEd #obgyntwitter
#HPV (human papillomavirus) is the most common #STI in the US; 80% of sexually active people will get it. There are 100s of different strains; many asymptomatic, others cause genital warts, abnormal pap smears, and cancer (cervical, vaginal, anal, penile, vulvar, oropharyngeal).
The HPV vaccine (gardasil in the US) protects against the 9 highest risk strains, significantly reducing the risk of cervical dysplasia and the cancers mentioned above. More than 90% of #cervicalcancer is caused by HPV.
Read 9 tweets

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