Infertility and Menstrual Problems

Dysmenorrhea, Menorrhagia, Endometriosis, Oligomenorrhea and other  Menstrual Abnormalities. Premenstrual Syndrome (PMS), Postpartum Depression (PD)

Contents of this Page:

1. Introduction
2. Teenagers before Sexual Activity
3. Women after Sexual Activity
4. Women after Delivery
5. Women just off Birth Control Pills
6. Women after IVF Cycles
7. Endometriosis
8. Premenstrual Syndrome (PMS)
9. Postpartum Depression (PPD)

During the last three decades we have documented that most women who develop menstrual problems exhibit pathogenic bacteria in the genital canal which are either inherited from their parents or acquired through sexual intercourse. It is important to remember that most of the infections that cause menstrual irregularities will interfere with future fertility at some point.

Teenagers, post menarche, before sexual activity

A wide range of menstrual disorders have been successfully treated at the MacLeod Laboratory. Based on an in-depth microbiological evaluation, antibiotic treatment is prescribed to eliminate bacterial infections that are often the underlying cause of menstrual problems. After treatment, the reversal of symptoms is prompt, dramatic, and permanent. The most common cause of developing menstrual problems in teenage girls who are not sexually active is pathogens acquired from the girls' mother, intrauterine, during pregnancy or while passing through the birth canal during labor and delivery. Assessment for this possibility is done by reviewing the mother's reproductive history. Following the proper antibiotic therapy, teenagers who have suffered for years from abnormal emotional and physical complications of menstruation, experience a balanced menstrual cycles without pain or mood swings. 

In some patients who have had regular menstrual cycles for several years following menarche the manstrual periods can become painful, irregular and sometimes very heavy. In this scenario, if the abnormal menstrual cycle develops before sexual activity begins, we suspect a vertically transmitted abnormal bacterial flora, that preexisted symptome free in the vagina for several years, and gradually ascended into the uterine cavity and has reached the ovaries. 

Women, post menarche, after sexual activity begins

  In teenagers or older women after sexual activity begins a previously normal menstrual cycle can suddenly become abnormal when sexual activity begins. In situations like this, either the sexual partner is a carrier of abnormal  bacteria or the type of birth control method used allowed his sperm to pick up bacteria preexisting in the vagina and carry them up to the uterus and ovaries. 

Women after delivery

A woman can have normal periods before conceiving a child and experiences sudden changes following delivery. The period suddenly becomes irregular with associated significant physical and emotional changes. Our hypothesis is that during pregnancy the uterus is immune suppressed allowing harmful bacteria to multiply and the access bacteria will disturbe normal menstrual function. After delivery when this immune suppressed state stops existing the excess bacteria will interfere with hormonal recovery. Proper antibiotic therapy will restore the normal menstrual flow and shortens postpartum depression and prevent PMS symptoms from developing later.

Women just off birth control pills

Women taking birth control pills are unaware that infection caused changes could progress in their pelvis. Often, birth control pills are prescribed to correct most of the above conditions. Not uncommonly these women will experience infertility once off the birth control pill. 

Women after IVF cycles

During and IVF procedure the ovaries are over stimulated, more eggs are produced and the female pelvis is flodded with steroid hormones. The created immune suppressed environment by allowing pathogens to multiply will adversly effect the course of the pregnancy and the newborn.   Since any type of infection in the human body has a cumulative effect, the chance of reversing the symptoms is inversely relates to the duration of the infection and to the structural damage it has already caused. The hormone, Estrogen produced by the ovaries governs female characteristics. Eliminating an infection that affects the ovaries helps balance the production of this hormone, thus prolonging youthful skin, bone strength, maintaining a healthy sex life, and preserve feminine emotional reserve. 

Endometriosis, a unique form of pelvic inflammatory disease

Based on our excellent results with antibiotic therapy we conclude that endometriosis is a form of PID caused by bacteria of high  immunogenecity. Endometriosis is a condition that affects 10-15 percent of women during their reproductive years. Its presence can only be confirmed through laparoscopy.  The common explanation for endometriosis is retrograde menstrual flow that allows fragments of the uterine lining to deposit inside the abdominal  cavity. Endometrial tissue outside the uterus will bleed with every menstruation causing most women to experience pain around the time of their normal menstrual cycle. We believe, endometriosis only deposits on tissue surfaces that harbor harmful bacteria.

Symptoms include pain, menstrual irregularitis, and infertility. The disease is only symptomatic during the reproductive years. The pelvic pain typically starts to intensify before menses and decreases with completion of menstrual flow. Premenstrual spotting, frequent or heavy periods and pain during intercourse are common.The most common locations for endometriosis are:  ovaries, the Fallopian tubes, surface of the uterus, Cul-de-sac (the space between the rectum and uterus), bowels, bladder and rectum. 

Treatments currently recommended:

There is a number of treatment methods offered, none is offering cure, rather just symptomatic reliefe. Expectant management,  pain relief with nonsteroidal anti inflammatory drugs, birth control pills, medical therapy with progestins, danazol, or gonadotropin-releasing hormone analogs and surgical therapy. Combination therapy is often offered,  when medical therapy is used before and/or after surgery. 

Our therapy

All symptomes of endometriosos promptly and permanently disappear following an all out compregensive antibiotic therapy. Exceptions to this are the cases where a long-lasting process has lead to cyst formation or extensive scar tissue formed in the pelvis. 

Premenstrual Syndrome (PMS), as vertical or horizontal ovarian infections

or by its psychiatric name  Premenstrual Dysphoric Disorder (PMDD) is classified as a mental disease. 

There are three groups of symptoms:

1. physical: enlarged breasts, increased girt, weight gain,  bloated abdomen, 
2. affective: mood swings, emotional, anxious, weepy, sensitive,  and 
3. behavioral: irritable, hostile, aggressive, restless,  

These symptoms are linked to the luteal phase of the menstrual cycle and relieved soon after the onset of menses. The disorder is chronic, can last all through the reproductive years of a woman and exerts a major impact on personal relationships and occupational productivity for an estimated 6% of reproductive-aged women, a moderate impact on almost 20% of women, and it is believed that up to 90% of women experience one or the other symptoms through their reproductive years. 

There are few pharmacologic agents offering temporary efficacy for PMS. Two are approved by the US FDA: selective serotonin re-uptake inhibitors; and low dose oral contraceptive pills containing the progestin, drospirenone. 

For information on Estroven PMS treatment, click here.

Other non-antibiotic and non-hormonal treatment information, click here.

Our research

Clinical research from our laboratory have shown that during undisturbed intrauterine life a recognition develops between the ovaries and the pituitary gland. At puberty this recognition initiates a cyclical dialogue and establishes a regular monthly cycle.  PMS, starting at puberty, is caused by intrauterine factors affecting ovarian development resulting in altered hormone production.  PMS, developing during the sexually active years, or PMS that follows a delivery, always have an infectious background.  Sexually transmitted bacteria reach the ovaries and influence hormone production leading to PMS. Estrogen and its metabolites are the main hormones of the ovaries. The lower level of these hormones during the luteal phase, in association with other hormonal changes make the last fourteen days of the cycle more vulnerable for the symptoms to manifest.

PMS will gradually worsen as more and more bacteria arrive to the ovaries by spermatozoa from an infected partner. Leveling off or sometimes even improvement of PMS symptoms may suggest complete occlusion of both tubes by the pathogenic bacteria.  PMS developing after delivery (usually after a complicated pregnancy) is caused by bacteria that multiplied during pregnancy inside the immune suppressed uterus. After delivery these bacteria can cause clinical infections in both the new born  and in the mother. Once breast feeding is finished and the first spontaneous period arrives the infected ovaries of these women will produce different levels and composition of hormones then prior to conception. The hypothesis is that perception of these differences by the brain and other endocrine organs leads to the development of PMS. 

Postpartum Depression (PPD), as failure of rapid recovery of suppressed, usually infected ovaries after delivery 

The mechanism is similar for the development of PPD as for PMS that develops on an infectious ground. The patient will suffer from PD since an infected ovary needs much longer time to establish its balanced hormone recovery.  In a large percentage of these women PD will convert, for the rest of the reproductive years, into one or the other form of PMS.  PD often follow an IVF delivery. Women will suffer more and more from PMS after each failed IVF attempt. Deterioration of the condition is caused by the unchecked proliferation of the same bacteria that was the original cause of the woman's infertility. We arrived to the above conclusions by the liberal use of antibiotics.

The work up for these patients is the same as for any other woman presenting with pelvic infections.  Antibiotic therapy offers the only permanent cure for PPD and PMS. If there is a clear cut evidence for horizontal infection the therapy will reverse most if not all of the symptoms. Much more challenging are patients with suspected vertical infections. Due to the high number of patients treated with satisfactory results even in this group we recommend antibiotic therapy if the cultures reveal pathogenic bacteria.