Friday, April 29, 2016

Polyps of the Uterus Can Grow Quite Large

Wednesday, April 27, 2016

Wednesday Women's Health News: Contraception Working Overtime!

Women have had more and more choices when it comes to contraception, and the new news is that many women can successfully use their contraception even past the FDA approved duration with continued great success. We have found that both the Nexplanon implant, and the IUDs are both very effective, and a 2015 study published in OBSTETRICS and GYNECOLOGY  they have been shown to be effective for two extra years after their expiration date. The data is very good for longer effectiveness, but questions remain before actually recommending that our patients depart from standard recommendations!

And... if the condom breaks, or you have not yet gotten effective longer term contraction and have had unprotected sex and want to prevent pregnancy it is important to know that you can use either of the approved medications for up to 5 days after having sex, and that a ParaGard IUD insertion is a viable method of emergency contraception as well.  But even the WHO  says that about 1/10 women don't think of getting or taking Emergency Contraception or the so called Morning After pill until that time has already passed. It is also important for women to realize that the treatment with the medications doesn't harm an existing pregnancy. The approved  Plan B method was designed to be given in the first 72 hours, however it can work for up to the 5 days, so this is also your contraception working overtime! If you want to make it easy, you can buy Plan B over the counter, and it is still necessary to contact your gyno if you want an IUD or Ella.  At the same time you see your gyno, discuss a longer term contraceptive.  Contraception is good health for women in so many ways, your Gyno Gab gal thinks that affordable, safe and effective methods of  contraception are available and important for women.

Tuesday, April 26, 2016

Top Form Tuesday: Comparing Estrogen Treatments For Vaginal Symptoms

Women who report vaginal symptoms, particularly pain with intercourse have been  turn to estrogen. But many estrogens are available, and women, with guidance from their gynos, after they decide if they are ever going to use estrogen, the question is what type. The vaginal symptoms formerly termed Vulvovaginal Atrophy  (VVA) and now called The Genitourinary Syndrome of Menopause have a variety of therapies that can treat the symptoms. Traditionally, when medication has been called for women were given an estrogen. The Society of Gynecologic Surgeons Systemic Review Group , which issues opinions on a variety of topics important to your gyno has undertaken a review of vaginal estrogen based on studies that included estrogen, placebo, no treatment, moisturizers, and lubricants. They did not include comparisons to the SERM medication of Osphena which is not vaginal, but offers significant additional health benefits such as a positive effect on the bones, nor did they review non-medical CO2 laser therapy MonaLisa Touch which has begun to revolutionize vaginal treatment for women. The symptoms the estrogen was treating include burning, painful sex, dryness, painful or uncomfortable urination, going to urinate frequently feeling urgency, and in some cases unusual discharge. This condition is chronic. The genitourinay syndrome with the vaginal symptoms of menopause will continue to progress and worsen as a woman ages, and even if treated will revert if the therapy is stopped. The basic conclusion was that each of the estrogens were very similar to each other formula. Interestingly some of the studies also included pelvic floor muscle therapy WITH the estrogen, so it's important for women to understand that they need individual consultation, not just a prescription, to get their best results. Also importantly, their review underscored that in these studies the safety of vaginal estrogen was mostly, but not yet conclusively, confirmed. There were no cases of blood clots ( thromboembolism) or breast cancer, but there is not enough data to say whether there is risk to the lining of the uterus or risk of uterine cancer. It was not clear whether vaginal estrogen would be able to help prevent UTIs, but the authors of this review presented in OBSTETRICS and GYNECOLOGY did point out that estrogen treatment is still considered recommended for women in menopause who have recurrent urinary tract infections.  The researchers did not look at compounded or herbal therapy, and thus these conclusions cannot be extrapolated to those treatments.

Top Form Tuesday: The Treatment of Pelvic Endometriosis Helps To Prevent Ovarian Cancer


Most endometriosis is like what is seen in this picture, a small powder burn hidden deep in the pelvis seen at the time of laparoscopy. But some endometriosis is found by the presence of a cyst of the ovary. Indeed that cyst, known as an endometrioma, probably is due to a simple ovarian cyst that is invaded by endometriosis. Cysts are relatively easy to find, the endometriosis shown here is much harder to find. And now a study by the Ovarian Cancer Association Consortium is pointing out the links between ovarian cancer and endometriosis and the importance of controlling endometriosis to help prevent ovarian cancers. Pelvic endometriosis is most often found when evaluating a patient for pelvic pain, infertility, or literally stumbled upon when a woman is getting pelvic surgery for another reason. Endometriosis is common, occurring in 1/10 women. Endometriosis, however is rarely felt on exam, found on an x ray or an ultrasound, unless a woman has a large ovarian mass. For most, this challenge means that there are significant delays in the diagnosis of endometriosis. The average delay has been said to be 7-9 years between the start of symptoms and the diagnosis. And that long sequence, accompanied by the fact that endometriosis that is not symptomatic means many women with endometriosis harbor their disease for a long time and may find themselves at risk for having their endometriosis turn cancerous. Even once the diagnosis of endometriosis is made by surgery has been frustrating for patients as there is no way to figure out at what rate the disease will progress for women who want children and even more importantly, for all patients with endometriosis, what puts them at risk for disease progression is still unknown. But we do think that it is clear that there is a link between endometriosis and ovarian cancers of a particular cell type. Even the original purveyor of the disease mechanism of endometriosis, Dr. J. Sampson in 1925 thought there was a link between ovarian cancer and endometriosis. and to prevent ovarian cancer we now think carefully removing all endometriosis at surgery, removing the fallopian tubes when possible to prevent uterine tissue from gaining access to the pelvis, and checking for when there is a change to ovarian cysts is going to all help prevent ovarian cancers. What Dr. Sampson couldn't have known is the link between certain genetics and the predisposition of a woman to have her endometriosis turn to cancer. Knowing a woman's genetics is probably the future of predicting who will be at risk for her endometriosis to convert to a cancer. For now we have to use tests that will reveal endometriosis. Blood testing for inflammation had been proposed as a way to detect endometriosis in young women in a study we reported from  Human Reproduction . Indeed they found that levels of IL-6, IL-8 and in their study even CA-125 were increased in all women with endometriosis. They think they will be able to use a panel of six blood tests, called biomarkers, to determine within 90% accuracy if a patient has endometriosis even in the mild to minimal stages (Stages I or II out of IV).  With endometriosis if gynos could find a panel of tests to use, like the screening blood tests that are used to screen some women for ovarian cancer, many women could be helped significantly. And in a study published in the American Journal of Obstetrics and  Gynecology researchers from Utah used MRI's non-invasively to diagnose endometriosis. Although ultrasound is very good at finding the endometriosis experts reporting on the Consortium's findings also note that an MRI may be better at determining if the malignant transformation has occurred in women who are keeping their cysts and not removing them. Removing these cysts will help to prevent conversion to ovarian cancer. Do you think you need additional testing because of symptoms of pelvic pain?

Monday, April 25, 2016

Mom's Day Monday: Better Sleep Helps Prevent Gestational Diabetes and Stillbirth In Pregnancy

Mom's toss and turn at night, and often just can't get comfortable. Gynos are quick to point out that proper blood flow to the baby cannot occur when mom's are flat on their back, and mom's are horrified if they awake to find that they were happily snoozing on their back (not thought to be harmful in the context of shifting sleep positions). Poor sleep for those who are not pregnant can be an important contributing cause of both heart and endocrine disease, and it's likely no different in pregnancy. But the facts are not completely clear either! Two new studies look at overall sleep quality and what that does to the placenta, and in turn, what it does for developing babies. In a study from Obstetrics and Gycology Dr. Roxanna Twedt found that the worse a mom's sleep was in pregnancy the more likely she was to have poor blood sugar control if she was a gestational diabetic. A British Medical Journal study just published about causes of late pregnancy still birth looked at how you sleep, and how often you run to the bathroom and the lowering of the risk of stillbirth. Although intuitively pregnant women feel like too much running to the bathroom increases their pregnancy fatigue, the interesting twist is that it's good for them! The good news is that snoring, daytime sleepiness (measured with the Epworth sleepiness scale), and sleep position at the time of going to sleep and on waking (left side, right side, back, and other) showed no connection to what is one of the worst outcomes in pregnancy which is the baby not surviving in the uterus late in pregnancy. The risk of stillbirth in the group study was about 3/1000 overall. We’ve always have said there has to be a reason that women get up often to pee during the night in late pregnancy and now there is an interesting theory. Maybe it’s not just getting you ready to do late night feedings, but in fact it is a boost to placental circulation, and this study found that women who got up to go to the toilet once or less on the last night were more likely to experience a late stillbirth compared with women who got up more frequently. Interestingly daytime napping wasn’t as healthy as not napping late in pregnancy. This was a prospective study which is considered the most reliable form of research, but not done in a sleep lab or with any technology to confirm these sleep characteristics. Other ways of testing the placental health involve ultrasound. It therefore isn’t something we can really change pregnancy recommendations on, but it will give us something to gab about with our gyno.

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Vaginal Contraceptive Ring

If you are a female between the ages of 18 and 35 you may be eligible for a contraceptive ring investigational contraceptive medication study. Qualified participants will receive study-related medical evaluations and care at no cost. If interested, please call 217-356-3736.

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