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.

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.

50%-90% of pregnant women experience symptoms of ‘morning sickness’ in the early months of pregnancy.  These symptoms can range from mild intolerance to certain odors or food, to more significant, daily nausea and vomiting (N/V).  Studies suggest that up to 25% of pregnant women experience nausea, 50% experience both nausea and vomiting, leaving only 25% of pregnant women unaffected.  In those affected, the symptoms usually manifest by the 9^th week of pregnancy.

Much is written and discussed about home/medical remedies for morning sickness, but much less is written/discussed about the (possible) causes for nausea and vomiting in pregnancy (NVP).  Though the cause of NVP has not been proven, it has been postulated that NVP is an innate mechanism, presenting as a ‘protection’ for the developing fetus (an inherent ‘aversion’ to substances that could be harmful to the fetus.)  Leading medical theories consider the adverse reaction of the ‘hormones of pregnancy’ as potentially causative (in the absence of other intestinal or medical problems that could present with N/V.)

If anyone should know the concerns of choosing pregnancy and childbirth later in life, as an Ob-Gyn physician, having given birth to my first child at 39 yo, I should think I’d be one of them.   With my training and experience as an Ob-Gyn physician, I was fully aware of my risks in deciding on childbirth…as a woman of ‘advanced maternal age’.  I counsel women on their risks nearly every day.

I already knew that at my age, it may take longer for me to get pregnant. I knew that advancing age is associated with subfertility (prolongation in time to achieve conception,) and I knew this to be related to altered/changing hormonal patterns as we age, leading to suboptimal ovulation.  I already knew that there is decreased ovarian reserve (fewer fertilizable eggs remaining in our ovaries) as we age.  I also knew that advancing age was associated with a higher risk of miscarriage, most likely related to the poorer quality of aging eggs, and the increased chances of fertilizing an egg containing abnormal chromosomal material...

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Suzanne Hall, MD  (@drsuzyyhall)

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