GynoFiles

Dermoid Cyst of the Ovary (Benign Cystic Teratoma) Most ovarian cysts come and go. In fact most ovarian cysts never make it to the attention of your health care provider. However, those ovarian cysts that are present on a serial set of ultrasounds become signficantly less likely to ever resolve without your gynecologist intervening. Persistent pelvic masses are not always ovarian cancers, in fact many will be the non-cancerous dermoid cyst shown in this picture.In a review of a study of ovarian masses seen on ultrasound in women over 50 a new study reported in the AJOG in November 2015 has shown that watching and repeating the ultrasound actually did better at determining if an ovarian mass was really cancerous. In this study patients were watched over 3 years. In the past it was thought that a mass of stable size over 6 months would not be a cancer. The theory was that ovarian masses either are cancerous or not cancerous and that masses that are not cancerous cannot evolve into a...

About 35% of hysterectomies per year are done for chronic pain, about 20% are done for endometriosis, which is the most common cause of chronic pain. Curing endometriosis has the ability to significantly improve the life of women and reduce the numbers of hysterectomies. Women who have endometriosis have much worse pain reactions in general. For instance if you have endometriosis you are more likely to experience pain from kidney and bladder stones than other women, although we do not think endometriosis causes kidney stones. The definition of endometriosis has been fairly straight forward: the presence of endometrial glands and endometrial lining tissue (or the stroma, what the glands grow in) outside the uterine lining where it naturally occurs.We also now know that there is a disruption of pain signals that can cause this But the definition has become more complicated: maybe the person with a spot of endometriosis who has no pain doesn't even really have visible signs of e...

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...

Pelvic pressure is a common complaint, with many common causes. It can be a premenstrual cramp, a bit of bloating, a big meal or just what most pregnant moms feel. Pelvic pressure can be due to enlarging pelvic organs for reasons other than pregnancy: fibroids, or an ovarian cyst. Bladder infections, constipation, and hemorrhoids can also cause symptoms of pressure.  But there is something called a hernia due to a weakness in the very back upper portion of the vagina, called the pouch of Douglas, that can cause pelvic pressure. Some women have other pelvic problems at that same time as this internal vaginal hernia: they may have dropping of the bladder, the back wall of the vagina, or an actual dropping of the uterus itself. These problems, having the, cystocele, dropping of bladder, or a rectocele, dropping of the rectum into the vagina are actually both hernias as well, and an anatomic problem you may be able to have some sense of just by self examination. Internal hernias ...

Since endometriosis is a long term chronic disease, we need therapies that can be given over many years and therapies that might even allow some women to be treated and then relieved of further symptoms. New treatments are needed. Endometriosis never appears prior to puberty, and resolves in most women with menopause. Thus it has always been assumed to primarily be a disease caused by the estrogen in the body. Since estrogen is primarily made from the ovary most treatments involve shutting down the ovary's ovulation and therefore the ovary's production of estrogen. But there are alternative ways of decreasing estrogen in the body, and decreasing it more efficiently than just treating the ovulation sequence. Medications that would do that target the body's chemical pathway to produce estrogen from whatever source including the adrenal gland and the body's fat. That is done with medications called aromatase inhibitors.  For women with the pain of endometriosis the newe...

The definition of endometriosis has been fairly straight forward: the presence of endometrial glands and endometrial lining tissue (or the stroma, what the glands grow in) outside the uterine lining where it naturally occurs. But the definition has become more complicated: maybe the person with a spot of endometriosis who has no pain doesn't even really have endometriosis. We now properly term endometriosis: the endometriosis syndrome. The endometriosis syndrome is associated with the errant tissue, but also with pain, various somatic symptoms, and infertility. Endometriosis syndrome pain can be menstrual cramps, it can be bloating, it can be painful intercourse. The endometriosis syndrome likely begins with the very first menstrual period, and it is characterized by progression and recurrences. Those who are born with abnormalities of the uterus and those who grow uterine abnormalities are more prone to developing the endometriosis syndrome. So women with bicornuate uteri or ut...

Gynos spend about 40% of their patient time in evaluating women for pelvic pain. Women undergo more treatments and surgeries for pelvic pain than any other specific cause. We define acute pain as pain that came on intensely, but then has lasted no more than 3 months. Acute pain in pregnancy may be due to tubal pregnancies, or ruptured cysts, twisting ovaries, pelvic inflammatory disease, or  even due to serious problems that are not specifically related to pregnancy such as appendicitis. It is not wise to wait three months to have the chronic pain of pregnancy be treated, but these conditions require management in hours, or days in order to be treated safely. Ultrasound, pelvic examinations, and blood testing can usually make an accurate diagnosis. Pain in pregnancy that is not accompanied by bleeding may be something as simple as cramping, but it would still be important to see your gyno for evaluation.

Endometriosis is tissue outside the uterus that is anatomically and functionally like the lining of the uterus which is called the endometrium. Once it was thought that if you had endometriosis that you were likely to be infertile, and women with severe endometriosis are mostly not fertile. Women with endometriosis through control of the disease and the use of ovulation treatments are achieving pregnancy in greater and greater numbers. Now we have the newest studies showing that what endometriosis persists in pregnancy may in fact cause a number of pregnancy problems. So again, with pregnancy: the yin and the yang of endometriosis, is something you and your gyno will have to sort out. Have you previously been  told that "pregnancy is a good treatment for endometriosis?" Wow, for those who wanted to become pregnant, that was good news, and a potential two birds with one stone catch because the hope was that you would both achieve pregnancy and be (at least temporarily) reli...

Women's Health Practice has begun a study endometriosis. We one of several research sites participating in this study which is trying to help develop a  patient reported outcome tool to help health care providers determine the effectiveness of endometriosis symptoms. You must be 18-45 having painful symptoms of endometriosis, and no other active major health problems. The study will involve 2 visits, and then tracking your symptoms with an electronic diary, there is some minimal compensation. Would you like to set up an appointment? Call Clinical Reasrch Division 217-356-3736.

Pelvic pain may be due to a variety of causes, but sometimes an infrequently thought of diagnosis is that of what I might term pelvic nerve disease. Nerve based pain can occur in almost any part of the body. Typically it can be from an injury: such as a back pain. It is one of those conditions that some gynos have discovered to be a less common cause, but important none the least. Pain is produced because a woman will have a heightened nerve signal feedback due to damage or disease of one or more of the affected nerves which is a condition called  neuropathy. Pelvic nerve neruropathy is most often due to nerve based pain in either or both of the the two largest pelvic nerves: the pudenal and the perineal nerves. The pain, or neuropathy, is secondary to either stretch and compression. A more rare cause of pudenal or perinal neuropathis,  could be genetic tendency to getting nerve inflammation. The causes may have been compression...

But another cause has been discovered by Dr. Mousa Shamoni of University of Siena, Italy, and presented at the Annual InVitro Fertilization and Embryo Transfer Conference. That is scaring of the cervix after a C-section. These women may have scars that actually close the cervix, or scars that partially close the cervix, or pockets of fluid near the old c-section scar. Once these scars occur, the natural uterine fluids and/or menstrual blood then doesn't have the natural passageway out and can accumulate in the uterus. This can lead to obstructions that will prevent normal sperm passage, it can lead to problems with implantation, and chronic abnormal periods or pain. Whether it can cause out right infection is so far speculation. But since between a 1/3 and 50% of women at any given hospital are born by c-section today it's becoming more and more frequent. We know a lot about what internal scaring can cause in women who still have periods after having an endometrial ablation. W...

You may have had a diagnosis of uterine fibroids, and been told that you might need surgery, but there is a lot to know regarding fibroids and women should realize they have a lot to discuss with their gyno if they've been diagnosed. Many fibroids are found on pelvic exam or pelvic ultrasound, and it's a surprise as the woman wasn't seeking consultation for period symptoms. Not all fibroids progress to having symptoms, and in fact a significant percent of women who do have symptoms won't need medicine or surgery because they report reduction of symptoms with observation alone. But for those with uterine bleeding, pelvic pains, or women with bulk symptoms such as abdominal swelling, pelvic heaviness, frequent urination, discomfort with sex, or bladder discomfort Both suregical and medical therapy for uterine fibroids are used commonly..  The chances of successful resolution of your symptoms depends upon what your symptoms are and what your plans for the future...

Surgical treatment for endometriosis usually resolves the pain, either partially or completely, for at least months, and possibly years. Women who undergo surgical treatment of endometriosis are still very likely to have recurrence.  A study by Vercellini in the British Journal of Obstetrics and Gynecology stated that after endometriosis surgery about 60% have recurrence of pain and that it's very important to take medical therapy after the surgery to make sure the pain doesn't return. They have showing in other studies that just using medical therapy for under 3 months after surgery is of no benefit at all.. Actually the type of surgery that people have is important. If you had a cyst of endometriosis called an endometrioma removal of the whole cyst rather than just cauterizing it, delayed the recurrence of pain and sped up the time to pregnancy in one study conducted in the late 90s. But a study in AJOG in March 2014 showed that 20% of women have a recurrance of an endo...

1. Dysmenorrhea or Painful periods 2. Painful Intercourse or Dysparunia 3. Painful Urination or Dysuria 4. Painful bowel movements or Dyschezia 5. Lower back pain 6. Abdominal discomfort 7. Mid Cycle pelvic pain 8. Pelvic Pain throughout the Cycle 9. Ovulation Pain 10. Blood in urine or with bowel movements Endometriosis is a disease of the pelvis in which growths of cells, that is similar to, but not identical uterine lining tissue, appear in locations not just within the wall of the uterus. Endometriosis is a cause of pelvic pain, and the most common reason women are treated by their gynos for pelvic pain. Delaying the diagnosis of endometriosis can cause progression, but the symptoms may be mild at first or thought to be due to something else. All medical therapies for endometriosis also decrease a woman's estrogen in her body. Because of this management of endometriosis can be very difficult and lead to side effects that need treatment. In many cases women suffe...

Endometriosis is a disease of the reproductive time of our life, so that once diagnosed, its recurrence is common. A lot is known about the condition but not too many theories have explained why one woman gets endometriosis while another: perhaps her sister or a friend does not.  It may be internally caused, your own hormone levels, or perhaps something like pesticides triggers the abnormal production of hormones . One current theory is that local increases in the enzyme that makes our body produce estrogen compounds may produce the a spot lesion that is the endometriotic growth in a particular spot in the pelvis, and then the overproduction of inflammation chemicals may produce the pain that accompanies the lesions that exist. Since growth factors then become over expressed by this situation of lesions and inflammatory chemicals, there is a stimulus to increased the density of nerve fibers. Extra nerve fibers, extra inflammatory chemicals, the result is extra pain. The ner...

Sperm With Bacteria on Surface Pelvic Inflammatory Disease (PID) comes from an infection inside the female organs. The question is how does bacteria gets past what is an effective mucus cervical barrier, and yet wind up in the uterus and fallopian tubes? Did you know how to avoid infection with these bacteria? How to avoid infection women: One very effective way, Avoid contact with these bacteria hitchhiking sperm! Take a look at this picture that shows the bacteria on the surface of sperm. Yes that's how infections get past the cervical mucus, into the cavity of the uterus, into the corners of the fallopian tubes, out into the the tubal fimbria (the fingers on the ends of tubes) and finally bacteria then tumbling past the ovaries into the the peritoneal cavity. PID can be a serious disease, with about 12% of women infertile after a single episode and over 50% of women infertile after three or more episodes of PID. And how to avoid contact: still condoms are the best defense! ...

Photography W. Scifres Women might want to know their Hoogland score , because it would give you a hint as to whether or not you are protected against getting pregnant when using birth control pills (OCP ). One of the main ways to detect effectiveness of birth control and cycle control is to measure how little one ovulates, medically termed "ovarian suppression." There is an official, gyno endorsed, way to measure ovarian suppression during OCP use: it is cored on 6 features of possible egg development: 1. no evidence of any ovarian activity on ultrasound, 2. potential activity on ultrasound, 3. non-active follicle like structures, 5) luteinized unruptured follicle and 6 ) ovulation . Other factors contribute to how successful the ovarian suppression is.  Measuring estrogen levels, and thickness of the lining of the uterus called the endometrium, and measuring progesterone for evidence of ovulation can all contribute towards making a diagnosis of ovulation. We use the...

Belts and Suspenders, One of My Favorite Pants Tricks, Works for Endometriosis Too! How to best treat endometriosis is highly debated. Giving strong medication like Gonadotropin releasing hormone (GnRH, more commonly known as Lupron) may be too strong for many although is is the "top of the line" treatment. For others its the male hormone danazol which is their best treatment, but also strong. For many there is no tolerance for the stronger  medications without taking birth control pills as well. The birth control pills will not hurt the effectiveness of Lupron, and the progesterone in the pills might enhance the effectiveness. And if you think that you want to grab both a belt and suspenders so that you're not so likely to ever be caught loosing those pants, you're thinking is kind of like mine some times. That 'back up plan' mentality, probably instilled by our moms, or our public post-depression mentality. However, as with all the wittiest sayings, it ap...

Pain seems like something your gyno should be able to fix, and more often than not, we can. But there are aches and pains that just seem to defy solutions and remain a puzzle. Scientists are trying to figure out why. Start with the concept that pain is the feeling we get when a particular type of nerve fiber sends the brain a signal. A nerve is not just a nerve by any name. While this discussion is of course a gross over simplification, a few important facts have started to emerge. We have Type A-beta fibers, the mediate touch and sensation and we have C fibers, those mediate our perception of noxious stimuli. What triggers the chronic pain, irritation and discomfort of women with vulvodynia seems to be these C fibers getting out of whack. They release cytokines and neurokines to perform their signaling. And with chronic inflammation, product use, treatments, the responses can become inappropriate. So simple touch can give off a pain signal. Makes some sort of sense. In fact it's t...

This model can fully articulate all her joints and get her pelvis attached and unattached to demonstrate the forces of pregnancy and labor. She's feeling no pain as we work our labor drills. But not so with most of the pregnant women we take care of. They present in labor having toughed out many a day of pain. This pain now has a name: PGP, Pelvic girdle pain. "Pelvic girdle pain affects 20-45% of all pregnant women," write Elisabeth K. Bjelland, MSc, from the Norwegian Institute of Public Health in Oslo, and colleagues. But to find out if you are suffering from this, contact your gyno.