Tuesday, June 21, 2016
As for when to have the test: every year, every other year, every third year (or every fifth year which I do not recommend) will depend on your age, your prior tests and whether you are getting an HPV test also. The guidelines as to when to have a pap do vary very slightly from one medical society to the next. And you can have the discussion with your gyno as to which guideline applies best to you. So it's important if you are a mom of a young woman, ask your gyno what she currently recommends for your daughter, it's changed over what she recommended for you! The current guidelines can be summarized like this: get your first pap at age 21, and then begin getting every two years. After thirty, if you are low risk, and have been getting normal pap smears, you can get pap smears even every 3 years.
Pelvic exams to screen for STDs, to check your uterus and ovaries are still done every year. Women under the age of 25 and women with new partners should have tests for gonorrhea and chlamydia at the time of the pap, and it can often be tested for on the same swab. For those too young for pap smears (under the age of 21) STD testing can be done on urine. If you are age 65 or 70, you may be low enough risk to stop pap smears; you would not want to stop getting pelvic examinations. If you have had abnormal pap smears, if you have immune compromising conditions, or HIV, you need to keep getting pap tests every year.
The FDA has approved adding HPV testing to your pap after the age of 30, and it is a separate test you may need to ask for as most labs are set up only to do that test if your pap test comes back ambiguous. It is now also approved to have type specific HPV testing: so not just a pap or pap plus HPV but a typing of the HPV virus to see if you have HPV 16 or 18. It is also approved to have the activity of any HPV virus infection of the cervix tested which can tell you how likely it is that you have moderate or severe cervical dysplasia. HPV 16 and 18 are responsible for a large percentage of cervical cancers. If you had the HPV vaccine you have been immunized against these viruses. If you had your vaccine after you had sexual contact or intercourse, you may have already picked one or more of of these HPV types up. There is no specific cure, so it's important to have testing if you have had sex with a new partner in the past few years. Keep posted, as the guidelines do not yet say when to get pap tests if you have had the HPV vaccine, but we are anticipating that in the future they will recommend fewer pap smears if you were vaccinated.
Monday, June 20, 2016
1. Have you had medical issues with contraception before?
2. Do you know what medications/contraception your plan covers, help make cost effective decisions
3. Are you aware of the non-contraceptive benefits of pills, often the focus is on contraception, but in truth there are a variety of gynecologic conditions to consider
4. What is your access to a provider you have spoken to before? If you cannot get the same provider, then each time you will be starting over with your medical history
5. Do you have a reproductive life plan? When are you having children? What are the fertility aspects of your contraception going to be?
6. Most gynecologists think that effectiveness and safety is enhanced with long acting contraceptive methods, and most of those (IUDs, injections like DMPA and Nexplanon) require an in person exam, consultation and administration of the method.
7. Are you on other medication? Contraceptives may interact with other medication, and often it's best to have your provider be able to access records, communicate with your primary physician, and or see you if there is adjustment to medications or an development in your medical issues, this also cannot be handled by remote access with just on line access.
Sunday, June 19, 2016
Uterine fibroids are hormone sensitive, and they literally are powerhouses of estrogen. . All uterine muscle cells have receptors for estrogen and progesterone. Thus a uterine cell s stimulated to grow by these hormones. A uterine fibroid tumor has a greater density of these receptors than in the case of most uterine cells. In pregnancy this is a very effective strategy, hormones trigger growth as a pregnancy progresses. But in the case of uterine fibroid, the excessive growth is the source of many of the complications of fibroids.
The hormone sensitivity of uterine fibroids also produces a estrogen excessive environment. This is a situation where the uterine fibroids adhere (also known as binding) to the estrogen molecules. Thus there is more estrogen and this can be responsible for many of the associated symptoms. Not only that but the fibroid cells are able to manufacture estrogen from other molecules. This also responsible for the powerhouse of estrogen. Obese women, or women with other high estrogen conditions like PCOS are more likely to have uterine fibroids.
Oddly women who smoke have lower risk of fibroids do to the fact that their estrogen levels are lower.
If your fibroid has grown or changed, it is important to get accurate ultrasound measurements measurements, to determine if this is true. It is equally important to know if you have other reasons for excess estrogen so that you can try to mitigate the side effects.. Generally the largest fibroid present in a uterus grows about 35% per year! It has never been shown that birth control pills or even other estrogen hormone treatments cause fibroids to grow. It is not clear why this would be so. It could be the types of hormones, the dosage, or the fact that local and genetic factors are so dominant that supplemental hormones don't have an effect. Since a uterine fibroid is a powerhouse of estrogen it is probably possible to alter that fact and help to shrink the fibroid. That is where all the new research is going. Antiprogesterone and other new hormonal therapies do however help to shrink fibroids. If you are interested in participating in a clinical research study of uterine fibroids call Women's Health Practice, 217-356-3736.
Tuesday, June 14, 2016
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.
Join one of our studies, become a patient at Women's Health Practice, come for an event, or visit any one of my websites our FB https://www.facebook.com/pages/Womens-Health-Practice/149858581724556?ref=hl
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