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If you have fibroids, you’re not an anomaly. According to the U.S. Department of Health & Human Services, a study found that by the time they reached the age of 50, a whopping 80 percent of Black women ended up with fibroids. And while some of us might have them before that age and not know it, there’s no confusing it for others. Uterine fibroids, which are non-cancerous tumors that can vary in size and location in the uterus, can make one’s period pretty hard to deal with. It can be accompanied by much heavier bleeding and last longer than a woman is used to.

And even though some people go the surgery route to deal with them, even getting a hysterectomy when they have too many fibroids (200,000 are performed a year because of fibroids), for those with smaller and fewer ones, there are ways to deal with the havoc they wreak on our menstrual cycles.

OBGYN and women’s health expert Dr. Jessica Shepherd spoke with us on behalf of Kotex, who has a pretty amazing option for heavy bleeders in its new AllNighter Extra Heavy Overnight pads, and gave us the scoop on how we can make sure heavier, more complicated (and clot-filled) cycles don’t put a wrench in our quality of life. And it’s a timely conversation since July is Uterine Fibroids Awareness Month.

MadameNoire: Why does wearing tampons for many women who have fibroids tend to create a clotting effect? Some women have complained that in addition to the longer and heavier periods, they experience a lot of clotting and cramping, particularly when they try and wear tampons. 

Dr. Jessica Shepherd: I haven’t heard that too much. But in general, the whole menstrual cycle is an inflammatory phase. Inflammatory meaning not really bad, but that’s the physiologic way that the body is shedding the endometrium of its lining. So as far as like a scientific cause of why they might feel more cramping or have more clotting, typically if you’re a heavier bleeder, then you will have more clots because the longer the time that blood has to sit, it will clot. So if you’re bleeding pretty heavy and it’s not really exiting as quickly as you’re bleeding, then it will tend to clot. Because the blood is not exiting onto a pad and maybe it’s in the vaginal vault a little bit longer, then it could have a tendency to clot. But in general, if you’re a heavy bleeder, you’re more prone to having clotting, period. Whether that’s with a pad or tampon.

Sleeping with a heavy period can be a mess. What would you say is the best way to kind of sleep when you have an especially heavy flow?

That’s a good question because, typically, it’s going to follow the path of easiest resistance, meaning it’s going to go wherever it can to do what it needs to in order to exit. So there is no really perfect position for sleeping. I think that most times, you know, even in the past when I’ve had leaking at night, it really is dependent on what you’re wearing, which would depend on both the underwear that you’re wearing and how much support that gives you, but also then the type of pad that you’re wearing. The U by Kotex AllNighter would definitely give you more of that support that you need in order to kind of cover all the areas, so it shouldn’t matter what angle you’re sleeping. And also, that’s why I don’t like to promote best position to sleep in because I just want you to sleep. If sleeping on your back is the way that you sleep, then do it. A woman’s quality of life doesn’t specifically have to change just because she’s on her period. So if they can have a product that will facilitate that and improve quality of life and allow them to just sleep whatever way they want to, U by Kotex AllNighter should be able to help them satisfy that. A simple thing of being able to sleep at night, not necessarily having to change your position every time you bleed is important.

Speaking of blood flow and blood loss, let’s talk anemia. It can happen when you have fibroids and you have very, very heavy periods. Is there a certain number of pads that one can go through in a day, even one as big as the AllNighter, that you should maybe worry about?

That’s a great question and I’m involved in a lot of studies where we look at quality of life through bleeding. What we’ve noticed is that people change their pads at different comfort levels. So some people change it every time they go to the bathroom, while some people wait until it’s completely saturated. So when we ask that question, it’s somewhat of a loaded question because the answers vary so much based on that person’s comfort level in one day. People have looked at studies and we asked them how many pads they changed. They may say, “Oh, I changed from like 10 to 12 a day,” but when we asked them is it saturated? Is it filling up? They’re like, “No, not really. I just don’t like blood on my pad at all.” They’ll change it much more readily than someone who might be two-thirds full and then say, “Okay, that’s considered my full.” But really it’s hard to ascertain how many pads you would change before you to need to go to the doctor. What we do know is that if you are completely saturating a pad and have to change it in less than an hour, then that would indicate to us that there’s significant bleeding that we might need to discuss and find a way to temper.

Do you have any suggestions or thoughts on how to find comfort with a heavy period when you want to be active? In commercials, you know, they make it seem like it’s so simple, but it can be a very uncomfortable. Sometimes you can still leak because of the movement. So I was wondering if you had any thoughts on like a good way or the right products to use when you want to exercise but have a very strong flow?

That again depends on people’s heavy days. Some people have a really heavy one or two days and so they may have to miss their workout those days. I want women to be able to work out whenever during their period, but sometimes there really are days that you’re just like, “Okay, today is not the day.” I’ve actually recommended this for women, you know, specifically for a workout. It’s okay to take an AllNighter and wear it during the workout. You will have that coverage in your workout that’s going to help decrease any accidents or leaking because you’re getting better coverage. Also, sometimes wearing leggings helps, keeping your pad more stationary or your period products more secure. That helps keep it in place rather than wearing loose clothing, which is not going to keep it in place as well.

What you would recommend for dealing with really intense cramps? That’s a big issue that women with fibroids have. And sometimes basic things like just taking ibuprofen can help. But sometimes it’s a lot worse. People feel like they don’t want to go to work because of the pain. Aside from just medication options, what would you say could help with that?

Exercise actually. A lot of women know, “I’ll probably start my period in the next 24 to 48 hours.” Actually leading into a period with exercise helps because it’s going to release endorphins, which will decrease the inflammation and some of the cramping you’ll have. Also, things that you can do pre-period is decrease your salt intake. Salt is going to make you lose water and you want to stay hydrated. And sometimes taking pain medication before for your period actually allows you to take less pain medication during your period because you’re kind of helping block those pain receptors before the pain gets too high. So it’s kind of like a backwards thinking about it. You’re being preventative with your medication as well as exercise and hydration, and cutting out things like alcohol and caffeine intake prior to your period so that you’re not starting behind, but starting ahead of the game.

How important would you say it is for women to not let their fibroids that make periods worse keep them from doing what they want and need to? Because sometimes our periods, in general, can put our lives on hold.

It’s so important. If you think about it, the average age of starting your period is anywhere from like 11 to 12, and average age of menopause is 52 to 53. So if you think of it, that’s a long time frame in a woman’s life. If you think, you know, “This part of my life is actually a very functional or relevant part of my life because it means that my reproductive system is working,” it could help. I really do feel that we have to find ways to, one, be able to talk about it and be a little bit more open, but also find ways that are useful in going through those time frames and not feeling quality of life is decreased. Like, you not being able to go out with your friends, take care of your family, go to work, work out. And if that means that you have to change your routine a little bit, then that’s okay. It’s just about finding that routine that’s going to be more helpful than hurtful.

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