Dr. Lawrence M. Nelson
My 28 Days was founded by Dr. Lawrence M. Nelson, the leading authority on primary ovarian insufficiency (POI). For 30 years, Dr. Nelson, a gynecologist who specializes in women‘s health, conducted POI research at the U.S. National Institutes of Health (NIH) Clinical Center in Bethesda, Md. His passion has been to help understand POI and its causes and to develop more effective treatments. He is the author of the New England Journal of Medicine article “Primary Ovarian Insufficiency,” and his work has also been featured on NPR, “Irregular Period? It Could Be More Than Just Stress,” and in USA Today, “Don’t say ‘early menopause,’ it’s primary ovarian insufficiency.”
After receiving his doctor of medicine degree from the University of Pittsburgh in 1973, Doc completed a residency in obstetrics and gynecology at the University of Southern California. He later spent several years in private practice in Lynchburg, Va., before returning to academia to complete a clinical research attachment at Hammersmith Hospital in London, a fellowship in reproductive endocrinology at George Washington University, and a research fellowship at NIH.
Doc received board certification from the American Board of Obstetrics and Gynecology for specialization in reproductive endocrinology. In addition to earning his M.D., Dr. Nelson holds an M.B.A. from George Mason University in Fairfax, Va., where he concentrated his studies on human resource management and the management of nonprofit organizations. He is a retired commissioned officer of the U.S. Public Health Service, as well as a recipient of its prestigious Meritorious Service Medal in honor of his POI research. His approach to patient care has been recognized by the Genetic Alliance. Doc’s efforts have also been recognized by the American Association of Occupational Therapists with their Health Advocate Award, given for his leadership in comprehensive interdisciplinary intervention in women‘s health.
Doc approaches both research and well-being in an integrated manner with the goal of helping women touched by POI achieve balance in body, mind, spirit, and emotion. He now serves as president of the nonprofit Mary Elizabeth Conover Foundation.
Know Your Numbers
Understanding POI begins with first understanding ovarian hormones. A woman’s reproductive system is a wonderfully complex system involving continuous communication between the brain and the ovary. The hypothalamus, pituitary, and ovary are the messengers that regulate the monthly cycle. Given the first sign of ovarian hormone complex is usually the loss of regular menstrual periods, it’s important to track your cycle’s regularity.
Women who have POI are deficient in estradiol, a critical hormone typically present in a young woman‘s blood. Evidence has shown the onset of estradiol deficiency early in life is associated with a shorter life expectancy — among other health concerns — which makes education, early diagnosis, and treatment of POI critically important.
To determine if a woman has POI, her clinician will test her blood for follicle stimulating hormone (FSH). FSH will be higher than normal in women whose follicles are no longer working to produce normal levels of estradiol in the blood. This simple blood test will often be the only test needed to determine if a woman has POI.
You could have ovarian hormone complex if:
- your menstrual cycles are erratic and unpredictable
- your menstrual periods are less than 21 days or more than 35 days apart
- you have bleeding or spotting between cycles
- you skip periods (sometimes for months at a time)
- you have had any of these symptoms in the past and were prescribed birth control pills with no testing to determine the cause of the abnormality
If any of these statements are true, it’s critical to ask your health care provider two questions:
- What is my FSH?
- What is my prolactin?
Once you have these answers, you can move forward empowered to take control of your menstrual health.
Published scientific evidence has demonstrated the most common problem preventing normal ovarian follicle function and ovulation in women with POI is inappropriate luteinization of growing follicles.
- Published evidence has demonstrated the NIH P-HRT regimen suppresses serum LH levels to normal in women with POI. Published evidence has demonstrated you should be on the NIH P-HRT regimen to keep your bones healthy.
- Theoretically, lowering the LH level in your blood should improve the chances of you ovulating by reducing the chances of the follicles becoming luteinized. This has not yet been proven by prospective study, however. As a group, women with POI should be advocating for more studies about how to improve their natural fertility.
If your doctor or healthcare professional has ever responded to your menstrual cycle symptoms with any of the following statements, it may be time for a second opinion.
- “Your periods stopped due to stress.”
- “We don’t need to do any tests.”
- “It is a blessing to not have any periods.”
- “All you can do is egg donation if you want to have a family.”
- “Take birth control, and you’ll be fine.”
- “Just let us know when you want to get pregnant.”
- “There is nothing we can do for you now.”