Women’s health issues

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Pregnancy Weight Gain: When the Guidelines Might Not Be Right for You

Monday, May 19th, 2014

When you find out you’re pregnant, one of the first things your doctor will probably want to discuss with you is how much weight you should gain over the course of your pregnancy. The guidelines say that most pregnant women should gain between 25 and 35 pounds – more if they start out underweight, less if they are overweight to begin with. How does that weight gain break down?

  • 1  pound for the placenta
  • 2 pounds for amniotic fluid
  • 2  pounds for the increased weight of the uterus
  • 1 pound for increased breast size
  • 3 ½ pounds for increased blood volume
  • 6 ½ pounds for maternal fat stores
  • 6-7 ½ pounds for the full-term baby

All of this adds up to between 22 to 24 pounds that a healthy woman of normal weight can safely gain during her pregnancy.  The operative term here is “normal weight”.

However, many women don’t start pregnancy at their ideal weights. For a woman who is very underweight, somewhat more weight gain may be optimal, and may be the natural outcome of eating enough nutritious food to nourish herself and her growing fetus.

A much more common problem, though, is that of the woman who starts her pregnancy overweight. One in five pregnant women (20%) are obese at the start their pregnancy.   Gaining too much weight during pregnancy is one of the most preventable causes of complications, ranging from gestational diabetes to preeclampsia to overly large babies that require cesarean deliveries.

A woman who is overweight or obese can safely gain less than 25 pounds during her pregnancy as long as she eats a healthy diet. Keep in mind that “eating for two” should mean that you are eating twice as well, not twice as much.  The fetus usually weighs less than 1/20 of its Mom’s weight. So for an overweight or obese woman, switching to the healthy diet she needs for pregnancy may actually mean a reduction in calories, and gaining less than the recommended amount or even losing weight may be the natural result.  And, an obese pregnant woman shouldn’t get overly concerned about it.  If you are obese, you already have a fluffy substrate or matrix upon which your pregnancy will grow.  A numerical end-point, i.e., weight gain or loss, should not be used in obese pregnant women, but rather a healthy, balanced nutritional intake should take priority. 

This is perfectly fine as long as your doctor agrees (always discuss matters related to your pregnancy with your own doctor, because your situation is unique), and as long as your diet contains all the necessary nutrients and fluids you and your baby need.  I, as the principle investigator, have done the original research and have published the first and, to date, the only randomized clinical trial regarding the outcomes of nutritionally monitored obese pregnant women.  A well-balanced diet is the way to go resulting in less problems during the pregnancy.

A pregnant woman should be drinking lots of water – at least eight cups a day – and another four cups of skim milk, leaving very little room for soda or fruit juice (which are both mostly sugar). And eating all the fresh fruits, vegetables, lean meats, fish, and whole grains you need does not, for the most part, leave room for junk food.

The occasional treat is fine. A cup of coffee, a small serving of chocolate, and the like do not have to be abandoned entirely for nine months, and trying to do so would most likely set you up for failure anyway as the temptation to “cheat” would be too great. Tell yourself you can have treats – just not every day and not in large amounts.

Exercise will also help you feel better and keep your weight in check during pregnancy. Walking, swimming, and using a stationary bicycle are excellent exercises now. Keeping track of everything you eat and which exercise you perform each day and for how long can help you stay accountable and motivated.

Just because countless people – even strangers – will tell you that you “should” be gaining 25-35 pounds does not make this necessarily right for you. They don’t even know you!  Talk to your doctor to determine whether you can safely gain less; delivering a baby in better shape than they were in nine months ago is a very real possibility for many women. See my book, Inside Information for Women, for much more information on this and other women’s health issues.

– Yvonne S. Thornton, M. D., M. P. H

Men and Women Not Equal When It Comes to Alcohol Abuse

Thursday, May 15th, 2014

With media recently purporting the health benefits of moderate alcohol consumption (most popularly red wine, for the antioxidants), you may be wondering whether to add a daily glass (or two) of wine to your diet. Here are some reasons to think twice – or at least strictly moderate your intake.

Even though on average men drink alcohol in larger amounts than women, women’s bodies have a harder time metabolizing it. That means that if a woman matches her male companion drink for drink, she will be affected by the alcohol faster and more powerfully and will have more alcohol in her blood than him. She will also suffer more pronounced long-term health effects from overindulging.

Alcohol in Pregnancy

There is no justification for drinking any amount of alcohol at all when you’re pregnant, because there is no known safe amount. Drinking alcohol during pregnancy increases the risk of fetal alcohol spectrum disorders, which can cause birth defects and mental retardation. Because you may not know you’re pregnant for several weeks, you should also avoid alcohol if you are trying to become pregnant, and seriously consider whether drinking is wise if there is a chance you could get pregnant.

Other Health Concerns Related to Alcohol Abuse

Excessive alcohol consumption can cause reproductive health problems, such as disruption of the menstrual cycle, miscarriage, stillbirth, or premature delivery. In addition, excessive alcohol intake increases the likelihood of having multiple sexual partners, resulting in an elevated risk of sexually transmitted diseases and unintended pregnancy. Binge drinking is strongly linked to sexual assault, especially among college students.

Women also have a greater risk of cirrhosis of the liver and other liver diseases related to alcohol. Effects on the brain impact women more as well, and these can include brain shrinkage and memory loss. These effects tend to take place in women sooner and with shorter periods of alcohol abuse than in men.

Consuming too much alcohol also affects women’s hearts differently than men’s, and women have a greater risk of damage to the heart muscle. Alcohol consumption leads to a higher risk of cancers of the breast, colon, liver, esophagus, throat, and mouth.

What about the Benefits?

So what about those antioxidants in red wine? New studies show that they aren’t particularly effective at the low doses obtained from a daily glass of wine anyway. You’re better off getting your antioxidants from a balanced, healthy diet that includes lots of fresh fruits and veggies. You can get resveratrol, the specific compound found in red wine, from grapes and raisins (and, to a lesser extent, peanuts); a wide range of other antioxidants can be found in other natural foods such as berries, apples, beans, plums, and many, many more. So if it’s antioxidants you’re after, head to the farmers’ market or the produce department – not the beer and wine aisle.

– Yvonne S. Thornton, M. D., M. P. H

Faced with an Unintended Pregnancy? Here Are Your Options

Thursday, April 24th, 2014

Half of all pregnancies are unintended.  Finding out that you are pregnant can be a shock even if you were trying – but even more so if you weren’t. If you have become pregnant without intending to, you have three basic options, but first take some time to let the news sink in and think about your choices. If you haven’t already, see your doctor as soon as possible to confirm the pregnancy. Then talk to him or her – or a counselor – to make sure you understand your options and are equipped to make the best decision for you. The choices you have are:

1. The Decision to Become a Parent

Parenting is both challenging and rewarding. The experience of growing a baby inside of you is unlike any other, and then you get to raise a child to be a unique individual with his or her own talents, interests, and personality.

If you choose this option, keep in mind that a good support system is essential. There are seemingly endless decisions to make: if you are single, will you marry the father? If not, what type of financial and parental support is he able to provide? Will you have the financial support you’ll need otherwise? How can you make raising a child fit in with continuing to strive for your personal long-term goals?

In addition to making choices about your future lifestyle and choices about parenting, there are even more immediate concerns, and those include the fact that you have gotten pregnant without first preparing your body and ensuring that you were doing everything you could to be as healthy as possible. Prenatal care is especially important, and be sure to discuss with your doctor any medications you have been taking, including herbal or “natural” supplements. You’ll need to start taking care of yourself and your baby immediately, but don’t worry – your chances of delivering a healthy baby are excellent.

2. The Decision to Place Your Baby for Adoption

Adoption has come a long way, so if raising a child isn’t a good option for you and abortion isn’t right for you either, you should be aware of the wide range of options available to mothers looking to place their babies for adoption today.

Benefits of adoption include being able to choose the adoptive family, having considerable control over many of the details that will affect your child’s future. You can also choose what type of relationship, if any, you would like to have with your child over the coming years. Remember that you can change your mind at any point in the process, up until the child is six months old in many states. Support groups and other counseling services can help you work through your feelings and feel good about your choice – whatever that choice turns out to be.

3. The Decision to Have an Abortion

The decision to have an abortion is never an easy one, but sometimes it is the right one. Learning about the different types of procedures and the risks they carry can help you make an informed decision.

Every woman’s situation is unique, and women choose abortion for many reasons, including not being ready to be a parent, not being financially able to support a baby, feeling that having a baby would make school, work, or caring for other children too difficult, being too young to be an effective parent, feeling that her family is already complete, having health problems, and having a pregnancy that is the result of incest or rape.

Talking to someone you trust who has had an abortion can be helpful, as can learning as much as you can about the laws in your state regarding abortion. Think about your values and your views on abortion, as well as your reasons for choosing this option. Talk to your doctor about any concerns you have about how an abortion might affect your health, relationships, or future fertility.

Unintended pregnancy is never easy, but getting as much information as you can about your choices, talking to someone who can help you through the process, and being honest with yourself about your individual situation can help you make the right decision for you.

– Yvonne S. Thornton, M. D., M. P. H

Making the Most of Your Annual OB-GYN Appointment

Monday, April 21st, 2014

Too often, women have a list of questions or concerns in their heads in the days leading up to an appointment with their doctors, only to forget most or all of them once in the exam room. Or, they leave the doctor’s office without feeling they received all of the information they needed. You don’t get a lot of time with your gynecologist, so it’s a good idea to be aware of some strategies for making sure you get as much as you can out of the visit. Here are some tips for making sure you and your doctor communicate well and that you get what you need out of your visit.

1. Know when your last period was. Mark it on a calendar and know the date – your gynecologist needs to know this. If you are experiencing irregular bleeding, a calendar tracking your periods as far back as possible is preferable.

2. For a couple of days before your visit, do not douche (which you should not be doing anyway) or have sex. Both of these things can interfere with the results of your pap test.

3. Bring a written list of all medications you are taking, including herbal supplements and vitamins. Know the doses and names of all of them.

4. Bring a list that you have prepared ahead of time of all questions you want to ask or concerns you want to bring up. Even if there are only a few items on the list, write them down – it’s too easy to forget them during the visit.

5. Ask for clarification. If the doctor says something you don’t fully understand, speak up. If you aren’t sure, repeat it back to the doctor in your own words to make sure you get it. Also ask if he or she can recommend any books or other resources for information on any condition you may have.

6. Be completely honest. Never lie about drug or alcohol use, your sexual history, or any other issues your doctor asks about, no matter how embarrassing the conversation may feel. Not being truthful can lead to a wrong diagnosis or the wrong advice.

7. If you need to discuss a specific problem you are having, take some time to make some notes before your appointment and know the answers to questions such as: When did the problem begin? What have you tried to improve your symptoms? What worked and what didn’t? Has any other doctor seen you for the condition; have any tests been done? What were the results? What makes the problem worse and what alleviates it? Include any information you can think of that might be relevant.

Most women don’t look forward to their annual gynecologic checkup, but it is one of the most important things you will do all year. Following these tips for making the most of your visit can ensure you get the highest quality care possible.

– Yvonne S. Thornton, M. D., M. P. H

Postmenopausal Bleeding

Thursday, April 17th, 2014

Once you have gone through menopause (and it has been a year since you’ve had a period), you should not be bleeding. More conservative doctors consider bleeding after six months of not bleeding to be a potentially worrisome sign. Not even spotting is considered normal after menopause, and should be evaluated by your doctor as soon as possible. Some of the conditions that can be responsible for postmenopausal bleeding include:

Polyps: These typically benign growths can develop on the cervix or in the uterus and can cause bleeding.

Endometrial atrophy: This is the thinning of the tissue lining the uterus, the endometrium. After menopause, lower estrogen levels are responsible for this condition, which can be a cause of unexpected bleeding.

Endometrial hyperplasia: Sometimes, when too much estrogen and too little progesterone are present, the endometrium can thicken, and this can cause bleeding.

Endometrial cancer: Endometrial or uterine cancer can cause bleeding. This is most common between the ages of 65 and 75.

Other potential causes for postmenopausal bleeding include infection, hormone therapy, certain medications (blood thinners, for example), and other types of cancer besides endometrial.

In order to find the reason for your bleeding, your doctor will want to take your medical history, perform a physical examination, and perform some tests. These tests may include a transvaginal ultrasound, a biopsy, a hysteroscopy (in which the inside of your uterus is examined with a small camera), a sonohysterogram (which is a transvaginal sonogram with saline solution instilled into the uterine cavity) or a D&C (dilation and curettage; during this test, uterine tissue is removed and sent to a lab to be analyzed).

Which treatment your doctor recommends will depend on the cause of the bleeding. If you have polyps, surgery may be necessary to remove them. Medication is typically used for endometrial atrophy; endometrial hyperplasia may call for both medication and surgery aimed at the removal of the thickened endometrial tissue.

What If It’s Cancer?

If it is determined that you have endometrial cancer, your doctor will probably want to perform a total hysterectomy, a surgical procedure in which your uterus and cervix are removed. Other parts that might need to be removed include the ovaries, fallopian tubes, part of the vagina, or nearby lymph nodes. You may also need radiation, chemotherapy, or hormone therapy.

Just keep in mind that while irregular bleeding during perimenopause can be normal, bleeding after menopause isn’t. Even if it’s very light, postmenopausal bleeding warrants an immediate call to your doctor to have it checked out. Chances are good that the bleeding is being caused by a minor problem, but there is always the chance that it could be something more serious. And if it is cancer, the earlier it is treated, the better, so don’t ignore even very light postmenopausal bleeding.

Read more about the menopause and other natural changes in your body in my health book, “Inside information for Women”.

– Yvonne S. Thornton, M. D., M. P. H

Getting the Facts on Genital Herpes

Monday, April 7th, 2014

Herpes is a common sexually transmitted infection (STI) caused by one of two types of viruses, herpes simplex type 1 and herpes simplex type 2, and that anyone who is sexually active can get. Most of the time, individuals with the virus have no symptoms, and it’s important to understand that even those with no symptoms can still spread it to sexual partners.

Of people in the United States between the ages of 14 and 49, about one out of six has genital herpes. It is spread through vaginal, anal, or oral sex with an infected individual. The fluid in herpes sores carries the virus, and infection can be the result of contact with those fluids. However, the virus can also be released through the skin, so you can even get herpes from someone who is not showing symptoms, or may not even be aware that he or she is infected. The flip side of this, of course, is that if you are the infected partner, keep in mind that you can still spread the virus to your sexual partner(s) even when you have no symptoms.

Realize that condoms may not fully protect you from herpes infection. That’s because outbreaks can occur in areas that aren’t covered by a condom. You should still use a condom every time you have sex, of course, unless you are in a long-term monogamous relationship and you and your partner have both had negative STI test results. The only other way to fully protect yourself from genital herpes is to avoid having sex.

Genital Herpes Symptoms

Herpes often causes no symptoms, or symptoms that are very mild. Mild symptoms may not even be noticed, or they may be mistaken for a skin condition such as an ingrown hair. This is why so many people have herpes and don’t know it.

When there is an outbreak, herpes causes sores that appear as blister(s) in the genital area. When the blisters break, they form painful sores that can take weeks to heal. The first time an infected individual experiences an outbreak, the sores may be accompanied by flu-like symptoms such as fever or swollen glands.

Genital Herpes and Pregnancy

Prenatal care is even more important for pregnant women with genital herpes. Be sure to tell your doctor if you have herpes or if there is any chance you may have it. Because herpes can cause pregnancy complications and is dangerous to your baby, it is important to avoid being exposed to it during pregnancy. At 36 weeks of pregnancy, women with a history of herpes are given an antiviral oral medication in order to decrease their likelihood of having a recurrence.  However, if any symptoms at all or evidence of a lesion are present when it is time for you to deliver, a cesarean delivery will most likely be performed.

If You Have Herpes

Herpes cannot be cured, but there are medications that can shorten outbreaks or help prevent them in the first place. Certain medications are also available that are taken daily and lower the likelihood that you will spread the infection to any sexual partner(s) you may have.

It is very important to inform any potential sexual partners of the fact that you have genital herpes and discuss the involved risks. Not having symptoms and using condoms are two things that can lower the risk of infection, but again, not remove it.

It is possible to spread a genital herpes infection to other parts of your body, such as your eyes, so you should not touch the sores or the fluid from the sores. If you do, you should immediately wash your hands.

Talk to your doctor about how herpes may affect your relationships and overall health, if these are concerns. Realize that while herpes isn’t curable, it is manageable. Talk to a doctor, take the medications he or she recommends, and be cautious about spreading the infection to others. You can find more information on this and other topics in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H

What Is Endometrial Ablation?

Monday, March 31st, 2014

Endometrial ablation is a procedure in which a layer of the uterine lining is permanently removed in order to reduce or stop abnormal bleeding. The procedure is performed only on women who do not wish to have any more children. In some cases, it is performed in place of a hysterectomy.

The techniques used to perform endometrial ablation vary and include electrocautery, radiofrequency, cryoablation, and hydrothermal procedures, among others. The procedure is performed on women who are experiencing abnormal bleeding (bleeding between periods) or menorrhagia (prolonged or extremely heavy periods). Abnormal bleeding can be so severe in some cases that daily life is interrupted and some women may even develop anemia.

Reasons for abnormal bleeding and menorrhagia include hormone disorders or imbalances, fibroid tumors, polyps, or endometrial cancer. However, as stated earlier, the lining of the uterus is destroyed during ablation and is no longer able to function normally; therefore, bleeding is significantly lessened or even stopped entirely, and it is important to know that the woman also will no longer be able to become pregnant.

Endometrial ablation carries the same risks as any surgical procedure, including infection, bleeding, perforation of the uterine wall, or complications due to medication sensitivities the patient is not aware of (or neglects to inform the doctor of). In addition, women with certain medical conditions should not have this procedure, and these include vaginal infections, cervical infections, pelvic inflammatory disease, weakness of the uterine muscle, abnormal shape or structure of the uterus, and having an IUD in place, among others. In my health book, “Inside Information for Women”, I discuss this technique under “Resectoscopy”.  Endometrial ablation with cautery via a resectoscope or any other modality is a little tricky if the patient ultimately is found to have uterine cancer.  Why?  Because all the evidence regarding the extent of the disease (cancer) is burned away and the physician will have difficulty in staging the cancer, which is important in formulating the best management for a patient with uterine cancer. 

If your doctor and you decide that endometrial ablation may be right for you, your doctor should explain the procedure to you thoroughly and give you a chance to ask any questions you have. If you are to have a procedure that requires general anesthesia, you will be asked not to eat or drink before the procedure, most likely for at least eight hours or after midnight the night before. Be sure to tell your doctor if you may be pregnant, are allergic to any medications, or are taking any prescription drugs or herbal supplements.

Your procedure may take place in a hospital or in your doctor’s office on an outpatient basis. Recovery will depend on the type of anesthesia and the type of ablation used. In general, you can expect to need to wear a sanitary pad for a few days after the procedure, as bleeding during this time is normal. Also for the first few days, you may experience cramping, frequent urination, nausea, and/or vomiting.

Your doctor will probably instruct you not to use tampons, douche, or have sex for at least a few days. Usually restrictions on other activities are also necessary, such as heavy lifting and strenuous exercise. Let your doctor know if you experience fever, chills, severe pain, difficulty urinating, excessive bleeding, or foul-smelling discharge.

This information applies in general to most ablation procedures, but because each woman and situation is unique, the most important thing to remember is to follow your doctor’s specific instructions, and ask any questions you may have.

– Yvonne S. Thornton, M. D., M. P. H.

Dealing with Painful Intercourse

Thursday, March 27th, 2014

Pain felt during sex is known as dyspareunia, and it can cause a number of problems for you and your relationship. Besides the physical discomfort, painful intercourse can have emotional side effects as well, so this problem should be dealt with as soon as you become aware of it.

Causes of Painful Intercourse

Sometimes the reason for pain during intercourse is as simple as insufficient vaginal lubrication. Taking more time with foreplay or using a water-based lubricant will often solve the problem. However, sometimes there is a condition responsible for the discomfort that needs to be addressed. Conditions that may cause dyspareunia include:

  • Vaginal infections, such as a yeast infection or bacterial vaginosis
  • Menopause, which can cause a significant reduction in natural lubrication, as well as thinning of the vaginal tissues which can lead to discomfort
  • Vaginal dryness not caused by menopause – this can also be triggered by breastfeeding and certain medications
  • Injury to the vagina or vulva, such as a tear or episiotomy from childbirth, or
  • A sexually transmitted infection (STI)
  • Vaginismus, a condition in which the vaginal muscles contract involuntarily
  • Endometriosis, in which the tissues that normally line the inside of the uterus grow elsewhere
  • Problems involving the uterus, such as myoma (fibroid tumors)
  • Problems involving the ovaries, such as cysts
  • Problems involving the cervix, such as infection
  • Ectopic pregnancy

Treatment for Painful Intercourse

If you aren’t sure why you are experiencing pain during intercourse, a visit to your gynecologist is in order. For example, in the case of dryness caused by menopause, your doctor can prescribe estrogen creams or other medications. Most infections and endometriosis can be treated by your doctor as well.

When no apparent cause is found, therapy might be helpful. Sexual activity is deeply intertwined with emotion; therefore any type of negative emotion such as anxiety, depression, fear, or feelings of low self-esteem can play a role in painful intercourse. Issues such as guilt, negative emotions regarding past abuse, or conflicting feelings about sex can also cause physical reactions that make sex unpleasant. It can be difficult to tell whether pain has psychological or physical causes (or a combination), so a conversation with your doctor about all possible issues is the best course of action.

When you see your doctor, be sure to mention additional symptoms that you may be having in addition to pain, such as bleeding, irregular periods, genital lesions, unusual discharge, or involuntary contractions of the vaginal muscles, that may give him or her the clues needed to diagnose and treat your problem effectively.

– Yvonne S. Thornton, M. D., M. P. H

What Is a Pap Test Used For?

Thursday, March 20th, 2014

The term  “Pap test” or “Pap smear” is known by almost every woman in the United States.  However, over the past few years, its annual frequency has been questioned and the actual manner in which it is performed has been enhanced in many gynecologists’ offices. One of the components of a gynecologic exam that you have undoubtedly undergone is the Pap test (or Pap smear).  As stated in my health book for women and many times before on this blog, A Pap smear is NOT a pelvic exam.  The purpose of a pelvic (gynecologic exam) is to check all of your reproductive organs, which includes uterus, ovaries, vagina and vulva.  The Pap test is only to check for cellular changes in your cervix (the mouth of the womb) that may signal cancer or precancer. This is why regular appointments with your gynecologist are so important – because a precancerous condition can be treated before it becomes invasive cervical cancer, but the only way to detect a condition like this is with a Pap test.

Make no mistake – a Pap test can save your life. The chances of treating cervical cancer successfully are far, far higher when it is caught in its early stages. In most cases, precancerous cell changes can be treated before they ever become cancer at all. If you are wondering why you need a Pap test, or have been putting off making an appointment for your annual visit to the gynecologist, remember: a Pap smear is the absolute best way to prevent cervical cancer.

With that said, a Pap test is not recommended for women less than 21 years of age.  However, between the ages of 21 and 65, most women need an annual Pap test. Even though the American Cancer Society recommends Pap tests every three years, the American College of Obstetricians and Gynecologists recommends this screening test every year, because three years is a long time for cancer to grow and spread. Why wait three years when your cervical cancer could have been caught in its precancerous stage two years earlier?

Even if a woman has had a hysterectomy, she still needs a Pap test if her cervix is still in place, which is the case with certain types of hysterectomies (known as subtotal or supracervical hysterectomies). Either way, she still needs an annual pelvic exam; you can find more information on this in my book, Inside Information for Women.

To help ensure accurate Pap test results, you should not douche for a couple of days beforehand. That was a trick question, you should not be douching in the first place!!). Also avoid sex, vaginal creams or suppositories, deodorant sprays or powders in the vaginal area before a pelvic exam and Pap test.  Although some gynecologists prefer that the patient is not menstruating, a Pap test can be performed during your menses and they are not mutually exclusive.  If there are cancer cells present, they will be present whether you are menstruating or not.

What Does a Pap Test Involve?

The Pap test is done as part of the pelvic exam, and is very quick. The doctor places a bi-valved instrument called a speculum (hopefully warmed) in the patient’s vagina, which allows the cervix to be visualized.  The word “speculum” comes from the Latin “to see”. The doctor then uses a special brush (cytobrush) or swab (similar to a Q-tip) to collect cells from the cervix. These cells are placed on a slide and examined in the lab under a microscope. That is the traditional Pap smear.  Recently, liquid-based Pap tests have essentially replaced the conventional Pap smear.  In this test, after the cytobrush or the Q-tip has collected the cells from the cervix, it is submerged into a small vial of liquid preservative for transport to the laboratory, where it is then processed and smeared on the slide.  The presence of Human Papilloma Virus (HPV) can also be tested with this technology.  Some spotting is not unusual after a Pap test, but the test does not hurt. If the test shows a potential problem, your doctor will let you know that further testing is needed. Although this can be scary, remember that abnormal test results do not necessarily mean you have cancer.

Most insurance plans cover Pap tests as part of the gynecologic visit. However, if you are uninsured and not participating in the coverage afforded by the Patient Protection and Affordable Care Act, there are facilities that offer free or low-cost Pap tests

– Yvonne S. Thornton, M. D., M. P. H.

About Endometriosis

Monday, March 10th, 2014

Over five million women in the United States suffer from endometriosis. Most common in women in their 30s and 40s, it can occur in any woman who menstruates, and is one of the most common health problems experienced by women.

The word “endometriosis” comes from the word “endometrium,” the name for the lining of the uterus. Endometriosis is the condition in which this tissue is found growing in locations outside the uterus, such as the outside of the uterus, the ovaries, the fallopian tubes, or elsewhere.

Endometriosis Symptoms

Endometriosis often causes lower abdominal or pelvic pain, or lower back pain, mostly during the menstrual period. The amount of pain the woman experiences is not necessarily linked to the extent of the endometriosis; some women experience a lot of pain with just a few small growths, and other women may experience little to no pain even though large areas of their bodies are affected.

Other symptoms can include painful sexual intercourse, painful urination or bowel movements, bleeding between periods, infertility, fatigue, and gastrointestinal disturbances.

Endometriosis is not cancerous, but it can still present a number of problems. Growths can expand month by month, causing increasing symptoms. Untreated, endometriosis can cause scar tissue, inflammation, and increasing pain. It can block the fallopian tubes; it can grow into the ovaries. Cysts can form as a result of blood trapped in the ovaries. Adhesions, tissue that can bind organs together, can form as a result of scar tissue.

Risk Factors for Endometriosis

Women who have never had children, have longer than normal periods, shorter than normal cycles, a family history of the disease, and cellular damage caused by a previous pelvic infection are at higher risk for developing endometriosis.

The cause of endometriosis isn’t well understood, but theories include:

  • Genetics
  • Immune system disorders
  • Endocrine system disorders
  • Unintended relocation of uterine tissue during surgery
  • Exposure to certain chemicals
  • Reflux of endometrial tissue into the abdomen during a woman’s period

Diagnosis and Treatment of Endometriosis

Be sure to talk to your gynecologist if you have symptoms of endometriosis. Your doctor will most likely want to perform certain tests, such as a pelvic exam, an ultrasound, and/or exploratory surgery.

If endometriosis is found, there is no cure, but a number of treatments are available that can help with symptoms such as pain and infertility. Your doctor should inform you of your options and help you select the ones that best suit your individual condition.

Pain medications, hormone treatments such as birth control pills or GnRH agonists and antagonists, which reduce estrogen, and surgery (best for severe cases) are all possible treatment options. Surgery may involve the removal of growths and scar tissue, or it may involve removing the uterus altogether (hysterectomy).

Endometriosis can be difficult to cope with on an emotional level. Talking with other women who have endometriosis can help. http://endometriosis.org/support/support-groups/ is a good resource for information and support. Above all, talk to your doctor about your symptoms and your options; learn as much as you can, and follow your doctor’s recommendations for treatment. Many women with endometriosis are able to find significant relief.

You can find more information on endometriosis in my book, Inside Information for Women.

– Yvonne S. Thornton, M. D., M. P. H.