Tuesday, July 29, 2014

Thinking of a Baby, Here's Why to Check Your Cholesterol First

It is true that pregnancy, and even at time raising the children, can be hard on the heart; but that is not why you need a cholesterol test if you are trying to get pregnant. Poor cholesterol can affect your chances of getting pregnant in a new study in the Journal of Endocrinology and Metabolism. In their study the higher the cholesterol the longer it took for the couples to get pregnant. Who knows why this is, it may be that the cholesterol levels affect estrogen and testosterone hormone levels and thus affect ovulation that way. We known that cholesterol is one of the prime factors that contribute to blood vessel disease and blockages and ultimately lead to strokes, heart attacks, poor kidneys, poor circulation in our eyes, and poor circulation in our brains and feet, and well as reduced sexual function!  So maybe it's just not enough sex. As the couples that took the longest time to get pregnant both mom and dad had high cholesterol! Ultimately we are more worried about circulation, and the blocks to circulation cholesterol can create. Some critical sites for blockage due to plaque is due to factors that have to do with blood flow, the lower the flow in an area the easier it is for particles to dock and build the plaque. For those trying to get pregnant I theorize that the placental circulation could be one of those critical sites, or perhaps just the fertilized embryo trying to attach to the uterine wall and establish good circulation. Plaque could affect implantation that way as well. Thus when we want to know about all the factors that affect blood flow and hormonal levels before we just blame cholesterol, but then your cholesterol is relatively easy to correct if you want a baby! We advocate additional lipid testing for many women through one of our partners called Health Diagnostic Laboratory. Call your gyno for a test and see what your number is before you try the baby making!

Monday, July 28, 2014

Uterine Myomas Can Miscarry Also!

There is a condition that is called in lay terms miscarrying myoma. It is not common, but all gynos will see these cases. The fibroid may have once been inside the wall of the uterus or on a stalk within the uterus and it just begins to work it's way free. Often these cases create extremely heavy bleeding and need immediate attention. Here are pictures illustrating what is seen. Treatment is usually surgical and in many cases the fibroids can be removed and the uterus saved, in some cases it causes such profuse bleeding a hysterectomy has to be done. For information on uterine fibroid treatment options please refer to the Venus study site.
Cervical Fibroid

Cervical Fibroid Trying to Deliver Itself

Thursday, July 24, 2014

Like Other Medical Organizations We Recommend Hepatitis B and C Screening For Women

Liver disease is often caused by a virus, is serious if becomes chronic, and many of the viral infections are treatable if not preventable. Ask your gyno if you need this testing at your next appointment. Hepatitis B and C can cause liver disease or liver cancers although they are viruses that couple potentially be cleared spontaneously from your body. The United States Preventative Task Force estimates between 700,000 and 2.2 million people in the U.S. have chronic Hepatitis B,  The Centers for Disease Control and Prevention (CDC) estimates that the number of new cases ofacute HCV infection in the United States is about  17,000 cases per year. Indeed, estimates are that between 15% and 25% of people with chronic Hepatitis B (HBV) eventually die of cirrhosis or liver cancer. People with chronic HBV can also transmit the infection to others, the task force noted, and screening could identify people who might benefit from treatment or other interventions. Testing for hepatitis is a blood test that can be ordered on any of our patients (or of family members by special arrangement). At your next appointment find out if you would be a candidate for testing, even if you think you may have once been vaccinatated. Most of the infections begin with no symptoms but can be detected by blood testing.

Pharmaceutical websites offer excellent patient information

Pharmaceutical websites offer excellent patient information about your medication, and many also offer coupons to lower copays and medication costs. Patients forget that if they want excellent information, their gyno, their pharmacist, the package insert, are all excellent sources of accurate risks and benefits for your medications. However for cost savings, and updates on your particular medication, and should be checked when you are on medication. Many women are currently on oral contraception LoLoestrin or Minastrin, and here are their links.

Wednesday, July 23, 2014

Even After Yard Work Check For Ticks

Having had Lyme's disease doesn't prevent reinfection, and it is important to treat promptly. If you have had a rash develop after what you thought might have been a bug bite it would be important to see your health care provider for advice. Antibiotic treatments are very effective. In this case the patient thought she had perhaps developed a shaving rash, so those may need evaluation as well!
Rash Consistent With Lyme's Disease

Monday, July 21, 2014

Don't Skip Mammograms if YOu Have Progesterone IUD

It's very difficult to determine cancer risks as you have to study large group of women over long periods of time. Your gyno can estimate your personal risk when combining her knowledge of research studies and her knowledge of your personal risk factors and personal breast cancer protection factors. Of course your gyno is going to weigh other cancer risks when giving you contraceptive advice as described on the American Cancer Society stay healthy page.  A levonorgestrel-releasing intrauterine device (IUD) may protect users against cancers of the endometrium, ovary, pancreas, and lung, but increase their risk for breast cancer, according to a new study by Tuuli Soini, MD, from the Department of Obstetrics and Gynecology, Hyvink√§√§ Hospital, Finland, and colleagues write in an article (Obstet Gynecol. 2014;124:292-299) published in the August issue of Obstetrics & Gynecology.Using data from administrative registers in Finland, Dr. Soini and coauthors analyzed data on all Finnish women between 30 and 49 years of age who used the levonorgestrel-releasing IUD between 1994 and 2007 for the treatment of heavy menstrual bleeding also known as menorrhagia.  The cancer incidence among users of the hormone-releasing IUD was 7% higher than expected compared with women who did not use the IUD. Among women had received at least 2 IUDs, there was an excess risk of 20%. This research study looked Sorting your cancer risk with your gyno is a reason to get your annual gynecologic examination, even if it's not time for your annual pap smear.
at all cancer, not just gynecologic. Some cancers were lower than the non-using general population including uterine, ovarian, lung and pancreatic cancers, and breast cancers accounted for most of the excess risk of cancer cases.  Over 5 years of IUD use in this study significantly increased risk. Since these women specifically had disordered menstrual bleeding, it's possibly they have other risk factors that were not obvious from this study.

Thursday, July 17, 2014

Keep Pushing or Have Your Obstetrician Intervene?

Once a woman gets fully dilated in labor she has completed her first stage. Once she has her baby she has completed her second stage. The amount of time it takes to complete the second stage is dependent on many factors: the size of the pelvis and the size of the baby, the force of the contractions and the force of the pushing, the direction the baby is going (even a bit off of coming straight down the pelvis slows one down), and whether she has an epidural that is affecting any of the power of pushing. Whether the obstetrician shortens the second stage with a vacuum or forceps or c-section obviously affects that time sequence. And the delivery of the head can be accomplished more easily than the delivery of the shoulders which are a larger diameter than the head.  American College of Obstetricians and Gynecologists guidelines to define prolonged second stage for nulliparous women as greater than 3 hours with epidural or greater than 2 hours without epidural. For multiparous women, they defined prolonged second stage as greater than 2 hours with epidural or greater than 1 hour without epidural. . As your birth provider watches you there are clues beyond the stop watch. Specifically the amount of progress, with very little progress from the early pushes there is less hope of achieving a healthy vaginal birth.

S. Katherine Laughon, MD, Investigator, Epidemiology Branch, Division of Intramural Population Health Research, Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Rockville, Maryland, and colleagues published the results of their labor review study in the June issue of Obstetrics & Gynecology, showing that beyond 2 hours there are increased risks for both the mother and the child. They noted that labors are longer in these past few years than they were in the past.

The investigators reviewed electronic medical record data from 2002 to 2008, using a retrospective cohort from 19 hospitals at 12 US clinical centers. The researchers included 43,810 first time moms and 59,605 women who had had a child before who were at least 36 or more weeks of gestation, with head down (vertex) presentation and 10 cm of cervical dilation in the analysis, meaning they specifically studied the second stage.. Longer labors are common, about 10-15% in women who have epidurals, and about 3-5% of women who do not, and yet most women, about 80-90% will still accomplish the vaginal delivery even if they are moving slowly compared to normal standards.

The risks for mom of having that long second stage are infection and more significant tears to the pelvic floor, with baby also infection rates, and rates of having low oxygen increase, although they found no severe complications of that hypoxia, it is critical to note there was no increased rates of perinatal death. Experienced obstetricians can diagnose this lack of progress prior to two hours, and be able to predict whether normal or slowed progress is occurring, and whether it is healthy for you to keep pushing or have your obstetrician intervene.
Obstet Gynecol. 2014;124:57-67

Monday, July 14, 2014

You Have Been Exposed, but Will You Get HPV?

HPV exposure is almost universal, but even without vaccination, not everyone exposed tests positive and not everyone who tests positive will go on to develop abnormal pap smears or cancers. Other factors will determine whether you will test positive for HPV, and the list is mounting as to what these factors are. Smoking, menopause, poor immunity, frequent exposure to the HPV virus are just a few of the factors that have been associated with a positive HPV test.  Birth control pills have effects on the cervix and the uterus, and these effects have been well studied and discussed in many forums, they cause an enlargement of the sensitive t-zone area of the cervix that might make picking up an HPV infection easier. One group that has been particularly active in this research has been the International Agency for Reseach on Cancer . This group feels that taking birth control will increase your risk for cervical cancer by about double. But whether this directly is mediated through the effects on HPV or through the effects on some other aspect of our health, such as exposure to herbals, is still being debated. We like to test for HPV presence and rely on that test. But for a long time women have suspected there is something else that accounts for whether those tests are positive or negative besides just the fact that HPV is or is not present. And a new factor has just surfaced. Tests are more likely to be positive during certain times of the menstrual cycle. With tests reading slightly more positive later in the cycle in this recent study, although mid cycle peaks in detection have been previously reported. There is some biologic plausibility as to why this would occur. It has to do with the effects of hormones on various types of immunity which in turn would change how much HPV would be controlled or thriving. But don't worry about when to schedule your HPV test, the menstrual cycle won't affect whether it turns out positive. This is a very active area of research right now, there will be a lot more to read about.

Sunday, July 13, 2014

eCigarettes Going American But What Do They Contain And Does This Make Them Safer?

A large American company now will be making the first American made eCigarettes. Previously they have all been from China, but by being manufactured here does that mean they are safer? The Chinese made eCigarettes are not regulated in content, and thus the chemicals and percentages of nicotine varies greatly. A lot of the marketing says they're only harmless water vapor. The FDA has a definition of eCigarettes on line. Medscape points out that this is completely untrue and vaporized propylene glycol, nicotine, as well as flavoring agents that are vaporized by a heating element which is powered by a battery, and it delivers this aerosols using ultrafine particles. There are about 400 vapors, or vapes, per cartridge, and there's a poor concordance between labeled and actual nicotine content, although a typical vape puff will be about a fifth as potent as a cigarette's puff..For those who worry about second hand smoke, there's talk of turning marijuana reefers into eCigarettes, which poses a whole new set of risks. physicians are struggling with whether there is true therapeutic potential, verses just the potential for mind altering states. The NIH points out that adolescents may have special concerns, such as psychiatric risks with marijuana use, and no one knows what the effects of eCigarettes with marijuana in them may pose.
We have never been completely sure on a physiological level as to what about smoking raises the cancer risk, however we have many clues. Smoking and eCigarettes contain nanoparticles, that are so tiny they have ability to affect our cells, our stem cells, and the DNA within cells producing a wide variety of ways they can are or can transform into carcinogens. And for those who only use eCigarettes part time to decrease overall nicotine, it's questionable how that wide variety of different chemicals and particles will interact with each other to produce risk. Generally physicians know that less is more and certainly in pregnancy the safety of tobacco, alcohol, coffee, energy drinks, and marijuana are all not established!

Friday, July 11, 2014

Monday, July 7, 2014

Fibrocystic Breast Disease Fluid Evaluated

Women who have painful and lumpy breasts are most likely suffering from fibrocystic breast disease. It's been argued that it should be called a breast condition as almost 70% of women will have breast changes consistent with this diagnosis by the time they are in their 40s. The cause is not really known, but we do know that you are about 50% less likely to get FCBD if you have use birth control pills. Women know there are certain times of the month their breasts feel more painful, and seem to be more tender to the touch, and even physically larger. So it is no surprise to learn that on a microscopic level breasts do change during a cycle. During the menstrual cycle the breasts actually cycle, in sync with what the hormones of the ovaries are doing. So that in the early part of the cycle, the estrogen dominant part of the cycle, there is growth of the breast cells. And this is why after the menstrual cycle the breasts are less painful as the estrogen levels are the lowest, and during oral contraception use, the suppression of the estrogen cycle, with the suppression of ovulation, decreases breast pain. Whether you just need an exam, a mammogram, an ultrasound, or other test like a cystic aspiration, that will be up to your gyno. There are many ways to evaluate breast disease according to the American Family Physician.  For those who have developed the actual lumps, fluid begins to accumulate and if your gyno needles the fluid out of your breast it may look something like this.

Saturday, July 5, 2014

Understanding PCOS and Where To Find More Information

PCOS: The Syndrome of Hormones, Hair and Havoc of menstrual cycles
Polycystic Ovarian Syndrome (PCOS)

The doctors Stein and Leventhatal in 1935 discovered why some women had big cysts on their ovaries, extra hair growth and troubles getting pregnant. And though we recognize their work as the beginning, their name long left the condition of Polycystic Ovaries. After it was called Stein and Leventhal's disease this has been called a disease, a condition and now a syndrome, PCOS or Polycystic Ovarian Syndrome. The definition has been changed so that almost 1/10 women can meet the definition and in fact many women with perfectly regular menstrual periods are surprised to learn upon visiting their gynos that they are now diagnosed with an important condition that can have fertility and  life long health consequences. If you’ve got to shave your chin regularly, you may just have that sort of genetics, and on the other hand your ovaries may be producing too much testosterone, or one of the other boy hormones that emanate from the ovary or the adrenal gland. The most common symptom of PCOS is hyperandrogenism (too much boy hormone), chronic anovulation (skipped periods due to not popping an ovarian egg), many are overweight (7 out of 10) and finally either diabetic or pre-diabetic (again 7 out of 10), insulin resistance (you have it but it won’t work like it’s supposed to with your metabolism) and compensatory hperinsulinemia (the pancreas cranks out extra) are also features. And many have ovaries seen on ultrasound with a “string of pearls” look…little cysts all lined up around the edge as seen when looking with the ultrasound.

The insulin excess in a woman's body is probably in large part responsible  of the extra hair. The insulin stimulates the cells of the ovary to produce more male hormones. These extra male hormones right in the ovary mess up ovulation. Insulin can also suppress the liver substance SHBG (sex hormone binding globulin) which is supposed to bind male hormones and keep them inactive and there for in check. So the more deranged your metabolism is, the heavier you get, the worse your PCOS gets.

So how to fix: well to some extent there is no fix, it’s in your genes, but it can be controlled. Control anything and everything diet: lower bad LDL cholesterol, lower the blood fat triglyceride, exercise and increase good HDL cholesterol, and changing the biology of your blood fats so you change your cholesterol particle sizes and numbers of particles. Overall weight is related to how serious your PCOS is, slim by even 5%, control the sugar and use diabetic drugs like metformin if you need to. But watch for side effects of the medications used to control insulin and blood sugar. metformin can have its negative side, it can lower vitamin B12 levels (side effects of low B12 levels might include numbness, other odd neurologic symptoms such as memory loss and behavior changes). Oral contraceptives can suppress the boy hormones of the ovary, so that’s a good bet that it will be recommended as a possible solution by your gyno.

The fix for PCOS is not simple, and the more we learn, the more we know that we have to follow our PCOS patients closely, check their sugars, scan their gall bladders, check their hormone levels, discuss contraception carefully, help them control their weight, and help them when they want to get pregnant, there's a lot to gab about here!

Friday, July 4, 2014

Day Off Thoughts

On the fourth Americans celebrate the concept of freedom, gynecologists think about how to help their patients be free to feel empowered in their health care. So if you have a day off, and there is some quiet time to think about yourself it is a good time to take stock of the top questions on line regarding women's health. Always a good time to read them and think about what to ask your gyno at your next appointment, and make a list! For those who have inquiries about current Women's Health Practice news, be sure to go to our website and sign up for eblasts or follow on Facebook or Pinterest. Happy 4th of July gals!

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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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