Month: January 2017

Endometriosis is a condition in which the endometrium, the lining of the uterus, grows outside of the uterus.  The tissue can be found on any part of the reproductive system, to include the ovaries, fallopian tubes, or the intestines.  Despite growing in an unintended place, the tissue continues to act as it would in the uterus–thickening, breaking down, and bleeding with each menstrual cycle.  This tissue may also cause cysts (endometriomas), development of scar tissue, and adhesions (organs that stick together).

Risk factors.  While the exact cause of endometriosis remains uncertain, there
are several known risk factors such as: having never birthed a child; starting menstruation at an early age; going through menopause at a later age; having shorter periods; regular alcohol consumption; low body mass index; and a family history of endometriosis.

Symptoms.  A woman with endometriosis may experience abdominal, pelvic, rectal, or vaginal pain; painful intercourse; irregular, heavy, or painful menstruation; constipation; nausea; abdominal cramping; and infertility.

Complications.  Infertility and ovarian cancer are the two most concerning complications of endometriosis.  Approximately 1/3 – 1/2 of women who suffer from the condition have fertility issues, yet pregnancy is still possible.  Fortunately, the rates of associated ovarian cancer are much lower.

Diagnosis. Possible diagnostic tools when endometriosis is suspected are a pelvic exam, transvaginal ultrasound, or laparoscopy.

Once diagnosed, endometrosis can be classified into 4 different stages based on their severity.   Stage I (minimal) and II (mild) are most common.  Stage III (moderate) typically means that cysts and severe scarring are present.  Stage IV (severe) indicates that the damage has caused infertility.

Treatment. Self-care can help to improve minor symptoms.  Warm baths and heating pads can reduce pain and cramping by relaxing the pelvic muscles.  OTC pain medications can also help to alleviate muscle cramps.

Hormonal therapy, such as birth control medications, can be effective in relieving the pain associated with endometriosis.  It is the rise of fall of hormones as a part of the menstrual cycle that causes the tissue to thicken, break down, and bleed.  Hormone medications help to slow tissue growth, and prevent new tissue from building.

If hormonal therapy fails, conservative surgery may be used to remove the displaced tissue.  This option removes only the abnormal tissue and leaves the female reproductive organs intact.  In the most severe cases, a hysterectomy may be required.

Uterine fibroids are benign (noncancerous) tumors that grow in the uterus.  Fibroids can range in size from tiny to as large as a grapefruit.  They can also exist as a single fibroid or in multiples.  Most women (up to 80% of them) will have a fibroid at some point in their lifetime, but are unaware because they don’t experience any symptoms.  Fortunately, fibroids generally do not increase a woman’s risk of developing any cancers of the reproductive system.

Cause.  The exact cause of fibroids is unknown, but there is a possible link to genetics, increased levels of the hormones estrogen and progesterone, and increased levels of insulin.

Risk Factors.  A family history of fibroids, increased age (30s through menopause), African American ancestry, early-onset of menstruation, use of birth control, obesity, vitamin D deficiency, frequent use of alcohol, and a diet high in red meat all seem to increase a woman’s risk of developing fibroids.

Symptoms. Common symptoms of fibroids are pain in the abdomen, lower back, or pelvis; heavy, painful, or irregular periods; frequent urination; difficulty urinating; constipation; and abdominal cramps.

Complications.  Though rare, fibroids may cause infertility.  If able to get pregnant despite the presence of fibroids,  miscarriage, breeching of the baby, fetal growth restriction, and preterm delivery may result.

Diagnosis.  Most often, uterine fibroids are first identified with a manual pelvic exam at your annual gynecological visit.  The presence of fibroids may be confirmed with an ultrasound, MRI, x-ray, cat scan, hysterosonogram, or hysterosalpingogram.

Treatment.  If the fibroids are small or painless, your doctor will usually just recommend “watchful waiting.”  This means no interventions will be done unless symptoms worsen at some point in the future.  Regular exercise and eating a diet high in fresh fruits and cruciferous vegetables (arugula, broccoli, cabbage, cauliflower, and greens) may help lower risk of developing further fibroids.  OTC pain medication such as Tylenol or Motrin can help treat mild-to-moderate pain.  Iron supplements can help prevent anemia in women who suffer from heavy periods.  Hormonal medications such as oral contraceptives, the Depo-Provera shot, and the Mirena IUD can all help to shrink fibroids and/or relieve heavy periods.  Surgery at varying levels of intensity can remove fibroids.  And in the most extreme cases, a hysterectomy may be done to remove all female reproductive organs.

A pap smear is a test that checks for cervical cancer.  A small sample of cells are scraped from the opening of the cervix, and then sent to a lab for examination under a microscope.

How should I prepare?  Try to avoid scheduling your pap smear during your period.  In the 48 hours prior to the exam, be sure to avoid douching, tampons, sex, and vaginal medications, foams, creams, jellies, etc.

What happens during the test?  Pap smears are generally done by your gynecologist at your annual wellness exam.  During the test, you lay down on the exam table with your legs spread open in stirrups.  The provider inserts a small tool (a speculum) into your vagina to keep it open, and then removes the needed cell sample.  The cells are then sent to a lab for microscopic examination.  For most women, the test is not painful, but may cause some discomfort.  Fortunately, the entire procedure is usually over in just a few minutes.

Why is it important?  Cervical cancer is the 4th most common cause of cancer-related death in women.  Generally cervical cancer does not have any symptoms, so getting your pap smears on schedule is vital as the primary screening tool.  Like many other cancers, the earlier it is detected, the better your chances of survival.  Pap smears are highly accurate, and getting one done regularly can decrease your risk of cancer and cancer related-death by 80%.

How often should I get a pap smear?  Generally, screening should start at age 21. If sexually active as a teenager, your doctor may recommend that you start your pap smears sooner.  After that, the test should be repeated every 3 years.  If you have a history of human papillomavirus (HPV) or abnormal pap smears in the past, you may need to get them done more frequently.  If aged 30-65, you can get both a pap smear and HPV test every 5 years as long as they both remain negative.  Most women can stop having pap smears after age 65 as long as their previous 3 pap smears have been negative.

What do my test results mean?  A normal result indicates that there are no abnormal cells present.  An abnormal result means that atypical, precancerous, or cancerous cells are present.  Your doctor will decide the appropriate intervention depending on the severity of your results.

Anxiety is defined as “a nervous disorder characterized by a state of excessive uneasiness and apprehension, typically with compulsive behavior and/or panic attacks.”   The effects of anxiety disorders are so severe that they interfere with normal daily activities.

Subtypes.  There are many different types of anxiety disorders.  Examples include:

• Generalized anxiety disorder (GAD) – people with GAD experience chronic excessive anxiety and worry in relation to several different stressors
• Panic disorder – those who suffer from panic disorder experience recurrent unexpected panic attacks
• Social anxiety disorder – people with social anxiety disorder fear social situations in which they may be embarrassed, judged, or rejected
• Post-traumatic stress disorder (PTSD) – anxiety related to PTSD is triggered by a terrifying event.  This event may have been a natural disaster, serious accident, terrorist attack, war, or violent personal attack.
• Obsessive compulsive disorder (OCD) – someone with OCD will experience unwanted and repeated thoughts or behaviors that make them feel driven to complete a specific task (compulsion)

Symptoms.  Fatigue, restlessness, excessive sweating, hypervigilance, irritability, excessive worry or fear, feelings of impending doom, inability to concentrate, and increased heart rate are all possible symptoms of an anxiety disorder.

Diagnosis. Psychological testing is the primary means of diagnosing anxiety disorders.

Management. If experiencing symptoms of anxiety, exercise and relaxation techniques may be beneficial.  Seeking professional help, such as with a clinical social worker or psychologist, should also help.  Mental health professionals can teach you skills that will help you deal with stress, negative thoughts, and unhealthy emotional responses related to those thoughts.  These skills may include relaxation techniques (meditation, yoga, and self-hypnosis), muscle relaxation, and deep-breathing exercises.  Avoiding stimulating substances such as caffeine and certain illicit drugs is also important.

Medications. If still struggling with anxiety despite putting these skills into practice, your doctor may suggest trying a medication to help.  Available options include antidepressants, anxiolytics, sedatives, and beta-blockers.

Anxiety may be caused by a combination of factors including changes in the brain and environmental stress.  There is no shame in having anxiety or any other mental illness.  Having anxiety does not mean that you are “paranoid” or “crazy.” If experiencing any of the symptoms above, I encourage you to seek help so that you can manage your symptoms and be your best self.

Bipolar disorder, sometimes also known as manic depression, is a mental health disorder in which someone’s mood alternates between periods of depressive lows and manic (or hypomanic) highs.  Each phase may last a few weeks up to several months.

Cause.  Bipolar disorder is caused by an imbalance in neurotransmitters in the brain, namely norepinephrine, serotonin, and/or dopamine.  The manic phase is caused by overactivity of these neurotransmitters, while the depressive phase is caused by a deficiency of them.

Symptoms.   Manic episodes are marked by high levels of energy and productivity, combined with decreased need for sleep.  Depressive episodes bring the opposite effects–low energy, low motivation, and loss of interest in day-to-day tasks.

Diagnosis. Bipolar disorder is diagnosed through psychological testing.

Management.  Psychological treatment options for people with bipolar disorder include psychotherapy and support groups.  See last week’s post on depression for a full list of activities you can do to try to help improve your mood when its low. (http://www.healthandblackness.com/depression/).

Management of manic phases is a little more difficult as many people find that they enjoy feeling manic.  They feel full of life…as if they can conquer the world.  Yet, due to this sense of euphoria, people often find that they may battle with hypersexuality, taking unnecessary risks (i.e gambling), or other dangerous behaviors during this phase.  So it is important to continually be aware of your mood, and avoid potentially self-destructive activities even if they provide pleasure at the time.

Medications.  In addition to therapy, medications that may be helpful include mood stabilizers and antipsychotics.  These medications work to balance the neurotransmitters in the brain.  Your doctor will decide which is best depending on your symptoms, frequency of mood swings, other diseases you may have, etc.  If prescribed any medication within these two groups, it is important to take them everyday, even on days that you are feeling well.  Also, be sure to discuss any unwanted side effects with your doctor, versus discontinuing the medication(s) abruptly.

As with all mental health disorders, it is important to remember that there is no shame in having bipolar disorder.  A diagnosis does not mean that you are “broken” or that something is “wrong” with you.  If experiencing any of the symptoms above, I encourage you to seek help so that you can mange your symptoms and be your best self.

If ever experiencing thoughts of suicide, please call the National Suicide Prevention Lifeline at 1-800-273-TALK(8255).