Gynecology FAQs

Adenomyosis

Adenomyosis is a condition in which tissue that normally lines the uterus also grows within the muscular walls of the uterus. The cause remains unknown, but the disease typically disappears after menopause. Although Adenomyosis can be quite painful, the condition is benign.

Symptoms

In some women, Adenomyosis is “silent” causing no signs or symptoms or only mildly uncomfortable ones. Other women may experience:

• Heavy or prolonged menstrual bleeding, passing blood clots

• Severe cramping or sharp, knife-like pelvic pain during menstruation

• Menstrual cramps that last throughout your period and worsen as you get older

• Pain during intercourse

• Bleeding between periods

• Your uterus may increase to double or triple its normal size

Risk Factors

Women who have had prior uterine surgery, such as C-section or fibroid removal, are at greater risk of adenomyosis. It is also more common among women who have given birth to at least one child.

Complications

Although not harmful, the pain and excessive bleeding with adenomyosis can have a negative effect on your lifestyle. Painful periods can cause you to miss work or school and can strain relationships. Recurring pain can lead to depression, irritability, anxiety, anger, and feelings of helplessness. Also, prolonged heavy bleeding can result in chronic anemia. These are the reasons why it is important to seek medical evaluation if you suspect you may have Adenomyosis.

Treatment and Drugs

• Anti-inflammatory drugs – by taking medication such as Ibuprofen two to three days before your period begins and continuing during your period, you can reduce blood flow and relieve pain.

• Hormone therapy – these options include estrogen-progestin oral contraceptives, hormone-containing patches or vaginal rings, an IUD containing progestin, or a continuous-use birth control pill.

• Hysterectomy – if your pain in severe and menopause is years away, your doctor may suggest surgery to remove your uterus. Removing your ovaries isn’t necessary to control Adenomyosis.

Endometriosis is a common condition that occurs in 1 out of 10 women. It occurs when the endometrium, the tissue that lines the uterus, is found outside of the uterus. Endometriosis can implant along pelvic organs including fallopian tubes and ovaries. Endometrial implants respond to estrogen produced by the ovaries and can grow and shed like the uterine lining does during the menstrual cycle. Endometriosis can cause pelvic tissues to become inflamed and swollen, causing painful menses. Endometriosis can also lead to formation of scar tissue or adhesions.

Endometriosis may be suspected if a woman has severe pain during menses. Endometriosis is officially diagnosed through a surgical procedure called a laparoscopy. A biopsy, a small piece of tissue may be removed during surgery to confirm diagnosis.

Treatment may be recommended if Endometriosis is suspected and/or after surgical confirmation. Treatment options vary depending on symptoms and desire for future childbearing.

• NSAIDs, anti-inflammatory medications like Ibuprofen or Naproxen can be helpful to control pain.

• Hormonal treatment, birth control pills, or a progesterone releasing IUD can be helpful to slow the growth of endometrial implants and may prevent new adhesions from forming.

• GNRH agonists – work to block the effects of estrogen.

• Pelvic floor physical therapy can help manage pain.

• Laparoscopic surgery to remove visible Endometriosis – can be done to attempt to relieve pain and improve fertility. Approximately 40-80% of women have return of pain within 2 years of surgery. Using hormonal treatment after surgery may help extend the pain-free period.

• Hysterectomy – removal of the uterus and possible ovaries, is a “last resort” if childbearing is complete and other treatments do not help with severe pain.

Pelvic Floor Muscle Exercises (often called “Kegel” exercises)

These can strengthen the muscles that help hold urine in the bladder.

• Imagine that you are trying to control passing gas.
• Tighten your rectum for a count of 3.
• Then fully relax the muscle for a count of 3. (Try to control both the tightening and relaxing of the muscle.)
• Repeat 10-15 times. Do these at least 3 times a day. You can do this anywhere.

Polycystic Ovarian Syndrome (PCOS) is a condition that affects 10-20% of women. The exact cause is not certain, but it appears that several factors contribute to this health problem. Women with PCOS have elevated levels of androgen hormones, insulin resistance, and irregular menstrual cycles. PCOS is a common, but treatable cause of infertility.

Symptoms of PCOS

• Irregular menstrual cycles

• Hirsutism – excess facial or body hair

• Severe acne

• Dark velvety patches on skin

• Obesity – 80% with PCOS are overweight

• Multiple small cysts on ovaries

Health Risks of PCOS

• Infertility – irregular menses can lead to difficulty becoming pregnant due to irregular ovulation.

• Insulin Resistance – cells in the body do not respond normally to insulin, leading to high insulin levels, and over time high blood sugar levels. Excess production of insulin appears to increase production of androgens. Insulin resistance can cause diabetes. Insulin resistance can also increase risk of metabolic syndrome and cardiovascular disease later in life.

• Endometrial Hyperplasia - a condition where the endometrial lining of the uterus becomes abnormally thick, which increases risk of endometrial cancer.

Treatment of PCOS

PCOS treatment is determined by the woman’s symptoms, health problems, and desire to prevent or achieve pregnancy.

• Weight loss – for women that are overweight, weight loss can help to make menses more regular and restore regular ovulation. Weight loss can decrease insulin levels and decrease symptoms of acne and hair growth.

• Low carbohydrate diet – works to decrease blood glucose and insulin levels which can help to restore regular ovulation.

• Hormonal birth control – works to regulate the menstrual cycle, and decreases the risk of endometrial cancer. Birth control pills can also reduce androgen levels helping to decrease hirsutism and acne.

• Metformin – medication that helps the body respond to insulin, decreases insulin levels and blood sugar, can help decrease androgen levels and improve ovulation.

• Spironolactone – medication that can be used to decrease androgen levels, decrease acne and hirsutism.

• Clomid – may be given to stimulate ovulation when trying for pregnancy.

Overactive Bladder (OAB)

This can happen when the bladder muscle squeezes too often, or when you don’t want it to. This can happen even when your bladder is not full. This can cause:

• Strong, sudden urges to urinate (urinary urgency)

• Frequent trips to the bathroom, often more than 8 times a day, which may include waking up at night to go to the bathroom.

• Wetting accidents (for some people)

There are treatments for this medical condition that may help. They include:

• Bladder training

• Medications

• Lifestyle changes

• Pelvic floor muscle exercise (Kegels)

Often patients will use more than one of these options to improve their symptoms. Some changes seem like common sense, but they can improve your symptoms and have a big impact on your life.

When you begin treating OAB with medication and using other suggested changes, you may notice improvement in as little as 2-3 weeks. Be patient! Most people improve more over the next 12 weeks. Then, continue taking your medications and following your doctor’s instructions, even when you are feeling better.

Bladder Training

This will help you to regain control of your bladder.

The goal is to urinate every 3-4 hours during the day without fear of wetting accidents.

Do your best to follow the same schedule each day during waking hours. You may need to get used to the idea that you can wait longer before going.

• Urinate each morning upon waking, and each night before you go to sleep.
• Try to gradually increase your time between bathroom visits during the day. If you typically go every hour, try to wait 1 hour and 15 minutes.
• When you can wait that long without a problem for 1-2 weeks, try to increase the time by 15 more minutes. Then, gradually wait longer in between trips.
• Stick to the schedule as much as you can, whether or not you have to go.
• If you have a strong urge to go before your scheduled time, work on controlling the urge (using techniques below) to put off going until the scheduled time.

Control Tips:

• Perform 5 quick, strong, pelvic muscle contractions. They should help calm the urge.
• Try to distract your thoughts from the urge to go:
  • Count backwards from 100 by 7’s.
  • Recite a song/poem from memory.
  • Relax, take 5 deep breaths. Focus on breathing slow and regular, not on your bladder.

Pelvic Floor Muscle Exercises (often called “Kegel” exercises)

These can strengthen the muscles that help hold urine in the bladder.

• Imagine that you are trying to control passing gas.
• Tighten your rectum for a count of 3.
• Then fully relax the muscle for a count of 3. (Try to control both the tightening and relaxing of the muscle.)
• Repeat 10-15 times. Do these at least 3 times a day. You can do this anywhere.

Other tips to help your symptoms:

• Watch how much you drink: Some people limit their fluid intake in an attempt to reduce OAB symptoms, but this can concentrate urine. This may lead to bladder irritation and constipation.
• Your body typically needs 4-6 glasses of fluid per day. This amount also depends on how much you sweat (from activity and heat) and may need to be increased. Your primary source of fluid should be water.
• Avoid food and drinks that may irritate your bladder:  Caffeinated drinks (coffee and tea), carbonated drinks (soda), citrus fruits or drinks (like orange or grapefruit), artificial sweeteners and spicy foods (like salsa). 
• Normal bowel movements will help. These are bowel movements that are nonpainful and easy. Avoid straining to empty your bowels. Eat a high fiber diet, drink plenty of water and exercise to help to stay regular.
• Watch your weight. If you are overweight, your OAB symptoms may be increased.
• Stop smoking. Chemicals from smoking can irritate the bladder.

Uterine fibroids are benign growths that occur from the muscle layer of the uterus. Fibroids are extremely common, 20-80% of women develop fibroids by age 50. Some women have single fibroids, while others have multiple uterine fibroids. A fibroid may be the size of a seed, or grow larger than a softball. A fibroid may remain small, grow slowly, or grow rapidly.

Many small fibroids cause no symptoms at all. Some fibroids can cause irregular bleeding, longer or heavy menses, cramping and anemia due to blood loss. Fibroids may also cause pelvic pain or pain during intercourse, frequent urination or rectal pressure, or problems with fertility.

Fibroids may be suspected after evaluation of symptoms and upon pelvic exam. Fibroids may be detected on ultrasound, or detected surgically during hysteroscopy or laparoscopy.

Treatment of fibroids depends on symptoms, size, and location of fibroids along with desire for future childbearing.

• Fibroids that are small and are not causing symptoms often do not require treatment.
• Birth control pills or hormonal medications may be used to control heavy bleeding and pelvic pain associated with fibroids.
• A progestin releasing IUD may be used to control heavy bleeding and pelvic pain if the fibroids do not distort the uterine cavity.
• GnRH Agonists – suppress estrogen and may be used for 6 months to help shrink fibroids prior to surgery.
• Myomectomy – surgery to remove fibroid(s) may be used if future fertility is desired.
• Uterine Artery Embolization – blood flow is cut off to the fibroid causing it to shrink.
• Hysterectomy – surgery to remove uterus, if childbearing is complete.