WOMEN’S HEALTH WEDNESDAY

Uterine Fibroids. What the heck are those, right?

They are benign tumors that grow in and around the uterine walls. In extremely rare cases (less than .1%) they lead to cancer. They come in all sizes (from the size of a pea to the size of an orange) and grow in all areas of the uterus - so their symptoms and treatments are dependent on size/location. 

Smaller fibroids are usually asymptomatic. They may never have to be treated. In other cases, the fibroid may place pressure on the bladder/bowel causing urinary retention/frequency or painful defecation and constipation. They may cause other symptoms such as back pain or painful/heavy menstruation. Rarely, they can interfere with ovulation which can lead to infertility. 

Fibroids are fairly common, especially in the African-American population and women in their later reproductive years. There is a correlation between patients with fibroids and patients with hypertension. They can be diagnosed by use of ultrasound or MRI and may even be palpated during a gynecological exam. Like with reproductive cancers, there’s no surefire prevention. 

As stated before, treatment varies on severity. Tumor-shrinking medications may be prescribed. One method of treatment is cutting off the blood circulation to the fibroids. Radiation can be used. Unfortunately, hysterectomies are typically the go-to treatment and may even be suggested for patients with asymptomatic fibroids - although I hope that in coming years this trend dies down and alternative, less invasive treatments take over. 

WOMEN’S HEALTH WEDNESDAY

Placenta previa vs Placental abruption. They’re both life threatening conditions that can occur during pregnancy, but what’s the difference?

Placenta previa

• When the placenta is fully or partially located over the cervix
• Occurs in 0.5% of pregnancies
• Symptoms include painless vaginal bleeding
• Indicates delivery via cesarean section
• High risk for post-partal hemorrhage 

Placental abruption

• When the placenta separates from the uterine wall
• Occurs in 1% of pregnancies
• Symptoms include painful cramping, vaginal bleeding, fetal distress and contractions that may seem continuous
• Baby is at risk for still birth or severe birth defects (including brain damage), as its source of oxygen and nutrients is reduced
• Mother is at risk for post-partal hemorrhage, shock and may need medication to help the uterus contract after delivery
• If the baby is 36+ weeks, indication for immediate delivery

WOMEN’S HEALTH WEDNESDAY

The intrauterine device or IUD is a long term contraceptive option. There are two types: 

• Copper IUD. Brand name in the US: Paragard. Hormone free. Works by impairing the mobility of the sperm and making it difficult for a fertilized egg to implant. Needs to be replaced after 10 years. May cause a heavier period. 
• Hormonal IUD (often called intrauterine system). Brand name in the US: Mirena. Works by thickening the cervix mucous and thins the lining of the uterus, as well as a low dose of progesterone inhibiting ovulation. Needs to be replaced after 5 years. May decrease period flow. 

The IUD is placed by a gynecologist during an in-office procedure. Both forms can be removed whenever the woman chooses, resulting in immediate return to fertility. There is a 1% chance conception may occur with either. The device usually costs $600-700 but is often covered by insurance (I believe including Medicaid, which sort of surprised me!) It’s important to note that an IUD is not recommended for a woman who has not carried a pregnancy to term. This is because certain changes in the cervix occur during pregnancy that prevent the device from being expelled from the body. In addition, it’s important that patients understand that just like any hormonal birth control, there is no protection against STDs.

WOMEN’S HEALTH WEDNESDAY

You may have heard of gestational diabetes, but a new study shows that the prevalence of gestational hypothyroidism may lead to a new standard in pre-natal screenings. Quest Diagnostics labs conducted a study of over 500,000 pregnant mothers recently and discovered that 15% of them had TSH (thyroid stimulating hormone) levels above the norm, despite the fact that they showed few clinical symptoms. Undetected hypothyroidism during pregnancy may result in miscarriage, hypertension, gestational diabetes, low birth weight and delayed cognitive development. Just like with pregnancy-related diabetes, the condition was relieved in some patients but not all. Postpartum hypothyroidism has been predicted to be a contributing factor in fatigue, depression and weight gain. Risk factors include maternal age (35+), obesity and Asian heritage. 

Source.

WOMEN’S HEALTH WEDNESDAYS

Pre-Menstrual Syndrome: Difficult to define but you know it when you see it (or, experience it). Here are some natural remedies for reducing symptoms:

• Avoid sugar, it perpetuates mood swings. In a non-diabetic person, the more sugar you eat, the more insulin your body releases - which can leave you hypoglycemic and in a bad mood. 
• Decrease sodium intake. This will help you avoid “bloating” or putting on temporary water weight.
• Avoid fatty animal products such as red meat, whole milk, butter - they contain hormones which will contribute to symptoms such as breast tenderness. Caffeine can boost your estrogen levels as well.
• Hydrate! Exercise! These can decrease headaches and cramps. Exercise releases endorphins, nature’s painkillers. 
• Supplements. Vitamin B6 can reduce emotional factors related with PMS (such as depression and anxiety) and studies show that adequate calcium intake can cut PMS symptoms by 50%.

PS) Sorry all of the things to avoid are things that you crave with PMS :/

WOMEN’S HEALTH WEDNESDAY

The cervical cancer prevention process in three steps:

1 The Pap test/Pap smear. This is a screening for pre-cancerous and cancerous cells in the cervix. A speculum tool is used to allow a swab to collect a sample of cells for examination under a microscope. Common misconception: Pap is short for the doctor’s name who invented it (Paponikolaou), not human papilomavirus - which coincidentally can cause cancerous cell growth in the cervix. A Pap smear is performed annually in sexually active females and usually ever 5 years in post-menopausal women with no history of abnormal findings.

2 If suspicious cells are collected in the Pap, the next step is a coloscopy (not to be confused with a colonoscopy). In this procedure, a tool called a coloscope is used to illuminate and magnify the cervix and vaginal tissue (“scopy” = to look). It is usually paired with biopsy - cells are removed from cancerous or pre-cancerous lesions for further evaluation. A coloscope is also used to examine and collect evidence from rape victims. 

3 If it is determined that cervical dysplagia is evident, a LEEP procedure is performed (loop electrosurgical excision procedure). It is performed within an office and requires local or general anesthesia. The tool used simultaneously cuts and cauterizes the tissue as lesions are removed.