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Dr. Jones: Your period is late and you got the test and you're pretty sure it says that it's positive, but this pregnancy wasn't planned. What are you thinking about and how do you feel?

Well, it turns out that in the United States and around the world, about half of pregnancies are unplanned. Unplanned meaning you weren't thinking about having a baby next month, it wasn't exactly on time, but unplanned usually means that you weren't planning on having a baby any time in the immediate future.

In the unplanned category, of these 50% of pregnancies that are unplanned, about half of them are mistimed. You might say that. A woman would say that she was planning on having a baby sometime, but just not right now.

And about half of those unplanned pregnancies are unwanted, meaning the woman when asked in interviews . . . And these interviews are done nationally about every five to six years through the National Survey of Family Growth and many other organizations who try to get a better understanding of this issue. In that spectrum of unplanned pregnancies comes a spectrum of different emotions.

In the virtual Scope studio today is Jamie Hales. And Jamie is a clinical manager at the Huntsman Mental Health Institute. She's here as a social worker to help us kind of think about what are the emotional responses to an unplanned pregnancy. So thank you for being in the studio, the virtual studio with us, Jamie.

Jamie: Thank you. I appreciate you having me.

Dr. Jones: So I'll give you a little bit of my background. I'm a reproductive endocrinologist and an infertility specialist. So, clearly, the unplanned pregnancy among my infertility patients is one that's met with often surprise and joy. But I'm also a family planning specialist and I've been an abortion provider for pregnancy termination.

And the spectrum of emotions is huge in terms of people who come and are faced with a pregnancy that they either didn't want now or didn't want ever. Can you tell me a little bit about your experience and what you've seen?

Jamie: I would completely echo that experience. What I most often see in my practice is more when somebody has had an unexpected pregnancy, it's a happy thing. They're excited about it. But I 100% see people where that is the exact opposite experience.

Sometimes our society, the idea is that, as a woman, you're supposed to be extremely excited about this new journey and chapter in your life. It isn't always that way for everybody, and that's not a bad thing.

And I think something that's really important when you're working with people who are childbearing age is to be as open-minded as possible about this because not everybody's pregnancy journey is the same. There is variation all over the place, and I think it can be hard sometimes for people to admit that, "Yeah, this is something that I'm really struggling with."

Dr. Jones: We go down this pathway of healthy baby, healthy mommy, and we don't spend a little time and say, "Why don't you tell me how you're feeling about this?"

Quite frankly, I'm a mother and a grandmother, and I planned my pregnancy down to the minute, but I was ambivalent. Even though it was highly planned, I was ambivalent thinking, "My life will never be the same." And there was a little bit of worry and grieving about that, even in a very planned pregnancy.

I think it's a matter of recognizing that it's an emotional rollercoaster. First of all, your hormones are different. You are now in a potentially new social domain going forward. You will now be a new person, if you choose to continue the pregnancy, called a mother. And then there's your own emotional makeup and you don't want to do that.

Listen with an open heart. I don't know how to put that in any other way. It's rare to have someone who's so neutral that they've got nothing going on. I worry if I see that.

Jamie: That's a very good point. I think being completely neutral about your pregnancy probably is more of a red flag than having some strong feelings about it either direction.

And those feelings can change, right? One day you may be feeling absolutely fantastic about it, and then there may be other days where that is not the case. And ultimately, it isn't up to the people around you to decide what the normal range of emotion is. That's up to you.

It can be a very fraught topic, but it's also one that I think is very important for us to discuss because this is another one of those situations where you might be out there experiencing some of these thoughts and feelings and think, "Wow, I'm the only one that's dealing with this right now," or, "I don't want to say anything because nobody is going to understand." And it is much more common than I think people realize. 

Dr. Jones: So how do we begin to help women negotiate how they're feeling and what they're planning on doing, figure out what are the resources available to them?

Jamie: Resource-wise, there are a couple of groups that are done online through Postpartum Support International. They have a virtual group for medical termination and also one for post-termination support, even if it wasn't for medical reasons.

So there are really good resources out there, and I think it's important to speak up if it's something that you're struggling with.

Ultimately, at the end of the day, we're not the ones that have to make really tough choices around this. And what the person wants and how they're feeling about it absolutely comes ahead of what any of the rest of us may or may not think about that pregnancy.

If you're going to therapy, that's a really great safe space, I think, a lot of the time to bring up complicated feelings about stuff because it's confidential.

And not everybody in your life may agree one way or the other with your choice whether to continue, not continue, the fact that it happened in the first place.

There are a lot of factors that go into unplanned pregnancies. There's a change in identity. Everyone, I think, comes at it with a different background, a different degree of support and resources.

Dr. Jones: Right. And most women struggle in the sense that they are making a decision thoughtfully, and when they finally make their decision, they're usually pretty sure. But on the way, it's giving them the information that they need so that they can feel that the next 60 years of their life one way or the other is written in a way that they can feel comfortable and move ahead.

I want to thank you so much for joining us. And for everyone who's been listening, thank you for joining us on the "7 Domains."

Dr. Jones: You or someone in your house has painful menstrual cramps. What can you do without going to the drugstore or seeing a professional? This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health and this is The Scope.

Announcer: Covering all aspects of women's health, this is the Seven Domains of Women's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Menstrual cramps seem to be a uniquely human problem, well female human problem. Of course, part of that is because only primates have a menstrual cycle. Other animals have other biology and don't have nearly as many cycles and even other primates, chimpanzees and gorillas, don't seem to bleed as much or suffer cramps as much as we do.

About two weeks after ovulation if we don't become pregnant, the hormones from the ovary that would have supported an early pregnancy, progesterone or pregnancy, starts to fall and the uterus makes another local hormone called prostaglandins that causes the uterus to cramp, the blood vessels to constrict, and push out the old uterine lining to make way for the new with a bunch of blood that doesn't really seem necessary.

So what can you do right now? A hot but not too hot water bottle on your lower abdomen can be soothing or on your back if you primarily feel the cramps in your back. This was used by our mothers and probably their mothers. It doesn't really heat up your uterus but thermally stimulating the skin can distract other nerve pathways involving pain. Using this principle, a new take on an old device called a transcutaneous nerve stimulator that's been used for chronic back pain, might be useful for period cramps. But we're talking about right here and right now in a hot water bottle or a hot towel and a plastic bag is available to everyone but remember not too hot. Many women get in a hot bath tub and find this is helpful.

Well, what else right now? Well, believe it or not, exercise helps period cramps. Get out and move. A vigorous walk or ride or jog actually decreases the perception of menstrual pain for many women. Of course, if you never do these things, doing them now could be more painful but it will distract you from your cramps. Women who exercise regularly have less perception of menstrual pain, so for right now get up and move and if that doesn't work for you, go get that hot water bottle.

For women who have menstrual periods regularly, there are some habits that may decrease your pain. Some studies have found that decreasing fat in the diet significantly decreasing fat and particularly animal fat can lead to less painful periods. It won't work for you today, but it could be helpful for your next period.

Now personally and scientifically, I wouldn't say that supplements, substances you get in a pill at the health food store, are natural, but some studies found that fish oil decreased the intensity of menstrual cramps. It takes a lot of fish oil, about five pills a day.

A Danish study found that fish oil in combination with vitamin B12 worked better than other oils or placebo. Interestingly the women in the study were women who were chosen because they had bad period cramps. These women had low levels of omega-3 fatty acids in their diet compared to other Danish women. So all of the recommendation for decreasing period cramps is to decrease that in the diet, it may be all about the kinds of fat, less omega-6 from animal and dairy fats, which are associated with inflammation and prostaglandins and more omega-3s from nuts, fish, and seeds, which are anti-inflammatory.

Taking supplements may feel natural to some women but what's in the supplement may not be natural at all and they may contaminant, so be careful. The best choice may come down to dietary choices of low sugar and fat diets with seeds, nuts, and beans as the carbs and healthy oils and fish for the fat.

Of course the category of over-the-counter medicines called NSAIDs, non-steroidal anti-inflammatory drugs such as aspirin, ibuprofen, and naproxen, all work to stop the production of prostaglandins, which cause the cramps. But we're talking about home remedies today.

Remember aspirin was originally isolated from willow bark and teas made from the bark of trees in the willow family have been used by many indigenous peoples to treat pain. Some herbal teas that claim to help period cramps may have some of these substances in them.

So these are some of things you try at home and a few options from the health food store and from the pharmacy section of your grocery store. But two things to consider, if your periods never used to be painful when you were younger and now are increasingly painful or heavy, it's important to see your clinician. Some diseases in the pelvis like endometriosis or fibroids in the uterus can grow and lead to increasingly painful periods.

In medicine we divide painful periods into two categories -- primary painful dysmenorrhea and secondary dysmenorrhea. Primary dysmenorrhea refers to the menstrual cramps that started in early teen hood, the periods were always painful. The good news about primary dysmenorrhea is it gets better as women get older or maybe we just cope with it better.

Secondary dysmenorrhea means you didn't use to have cramps when you were younger and now you do. Secondary dysmenorrhea if it interferes with your daily activity, warrants a visit to your gynecologist.

Lastly if your painful periods interfere with your life and your home remedies and over the counter remedies aren't working, we as gynecologists have some options that are very helpful. Give us a call and thanks for joining us on The Scope.

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Dr. Jones: All of us who've had menstrual periods know that we feel a little different in our bodies in the days around the start of our periods. We have what is called catamenial symptoms, symptoms around the period, but sometimes something big happens. This is Dr. Kirtly Jones from of obstetrics and gynecology at University Health Care and we're talking about catamenial catastrophes today on The Scope.

Announcer: Covering all aspects of women's health, this is the Seven Domains of Women Health, with Dr. Kirtly Jones, on The Scope.

Dr. Jones: The hormonal events at the start of the period are a big deal. Estrogen and progesterone levels made by the cyst that created the egg for that month were high the week before the period. If no pregnancy happens, these hormones drop rather quickly and that signals the uterus to make prostaglandins, a chemical that causes the uterus and the blood vessels in the uterus to contract and that starts the period.

These are normal and natural events, but they may cause cramping and occasionally nausea and vomiting and diarrhea, sometimes even fainting. But for some women with other medical problems, the drop in hormones and the rise in prostaglandins can exacerbate other conditions. Asthma and seasonal allergies can get worse. Some skin conditions, including eczema and hives can get worse around the pre-menstrual time.

But I use the word catamenial catastrophe and I made up that term, for things that can really go wrong and here are a few. Catamenial migraine, now this is really pretty common. About 15% of women have migraine and many of those women have predictable migraine with their periods. Catamenial migraine may be triggered by the change in hormones, or it may be the prostaglandins. For some women, it's the only time they have migraine. Migraine is one of those headache conditions that tendsto get better after menopause. No more periods, but for migrainers, that's the name of someone with a migraine, the monthly migraine can be very disruptive.

Catamenial epilepsy, seizures that occur just before or on the first day of the period. This happens to women who usually already have a seizure disorder, but they predictively have seizures about the time of their period. There are some women whose seizures start in adolescence when their period started, and some people have all of their seizures controlled with medications, but just not the ones that happen when they have their period.

Catamenial pneumothorax, this is a biggie. A pneumothorax is when there's a hole in the surface lining of the lung that lets air out underneath the ribs. With each breath, the air is trapped, making the lung get squished smaller and smaller. We're not exactly sure why this happens, but it can be associated with endometriosis on the surface of the lung that bleeds when the period starts and makes a hole for the air to leak out. Compared to the first two catastrophes, this one is rare and it can really be a catastrophe, requiring medical intervention to get the air or blood that's compressing the lung. Rare means about one in 100,000 women per year and that's really pretty rare.

Catamenial anaphylaxis, now, anaphylaxis is an acute reaction that is usually allergic that can cause hives, itching, swollen airways and difficulty breathing, low blood pressure and fainting. Catamenial anaphylaxis is really rare and it isn't probably an allergic reaction, but it is a reaction to the prostaglandins made by the uterus, which is also made in the ordinary kind of anaphylaxis. This is so rare, it hasn't been studied much.

If you think you have a big problem associated with your periods, who should you see? Your doctor who's helping you with your migraine, seizures, pneumothorax or anaphylaxis should consult with an OBGYN, preferably a reproductive endocrinologist, omeone who specializes in women's hormones. Together, they can figure out if it's really consistently related to the periods. Often, women say, "Oh yes, it happens before my periods and during my periods and after my periods."

For women with a 28-day cycle, that means it happens all the time so that's not really period-related. In some cases, it's appropriate to stop the periods and there are several hormonal ways of doing this. The good news is that once the connection is made between the period and the catastrophe, there are a number of options available. It makes cramps and crabbiness seem not so bad, huh? It makes the menopause sound better and better every day.

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