OB/GYN Reports

• Playing Down Heavy Periods

Girlfriends may have warned that your periods could become heavier as you get older — but that’s not always true. “As menopause approaches, your periods may come closer together or farther apart, but they shouldn’t necessarily be heavier,” says Suzanne Kavic, MD, associate professor of obstetrics and gynecology at Loyola University Chicago Stritch School of Medicine. If your periods do become heavier, or if they’re coming way more often (like every two weeks), or you’re bleeding in between periods or after sex, let your doctor know. Heavy bleeding can be a sign of fibroids (benign uterine tumors), anemia, a hormonal issue like polycystic ovarian syndrome, or more rarely, cervical, uterine, or ovarian cancer.

• Treating the Wrong Infection

“As soon as they experience any itching and discharge, most women assume it’s a yeast infection and apply an over-the-counter anti-fungal cream, but that’s not always the cause,” says Mary Peterson, MD, director of the Midlife Health Center at the University of Pittsburgh Medical Center’s Magee-Women’s Hospital. Although yeast infections are common — nearly 75 percent of women have at least one in their lifetime — they are only one of three common vaginal infections. Bacterial vaginosis (BV), caused by an overgrowth of the bacteria in the vagina, and trichomoniasis (trich), a sexually transmitted infection, are the other two. Both vaginosis and trich can cause symptoms similar to those of yeast infections, which is why it’s so important to make sure it’s really a yeast infection. If left untreated, BV can cause pelvic inflammatory disease, and both BV and trich can make you more susceptible to sexually transmitted diseases. “If you’ve had lots of yeast infections and this seems to be exactly the same, you can probably get away with treating yourself,” Dr. Peterson says. However, if symptoms are slightly different or you’re just not sure, check with your doctor. Yeast infections, vaginosis, and trich are all easily treated. An over-the-counter or prescription anti-fungal cream or prescription pill will treat yeast; prescription antibiotics are needed for BV or trich.

• Applying Talcum Powder

Patting on talcum powder (or any powders, including some baby powders, that list talc among their ingredients) to feel fresher isn’t just a harmless hygiene measure. The habit can raise your risk of invasive ovarian cancer by about 30 percent, according to new research presented at the 2011 annual meeting of the American Association for Cancer Research. Frequent, long-term use doubled or even tripled the risk. The study authors speculate that the powder could spread to the genital tract and create an inflammatory reaction. Peterson’s advice: Don’t use it. “There are other ways to keep dry,” she says. If you’re prone to sweating down there, Peterson recommends wearing cotton underwear and changing them often, avoiding tight-fitting pants, and going commando at night (to give the area a chance to breathe).

• Forgetting About Kegel Exercises

Maybe you attempted Kegel exercises during or after pregnancy to tighten things up, but not doing them regularly can set you up for urinary incontinence later in life. If you had incontinence then, it’s more likely to strike again when you’re older, says Peterson. According to a University of Washington survey, urinary incontinence affects more than 40 percent of women in their forties and almost half of all women over age 50. The problem occurs when the muscles in the pelvic area become weaker (due to such issues as pregnancy, childbirth, menopause, or excessive weight), which can lead to urine leaks when you exercise, cough, or laugh. Kegels strengthen those weak muscles and prevent or improve symptoms. Need a refresher? Imagine you’re going to the bathroom, then squeeze as though you’re trying to stop the flow. Aim to do three sets of 12 to 15 a day.

• Not Using Birth Control

If you’ve skipped a period or two and have what seem to be hot flashes, you may think you can no longer get pregnant because you’re starting to enter menopause. But you’re wrong. “As long as you’re having periods of any kind, no matter how irregular they are, there is always a chance of becoming pregnant,” Peterson says. In fact, an analysis by the Pew Research Center found that in 2008, 14 percent of births were to women age 35 and older (compared to 10 percent of births to teen moms). More than half of all pregnancies in women over age 40 are unintended, according to the Guttmacher Institute, a sexual and reproductive health research organization. So don’t toss out birth control unless you’re okay with getting pregnant. “You’re not safe until it’s been at least a year since your last menstrual period,” says Peterson.

• Skipping Barrier Contraceptives

Adults over age 40 are less likely to use condoms than younger people, according to the National Survey of Sexual Health and Behavior (NSSHB), which evaluated sexual health information collected from almost 6,000 people between the ages of 14 and 94 — and the unsafe habit is affecting their health. In 2009, people between age 50 and 64 accounted for 15 percent of all new HIV diagnoses. Diseases such as chlamydia and syphilis are also on the rise among people over 40, according to the latest U.S. government data. Even if you use hormonal birth control, or you’re past menopause and have no chance of getting pregnant, it’s still a good idea to use condoms every time you have sex “unless you’re in a mutually monogamous relationship and you and your partner have both been tested for sexually transmitted infections,” says Peterson.

• Putting Sex on the Back Burner

According to data published last year in the Journal of Sexual Medicine, 30 percent of women in their forties and 50 percent of women in their fifties say they hadn't had vaginal sexual intercourse in the previous year. And — surprisingly — such a dry spell could affect their health down there. “When estrogen levels drop after menopause, the tissues of the vagina tend to flatten and become thinner, which can cause painful sex, as well as itching, dryness, burning, and discomfort,” says Machelle Seibel, MD, professor of obstetrics and gynecology at the University of Massachusetts Medical School in Worcester. But having sex regularly can help prevent symptoms by keeping the vagina moisturized and improving elasticity. If you experience vaginal dryness during intercourse, a good lubricant can make things more comfortable. For women who aren’t sexually active, consider self-stimulation with a vibrator and non-hormonal vaginal moisturizers, like Replens, or vaginal estrogen creams, rings, or pills.

• Wearing a Panty Liner Too Often

If your periods are irregular or you’re dealing with incontinence, you may wear a panty liner frequently to avoid embarrassing situations. But this can set you up for infections and irritation. “The plastic backing on the panty liner prevents air from flowing through and retains heat and sweat, and wearing the same one for too long can lead to bacterial or fungal infections,” Peterson says. Plus, the constant rubbing may cause vulvar irritation. Having a change of underwear, keeping tampons or pads on hand for unexpected periods, and managing incontinence with Kegels, lifestyle changes, or medication may reduce your reliance on panty liners. When you do use them, change your panty liner at least every four hours.

• Not Seeing Your Doctor Enough

According to the most recent guidelines from the American College of Obstetricians and Gynecologists, women 30 and older who have had three consecutive, negative (meaning normal) Pap tests need only get Paps every three years. But that doesn’t mean you can skip your annual checkup. Your gynecologist still needs to see you once a year — and the clinical breast exam and bimanual pelvic exam she’ll perform can help detect serious health issues like cancer, ovarian cysts, and fibroids. It’s also a great opportunity to get advice on anything from hot flashes to birth control to your sex drive.

Make sure you make an appointment to see your doctor through ezdoctor.com. You can search for doctors and filter by specialty, name and insurance plan. Before booking your appointment, make sure you get an EZDoctor Report. EZDoctor Reports contain important information about doctors such as; malpractice claims, criminal offenses, and board actions. Go to ezdoctor.com now to get started.

Original and full article: everyday health.com 

Prioritize. Give yourself permission to admit that you can't do everything, all at once. Instead, you can nibble away at your to-do list, and feel more satisfied, by setting some priorities. So make a list, figure out what really matters, what can wait, and what you can skip. Work your way down the list, handling your top priorities first. 

Pack a snack. Before you head out the door in the morning, prep a healthy snack to take with you. Ideas include fruit, unsalted nuts, and low-fat cheese or yogurt.

Meditate. It's easier than you may think. Here's how: Settle into a comfortable position in a chair or on the floor. Then follow your breath -- in, out -- for a few minutes. Thoughts are bound to bubble up in your mind -- no problem. Just let them float by and turn your attention back to your breath. Meditating daily, even just for a few minutes, may help tame stress.

Stretch. Just a few easy moves will do. Stretch your arms overhead. Raise and lower your shoulders a couple of times. Stretch your legs as you lean your torso against a wall. Be gentle, so you don't overdo it. Stretching can help improve your circulation and flexibility, and may help ease the tight muscles that come with stress.

Turn off your electronics. Take a little break from all your gadgets. Staring at computer screens and electronics all day long can zap your energy and encourage inactivity. So log off -- of everything -- every now and then. This is especially important to allow you to unwind and relax before bed. Just because the world is on, 24-7, you don't have to be!

Source: Webmd.com

EZDoctor, the leader in healthcare transparency and April, a global travel insurance provider have recently partnered to offer telemedicine services to patients traveling abroad that are in need of medical assistance.

When you choose a primary care doctor for yourself or a loved one, make sure to choose a doctor you can trust. A primary care doctor can help you make important decisions, like which screening tests and shots to get, treat many health problems, refer you to a specialist when you need more help with a specific health issue.

Here are some things you should know before selecting a physician

• Listens to your opinions and concerns
• Encourages you to ask questions
• Explains things in ways you can understand

When you and your doctor work together as a team, you’ll get better health care. Try the following tips to find a doctor who’s right for you.

Research your doctor.

If you have health insurance, you may need to choose a doctor in their network. Some insurance plans may let you choose a doctor outside the network if you pay more of the cost.

What you should know about your doctor:

• Contact information, Locations and Gender. 
• License Information. It is important to know if your doctor is licensed to provide the care that you need.
• Education. To learn more about your physician’s background EZDoctor Reports contain information regarding where they studied, graduation date, board certifications, as well as their internship, residency and fellowship. This will help you make an educated decision regarding your doctor’s training and ability.
• Hospital Affiliations/Privileges.  Its common practice for a doctor to have their office in one location and perform treatment in a separate location. For example, you could go to a doctor’s office for a consultation regarding your knee and that doctor might provide treatment and/or surgery at a hospital that he is affiliated with or has privileges. By having this information before hand, it can help you in deciding whether this doctor would be the most convenient for you.
• Procedure Pricing Information. When taking care of any health concern, one of the main things we consider is the cost associated with any procedures that might be necessary. An EZDoctor report will display an average charge for procedures performed by the physician you are reviewing.
• Patient Referral Summary.  Primary care physicians, when needed, refer patients to a specialist. Especially when they face a diagnosis that is beyond their Scope of Practice. With an EZDoctor report you will see the  physicians referral pattern.
• Pricing/Prescribing Habits. Is your  doctor more likely to prescribe a name brand versus a generic drug? Despite your preference, by seeing a breakdown of the most common prescriptions a physician orders you can get a clear view of his prescribing tendencies and average price per prescription.
• Disciplinary Actions. Finding out if a physician has been sanctioned or not by a state medical board can be very useful when it comes to selecting a doctor to visit. Equally important is to know  what those infractions were related to.
• Criminal Offenses. While federal criminal records are not available to the public, EZDoctor reports include state government records that indicate whether a physician has ever been charged or convicted of a crime. Allowing you to have this information prior to any consultation and/or treatment.
• Malpractice Claims. You have the right to know if your physician has been involved in any incidents regarding his medical care. From surgical and medication errors to misdiagnoses, EZDoctor will provide the information you need.
• Patient Reviews. It’s always good to know what other patients are saying about a physician. EZDoctor reports collect patient reviews from multiple sources.

Other important questions to ask about the doctor:

• Is the doctor taking new patients?
• Is the doctor part of a group practice? Who are the other doctors?
• Who will see you if your doctor isn’t available?
• Which hospital does the doctor use?
• If you have a medical condition, does the doctor have experience treating it?
• What languages does the doctor speak? 

You can find all the information you need on a physician by obtaining an EZDoctor Report. Go to ezdoctor.com now to get started! 

Source: healthfinder.gov

Step 1: Complete an Undergraduate Degree Program

Prospective OBGYNs must pursue a four-year undergraduate degree such as a Bachelor of Science in Human Biology. Students may consider taking courses in biology, chemistry and anatomy, which provide a foundation of education for medical school and human health. Most programs that offer science degrees also include laboratory courses, which allow students to become familiarized with lab equipment and procedures.

Step 2: Pass the Medical College Admissions Test (MCAT)

Upon graduating from a bachelor's degree program, aspiring OBGYNs are required to pass the MCAT to gain entry into medical school. The MCAT is an intensive, day-long exam that tests students on biology, chemistry and physics, in addition to reading and writing skills. The Association of American Medical Colleges notes that roughly half of the students who apply to medical school are accepted (www.aamc.org). As a result, many pre-med students begin studying for the exam well in advance of college graduation.

Step 3: Complete Medical School

Like all physicians and surgeons, OBGYNs must complete a 4-year medical school program. Aspiring OBGYNs take many of the same courses as general physicians, but may choose classes with a concentration in obstetrics and gynecology. Medical school programs also include extensive hands-on practice through clinical rotations in which students can gain experience in OBGYN.

Step 4: Complete a Medical Residency

After concluding the academic portion of their training, OBGYN students must complete an internship and residency in a hospital. An internship is usually a year long, while a medical residency may last between 3-7 years. During a medical residency, OBGYN students are paid employees and may evaluate patients, create treatment plans and observe patient progress.

Step 5: Obtain Licensure

State licensure is mandatory in order to officially become an OBGYN. Students who are licensed can legally begin medical practice in the U.S. and its related territories. Licensure requires passing the United States Medical Licensing Examination (USMLE), which tests a physician's ability to relate medical concepts and principles to their practice (www.usmle.org).

Read more: study.com

The intrauterine device (IUD) is a method of birth control designed for insertion into a woman's uterus so that changes occur in the uterus that make it difficult for fertilization of an egg and implantation of a pregnancy. 

IUDs also have been referred to as "intrauterine contraception (IUC). IUDs approved for use in the U.S. contain medications that are released over time to facilitate the contraceptive effect.

The IUD is a small "T"-shaped device with a monofilament tail that is inserted into the uterus by a health care practitioner in the office setting. When inserted into the uterus, the arms of the "T" are folded down, but they then open out to form the top of the "T". The device rests inside the uterus with the base of the T just above the cervix and the arms of the T extending horizontally across the uterus. A short piece of monofilament string attached to the IUD extends through the cervix into the vagina. This string makes it possible to be sure that the IUD is still in the uterus.

Although IUDs are highly effective, no birth control method, except abstinence, is considered to be 100% effective.

How does an IUD work?

It is not fully understood how IUDs work. They are thought to prevent conception by causing a brief localized inflammation that begins about 24 hours after insertion. This causes an inflammatory reaction inside the uterus that attracts white blood cells. The white blood cells produce substances that are toxic or poisonous to sperm. The progesterone-releasing IUDs also cause a subtle change in the endometrial environment that impairs the implantation of the egg in the uterine wall. This type of IUD also alters the cervical mucus, which, in turn, inhibits sperm from passing through the cervix.

IUDs are only available by prescription and must be properly inserted by a health care professional. A pelvic exam is required to insert an IUD. The IUD is inserted into the uterus long as she is not pregnant.

The woman must check her IUD every month to be sure that it is still in place. The woman with an IUD in place will still have normal menstrual periods, although some women notice that flow is heavier. Other women, especially those with a hormone-releasing IUD, may have lighter flow. Sometimes, the uterus expels (pushes out) the IUD. Expulsions may not cause any specific symptoms and can be overlooked. In addition to the woman checking the IUD, the device must also be checked periodically by a health-care professional.

Risks and Complications

An IUD may not be appropriate for women who have heavy menstrual bleeding, had previous pelvic infections, have more than one sexual partner, or plan on getting pregnant. This is because IUDs do not protect against sexually transmitted infections (STDs) and should not be in place if a woman intends to become pregnant.

If women become pregnant with their IUDs in place, 50% of the pregnancies end in miscarriage. Any woman with an IUD who develops signs or symptoms of pregnancy, or has a positive pregnancy test, should see her health-care professional right away.

Women who use non-progesterone types of IUDs are less likely to have an ectopic pregnancy compared to women using no contraception. When a woman using an IUD does become pregnant, the pregnancy is more likely to be ectopic, but still ectopic pregnancy in a user of an IUD is a rare occurrence.

Serious complications due to infection (pelvic inflammatory disease) associated with an IUD may prevent a woman from being able to become pregnant in the future.

Also, with the progesterone-releasing IUDs (levonorgestrel IUDs), a reduction in menstrual flow and a decrease in painful menstrual cramping are often observed with continued use. This is because the progesterone hormone can cause thinning of the lining of the uterus. These menstrual changes are not dangerous in any way and do not mean that the contraceptive action of the IUD is diminished.

The IUD provides no protection against sexually transmitted diseases (STDs).

How is an IUD removed?

An IUD must be removed by a health care professional.

It is very important that a woman not attempt to remove an IUD on her own, as serious problems may result. IUD removal is carried out by determining the position of the uterus, then locating and grasping the stings of the IUD with a special forceps or clamp. The health care professional will then remove the IUD by gentle traction on the strings.

Occasionally, the strings of the IUD will not be located. In these situations, the strings have often slipped higher into the cervical canal. Your health care professional can use special instruments to locate the strings and/or remove the IUD. Complications of IUD removal are rare, and removal can take place at any time. Some studies have shown that removal is easier during the menstrual period, when a woman's cervix is typically softer, than during other times in the menstrual cycle.

Source: WebMd

Fibroids (leiomyomata uteri) are the most common benign tumors of the uterus. They usually come in a variety of shapes and sizes, as well as numbers, in the uterus. Very rarely do they turn to cancer – the exact incidence being less than 1% in a patient’s lifetime. Women who are at risk usually have a family history, are Black or Hispanic, and may have an elevated Body Mass Index (BMI). As a matter of fact, because we are seeing more women with an increase in BMI, Caucasian women are presenting with fibroids more frequently as well. While there is still a lot to understand about the development of fibroids, they grow for two reasons: hormones, in particular estrogen, and blood supply.

Fibroids can be located in different parts of the uterus. There are some fibroids that are located underneath the surface of the uterus, which are called subserosal; these generally do not cause bleeding but can cause pressure. There are those that are embedded in the muscle of the uterus, which are called intramural. Finally, there are those fibroids that affect the lining of the uterus, which are called submucosal, and these are the ones that usually present with excessive bleeding.

Symptoms and Tests

The most common symptoms of fibroids are heavy bleeding, pressure, increased frequency in urination and pelvic pain. Although most fibroids do not usually cause pain, if they outgrow their blood supply, it can cause pain due to degeneration (which means tissue breakdown). Fibroids are usually diagnosed with a pelvic exam and a pelvic sonogram. Transvaginal sonography is very good at detailing whether a fibroid is affecting the uterine lining or not.

Treatment

While the leading cause of hysterectomies is fibroids, there are many more conservative treatments that are available now. Birth control pills are one of these treatments; not only can they suppress bleeding, but they can also suppress the hormones that can control the growth of the fibroid. Decreasing weight also decreases the amount of exogenous estrogens that can control the growth as well. Uterine artery embolization can cut off the blood supply to the uterus, thus controlling growth and bleeding. In the case of submucosal fibroids, they can be resected hysteroscopically by going into the uterus and removing the fibroid through the vagina. Another procedure called a myomectomy just removes the fibroids, thus conserving the uterus. Lastly, you can also just watch them: If they don’t bother you, don’t bother them. Specific treatment modalities should be discussed with your physician to see what works best for you.

Types of Fibroids

All uterine fibroids are made of abnormal uterine muscle cells growing in a tight bundle or mass.

Uterine fibroids are sometimes classified by where they grow in the uterus:

• Myometrial (intramural) fibroids are in the muscular wall of the uterus.
• Submucosal fibroids grow just under the interior surface of the uterus, and may protrude into the uterus.
• Subserosal fibroids grow on the outside wall of the uterus.
• Pedunculated fibroids usually grow outside of the uterus, attached to the uterus by a base or stalk.

Uterine fibroids can range in size, from microscopic to several inches across and weighing tens of pounds.

Symptoms of Uterine Fibroids

Most often, uterine fibroids cause no symptoms at all -- so most women don’t realize they have them. When women do experience symptoms from uterine fibroids, they can include:

• Prolonged menstrual periods (7 days or longer)
• Heavy bleeding during periods
• Bloating or fullness in the belly or pelvis
• Pain in the lower belly or pelvis
• Constipation
• Pain with intercourse

Some experts believe that some uterine fibroids can occasionally interfere with fertility and pregnancy. Although it's rare, a uterine fibroid projecting into the uterus might either block an embryo from implanting there, or cause problems with the pregnancy later.

Effects on Pregnancy

One of the most common concerns that I am asked about in my clinical practice is whether the patient can become pregnant with a fibroid. Again, location is key. Depending on where it is, whether it affects the cavity where the baby grows or blocks the fallopian tube for fertilization, treatment will be dictated by these factors. If those issues are not present, women can become pregnant and have a normal pregnancy. All these issues should be discussed with your physician prior to pregnancy to determine your specific needs. Fibroids will grow during pregnancy, often experiencing the greatest growth during the first trimester.

Conclusion

Although intimidating at first, fibroids are not as scary as they sound. Not everyone must have them removed, and a solid relationship with your physician will help guide you as to the best treatment.

If you are ever in doubt, seek a second opinion. If your physician does not perform minimally invasive procedures, there are many specialists that do.

Source: DoctorOz, WebMD

You can prevent infections and help keep your unborn baby safe. Here’s how:

A hysterectomy is a surgery to remove a woman’s uterus (also known as the womb). The uterus is where a baby grows when a woman is pregnant. During the surgery the whole uterus is usually removed. Your doctor may also remove your fallopian tubes and ovaries. After a hysterectomy, you no longer have menstrual periods and cannot become pregnant.

Why would I need a hysterectomy?

You may need a hysterectomy if you have one of the following:

• Uterine fibroids
• Heavy or unusual vaginal bleeding
• Uterine prolapse
• Endometriosis
• Adenomyosis
• Cancer (or pre-cancer) of the uterus, ovary, cervix, or endometrium (the lining of the uterus)

Keep in mind that there may be alternative ways to treat your health problem without having a hysterectomy. Hysterectomy is a major surgery. Talk with your doctor about all of your treatment options.

How common are hysterectomies?

Each year in the United States, nearly 500,000 women get hysterectomies. A hysterectomy is the second most common surgery among women in the United States. The most common surgery in women is childbirth by cesarean delivery (C-section).

What are the different types of hysterectomies?

• A total hysterectomy removes all of the uterus, including the cervix. The ovaries and the fallopian tubes may or may not be removed. This is the most common type of hysterectomy.
• A partial, also called subtotal or supracervical, hysterectomy removes just the upper part of the uterus. The cervix is left in place. The ovaries may or may not be removed.
• A radical hysterectomy removes all of the uterus, cervix, the tissue on both sides of the cervix, and the upper part of the vagina. A radical hysterectomy is most often used to treat certain types of cancer, such as cervical cancer. The fallopian tubes and the ovaries may or may not be removed.

OB/GYNs can deal with a range of sexual, reproductive and gynecological health issues, from HPV screenings and breast cancer risk factors to abdominal cramping and low sex drives. 

Here are some of the questions you may want to ask your doctor on your next visit: 

• How can I make PMS symptoms less severe?
• Could I have premenstrual dysphoric disorder? 
• Why do I get cramps at times other than my period? (It could be totally normal or it could be a sign of conditions such as endometriosis.) 
• Should I worry about an irregular period?
• Should I get tested for sexually-transmitted diseases, and which ones? 
• How often should I get STD tests? 
• How often should I get a pap smear (considering individual risk factors)? 
• When should I get my first mammogram and how often should I get them?
• How do I perform a breast self-exam correctly? 
• What should I do if I feel something off during my self-exam? 
• How do I assess my breast or ovarian cancer risk? 
• Should I be concerned about my family breast cancer or ovarian cancer history? 
• Am I eligible for and should I get the HPV vaccine? 
• How can I prevent frequent yeast infections or urinary tract infections? 
• What do I do if I notice yeast infection or UTI signs?
• What might cause itching or burning other than yeast, urinary tract or sexually transmitted infections?
• Is my sex drive “normal”? 
• I’m X-years-old, should I be concerned about fertility? 
• Should I adjust my birth control choice if I don’t want to get pregnant now but do in the near future?
• What are my best birth control options? 
• Are hormonal contraceptives safe considering my age/smoking/personal or family health history?
• Is there a cheaper generic version of this birth control? 
• Will Plan B be effective for me?
• Where can I get Plan B emergency contraception?