GynoFiles

When it comes to molding character, vision, culture and ethics we have long known "it takes a village", but apparently when it comes to fertility treatments, that's the newest standard too. In London we have seen an official scientific panel endorsing genetically modified embryos, allowing for babies to be born from the "three parent" technique. This involves a mom who is the egg donor, the mom who donates genetic material in the form of mitochondria, so having two mommies is the correct genetic designation. Finally some are calling these embryo's "three parent" eggs, as they also have genetic material from a dad. and then there is the option to put the whole embryo in a "third mom, or fourth parent" by way of surrogate uterus. Hence, we have now involved a good part of the village in the genetic start of a child. No children have been born from these combinations, and it may or may not prove to be safe or warranted in many situations....

If you have had an endometrial ablation and have developed symptoms of pelvic pain you might have post endometrial ablation syndrome. What is post-endometrial ablation syndrome? It is a constellation of symptoms due to entrapped blood or tissue within a uterus that has previously undergone an endometrial ablation. We are able to diagnose this at Women's Health Practic e but occasionally other conditions are causing similar symptoms. Other complications of endometrial ablation include pregnancy, risks from pre-existing conditions such as a polyp or fibroid, an infection of the uterus, or a pregnancy. If you have had a tubal ligation then it is possible that the condition could be post-ablation tubal sterilization syndrome. The ablation procedure is designed to destroy all lining tissue, but in fact there is no way to confirm the completeness of the ablation. It is thought that either residual or regrowth of the tissue is producing the symptoms of post-endometrial ablation syndrom...

Reliability of gyno, and all medical information, has evolved rapidly over the recent years. We used to rely on physicians advice, most wasn't written down, little was studied and that that was studied was often considered to be a propitiatory secret. The often recounted "The Secret of the Chamberlens" story of forceps invention, that was kept a family secret for generations. But that was the middle ages, and we have progressed. Most of our parents will tell us that in their youth they let their docs make decisions, because they had information access. Now even the most esoteric of studies are often out there on the web, and often before they are even published. And now the decision making part of applying that medical information has landed in the public domain through the tens of thousands of medical apps out there. Many of these are literally fun and informative, some really are to just help the doctor, and here is where "approval for apps" comes into the st...

There is a formal definition of menstrual migraines called medically "menstrually related migraines". the International Headache Society. the define menstrual migraines as a migraine that occurs on day one of the period with symptoms 2 days before or after the state. And thus it's a headache that occurs within a 5 day window. There are other criteria they use to define severity and more defined types that have various sorts of aura if you want to browse their site . Some think this is a particularly severe form of migraine, not responsive to the typical medications, and one that actually lasts longer than typical migraines. Patients with other menstrual symptoms can be extra miserable just because they have cramps and migraines, or breast pain and migraines. Menstrual headaches are not identical to hormonal headaches, which is the term applied to headaches that occur with hormone use. For instance, if a woman takes birth control pills, and now has more tension headach...

It's been a bad joke for years, "aspirin only works for contraception if you hold it between your knees," and aside from the axiom that abstinence does prevent pregnancy, this was never a workable plan on so many levels! But oddly, an interesting study has emerged from the Eastern Virginal Medical School research group that looked at the ability for substances called COX-2 inhibitors (NSAID-S) actually was noted to delay the release of an egg from a rip follicle. It's not so far fetched a concept. We think the fertile egg has to rupture out of it's own growth womb in order to be able to be fertilized. The step of rupturing apparently occurs by a series of enzymes that eat open the follicle to release the egg. These enzymes use prostaglandins to ultimately create the breach in the wall of the follicle. COX-2 inhibitors inhibit the prostaglandin pathway, and thus may prevent a ripe egg from releasing, An egg retained in the ovary too long and not released is probab...

What are the first things that pop into your mind when you think about a potential partner? He’s so good looking. She’s so smart and funny. I can’t wait to spend some alone time with him. Maybe you are looking for that Russian bibliophile or that other owner of the 100 best philatelic nudes ever printed. However, as a gyno, I’m as concerned about your sexual health as your intellectual health. And frankly, without both, nope, there’s no staying together. So, before you get that alone time with your partner and get out a large magnifying glass to examine your…ah….. relationship and where it is going, there should be a frank discussion about sexual histories and sexual health. The couple that does STD screening together will likely stay together, let alone stay heathlier. Although you want to trust the person that you are spending time with, you need to consider the fact that many people aren’t completely open and honest about their sex lives. And, when it comes to...

It's never a fun discussion to reveal STDs to new partners, whether they be past or current infections. Some times infections pose very significant risk: HIV or Hepatitis C. Sometimes the infections are so easily curable that the state will typically track your partner down for treatment whether you spill or don't, like chlamydia. HPV is a difficult one to discuss. If it's HPV warts you have, well, the guy may get these warts and he really should be check for them. HPV caused abnormal pap smears present an unclear risk to the partner. He can pass on the infection , but his risk of getting a cancer is low, and thus patients express a lot of reluctance to be frank about the discussion if they have been told they have a positive HPV test.  I've heard all sorts of poor strategies  from patients about what to tell their guys about HPV infection. 1. Lie, after all, maybe the test is wrong 2. Wait to see if it goes away 3. Find out if he's already had the infection 4...

Bloggers love the topic of caffeine effects on our health. The effects of caffeine cannot be sorted out without looking at how you are getting the caffeine: coffee, tea, herbal drinks, or coco. The Institute of Medicine and the FDDA are looking into the levels of caffeine in drinks, especially those with the highest caffeine content. The amount of caffeine effect will always be affected by how much you normally consume, whether you are a child or an adolescent, or a senior,and whether you are pregnant. So some consultation with your health care provider is sensible, as is moderation. Oddly the newest study shows that coco consumption in seniors may decrease risks of brain deterioration and improved brain function. Although they were drinking two cups a day, which means you better cut some calories some where else or there will be consequences to your waistline!

In gynecology (and all of medicine, but gals being our focus) the 'gold standard' of treatment is within the realm of "evidence based" data for diagnosis and therapies. And the way we define success is "cure." In some cases there is never cure, there is just control. Good gyno examples of conditions that we can control and not cure would be atrophic vaginitis and lichen sclerosus. For these conditions treatments render the patient free of disease, but stop the treatment and the disease returns. For other conditions cure is possible, for instance a urinary tract infection: if the appropriate antibiotic is used the urine can be shown to no long grow the bugs that were infecting it. But many conditions the treatments have to rely on the patient reports formally called " Patient-reported outcomes (PROs) . Headaches are a good example of this type of condition no test of headache resolution, only efficacy based on patient symptom questionnaires. Hysterect...

Vitamin D has come out of the closet as only a nutrient for bone health, and has grabbed the spotlight as a component that is essential for many aspects of women's health. The newest buzz on vitamin D is that proper levels can help prevent uterine fibroids in women. In the May issue of Epidemiology a group of researchers has linked Vitamin D to uterine fibroids.   The researchers studied a group of white women and a group of black women for whom they measured blood levels of vitamin D. The cut off for health vitamin D level in this study was 20, although many experts would set that number much higher. They then asked the groups of women health history. Uterine fibroids, or leiomyomata are common muscle cell growths in a woman's uterus. There seems to be both increased cells and thickened substances between the cells in the case of uterine fibroids. The growths can be so small as to permanently escape detection, or so large that the uterus itself can harbor growths the siz...

Too much exercise can be disruptive to the menstrual cycles, but for overall calorie consumption, heart health, and confidence there is nothing better than a girl in sports. One study even showed that girls in sports have "more shapely hips" meaning better overall hip joints and pelvic bone health implying that sports when growing up helps us become better birthing moms! But girls do have special considerations when it comes to sports issues. These things are tracked by  U.S. high school sports-related injury data were collected for 20 sports using the National High School Sports-Related Injury Surveillance System, High School RIO TM Girls will have more injuries when compared to boys in the same sport. Knee injuries are known to be more common in girls. Athletes have been shown to have more abnormal cycles. As a group athletes are more likely to skip occasional cycles or even go months without any menstrual cycle at all. It's due to the suppression of ovulation, so t...

Most women worry about their pap smears showing cancer. We worry the most about a pap that shows high grade squamous intraepithelial neoplasia (HGSIL), but of women who have the low grade form, LGSIL about a third will still have serious precancer. And pap tests do show more than just cancer or precancer, they can help figure out infection or precancer. If you have culture tests, often they are the best check of infection. There are ways to detect infection, including tests on the pap cells themselves, or on the liquid that the pap cells are suspended in after collections. So if you get a pelvic exam, find out what types of infection tests. Years ago the only time we could identify an infection would have been to culture for it. Now tests of the organism with tests called PCR are actually done. With these PCR tests, technically we cannot say if it is still an active infection, or a newly treated infection, but eventually all tests go to negative if some one is treated. Infections ...

Birth control pills come with lots of choices, and these choices are right for over 11 million US women as ACOG President Douglas W. Laube, MD, MEd says. In fact the pill for women and condoms for men account for about 50% of overall contraceptive use. The FDA wants women to use the lowest dosage of hormones possible, that is still compatible with a low pregnancy rate. To that end the pills on the market today have been designed to allow your gyno to pick what is really best for you. Often when they are packaged, they either have a single hormone dosage, or they have a variety of hormone dosages that are given over the cycle. With this they can be packaged as a 28 day cycle with 7 placebo pills, or 4 placebo pills, or pills that aren't truly placebos but have iron for instance. The pills you will have will use color coding to alert you to which pills to take on which days. And studies show if you get the branded pills with the right color coding, it actually helps you to stick to ...

Women suffer from more depression than men, almost double the rates, and we think that the sex hormones are the physiologic reason for this. It may not just be that women have that high level of estrogen that men don't, but perhaps it's their hormonal swings that are at the root of depressive symptoms. A new study in 2013 looks at this, in the Multiethnic Study of Atherosclerosis, and what they found was that depression was linked with hormone levels in the early menopausal transition. They also tried to look at the specific tests of hormone function, like using Sex Hormone Binding Globulin (SHBG) as a marker. Their decided that SHBG helped them pin point bioavailable estrogen and testosterone in their patients. This attempted to repeat the work done by Barrett-Conner in 1999 when she looked at a large number of hormonal levels and worked out that only DHEA-S, an adrenal hormone was actually linked with symptoms. Menopausal health answers also continue to come from the Nationa...

Varicose Veins With Ankle Swelling If you have had fertility treatments in your past, you probably do need closer follow up than routine gynecologic care. The reason you need closer follow up is that the side effects of treatment, and the reasons you were infertile may lead to gynecologic problems and medical health issues in later life. Here we suggest the topics to investigate with your gyno. Each infertile woman may have concerns in some or all of these in our list, but consulting with your health provider is important to see if you had special aspects of your case. The guidelines regarding future care from organizations do vary depending on the following factors: what treatments you received, did you successfully achieve pregnancy, did you breastfeed, your weight, your genetics, and your nutrition. If you had endometriosis syndrome you may need follow up as it is a chronic and recurring disease. But these are some of the post fertility treatment considerations we have at Wome...

Operations have risks as well as benefits, and there are risks as well as benefits from not going ahead with the surgery that is recommended. But improving safety has been a goal of surgeons and it;s helpful on the patient end to do what you can to enhance safety. Going into an operation, well rested, well nourished including consistent multivitamin with iron use over the past days, weeks or months, in optimal physical exercise shape always are beneficial. But many women approaching surgery have no luxury of the time, the fortitude, or the health to make those first tips work. But there are other simple things. A basic check up with your primary care physician is important. The American Society of Anesthesiologists (ASA) has recommendations for what tests each person needs. Many surgeons believe in a pre-procedure bowel clean out. That helps in two ways, it makes it safer if, hopefully not, but if there is a bowel injury; but it is also a way that the bowel can collapse an...

Understand what your gyno is looking at to figure out the statistics. The test is sensitive if it accurately distinguishes who has the disease vs  specific if it really says who does not have the disease. A test has positive predictive value if it predicts who with the disease really has it and it has negative predictive value if it can say, statistically well, that a person with a negative test really does not have the disease. Once a physician knows these factors she can either recommend the test, or not recommend the test for you based on your medical history.

You hear the word progesterone used a lot. This general class of hormone, and it's synthetic varieties is about ubiquitous as any medication in current use. If a compound acts like a progesterone its classified as a "progestin" and this class of medicines is very broad and some form or other is in the birth control pill, its made by the ovary, it's made by the placenta, it's used to prevent miscarriages, its been a treatment for PMS, it's been used to bring on missing periods, to prevent preterm birth, and it's used to protect the uterus from estrogen use in menopausal hormone therapy. So when we say there is a tug of war out there of information on which is better to be taking, natural or synthetic, we want you to understand there is a lot of scientific evidence and some of it conflicting. In general you can think of two big classes of medicines if we are just talking about menopausal hormones: we are talking about Natural Progesterone vs Synthetic...

Uterine cancer is still the most common pelvic cancer in women. The average woman has a lifetime risk of 1/38 of getting uterine cancer.  Since risk factors for endometrial cancer, or lining cancer of the uterus (the most common type) include diabetes, being over weight, and irregular periods, there are many women with potentially treatable conditions that are still at risk for this cancer. Screening tests don't exactly exist for uterine lining cancer, the pap rarely picks up uterine cancer and ultrasounds can show abnormalities but we don't routine do ultrasound in everyone. It is not linked to HPV disease or any infections, so testing for those conditions won't help the diagnosis of uterine cancer. Most women with uterine cancer have had treatment for a polyp or a thickening of their uterine lining, so if you have had one of these treatments you are known to be at risk. But prevention is possible with uterine cancer. The best protection factors against uterine cancer i...

Take your pills, don't break your contraception's effectiveness by stopping them! My top gyno guru, Dr David Grimes, is trying to teach me Latin again. " post hoc ergo propter hoc ." I think it goes like this: if I tell you to expect a pill side effect, apparently you'll get that side effect. It has another word "nocebo" effect (is that just not a great scrabble word, I so struggle when I get the two o's and I just can't win with all those three point "too"s). Enough gabbing,back to the gyno. Side effects from the pill, are common, but are they mind over matter?It I tell you spotting is annoying, will you just get annoyed and stop your contraception like almost 1/3 pill users do each year. How likely will it be for you to get a headache for instance on the pill, well, no "placebo" studies ever really done Dr. Grimes points out in the current issue of Contraception. And he gets to the root of what plagues us. The FDA labeling. ...