GynoFiles

Women think their menstrual flow should all flow 'out' of the body, in effect ridding the tissue and any potential toxins from the system. In fact some bleeding comes from the lining into the fallopian tubes and then into the pelvic cavity settling into the deeper areas of the pelvis including the posterior culdesac, or the very deepest portion of the pelvis located right behind the uterus. The culdesac or culdesac of Douglas as it was formerly known, shown here, has evidence of retrograde menses. The backwards flow of the uterus can also settle into the pelvic side walls and the ovaries as well as around the bladder. The blood contains some menstrual and tubal lining. The tissues that are bled through this backwards bleeding period itself may contain substances known as ,released from cell break down, which can cause cramping or bowel or bladder symptoms. The tissue is often mere fragments and it's relatively rapidly cleared out of the pelvis, but heavier bleeding w...

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.

15 Week Pregnancy

 

If you caught Dr. Trupin on the Morning Show on WCIA-TV, back in September of 2012, you would have heard that September is Ovarian Cancer Awareness Month, and it is felt that awareness can help conquer ovarian cancer. Each year there are 21,000 women diagnosed and 14,000 women who succumb to ovarian cancer. So seeing your physician to try to reduce your risk of ovarian cancer is an important way to honor Ovarian Cancer Awareness month.  Yet this is what you should not do: ovarian cancer screening if you have no risk factors and no symptoms.  A reported in Ob Gyn News: In the Prostate, Lung, Colorectal, and Ovarian (PLCO) Cancer Screening Trial, a randomized, controlled trial of 78,216 women in the United States, there was no significant difference in the number of ovarian cancer cases diagnosed in women randomized to annual screening vs. usual care (212 vs. 176) over 13 years. However, just to be clear those with risk factors do need to be screened; and those with symp...

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...

 Uterine fibroids may be affected by pregnancy, and women who are pregnant can have their pregnancy affected by uterine fibroids. If you have had children, you are less likely to ever get a uterine fibroid. Uterine fibroids can also cause infertility, and miscarriages, and preterm deliveries, and be of a size that will block the birth canal, and make your risk of having a c-section greater.  Only 10-15% of pregnant women will have a uterine fibroid. It is very ethnic dependent: African American Women are more likely to have uterine fibroids in pregnancy that Caucasian women. 18% of African American women will have uterine fibroids in pregnancy, and only about 5-8% of Caucasian women. You may or may not know that you have a fibroid, if it is large, such as over 2.5 inches (5 centimeters) then it's very likely your gyno will feel it on examination. If you have a smaller fibroid, it's most likely to only be detected on ultrasound, but no on examination. So you may not even kno...

One in four pregnancies are lost to miscarriage, and your gyno is going to need to know what type of miscarriage you had in order to recommend any treatment or follow up. If you have bleeding in early pregnancy, your pregnancy is very likely to be fine. Only about half (or fewer) of the pregnancies with early bleeding will go on to a pregnancy loss by 20 weeks of pregnancy. If you have had pregnancy confirmed, and you are bleeding, please contact your gyno so you can be checked. When you first come in to be checked early in pregnancy thinking you are having a miscarriage the question will be: how far pregnant are you, how many babies (twins?), what is the source of the bleeding, and if the pregnancy is still healthy. Some of our patients have bleeding and what has occurred in prior pregnancies is important, did you have an early miscarriage, or an evolving miscarriage, or a history of miscarriage. Prior to trying to get pregnant we spend time trying to discuss what did happen or wh...

Much discussion in the gyno office is about how thick or thin the lining layer of the uterus should be. Normal measurements have to be considered based on your age, where you are in a menstrual cycle if you still have periods, and what hormonal medication you are on. Other factors such as prior c-sections or surgeries will play a part in this as well. Mulling over the varied colored sage from the garden I am reminded that there are many shades to "normal" when it comes to lining thickness. Experts have published  the newest meta-analysis of studies that looked at normal and abnormal endometrial thickness measurements, and I see many patients who have been told conflicting advice about their lining tissue and they come in to see their gyno and are wondering what to do. Although clinical factors mentioned above were always a consideration, we gynos heavily have relied on the objective measurements and certain cut off points of endometrial thickness when evaluating patients w...