When Jenny Richards came to my office for the first time she was crying, but she refused to tell Nancy, my receptionist, what the problem was. Nancy asked me if I could fit Jenny in between my other scheduled patients. When I spoke with Jenny in the waiting room, she told me that she’d suddenly felt weak and dizzy while passing the sign for my office. I am an internist, and I agreed to see her immediately.
Jenny appeared to be in her mid-twenties, though the age stated on her patient intake form was 35. She said she was an artist. Her blue denim shirt and khaki pants were stained with red and yellow blotches, and her long hair was also speckled with paint. She sat far forward on the examining table, kicking her feet back against the metal and biting her lower lip. When I asked her what the problem was, she said she had been feeling fatigued and stressed. As I asked more questions, I discovered that Jenny had been experiencing irregular menstrual periods for most of the past year. She said she sometimes missed her period altogether; at other times it was either early or late. Some months she had even had an extra period.
Jenny showed no embarrassment or shyness in talking about her problems. She said that she thought the stress of being an artist was somehow causing the menstrual irregularities. Things always got worse, she explained, just before her paintings were due to appear in a gallery. I agreed that this was a possibility. The hormones that regulate the menstrual cycle, estrogen and progesterone, fluctuate widely and may be affected by changes in mood as well. Conversely, mood may be altered by rapid or extreme fluctuations in the hormones, which can occur when the menstrual cycle is out of whack. I also believe that toxins from paints may interfere with hormone regulation. I mentioned this to Jenny, but added that this had not been proved.
Jenny’s physical examination was normal. I suggested that she see a gynecologist about her irregular periods.
What about the dizziness? she asked.
It could be related to the stress, I said. Let’s see what the lab work shows.
Two days later, the results came back. They showed no signs of anemia, dehydration, or any metabolic problems that indicate disease. When I called Jenny to tell her the blood work was normal, she blurted out that she had been seeing a psychotherapist for some time.
Do you think this could all be in my head? she asked.
I don’t think so, I said. Let’s see what the gynecologist says.
I hadn’t ordered hormone levels on Jenny, figuring that the gynecologist would order them as part of a routine workup. When Jenny skipped her follow-up appointment with me and Nancy was unable to reach her by telephone, I assumed the gynecologist was taking care of her problem.
Five months later, Jenny suddenly reappeared, again without an appointment, and again Nancy fit her into my schedule. In the examining room, Jenny looked very anxious and angry. She handed me a folder of test results from the gynecologist, and I read that the gynecologist had entertained several possibilities for the irregular menses, including ovarian cysts, uterine polyps, and fibroids. Such growths on the ovary or within the uterus can cause irregular periods. But when he performed an ultrasound and a biopsy of the uterine lining, he found no signs of disease. Reviewing the blood tests, I noticed that he hadn’t checked Jenny’s hormone levels.
How are your periods? I asked. Are they still irregular? online slots
Tears began streaming down Jenny’s face. She told me that the gynecologist had put her on a birth control pill. After that, said Jenny, her cycles became regular for a few months. But when she stopped taking the pills, her periods had stopped altogether.
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