Tuesday, November 18, 2014

What Kills Women Most Commonly?

WHO lists the leading causes of death in women, and shows us how developed and underdeveloped nations differ.  It varies from country to country, and there are some shockers, in England, it's dementia that kills the most women! The rates differ by states as well. The National Center for Health Statistics last released data on what women, per age group, die of in 2004. The provisional data for 2011 is now available for comparisons on line. http://www.cdc.gov/nchs/fastats/deaths.htm
In the last tabulation if you were between 19 and 64 years old you are most likely to diet of malignant neoplasms. If you are 65 years or older you are most likely to die of diseases of the heart. If you are younger than age 19 then you are most likely to die of an accident or unintentional injury. They do list the top ten conditions that cause mortality in women, it's interesting to browse and think about what health screenings could help you prevent these conditions. As we in the US move to Universal Health Care coverage, and the essential screenings begin to be emphasized, those who haven't had screening tests such as breast exams, pelvic examinations, paps or mammograms need to get right in for those examinations.Come in and gab with your gyno if you need to know more!

Monday, November 17, 2014

Uterine Fibroid Bleeding Can Be Controlled by Ulipristal Acetate in the PEARL 1 Trial

Medical therapies for shrinking fibroids have been shown that fibroid tumors and hormonally responsive and could shrink without surgery although both hysterectomies and myomectomies can control the bleeding from fibroids/ Women no longer want a hysterectomy or a myomectomy to control uterine fibroid bleeding, but if you have fibroids and heavy periods, and anemia, or pelvic pain, or pain with intercourse you probably need to gab with your gyno as it's important to get them treated. The amount of menstrual bleeding women experienced when they have both bleeding uterine fibroids and anemia has been published in what is call the PEARL I  research study of the selective progesterone receptor modulator (SPRM), ulipristal acetate (UPA). This medication can treat bleeding with fibroids, and is currently undergoing more research trials. In this first study, the fibroids were between 3 and 10 cm in size, and the uterus was no greater than a 16 week pregnant uterus. This first study did show significant promise with respect to uterine fibroid bleeding and a story we will follow closely.

ClinicalTrials.gov Identifier: NCT00755755 (PEARL I).

Tuesday, November 11, 2014

Adrenal Stress Can Cause Hair Loss

One of the most common complaints from women is that they are losing their hair. Healthy shedding of old hairs from their follicles and allowing new ones to grow in can be very healthy. This natural hair loss is cyclical, some seasons it will grow and in some seasons you will lose more. In general we lose about 100 hairs a day. Exactly how much you lose, and how thick your hair is at the end of the hair loss is related to both age and genetics. All hair follicles can respond to nutrition, stress, pregnancy, menopause, and medication exposure; and there are many more conditions that can produce hair loss. But, certain hair loss may be related to unique hormonal patterns. In puberty, usually breast development occurs first and then the adrenal gland male hormones, like DHEA.  This adrenal gland hormone is thus a stimulus for pubic hair growth. The pubic hair appearance, at approximately the same time as underarm (axillary) hair appearance, comes from a separate but similar hormonal influences. And changes in adrenal hormones can cause loss of pubic hair as well. Adrenal stress can be confused with other conditions, and it can manifest by several symptoms, and tested for with blood work, but one obvious physical sign may just be losing pubic hair. Factors that cause graying of hair and factors that cause hair loss might be related, but they may be separate as well. Age and medication and stress are more likely to be related to graying of the hair, rather than loss of hair. It is best to come in and gab with your gyno to determine whether any hormone imbalances are causing this issue. 

Monday, November 10, 2014

Plan Your Pregnancy Tips

Planning your pregnancy by some simple tests and steps is more likely to result in getting pregnant more quickly and having a healthier pregnancy.
  • See your gyno to discuss any medical concerns, especially missed or menstrual periods, what your gyno likes is data! So get a calendar, and app, or a tracker
  • Normalize your weight (as much as possible) and boost your nutrition, this is a time for basic vitamin use, pregnancy vitamin guidelines can be found on line
  • When you track your cycles figure out if you are ovulating, simple tests are available in the drug store or with free apps, fertility problems respond best to early treatment
  • Treat anemia, begin folic acid and begin  Vitamin D if you have blood level deficiency, and this is a time of your life you may have to consider eating meat  if you are vegetarian, read ACOG nutrition recommendations
  • Take omega-3s, or eat more fish (check locally regarding fish mercury recommendations)
  • Track your blood pressure, blood sugar, and your BMI, get any hypertension, diabetes, obesity (ideally) get these treated before conceiving, it will lower your miscarriage and birth defect rate
  • Treat any vaginal or bladder infections, discharge and odor, see your gyno if you have questions
  • Decrease toxin exposure, minimizing red meet can also reduce hormone exposure, toxins can be found in unregulated supplements, always check with your health care provider for questions
  • Get a visit and perhaps blood testing to confirm vaccinations still are current, and catch up on vaccines prior to pregnancy as some cannot be given when you are pregnant
  • Get tested for Herpes if symptoms are suspicious, and get on suppressive medication if your gyno thinks it is indicated
  • Ask your family and his family about any known genetic problems, and get blood genetic testing for you and the baby's dad; there are so many options, consultation can lead you to many sources of information, it is not legal to be discriminated against on the basis of genetic information, so that is not a reason to not test
  • Exercise regularly
  • Drag the baby daddy in and get any problems with him sorted, his health will impact fertility, miscarriage rate, birth defects, and stress levels 
  • And make time for sex!

And most commonly, is weight and nutrition management first. Anemia, vitamin D deficiency and obesity are all associated with subfertility, as well as miscarriages, growth disorders for the fetus, birthing problems, diabetes and hypertension, just to name a few of the issues. It is not known exactly why obese patients have trouble conceiving. Women who are obese and have polycystic ovarian disease (PCOS) are less likely to ovulate and conceive. But women who are obese without PCOS are also less likely to ovulate than the average person due to increased insulin resistance (your body not responding to insulin as normal women do), and that treating this will increase fertility.  Miscarriages also called Spontaneous abortions (SAB) and recurrent SAB are also associated with obesity. We don't know if this is more related to insulin and sugar levels, how you process carbohydrates, or if in fact it could be related to the level of inflammation in your blood. And those women who also have diabetes secondary to obesity are particularly prone to risk. In some states the diabetes rate is already over 10%. New criteria for the diagnosis of diabetes in pregnancy likely is going to push the rate of diabetes to over 20% of all pregnancies. Those states right now that have diabetes rates of over 10% are Texas, Alabama, Tennessee, Georgia and West Virginia. And if you do not lose weight we therefore will see that getting pregnant when you are obese puts both mom and baby at risk. 
Obesity has risks other than miscarriages and diabetes, they also have more risk for hypertension, preeclampsia, gestational diabetes, thrombophlebitis, preterm or post term delivery, abnormal labor, c-sections, and complications of c-sections. 
When you are obese and pregnant your body doesn't pass nutrients to the baby as effectively. Moms who are obese will preferentially put on midline fat in the last trimester, and that this is not necessarily beneficial for the developing fetus. Hypertension and diabetes as well as labor abnormalities are associated with obesity during pregnancy. Moms who are obese or diabetic also at more risk to have pre-eclampsia and to have the most severe forms of PEC.  Stillbirth rates are increased 2.6 fold in women with obesity.  If an obese woman receives surgery, such as a C-section, it is more likely she will have a complication of that surgery, including increased risks with anesthesia and/or bleeding and infection. So see your gyno first. We want to know about your sugar processing, your nutrition, your overall fitness as well as whether you are overweight. There maybe ways we can, through blood testing, find out if you are fit for your weight as well as ready for a pregnancy. If you can effectively post pone pregnancy until you have normalized your weight, or at least gotten closer to a normal weight, you will likely have a much healthier and happier pregnancy. If you develop hypertension in pregnancy, there are new guidelines as to how to minimize the effects on the pregnancy, but it is still important to try to become healthy, before you become pregnant.

Sunday, November 9, 2014

Omega-3 Research Confirms New Benefits In Pregnancy

We have been promotion omega3 consumption and the lowering of stress for pregnant women for a long time. Previous discussions included prevention of baby blues and lowering of depression with the post-partum use of omega-3 supplements. Now there is a way to both prevent stress and give your baby all the benefits of omega-3 consumption at the same time as a new study shows that women who report high-stress situations may benefit from supplements of the omega-3 fatty acid DHA (docosahexaenoic acid), according to a randomized controlled trial published online November 5 and in the December issue of Obstetrics & Gynecology. The ultimate reason for the benefit may in fact be the biological reduction of the stress hormone cortisol output may improve the uterine environment for the developing fetus. Kate Keenan, PhD, professor, Department of Psychiatry, University of Chicago, Illinois, and colleagues. The investigators measured participants' stress levels through self-report on questionnaires and through saliva sample tests both at the start of the study and at 24 and 30 weeks of pregnancy. The saliva tests measured the women's cortisol levels before and after they took the Trier Social Stress Test, which measures stress levels. The women on DHA had much less stress on these exams, and a physiologic benefit to less cortisol as well. 
It is the hope that reducing the stress levels for moms will translate into better development for the baby and less behavioral problems after birth such as less crying and fewer learning problems as they grow up. Omega-3 levels can help brain and eye development and has been linked to the reduction of preterm birth as well. At Women's Health Practice we can measure omega-3 in pregnancy by blood testing. DHA, one omega-3, can be gotten from fish and fish oil as well as supplements. You can get some, but not all, of your omega-3 from eating fish as Mercury concerns have led to restrictions. 

The data was reviewed on Medscape and they note the research was supported by the National Institutes of Health and the University of Chicago Institute for Translational Medicine. Nordic Naturals provided the nutritional supplement and placebo. The authors have disclosed no relevant financial relationships.
Obstet Gynecol. Published online November 5, 2014. Abstract

Wednesday, November 5, 2014

Ovarian Cysts: Pictures From Ultrasound To Pathology Lab

 Ovarian Cyst Found after Pelvic Exam, and Seen on Ultrasound

The cyst Then Seen At the Time of Diagnostic Laparoscopy

The Cyst Opened, Clear Fluid Was Discarded, and Pathology Showed a Non-Cancerous Cyst Called Serous Cyst Adenoma


Monday, November 3, 2014

Pregnancy Hormone Stimulation of Skin Tags Intensifies The Effect

Skin Tag on Thick Stalk

Skin tags do grow from hormonal stimulation. Most are the size of a pin head, some get enlarged to about 1/2 inch size. This one was stimulated by pregnancy hormones to significantly enlarge over a fairly short period of time. If you think your skin tags are enlarging, see your gyno to discuss what is the next best step in management.

Sunday, November 2, 2014

When Does The Uterus Return To Normal After a Pregnancy

The uterus returning to a normal size after delivery generally takes 6 weeks, it could take 8 weeks. At that time the bleeding has resolved, the lining has returned to a quiet state, and it has become the size it will remain until pregnant, medical changes (growth of fibroids) or menopause. This process is called uterine involution and it occurs after miscarriages or terminations of pregnancy. If a pregnancy only lasted a month the involution sequence can occur at a much more rapid pace. After the placenta is expelled from the uterus, immediately the walls made of a muscle layer known as the myometrium begins to contract, so that process of returning to normal size begins immediately. The contraction of the muscle layer helps to seal blood vessels that fed the placenta and are a critical step in reducing the bleeding after delivery. This is why administration of medications that enhance this muscular contraction, such as pitocin or misoprostol, helps a woman to lose less blood after pregnancy.  The top of the uterus reaches the bottom of the rib cage at full term, but with in the first day it's located around a woman's belly button. Since the uterus is a bit larger if you have already had a baby, and the muscles of the uterus contract better when you breastfeed, lots of factors will actually impact the final process of uterine involution. One more good reason to breastfeed your baby! The uterus weighs about 60 grams before pregnancy, about 1000 grams at full term, and it shrinks back to about 70 grams. The amount of bleeding and the exact size of the uterus do not always go hand in hand.

Saturday, November 1, 2014

One Oops: What Are Your Chances and What Should You Do?

Most women are prepared and thoughtful about risk of STDs and risk of pregnancy in their sexual encounters. And don't just think 'what are the chances,' although it's good to know some facts about that! And when the partners have been together and faithful and have a plan for when to begin unprotected sex for the reason of planning pregnancy, it's a completely different situation than if a woman had an unplanned encounter with a new partner. If you were to go to your gyno and ask what tests or treatments you might need to consider after unprotected sex, possible treatments could include antibiotics for prophylaxis against sexually transmitted infections, hepatitis vaccination, tetanus prophylaxis, medications to protect against herpes, HIV and urinary tract infections, as well as a prevention of pregnancy. Pregnancy encounters are somewhere between 8-25% risk, STD acquisition depends on the virus or bacteria, and your susceptibility, so harder to estimate.  For the prevention of pregnancy that you can take for up to 5 days after sex you can use Ella.  For an over the counter morning after pill you can take Plan B. And for those without active infections currently you can consider getting the copper IUD as an emergency contraceptive. There are many sites for resources on the internet that discuss emergency contraception. Whether you need to go to the extent of vaccinations and antibiotics depends upon you and your individual risk status and risk tolerance, so it has to be a discussion between you and your gyno.

Thursday, October 30, 2014

Contraception Studies Reveal that Medical Contraindications To Bith Control Pills Are Actually Rare

Many women have been told, or think, erroneously that they cannot take the birth control pill because they have medical conditions that prohibit the pill. And when we discuss whether women should be able to buy contraceptive pills over the counter much of the discussion regarding  has to do with whether such access would be harmful to women as women who shouldn't take the pill would have too easy access if they could get without seeing a physician to determine if they could safely take the pill. The  CHOICE project has been looking at many aspects of contraceptives and has an excellent site which discusses many of these issues in depth. For most women begun on oral contraception the risks are low, and if you develop medical problems like hypertension, or diabetes, if they are controlled it is acceptable to use your pills until perimenopause, and even into early menopause for some. Women with active uterine or breast cancer cannot use hormonal methods of contraception. Women who have an active blood clot, or DVT, cannot be given estrogen hormonal contraception such as the combination oral contraceptive pill. But women with DVTs can use any progesterone only hormonal contraception. If you smoke, if you become ill with a medical condition that is a contraindication to pill use, or have special considerations from your gynecologist, you may indeed have to be taken off the pill prior to the time of menopause, but women in their late 30s and 40s can most likely stay on a contraceptive pill that is working for them. Smokers should not be on the pill after the age of 35. The CDC talks about contraceptives and their risks in benefits in their publications, the last being in 2013.It is not known what is the average age of loss of fertility and ACOG and NAMS recommend women continue contraception until menopause or until the age of 50-55, so age alone is not a medical reason to stop the pill . For the government document see this link.  Studies of breast cancer and birth control pills have been conflicting In general there are only weak links if linked at all. It appears that women over 40 or over 45 (depending on which research studies) have increased risks of breast cancer if they stay on the birth control pill. The important factor is to get on the contraceptive that works best for you and your lifestyle, and to do that the best, you should gab with your gyno yearly!

Wednesday, October 29, 2014

Piercings, What Might You Not Know

When it comes to piercings women often ask about scaring, the risk of infections, the potential for nerve damage, and the reversibility of the location. For most the piercing is fashionable, safe, and even for the most part reversible. For the ease of removal, remember not every piercing is the same. Some of the piercings have simple bars or balls under the surface of the skin to hold them in place, some have more odd contraptions holding them in place. Many gynos suggest having the individual that is going to remove the device watch some You Tube videos on the structure before any cuts are made to remove an implanted device that isn't a simple ring or screw. Cleaning the piercing is important, for those who have gotten a bit aggressive with soaps you can use dilute salt (saline) to wash the area regularly to keep it clean, especially if it is relatively new piercing.   Other important considerations, such as, exposure to metals that you make be allergic to. However there are more obscure facts that gynos want their patients to be aware of with regards to piercings. Did you realize that the tracts left by body piercing as well as any grooves in the jewelry of piercings may trap DNA? In fact DNA recovered in those locations has helped solve crimes by detecting DNA from victim or the perpetrator. It is a good idea for you , and your gyno to record the locations of piercings as sometimes the bruises they might leave if someone was assaulted can help document the assault. Also remember that all of these things show up on x rays and other imagining devices (ultrasound) and it is possible for the piercing to block what your gyno is trying to see on a particular test.

Monday, October 27, 2014

Menstrual Cramps Treated by



Dysmenorrhea, or menstrual cramps can be primary or secondary. The treatments can overlap, but in secondary, there is usually a cause, like fibroids, infection, or endometriosis. The treatment of secondary dysmenorrhea means treatment of the underlying condition. For others the only 'condition' is the cramping, there is no specific condition, and it usually starts in one's youth. There are currently many treatments available for menstrual cramps: NSAIDS, Lysteda, Oral Contraception, the Mirena IUD, over the counter treatments as mild pain medication, and even yoga, exercise and psychotherapy. Other treatments get more expensive and more dubious such as the use of thyme oil. But the male erection drug sildenafil citrate (made more famous under the name Viagra) is one of the newer medications that has been shown to work for menstrual cramps in a study of women with primary dysmenorrhea (PD). is not the first medical use of this medication, as the same drug sildenafil citrate has been used under the brand name Revatio, which is used to treat pulmonary arterial hypertension and improve exercise capacity in men and women with this disabling disease. For women with the severe menstrual cramps the medicine is given vaginally in this NIH funded study. Many common menstrual treatments rely in decreasing the release of prostaglandins, this is how ibuprofen works for menstrual cramps. And the medical tratments have gotten more sophisticated in terms of which exact prostaglandin is being treated. The first studies of a novel prostaglandin receptor was published just recently. As always it's important to get a personal evaluation before you decide what, if any, treatment is going to be best for you.

Friday, October 24, 2014

Microbicides to Prevent STDs

Still not here, but would be handy if we could have medications that when inserted would prevent a woman from getting an STD no matter what the exposure was! This sort of product would be called a microbicide, and WHO has a good review of them. The NIH is working on this topic as well. Although Ebola keeps in the news, in gyno world prevention of HIV, and other serious STDs such as hepatitis, syphilis, and the infections that cause pelvic inflammatory disease (PID) are still what we gab about. Several organizations are pushing hard to get these products developed. Three have failed in later stages of clinical research: SAVVY, Carraguard, and cellulose sulfate gel. But Invisible Condom is still working it's way through research trials and still shows promise. Dr. Francois-Xavier Mbopi-Keou the lead author in the recent study was quoted as saying that "as many of 2.5 million cases of HIV could be averted over a three year period of time if even a partially effective microbicide is developed." The current statistics are that over 340 million cases of sexually transmitted infections that are curable occur world wide. A huge impact could be made on these infections as well!

Thursday, October 23, 2014

Yeast Infection of the Bladder

Vaginal and vulvar yeast infections and bladder infections can have some similar symptoms, or  occur together. Women given antibiotics for bladder infections then can secondarily get a yeast infection, however it is possible that the offending organism is actually the same candida of a vaginal yeast infection, but actually in the lbadder. Women who report that frequent bladder infections may be suffering from other conditions (stones in the bladder for instance), but most likely are having chronic bladder infections and not another condition. Bladder infections aren't usually a confusing diagnosis to make based on symptoms alone. Lower abdominal pain, especially above the bladder, pain with trying to pee, and having to pee all the time are the most common symptoms. If you see blood (hematuria) it's even a more obvious diagnosis. So most women will know if they ave had a an issue of recurrent bladder infections. Bladder infections called Urinary Tract Infections or UTIs are quite common. In fact 1/10 women have one physician diagnosed infection per year. The genital areas of the vaginal, the urethra, the vulva, has bacteria, and if we run around culturing the pee of women without symptoms many will have growth of some sort of bugs, urine is not sterile, and usually those cultures will be positive for of the microorganism E. coli. It's a bowel bacteria that can glom on to the wall of the bladder. And some women have E. coli with the ability to glom on even more effectively. And modern life seems to just put more road blocks in our way. For instance our gynos excessive insistence on us protecting ourselves from new partners with condoms. Using condoms and spermacide protects against STDs, but oddly they can cause more urinary tract infections because the condoms and spermacide use seems to improve the ability for our bladder and E. coli to adhere on to each other. What's the worse kind of infection to get is that of E. Coli of the type that have something in their anatomy known as P-fimbria. Other bacteria are commonly found in the the area: the vagina, the bowel, the skin of the region, but about 80 to 90% of all urinary tract infections end up being E. coli. And your gyno needs to know so that treatment could be specifically targeted. In fact virtually all bladder infections are bacterial, but very rare fungal infections can occur, and virus infections can occur, but don't seem to bring on the symptoms of a typical UTI. The fungal infections that do occur, the funguria, usually are in very sick hospitalized patients and they typically will have a blood infection too. However diabetics are more likely to have funguria and anyone with a poor immune system may as well.

Although lots of factors play into whether you will acquire a bladder infection, an important factor is to consider: sex. It is important to get the bacterial count of the bladder down after sex.  Peeing after you have sex actually can eliminate some bacteria that may just have been sitting around and help have fewer infections. If you have had multiple infections going on antibiotics for a longer duration of treatment, or using antibiotics after each episode of intercourse are possible solutions.Most recently it has been shown that probiotics an prevent UTIs. One such probiotic is called Lactin-V and it's the beneficial lactobacillus crispatus organism that is used as a vaginal suppository, but many are very helpful. If the new lactobacillus do take women will have less bladder infections So don't give up, UTIs can have serious health consequences if left unchecked, so try to get them under control!

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Uterine Fibroid Study

If you are a female between the ages of 18 and 50 years old and are experiencing abnormal bleeding due to uterine fibroids, you may be able to take part in the VENUS research study, testing an investigational medicine. Qualified participants will receive study-related medical evaluations and care at no cost. If interested, please call 217-356-3736.

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