Female Problems Four Issues to Talk to Your Gynecologist About
May 2023 Issue — Pink Prescriptions
Female Problems Four Issues to Talk to Your Gynecologist About
As if dealing with a monthly period isn’t bad enough, there are conditions some women experience that make matters worse. Almost everyone dreads
“that time of the month” but having a regular menstrual cycle is a good sign.
There are many things that can go wrong whether you’re trying to
get pregnant or not. This month our local medical experts chime in
on four of the most common reasons women experience
menstrual irregularity, severe cramps and pain, and infertility.
By Tiffany Bersani, M.D. | Beaufort Memorial Hospital
Tell us about endometriosis (in relation to fertility), if preventable and what women can do to overcome or work around it.
Endometriosis is a condition in which tissue from the uterine lining develops outside the uterus in other areas of the pelvis. These lesions can cause inflammation, pain and scar tissue on surrounding organs. Symptoms of endometriosis can include pain with intercourse, pain with bowel movements or urination, and excessive menstrual bleeding.
There does seem to be a connection between endometriosis and infertility, as approximately one-third to one-half of women with endometriosis have difficulty becoming pregnant.
While one in 10 women in their childbearing years suffers from endometriosis, it’s a difficult disorder to diagnose because the symptoms can often be mistaken for other conditions that cause pelvic pain. If other possible causes have been ruled out, the only way to know for certain you have endometriosis is to undergo laparoscopic surgery that allows the physician to look inside your abdomen for signs of endometrial tissue.
Endometriosis is an idiopathic condition, meaning there is no known cause. There are also no specific ways to prevent endometriosis. However, being aware of the symptoms and whether you could be at higher risk can help you know when to seek treatment. Risk factors include: A family history (mother, sister or daughter) of endometriosis; early menstruation (before age 11); shorter menstrual cycles (less than 27 days on average); heavy menstrual periods lasting more than seven days.
While there is not a cure for endometriosis, it can be treated with medication, such as nonsteroidal anti-inflammatory drugs, to ease painful menstrual cramps. Hormone therapy, including birth control pills, patches and vaginal rings, may also be used to slow the growth of endometrial tissue. If hormone therapy doesn’t alleviate the chronic pelvic pain, or if a patient is trying to become pregnant, the next step would be laparoscopic surgery to remove the tissue growths.
Tell us about unterine fibroids (in relation to fertility), if preventable and what women can do to overcome or work around it.
Uterine fibroids are noncancerous tumors that form in the muscle tissue inside or outside the uterus or within the uterine wall. Many women develop fibroids during their 30s and 40s. The cause for the growths is unknown, but possible contributing risk factors include genetics, changing hormone levels and being overweight. Some cases of uterine fibroids are harmless, while others cause severe pain and long-term side effects, including infertility.
Many women who have fibroids can get pregnant naturally, however, there are certain types of fibroids that can affect your fertility. For example, submucosal fibroids that bulge into the uterine cavity can increase your risk for infertility or pregnancy loss. If you are trying to get pregnant and know you have fibroids, talk with your OBGYN provider about whether they could cause problems with getting pregnant or your ability to carry a pregnancy.
You may also want to ask if fibroid treatments can help improve your odds for pregnancy success. As medicine has progressed, there are many non-surgical ways of treating fibroids with medication and hormones. If surgery to remove them is required, a myomectomy might be an appropriate choice for women who want to have children. While the procedure will remove the fibroids from the uterus, it will not necessarily prevent new fibroids from growing in the future.
Dr. Tiffany Bersani is an OB-GYN with Beaufort Memorial Obstetrics & Gynecology Specialists. She sees patients in both Beaufort and Okatie and can be reached at 843-522-7820.
By Katherine Coley, M.D. — Advanced Women’s Care of the Lowcountry
Polycystic Ovarian Syndrome (PCOS)
Tell us about Polycystic Ovarian Syndrome (PCOS)—in relation to fertility, if preventable and what women can do to overcome or work around it.
Polycystic Ovarian Syndrome (PCOS) is a condition in which the the ovaries don’t produce the normal ratio of hormones resulting in multiple follicles being stimulated a little bit rather than one follicle being stimulated each month to mature and release an egg (ovulation). This can cause irregular periods; usually women will go months without a cycle, but some women do get a period more regularly. Women with PCOS often have high levels of testosterone causing issues with acne and facial hair or excessive body hair. It is also associated with having insulin resistance or pre-diabetes. The insulin resistance can cause difficulty regulating weight and many women with PCOS are overweight or obese, but thin women can have this condition as well. Unfortunately PCOS is genetic and there is no way to prevent it, but there is hope. Following a diabetic type diet (low carb and low sugar), treatment with a diabetic medication (metformin) and getting your weight down below obese levels will often be enough to bring the insulin levels down, regulate your cycle and resume ovulation. Sometimes we will also use medications to help “force” your ovaries to ovulate such as Clomid or Femara. Since PCOS is a syndrome, it does not affect everyone the same way, so it is important to work with your gynecologist for proper diagnosis and to find the right treatment for you.
Dr. Katherine Coley is a Board Certified Ob/GYN at Advanced Women’s Care with 13 years of experience. She graduated residency from New York Presbyterian hospital/Weill-Cornell program. Call for more information: 843-301-0718.
By Dr. Tracy Blusewicz | Advanced Women's Care of the Lowcountry
Tell us about hormonal imbalances (in relation to fertility), if preventable and what women can do to overcome or work around it.
Wow, this is a loaded question since infertility has so many varied causes and possible treatments. First of all, if a woman is having regular periods this is a good sign that her hormones are in balance. A period that comes every 28-29 days is considered average but periods that are regular every 25-35 days can still be considered normal. If a period is on a regular schedule it usually means that the hormones to signal ovulation, or releasing of the egg, are getting the right cues and the hormones that signal the period to start if no fertilization happens are hitting the right peaks. So, a big sign of normal fertility is a regular period,
If a period is irregular, or if a woman is skipping periods, this can be a sign of a hormonal imbalance. There could be too low progesterone or too much testosterone. There could also be a thyroid hormone deficiency. Estrogen could be suppressed from medicines, overexercise, extreme weight changes or diets. So, the first step would be in the case of irregular periods to see your provider and check hormone and thyroid levels. It’s important to note how long it has been since your last period and any changes that have occurred in your health when talking to your provider. Also, if you are experiencing acne, hair loss or growth, skin color changes, or weight changes.
Sometimes in the case of hormonal issues, hormones can be added like progesterone during the luteal cycle (the phase of the cycle two weeks prior to when your period is scheduled to come) or a medicine called Clomid can be added to the beginning of your cycle to help boost your estrogen and egg stimulation for ovulation. Sometimes a hormone called Bhcg can be given at a specific time in your cycle to help with ovulation of eggs that are ready to be released. Another fix could be thyroid hormone if a woman’s thyroid hormone is too low, or medicine to bring down thyroid hormone levels that are excessive.
So, if a woman has any concerns about the regularity of her period, seeing a provider early when she notices the changes will help her get answers sooner and may save precious time during a fertility work up.
Tracy Blusewicz, M.D., F.A.C.O.G., compassionate, genuine bedside manner has earned her the trust of many women for their health care needs. She can be contacted at Advanced Women’s Care of the Lowcountry | The Medical Spa 843-341-9700; www.awclc.com