October is breast cancer awareness month. I would like to send hugs out to all of the breast cancer survivors including my dear friend Nancy (8 year survivor-yay!), And to all of the family and friends of those who were not so fortunate as to survive breast cancer. I am so sorry for your loss!
There is a lot of conflicting information regarding breast cancer screening. Currently I am following the lead of the American College of OB/GYN (ACOG), and still screening for breast cancer (with mammography and clinical breast exams) every 1-2 years starting at age 40.
I will include the new breast cancer screening guidelines from the US Preventative Services Task Force (USPSTF), and the official statement from ACOG regarding the new recommendations by the USPSTF. Please also read the article from the National Cancer Institute on breast cancer prevention.
Thanks,
~Lisa
NEW BREAST CANCER SCREENING GUIDELINES FROM THE USPSTF
November 16, 2009 ( UPDATED November 17, 2009 ) — The US Preventive Services Task Force (USPSTF) has issued new breast cancer screening guidelines, which are published in the November 17 issue of the Annals of Internal Medicine. The task force now recommends against routine mammography screening for women before age 50 years and suggests that screening end at age 74 years.
The new USPSTF recommendations are in opposition to other existing breast cancer screening guidelines from organizations such as the American Cancer Society and the American College of Radiology, which have both criticized the new document. Several agencies and organizations, such as the Seattle Cancer Care Alliance, have said they will continue to follow the American Cancer Society guidelines. However, according to an article in the New York Times, advocacy groups like the National Breast Cancer Coalition, Breast Cancer Action, and the National Women’s Health Network "welcomed the new guidelines."
Updated USPSTF Breast Cancer Screening Guidelines
The new USPSTF guidelines, which update those they issued in 2002, also recommend changing the screening interval from 1 year to 2 years and suggest that women aged 40 to 49 years who are at high risk for breast cancer consult with their clinician concerning the optimal time to begin regular, biennial screening mammography.
"Mammography, as well as physical examination of the breasts, can detect presymptomatic breast cancer," write Ned Calonge, MD, MPH, from the Colorado Department of Public Health and Environment in Denver, and colleagues from the USPSTF. "Because of its demonstrated effectiveness in randomized, controlled trials of screening, film mammography is the standard for detecting breast cancer; in 2002, the USPSTF found convincing evidence of its adequate sensitivity and specificity."
Because of insufficient evidence to determine the benefits and harms of screening mammography in women older than 75 years, the updated guidelines recommend stopping screening at age 74 years.
Because the USPSTF found adequate evidence that teaching self-examination is not associated with a decrease in breast cancer mortality rates, the task force recommends against teaching breast self-examination (BSE).
Current evidence is now insufficient to evaluate additional benefits and harms of clinical breast examination (CBE) for women aged at least 40 years. This recommendation is a change from the 2002 statement, which endorsed mammography screening, with or without CBE, annually or biennially for women 40 years or older.
Film mammography is associated with decreased breast cancer mortality rates, particularly in women aged 50 to 74 years, based on evidence to date. Women aged 60 to 69 years appear to have the greatest benefit, whereas evidence of benefit associated with film mammography is lacking for women aged at least 75 years.
Current evidence is insufficient to determine additional benefits and harms of either digital mammography or magnetic resonance imaging (MRI) as screening modalities for breast cancer vs film mammography. Therefore, the USPSTF did not recommend one form of mammography vs another.
The evidence base for the updated guidelines was a systematic review of published evidence of the efficacy of the 5 screening modalities in lowering breast cancer mortality rates. These include film mammography, CBE, BSE, digital mammography, and MRI.
Other evidence reviewed by the USPSTF included 2 studies commissioned by the task force. These were a systematic evidence review targeting 6 questions concerning the benefits and harms of screening and a decision analysis using population modeling techniques to determine anticipated health costs and outcome benefits of screening every year vs every 2 years, and of starting and ending mammography screening at various ages.
Specific Recommendations
Specific recommendations of the USPSTF, and the accompanying strength of recommendations, were as follows:
•The USPSTF recommends against routine screening mammography in women aged 40 to 49 years. Based on patient context, including patient values concerning specific benefits and harms, individual decisions should be made regarding starting regular, biennial screening mammography before age 50 years (grade C recommendation).
•Women aged 50 to 74 years should undergo biennial screening mammography (grade B recommendation).
•Current evidence is insufficient to determine additional benefits and harms of screening mammography in women 75 years or older (I statement).
•In women 40 years or older, current evidence is insufficient to determine the additional benefits and harms of CBE beyond screening mammography (I statement).
•The USPSTF recommends against clinicians teaching women the technique of BSE (grade D recommendation).
•Current evidence is insufficient to determine additional benefits and harms of either digital mammography or MRI vs film mammography as screening modalities for breast cancer (I statement).
Evidence-Based Findings
The accompanying updated evidence review on breast cancer screening looked at published studies identified from a search of Cochrane Central Register of Controlled Trials and Cochrane Database of Systematic Reviews through the fourth quarter of 2008, MEDLINE January 2001 to December 2008, and bibliographies of identified articles. Also reviewed were Web of Science searches and Breast Cancer Surveillance Consortium for screening mammography data.
"Mammography screening reduces breast cancer mortality for women aged 39 to 69 years; data are insufficient for older women," write Heidi D. Nelson, MD, MPH, from Oregon Health & Science University in Portland, and colleagues. "False-positive mammography results and additional imaging are common. No benefit has been shown for CBE or BSE."
Inclusion criteria for studies were randomized controlled trials with breast cancer mortality outcomes for screening effectiveness and studies of varying designs and multiple data sources regarding harms. The reviewers found that for women aged 39 to 49 years, mammography screening was associated with a 15% decrease in breast cancer mortality rates (relative risk, 0.85; 95% credible interval, 0.75 - 0.96; 8 trials). However, data are lacking for women 70 years or older.
Radiation exposure from mammography is low, and adverse experiences are common but transient and do not alter screening practices. The estimated rate of overdiagnosis from screening ranges from 1% to 10%. Compared with older women, younger women have more false-positive mammography results and additional imaging but fewer biopsies. Trials of CBE are ongoing. In trials of BSE, benign biopsy results increased, and there were no decreases in mortality rates.
Study Limitations
Limitations of this review include lack of studies in older women, lack of digital mammography studies, and lack of MRI studies.
"We can improve primary and secondary breast cancer prevention effectiveness by implementing risk assessment in primary care and mammography facilities and providing tailored recommendations for prevention based on individual risk," Karla Kerlikowske, MD, from San Francisco Veterans Affairs Medical Center in San Francisco, California, writes in an accompanying editorial.
"Health professionals will need education about how to communicate breast cancer risk to women, potential benefits and harms of prevention interventions, and how to assist women in understanding which factors might influence their choice to have an intervention or not. Women should have the opportunity to make informed choices about primary and secondary breast cancer prevention on the basis of their risk for disease and the potential benefits and harms of prevention interventions."
The guidelines were supported in part by a National Cancer Institute–funded Breast Cancer Surveillance Consortium cooperative agreement and National Cancer Institute–funded University of California, San Francisco, Breast Cancer Specialized Programs of Research Excellence.
The updated evidence review was supported by grants from the Oregon Evidence–based Practice Center under contract to the Agency for Healthcare Research and Quality, the Veterans Administration Women's Health Fellowship, and the Oregon Health & Science University Department of Surgery in conjunction with the Human Investigators Program.
The USPSTF is an independent, voluntary body supported by the Agency for Healthcare Research and Quality. Recommendations made by the USPSTF are independent of the US government and should not be construed as an official position of the Agency for Healthcare Research and Quality or the US Department of Health and Human Services.
The review authors, task force, and editorialist have disclosed no relevant financial relationships.
Ann Intern Med. 2009;151:716-726, 727-737, 750-752.
[CLOSE WINDOW]Authors and DisclosuresJournalistLaurie Barclay, MDFreelance writer and reviewer, MedscapeCME
Disclosure: Laurie Barclay, MD, has disclosed no relevant financial relationships.
ACOG STATEMENT
ACOG Statement on Revised US Preventive Services Task Force Recommendations
On Breast Cancer Screening
Washington, DC -- In response to today's US Preventive Services Task Force (USPSTF) statement that recommends against routine mammography screening for women in their 40s and recommends screening only once every two years for women ages 50 to 74, The American College of Obstetricians and Gynecologists (ACOG) maintains its current advice that women in their 40s continue mammography screening every one to two years and women age 50 or older continue annual screening. The USPSTF revised recommendations are published in the November 17, 2009, issue of Annals of Internal Medicine. (Read more.)
As the organization representing the nation's ob-gyns who provide health care exclusively for women, ACOG welcomes these new review data on breast cancer screening. However, the implications of the USPSTF's recommendations for both women and physicians are not insignificant and require that ACOG evaluate both the data and the USPSTF's interpretations in greater detail. All women, along with their physicians, should individually assess the benefits and as well as the risks of mammography screening.
The USPSTF also recommends against clinicians teaching women how to perform breast self-exams (BSE). At this time, ACOG's position is that ob-gyns should continue to counsel women that BSE has the potential to detect palpable breast cancer and can be performed.
ACOG strongly supports shared decision making between doctor and patient, and in the case of screening for breast cancer, it is essential.
NATIONAL CANCER INSTITUTE ARTICLE
General Information About Breast Cancer and Breast Cancer Prevention
What is prevention?
Cancer prevention is action taken to lower the chance of getting cancer. By preventing cancer, the number of new cases of cancer in a group or population is lowered. Hopefully, this will lower the number of deaths caused by cancer.
To prevent new cancers from starting, scientists look at risk factors and protective factors. Anything that increases your chance of developing cancer is called a cancer risk factor; anything that decreases your chance of developing cancer is called a cancer protective factor.
Some risk factors for cancer can be avoided, but many cannot. For example, both smoking and inheriting certain genes are risk factors for some types of cancer, but only smoking can be avoided. Regular exercise and a healthy diet may be protective factors for some types of cancer. Avoiding risk factors and increasing protective factors may lower your risk but it does not mean that you will not get cancer.
Different ways to prevent cancer are being studied, including:
Changing lifestyle or eating habits.
Avoiding things known to cause cancer.
Taking medicines to treat a precancerous condition or to keep cancer from starting.
General Information About Breast Cancer
Key Points for This Section
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
Breast cancer is the second most common type of cancer in American women.
Breast cancer is a disease in which malignant (cancer) cells form in the tissues of the breast.
The breast is made up of lobes and ducts. Each breast has 15 to 20 sections called lobes, which have many smaller sections called lobules. Lobules end in dozens of tiny bulbs that can produce milk. The lobes, lobules, and bulbs are linked by thin tubes called ducts.
Each breast also has blood vessels and lymph vessels. The lymph vessels carry an almost colorless fluid called lymph. Lymph vessels lead to organs called lymph nodes. Lymph nodes are small bean-shaped structures that are found throughout the body. They filter lymph and store white blood cells that help fight infection and disease. Clusters of lymph nodes are found near the breast in the axilla (under the arm), above the collarbone, and in the chest.
Women in the United States get breast cancer more than any other type of cancer except skin cancer. The number of new cases of breast cancer decreased from 1999 to 2006. Breast cancer is second to lung cancer as a cause of cancer death in American women. However, deaths from breast cancer have decreased a little bit every year for the past several years. Breast cancer also occurs in men, but the number of new cases is small.
Breast Cancer Prevention
Key Points for This Section
Avoiding risk factors and increasing protective factors may help prevent cancer.
The following risk factors may increase the risk of breast cancer:
Estrogen (endogenous)
Hormone replacement therapy/Hormone therapy
Exposure to Radiation
Obesity
Alcohol
Inherited Risk
The following protective factors may decrease the risk of breast cancer:
Exercise
Estrogen (decreased exposure)
Selective estrogen receptor modulators
Aromatase inhibitors
Prophylactic mastectomy
Prophylactic oophorectomy
Fenretinide
The following have been proven not to be risk factors for breast cancer or their effects on breast cancer risk are not known:
Abortion
Oral Contraceptives
Environment
Diet
Active and passive cigarette smoking
Statins
Cancer prevention clinical trials are used to study ways to prevent cancer.
New ways to prevent breast cancer are being studied in clinical trials.
Avoiding risk factors and increasing protective factors may help prevent cancer.
Avoiding cancer risk factors such as smoking, being overweight, and lack of exercise may help prevent certain cancers. Increasing protective factors such as quitting smoking, eating a healthy diet, and exercising may also help prevent some cancers. Talk to your doctor or other health care professional about how you might lower your risk of cancer.
NCI's Breast Cancer Risk Assessment Tool uses a woman's risk factors to estimate her risk for breast cancer during the next five years and up to age 90. This online tool is meant to be used by a health care provider. For more information on breast cancer risk, see Estimating Breast Cancer Risk: Questions and Answers or call 1-800-4-CANCER.
The following risk factors may increase the risk of breast cancer:
Estrogen (endogenous)
Endogenous estrogen is a hormone made by the body. It helps the body develop and maintain female sex characteristics. Being exposed to estrogen over a long time may increase the risk of breast cancer. Estrogen levels are highest during the years a woman is menstruating. A woman's exposure to estrogen is increased in the following ways:
Early menstruation: Beginning to have menstrual periods at age 11 or younger increases the number of years the breast tissue is exposed to estrogen.
Late menopause: The more years a woman menstruates, the longer her breast tissue is exposed to estrogen.
Late pregnancy or never being pregnant: Because estrogen levels are lower during pregnancy, breast tissue is exposed to more estrogen in women who become pregnant for the first time after age 35 or who never become pregnant.
Hormone replacement therapy/Hormone therapy
Hormones that are made outside the body, in a laboratory, are called exogenous hormones. Estrogen, progestin, or both may be given to replace the estrogen no longer produced by the ovaries in postmenopausal women or women who have had their ovaries removed. This is called hormone replacement therapy (HRT) or hormone therapy (HT) and may be given in one of the following ways:
Combination HRT/HT is estrogen combined with progesterone or progestin. This type of HRT/HT increases the risk of developing breast cancer. Studies show that when women stop taking estrogen combined with progesterone, the risk of getting breast cancer decreases.
Estrogen-only therapy may be given to women who have had a hysterectomy. It is not known if this type of HRT/HT affects the risk of breast cancer. In women who have a uterus, estrogen-only therapy increases the risk of uterine cancer.
Exposure to Radiation
Radiation therapy to the chest for the treatment of cancers increases the risk of breast cancer, starting 10 years after treatment and lasting for a lifetime. The risk of developing breast cancer depends on the dose of radiation and the age at which it is given. The risk is highest if radiation treatment was used during puberty. For example, radiation therapy used to treat Hodgkin disease by age 16, especially radiation to the chest and neck, increases the risk of breast cancer.
Radiation therapy to treat cancer in one breast does not appear to increase the risk of developing cancer in the other breast.
For women who are at risk of breast cancer due to inherited changes in the BRCA1 and BRCA2 genes, exposure to radiation, such as that from chest x-rays, may further increase the risk of breast cancer, especially in women who were x-rayed before 20 years of age.
Obesity
Obesity increases the risk of breast cancer in postmenopausal women who have not used hormone replacement therapy.
Alcohol
Drinking alcohol increases the risk of breast cancer. The level of risk rises as the amount of alcohol consumed rises.
Inherited Risk
Women who have inherited certain changes in the BRCA1 and BRCA2 genes have a higher risk of breast cancer, and the breast cancer may develop at a younger age.
The following protective factors may decrease the risk of breast cancer:
Exercise
Exercising four or more hours a week may decrease hormone levels and help lower breast cancer risk. The effect of exercise on breast cancer risk may be greatest in premenopausal women of normal or low weight. Care should be taken to exercise safely, because exercise carries the risk of injury to bones and muscles.
Estrogen (decreased exposure)
Decreasing the length of time a woman's breast tissue is exposed to estrogen may help prevent breast cancer. Exposure to estrogen is reduced in the following ways:
Pregnancy: Estrogen levels are lower during pregnancy. The risk of breast cancer appears to be lower if a woman has her first full-term pregnancy before she is 20 years old.
Breast-feeding: Estrogen levels may remain lower while a woman is breast-feeding.
Ovarian ablation: The amount of estrogen made by the body can be greatly reduced by removing one or both ovaries, which make estrogen. Also, drugs may be taken to lower the amount of estrogen made by the ovaries.
Late menstruation: Beginning to have menstrual periods at age 14 or older decreases the number of years the breast tissue is exposed to estrogen.
Early menopause: The fewer years a woman menstruates, the shorter the time her breast tissue is exposed to estrogen.
Selective estrogen receptor modulators
Selective estrogen receptor modulators (SERMs) are drugs that act like estrogen on some tissues in the body, but block the effect of estrogen on other tissues. Tamoxifen is a SERM that belongs to the family of drugs called antiestrogens. Antiestrogens block the effects of the hormone estrogen in the body. Tamoxifen lowers the risk of breast cancer in women who are at high risk for the disease. This effect lasts for several years after drug treatment is stopped.
Taking tamoxifen increases the risk of developing other serious conditions, including endometrial cancer, stroke, cataracts, and blood clots, especially in the lungs and legs. The risk of developing these conditions increases with age. Women younger than 50 years who have a high risk of breast cancer may benefit the most from taking tamoxifen. Talk with your doctor about the risks and benefits of taking this drug.
Raloxifene is another SERM that helps prevent breast cancer. In postmenopausal women with osteoporosis (decreased bone density), raloxifene lowers the risk of breast cancer for women at both high risk and low risk of developing the disease. It is not known if raloxifene would have the same effect in women who do not have osteoporosis. Like tamoxifen, raloxifene may increase the risk of blood clots, especially in the lungs and legs, but does not appear to increase the risk of endometrial cancer.
Other SERMs are being studied in clinical trials.
Aromatase inhibitors
Aromatase inhibitors lower the risk of new breast cancers in postmenopausal women with a history of breast cancer. In postmenopausal women, taking aromatase inhibitors decreases the amount of estrogen made by the body. Before menopause, estrogen is made by the ovaries and other tissues in a woman's body, including the brain, fat tissue, and skin. After menopause, the ovaries stop making estrogen, but the other tissues do not. Aromatase inhibitors block the action of an enzyme called aromatase, which is used to make all of the body's estrogen. Possible harms from taking aromatase inhibitors include osteoporosis and effects on brain function (such as talking, learning, and memory).
Prophylactic mastectomy
Some women who have a high risk of breast cancer may choose to have a prophylactic mastectomy (the removal of both breasts when there are no signs of cancer). The risk of breast cancer is lowered in these women. However, it is very important to have a cancer risk assessment and counseling about all options for possible prevention before making this decision. In some women, prophylactic mastectomy may cause anxiety, depression, and concerns about body image.
Prophylactic oophorectomy
Some women who have a high risk of breast cancer may choose to have a prophylactic oophorectomy (the removal of both ovaries when there are no signs of cancer). This decreases the amount of estrogen made by the body and lowers the risk of breast cancer. However, it is very important to have a cancer risk assessment and counseling before making this decision. The sudden drop in estrogen levels may cause the onset of symptoms of menopause, including hot flashes, trouble sleeping, anxiety, and depression. Long-term effects include decreased sex drive, vaginal dryness, and decreased bone density. These symptoms vary greatly among women.
Fenretinide
Fenretinide is a type of vitamin A called a retinoid. When given to premenopausal women who have a history of breast cancer, fenretinide may lower the risk of forming a new breast cancer. Taken over time, fenretinide may cause night blindness and skin disorders. Women must avoid pregnancy while taking this drug because it could harm a developing fetus.
The following have been proven not to be risk factors for breast cancer or their effects on breast cancer risk are not known:
Abortion
There does not appear to be a link between abortion and breast cancer.
Oral Contraceptives
Taking oral contraceptives ("the pill") may slightly increase the risk of breast cancer in current users. This risk decreases over time. The most commonly used oral contraceptive contains estrogen.
Progestin-only contraceptives that are injected or implanted do not appear to increase the risk of breast cancer.
Environment
Studies have not proven that being exposed to certain substances in the environment (such as chemicals, metals, dust, and pollution) increases the risk of breast cancer.
Diet
Diet is being studied as a risk factor for breast cancer. It is not proven that a diet low in fat or high in fruits and vegetables will prevent breast cancer. For more information on diet and health, see the Fruits and Veggies website.
Active and passive cigarette smoking
It has not been proven that either active cigarette smoking or passive smoking (inhaling secondhand smoke) increases the risk of developing breast cancer.
Statins
Studies have not found that taking statins (cholesterol -lowering drugs) affects the risk of breast cancer.
Cancer prevention clinical trials are used to study ways to prevent cancer.
Cancer prevention clinical trials are used to study ways to lower the risk of developing certain types of cancer. Some cancer prevention trials are conducted with healthy people who have not had cancer but who have an increased risk for cancer. Other prevention trials are conducted with people who have had cancer and are trying to prevent another cancer of the same type or to lower their chance of developing a new type of cancer. Other trials are done with healthy volunteers who are not known to have any risk factors for cancer.
The purpose of some cancer prevention clinical trials is to find out whether actions people take can prevent cancer. These may include exercising more or quitting smoking or taking certain medicines, vitamins, minerals, or food supplements.
New ways to prevent breast cancer are being studied in clinical trials.
Clinical trials are taking place in many parts of the country. Information about clinical trials can be found in the Clinical Trials section of the NCI Web site. Check NCI's PDQ Cancer Clinical Trials Registry for breast cancer prevention trials that are now accepting patients.
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Changes to This Summary (03/12/2010)
The PDQ cancer information summaries are reviewed regularly and updated as new information becomes available. This section describes the latest changes made to this summary as of the date above.
Changes were made to this summary to match those made to the health professional version.
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About PDQ
PDQ is a comprehensive cancer database available on NCI's Web site.
PDQ is the National Cancer Institute's (NCI's) comprehensive cancer information database. Most of the information contained in PDQ is available online at NCI's Web site. PDQ is provided as a service of the NCI. The NCI is part of the National Institutes of Health, the federal government's focal point for biomedical research.
PDQ contains cancer information summaries.
The PDQ database contains summaries of the latest published information on cancer prevention, detection, genetics, treatment, supportive care, and complementary and alternative medicine. Most summaries are available in two versions. The health professional versions provide detailed information written in technical language. The patient versions are written in easy-to-understand, nontechnical language. Both versions provide current and accurate cancer information.
The PDQ cancer information summaries are developed by cancer experts and reviewed regularly.
Editorial Boards made up of experts in oncology and related specialties are responsible for writing and maintaining the cancer information summaries. The summaries are reviewed regularly and changes are made as new information becomes available. The date on each summary ("Date Last Modified") indicates the time of the most recent change.
PDQ also contains information on clinical trials.
A clinical trial is a study to answer a scientific question, such as whether a certain drug or nutrient can prevent cancer. Trials are based on past studies and what has been learned in the laboratory. Each trial answers certain scientific questions in order to find new and better ways to help cancer patients and those who are at risk for cancer. During prevention clinical trials, information is collected about the effects of a new prevention method and how well it works. If a clinical trial shows that a new method is better than one currently being used, the new method may become "standard." People who are at high risk for a certain type of cancer may want to think about taking part in a clinical trial.
Listings of clinical trials are included in PDQ and are available online at NCI's Web site. Descriptions of the trials are available in health professional and patient versions. Many cancer doctors who take part in clinical trials are also listed in PDQ. For more information, call the Cancer Information Service 1-800-4-CANCER (1-800-422-6237).
Monday, October 4, 2010
Thursday, September 9, 2010
September is PCOS Awareness Month!
Polycystic ovary syndrome (PCOS) is a very common genetic disorder. Approximately 10 percent of women in the US have PCOS. Signs, and symptoms vary and may include:
-Excessive hair on face, and body (hirsuitism)
-Acne
-Darkened color, and change in texture of the skin along neck, airpits, groin, and inner thighs
-Obesity, rapid weight gain, stretch marks
-Difficulty losing weight despite diet, and exercise
-Irregular periods (or no periods)
-Difficulty getting pregnant or recurrent miscarriage
-Recurrent vaginal infections
-Male pattern hair loss (on scalp)
The diagnosis of PCOS is typically made by your healthcare provider after reviewing your history, lab tests, and/or ultrasound results.
Treatment is designed to correct hormone imbalances and treat insulin resistance to decrease the symptoms of PCOS, and improve overall health. PCOS increases the risk of weight gain, and problems associated with obesity (high blood pressure, diabetes, heart disease and certain cancers).
Weight reduction can be more difficult for patients with PCOS. Managing the hormone, and insulin imbalance along with consistent exercise, and a healthy diet can be helpful. Weight loss not only improves overall health and feels great, but can help cycles regulate, and improve chances of becoming pregnant.
I enjoy helping women with PCOS manage their condition as proactively as possible to improve their quality of life, and overall health, and also to reach their weight loss goals, and achieve pregnancy. If you have the signs, and symptoms of PCOS please make an appointment with your healthcare provider. To schedule an appointment with me, please call (435) 674-0999.
Thanks!
~Lisa
For more information on PCOS read the following comprehensive article from the Mayo Clinic:
Polycystic ovary syndrome (PCOS) — Comprehensive overview covers symptoms, treatment of this common hormonal disorder.
Definition
Polycystic ovary syndrome is a disorder involving infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries develop numerous small cysts and may fail to release eggs.
Polycystic ovary syndromePolycystic ovary syndrome (PCOS) is the most common hormonal disorder among women of reproductive age. The name of the condition comes from the appearance of the ovaries in most, but not all, women with the disorder — enlarged and containing numerous small cysts located along the outer edge of each ovary (polycystic appearance).
Infrequent or prolonged menstrual periods, excess hair growth, acne and obesity can all occur in women with polycystic ovary syndrome. Menstrual abnormality may signal the condition in adolescence, or PCOS may become apparent later following weight gain or difficulty becoming pregnant.
The exact cause of polycystic ovary syndrome is unknown. Women with polycystic ovary syndrome may have trouble becoming pregnant due to infrequent or lack of ovulation. Early diagnosis and treatment of polycystic ovary syndrome can help reduce the risk of long-term complications, such as type 2 diabetes, heart disease and stroke.
Symptoms
Polycystic ovary syndrome signs and symptoms often begin soon after you first begin having periods (menarche). In some cases, PCOS develops later on during your reproductive years, for instance, in response to substantial weight gain.
Signs and symptoms vary from person to person, in both type and severity. To be diagnosed with the condition, your doctor looks for at least two of the following:
Menstrual abnormality. This is the most common characteristic. Examples of menstrual abnormality include menstrual intervals longer than 35 days; fewer than eight menstrual cycles a year; failure to menstruate for four months or longer; and prolonged periods that may be scant or heavy.
Excess androgen. Elevated levels of male hormones (androgens) may result in physical signs, such as excess facial and body hair (hirsutism); adult acne or severe adolescent acne; and male-pattern baldness (androgenic alopecia). However, the physical signs of androgen excess vary with ethnicity, so depending on your ethnic background you may or may not show signs of excess androgen. For instance, women of Northern European or Asian descent may not be affected.
Polycystic ovaries. Enlarged ovaries containing numerous small cysts can be detected by ultrasound. Despite the condition's name, polycystic ovaries alone do not confirm the diagnosis. To be diagnosed with PCOS, you must also have abnormal menstrual cycles or signs of androgen excess. Some women with polycystic ovaries may not have PCOS, while a few women with the condition have ovaries that appear normal.
Other conditions associated with PCOS
Infertility. Women with polycystic ovary syndrome may have trouble becoming pregnant because they experience infrequent ovulation or a lack of ovulation. PCOS is the most common cause of female infertility.
Obesity. About half the women with polycystic ovary syndrome are obese. Compared with women of a similar age who don't have polycystic ovary syndrome, women with PCOS are more likely to be overweight or obese.
Prediabetes or type 2 diabetes. Many women with polycystic ovary syndrome are insulin resistant, which impairs the body's ability to use insulin effectively to regulate blood sugar. This can result in high blood sugar and type 2 diabetes. Prediabetes is also called impaired glucose tolerance.
Acanthosis nigricans. This is the medical term for darkened, velvety skin on the nape of your neck, armpits, inner thighs, vulva or under your breasts. This skin condition is a sign of insulin resistance.
When to see a doctor
Early diagnosis and treatment of polycystic ovary syndrome may help reduce your risk of long-term complications, such as type 2 diabetes, high blood pressure, heart disease and stroke.
Talk with your doctor if you have menstrual irregularities — such as infrequent periods, prolonged periods or no menstrual periods — and have excess hair on your face and body or acne.
Causes
Your normal reproductive cycle is regulated by changing levels of hormones produced by the pituitary gland in your brain and by your ovaries. The pituitary gland produces follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which control the growth and release of eggs (ovulation) in the ovaries. During a monthly cycle, ovulation occurs about two weeks before your period.
Your ovaries secrete the hormones estrogen and progesterone, which prepare the lining of the uterus to receive a fertilized egg. The ovaries also produce some male hormones (androgens), such as testosterone. If pregnancy doesn't occur, estrogen and progesterone secretion decline and the lining of the uterus is shed during menstruation.
In polycystic ovary syndrome, the pituitary gland may secrete high levels of LH and the ovaries may make excess androgens. This disrupts the normal menstrual cycle and may lead to infertility, excess body hair and acne.
Doctors don't know the cause of polycystic ovary syndrome, but these factors likely play a role:
Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugar (glucose), your body's primary energy supply. If you have insulin resistance, your ability to use insulin effectively is impaired, and your pancreas has to secrete more insulin to make glucose available to cells. The excess insulin is thought to boost androgen production by your ovaries.
Low-grade inflammation. Your body's white blood cells produce substances to fight infection in a process called inflammation. Eating certain foods can trigger an inflammatory response in some predisposed people. When this happens, white blood cells produce substances that can lead to insulin resistance and cholesterol accumulation in blood vessels (atherosclerosis). Atherosclerosis causes cardiovascular disease. Research has shown that women with PCOS have low-grade inflammation.
Heredity. If your mother or sister has PCOS, you might have a greater chance of having it, too. Researchers also are looking into the possibility that mutated genes are linked to PCOS.
Abnormal fetal development. New research shows that excessive exposure to male hormones (androgens) in fetal life may permanently prevent normal genes from working the way they're supposed to — a process known as gene expression. This may promote a male pattern of abdominal fat distribution, which increases the risk of insulin resistance and low-grade inflammation. Research continues to establish to what extent these factors might contribute to PCOS.
Researchers continue to explore possible causes of PCOS. Among topics of current research are whether low-grade inflammation and fetal exposure to excessive androgens might trigger the condition.
Complications
Having polycystic ovary syndrome makes the following conditions more likely, especially if obesity also is a factor:
Type 2 diabetes
High blood pressure
Cholesterol abnormalities, such as high triglycerides or low high-density lipoprotein (HDL) cholesterol, the so-called "good" cholesterol
Elevated levels of C-reactive protein, a cardiovascular disease marker
Metabolic syndrome, a cluster of signs and symptoms that indicate a significantly increased risk of cardiovascular disease
Nonalcoholic steatohepatitis, a severe liver inflammation caused by fat accumulation in the liver
Sleep apnea
Abnormal uterine bleeding
Cancer of the uterine lining (endometrial cancer), caused by exposure to continuous high levels of estrogen
Gestational diabetes or pregnancy-induced high blood pressure, if you do become pregnant
Preparing for your appointment
You're likely to start by first seeing your family doctor or primary care provider. However, in some cases when you call to set up an appointment you may be referred immediately to a doctor who specializes in conditions affecting the female reproductive tract (gynecologist), one who specializes in hormonal disorders (endocrinologist) or one who specializes in both areas (reproductive endocrinologist).
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
What you can do
Write down any symptoms you're experiencing. Include all of your symptoms, even if you don't think they're related.
Make a list of any medications, vitamins and other supplements you take. Write down doses and how often you take them.
Have a family member or close friend accompany you, if possible. You may be given a lot of information at your visit, and it can be difficult to remember everything.
Take a notebook or notepad with you. Use it to write down important information during your visit.
Think about what questions you'll ask. Write them down; list the most important questions first, in case time runs out.
For polycystic ovary syndrome, some basic questions to ask include:
What kinds of tests might I need?
How does this condition affect my ability to become pregnant?
Are medications available that might improve my symptoms or my ability to conceive?
What side effects can I expect from medication use?
Under what circumstances do you recommend surgery?
What treatment do you recommend for my situation?
What are the long-term health implications of PCOS?
Do you have any brochures or other printed materials that I can take with me?
What Web sites do you recommend visiting?
Make sure that you understand everything that your doctor tells you. Don't hesitate to ask your doctor to repeat information or to ask follow-up questions for clarification.
What to expect from your doctor
Some potential questions your doctor or other health care provider might ask include:
What signs and symptoms are you experiencing?
How often do you experience these symptoms?
How long have you been experiencing symptoms?
How severe are your symptoms?
When did you last have a period?
Have you gained weight since you first started having periods? How much weight have you gained? When did you gain the weight?
Does anything improve your symptoms?
Does anything make your symptoms worse?
Are you trying to become pregnant, or do you wish to become pregnant in the future?
Has your mother or sister ever been diagnosed with PCOS?
Tests and diagnosis
Click to enlarge
During a transvaginal ultrasound, your doctor or a medical technician inserts a wand-like device (transducer) into your vagina while you lie on your back on an exam table. The transducer emits sound waves that generate images of your pelvic organs, including your ovaries. On an ultrasound image (inset), a polycystic ovary shows a classic "string of pearls" appearance. Each dark circle on the ultrasound image represents a cyst on the ovary.
In a pelvic exam, your physician inserts two gloved fingers inside your vagina. While simultaneously pressing down on your abdomen, he or she can examine your uterus, ovaries and other organs.
Pelvic examinationThere's no specific test to definitively diagnose polycystic ovary syndrome. The diagnosis is one of exclusion, which means your doctor considers all of your signs and symptoms and then rules out other possible disorders.
During this process, your doctor takes many factors into account:
Medical history. Your doctor may ask questions about your menstrual periods, weight changes and other symptoms.
Physical examination. During your physical exam, your doctor will note several key pieces of information, including your height, weight and blood pressure.
Pelvic examination. During a pelvic exam, your doctor visually and manually inspects your reproductive organs for signs of masses, growths or other abnormalities.
Blood tests. Your blood may be drawn to measure the levels of several hormones to exclude possible causes of menstrual abnormalities or androgen excess that mimic PCOS. Additional blood testing may include fasting cholesterol and triglyceride levels and a glucose tolerance test, in which glucose levels are measured while fasting and after drinking a glucose-containing beverage.
Pelvic ultrasound. A pelvic ultrasound can show the appearance of your ovaries and the thickness of the lining of your uterus. During the test, you lie on a bed or examining table while a wand-like device (transducer) is placed in your vagina (transvaginal ultrasound). The transducer emits inaudible sound waves that are translated into images on a computer screen.
Treatments and drugs
Polycystic ovary syndrome treatment generally focuses on management of your individual main concerns, such as infertility, hirsutism, acne or obesity.
Your doctor might recommend that you:
Schedule regular checkups. Long term, managing cardiovascular risks, such as obesity, high blood cholesterol, type 2 diabetes and high blood pressure, is important. To help guide ongoing treatment decisions, your doctor will likely want to see you for regular visits to perform a physical examination, measure your blood pressure, and obtain glucose and lipid levels.
Adjust your lifestyle habits. Making healthy-eating choices and getting regular exercise is the first treatment approach your doctor might recommend, particularly if you're overweight. Obesity makes insulin resistance worse. Weight loss can reduce both insulin and androgen levels, and may restore ovulation. Ask your doctor to recommend a weight-control program, and meet regularly with a dietitian.
Regulate your menstrual cycle. If you're not trying to become pregnant, your doctor may prescribe low-dose birth control pills that contain a combination of synthetic estrogen and progesterone. They decrease androgen production and give your body a break from the effects of continuous estrogen. This decreases your risk of endometrial cancer and corrects abnormal bleeding.
An alternative approach is taking progesterone for 10 to 14 days each month. This regulates your periods and offers protection against endometrial cancer, but it doesn't improve androgen levels.
Your doctor also may prescribe metformin (Glucophage, Glucophage XR), an oral medication for type 2 diabetes that lowers insulin levels. This drug improves ovulation and leads to regular menstrual cycles. Metformin also slows the progression to type 2 diabetes if you already have prediabetes and aids in weight loss if you follow a diet and exercise program.
Reduce excessive hair growth. Your doctor may recommend birth control pills to decrease androgen production, or another medication called spironolactone (Aldactone) that blocks the effects of androgens on the skin. Because spironolactone can cause birth defects, effective contraception is required when using the drug, and it's not recommended if you're pregnant or planning to become pregnant. Eflornithine (Vaniqa) is another medication possibility; the cream slows facial hair growth in women.
Shaving, waxing and depilatory creams are nonprescription hair removal options. Results may last several weeks, and then you need to repeat treatment.
For longer lasting hair removal, your doctor might recommend a procedure that uses electric current (electrolysis) or laser energy to destroy hair follicles and control unwanted new hair growth.
Use medication to induce ovulation. If you're trying to become pregnant, you may need a medication to induce ovulation. Clomiphene citrate (Clomid, Serophene) is an oral anti-estrogen medication that you take in the first part of your menstrual cycle. If clomiphene citrate alone isn't effective, your doctor may add metformin to help induce ovulation.
If you don't become pregnant using clomiphene and metformin, your doctor may recommend using gonadotropins — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications that are administered by injection.
Have surgery. If medications don't help you become pregnant, an outpatient surgery called laparoscopic ovarian drilling is an option for some women with PCOS. Your doctor can help you determine if you're a candidate for this type of surgery.
In this procedure, a surgeon makes a small incision in your abdomen and inserts a tube attached to a tiny camera (laparoscope). The camera provides the surgeon with detailed images of your ovaries and neighboring pelvic organs. The surgeon then inserts surgical instruments through other small incisions and uses electrical or laser energy to burn holes in follicles on the surface of the ovaries. The goal is to induce ovulation by reducing androgen levels.
Lifestyle and home remedies
You may hear conflicting advice from media, support groups and health care professionals on the role of diet in weight management. Much of the disagreement focuses on carbohydrates. The glycemic index is a measure of the degree a carbohydrate will raise insulin levels after eating. Starches are high glycemic index carbohydrates that tend to increase insulin levels to a greater degree compared with low glycemic index carbohydrates such as green leafy vegetables.
Some health and nutrition advocates advise women with PCOS to follow a low-carbohydrate diet without discriminating between carbohydrates on either end of the glycemic index. In addition, a diet that calls for increased protein to compensate for decreased carbohydrates may spike your intake of saturated animal fats typically found in red meat, elevating your blood cholesterol levels and increasing your risk of cardiovascular disease. Initial studies seem promising, but more research is needed to determine whether a diet low in glycemic index carbohydrates and animal fats is an appropriate alternative for people who are insulin resistant, including many women with PCOS.
Choose complex carbohydrates
Choose carbohydrates that are high in fiber. The more fiber in a food, the more slowly it's digested and the more slowly your blood sugar levels rise. High-fiber carbohydrates include whole-grain breads and cereals, whole-wheat pasta, bulgur, barley, brown rice, and beans. Limit less healthy, simple carbohydrates such as soda, excess fruit juice, cake, candy, ice cream, pies, cookies and doughnuts.
Additional research may determine which specific dietary approach is best, but it's clear that losing weight by reducing total calorie intake benefits the overall health of women with polycystic ovary syndrome. Work with your doctor and registered dietitian to determine the best dietary plan for you.
Get your exercise
Exercise helps lower your blood sugar levels. For women with polycystic ovary syndrome, an increase in daily physical activity and participation in a regular exercise regimen are essential for treating or preventing insulin resistance and for helping weight-control efforts
SHARE:FacebookTwitterEmailLast updated 2010-08-03
See this article at MayoClinic.com.
© 1998-2010 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only.
-Excessive hair on face, and body (hirsuitism)
-Acne
-Darkened color, and change in texture of the skin along neck, airpits, groin, and inner thighs
-Obesity, rapid weight gain, stretch marks
-Difficulty losing weight despite diet, and exercise
-Irregular periods (or no periods)
-Difficulty getting pregnant or recurrent miscarriage
-Recurrent vaginal infections
-Male pattern hair loss (on scalp)
The diagnosis of PCOS is typically made by your healthcare provider after reviewing your history, lab tests, and/or ultrasound results.
Treatment is designed to correct hormone imbalances and treat insulin resistance to decrease the symptoms of PCOS, and improve overall health. PCOS increases the risk of weight gain, and problems associated with obesity (high blood pressure, diabetes, heart disease and certain cancers).
Weight reduction can be more difficult for patients with PCOS. Managing the hormone, and insulin imbalance along with consistent exercise, and a healthy diet can be helpful. Weight loss not only improves overall health and feels great, but can help cycles regulate, and improve chances of becoming pregnant.
I enjoy helping women with PCOS manage their condition as proactively as possible to improve their quality of life, and overall health, and also to reach their weight loss goals, and achieve pregnancy. If you have the signs, and symptoms of PCOS please make an appointment with your healthcare provider. To schedule an appointment with me, please call (435) 674-0999.
Thanks!
~Lisa
For more information on PCOS read the following comprehensive article from the Mayo Clinic:
Polycystic ovary syndrome (PCOS) — Comprehensive overview covers symptoms, treatment of this common hormonal disorder.
Definition
Polycystic ovary syndrome is a disorder involving infrequent or prolonged menstrual periods or excess male hormone (androgen) levels. The ovaries develop numerous small cysts and may fail to release eggs.
Polycystic ovary syndromePolycystic ovary syndrome (PCOS) is the most common hormonal disorder among women of reproductive age. The name of the condition comes from the appearance of the ovaries in most, but not all, women with the disorder — enlarged and containing numerous small cysts located along the outer edge of each ovary (polycystic appearance).
Infrequent or prolonged menstrual periods, excess hair growth, acne and obesity can all occur in women with polycystic ovary syndrome. Menstrual abnormality may signal the condition in adolescence, or PCOS may become apparent later following weight gain or difficulty becoming pregnant.
The exact cause of polycystic ovary syndrome is unknown. Women with polycystic ovary syndrome may have trouble becoming pregnant due to infrequent or lack of ovulation. Early diagnosis and treatment of polycystic ovary syndrome can help reduce the risk of long-term complications, such as type 2 diabetes, heart disease and stroke.
Symptoms
Polycystic ovary syndrome signs and symptoms often begin soon after you first begin having periods (menarche). In some cases, PCOS develops later on during your reproductive years, for instance, in response to substantial weight gain.
Signs and symptoms vary from person to person, in both type and severity. To be diagnosed with the condition, your doctor looks for at least two of the following:
Menstrual abnormality. This is the most common characteristic. Examples of menstrual abnormality include menstrual intervals longer than 35 days; fewer than eight menstrual cycles a year; failure to menstruate for four months or longer; and prolonged periods that may be scant or heavy.
Excess androgen. Elevated levels of male hormones (androgens) may result in physical signs, such as excess facial and body hair (hirsutism); adult acne or severe adolescent acne; and male-pattern baldness (androgenic alopecia). However, the physical signs of androgen excess vary with ethnicity, so depending on your ethnic background you may or may not show signs of excess androgen. For instance, women of Northern European or Asian descent may not be affected.
Polycystic ovaries. Enlarged ovaries containing numerous small cysts can be detected by ultrasound. Despite the condition's name, polycystic ovaries alone do not confirm the diagnosis. To be diagnosed with PCOS, you must also have abnormal menstrual cycles or signs of androgen excess. Some women with polycystic ovaries may not have PCOS, while a few women with the condition have ovaries that appear normal.
Other conditions associated with PCOS
Infertility. Women with polycystic ovary syndrome may have trouble becoming pregnant because they experience infrequent ovulation or a lack of ovulation. PCOS is the most common cause of female infertility.
Obesity. About half the women with polycystic ovary syndrome are obese. Compared with women of a similar age who don't have polycystic ovary syndrome, women with PCOS are more likely to be overweight or obese.
Prediabetes or type 2 diabetes. Many women with polycystic ovary syndrome are insulin resistant, which impairs the body's ability to use insulin effectively to regulate blood sugar. This can result in high blood sugar and type 2 diabetes. Prediabetes is also called impaired glucose tolerance.
Acanthosis nigricans. This is the medical term for darkened, velvety skin on the nape of your neck, armpits, inner thighs, vulva or under your breasts. This skin condition is a sign of insulin resistance.
When to see a doctor
Early diagnosis and treatment of polycystic ovary syndrome may help reduce your risk of long-term complications, such as type 2 diabetes, high blood pressure, heart disease and stroke.
Talk with your doctor if you have menstrual irregularities — such as infrequent periods, prolonged periods or no menstrual periods — and have excess hair on your face and body or acne.
Causes
Your normal reproductive cycle is regulated by changing levels of hormones produced by the pituitary gland in your brain and by your ovaries. The pituitary gland produces follicle-stimulating hormone (FSH) and luteinizing hormone (LH), which control the growth and release of eggs (ovulation) in the ovaries. During a monthly cycle, ovulation occurs about two weeks before your period.
Your ovaries secrete the hormones estrogen and progesterone, which prepare the lining of the uterus to receive a fertilized egg. The ovaries also produce some male hormones (androgens), such as testosterone. If pregnancy doesn't occur, estrogen and progesterone secretion decline and the lining of the uterus is shed during menstruation.
In polycystic ovary syndrome, the pituitary gland may secrete high levels of LH and the ovaries may make excess androgens. This disrupts the normal menstrual cycle and may lead to infertility, excess body hair and acne.
Doctors don't know the cause of polycystic ovary syndrome, but these factors likely play a role:
Excess insulin. Insulin is the hormone produced in the pancreas that allows cells to use sugar (glucose), your body's primary energy supply. If you have insulin resistance, your ability to use insulin effectively is impaired, and your pancreas has to secrete more insulin to make glucose available to cells. The excess insulin is thought to boost androgen production by your ovaries.
Low-grade inflammation. Your body's white blood cells produce substances to fight infection in a process called inflammation. Eating certain foods can trigger an inflammatory response in some predisposed people. When this happens, white blood cells produce substances that can lead to insulin resistance and cholesterol accumulation in blood vessels (atherosclerosis). Atherosclerosis causes cardiovascular disease. Research has shown that women with PCOS have low-grade inflammation.
Heredity. If your mother or sister has PCOS, you might have a greater chance of having it, too. Researchers also are looking into the possibility that mutated genes are linked to PCOS.
Abnormal fetal development. New research shows that excessive exposure to male hormones (androgens) in fetal life may permanently prevent normal genes from working the way they're supposed to — a process known as gene expression. This may promote a male pattern of abdominal fat distribution, which increases the risk of insulin resistance and low-grade inflammation. Research continues to establish to what extent these factors might contribute to PCOS.
Researchers continue to explore possible causes of PCOS. Among topics of current research are whether low-grade inflammation and fetal exposure to excessive androgens might trigger the condition.
Complications
Having polycystic ovary syndrome makes the following conditions more likely, especially if obesity also is a factor:
Type 2 diabetes
High blood pressure
Cholesterol abnormalities, such as high triglycerides or low high-density lipoprotein (HDL) cholesterol, the so-called "good" cholesterol
Elevated levels of C-reactive protein, a cardiovascular disease marker
Metabolic syndrome, a cluster of signs and symptoms that indicate a significantly increased risk of cardiovascular disease
Nonalcoholic steatohepatitis, a severe liver inflammation caused by fat accumulation in the liver
Sleep apnea
Abnormal uterine bleeding
Cancer of the uterine lining (endometrial cancer), caused by exposure to continuous high levels of estrogen
Gestational diabetes or pregnancy-induced high blood pressure, if you do become pregnant
Preparing for your appointment
You're likely to start by first seeing your family doctor or primary care provider. However, in some cases when you call to set up an appointment you may be referred immediately to a doctor who specializes in conditions affecting the female reproductive tract (gynecologist), one who specializes in hormonal disorders (endocrinologist) or one who specializes in both areas (reproductive endocrinologist).
Here's some information to help you prepare for your appointment, and what to expect from your doctor.
What you can do
Write down any symptoms you're experiencing. Include all of your symptoms, even if you don't think they're related.
Make a list of any medications, vitamins and other supplements you take. Write down doses and how often you take them.
Have a family member or close friend accompany you, if possible. You may be given a lot of information at your visit, and it can be difficult to remember everything.
Take a notebook or notepad with you. Use it to write down important information during your visit.
Think about what questions you'll ask. Write them down; list the most important questions first, in case time runs out.
For polycystic ovary syndrome, some basic questions to ask include:
What kinds of tests might I need?
How does this condition affect my ability to become pregnant?
Are medications available that might improve my symptoms or my ability to conceive?
What side effects can I expect from medication use?
Under what circumstances do you recommend surgery?
What treatment do you recommend for my situation?
What are the long-term health implications of PCOS?
Do you have any brochures or other printed materials that I can take with me?
What Web sites do you recommend visiting?
Make sure that you understand everything that your doctor tells you. Don't hesitate to ask your doctor to repeat information or to ask follow-up questions for clarification.
What to expect from your doctor
Some potential questions your doctor or other health care provider might ask include:
What signs and symptoms are you experiencing?
How often do you experience these symptoms?
How long have you been experiencing symptoms?
How severe are your symptoms?
When did you last have a period?
Have you gained weight since you first started having periods? How much weight have you gained? When did you gain the weight?
Does anything improve your symptoms?
Does anything make your symptoms worse?
Are you trying to become pregnant, or do you wish to become pregnant in the future?
Has your mother or sister ever been diagnosed with PCOS?
Tests and diagnosis
Click to enlarge
During a transvaginal ultrasound, your doctor or a medical technician inserts a wand-like device (transducer) into your vagina while you lie on your back on an exam table. The transducer emits sound waves that generate images of your pelvic organs, including your ovaries. On an ultrasound image (inset), a polycystic ovary shows a classic "string of pearls" appearance. Each dark circle on the ultrasound image represents a cyst on the ovary.
In a pelvic exam, your physician inserts two gloved fingers inside your vagina. While simultaneously pressing down on your abdomen, he or she can examine your uterus, ovaries and other organs.
Pelvic examinationThere's no specific test to definitively diagnose polycystic ovary syndrome. The diagnosis is one of exclusion, which means your doctor considers all of your signs and symptoms and then rules out other possible disorders.
During this process, your doctor takes many factors into account:
Medical history. Your doctor may ask questions about your menstrual periods, weight changes and other symptoms.
Physical examination. During your physical exam, your doctor will note several key pieces of information, including your height, weight and blood pressure.
Pelvic examination. During a pelvic exam, your doctor visually and manually inspects your reproductive organs for signs of masses, growths or other abnormalities.
Blood tests. Your blood may be drawn to measure the levels of several hormones to exclude possible causes of menstrual abnormalities or androgen excess that mimic PCOS. Additional blood testing may include fasting cholesterol and triglyceride levels and a glucose tolerance test, in which glucose levels are measured while fasting and after drinking a glucose-containing beverage.
Pelvic ultrasound. A pelvic ultrasound can show the appearance of your ovaries and the thickness of the lining of your uterus. During the test, you lie on a bed or examining table while a wand-like device (transducer) is placed in your vagina (transvaginal ultrasound). The transducer emits inaudible sound waves that are translated into images on a computer screen.
Treatments and drugs
Polycystic ovary syndrome treatment generally focuses on management of your individual main concerns, such as infertility, hirsutism, acne or obesity.
Your doctor might recommend that you:
Schedule regular checkups. Long term, managing cardiovascular risks, such as obesity, high blood cholesterol, type 2 diabetes and high blood pressure, is important. To help guide ongoing treatment decisions, your doctor will likely want to see you for regular visits to perform a physical examination, measure your blood pressure, and obtain glucose and lipid levels.
Adjust your lifestyle habits. Making healthy-eating choices and getting regular exercise is the first treatment approach your doctor might recommend, particularly if you're overweight. Obesity makes insulin resistance worse. Weight loss can reduce both insulin and androgen levels, and may restore ovulation. Ask your doctor to recommend a weight-control program, and meet regularly with a dietitian.
Regulate your menstrual cycle. If you're not trying to become pregnant, your doctor may prescribe low-dose birth control pills that contain a combination of synthetic estrogen and progesterone. They decrease androgen production and give your body a break from the effects of continuous estrogen. This decreases your risk of endometrial cancer and corrects abnormal bleeding.
An alternative approach is taking progesterone for 10 to 14 days each month. This regulates your periods and offers protection against endometrial cancer, but it doesn't improve androgen levels.
Your doctor also may prescribe metformin (Glucophage, Glucophage XR), an oral medication for type 2 diabetes that lowers insulin levels. This drug improves ovulation and leads to regular menstrual cycles. Metformin also slows the progression to type 2 diabetes if you already have prediabetes and aids in weight loss if you follow a diet and exercise program.
Reduce excessive hair growth. Your doctor may recommend birth control pills to decrease androgen production, or another medication called spironolactone (Aldactone) that blocks the effects of androgens on the skin. Because spironolactone can cause birth defects, effective contraception is required when using the drug, and it's not recommended if you're pregnant or planning to become pregnant. Eflornithine (Vaniqa) is another medication possibility; the cream slows facial hair growth in women.
Shaving, waxing and depilatory creams are nonprescription hair removal options. Results may last several weeks, and then you need to repeat treatment.
For longer lasting hair removal, your doctor might recommend a procedure that uses electric current (electrolysis) or laser energy to destroy hair follicles and control unwanted new hair growth.
Use medication to induce ovulation. If you're trying to become pregnant, you may need a medication to induce ovulation. Clomiphene citrate (Clomid, Serophene) is an oral anti-estrogen medication that you take in the first part of your menstrual cycle. If clomiphene citrate alone isn't effective, your doctor may add metformin to help induce ovulation.
If you don't become pregnant using clomiphene and metformin, your doctor may recommend using gonadotropins — follicle-stimulating hormone (FSH) and luteinizing hormone (LH) medications that are administered by injection.
Have surgery. If medications don't help you become pregnant, an outpatient surgery called laparoscopic ovarian drilling is an option for some women with PCOS. Your doctor can help you determine if you're a candidate for this type of surgery.
In this procedure, a surgeon makes a small incision in your abdomen and inserts a tube attached to a tiny camera (laparoscope). The camera provides the surgeon with detailed images of your ovaries and neighboring pelvic organs. The surgeon then inserts surgical instruments through other small incisions and uses electrical or laser energy to burn holes in follicles on the surface of the ovaries. The goal is to induce ovulation by reducing androgen levels.
Lifestyle and home remedies
You may hear conflicting advice from media, support groups and health care professionals on the role of diet in weight management. Much of the disagreement focuses on carbohydrates. The glycemic index is a measure of the degree a carbohydrate will raise insulin levels after eating. Starches are high glycemic index carbohydrates that tend to increase insulin levels to a greater degree compared with low glycemic index carbohydrates such as green leafy vegetables.
Some health and nutrition advocates advise women with PCOS to follow a low-carbohydrate diet without discriminating between carbohydrates on either end of the glycemic index. In addition, a diet that calls for increased protein to compensate for decreased carbohydrates may spike your intake of saturated animal fats typically found in red meat, elevating your blood cholesterol levels and increasing your risk of cardiovascular disease. Initial studies seem promising, but more research is needed to determine whether a diet low in glycemic index carbohydrates and animal fats is an appropriate alternative for people who are insulin resistant, including many women with PCOS.
Choose complex carbohydrates
Choose carbohydrates that are high in fiber. The more fiber in a food, the more slowly it's digested and the more slowly your blood sugar levels rise. High-fiber carbohydrates include whole-grain breads and cereals, whole-wheat pasta, bulgur, barley, brown rice, and beans. Limit less healthy, simple carbohydrates such as soda, excess fruit juice, cake, candy, ice cream, pies, cookies and doughnuts.
Additional research may determine which specific dietary approach is best, but it's clear that losing weight by reducing total calorie intake benefits the overall health of women with polycystic ovary syndrome. Work with your doctor and registered dietitian to determine the best dietary plan for you.
Get your exercise
Exercise helps lower your blood sugar levels. For women with polycystic ovary syndrome, an increase in daily physical activity and participation in a regular exercise regimen are essential for treating or preventing insulin resistance and for helping weight-control efforts
SHARE:FacebookTwitterEmailLast updated 2010-08-03
See this article at MayoClinic.com.
© 1998-2010 Mayo Foundation for Medical Education and Research (MFMER). All rights reserved. A single copy of these materials may be reprinted for noncommercial personal use only.
Wednesday, June 9, 2010
Spacing of Children
Q: I am 27 and my first child just turned one last week. We are starting to talk about having baby number two and I was wondering what your opinion is on how far apart to space your pregnancies. I have heard some people say 18 months, but I have also heard some people say more or less than this. Let me know...thanks!
A: The spacing of children is a very personal decision but there are some medical statistics that might help in your decision making. Medically speaking the ideal spacing of children (the time between the birth of one child and the birth of the next child) is between 18-60 months. Spacing sooner or later may slightly increase the risk of premature birth and low birth weight.
Other factors may include obstetrical history (gestational age of prior delivery, route of delivery, pregancy/delivery complications, etc.), general health, age, number of children you desire, age you want to be finished having children, etc. If you had a high risk pregnancy you may want to sit down with your health care provider and discuss ideal pregancy spacing for you, specifically.
Some women do great having a shorter space between children. Others need more time to feel physically and emotionally ready. Also consider the age and stage of your first child when your second child would be born. Do you mind having two babies in diapers, for example. Everyone has their opinion on the matter. I would say the most important opinions are those of you and your husband. You should have your next baby when you feel you are physically and emotionally ready.
Thanks! ~Lisa
A: The spacing of children is a very personal decision but there are some medical statistics that might help in your decision making. Medically speaking the ideal spacing of children (the time between the birth of one child and the birth of the next child) is between 18-60 months. Spacing sooner or later may slightly increase the risk of premature birth and low birth weight.
Other factors may include obstetrical history (gestational age of prior delivery, route of delivery, pregancy/delivery complications, etc.), general health, age, number of children you desire, age you want to be finished having children, etc. If you had a high risk pregnancy you may want to sit down with your health care provider and discuss ideal pregancy spacing for you, specifically.
Some women do great having a shorter space between children. Others need more time to feel physically and emotionally ready. Also consider the age and stage of your first child when your second child would be born. Do you mind having two babies in diapers, for example. Everyone has their opinion on the matter. I would say the most important opinions are those of you and your husband. You should have your next baby when you feel you are physically and emotionally ready.
Thanks! ~Lisa
Tuesday, June 8, 2010
Vaginal Birth After Cesarean (VBAC)
Q: I am 32 years old. I had a normal vaginal delivery with my first child and a C-section with my second child due to breech position. Am I a good candidate to try for a vaginal birth after cesarean (VBAC) with my next pregancy? How likely is it that I will be able deliver vaginally?
A: There are many factors that affect your ability to have a successful VBAC. Some can be predicted ahead of time (prior obstetrical history, reason for prior C/S, general health, etc.) and some may not be known until closer to deliver (such as cervical dilation, size and presentation of fetus, etc.)
Many studies have been done to identify factors that affect the chance of trial of labor success (resulting in successful VBAC). Some factors that increase success include: Caucasian race, nonsmoker, body mass index less than 30, prior vaginal birth, uncomplicated pregnancy without other comorbid medical conditions and prior C/S related to multiples (like twins).
There are models in which specific factors such as demographics, OB history, overall health, etc. can be plugged in to help predict success rates. One can be found at www.bsc.gwu.edu/mfmu/vagbirth.html. With the limited information I have about you I would say your chances of a successful VBAC are very good, but I recommend a visit with your health care provider to further discuss this. Thanks for asking the question and good luck!
~Lisa
A: There are many factors that affect your ability to have a successful VBAC. Some can be predicted ahead of time (prior obstetrical history, reason for prior C/S, general health, etc.) and some may not be known until closer to deliver (such as cervical dilation, size and presentation of fetus, etc.)
Many studies have been done to identify factors that affect the chance of trial of labor success (resulting in successful VBAC). Some factors that increase success include: Caucasian race, nonsmoker, body mass index less than 30, prior vaginal birth, uncomplicated pregnancy without other comorbid medical conditions and prior C/S related to multiples (like twins).
There are models in which specific factors such as demographics, OB history, overall health, etc. can be plugged in to help predict success rates. One can be found at www.bsc.gwu.edu/mfmu/vagbirth.html. With the limited information I have about you I would say your chances of a successful VBAC are very good, but I recommend a visit with your health care provider to further discuss this. Thanks for asking the question and good luck!
~Lisa
Tuesday, April 20, 2010
HPV vaccine
Q: I've been hearing about a vaccine that can decrease the risk for getting cervical cancer. Can you tell me more about it?
A: There are currently two vaccines available (Cervarix and Gardisil) that decrease the risk of cervical cancer caused by HPV (Human Papillomavirus). There are 100+ types of HPV and 30+ types of HPV that can affect the genital area. HPV types 16 and 18 cause about 70% of cervical cancer and HPV types 6 and 11 cause about 90% of genital warts. HPV is transmitted by any kind of sexual activity that involves skin to skin contact with the genital area (not just sexual intercourse). Getting the vaccine does not treat a current HPV infection and should not replace cervical cancer screening (such as pap smears). It is also still important to practice safe sexual practices as vaccines may not fully protect everyone and do not protect against non-vaccine HPV types or other STDs.
Gardisil is a quadrivalent vaccine that covers four HPV types (6, 11, 16 and 18) and Cervarix is a bivalent vaccine that covers two HPV types (16 and 18). The vaccines are approved for administration between the ages of 9 and 26 (Gardisil) and 10 to 25 (Cervarix). The vaccines are administered in a three shot series over six months. The vaccine should not be administered to women who are pregnant. Common side effects include pain, redness or swelling at injection site, fatigue, headache, muscle pain, joint pain and gastrointestinal symptoms. For more information on Cervarix visit www.cervarix.com and Gardisil visit www.gardisil.com.
I hope this helps!
Thanks,
~Lisa
A: There are currently two vaccines available (Cervarix and Gardisil) that decrease the risk of cervical cancer caused by HPV (Human Papillomavirus). There are 100+ types of HPV and 30+ types of HPV that can affect the genital area. HPV types 16 and 18 cause about 70% of cervical cancer and HPV types 6 and 11 cause about 90% of genital warts. HPV is transmitted by any kind of sexual activity that involves skin to skin contact with the genital area (not just sexual intercourse). Getting the vaccine does not treat a current HPV infection and should not replace cervical cancer screening (such as pap smears). It is also still important to practice safe sexual practices as vaccines may not fully protect everyone and do not protect against non-vaccine HPV types or other STDs.
Gardisil is a quadrivalent vaccine that covers four HPV types (6, 11, 16 and 18) and Cervarix is a bivalent vaccine that covers two HPV types (16 and 18). The vaccines are approved for administration between the ages of 9 and 26 (Gardisil) and 10 to 25 (Cervarix). The vaccines are administered in a three shot series over six months. The vaccine should not be administered to women who are pregnant. Common side effects include pain, redness or swelling at injection site, fatigue, headache, muscle pain, joint pain and gastrointestinal symptoms. For more information on Cervarix visit www.cervarix.com and Gardisil visit www.gardisil.com.
I hope this helps!
Thanks,
~Lisa
Wednesday, April 7, 2010
Risks of hormone therapy
Q: I am 50 years old and stopped having periods about eight months ago. I saw my family doctor and he did blood tests and said I am menopausal. I have been having a lot of the symptoms like hot flashes, night sweats, fatigue, insomnia and terrible mood swings. I worry about the bad things I hear about hormones and wonder if they are still being recommended. What are the pros and cons of taking hormones?
A: Hormones are the most effective way of relieving menopausal symptoms, but there are a lot of factors to consider when deciding whether hormone therapy (HT) is the right choice for you.
According to the 2002 Women's Health Initiative (WHI) study taking combine oral HT (estrogen and progesterone) slightly increases your risk for heart attack (7 more per 10,000 women per year), stroke (8 more per 10,000 women per year), blood clots (18 more per 10,000 women per year) and breast cancer (8 more per 10,000). The benefits include fewer cases of colorectal cancer (6 fewer per 10,000 women per year) and hip fractures (5 fewer per 10,000 women per year).
Having your health care provider review your personal and family history for additional risk factors is important prior to starting HT.
The biggest motivation for taking hormone therapy is moderate to severe vasomotor symptoms (hot flashes and night sweats) because they can be so debilitating and don't always respond well to other treatments. If you and your health care provider choose HT for you, it is recommended you use the lowest effective dose for the shortest amount of time possible.
Many of the other menopausal symptoms can be effectively relieved with medication (or lifestyle modification) with fewer risks than HT. For example a menopausal woman who is only experiencing mood changes might do well with increasing exercise, getting adequate rest, and taking supplements and/or prescription medication to treat mood disorders and avoid HT.
There are many options for the route of administration of hormone therapy (HT). Hormones come in the form of a pill, cream, gel, shot, troche or patch. Some hormones are synthetic and others are bioidentical (or bioequivalent). The risks/benefits may vary slightly according to the route of administration and manufacturing or compounding process but none are without potential risks.
There are a number of over the counter supplements (such as Black Cohosh, Wild Yam and Dong Quai) that may relieve menopausal symptoms to some degree also.
I would recommend you schedule a visit with your health care provider to discuss treatment options for managing your menopausal symptoms.
Thanks! ~Lisa
A: Hormones are the most effective way of relieving menopausal symptoms, but there are a lot of factors to consider when deciding whether hormone therapy (HT) is the right choice for you.
According to the 2002 Women's Health Initiative (WHI) study taking combine oral HT (estrogen and progesterone) slightly increases your risk for heart attack (7 more per 10,000 women per year), stroke (8 more per 10,000 women per year), blood clots (18 more per 10,000 women per year) and breast cancer (8 more per 10,000). The benefits include fewer cases of colorectal cancer (6 fewer per 10,000 women per year) and hip fractures (5 fewer per 10,000 women per year).
Having your health care provider review your personal and family history for additional risk factors is important prior to starting HT.
The biggest motivation for taking hormone therapy is moderate to severe vasomotor symptoms (hot flashes and night sweats) because they can be so debilitating and don't always respond well to other treatments. If you and your health care provider choose HT for you, it is recommended you use the lowest effective dose for the shortest amount of time possible.
Many of the other menopausal symptoms can be effectively relieved with medication (or lifestyle modification) with fewer risks than HT. For example a menopausal woman who is only experiencing mood changes might do well with increasing exercise, getting adequate rest, and taking supplements and/or prescription medication to treat mood disorders and avoid HT.
There are many options for the route of administration of hormone therapy (HT). Hormones come in the form of a pill, cream, gel, shot, troche or patch. Some hormones are synthetic and others are bioidentical (or bioequivalent). The risks/benefits may vary slightly according to the route of administration and manufacturing or compounding process but none are without potential risks.
There are a number of over the counter supplements (such as Black Cohosh, Wild Yam and Dong Quai) that may relieve menopausal symptoms to some degree also.
I would recommend you schedule a visit with your health care provider to discuss treatment options for managing your menopausal symptoms.
Thanks! ~Lisa
Tuesday, March 16, 2010
Irregular period after stopping pill
Q: We're excited to begin our family. I stopped taking birth control in December. I had two "regular" periods starting January 7th and then again on January 21st. Since then I haven't had a period. I'm wondering if I need to come in? Or if it is normal to get back in the swing of things once you stop birth control? My annual appointment isn't until the end of April, but should I try to get in sooner?
A: If your periods were irregular before taking birth control they may become irregular again once you stop using it. Skipping two months is certainly not normal. Assuming you have a negative pregnancy test we may want to do some other testing to figure out why your cycles are so irregular. I can see you sooner if you would like. Call for an appointment and tell our scheduler you're having irregular cycles and trying to get pregnant and would like to be seen sooner to discuss the problem. Thanks! ~Lisa
A: If your periods were irregular before taking birth control they may become irregular again once you stop using it. Skipping two months is certainly not normal. Assuming you have a negative pregnancy test we may want to do some other testing to figure out why your cycles are so irregular. I can see you sooner if you would like. Call for an appointment and tell our scheduler you're having irregular cycles and trying to get pregnant and would like to be seen sooner to discuss the problem. Thanks! ~Lisa
Monday, March 8, 2010
First GYN exam
Q: When should my 13 year old daughter have her first gynecology visit? At what age do you start pap testing?
A: It is recommended that a young woman start having yearly gynecologic exams and pap smears when she is 18 or sooner if she becomes sexually active, anticipates becoming sexually active or has problems such as painful or irregular menstrual cycles, pelvic pain, breast problems or vaginal discharge.
If your daughter is not having any problems a visit between the ages of 13-15 may still be helpful to establish a baseline, build trust and explain what to expect at future visits. I would not anticipate doing a pelvic exam at that visit unless she was having problems. I would also gather information using the least invasive technique possible. For example, I'd prefer ordering a pelvic ultrasound on a girl who is young and has not been sexually active than doing a pelvic exam because it is less traumatic.
I understand that young women are very nervous for their first exam. I will explain what I am going to do, explain normal female anatomy, show her the speculum,etc. before the exam. I will also explain what I'm doing during the exam and make it as comfortable as possible. ~Lisa
A: It is recommended that a young woman start having yearly gynecologic exams and pap smears when she is 18 or sooner if she becomes sexually active, anticipates becoming sexually active or has problems such as painful or irregular menstrual cycles, pelvic pain, breast problems or vaginal discharge.
If your daughter is not having any problems a visit between the ages of 13-15 may still be helpful to establish a baseline, build trust and explain what to expect at future visits. I would not anticipate doing a pelvic exam at that visit unless she was having problems. I would also gather information using the least invasive technique possible. For example, I'd prefer ordering a pelvic ultrasound on a girl who is young and has not been sexually active than doing a pelvic exam because it is less traumatic.
I understand that young women are very nervous for their first exam. I will explain what I am going to do, explain normal female anatomy, show her the speculum,etc. before the exam. I will also explain what I'm doing during the exam and make it as comfortable as possible. ~Lisa
Monday, March 1, 2010
Weight management with PCOS
Q: I have Polycystic ovarian syndrome (PCOS) and can't seem to lose weight with diet and exercise. What are my options for weight loss?
A: Weight gain and difficulty losing weight are common problems with PCOS. Although diet and exercise play an important role in weight management sometimes they aren't enough. I typically recommend patients with PCOS who are not trying to become pregnant, use an oral contraceptive pill to regulate cycles and decrease testosterone production. Glucophage (Metformin) can help the body better use insulin and decrease insulin resistance which can lead to weight loss. Anti-testosterone medications (such as Spironolactone) may also help with weight reduction by lowering testosterone levels. Appetite suppressants (like phentermine) and fat blockers (like Zenical or Alli) can also be very effective adjunct therapy. Of course, close medical supervision is recommended with all prescription medication use.
For people with PCOS achieving and maintaining optimal weight is very important and will decrease the risk of PCOS complications such as infertility, adult onset diabetes and cardiovascular disease. I recommend dietary counseling or following a diet plan (such as Weight Watcher's) in addition to exercising 3-5 times a week. Being consistent over time is very important. You are less likely to get frustrated and give up if you are seeing measurable improvement. I recommend you don't just focus on weight loss. Take measurements of your upper arms, breast, waist, hips and thighs so you can watch the inches drop off along with the pounds. Having a good support system will also help you stay focused. Having to "weigh in" at your health care provider's office or your Weight Watcher's meeting may serve to further motivate you. Hang in there you are not alone. 10 percent of the population has PCOS. It is very manageable with the right support! ~Lisa
A: Weight gain and difficulty losing weight are common problems with PCOS. Although diet and exercise play an important role in weight management sometimes they aren't enough. I typically recommend patients with PCOS who are not trying to become pregnant, use an oral contraceptive pill to regulate cycles and decrease testosterone production. Glucophage (Metformin) can help the body better use insulin and decrease insulin resistance which can lead to weight loss. Anti-testosterone medications (such as Spironolactone) may also help with weight reduction by lowering testosterone levels. Appetite suppressants (like phentermine) and fat blockers (like Zenical or Alli) can also be very effective adjunct therapy. Of course, close medical supervision is recommended with all prescription medication use.
For people with PCOS achieving and maintaining optimal weight is very important and will decrease the risk of PCOS complications such as infertility, adult onset diabetes and cardiovascular disease. I recommend dietary counseling or following a diet plan (such as Weight Watcher's) in addition to exercising 3-5 times a week. Being consistent over time is very important. You are less likely to get frustrated and give up if you are seeing measurable improvement. I recommend you don't just focus on weight loss. Take measurements of your upper arms, breast, waist, hips and thighs so you can watch the inches drop off along with the pounds. Having a good support system will also help you stay focused. Having to "weigh in" at your health care provider's office or your Weight Watcher's meeting may serve to further motivate you. Hang in there you are not alone. 10 percent of the population has PCOS. It is very manageable with the right support! ~Lisa
Saturday, February 20, 2010
February American Heart Month
February is American Heart Month. Please read the following article from acog.com to learn how to protect your heart health and understand your risks for heart disease. This is such an important topic as 1 in 3 women over the age of 20 will die of cardiovascular disease. There are many modifiable risk factors ladies, let's take control of our heart health and live happier, healthier lives! ~Lisa
For Release: February 10, 2010
Women's Heart Health Takes Center Stage in February
Washington, DC -- Despite strides in raising awareness of cardiovascular disease as the leading cause of death and illness among women, heart disease is still under-recognized, under-treated, and under-diagnosed in women. During American Heart Month, The American College of Obstetricians and Gynecologists encourages women to learn how they can protect their heart health.
Heart disease killed more than 432,000 US women in 2006—roughly one woman per minute. Women over age 20 have more than a one in three chance of dying from cardiovascular disease.
Long considered a man's disease, awareness efforts have helped many people understand that heart disease is very much a women's disease. It often manifests differently in men and women making the signs harder to recognize and delaying diagnosis in women. And while heart disease kills more women than men in the US, vast disparities still exist in the care of women with heart disease, their treatment after cardiac events such as heart attack, and their representation in clinical trials.
More women today know about the factors that increase their risk of heart disease, including diabetes, obesity, high cholesterol, and high blood pressure. Unfortunately, these conditions are on the rise among American women. According to the American Heart Association, an estimated 11.5 million women in the US are diabetic; more than half of white, black, and Hispanic women (58%, 80% and 78% respectively) are overweight or obese; 48% of women have borderline high cholesterol; 39% of women have high blood pressure; and many women (50% white, 64% black, and 60% Hispanic) are sedentary and get no physical activity.
Heart disease is largely preventable and individual efforts can make a difference. Ob-gyns are encouraged to discuss heart disease with their patients, the health problems that may contribute to it, and steps to improve their heart health. Women who know their health indicator numbers—such as body mass index (BMI), waist circumference, blood pressure, and blood cholesterol and sugar levels—are better equipped to tackle personal risk factors and work with their doctors to improve them.
Healthy lifestyle habits play an important role in reducing the risk of heart disease. Women should aim to consume a diet high in fiber and low in saturated fats, cholesterol, and refined carbohydrates. They should also get 30 to 90 minutes of exercise on most days of the week and quit smoking.
For more information on heart disease, go to www.americanheart.org.
# # #
For Release: February 10, 2010
Women's Heart Health Takes Center Stage in February
Washington, DC -- Despite strides in raising awareness of cardiovascular disease as the leading cause of death and illness among women, heart disease is still under-recognized, under-treated, and under-diagnosed in women. During American Heart Month, The American College of Obstetricians and Gynecologists encourages women to learn how they can protect their heart health.
Heart disease killed more than 432,000 US women in 2006—roughly one woman per minute. Women over age 20 have more than a one in three chance of dying from cardiovascular disease.
Long considered a man's disease, awareness efforts have helped many people understand that heart disease is very much a women's disease. It often manifests differently in men and women making the signs harder to recognize and delaying diagnosis in women. And while heart disease kills more women than men in the US, vast disparities still exist in the care of women with heart disease, their treatment after cardiac events such as heart attack, and their representation in clinical trials.
More women today know about the factors that increase their risk of heart disease, including diabetes, obesity, high cholesterol, and high blood pressure. Unfortunately, these conditions are on the rise among American women. According to the American Heart Association, an estimated 11.5 million women in the US are diabetic; more than half of white, black, and Hispanic women (58%, 80% and 78% respectively) are overweight or obese; 48% of women have borderline high cholesterol; 39% of women have high blood pressure; and many women (50% white, 64% black, and 60% Hispanic) are sedentary and get no physical activity.
Heart disease is largely preventable and individual efforts can make a difference. Ob-gyns are encouraged to discuss heart disease with their patients, the health problems that may contribute to it, and steps to improve their heart health. Women who know their health indicator numbers—such as body mass index (BMI), waist circumference, blood pressure, and blood cholesterol and sugar levels—are better equipped to tackle personal risk factors and work with their doctors to improve them.
Healthy lifestyle habits play an important role in reducing the risk of heart disease. Women should aim to consume a diet high in fiber and low in saturated fats, cholesterol, and refined carbohydrates. They should also get 30 to 90 minutes of exercise on most days of the week and quit smoking.
For more information on heart disease, go to www.americanheart.org.
# # #
Tuesday, February 16, 2010
No sex drive
Q: I am 29 years old, married, have three kids (ages 2, 4 and 5 1/2) and have no desire for sex. Do I have a hormone imbalance? What can I do to improve my sex drive?
A: Low sex drive is a common problem among women. It is particularly common in women with young children and women who are post menopausal. I will focus this discussion on women with young children since that is your demographic. In women with young children I think fatigue plays a large role. I've had many women tell me after chasing children around, having children climb all over them and "need" them all day they are exhausted. She climbs into bed at the end of a long day and her husband wants attention and sex and she just feels depleted and feels like one more person "needs" something from her.
Some women have a hard time transitioning from "multitasking mom" to "romantic lover". My theory is that women need to warm up emotionally in order to warm up physically. A woman needs talk, touch, kissing and laughter. Once she is feeling connected emotionally the physical desire follows. Women also need adequate rest. In our hierarchy of needs sleep comes before sex. That may not hold true for men. I recommend women who are busy get adequate help with the household chores, children, etc. If, for example, a woman and her husband can share in the responsibility of meal prep and clean up, and bathing and putting the children to bed more time can be spent relaxing and connecting. I think it's important for couples to have alone time without their children. Activities such as date night can help couples keep a close connection. If schedules are so hectic that sex needs to be scheduled that is acceptable, too. To make it fun and exciting take turns coming up with new things to try. Communication is very important in relationships and especially important with regards to your sexual relationship.
I've had women report withdrawing affection because they feel like a loving gesture such as kissing, hugging, giving a back rub, etc. is mistaken for an invitation for sex. In fairness to our partners those can also be acts of foreplay so communicating what you want and need is important. It is very important for you and your partner to be able to communicate your needs without feeling judged. Compromise may be necessary so after discussing what you both want and need figure out how to meet in the middle. Focus on win-win.
There are times when testing hormone levels may be appropriate. Other factors that may affect sex drive, sexual response (ability to lubricate, climax, etc) and overall sexual health can be things such as medication, overall health of the relationship, history of abuse, general physical and emotional health and so on. If you are having sexual problems it is worth discussing with your healthcare provider. ~Lisa
A: Low sex drive is a common problem among women. It is particularly common in women with young children and women who are post menopausal. I will focus this discussion on women with young children since that is your demographic. In women with young children I think fatigue plays a large role. I've had many women tell me after chasing children around, having children climb all over them and "need" them all day they are exhausted. She climbs into bed at the end of a long day and her husband wants attention and sex and she just feels depleted and feels like one more person "needs" something from her.
Some women have a hard time transitioning from "multitasking mom" to "romantic lover". My theory is that women need to warm up emotionally in order to warm up physically. A woman needs talk, touch, kissing and laughter. Once she is feeling connected emotionally the physical desire follows. Women also need adequate rest. In our hierarchy of needs sleep comes before sex. That may not hold true for men. I recommend women who are busy get adequate help with the household chores, children, etc. If, for example, a woman and her husband can share in the responsibility of meal prep and clean up, and bathing and putting the children to bed more time can be spent relaxing and connecting. I think it's important for couples to have alone time without their children. Activities such as date night can help couples keep a close connection. If schedules are so hectic that sex needs to be scheduled that is acceptable, too. To make it fun and exciting take turns coming up with new things to try. Communication is very important in relationships and especially important with regards to your sexual relationship.
I've had women report withdrawing affection because they feel like a loving gesture such as kissing, hugging, giving a back rub, etc. is mistaken for an invitation for sex. In fairness to our partners those can also be acts of foreplay so communicating what you want and need is important. It is very important for you and your partner to be able to communicate your needs without feeling judged. Compromise may be necessary so after discussing what you both want and need figure out how to meet in the middle. Focus on win-win.
There are times when testing hormone levels may be appropriate. Other factors that may affect sex drive, sexual response (ability to lubricate, climax, etc) and overall sexual health can be things such as medication, overall health of the relationship, history of abuse, general physical and emotional health and so on. If you are having sexual problems it is worth discussing with your healthcare provider. ~Lisa
Tuesday, February 9, 2010
hormone patch
Q: I have been using a bioidentical hormone cream with a combination of estrogen and progesterone. I feel great but don't like the inconvenience of applying the cream twice a day and the expense (my insurance does not cover the cost). I was talking to a friend who uses a bioidentical patch (Vivelle Dot) that her insurance pays for. She is also using a compounded progesterone capsule. She pays for the progesterone out of pocket but says it is very inexpensive. Do you have patients who are using Vivelle and are they happy with it? Does the patch stick well?
A: Yes, I prescribe Vivelle Dot regularly and have been very happy with it. If my patients are happy, I'm happy! Patients seem to like the convenience and effectiveness of Vivelle. It is much smaller than a generic estradiol patch and adheres better. On a rare occasion I will run into someone who has to discontinue using it due to an allergic reaction to the adhesive. Otherwise I've had no complaints! ~Lisa
A: Yes, I prescribe Vivelle Dot regularly and have been very happy with it. If my patients are happy, I'm happy! Patients seem to like the convenience and effectiveness of Vivelle. It is much smaller than a generic estradiol patch and adheres better. On a rare occasion I will run into someone who has to discontinue using it due to an allergic reaction to the adhesive. Otherwise I've had no complaints! ~Lisa
Saturday, February 6, 2010
Infertility question...
Q: I am having a difficult time getting pregnant. Do I need to make an appointment with you? Should I bring my husband to the appointment? What should I expect at the appointment?
A: Yes, an appointment is an appropriate first step in evaluating fertility problems and I encourage you to bring your husband. The appointment will usually consist of a discussion (history) and a physical.
I will start by asking questions about your health history, such as:
General: General health, Past obstetric, medical and surgical history; medications and allergies.
Menstrual history: age of onset, regularity and pain. If you have painful or irregular periods what tests, procedures or surgeries have been performed to work up the pain or irregularity? They might include things such as hormone testing (including thyroid function tests), pelvic ultrasound, hysterosalpingography (HSG), laparoscopy, hysteroscopy, etc? Have you been given a diagnoses that might affect fertility such as polycystic ovarian syndrome, endometriosis, uterine malformation, pelvic inflammatory disease or history of sexually transmitted infections? Have you had problems with facial acne, dark hair growth or weight gain? Do you have PMS or any other problems associated with your cycle? How long have you been trying to conceive?
Ovulation: can you tell when you ovulate, have you documented ovulation using an ovulation predictor test or basal body temperature charting? Have you tried any treatments for infertility (such as Clomid)?
Intercourse: do you experience pain with intercourse? If so, is it with initiation (vaginal pain) or deeper inside (like something is being hit)? do you understand when you should be timing intercourse when you are trying to conceive?
Contraception: What forms of birth control have you used and when did you discontinue use? Some medication (such as Depo Provera) may cause a short term delay in fertility (up to 18 months after stopping use).
Preconceptual meds/vaccines/counseling: Have you been taking a prenatal vitamin with folic acid (for atleast two months preconceptually) to decrease the risk of open neural tube birth defects? Have you had chicken pox or the vaccine for chicken pox? Have you had two MMR vaccines? If not, checking titers and/or giving vaccines are appropriate before trying to conceive.
Genetic/Obstetric history: Do you have a family history of genetic disorders that you want preconceptual counseling for prior to becoming pregnant? Any risk factors for a high risk pregnancy (i.e. personal or family history of blood clots, gestational diabetes, high blood pressure, obesity, preeclampsia or other pregnancy or birth complications?
Mental health: History of depression, anxiety or other mental health disorders? Past/current treatments? How are you and your husband coping with the fertility issues you are experiencing?
Questions specific to your husband's health:
General health including medical and surgical history and medications. Do you have a history of diabetes, hypertension or depression? Are you taking medication for any of those conditions? Do you have any problems with erection or ejaculation? Do you have any lumps or pain in your scrotum (around your testicles)? Have you ever been diagnosed with a varicocele or hernia? Have you fathered children? Any past illness that resulted in high fever? Any recreation that may cause heat to testicles such as frequent use of hot tub or avid bicycling? Do you use steroids (i.e. testosterone), elicit drugs, alcohol and/or caffeine?
I will examine you (need current exam/pap) and order diagnostic tests as indicated by the history and physical.
I will encourage you to test for ovulation if you have not prior to the visit and I would recommend a semen analysis on your husband. I may consider ordering a HSG to rule out uterine abnormalities and/or blockages in your fallopian tubes. Please start or continue taking a prenatal vitamin with 800-1000 mcg of folic acid daily.
After the initial work up (history, physical and diagnostic tests) we will meet again and discuss your treatment options. This is an exciting time but it can become very stressful. If you get frustrated with the process please schedule an appointment, call or email me. Communication is very important and the speed with which we proceed is largely up to you and your husband. If, at any time in this process, you want a referral to a fertility specialist (Reproductive Endocrinologist) I would be happy to make a referral for you. I am here for you and your family. I appreciate the opportunity to help you achieve your pregnancy goals. ~Lisa
A: Yes, an appointment is an appropriate first step in evaluating fertility problems and I encourage you to bring your husband. The appointment will usually consist of a discussion (history) and a physical.
I will start by asking questions about your health history, such as:
General: General health, Past obstetric, medical and surgical history; medications and allergies.
Menstrual history: age of onset, regularity and pain. If you have painful or irregular periods what tests, procedures or surgeries have been performed to work up the pain or irregularity? They might include things such as hormone testing (including thyroid function tests), pelvic ultrasound, hysterosalpingography (HSG), laparoscopy, hysteroscopy, etc? Have you been given a diagnoses that might affect fertility such as polycystic ovarian syndrome, endometriosis, uterine malformation, pelvic inflammatory disease or history of sexually transmitted infections? Have you had problems with facial acne, dark hair growth or weight gain? Do you have PMS or any other problems associated with your cycle? How long have you been trying to conceive?
Ovulation: can you tell when you ovulate, have you documented ovulation using an ovulation predictor test or basal body temperature charting? Have you tried any treatments for infertility (such as Clomid)?
Intercourse: do you experience pain with intercourse? If so, is it with initiation (vaginal pain) or deeper inside (like something is being hit)? do you understand when you should be timing intercourse when you are trying to conceive?
Contraception: What forms of birth control have you used and when did you discontinue use? Some medication (such as Depo Provera) may cause a short term delay in fertility (up to 18 months after stopping use).
Preconceptual meds/vaccines/counseling: Have you been taking a prenatal vitamin with folic acid (for atleast two months preconceptually) to decrease the risk of open neural tube birth defects? Have you had chicken pox or the vaccine for chicken pox? Have you had two MMR vaccines? If not, checking titers and/or giving vaccines are appropriate before trying to conceive.
Genetic/Obstetric history: Do you have a family history of genetic disorders that you want preconceptual counseling for prior to becoming pregnant? Any risk factors for a high risk pregnancy (i.e. personal or family history of blood clots, gestational diabetes, high blood pressure, obesity, preeclampsia or other pregnancy or birth complications?
Mental health: History of depression, anxiety or other mental health disorders? Past/current treatments? How are you and your husband coping with the fertility issues you are experiencing?
Questions specific to your husband's health:
General health including medical and surgical history and medications. Do you have a history of diabetes, hypertension or depression? Are you taking medication for any of those conditions? Do you have any problems with erection or ejaculation? Do you have any lumps or pain in your scrotum (around your testicles)? Have you ever been diagnosed with a varicocele or hernia? Have you fathered children? Any past illness that resulted in high fever? Any recreation that may cause heat to testicles such as frequent use of hot tub or avid bicycling? Do you use steroids (i.e. testosterone), elicit drugs, alcohol and/or caffeine?
I will examine you (need current exam/pap) and order diagnostic tests as indicated by the history and physical.
I will encourage you to test for ovulation if you have not prior to the visit and I would recommend a semen analysis on your husband. I may consider ordering a HSG to rule out uterine abnormalities and/or blockages in your fallopian tubes. Please start or continue taking a prenatal vitamin with 800-1000 mcg of folic acid daily.
After the initial work up (history, physical and diagnostic tests) we will meet again and discuss your treatment options. This is an exciting time but it can become very stressful. If you get frustrated with the process please schedule an appointment, call or email me. Communication is very important and the speed with which we proceed is largely up to you and your husband. If, at any time in this process, you want a referral to a fertility specialist (Reproductive Endocrinologist) I would be happy to make a referral for you. I am here for you and your family. I appreciate the opportunity to help you achieve your pregnancy goals. ~Lisa
Tuesday, February 2, 2010
Initially I plan to post twice weekly blogs (Saturday and Tuesday). I will choose a question or two to answer as well as providing informational pieces to cover commonly asked questions. I especially enjoy covering topics that can be a little complicated. I want to offer insight from my clinical experience. Trial and error can be a great teacher! I'm sure I have learned as much (or more) from the things that have not worked as the things that have. I have bonded with many women and found a few of my closest friends just by doing what I do. I can't tell you how blessed that makes me feel! I am beyond excited about this! Thank you so much for supporting my dream! ~Lisa
Monday, February 1, 2010
Here is why...
After answering thousands of questions from hundreds of my patients in the clinic setting, I realized there is a real need for doing what I love...providing simple answers to perplexing and sometimes complicated questions on topics such as hormone therapy, infertility, polycystic ovarian syndrome, sexual dysfunction and weight management. I am told regularly that I am the first health care provider to take the time to answer questions and explain things in an honest, caring, easy to understand way. I think half the battle is finding someone who will take the time to listen and offer follow through; someone who is willing to offer encouragement and see the process through even if it means going to plan B, C, D or whatever it takes! My inspiration for the blog is the wonderful opportunity to share my passion for being a health care resource to women. I want to be able to provide this service to many women, many more than time would ever allow for in the clinic. ~Lisa
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