The Infamous "Period" and PMS

Over the past few years, I have noticed a number of changes surrounding my menstrual cycle. I'm not sure if it's the fact that I use a hormone free IUD, or if it's my aging process (wine gets finer with time)...I'm pleading the fifth on the aging process...lol ;) So, I decided to dig a little into the actual pathophysiology behind my "Horrible Headaches" or H² surrounding my menstrual periods. Yes, I named them H²...I was a Math major and I'm a SUPER nerd!  

It is absolutely undisputed how miraculously our bodies function, and I'm always in awe of the many variations of beauty our body's represent.  A portion of the female body's beauty stems from its ability to manage stress, hormones, emotions, and reproduction with ease.  "With ease" is a bit of an under statement, when I actually think about the monthly process our bodies are subject to upon reaching our first menstrual cycle.  I remember entering middle school and all of my friends and female family members of my age group were all discussing their "period"... and I remember looking at them with my "shut the front door" face, thinking "it can't really be that bad...seriously...it's so bad that we have to have a full blown conversation instead of riding bikes"?  Anddddd 15 years later, I must confess that at least "MY" menstrual cycle needs/deserves/will occupy more than a full blown conversation...besides who would I be kidding if I didn't recognize that it basically runs things!  MY definition of running things doesn't exactly mean that I "bow down" to it...I just understand my body's natural process and I don't fight it nor do I attempt to agitate it because ultimately...my body WILL win (hands down) every time!  And I only know that my body's a winner because in my younger, not so in tune with my body self...I thought it was possible to live around my monthly cycle, as in not listening to my body and its needs during this very pivotal period of time.  However, my body had a way of ever so gently knocking me on my butt, at which point I had no choice but to listen.

In my younger days, I would battle with very painful cramping, but after child birth I started to notice a new pattern, and yet another pattern began after I started using a hormone free IUD.  So, I would go through periods of time where I thought I had my monthly cycles and symptoms all figured out, when in actuality just like any life long process my monthly cycles were evolving with my lifestyle environment.  In order to get in touch with and to understand my monthly cycles better, I had to call on my nursing background to research a few topics.  Mentally, I understand that my body is very complex, and it needs to be taken care of as such, but physically (in the real world) there are so many things that need to be taken care of in addition to "ME", which implies that my body may suffer from "I'm gonna start that next week" syndrome from time to time!  But, I'm human and this will occur from time to time, and I'm okay with that as long as I learn from my experiences and in turn share with you ;)

What is the "Menstrual Cycle" Exactly

In the most basic explanation, our menstrual cycle is a 4 week or 28 day cycle where our reproductive hormones participate in an automatic balancing act initiated by the hypothalamus to:

• mature an egg within one of our ovaries for release during ovulation, and to
• build a foundational endometrial lining along the wall of our uterus for future egg implantation1

The Hormones of Our Menstrual Cycle

1. Luteinizing Hormone (LH) - causes the complete maturation of follicles and pushes the follicles through ovulation.  It is also responsible for the development of the area on the ovum where the ovum exited during ovulation.  This exit area or ruptured follicle turns into a corpus luteum that excretes progesterone.
2. Estrogen - produced by the mature follicle, and suppresses the release of the FSH 
3. Progesterone - maintains the layer of the uterus that supplies blood circulation in preparation for fertilization and implantation for a developing fetus.  
4. Follicle-Stimulating Hormone (FSH) - stimulates the growth and maturity of the ovarian follicles necessary for ovulation1

For symptom identification reasons, I am going to focus on estrogen and progesterone along with serotonin.  Serotonin is a neurotransmitter that is involved with moods, emotions, and sleep; these levels are usually elevated in those with schizophrenia1

How Hormones & Neurotransmitters Affect Premenstrual Syndrome (PMS)

The fluctuations of our hormones has been mentioned by many as the foundation of our PMS symptoms.  Recently, I read a few articles that introduced a new variable to the PMS equation; the neurotransmitter serotonin.  In the Monthly Hormone Chart below, I have tried to illustrate the fluctuations of our key hormones (estrogen and progesterone), and serotonin with respect to our monthly menstrual cycle.

Monthly Hormone Chart.  Displays our typical monthly menstrual cycle from day 1 through day 31.  Where mensing (bleeding) or our "period" starts approximately on day 28 and continues through day 3 of our new cycle.  Each colored line represents a significant hormone and its fluctuation throughout our menstrual cycle.  Serotonin has two lines, where the green line represents its levels in women without PMS, and the purple line represents its levels in women with PMS.

In an ideal health situation, our serotonin levels remain steady (as seen with the green line) throughout our monthly menstrual cycle.  However, research has shown that women who experience PMS also experience a drop in their serotonin levels as their estrogen levels drop2 (as seen with purple line).  In my case, my PMS symptoms begin around the 14th day before my "period" starts.  Just for clarification, our menstrual cycle is a 4 week time frame that ends with a 3-7 day mensing interval.  This 3-7 day mensing interval is the portion of our menstrual cycle that we call or have come to know as our "period" because it's the most external evidence of our internal reproductive cycle.  At the end of our mensing interval or "period", our menstrual cycle starts again!  I felt the need to clarify this because at times we may forget that our body is ALWAYS in a menstrual cycle, but we tend to only acknowledge or pay attention to the portions of this continuous cycle that affects our activities of daily living (cramping, mood swings, bleeding, bloating, etc).

Soooo, back to these serotonin levels...serotonin levels tend to reach their lowest levels during the 2 weeks prior to mensing2.  Ultimately, women who experience this drop in serotonin also experience PMS.  And there lies the supposed connection...

The Infamous PMS Progression.  Displays the supposed relationship between hormones and PMS.  Granted it is not known what causes serotonin levels to mimic the decrease of estrogen levels.  However when serotonin does decide to follow the drop in estrogen, the decreased level of serotonin has been linked to PMS.

What Can We Do About It?

There are a number of options for limiting and alleviating symptoms related to PMS.

If you are anything like me, you want the justification behind as many of these options as possible.  So, here is my attempt at providing justification...

• Stress - this is problem if you are a person with great health, so imagine adding the element of stress to your body when it's in a state of imbalance...enough said!
• Avoiding caffeine and refined carbohydrates - this allows your body to minimize nervous system arousal.
• Increasing complex carbohydrates, high fiber, foods rich in vitamin B6, dairy, and poultry - these diet options are supposed to promote serotonin production.
• Exercise - enables the release of endorphins, which elevates your mood.  Aerobic exercises are especially good for relaxing the body.
• Calcium and magnesium - help with alleviating psychological and physiological symptoms.

Now for the "Happy" foods list...

• Sweet potatoes - loaded with folate, and B vitamins that increase serotonin and dopamine (neurotransmitters) levels, leading to better moods,
• Bananas - loaded with tyrosine, which is a building block for neurotransmitters,
• Eggs - have ideal proportions of fat and protein which will keep your blood sugar from jumping all over the place, preventing extreme mood highs and lows,
• Quinoa - (my favorite rice/noodle replacement) loaded with protein, B vitamins, magnesium, and iron, all of which regulate serotonin levels, evening out your moods,
• Tomatoes (cooked) - loaded with lycopene which prevents inflammation that can accompany PMS, leading to stress on your body...not to mention discomfort and pain,
• Avocados - loaded with healthy fat like Omega-3's which increases a positive mood,
• Coconut oil - (the only oil I use for cooking) loaded with medium-chain triglycerides which improves the brain's production of serotonin 3
• Chocolate, eggplant, pineapples, plantains, red plums, and walnuts - increase serotonin levels 5

After all of the information provided, I have to say that regular exercise, eating healthy, and taking a daily multi-vitamin seem to handle my mood swings and fatigue related to PMS.  I also take an iron supplement Floradix Iron + Herbs in order to prevent fatigue related to low iron levels due to heavy mensing.  It's perfect for me because it does not cause constipation or hard stools, however the taste isn't that great and I have to remember to take it 30 minutes prior to eating.  When my symptoms are severe and I'm experiencing migraines and severe cramping, I utilize Tylenol for cramping (because I can't take Ibuprofen...but if I could I would take an NSAID instead), Frova which is a prescription medication for migraines, and my old faithful heating pad ;) Frova works really well for immediate relief as soon as I feel a migraine coming on or after one has started.  The multi-vitamin I use is Ola Loa, and it comes in a powder form that you mix with water and drink.  I'd rather drink my vitamins in a powder form versus swallowing them in a pill form, as the pill forms can be inefficient and lead to additional free radicals roaming around in my system.  I'm also a heating pad snob, so I figured out the exact heating pads that work best for me and they happen to be made by Sunbeam.  You can find more information about the heating pads I use here, and here.  I also use a few applications to track my menstrual cycle and symptoms, they all have their strengths, it just depends on which is more comfortable for you.  My tracking apps are...

Period Tracker, by GP International LLC

I've been using this app the longest.

Period Calendar/Tracker by ABISHKKING
This app has grown on me, and it's presentation is really cute.

Period & Ovulation by SMSROBOT LTD

LoveCycles Menstrual Calendar by Plackal Tech

Another random note...there was also a study done recently that showed significant improvements in PMS with the usage of a medication named Fluoxetine (also named Sarafem and Prozac) in the place of Calcium supplements, please contact me for information if you can't find the article on the web4

In short, my monthly "horrible headaches" are related to PMS that has been linked to a decrease in my serotonin levels that happens to decrease with my estrogen levels prior to mensing!  As always, please consult with your physician prior to starting any new exercise regimens or prior to starting new medications or supplements.  This information has been provided for educational purposes, and I hope you find it helpful.  Please feel free to follow and share ;)  Until next time!

________________________________________________________

¹  Dunn, J. (2015, March). Bad Moods, If you’re sometimes Ms. Grouchypants (and who new ways to head off downer feelings and bring. Health.com.

²  Lewis, S., Heitkemper, M., Dirksen, S., O'Brien, P., & Bucher, L. (2007). Medical Surgical Nursing Assessment and Management of Clinical Problems (Seventh ed.). St. Louis, Missouri, USA: Mosby Elsevier.

³  University of Minnesota Health Center. (2014). Understanding PMS and Your Cycle. Retrieved April 1, 2015, from University of Minnesota Health Center: http://www.uofmmedicalcenter.org/healthlibrary/Article/85704

⁴  Yonkers, K. (2014, January). Fluoxetine better than calcium in premenstrual syndrome. Journal of Clinical Psychopharmacological.

⁵   Leeuwen, A. M., & Poelhuis-Leth, D. J. (2009). Davis's Comprehensive Handbook of Laboratory and Diagnostic Tests with Nursing Implications (Third ed.). Philadelphia, PA, USA: F. A. Davis Company.

Food for Crohn's Flares

I’ve finally had the opportunity to write down the foods and process that works for me during a Crohn’s flare, as well as how I minimize my symptoms on a daily basis.  Anyone exposed to the daily struggle with Crohn’s disease symptoms, can appreciate when any amount of relief can be attained without prescription medications.  I have been working on a few diet changes to reset my gastrointestinal system to a healed and stable state.  After much researching along with trial and error.  I have found that a few almost hard to stick with diet changes ABSOLUTELY make the difference between having a good day and a horrible day.  The diet changes allow my gastrointestinal tract to heal during flares as well as on a daily basis.  The first thing I learned was to simplify my diet, and this was the hardest part to digest mentally.  It’s as if mentally I need sugar and fried foods to enjoy eating...not the case at all...at least not now ;)  

Simplifying my diet...

In simplifying my diet I had to...

• reduce my carbohydrate intake,
• make sure that foods I do eat are very rich in nutrients,
• stay away from processed foods,
• try to eat a majority of foods that MY system can easily digest,
• reduce foods that irritate my stomach (via food diary), and
• eat as many naturally anti-inflammatory foods as possible.

I’m sure the list above is very overwhelming, and it may only work for me.  However, in my opinion it’s worth sharing with everyone, just in case there’s a possibility that it can improve anyone’s symptoms associated with inflammatory bowel disease.  When I started the journey of developing my diet during flares...it was HORRIBLE!  It has taken me almost 4 years to understand my body, digestion, and how EVERYTHING we eat is an accumulation that presents itself as our daily health or “feel good” status.  

Bone broth...

So, at my very worst...when I’m nauseous, vomiting, can’t keep anything down = FLARE ALERT!  I instantly seek refuge in homemade bone broth.  Making bone broth consists of

1. Simmering water, 2 tbsp of apple cider vinegar, and fresh organic grass fed chicken bones or carcass.  I usually run to Whole Foods and purchase about 4 of their organic grass fed bone-in chicken breasts. 
2. I cut the meat and skin off the bones, and plop the bones and skin in the simmering vinegar water for 6-24 hours. 

Bone broth

This broth has been a total Godsend as it is rich in amino acids, gelatin, glucosamine, and chondroitin.  These nutrients from the chicken bone helps with

• strengthening the stomach lining (balances stomach acids),
• joint and skin health, and
• teeth and bone health.

I eat just this broth for all meals with Rooibos tea as my beverage until I am confident that my stomach is stable.  

Rooibos Tea...

The brand of Rooibos tea I use.

Rooibos tea has a very earthy smell and taste, but its feels so refreshing and soothing to my stomach.  In fact, I have a cup or two of Rooibos tea every morning (it has replaced coffee...completely) before eating or drinking anything.  It’s hands down the best start to my day!  Rooibos tea or sometimes-called Red tea is...

• caffeine free
• has very powerful antioxidants (cancer fighters)
• high in minerals
• magnesium – essential for nervous system
• calcium and manganese – creates strong teeth and bones
• zinc –  strengthens metabolisms
• iron – helps blood and muscles distribute oxygen
• prevents the enzyme that triggers cardiovascular disease
• lowers blood pressure and cholesterol
• relieves abdominal cramps, diarrhea, indigestion
• reduces abdominal spasms and inflammation
•  supports the body in absorbing iron, and
• prevents lipid peroxidation that can ultimately lead to Parkinson’s and Alzheimer’s diseases.

Advancing my diet to the next phase...

When my stomach feels stable, I advance my diet by eating...

•  organic chicken breasts and/or salmon,
• homemade bone broth (as a seasoning, or alone)
• cold-pressed coconut oil for cooking,
• cooked organic carrots and zucchini (I really call them green squash),
• plenty of water (with lemon or lime added), and
• salt and pepper.

I usually stick with this restricted menu for approximately 4-6 weeks.  My symptoms usually lessen within the first 2-3 days of bone broth consumption.  However, the length of time before symptom relief is experienced is directly related to the degree of internal inflammation.  Please make note that I don’t eat fruit, sweets, dairy, or grains during this phase of reestablishing gastrointestinal stability.  It’s very important to only eat foods that will assist in the healing of the gastrointestinal tract.  Also be sure to keep a food diary that includes a list of any and all symptoms you may be experiencing on a daily basis.

Next post I will discuss my approach to advancing my diet options to the next phase, as well as my approach to fulfilling my daily nutrient needs without compromising my gastrointestinal tract stability.  As with any diet or health changes, please seek advice from your physician regularly, and understand that this content is provided for educational purposes only.  My intentions are not to treat, diagnose, cure, or prevent any disease including digestive problems.  I hope this post has been helpful.  Feel free to comment and follow ;)

Three products that I LOVE!!!!!!!

I'm not sure how many of you have heard of the brand Luvena, but it is definitely a God send!  In previous posts I have mentioned that I use Summer's Eve wipes and body wash on a daily basis.  However, after such a long period of usage the products began to dry my skin and cause the infamous skin issues that I was ever so determined to prevent.  I decided to search around for a product similar to Summer's Eve with less harsh ingredients, but with more ingredients that would be proactive in maintaining the natural flora in and around my private area.  In my search I came across a brand named Luvena, and this brand happens to be labeled as "natural".  To be honest, I'm not quite sure if the FDA has even defined what the usage of the word "natural" means with regards to the products labelled with it, but I have used and will be reviewing three of Luvena's products below.

The first product of the three that caught my eye are the prebiotic feminine wipes.

The picture above happens to be a box of their individually wrapped wipes.  I must say that having these wipes individually wrapped has come to be very convenient at times.  Most times are when I'm working out and won't have a chance to shower prior to running errands.  I can just remove one or two from my purse or pocket (since they are very compact) freshen up and go on with my day.  This definitely prevents most types of skin break-down due to sweat sitting on ones skin for a long period of time.

Individually wrapped wipe

Size of individually wrapped wipe with respect to packaging

Individually wrapped wipe after being removed from packaging

Full size of the individually wrapped wipe with respect to packaging

Luvena also has another set of the same wipes packaged similar to that of baby wipes, as pictured below.

These wipes can be used in the same manner, but since the entire package of wipes will be exposed to additional bacteria and environmental elements each time the package is opened, I would opt to use these at home (for example on night stand, in bathroom, etc.)

Multiple wipe packaging

Size of the multiple pack wipe with respect to the two different packages

LEFT:  individually wrapped wipe size, and RIGHT:  multiple pack wipe size

Another Luvena product that I keep handy is their body wash, which is pictured below.

The smell is great, with a gel consistency, and it's clear in color.  I tend to use this wash on days that are a little more active than others.  For example, on heavy workout days, heavy intimacy days, or during menstruation.

Body wash poured into my hand

Consistency of body wash

Consistency of body wash

Consistency of body wash

Now to the good stuff...these products are considered "prebiotic" because they include...

• Lactoferrin - a multifunctional protein that can be found in human milk and cow milk.  Human colostrum or the newborn's first milk has the highest concentration of lactoferrin.  As a side note, colostrum is very significant for newborns as it gives them antibodies to assist their immune system in fighting off bacteria and viruses.  The inclusion of lactoferrin in these products helps to maintain the normal flora balance in areas that are prone to bacterial overgrowth and subsequent skin break-down.  Just to give an example of its benefits, lactoferrin was given to mice with weakened immune systems and oral ulcers via their drinking water.  After consumption, the number of yeast strains, as well as the size of their oral ulcers had decreased.

• Lactoperoxidase - an enzyme usually secreted by mammary, salivary, and mucousal glands that functions as a natural antimicrobial.  To give an example of its benefits, it has been used in preserving food, cosmetic products, and eye drop medications.

• Lysozyme - an enzyme that attacks the cell walls of bacteria such as Bacillus and Streptococcus.  

• Pramoxine Hydrochloride - an antipruitic or anti-itch agent that temporarily relieves burning, itching, and discomfort associated skin irritation or inflammation.

In my mind, I immediately confuse prebiotic with probiotic!!???  So, just for my clarification

• Probiotics - are live bacteria found in yogurt and other diary foods or pills, and
• Prebiotics - are enzymes that assist the "good" bacteria with growth.

With the inclusion of the above ingredients, the products seem to have "bad" bacterial overgrowth under control, which has the potential to leave room for the "good" bacteria to overgrow...this is where use moderation comes into play.  So, if you start to utilize the wipes too often in conjunction with not allowing the area to dry, there is a possibility that you could experience "good" bacterial overgrowth...enters the the infamous "yeast infection"!  Yeast infections in my opinion are the most annoying, inconveniencing infections EVER...I digress...they cause a lot of irritation that can lead to skin breakdown.  The question becomes...are these products worth the moderation headache?  The truth is...I can't make that decision for you...hoooooowever, I can share what works for me and my ideology behind it.  

I KEEP all three products in my home at ALL times, and I also have these products scheduled for automatic re-order every 30 days.  As if that's not enough to slant your view...I choose these products because:

1. they conveniently prevent instant skin breakdown after workouts and intimacy marathons when instant showering isn't optimal,
2. they also prevent skin irritation due to my body's excessive self cleaning mechanism and ovulation discharge,
3. when thorough cleansing is needed (during menstruation, at the end of my day, etc.) the body wash is "money", and
4. MOST importantly this prebiotic formula/combination is available in two compact and convenient forms for use anywhere I may need them.

So, in case I didn't make it apparent before, I will gladly accept a few random yeast infections versus frequent, multiple, predictable, and preventable skin irritations and/or other infections.  My skin is very sensitive with a natural bacterial equilibrium that is easily imbalanced...over the past year Luvena has earned my thumbs up :)

On another note, just as I share the sweet side of these products, I must share the sour side as well.  Here are a few issues regarding the products that I would like to share briefly:

• The body wash has lanolin as an ingredient, which can cause eczema flares or skin irritation. 
• The wipes have tea tree oil as an ingredient, which can be used topically to kill bacteria and to minimize inflammation.  On the flip side, tea tree oil can dry the skin out.
• Luvena products have been a little hard to come by for the past few months due to an issue with their claims of being prebiotic.  You can read about this topic at the following websites Women's Health Law Information, The United States Dept. of Justice, and Class Action News.

Please discontinue the use of any product that causes irritation or discomfort.  As always, thank you for reading and until next time :)  Please feel free to comment, repost, and follow.

Happy New Year

History is yesterday's missed opportunities, and yesterday guides today.  So continue to learn and be creative in everyday as to not become history...after all...we are not missed opportunities.

Happy New Year Everyone!!!!!!!

Monistat 1, 3, or 7...that is the question?

I have finally decided against the usage of ALL 1-day yeast infection treatments!  Just to clarify…this change has only come about due to the horrible discomfort I have experienced on many occasions while using the 1-day yeast infection treatments.  In addition, I have NEVER noticed such discomfort during the usage of 3, 5, or 7-day yeast infection treatments, and to be honest; only some of the 1-day yeast infection treatments have resulted in discomfort.  So, what does this mean and how can we avoid such discomfort?   Welll…

Yeast infections, also known as Candidiasis is common among females who are pregnant, diabetic, or taking antibiotics or oral contraceptives.  Yeast infections are also considered as an opportunistic infection because Fungi utilize the opportunity presented by the body such as a weakened immune system to provide the perfect environment for normal flora (such as yeast) to overgrow.  At the point of overgrowth, the infection has caused you to be irritable, itchy, and out right uncomfortable.  What’s the first thing we do?  We rush to the nearest store to purchase the best yeast infection treatment that will relieve our symptoms as soon as possible.  And…which medications do we usually reach for first…any one that screams its ability to relieve the discomfort in the shortest period of application time.  Those options usually include:

Monistat 1-Day or Night Ovule

Monistat 1-Day Prefilled Cream Ointment

Miconazole 1-Day or Night

When selecting a yeast infection medication I tend to look for the treatments that offer the following attributes:

• 1-day option, with
•  ovule medication

A 1-day option is important because I detest having to insert a messy medication every night, besides the fact that prolonging application time can limit intimacy!  An ovule option is important because it can be taken anytime during my busy schedule, and it appears to not be as messy as the cream or ointment options.  However, choosing the ovule form may be partially to blame for the excessive discomfort that begins shortly after insertion.

Some of the options available for yeast infection relief include the following.

Brand Names	Generic Name	Active Ingredient	Active Ingredient Strength	Form
Monistat-1 Day/Night	Miconazole	Miconazole Nitrate	1200mg	Ovule
Monistat-1 Day Prefilled Ointment	Ticonazole	Ticonazole	300mg at bedtime	Ointment
Monistat 3	Miconazole	Miconazole	200mg/per night for 3 nights	·      Ointment ·      Ovules ·      Prefilled cream applicators
Monistat 7	Miconazole	Miconazole	100mg/per night for 7 nights	·      Ovules ·      Cream ·      Prefilled cream applicators
Clotrimazole 3	Clotrimazole	Clotrimazole	Not available	Cream
Clotrimazole 7	Clotrimazole	Clotrimazole	50mg/per night for 7 nights	Cream
Miconazole 1 Day/Night	Miconazole	Miconazole	1200mg	Ovules

Usually I go for ANY 1-day option which means I never really read the labels...which resulted in my using the Monistat 1 pre-filled cream applicator (at 300mg) on numerous occasions without issues.  By the time I needed yeast infection medication again, the forms had changed to what we know now as ovules or suppositories at a much stronger strength of 1200mg.  As you can see in the table above, there may be a relationship between the 1-day day/night ovule medications and the active ingredient strength being 1200mg.

I'm not sure why any manufacturer would think that applying 1200mg of an antifungal to already irritated and inflamed skin would be a good idea, but it exists, and if you don't read carefully when choosing a yeast infection medication you will absolutely set your vagina on fire!!!!!  These medications cause intense burning, and itching to the point that sitting still is not an option!  There is no better way for me to articulate the absolute pain and discomfort you could experience.

I have found myself in this situation on more than one occasion, and the best advice I can give is to:

1.      read the labels carefully for the medication strengths,
2.      keep in mind that a 1-day day/night ovule medication may be 1200mg in strength,
3.           keep in mind that there are 1-day medications in other forms to choose from, and
4.           choose the medication that is <1200mg per application. 

If you happen to run across a yeast infection medication that works for you, it’s a good idea to have a few around the house in case you need it right away.  Most times when I go to the store for yeast infection medication, the type that I need is never available.  So, I purchase my medication online via drugstore.com, soap.com, walgreens.com, etc.  The worst scenario is being uncomfortable from a yeast infection and not having the medication to minimize the discomfort.  What's worse is being uncomfortable and not being able to pin point the source.  Monistat has a pretty reliable vaginal health test that can pin point the cause of your discomfort (yeast, bacterial, etc.).

Monistat Vaginal Health Test

However, if you find yourself using one of the 1200mg medications try to shower with less than hot water and allow the water to calm the situation.  Whatever you do, DO NOT scratch the irritated area.  Keep in mind that the discomfort does not usually start right away, but once it starts it can take up to an hour to calm down.  In my opinion, most 3 day ovule or suppository yeast infection medications are strong enough to treat yeast infections without causing additional intense discomfort.  Besides, having a yeast infection is uncomfortable enough, there is no need to add insult to injury!  I hope this post has been helpful.  Please feel free to comment and follow ;)