Gynecology Health Topics

There are many contraceptive options available for women today.  Your doctor will help you decide which option might be best for you.

ORAL CONTRACEPTIVES:
The birth control pill is the most popular choice for American women.  The “pill” is made of estrogen and progesterone hormones.  It is 99.9% effective if used properly and works by inhibiting ovulation.  Ovulation is the process by which the ovary releases an egg to be fertilized.  The “pill” needs to be taken every day.  There is also a “minipill” that contains only progesterone and is perfect for breastfeeding moms.

PATCH AND VAGINAL RING:
The patch and the vaginal ring are like the birth control pill except with a different delivery system.  The patch is attached to the skin like a bandage.  It needs to be changed on a weekly basis.  The vaginal ring is placed into the vagina where it secretes hormone locally.  It stays in place for three weeks, then is removed for one week after which time a new one is placed for another three weeks.  Both these methods are as effective as the “pill” and also work by inhibiting ovulation.

INJECTABLES:
Progesterone may be injected every three months for excellent contraceptive protection.  Irregular bleeding may occur initially but most women get to the point where they stop menstruating altogether.  This is not harmful to your body as the progesterone keeps the lining of your uterus so thin that there is nothing to slough off each month.  Like the “pill”, it also inhibits ovulation and is just as effective.  It is perfect for women who should not be taking estrogens.

INTRAUTERINE DEVICE:
The IUD has returned to popularity as a contraceptive option.  This is a device placed into the uterine cavity by your physician.  This is a fairly comfortable procedure done in the office.  There are two types on the American market today – Paraguard and Mirena.  The Paraguard lasts for ten years and may cause a slight increase to your monthly flow & mild cramping.  Mirena lasts for  five years and shouldn’t increase your flow or cause cramps.  Both these types can be removed at any time with return to fertility.  They work by inhibiting ovulation, decreasing motility of the tubes making it difficult for the sperm and egg to meet, and thickening cervical mucous which makes it difficult for sperm to get through.

BARRIER METHODS:
The diaphragm is a barrier method and doesn’t involve hormones, which may be a good choice for women who aren’t hormone candidates.  It is slightly less effective than hormone methods – 94-95%.  The diaphragm is to be fit by your physician.  It is placed prior to intercourse and removed after.  It fits over the cervix to prevent the entrance of sperm.

Condoms, female condoms and the sponge are barrier methods found over the counter.  They are placed prior to intercourse and removed after intercourse.  The effectiveness is approximately 94% if used with a spermicide.

PERMANENT METHODS:
Permanent methods of contraception include Essure tubal coils or tubaligation for women and vasectomy for men.  These are to be used only if you are absolutely sure that you are done having children.  These methods involve surgical procedures performed by your physician.  The newest method in the United States, Essure, can be done in the office.  Advantages over the traditional tubaligation, include; less expense, faster recovery, no incisions, and a lower risk of complications.
 

Nutritional Recommendations

1.  Increase intake of vegetables and fruits to 3-5 servings per day.

2.  Decrease refined sugar, starches (like cereals, pita bread, rice, corn, beans, and potatoes), salt, saturated fats, alcohol, dairy, and caffeine.  Increase omega-3 fatty acids (examples: tuna, salmon, walnuts).

3.  Eat three meals a day and three nutritious snacks which will help alleviate blood glucose swings.  A good example of a snack is sliced deli turkey, low fat cream cheese, and a third of an orange, a small apple or kiwi half.

4.  Vitamin B-6: 100 mg twice a day for anxiety, irritability, and depression.

5.  Tums Calcium for Life PMS (chew 2 tablets in the morning and 2 tablets at night) for mood, water retention, pain and cravings.  At night, a glass of milk, if desired.

6.  Vitamin E 400 units a day for breast pain, headaches, and/or sleep problems.

Exercise Recommendations

1.  Exercise! Exercise! Exercise!

2.  Exercise every day.  Make a plan to take a walk, ride a bike, or swim.

Stress Management

1.  Recognize what sets you off (eg. Your spouse and kids not helping you with the household chores).

2.  Be aware of when stress occurs in relation to your cycle.

Severe P.M.S. may require psychological evaluation and/or other medications.

Mild cramping during your period is common and usually normal. In this case, ibuprofen or other over-the-counter pain relievers, works nicely at keeping women comfortable and functioning during their period. However, some women experience disabling pain during their menstrual cycle. Often, for these women, nothing seems to completely get rid of the pain. They may experience pain with intercourse or at other times of the month. They may miss work and be unable to function in their normal capacity. If this sounds like you, please seek medical evaluation.

There may be underlying abnormalities that can explain the pain. One of the more common gynecologic abnormalities that may cause this pain is endometriosis. Your doctor may recommend surgery to help diagnose this condition, or it may be possible to treat empirically with special medications. Another important step, would be to rule out other non-gynecologic disorders, such as bowel, bladder, or orthopedic disorders. Our doctors at Oasis will be happy to discuss these options with you and answer any questions you may have.

Endometriosis is a condition often resulting in pain.  It may also be associated with bleeding abnormalities and infertility.  It is a benign but progressive disease characterized by tissue from the lining of the uterus implanting in an aberrant location outside the uterus.  It most commonly grows on the fallopian tubes, ovaries, and uterine ligaments, but may also involve the bowel, bladder or other sites of the body.  Although there are many theories, we don’t know for sure why this occurs.

This disease is most commonly diagnosed by visualization of the abnormal tissue in the pelvis through a procedure called a diagnostic laparoscopy.  During this procedure, your physician inserts a camera through an incision made in the belly button which allows visualization of the inner pelvis.  Any abnormal areas may be biopsied during the procedure for confirmation of the diagnosis.  Methods may also be employed to laser these areas to get rid of them, however much of the disease is microscopic and may not be directly visualized. 

Another option for therapy, once the disease is suspected or diagnosed, is a medication called depo-lupron.  This medication suppresses the ovaries into a temporary menopausal state.  The abnormal tissue growth shrinks during Lupron therapy and most women become pain-free after three months of therapy.  The full duration of therapy is six months.  Approximately 60% of women are still free of pain five years after therapy.  Ovaries regain function once the treatment is stopped so child-bearing is still possible.  There are other medications that may help with the pain of endometriosis but none are as effective as Lupron at slowing the progression of the disease.

For more information regarding endometriosis and its treatment options, visit endofacts.com.  Our providers at Oasis will address your concerns, as well.

If you are trying to become pregnant and are having difficulty, you may want to begin by monitoring your menstrual cycle.  The first day of your menstrual cycle is known as cycle day one.  Each day thereafter is counted, even after you have finished your period, until the next month’s period begins which is then back to cycle day one.  A normal menstrual cycle lasts from 21-35 days with flow typically lasting two to seven days. 

To help predict when and if you are ovulating, you may perform a basal body temperature chart, which is a chart that plots your daily temperature and may be found on a variety of sites on the internet, such as fertilityfriend.com.  The morning after your menstrual flow has ceased is a good day to begin taking your temperature.  You need to take it first thing in the morning using a mercury-type thermometer and holding it under your tongue for five minutes.  Do this before getting out of bed, then plot the results on your chart.  Approximately mid-cycle, you may notice a slight temperature rise indicative of ovulation.  It is best to have intercourse on this day and every other day for a week.  You may also try on ovulation predictor kit sold at your local pharmacy.  Start this on cycle day 10 and every day until positive.  Have intercourse when it is positive and every other day for a week.

If you have other health problems, or haven’t been able to get pregnant despite checking for ovulation, you may want to schedule an appointment with our providers for further evaluation.  Also, remember to start taking prenatal vitamins preferably three months prior to getting pregnant.  Avoid alcohol and anti-inflammatory products, such as aspirin or Motrin, if you could be pregnant.  Consult your physician if you are taking other medications you are unsure about.  Finally, if you are a smoker, please quit smoking prior to pregnancy.

Heavy vaginal bleeding, known as menorrhagia, may be either prolonged menstrual flow (greater than 9 days) or excessive flow which may occur at the time of menstruation or in between periods. Most women not on hormones (such as birth control pills) during a normal menstrual cycle can go several hours without changing their pads. If your pad is saturated and needs to be changed every one to two hours, or you need to get up at night to change pads, you should consider this abnormal and have this evaluated by a physician.

Bleeding that occurs in between periods may also be due to abnormal conditions, although some women normally have a day or two of spotting midcycle during their time of ovulation. This may also be normally seen when starting birth control pills or changing to a different pill. You may also experience a change in bleeding patterns during times of increased stress. Under these benign circumstances, bleeding in between periods should not be persistent. If it occurs consistently, see your physician.

Any vaginal bleeding that occurs after menopause should be considered abnormal and needs to be investigated immediately.

A popular treatment option for women undergoing menopause is hormone therapy. This includes treatment with hormones such as; estrogen, progesterone, or testosterone. Treatment may occur via pills, patches, injectables, or implantable pellets.

Perhaps, the biggest benefit to hormones is for the relief of menopausal symptoms such as; hot flashes, night sweats, vaginal dryness, trouble sleeping, forgetfulness, trouble concentrating, mood swings. Hormones work 90-95% of the time at controlling these symptoms. Other methods (anti-depressants, blood pressure medications, bellergal) work approximately 70% of the time, while placebo works 60% of the time. Hormones can also be used to control monthly flow.

Recently, there has been much hype in the public regarding risks of hormones. The Women’s Health Initiative (WHI) study found a slightly increased risk of breast cancer after four years in women taking Prempro©, a combination pill of estrogen and progesterone. This risk was only slight, however, and was not seen in women taking Premarin©, an estrogen only pill. Other studies in the past have shown this slightly increased risk of breast cancer, but studies have not shown an increased risk of breast cancer in women taking birth control pills. Also, some studies have shown that women taking hormones live longer than those who don’t. Studies looking specifically at breast cancer have shown that women on hormones at the time of diagnosis of breast cancer have an earlier stage of disease, live longer, and face a better prognosis than those women with breast cancer not on hormones at the time of diagnosis.

Another recent study (HERS – Heart and Estrogen/progesterone Replacement Study) has shown that women with heart disease being started on hormones have an increased risk of suffering an adverse cardiac event during the first year of use. For this reason, physicians will typically not start patients on hormones if they have heart disease.

To sum it all up – nothing is without risk. Everything we do in life involves risk and we, therefore, need to balance risks with the benefits to make the proper choices. Please schedule an appointment with your physician to see if hormones may be the right choice for you. She will help you balance those individual risks and benefits to aid in the making of an informed decision.

Menopause is the stage in a woman’s life when her ovaries stop functioning. This leads to cessation of menstruation, but can also result in many irritating symptoms, such as; hot flashes, night sweats, vaginal dryness, trouble sleeping, forgetfulness, trouble concentrating, and mood swings. Some women breeze through this time with a minimum of symptoms. Other women can be extremely uncomfortable.

The average age of menopause is 52, but can occur in women much younger. Perimenopause is the time “around” menopause which may last for several years. During this time, a woman’s period may space out and become irregular. Usually, the flow gets lighter, but may be heavier at times, especially when there has been a long gap between menses. One is considered post-menopause when there has been no vaginal bleeding for one year. After this time, if bleeding occurs, it should be considered abnormal and needs to be evaluated.

Even though menopause is a natural process, some symptoms may be especially irritating that therapy may be desired. Also, some menstrual cycles may become so unpredictable that women may desire therapies for improved cycle control. Make an appointment with our providers to see if perhaps you could benefit from treatment.

Maintaining bone health is an important part of a healthy lifestyle. As we age, our bone loses density and quality. Over time, this can lead to an increased risk for fracture (broken bones), chronic pain, decreased mobility, height loss & skeletal deformity (eg. Dowager’s hump of the back), and poor nutrition.

Your doctor may order a special bone density test called a DEXA scan which measures the density of your bone to determine your risk for fracture and other disabling consequences. A small amount of bone loss is called osteopenia and further loss may lead to osteoporosis. Your doctor may prescribe special medications that may help to strengthen bone and decrease your risk for fracture if you are found to have bone loss.

Certain lifestyle practices are imperative to maintain bone health. Make sure to include enough calcium in your diet. If you are still menstruating, you need approximately three servings of calcium-rich foods per day, or 800-1000 mg of calcium. If you are post-menopausal, you need 4-5 servings, or 1200-1500 mg of calcium. If you are pregnant, you need 4 servings, 1200 mg of calcium. Most multivitamins have 200 mg of calcium per pill. Examples of calcium-rich foods include; dairy products, green leafy vegetables, and calcium-fortified orange juice. It is also important to get weight bearing exercise. This includes any type of activity that places weight on your bones, eg. Walking, lifting weights. It does not include exercises such as; swimming or bicycling.

There are certain habits to avoid that increase bone destruction. This includes smoking and consuming large amounts of soft drinks.