Gyno Groupie

 

Commonly patients present with irregularities in their menstrual period, irritability or mood swings, bloating, fluid retention or weight gain, hot flashes, or decreased libido…wondering if their ‘hormones are out of balance’?  Unfortunately, there’s not always an easy answer to that question, but as Gynecologists, it does cause us to consider two common ‘hormonal’ conditions that could explain such symptoms:  Polycystic Ovarian Syndrome, and the Perimenopause.

Polycystic Ovarian Syndrome is characterized by menstrual irregularities (chronic anovulation) and signs of androgen excess (hair growth, acne), and is the most common ‘hormonal abnormality’ affecting reproductive aged women.  Nearly 1 in 15 women are affected, half of those women being overweight or obese.  Many women with PCOS have had a long history of irregular menstrual periods, dating as far back as they can remember.  The irregularities can vary between skipped periods to frequent periods, flow may be light to heavy, and short or prolonged in duration.  Some women describe light cramping/a sensation of pelvic ‘fullness’ or bloating (like their period is ‘about to start’), in the months of skipped periods.  Others describe a feeling of emotional ‘tension’, while in wait for that unknown date when their period will start.  Though the cause of PCOS is unknown, genetic inheritance may play a role.

 

In discussing the concerns of Menopausal Hormone Therapy (MHT) with patients in the office, it’s evident that ‘the fear’ of developing breast cancer from hormone use, by far outweighs the benefits of use, for many women.  With breast cancer being the number one cancer diagnosed among US women, and the second leading cause of cancer-related deaths (second to lung cancer,) those concerns are certainly understandable.

 

Though concern for an association of breast cancer from hormone use have perplexed patients and the medical community for many years, in the last 10 years, that level of concern has escalated to nearly a level of fear.  Despite some public perception of hormones as the cause of breast cancer, the medical evidence does not support hormones as a cause for breast cancer.  Unlike the causal link between smoking and most cases of lung cancer, a causal link between hormone use and breast cancer has not been established.  In fact, the cause of breast cancer is still unknown.

 

 

 

As an Ob/Gyn physician, it’s not uncommon for me to hear the question from patients, “Am I actually ABLE to conceive?”  For some women who are planning  pregnancy, as well as for some others who’ve never had a pregnancy (intended or not)…the question, “Can I get pregnant?” may be a looming concern.

Other than actually attaining a ‘positive’ pregnancy test, there really is no other specific test allowing us to know IF a woman CAN actually achieve pregnancy.  What we do know is, that for the normal couple (those without risk factors/or a history of infertility, regularly sexually active,) the chances of conception are actually stacked in our favor.  In fact, for regularly sexually active couples, there is a 15-25% probability of pregnancy with each menstrual cycle!

It is expected that nearly 90% of sexually active couples, without contraception, would become pregnant (intentionally or not) within one year.  The one year mark is typically used in defining those couples with ‘infertility’…the inability to become pregnant, despite frequent, unprotected sex within one year.  An infertility evaluation by your health care provider may be initiated at this time, and even earlier (at 6 months) for those women over 35.

 

Suzanne Hall, MD (@drsuzyyhall)

Eastside Gynecology Obstetrics

 

You may be worried about first visit to the gynecologist.  Don’t worry, this is normal, and with a little preparation it can be an empowering and educational experience.  Let your doctor know that you are nervous and we can be more effective at walking you through the process.  The American Congress of Obstetrician and Gynecologists recommends young women make their first visit to the gynecologist between ages 13-15.  Your doctor will want to ask you questions regarding your medical and surgical history, menstruation history, sexual history, exposures to alcohol or tobacco, and review vaccinations you’ve received or may be due for.  If these topics seem too personal, or you are uncomfortable discussing them, remember your conversation with the doctor is confidential.  It may be helpful to go to the appointment with a parent or friend, but be sure some of the time is spent with you and the doctor in private, so you can voice concerns or questions that might be awkward to discuss around others.  You may want to write questions down before-hand, as this is an opportunity for you to gain knowledge regarding your health and well-being.

mind well-informed.

Would you describe your sexual response as ‘fireworks’…‘a budding flame’…or ‘not much at all’?  Despite our societal conditioning of the ‘typical’ female orgasmic response, not all women experience “fireworks” at climax (like in the movies,)…possibly leaving those women with a ‘less than typical’ response, left wondering…‘Is there something wrong with me?’

 

If you experience ‘fireworks’, that’s great!  But not all women experience ‘fireworks’ with climax (orgasm.)  In fact, less than a third of women even consistently experience orgasm with sex.  Like other sensory responses in our body, the frequency and quality of our individual sexual response vary amongst women (and often vary amongst experiences). Just like the ‘savor’ of chocolate cake, the ‘scent’ of spicy perfume, the picturesque  ‘vision’ of a floral garden bring different sensations to different women, so does our experience of sex.  Women vary in type, intensity and duration of orgasm, as well as in our level of satisfaction with the experience.

 

There is no ‘right’ answer for your response to sexual stimulation.  A ‘less than typical’ response, is only a problem if you see it as one, and desire more from your experience.

 

Heavy menstrual flow is a common occurrence affecting 10-35% of women, and a common reason for visits to the gynecologist.  Though the causes for heavy menstrual periods (menorrhagia) vary, the Novasure endometrial ablation procedure is an excellent treatment option for many women, when child-bearing is completed.

As an Ob/Gyn physician with greater than 10 years of experience performing the Novasure procedure (and with hundreds of satisfied patients having selected the procedure), I thought it may be helpful to discuss common questions from patients considering the procedure as their treatment of choice. Here are my answers to 5 common patient questions regarding the Novasure procedure:

 

1. How is the procedure performed?/What can  I expect from my menstrual flow after the procedure…lighter periods or no period?

The procedure is considered minimally invasive, performed through the vaginal aspect without surgical incisions.  The Novasure wand (containing a triangular mesh) is inserted within the uterus, where a short (less than 2 minute) cauterization of the uterine lining occurs.  The procedure may be performed in an outpatient surgical setting (with anesthesia) or possibly in your doctor’s office.  You should expect to be back to normal activities within a day or so.

Several research studies on the results of the Novasure procedure note over 90-95% patient satisfaction with the procedure.  Expected results range from notably lighter menstrual periods (for most patients)…to skipped/or absent menstrual flows (up to 40% of patients.)  It’s not possible to predict for patient’s what result they will get, but when questioned overall, most patients are (very) satisfied with the results achieved.

 

 

Suzanne Hall, MD, FACOG

Heavy menstrual periods (medically termed ‘menorrhagia’) is a common GYN concern, and a frequent reason for women visiting their doctors.  10-35% of women report heavy menstrual periods in population-based studies.  Though patients may not know the clinical definition of menorrhagia, I believe them when they report ‘heavy periods’… (based on relative changes in their flow compared to when their period was more ‘normal’…or based on their perception of the flow being ‘heavier than normal’.)

Menorrhagia is clinically defined as menstrual flow lasting longer than 7 days…or greater than 80ml (5-6 tablespoons) blood flow…but who really knows how to measure blood flow that way? Admittedly, for both patients and physicians, blood loss is difficult to quantitate by these measures.  More relevant descriptions of heavy menstrual flow may include

At 15 years old I remember asking myself, “Is this what they mean by menstrual ‘cramps’?”  The term ‘cramp’ just seemed too mild to explain the horrid, 1 or 2 day experience, which regularly preceded the start of my monthly  period.  Back pain, ‘front’ pain, nausea, and sweats…felt more like a suffering from the flu…with an elephant stepping on my back!... than what I’d describe as menstrual ‘cramps’.  The usual ‘mother’s home remedies’ like a heating pad, hot tea, or over-the-counter pain reliever, hardly ever seemed to do enough, but I adhered to the regimen every month anyway…What else was I going to do?

 

As a Gynecologist, I now know the significance of the menstrual ‘cramps’.  In our rhythmic, monthly, hormonal cycle, and in response to the rise in our ovarian hormones (estrogen and progesterone), our ovaries form the ‘dominant follicle’, which releases the fertilizable egg for that month.  At the same time, the uterine lining develops a thick, shaggy layer (like a shag carpet) to enhance implantation of a fertilized egg (egg fertilized by a male sperm=pregnancy.)  On the other hand, if no egg fertilization occurs (no pregnancy), the ovarian hormones decline, allowing for release/shedding of the previously developed thickened uterine lining tissue (representing our ‘menstrual flow’), and the obvious sign of menstrual bleeding.

(cont'd)

Itching, redness, and discharge are common symptoms of genital infections, but a ‘Painful Sore’ usually raises the suspicion for Genital Herpes. Most people are unaware of how common the Herpes Virus infection actually is.  According to the CDC, 1 out of 6 people have the virus, though they may not be aware of it (i.e., never had an outbreak, or have never been tested for it.)  The risk of spreading the virus is greatest when an active lesion (a painful sore) is present.  Part of the reason for the high frequency of spread of this virus, is the fact that transmission of the virus can occur, even without visible signs of the infection (no sore present!) This is termed ‘asymptomatic shedding.’  Once exposed to the virus (by oral/genital skin contact during sex), infection may happen (the virus enters your bloodstream)…though, it may-or-may not, cause visible signs of infection.  1 out of 6 people would test positive for the infection by culture or blood test (even though they may not be aware of their previous exposure/infection.)

I’m glad you asked. There seems to be some confusion about the term, and how it’s used to define our reproductive state of being. First off, menopause is the permanent cessation of our reproductive hormones, and therefore, the end of our menstrual cycling. The average age of menopause is approximately 51yo in the United States, though some women may end earlier, and some later. For most women it’s not so much the ending of the periods that’s bothersome, but the symptoms that may go along with this “change"...

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Check out this amazing 'life-like' computerized graphic video of fibroids from simulated Myosure procedure!

 

Who really likes going to see the Gynecologist?  For some women, it probably ranks right up there with getting a tooth drilled at the dentist, or like nails to a chalkboard.  But let’s face it, the gynecologic exam/Pap smear is a necessary part of preventative Women’s Health screening.  Whether it’s your first visit, or you’re seeing the Ob/Gyn you’ve known for years, here are a few tips that may help to make your visit go more smoothly…

 

Prepare your questions/concerns

Make a list of your concerns/questions, include your medical history, medications, allergies, ect…

In that the average patient-physician interaction is 10-20 minutes, it’s helpful when your list of problems/concerns is concise.  Know your medical/surgical history, medication allergies, and list your current medications. Think about (or write down) your problem list/symptoms, when they began/worsened, what aggravates/or improve the symptoms, and from a gynecologic perspective, if they’re cycling with your menstrual period.  Understand that if your list of questions/concerns is long, we may have to address some of them at a subsequent visit.

 

 

 

Confused about Menopausal Hormone Replacement Therapy? Let's discuss the differences in FDA-Approved versus Bio-Identical Hormones...

I often use analogies when explaining concepts with patients in the office.  Though the issue of Menopause/Hormone Replacement Therapy (HRT)  is a complex one,  with many different considerations…We have to start somewhere in grasping the array of options.  Here’s my bit.  In my analogy we’ll start with 3 options:

1) FDA-approved HRT,

2) Bio-Identical HRT

3) Herbal options.

One of the main differences in FDA HRT and Bio-Identical HRT is their derivation.  FDA/HRT may come from plant or animal sources, whereas the Bio/HRT and herbal options come from plant sources only.  I explain to patients, you can take certain plants (mostly soy containing yams) and “squeeze out’’ products  EQUAL  to “human hormones” (there are both FDA-approved HRTs and Bio-identical/HRT options.)  Certain other plants have “plant hormone” with similar qualities, but not equal to human hormone (isoflavones like soy, Siberian rhubarb.)

 

So what is this HPV all about?  HPV (human papilloma virus) is a virus that causes 90% of genital warts in men and women, 75% of cervical cancer in women.  It also causes 70% of vaginal cancers and 50% of vulvar cancers as well.

So it is a big deal?

 

The use of estrogen/progesterone containing Birth Control Pills have long been known to slightly increase one’s risk for Venous Thromboembolic  events (i.e., deep vein blood clots.)  Recent reports have put into question additional increased risk by use of BCPs containing the progesterone, dropserinone (Yasmin, Yaz, Beyaz, and their generics.)  Available studies on this issue are inconsistent,  some studies showing a fractional increased risk, others showing no increased risk.  In comparing risks of VTE, the increased risk from any Birth Control Pill (3-9/10,000) is still significantly less than the increased risk of VTE in pregnancy (5-20/10,000), and the immediate post-delivery time period (40-65/10,000)…  According to the FDA’s advisory committee, the benefits of all contraceptive methods still outweigh the risks.

drsuzyyhall

(See WXYZ's interview with Dr. Suzanne Hall on their recent story on Yaz

at http://www.wxyz.com/dpp/news/health/mom-warns-birth-control-killed-her-daughter)

We frequently hear from our patients that sex isn't what it used to be.  In the younger patient, it am be pain secondary to previous pelvic infection, endometriosis, or uterine fibroids.  There maybe new physical issues involving their relationship, their children, or work.

The recommended time for getting mammograms is at age 40 and yearly thereafter.  However, I like to get one around age 35 as a baseline and age 40 thereafter.  The reason is that in my practice area, there seems to be higher incidence of breast cancer, especially in younger women.  So because of this demographic I get the earlier screening.

Talk to your doctor about what is best for you!

Thanks and I’ll talk to you soon.

docbchen

We spend a good amount of time explaining tests and test results to patients during routine office visits.  One particular test often leads patients’ to anxiety and misunderstanding: The Quad Screen.

 

The Quad Screen is a test from the mothers blood, drawn between 15 and 20 weeks of pregnancy.  The goal of the test is to evaluate the risk (or chance) that the current pregnancy is affected by Down’s Syndrome, or, more rarely, other chromosome abnormalities.