Archive for the ‘Medical Conditions’ Category

Endometriosis is a disease that affects your reproductive organs and monthly menstrual cycle. It can cause cramps and pain during your periods or pelvic pain throughout the month. If you have this disease and it is not treated, your health can be affected. But, with early diagnosis and treatment, endometriosis can be managed.

Understanding Endometriosis

If you have endometriosis, endometrial tissue grows outside the uterus in the pelvic cavity. During your menstrual cycle, this extra tissue swells with blood along with the normal tissue in your uterus. The tissue may also release tiny drops of blood. The swelling and blood irritate nearby tissues, causing pain and cramps. Constant irritation may cause scar tissue to form. This scar tissue can bind organs together and cause trouble getting pregnant (infertility).

Normal Female Anatomy

Severe Endometriosis

Common Symptoms

If you have endometriosis, you may have one or more of these symptoms:

• Cramps and menstrual pain
• Pelvic pain
• Pain during sexual intercourse
• Trouble getting pregnant (infertility)

Stages of endometriosis

The stages of endometriosis are ranked as follows: Minimal (I), Mild (II), Moderate (III), or Severe (IV). Staging depends on certain factors. These include the number, size, and site of the implants. The stage also depends on the extent of the adhesions and whether other pelvic organs are involved. The severity of your disease may not match the pain you feel. Even mild endometriosis can cause a lot of pain.

Stage 1		Stage 2
Stage 3		Stage 4

Treatment Options for Endometriosis

Endometriosis can be treated with hormone therapy, surgery, or a combination of both. Talk to your health care provider to see which treatment is best for your condition

Hormone Therapy

Hormone therapy regulates or blocks the hormones that control your menstrual cycle. This means it can limit the swelling of your endometrium and extra endometrial tissue (implants). This treatment may be used before, instead of, or after surgery. Following are different types of hormone therapies:

• GnRH Agonists and FSH and LH Inhibitors stop or lower the production of estrogen and progesterone hormones.
• Birth control pills contain estrogen and progesterone. Birth control pills help to regulate the levels of estrogen and progesterone in your body.
• Progestins are a form of progesterone. Progestins help keep estrogen levels low.
• Danazol is a hormone that stops or lowers the production of estrogen and progesterone.

Surgery

Surgery can be used to remove implants of endometrial tissue or for removal of the reproductive organs.

• With laparoscopy a laparoscope (a thin, lighted tube) is inserted through a small incision in your abdomen. Your doctor uses the laparoscope and another small instrument to remove the implants.
• Laparotomy is open surgery to remove large implants that can’t be reached with the laparoscope or when pelvic organs such as your bowel are involved.
• Hysterectomy is the surgical removal of your uterus. Any implants or adhesions in your pelvic cavity will also be removed.
• During a Total Hysterectomy with Bilateral Salpingo-oophorectomy procedure, your uterus, ovaries, and fallopian tubes are removed. Any implants or adhesions in nearby tissue are also removed.

da Vinci Hysterectomy

A new, minimally invasive approach to hysterectomy, da Vinci Hysterectomy, combines the advantages of conventional open and minimally invasive hysterectomies – but with potentially fewer drawbacks.

For patients, the benefits of da Vinci Hysterectomy may include:

• Significantly less pain
• Less blood loss
• Less scarring
• Shorter recovery time
• A faster return to normal daily activities
• And in many cases, better clinical outcomes

It is performed using the da Vinci System, which enables surgeons to perform surgical procedures with unmatched precision, dexterity and control. Read about what may be the most effective, least invasive approach to hysterectomy – da Vinci Hysterectomy.

Definition

Amniocentesis is a procedure used to diagnose fetal defects in the early second trimester of pregnancy. A sample of the amniotic fluid, which surrounds a fetus in the womb, is collected through a pregnant woman’s abdomen using a needle and syringe. Tests performed on fetal cells found in the sample can reveal the presence of many types of genetic disorders, thus allowing doctors and prospective parents to make important decisions about early treatment and intervention.

Purpose

Since the mid-1970s, amniocentesis has been used routinely to test for Down syndrome, by far the most common, nonhereditary, genetic birth defect, afflicting about one in every 1,000 babies. By 1997, approximately 800 different diagnostic tests were available, most of them for hereditary genetic disorders such as Tay-Sachs disease, sickle cell anemia, hemophilia, muscular dystrophy and cystic fibrosis.

Amniocentesis, often called amnio, is recommended for women who will be older than 35 on their due-date. It is also recommended for women who have already borne children with birth defects, or when either of the parents has a family history of a birth defect for which a diagnostic test is available. Another reason for the procedure is to confirm indications of Down syndrome and certain other defects which may have shown up previously during routine maternal blood screening.

The risk of bearing a child with a nonhereditary genetic defect such as Down syndrome is directly related to a woman’s age–the older the woman, the greater the risk. Thirty-five is the recommended age to begin amnio testing because that is the age at which the risk of carrying a fetus with such a defect roughly equals the risk of miscarriage caused by the procedure–about one in 200. At age 25, the risk of giving birth to a child with this type of defect is about one in 1,400; by age 45 it increases to about one in 20. Nearly half of all pregnant women over 35 in the United States undergo amniocentesis and many younger women also decide to have the procedure. Notably, some 75% of all Down syndrome infants born in the United States each year are to women younger than 35.

One of the most common reasons for performing amniocentesis is an abnormal alpha-fetoprotein (AFP) test. Alpha-fetoprotein is a protein produced by the fetus and present in the mother’s blood. A simple blood screening, usually conducted around the 15th week of pregnancy, can determine the AFP levels in the mother’s blood. Levels that are too high or too low may signal possible fetal defects. Because this test has a high false-positive rate, another test such as amnio is recommended whenever the AFP levels fall outside the normal range.

Amniocentesis is generally performed during the 16th week of pregnancy, with results usually available within three weeks. It is possible to perform an amnio as early as the 11th week but this is not usually recommended because there appears to be an increased risk of miscarriage when done at this time. The advantage of early amnio and speedy results lies in the extra time for decision making if a problem is detected. Potential treatment of the fetus can begin earlier. Important, also, is the fact that elective abortions are safer and less controversial the earlier they are performed.

Precautions

As an invasive surgical procedure, amnio poses a real, although small, risk to the health of a fetus. Parents must weigh the potential value of the knowledge gained, or indeed the reassurance that all is well, against the small risk of damaging what is in all probability a normal fetus. The serious emotional and ethical dilemmas that adverse test results can bring must also be considered. The decision to undergo amnio is always a matter of personal choice.

Description

The word amniocentesis literally means “puncture of the amnion,” the thin-walled sac of fluid in which a developing fetus is suspended during pregnancy. During the sampling procedure, the obstetrician inserts a very fine needle through the woman’s abdomen into the uterus and amniotic sac and withdraws approximately one ounce of amniotic fluid for testing. The relatively painless procedure is performed on an outpatient basis, sometimes using local anesthesia.

The physician uses ultrasound images to guide needle placement and collect the sample, thereby minimizing the risk of fetal injury and the need for repeated needle insertions. Once the sample is collected, the woman can return home after a brief observation period. She may be instructed to rest for the first 24 hours and to avoid heavy lifting for two days.

The sample of amniotic fluid is sent to a laboratory where fetal cells contained in the fluid are isolated and grown in order to provide enough genetic material for testing. This takes about seven to 14 days. The material is then extracted and treated so that visual examination for defects can be made. For some disorders, like Tay-Sachs, the simple presence of a telltale chemical compound in the amniotic fluid is enough to confirm a diagnosis. Depending on the specific tests ordered, and the skill of the lab conducting them, all the results are available between one and four weeks after the sample is taken.

Cost of the procedure depends on the doctor, the lab, and the tests ordered. Most insurers provide coverage for women over 35, as a follow-up to positive maternal blood screening results, and when genetic disorders run in the family.

An alternative to amnio, now in general use, is chorionic villus sampling, or CVS, which can be performed as early as the eighth week of pregnancy. While this allows for the possibility of a first trimester abortion, if warranted, CVS is apparently also riskier and is more expensive. The most promising area of new research in prenatal testing involves expanding the scope and accuracy of maternal blood screening as this poses no risk to the fetus.

Preparation

It is important for a woman to fully understand the procedure and to feel confident in the obstetrician performing it. Evidence suggests that a physician’s experience with the procedure reduces the chance of mishap. Almost all obstetricians are experienced in performing amniocentesis. The patient should feel free to ask questions and seek emotional support before, during and after the amnio is performed.

Aftercare

Necessary aftercare falls into two categories, physical and emotional.

Physical aftercare

During and immediately following the sampling procedure, a woman may experience dizziness, nausea, a rapid heartbeat, and cramping. Once past these immediate hurdles, the physician will send the woman home with instructions to rest and to report any complications requiring immediate treatment, including:

• vaginal bleeding. The appearance of blood could signal a problem.
• premature labor. Unusual abdominal pain and/or cramping may indicate the onset of premature labor. Mild cramping for the first day or two following the procedure is normal.
• signs of infection. Leaking of amniotic fluid or unusual vaginal discharge, and fever could signal the onset of infection.

Emotional aftercare

Once the procedure has been safely completed, the anxiety of waiting for the test results can prove to be the worst part of the process. A woman should seek and receive emotional support from family and friends, as well as from her obstetrician and family doctor. Professional counseling may also prove necessary, particularly if a fetal defect is discovered.

Risks

Most of the risks and short-term side effects associated with amniocentesis relate to the sampling procedure and have been discussed above. A successful amnio sampling results in no long-term side effects. Risks include:

• maternal/fetal hemorrhaging. While spotting in pregnancy is fairly common, bleeding following amnio should always be investigated.
• infection. Infection, although rare, can occur after amniocentesis. An unchecked infection can lead to severe complications.
• fetal injury. A very slight risk of injury to the fetus resulting from contact with the amnio needle does exist.
• miscarriage. The rate of miscarriage occurring during standard, second trimester amnio appears to be approximately 0.5%. This compares to a miscarriage rate of 1% for CVS. Many fetuses with severe genetic defects miscarry naturally during the first trimester.
• the trauma of difficult family-planning decisions. The threat posed to parental and family mental health from the trauma accompanying an abnormal test result can not be underestimated.

Normal results

Negative results from an amnio analysis indicate that everything about the fetus appears normal and the pregnancy can continue without undue concern. A negative result for Down syndrome means that it is 99% certain that the disease does not exist.

An overall “normal” result does not, however, guarantee that the pregnancy will come to term, or that the fetus does not suffer from some other defect. Laboratory tests are not 100% accurate at detecting targeted conditions, nor can every possible fetal condition be tested for.

Abnormal results

Positive results on an amnio analysis indicate the presence of the fetal defect being tested for, with an accuracy approaching 100%. Prospective parents are then faced with emotionally and ethically difficult choices regarding treatment options, the prospect of dealing with a severely affected newborn, and the option of elective abortion. At this point, the parents need expert medical advice and counseling.

Alpha-fetoprotein (AFP)

A protein normally produced by the liver of a fetus and detectable in maternal blood samples. AFP screening measures the amount of alpha-fetoprotein in the blood. Levels outside the norm may indicate fetal defects.

Anencephaly

A hereditary defect resulting in the partial to complete absence of a brain and spinal cord. It is fatal.

Chorionic villus sampling (CVS)

A procedure similar to amniocentesis, except that cells are taken from the chorionic membrane for testing. These cells, called chorionic villus cells, eventually become the placenta. The samples are collected either through the abdomen, as in amnio, or through the vagina. CVS can be done earlier in the pregnancy than amnio, but carries a somewhat higher risk.

Chromosome

Chromosomes are the strands of genetic material in a cell that occur in nearly identical pairs. Normal human cells contain 23 chromosome pairs–one in each pair inherited from the mother, and one from the father. Every human cell contains the exact same set of chromosomes.

Down syndrome

The most prevalent of a class of genetic defects known as trisomies, in which cells contain three copies of certain chromosomes rather than the usual two. Down syndrome, or trisomy 21, usually results from three copies of chromosome 21.

Genetic

The term refers to genes, the basic units of biological heredity, which are contained on the chromosomes, and contain chemical instructions which direct the development and functioning of an individual.

Hereditary

Something which is inherited–passed down from parents to offspring. In biology and medicine, the word pertains to inherited genetic characteristics.

Maternal blood screening

Maternal blood screening is normally done early in pregnancy to test for a variety of conditions. Abnormal amounts of certain proteins in a pregnant woman’s blood raise the probability of fetal defects. Amniocentesis is recommended if such a probability occurs.

Tay-Sachs disease

An inherited disease prevalent among the Ashkenazi Jewish population of the United States. Infants with the disease are unable to process a certain type of fat which accumulates in nerve and brain cells, causing mental and physical retardation, and death by age four.

Ultrasound

A technique which uses high-frequency sound waves to create a visual image (a sonogram) of soft tissues. The technique is routinely used in prenatal care and diagnosis.

Make an appointment with a Female Gynecologist in San Diego

Definition

The absence of menstrual periods is called amenorrhea. Primary amenorrhea is the failure to start having a period by the age of 16. Secondary amenorrhea is more common and refers to either the temporary or permanent ending of periods in a woman who has menstruated normally in the past. Many women miss a period occasionally. Amenorrhea occurs if a woman misses three or more periods in a row.

Description

The absence of menstrual periods is a symptom, not a disease. While the average age that menstruation begins is 12, the range varies. The incidence of primary amenorrhea in the United States is just 2.5%.

Some female athletes, who participate in rowing, long distance running, and cycling, may notice a few missed periods. Women athletes at a particular risk for developing amenorrhea include ballerinas and gymnasts, who typically exercise strenuously and eat poorly.

Causes and Symptoms

Amenorrhea can have many causes. Primary amenorrhea can be the result of hormonal imbalances, psychiatric disorders, eating disorders, malnutrition, excessive thinness or fatness, rapid weight loss, body fat content too low, and excessive physical conditioning. Intense physical training prior to puberty can delay menarche (the onset of menstruation). Every year of training can delay menarche for up to five months. Some medications such as anti-depressants, tranquilizers, steroids, and heroin can induce amenorrhea.

Primary Amenorrhea

However, the main cause is a delay in the beginning of puberty either from natural reasons (such as heredity or poor nutrition) or because of a problem in the endocrine system, such as a pituitary tumor or hypothyroidism. An obstructed flow tract or inflammation in the uterus may be the presenting indications of an underlying metabolic, endocrine, congenital or gynecological disorder.

Typical causes of primary amenorrhea include:

• excessive physical activity
• drastic weight loss (such as occurs in anorexia or bulimia)
• extreme obesity
• drugs (antidepressants or tranquilizers)
• chronic illness
• turner’s syndrome. (A chromosomal problem in place at birth, relevant only in cases of primary amenorrhea)
• the absence of a vagina or a uterus
• imperforate hymen (lack of an opening to allow the menstrual blood through)

Secondary Amenorrhea

Some of the causes of primary amenorrhea can also cause secondary amenorrhea — strenuous physical activity, excessive weight loss, use of antidepressants or tranquilizers, in particular. In adolescents, pregnancy and stress are two major causes. Missed periods are usually caused in adolescents by stress and changes in environment. Adolescents are especially prone to irregular periods with fevers, weight loss, changes in environment, or increased physical or athletic activity. However, any cessation of periods for four months should be evaluated.

The most common cause of secondary amenorrhea is pregnancy. Also, a woman’s periods may halt temporarily after she stops taking birth control pills. This temporary halt usually lasts only for a month or two, though in some cases it can last for a year or more. Secondary amenorrhea may also be related to hormonal problems related to stress, depression, anorexia nervosa or drugs, or it may be caused by any condition affecting the ovaries, such as a tumor. The cessation of menstruation also occurs permanently after menopause or a hysterectomy.

Polycystic ovary syndrome is another common cause of secondary amenorrhea. It is caused by ovaries containing many fluid filled sacs (cysts) with abnormal levels of male hormones (androgens). This condition is related to improper functioning of the pituitary gland, as it releases hormones necessary for pregnancy (leuteinizing hormones), and can cause women to develop male characteristics, such as acne and coarse body hair. If the condition is not treated, some of the androgens may convert to estrogen, and chronically high levels of estrogen may increase the chance of developing cancer of the uterine lining.

Diagnosis

It may be difficult to find the cause of amenorrhea, but the exam should start with a pregnancy test; pregnancy needs to be ruled out whenever a woman’s period is two to three weeks overdue. Androgen excess, estrogen deficiency, or other problems with the endocrine system need to be checked. Prolactin in the blood and the thyroid stimulating hormone (TSH) should also be checked.

The diagnosis usually includes a patient history and a physical exam (including a pelvic exam). If a woman has missed three or more periods in a row, a physician may recommend blood tests to measure hormone levels, a scan of the skull to rule out the possibility of a pituitary tumor, and ultrasound scans of the abdomen and pelvis to rule out a tumor of the adrenal gland or ovary.

Treatment

Treatment of amenorrhea depends on the cause. Primary amenorrhea often requires no treatment, but it’s always important to discover the cause of the problem in any case. Not all conditions can be treated, but any underlying condition that is treatable should be treated.

If a hormonal imbalance is the problem, progesterone for one to two weeks every month or two may correct the problem. With polycystic ovary syndrome, birth control pills are often prescribed. A pituitary tumor is treated with bromocriptine, a drug that reduces certain hormone (prolactin) secretions. Weight loss may bring on a period in an obese woman. Easing up on excessive exercise and eating a proper diet may bring on periods in teen athletes. In very rare cases, surgery may be needed for women with ovarian or uterine cysts.

Prognosis

Prolonged amenorrhea can lead to infertility and other medical problems such as osteoporosis (thinning of the bones). If the halt in the normal period is caused by stress or illness, periods should begin again when the stress passes or the illness is treated. Amenorrhea that occurs with discontinuing birth control pills usually goes away within six to eight weeks, although it may take up to a year.

The prognosis for polycystic ovary disease depends on the severity of the symptoms and the treatment plan. Spironolactone, a drug that blocks the production of male hormones, can help in reducing body hair. If a woman wishes to become pregnant, treatment with clomiphene may be required or, on rare occasions, surgery on the ovaries.

Prevention

Primary amenorrhea caused by a congenital condition cannot be prevented. In general, however, women should maintain a healthy diet, with plenty of exercise, rest, and not too much stress, avoiding smoking and substance abuse. Female athletes should be sure to eat a balanced diet and rest and exercise normally. However, many cases of amenorrhea cannot be prevented.

Key Terms

Hymen

Membrane that stretches across the opening of the vagina.

Hypothyroidism

Under active thyroid gland.

Hysterectomy

Surgical removal of the uterus.

Turner’s Syndrome

A condition in which one female sex chromosome is missing.

Make an appointment with a Female Gynecologist in San Diego

Definition:  Cervicitis is an inflammation of the cervix.

Description:
Cervicitis is a inflammation of the cervix (the opening into the uterus). This inflammation can be chronic and may or may not have an identified cause.

Causes and symptoms:
The most common cause of cervicitis is infection, either local or as a result of various sexually transmitted diseases, such as chlamydia or gonorrhea. Cervicitis can also be caused by birth control devices such as a cervical cap or diaphragm, or chemical exposure. Other risk factors include multiple sexual partners or cervical trauma following birth. In postmenopausal women, cervicitis is sometimes related to a lack of estrogen.
Although a woman may not notice any signs of infection, symptoms of cervicitis include the following:

* persistent unusual vaginal discharge
* abnormal bleeding, either between periods or following sexual intercourse
* painful sexual intercourse
* vaginal pain
* frequent need to urinate
* burning or itching in the vaginal area

Diagnosis:
The standard method of diagnosing cervicitis is through a pelvic examination or a Pap smear. During the pelvic exam, the physician usually swabs the affected area, and then sends the tissue sample to a laboratory. The laboratory tries to identify the specific organism responsible for causing the cervicitis. A biopsy to take a sample of tissue from the affected area is sometimes required in order to rule out cancer. Colposcopy, a procedure used to look at the cervix under a microscope, may also be used to rule out cancer.

Treatment:
The first course of treatment for cervicitis is usually antibiotics. If these medicines do not cure the cervicitis, other treatment options include:

* Loop Electrosurgical Excision Procedure (LEEP)
* cryotherapy
* electrocoagulation
* laser treatment

Prognosis:
Cervicitis will usually be cured when the course of therapy is complete. Severe cases, however, may last for a few months, even after the therapy is complete. If the cervicitis was caused by a sexually transmitted disease, both partners should be treated with medication.

Prevention:
Practicing safe sexual behavior, such as monogamy, is one way of lowering the prevalence of cervicitis. In addition, women who began sexual activity at a later age have been shown to have a lower incidence of cervicitis. Another recommendation is to use a latex condom consistently during intercourse. If the cervicitis is caused by any sexually transmitted disease, the patient is advised to notify all sexual partners.

Key terms:

Cryotherapy - Freezing the affected tissue.
Electrocoagulation - Using electrical current to cauterize the affected tissue.
LEEP - Loop Electrosurgical Excision Procedure.

Make an appointment with a Female Gynecologist in San Diego