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Chronic Pelvic Pain

Alaina49 — Thu, 24 Apr 2008 19:30:45 CDT

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Endometriosis

Alaina49 — Sat, 12 Jan 2008 23:59:19 CST

Endometriosis is a reproductive and immunological disease affecting an estimated 89 million women and girls around the world. Although they may suffer significant symptoms ranging from pelvic pain to infertility, many do not know that they have endometriosis.

While this condition can cause painful periods, endometriosis is far more than just "killer cramps". Endometriosis is a common problem. It occurs in an estimated 10% of women during their reproductive years. The rate may be as high as 35% among infertile women. Although endometriosis is typically diagnosed between the ages of 25 and 35, the problem probably begins about the time that regular menstruation begins.

A woman who has a mother or sister with endometriosis has a 6 times greater risk of developing endometriosis than the general population. Other possible risk factors include starting menstruation at an early age, regular menstrual cycles, and long periods (lasting 7 or more days).

Adenomyosis, sometimes called internal endometriosis, is uterine thickening that occurs when endometrial tissue, which normally lines the uterus, moves into the outer muscular walls of the uterus. Like endometriosis, it can cause bleeding and cramping, sometimes severe. It usually affects women in the 30 to 50 year age range but can affect younger women. Diagnosis can sometimes be made with an MRI but the only definite diagnosis can come from a pathology report done after a hysterectomy.

If you have experience with endometriosis including diagnosis, treatment, surgical interventions, medication, alternative treatments or coping skills, please write about your experience and share with others. Become a writer and tell us your story or learn more about Endometriosis.

Endometriosis Research Center (ERC) presents: Endometriosis Screening & Education Kit developed in collaboration with The United States Department of Health & Human Services Office on Women's Health. Includes information such as:

Endometriosis Self-Test: Do You Have Endometriosis? Only Surgery can Diagnose the Disease, but this Test can Help You & Your Doctor

Endometriosis: Answers to Frequently Asked Questions: Your Guide to Understanding the Enigmatic Disease

Endometriosis Pain Journal: Monitor & Communicate Symptoms to Your Healthcare Provider

Where to Get Help: About Our Education, Awareness, Support & Research Facilitation Programs

Download the kit in PDF format (379kb)

Join the discussion on the OBGYN.net Endometriosis Forum

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Endometriosis Nursing Scholarship Awarded

EndoFL3 — Tue, 07 Aug 2007 12:48:08 CDT

Endometriosis Research Center Announces Winner of Nancy Petersen, RN Nursing Scholarship

Delray Beach, FL (August 6, 2007) - The Endometriosis Research Center is extremely pleased to announce that Mary Zipperer of Wisconsin has been selected as the winner of the ERC Nancy Petersen, RN Nursing Scholarship for the 2007-2008 academic year.

The award, created in recognition of the ERC's tenth anniversary and Endometriosis Awareness Month, honors the decades of effort “Nurse Nancy” has contributed to the global Endometriosis Community. “All of our applicants were outstanding and expressed qualities that will serve them well in their professional nursing careers,” said ERC Founder and Executive Director Michelle Marvel. Applicants were judged based on their cumulative grade point average, community involvement, and an accompanying essay which detailed their professional and educational goals, why Endometriosis is an important area of patient care, and how the applicant hopes to impact the disease - and those affected by it - in a positive manner. “Ms. Zipperer was chosen as the sole recipient of our award based not only on her stellar academic performance, but for also embodying the spirit of the award and striving to make a positive difference in the Endometriosis community. It is our privilege to award this merit-based scholarship to such a deserving candidate,” said Marvel.

Endometriosis is a painful reproductive and immunological disease in which tissue similar to that which lines the uterus migrates and implants in other areas of the body. Affecting more than 5.5 million women and girls in the United States alone with over 70 million more worldwide, the illness continues to be stigmatized simply as “killer cramps.” A leading cause of female infertility, chronic pelvic pain and gynecologic surgery, Endometriosis accounts for more than half of the 600,000 hysterectomies performed in the U.S. annually. Symptoms include pelvic pain, infertility, pain with intercourse, gastrointestinal difficulties, fatigue, allergies, and immune system dysfunction. Researchers remain unsure as to the definitive cause of Endometriosis, which can only be diagnosed through surgery, though current studies indicate that gene dysregulation, immune system dysfunction, and exposure to environmental toxicants may be contributing factors. There is no absolute cure for Endometriosis, and recent research has even shown an elevated risk of certain cancers and autoimmune disorders in those with Endometriosis, as well as malignant changes within the disease itself.

Ms. Zipperer, who suffers from Endometriosis herself, has worked hard to overcome the disease in order to help others. “My goals are first to complete my nursing degree. Secondly, to be able to be a contact person for the purposes of Endometriosis education. My personal experiences show how disabling Endometriosis can be. I want to share my experiences with other women and girls so that they, too, can have an optimistic outlook as they deal with this disease,” said Mary. She believes so strongly in the cause that she left her lucrative corporate profession to become a Registered Nurse. Ultimately, she hopes to become a nursing professional working primarily with Endometriosis patients, in order to help women and girls become educated about the illness and obtain the best care they can. “When I was diagnosed with Endometriosis, none of the nurses within the clinic knew anything about the disease, or very little. They even commented 'it's just like bad cramps'. They were unable to help me with any of my questions. Their lack of knowledge has driven me to become a well-versed resource in Endometriosis, and I want to be the resource that makes a difference in the care the Endometriosis patient receives,” said Ms. Zipperer, who also selflessly volunteers as an EMT and First Responder in her community. “I am humbled to be the recipient of this first-time scholarship,” she said. “Nancy Peterson has done so much for the Endometriosis community.”

Nancy Petersen, RN is an ERC Advisor with over forty-five years of achievement in nursing and women's health. She is globally renowned for her pioneering efforts in Endometriosis education, awareness and patient support, and implemented the country's first Endometriosis program to feature Laparoscopic Excision surgery (LAPEX). Her groundbreaking work has led the way to improved patient care and empowered countless women and girls to live well in spite of the disease. The Scholarship, named in honor of her ongoing achievements and contributions, is intended to help a deserving nursing student pursue their dream of a career in the reproductive health or other Endometriosis-related field.

The ERC is 501(c)3 tax-exempt, tax-deductible organization that has been dedicated to serving the international Endometriosis community for a decade. The foundation has been facilitating disease research, raising awareness at the state and federal levels, and providing free patient education and support since its inception. “It is the ERC’s hope that by using the ‘power of one,’ we will help make a small difference in raising disease awareness among our healthcare leaders of tomorrow,” said Marvel. For more information about Endometriosis, contact the ERC online via endocenter.org or call the organization toll free at 800/239-7280. ###

Pregnancy and Birth Photos

JynMeyer — Tue, 03 Jul 2007 12:44:52 CDT

Click & Share!

This is a great area to share you images of your pregnancy and birth photos.

Please remember that our audience is large ranging from many ages and to not include images that are of an inappropriate nature, live birth shots that expose inappropriate areas, etc.

Women are many shapes and sizes during pregnancy, but all are beautiful and right for them.

Young Women and Teens

EndoFL3 — Sun, 03 Jun 2007 10:24:34 CDT

Endometriosis can and does affect young women. Pelvic pain and/or severe period cramps are among the most common symptoms. There can be pain before, during or after your period. The pain may occur at regular times in your cycle or at any time during the month. It is often referred to as chronic pelvic pain. Some teens may have pain with exercise, sex, and/or after a pelvic exam. Others may also have painful or frequent urination, diarrhea or constipation associated with their cycle. It's important to remember that as with all ages of patients, some teens may have significant disease yet very little pain, while others who may have a small amount may experience severe pain.

Studies have found that as many as 70% of teenagers and adolescents with chronic pelvic pain had Endometriosis proven by laparoscopy. Other reports indicate that as many as 41% of patients experienced Endometriosis pain as an adolescent. Often mistakenly minimized as simply "painful periods" or "killer cramps," the disease can be quite disruptive and cause significant dysfunction, especially at a time in life when self-esteem, school attendance and performance, and social involvement are critical. Recent studies have also shown that Endometriosis may have an even bigger impact on younger patients than older women. One such study discovered that in patients under 22 years of age, the rate of disease recurrence was double that of older women (35% as compared to 19%); the study also revealed that the disease behaves "differently" in younger women, leading some researchers to feel it is a different form of Endometriosis altogether.

It is very helpful to use a notebook, calendar or diary to keep track of your pain and menstrual cycle (see http://www.endocenter.org/pdf/Journal.pdf for an example). Bring this diary to your next doctor visit to discuss your concerns with your physician. Do not be afraid of asking questions. Your physician is there to help you, and s/he will. If there is something you do not understand, or something you feel you need to know more about, then ASK.

Endo Facts:

* Endometriosis can be hereditary.

* Young women CAN and DO suffer from symptoms of endometriosis.

* Endometriosis is NOT an STD (sexually transmitted disease).

* Chronic pelvic pain is not normal. Most young women have none or mild to moderate menstrual cramps one or two days a month. If you are absent from school due to pelvic pain or menstrual cramps or find your life interrupted by menstrual pain, consult your health care provider.

* Endometriosis occurs among women of ALL races.

* Getting pregnant does NOT cure this disease (but may temporarily improve symptoms for some women). Many women with endometriosis who have had children continue to have pain.

Please see, "Endometriosis in Teenagers" by Dr. David Redwine. Also: "Girl Talk," an Endo Program for young women under 25 years of age - http://www.endocenter.org/girltalk.htm and http://groups.yahoo.com/group/ERCGirlTalk.

Stages of Birth

maboulette — Sat, 26 May 2007 17:47:29 CDT

Labor falls into three distinct stages

The first, and longest, lasts an average of fourteen hours in a first birth, but less for later births, and involves the violent contractions which move the fetus into the birth canal. The second stage may last from a few minutes to two hours and in this stage, the contractions slow down as the baby begins its journey to the outside. The third stage may take from ten to forty-five minutes and is the process of expelling the placenta and the umbilical cord.

The first stage of birth will produce persistent, regular contractions as the uterine muscles shorten upward to force the fetus down and pull the cervix upward. As this stage progresses, the contractions become more intense, occurring about every minute or two to force the fetus down into the birth canal.

In the second stage, the contractions slow down and the baby starts moving to the outside world; the mother, working along with the contractions, pushes the baby down the birth canal.

During normal birth, the head appears first, the shoulders turn, and more contractions push the baby out. The baby's mouth and nasal passages are cleared of mucus, the baby breathes, cries, and is given to the mother. When the umbilical cord ceases to pulsate, it is clamped and cut. In 3%% of births, the baby comes "breech," that is, feet and buttocks first. It is sometimes possible to turn the baby before it moves into the birth canal; if not, a caesarean section, or surgical removal, is performed. Breech deliveries are dangerous to both the mother and the child. In the third (and final) stage of labor, the uterus continues to contract to expel the placenta and the umbilical cord, and the process of birth is complete.

By the time a baby is born it already knows how to nurse, since it has been sucking its own thumb for months. When the baby begins to suck the mother's nipple, it accomplishes two things. First, it stimulates the nerves at the base of the nipple to shut off bleeding vessels and forestall excessive bleeding from the uterus. At the same time, sucking acts upon the breast to force early milk out of the storage area into the breasts and into the ducts leading through the nipple so that the baby can feed.

Morning Sickness

maboulette — Sat, 26 May 2007 17:44:07 CDT

Up to 80 percent of all pregnancies will be affected by some degree of nausea and vomiting. Although this can happen at any time during the day, the mornings tend to be especially troublesome for most pregnant women. Although the exact cause is not known for sure, most likely it is related to the rising levels of hormones associated with the pregnancy.
The condition is usually temporary ending close to the 16th week (4th month) of pregnancy, although some unfortunate souls must endure for much longer. Fortunately, the majority of women who experience this condition are affected only mildly. Even so, up to one-half of employed women feel that their work is adversely affected, and 25% will actually require time off from work. One out of twenty women are affected so severely that they experience weight loss, dehydration, and electrolyte disturbances to such a degree that hospitalization may be required. This severe condition is referred to as hyperemesis gravidarum. If it persists, your doctor may want to run tests on your gallbladder, thyroid, pancreas, stomach or liver. But please do not let this disturb you, because treatment is available.

For women experiencing only mild symptoms it is recommended that you eat several small meals per day, instead of the usual three big meals. Also avoid fatty, or fried foods, and avoid smells that can sometimes trigger the nausea. It is a good idea to carry saltines or graham crackers in your purse. Munch on these during the day to prevent your stomach from becoming totally empty, which could also increase the nausea. If these measures do not work then your doctor can prescribe some anti-nausea medications, but these usually cause drowsiness and should only be used under close physician supervision.

Treatment of most cases of nausea and vomiting during pregnancy revolve around education and support. In some cases, all that is needed is reassurance that the baby is ok. In other situations women should modify their diets, to avoid foods that make nausea worse. One example of this is milk. Pregnant patients often hear from family and friends "drink all the milk that you can." Actually, while milk is fine, it can sometimes trigger nausea. Pregnant patients really need calcium, which they can get from a pill or other foods. If you tolerate milk, then continue drinking it. If not, then ask your doctor or midwife about other sources of calcium.

Sometimes pregnant women get relief from eating many small meals throughout the day, rather than the standard breakfast, lunch, and dinner. Forcing yourself to eat in order to provide nutrition to the baby will usually make things worse. The baby will "steal" nutrition from you in order to grow. It's usually more important to get calories than nutrition when there is a lot of nausea and vomiting, so it's generally better to eat anything that you like and can tolerate, and not concentrate so much on eating the "right" foods. Later, when you have adjusted to being pregnant and the morning sickness is gone, you can concentrate on eating a more balanced diet. Similarly, if you just can't tolerate prenatal vitamins, it may be better to skip them until you have less nausea. (However, always try to continue taking enough folic acid. If necessary, this important vitamin, which prevents certain birth defects, can be given as a small prescription pill). As always, check with your doctor or midwife.

There are also "alternative" therapies which are currently being discussed in the media. These include acupressure, vitamin B6, and hypnosis. The acupressure therapy involves putting pressure on the "Neiguan" point which is located about three inches below the wrist. This can be done manually four times a day, for 5-10 minutes at a time, or through the use of special wrist bands which are also popular for sea-sickness. One good aspect of this technique is that there is no risk involved for the fetus.

Do not begin any herbal remedy before consulting your obstetrician. Herbal supplements are under close scrutiny, and new research studies are published concerning their effectiveness and potential negative effects. The use of vitamin B6 is controversial, but it does appear that a short course does improve symptoms in some women. Another interesting herbal remedy is ginger. Ginger does appear to relieve nausea in some people, however there is a theoretic possibility that it could affect certain steroids in the fetal brain, it is not recommend for use during pregnancy.

Although many women will experience some degree of nausea and vomiting with their pregnancies, the vast majority of these cases are mild and temporary. For those women experiencing severe symptoms, your physician can provide therapy.

Premenstrual Syndrome (PMS)

maboulette — Sat, 26 May 2007 17:39:35 CDT

Dealing With PMS

by Carol E. Watkins, MD, Baltimore, Maryland Reprinted with permission fromNorthern County Psychiatric Associates

Premenstrual Syndrome (PMS) refers to uncomfortable physical and mental symptoms that occur before the onset of the woman’s menstrual period.

Estimates of affected women range from 40 to 80%. About 5% of women experience symptoms that cause them severe impairment. PMS may start at any time during the years that a woman menstruates. The peak occurrence is in the 20s and 30s. Once PMS begins, the symptoms often continue until menopause.
About 150 separate symptoms have been documented, but it is unlikely that any one woman will have all of them. The symptoms can be divided into three general categories.

Changes in Mood or Anxiety
- Depression
- Irritability
- Anger
- Tearfulness
- Increased emotional reactivity
- Changes in sexual desire
- Anxiety
- Exacerbation of existing psychiatric condition
Changes in Attention
- Forgetfulness
- Confusion
- Difficulty staying on task
- Prone to accidents
Physical Changes
- Breast tenderness
- Feeling bloated
- Swelling in arms and legs
- Migraine
- Back pain
- Difficulty sleeping
- Changes in energy level
- Nausea

Treating Symptoms of PMS

Lifestyle Changes: Many women find that healthy lifestyle changes decrease symptoms of PMS. Exercise, three to five days per week, improves mood, and increases physical tone. Women who exercise regularly have fewer PMS symptoms. Eating less salt may minimize bloating and swelling. Also helpful is a healthy diet, rich in complex carbohydrates and low in simple sugar. Decreasing caffeine and alcohol intake may help irritability and mood swings. Relaxation techniques, such as meditation or yoga, decrease physical discomfort and stress.

Self Knowledge: A woman with mild PMS, are able to accept and adjust to her monthly changes in energy and mood. Although parts of the experience are unpleasant, she discovers that it helps her to view things from a different perspective. If she is impulsive or irritable before her menses, she may decide to defer important decisions for a few days. If she feels angry at a friend, she may write down the anger. If, after a few days, it still bothers her, she then responds to the anger. Some women learn this on their own. Others may seek counseling to help reduce stress and to learn ways to actively cope with the PMS.

Social Support: A supportive spouse or roommate can be a great help during low energy days or periods of irritability. Some women can take turns helping each other during vulnerable times. However, women who live or work closely together often go into synch: they have their menses at the same time. Depending on the situation, this can either be a support or a difficult time for the entire group.

Vitamins and Minerals: There is some evidence that Calcium may decrease many PMS symptoms. Moderate doses of Magnesium and Vitamin E may also be helpful. Controlled trials have failed to show nay benefit from high dose Vitamin B6. Additionally, high doses of B6 can cause peripheral nerve damage.

Treating Physical Symptoms: If lifestyle and dietary changes are not effective, there are other treatments. Diuretics help reduce fluid buildup and decrease bloating. Some women find that oral contraceptives decrease symptoms of PMS. This varies, depending on the dosage and mix of hormones in the particular pill. Non-steroidal Anti-inflammatory Drugs such as Ibuprofen, are helpful for PMS-associated pain.

Mood Changes: Marked mood changes are called Premenstrual Dysphoric Disorder. (PMDD) The symptoms of PMDD resemble major depression. A woman with PMDD has her mood swings only in the one to two weeks before her menses. When we suspect PMDD, we often ask the woman to chart her moods for three months. This helps determine whether the mood shifts are confined to the premenstrual days. If depression or other mood shifts also occur in other phases of the cycle, we treat it as any depression, anxiety or bipolar disorder, using psychotherapy or medication. If charting reveals that depression occurs only before menses, we can choose to treat with medication all month or we may decide to use medication only during the days before menses. The woman should be an active participant in making this decision. Full-cycle treatment is easier to remember. It does not require the same degree of charting and calendar watching.

However, if the woman experiences medication side effects, or simply wants to minimize her medication use, she can take an antidepressant during the 10-14 days before her menses. The SSRIs (Prozac, Paxil, Zoloft and others) are the first-line antidepressants for premenstrual depression or irritability. They seem to work more rapidly for PMS mood symptoms than for regular major depression. If a woman has significant manic symptoms before her menses, she may need to take a mood stabilizer such as Lithium or Depakote during her entire cycle.
Some women find that when the most severe symptoms, mood, or physical symptoms, are addressed; the other symptoms are less intense. Thus, a woman who is successfully treated for premenstrual depression may experience fewer physical symptoms. Other women need active treatment for both kinds of symptoms.

Premenstrual-type symptoms may temporarily become worse in the perimenopausal period (the years just before menstruation ceases.) However, true menopause often brings the end of premenstrual symptoms.

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Hysterectomy

maboulette — Fri, 25 May 2007 13:18:18 CDT

Hysterectomy is the surgical removal of all or part of the uterus. Millions of women undergo this surgery for a myriad of reasons.

A total hysterectomy is removal of the entire uterus and the cervix. A radical hysterectomy is the removal of the uterus, the tissue on both sides of the cervix (parametrium), and the upper part of the vagina. A hysterectomy may be done through an abdominal incision (abdominal hysterectomy), a vaginal incision (vaginal hysterectomy), or through laparoscopic incisions (small incisions on the abdomen -- laparoscopic hysterectomy). Your physician will help you decide which type of hysterectomy is most appropriate for you, depending on your medical history and the reason for your surgery.

A hysterectomy is the second most common surgery among women in the United States. (The most common is cesarean section delivery.) Each year, more than 600,000 are performed. Estimates are that one in three women in the United States has had a hysterectomy by age 60.

Hysterectomy is indicated after consultation with a primary care physician for various conditions, including fibroids, endometriosis, uterine prolapse, cancer, unresponsive vaginal bleeding, chronic pain and pelvic congestion syndrome. There are non-surgical approaches to treat many of these conditions. Talk to your doctor about non-surgical treatments to try first, especially if the recommendation for a hysterectomy is for a cause other than cancer.

The average hospital stay depends on the type of hysterectomy performed, but is usually from 2 to 3 days. Complete recovery may require 2 weeks to 2 months. Recovery from a vaginal or laparoscopic hysterectomy is faster than from an abdominal hysterectomy. Intravenous and oral medications are used after the surgery to relieve postoperative pain. A catheter may remain in place for 1 to 2 days to help the bladder pass urine. Moving about as soon as possible helps to avoid blood clots in the legs and other problems. Normal diet is encouraged as soon as possible after bowel function returns. Avoid lifting heavy objects for a few weeks following surgery. Sexual intercourse should be avoided for 6 to 8 weeks after a hysterectomy.

If you have experience with hysterectomy, or have suggestions or tips about treatment options, write about your experiences and share your expertise. Become a writer and tell us your story or learn more about Hysterectomy...

OBGYN.net Hysterectomy & Alternatives Section

Hysterectomy Resource Center

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Diagnosing Fibroids

maboulette — Fri, 25 May 2007 12:59:50 CDT

Diagnosis of Fibroids

Fibroids may be felt during a pelvic exam, but many times myomas that are causing symptoms may be missed if the examiner relies just on the examination. Also, other conditions such as adenomyosis or ovarian cysts may be mistaken for fibroids. For this reason, I routinely do an ultrasound examination at the time of the first visit when a woman has symptoms of abnormal bleeding or cramping, or if I feel an abnormality on examination. Vaginal probe ultrasound only takes a few minutes to do, is not uncomfortable, and rapidly provides invaluable information if the examiner is experienced in looking at uterine abnormalities. It is possible to fill the uterus with a liquid during the ultrasound (saline enhanced sonography or sonohysterogrami). While this will often provide additional information to the regular ultrasound, I usually learn much more by looking inside the uterus with a little telescope. This exam, called hysteroscopy, is usually a quick office procedure, that allows directly looking inside the uterus.

One of the most common conditions confused with fibroids is adenomyosis. In adenomyosis the lining of the uterus infiltrates the wall of the uterus, causing the wall to thicken and the uterus to enlarge. On ultrasound examination this will often appear as diffuse thickening of the wall, while fibroids are seen as round areas with a discrete border. Adenomyosis is usually a diffuse process, and rarely can be removed without taking out the uterus. Since fibroids can be removed or treated by uterine artery embolization, it is important to differentiate between the two conditions before planning treatment. It is also common to have some adenomyosis in addition to fibroids.

MRI scans also provide an excellent picture of the uterus. An MRI provides detailed pictures of the uterus and fibroids, and can off tell the difference between adenomyosis and fibroids.

Please see the large collection of articles from Dr. Paul Indman, "The Basics of Gynecology - What Every Woman Should Know". Dr. Indman has generously included many informative articles about fibroids and treatment options.

Fibroids

maboulette — Fri, 25 May 2007 12:50:34 CDT

Fibroids are common non-cancerous (benign) growths of the muscle wall of the uterus. More than 75 percent of women can be found to have small fibroids using MRI, a very sensitive imaging technique. However, only about 30 percent of all women will have fibroids large enough to be noted during a pelvic exam, and the vast majority of even these women, more then 80 percent, will never have symptoms and will never require treatment. It is very likely that the cause of fibroids relates to genes there may also be environmental causes that stimulate fibroid growth.

Have your questions answered on the Fibroid Center Discussion Forum

Visit the OBGYN.net Fibroid Resource Center for more answers to your questions

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Contraception

maboulette — Fri, 25 May 2007 12:25:43 CDT

If you have experience with a specific contraceptive product, device, medication or method, please write about your experience with family planning and reproductive health. Become a writer and tell us your story.

Contraception, also known as birth control or family planning is the intentional prevention of conception or impregnation through the use of various devices, agents, drugs, sexual practices, or surgical procedures.

Methods

Barrier methods create a solid barrier to prevent the sperm from reaching the ovum. Barriers include condoms, diaphragms, cervical caps and the contraceptive sponge.

Hormonal methods include combinations of synthetic estrogen and progestins and can be delivered by pill, patch, vaginal ring or injection. There are also progesterone only formulas in minipill form, injection or implant.

Intrauterine methods also known as IUDs are shaped like a "T" and contain copper which has a spermicidal effect. The IUD is inserted into the fallopian tubes to prevent ova transfer to the uterus.

Surgical sterilization is known as tubal ligation in a female and vasectomy in males. A tubal ligation severs the fallopian tubes to prevent the ova from entering the uterus. A vasectomy is the surgical severence of the vas deferens, preventing sperm from combining with ejaculatory fluids. Even though both surgeries can be reversed they should be considered permanent as reversal is a highly specialized surgery, success cannot be guaranteed.

Non-surgical sterilization (permanent), inserts made of polyester fibres, nickel-titanium and stainless steel are inserted through the vagina, cervix, uterus and into the fallopian tubes. Over a period of approximately 90 days the body and the micro-inserts work together to form a scar tissue barrier that prevents sperm from reaching the ovum by blocking the fallopian tubes. A hysterosalpingogram (a a radiologic procedure using contrast dye) will confirm the blockage.

Fertility awareness methods or Natural Family Planning involve the use of the body's primary fertility signs to determine the fertile and infertile phases of a woman's cycle. This is the least reliable method as temperature charting and evaluating cervical mucus quality is often unreliable.

The Rhythm Method relies less upon very accurate charting of fertility signs and meticulously kept calendars and is loosely based on the menstrual cycle alone.

Coitus interruptus is when the male withdraws before ejaculation.

Avoiding vaginal intercourse by participating in "outercourse" or sex without penetration. Often practitioners will engage in oral or anal sex and believe that by avoiding penetrating the vagina that pregnancy is an impossibility. While improbable, it is not impossible and reliance on an extreme level of discipline is required while in a highly charged state.

Abstinence or celibacy is the only 100 percent guaranteed method of contraception.

Lactational Amenorrhea Method - shortly after childbirth while a woman is breastfeeding conception is less likely to occur. Even though this is the body's natural form of family planning it is not 100% reliable and a breastfeeding woman may choose to use a non-hormonal type of birth control.

Emergency Contraception by D. Ashley Hill, OBGYN.net Editorial Advisor.

Please visit the OBGYN.net Contraception Section for more articles and news.

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June Calendar

maboulette — Fri, 25 May 2007 09:50:05 CDT

There is no abstract available for this page revision.

Breast Cancer and Hormone Replacement Therapy

maboulette — Fri, 25 May 2007 09:33:48 CDT

by Ronald Barentsen, MD

The relationship of sex hormones and breast cancer is a matter of concern of many women. Breast cancer is the most common form of cancer in women in industrialized countries. Approximately one in every 10-12 women develops this disease during her course of life, sometimes before menopause (25%), but mostly after menopause. Many studies with conflicting results have investigated the relation between hormone replacement therapy (HRT) and breast cancer. The overall opinion was very confusing and publications in lay press underlined more often the studies that published an increase in risk than studies with less spectacular results.

During 1997 a excellent paper was published that combined all earlier studies, but the paper contains an enormous amount of data and is very difficult to read even for doctors. This contribution to OBGYN.net describes what really is known about the risk of breast cancer by the use of HRT based on the publication by: "The Collaborative Group on Hormonal Factors in Breast Cancer" in: Lancet 1997, volume 350, pages 1047-1059. The authors have carefully searched the literature for all studies concerning the relation between risk of breast cancer and HRT. They included all studies with at least 100 women with breast cancer and clear information on the use of HRT and on other factors related to reproduction and the menopause. They were rather successful and they give details on 63 eligible studies. Thereafter, the authors have retrieved all original data of those 63 studies. Unfortunately, for ten studies original data were not available anymore and one group with 2 studies declined collaboration.

Ultimately, detailed information was available from 51 studies of 52705 women with breast cancer and 108411 women without breast cancer. This enormous amount of data is described in the paper in The Lancet, but only experts with a thorough knowledge of epidemiology and statistics can read it easily. So is the cumulative incidence of breast cancer increasing with age, but at the same time the relative risk decreases with time since menopause. Furthermore, many variables are interdependent. To calculate the risk of HRT, the authors have constructed a model with all other factors constant. In this model age at menopause is set on 50 years and the cumulative incidence of breast cancer is calculated for women never using HRT and for women using 5 or 10 or 15 years of HRT. The results are demonstrated in the figure. On age 45 already 10 of 1000 women have acquired breast cancer and at the estimated age of menopause (=50 years) this number increased to 18. Without use of HRT 77 of every 1000 women will have diagnosed with breast cancer on age 75 and probably more of them when they become older. This number of

breast cancers is represented in the figure with the blue line: the incidence without any exogenous hormonal influence. With the use of HRT during 5 years, from 50 to 55 years, there is a very small increase in the calculated incidence of 2 extra breast cancers in 1000 women using HRT during this 5 years: 40 women with breast cancer on the age of 60 years instead of 38 (red line in the figure). But this difference is statistically not significant: this means that there is no real difference in the number of diagnosed breast cancers in 1000 women never using HRT and in 1000 women using HRT during 5 years. So, short term use has no breast cancer risk. With longer duration of HRT also the number of breast cancers increases. Ten years of HRT (from 50-60 years) result in the extra diagnosis of breast cancer in 6 out of 1000 women in this group (green line in the figure). Without HRT 77 cases of breast cancer will be diagnosed in 1000 women, and with 10 years of HRT this number will be 83. With 15 years duration of HRT the yellow line in the figure has to be followed. And this ends with an excess of 12 women more with breast cancer at age 75 than without HRT: 89 per 1000 women instead of 77 per 1000.

Do these data prove that HRT causes breast cancer? No, because this kind of research can only demonstrate that a relation exists, but not if this relation is causal. The possibility of better surveillance, more frequent palpation of the breasts, more mammographies in HRT-users as consumers more concerned with their health than never-users still exists. An argument for this so called healthier user effect is the observation that breast cancer diagnosed in HRT users is often more localised and has a better prognosis. This problem will only be solved by randomised trials. Such research is on-going: the Women’s Health Initiative. But the first results are not available before the year 2006. In the meantime, it is prudent to consider the small increase in number of breast cancers in HRT-users as a unwanted side-effect. On this moment most medical professionals have the opinion that breast cancer is not caused by oestrogens. In fact, the lesion starts as early as the second or third decade of life. But oestrogens can definitely promote the growth of an existing small breast cancer. There are several other conclusions to drawn from the paper in the Lancet.

The central hypothesis of the model described above is an age at menopause of 50 years. But the authors have also calculated the number of women with breast cancer with a menopause at age 55. These women have endogenous production of oestrogens during 5 years more than women with menopause at age 50. Comparing both models, one can conclude that one has to calculate not only the duration of use of HRT, but the total number of years with endogenous and exogenous oestrogens together. So, women with menopause at age 55 have the same number of breast cancer with 10 years of HRT use as women with menopause at age 50 and 15 years of use of HRT. This is good news for women with an early menopause.

The length of use of HRT in terms of breast cancer has to be calculated from age 50 and not from their earlier start: only the total number of years of endogenous and exogenous oestrogens count. The small increase in the incidence of breast cancer in long-term users of HRT should be considered in the context of the benefits of HRT. Long-term use is indicated for the prevention of serious disorders as osteoporosis and cardiovascular disease (and perhaps also useful in the prevention of dementia). Only in women without any risk factor for these diseases and especially for cardiovascular disease, the excess of breast cancer is of real importance in terms of cost-benfit calculations. But for some women a small increase in the incidence of breast cancer is so terrifying, that they accept the probability of an earlier (premature) cardiovascular death.

About the author:
Ronald Barentsen, MD of The Netherlands served as Chairman of the OBGYN.net Menopause and Perimenopause Editorial Advisory Board 1997 - 2005.

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maboulette — Fri, 25 May 2007 09:20:55 CDT

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Birthing Options

JynMeyer — Sat, 05 May 2007 18:19:58 CDT

A BIRTH PLAN is a list of your preferences for the birth of your child from pain medication, to the location of your delivery. The key to every plan is flexibility. Births don't always happen the way we want them to, but a record of your hopes and preferences will help you understand your labor and delivery options. Your plan will also be useful as you inform your caregiver of your views on variables such as induction or episiotomy. Whether or not you write down your choices, ask yourself these questions, and chat with your physician about your answers, in advance. In the United States, hospitals are the most common place to give birth.

Increasingly, hospitals try to transform their birthing units into comfortable, home-like settings with potentially necessary medical equipment hidden behind closet doors and picture frames. The main advantage is for women with medical conditions, that increase the risk of fetal death, postpartum hemorrhage, seizures, etc. These medical conditions include multiples, malpresentation (breech), premature labor, very late labors, and labors where the membranes have been ruptured for long periods. In many cases, the doctor or certified nurse midwife will not be with the patient at the hospital for the majority of labor, and will be only arriving just before the birth.

Hospitals vary widely in their acceptance of individual preferences, their familiarity with unmedicated childbirth, and their willingness to allow mothers to control the care of their newborns. When a risk of complications is present, a hospital is the best place to give birth. When risks are normal and low, a free-standing birth center or prepared home are safe and comfortable places to give birth. Birth centers vary as to how much and which technology is available to women. Giving birth at home almost always means very little medical technology available, although certified nurse midwives will generally carry resuscitation equipment and the necessary drugs to slow or stop postpartum hemorrhaging and other minor complications.

When deciding who to invite to the birth, it can be helpful to let these people know that the invitation is tentative, and that as labor progresses people will be called on an as-needed basis. Some women prefer solitude during labor, while others benefit from many or a few family members and friends. Increasingly women are discovering a hired support person called a doula. Doulas are people educated in pregnancy, birth and postpartum issues (such as breastfeeding) who provide informational, emotional and physical support throughout pregnancy, labor, childbirth and the early postpartum period. Many families believe in having siblings present at birth. This can be very beautiful. Young children (and older children that have been properly prepared) do not have the same fearful associations with blood and pain that adults have learned. Some mothers feel that the presence of their older child would inhibit them from concentrating on labor. Many mothers have their older children nearby but not in the same room throughout labor, and available to be called in before or just after the birth. Most hospitals permit siblings at birth if they are free of colds or other illnesses and or attended a preparation course.

Women can rely on many very effective, non-pharmacological means of pain relief. Non-narcotic pain relief is preferable because the narcotics in injections and epidurals reach the baby, and because babies born with such drugs in their system are more likely to have various difficulties (trouble nursing, extreme sleepiness, delayed bonding. Receiving an epidural can be painful and means being automatically "catheterized," given an IV, constant use of an external fetal monitor, and being restricted to bed. Epidurals usually slow labor, and can even stop it, leading to the use of pitocin. It is a decision that should be made with awareness of the risks. Some non-analgesic and non-anesthetic pain relief methods are massage, heat, counter-pressure, hydrotherapy, aromatherapy, positioning, visualization, Transcutaneous Electrical Nerve Stimulation, and acupressure. For more information on these techniques, consult a childbirth educator, a midwife or a doula.

Some obstetricians are knowledgeable in these techniques. Whether you plan to go "natural" or to say yes to any painkiller available to you, it pays to know the options. Systemic drugs, including narcotics and sedatives, are primarily used in the early stages of labor to take the edge off the pain. They act on your nervous system, so may cause drowsiness, disorientation, or nausea. The pitfalls of these meds are important reasons why doctors and delivering moms usually prefer epidurals, which block the pain from the waist down, leaving you comfortable but alert. Until a few years ago, women who hadn't yet dilated to at least four centimeters were dissuaded when they asked for an epidural. Doctors believed that the painkiller's numbing effect would interfere with labor, prolonging it and possibly prompting a c-section. But the American College of Obstetricians and Gynecologists (ACOG) now advises that a woman in labor should receive pain relief at whatever point she asks for it.

The ACOG also notes that studies are inconclusive regarding a link between epidurals and c-section risk. A recent landmark study published in The New England Journal of Medicine demonstrated that a "combined spinal epidural" does not increase a woman's chances of needing a cesarean (in fact, the study notes, in some cases the procedure may hasten birth). Even if you don't plan to accept pain relief, it's good to know what choices you have should you change your mind.

Discuss your thoughts with your caregiver — and don't wait until labor is in full swing to do it.

About one in five births is performed by cesarean — one may even be planned if your baby is in a breech (feet/bottom first) or transverse (sideways) position, or if you have preeclampsia or an active herpes infection. Surprise cesareans happen when labor stalls or problems arise in the womb. During a c-section, a doctor usually makes a horizontal incision through the skin and abdominal wall, moves the muscles aside, and opens the uterine wall. The incision is closed with stitches that dissolve in the body.

Your doctor may want to jump-start labor for many reasons: You're past 41 or 42 weeks, your blood pressure is high, your water has broken (infection risks rise if delivery doesn't follow within 48 hours), or you're full-term and your husband has taken next week off. Induction might entail the doctor breaking your water by rupturing the amniotic sac with a plastic tool or "stripping," a.k.a. performing a rough pelvic exam; she may also use Pitocin, a synthetic version of the natural hormone that starts labor, or Cytotec, a cervix-softening prostaglandin.

Some deliveries require an episiotomy, a small cut made between the vagina and rectum to ease delivery. But your doctor should have a good reason for doing it, since data shows that episiotomies can lead to unpleasant outcomes, including a more difficult recovery, a greater chance of incontinence, and sexual difficulties. As a result, many practitioners now allow the tissue to tear naturally, after which it appears to heal more easily.

The ACOG has renounced the routine use of episiotomy, but some old-school practitioners continue to perform it as a matter of course. So it's wise to know your doctor's position on the procedure long before you go into labor. Keep in mind that an episiotomy is the right call if your baby is in distress, if forceps or a vacuum extractor are needed, if the child is in a breech position, or if the baby's head has emerged but his or her shoulders are lodged inside the birth canal.

Discuss your plan (and contingencies) with your caregiver long before you're at the hospital.

Some other helpful tips:

Tour your hospital or birthing center.
Appoint your spouse or labor coach to look out for you.
Make clear your personal and religious preferences.
Find out who will deliver if your caregiver isn't there.
Be flexible, plans change with circumstances of each birth.

Routine Prenatal Tests

JynMeyer — Sat, 05 May 2007 18:13:37 CDT

Throughout your pregnancy, you will receive routine medical tests as part of prenatal care. These tests help your health care provider know how you and your baby are doing.

Your First Prenatal Visit
During your first prenatal visit, your health care provider will check your blood and urine for the following: Conditions that could harm your baby (for example, hepatitis B, and sexually transmitted infections. You will be offered a test to see if you carry HIV, the virus that causes AIDS. Antibodies that show whether or not you are immune to rubella (German measles) and chickenpox, both of which can cause birth defects if the mother is infected for the first time during pregnancy.

Anemia (low red blood cell count), which could cause you to feel especially tired and possibly increase your risk of preterm delivery. Your blood type, including whether you carry a protein called the Rh factor ; on your red blood cells. Women who lack the Rh factor are said to be Rh negative and usually need treatment to protect their babies from a potentially dangerous blood problem. Bacteria in your urine. Up to 10 percent of pregnant women have bacteria in their urine, which indicates a urinary tract infection. Most have no symptoms, but even a symptomless urinary tract infection may spread upwards to the kidneys, where it can pose a serious risk to mother and baby.

Urinary tract infections are treated with antibiotics that are safe for mother and baby. Sugar in your urine. This can be a sign of diabetes. Your health care provider may suggest additional tests if sugar shows up in your urine. Protein in your urine. This can indicate a urinary tract infection or, later in pregnancy, a pregnancy-related condition that includes high blood pressure. Your health care provider may suggest additional tests if your urine has protein in it. All of these tests are routine, but they play an important role in protecting the health of you and your baby. Your provider may check your urine at each prenatal visit. The blood test for anemia will be performed at least once more during your pregnancy.

Your health care provider may also offer you a screening test for cystic fibrosis (CF), an inherited disease that can severely affect breathing and digestion. There is no cure for cystic fibrosis. A child who inherits an abnormal gene from each parent will have the disease. The American College of Obstetricians and Gynecologists (ACOG) recommends that a CF screening test be offered to all couples who are planning a pregnancy or are pregnant. Whether or not you take this test is a personal decision. Genetic counseling may help you to make your decision.

At Every Prenatal Visit
At each prenatal visit, your health care provider will check your urine for protein and will measure your blood pressure. Protein in the urine and high blood pressure are symptoms of a pregnancy-related condition that includes high blood pressure called preeclampsia.

Preeclampsia affects about 5-8 percent of pregnant women. Left untreated, it can cause serious problems, including poor fetal growth. In rare instances, it can progress to a life-threatening condition called eclampsia. A patient with eclampsia has seizures and sometimes fall into a coma. Preeclampsia requires close observation and monitoring—another reason why it is important to keep all your prenatal appointments.

Also at every visit, your health care provider will listen to your baby’s heartbeat with a hand-held device called a Doppler. After about 20 weeks, he or she also will measure your abdomen to follow your baby’s growth. A normal heartbeat and growth rate are important signs that your baby’s development is on track.

Ultrasound
Many providers offer an ultrasound examination to all pregnant women. Ultrasound uses sound waves to show a picture of the baby on a screen. The health care provider rubs a hand-held device (called a transducer) across the pregnant woman’s belly or inserts a device into her vagina. The woman feels pressure as the provider moves the transducer, but usually no pain.

Special Prenatal Tests
Some women are offered special tests, such as amnioscentesis, because they or their babies are at increased risk of certain problems.

Bellies- Gestation weeks 21-43

JynMeyer — Sat, 05 May 2007 17:58:20 CDT

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Bellies- Gestation Weeks 1-20

JynMeyer — Sat, 05 May 2007 17:57:06 CDT

Type your photo caption or credit here.	Jynmeyer 20 weeks pregnant with baby #5.	Type your photo caption or credit here.
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HCG- what is it?

JynMeyer — Sat, 05 May 2007 17:35:45 CDT

Human Chorionic Gonadotropin (hCG) in Pregnacy
Also known as: Pregnancy test, Qualitatitve hCG, Quantitative hCG, Beta hCG

When a woman misses her period, one of the first things she considers may be, "Am I pregnant?"

One of the easiest and fastest ways to find out is an over-the-counter pregnancy test. But how do they really work?

Most over the counter pregnancy tests measures the amount of hCG (the human chorionic gonadotropin) in the urine, which is a hormone produced by the placenta confirming pregnancy. These tests do not measure an exact amount of the hormone, rather than if the amount is over a normal-non pregnant level. More hCG is released in the pregnancy of multiples (more than 1 baby) than in a pregnancy of only a single baby.

hCG can be detected in maternal plasma or urine by 8 to 9 days after ovulation. But hCG can also be present even if you do not have a viable pregnancy, such as certain tumors, especially those that come from an egg or sperm, molar pregnancies, or even some ovarion cysts. Certain drugs such as diuretics and promethazine (an antihistamine) may also cause false-negative urine results. Other drugs such as anti-convulsants, anti-parkinson drugs, hypnotics, and tranquilizers may cause false-positive results as well as drugs which include certain hormones in them.

Tests performed too early in the pregnancy may give false-negative results, while blood or protein in the urine may cause false-positive results. Urine hCG tests may give a false negative result in very dilute urine. Patients should not drink large amounts of fluid before collecting a urine sample for a pregnancy test.
For best results, read the package to see which drugs the test may give a false negative on.

HCG helps to maintain your pregnancy and even affects the development of your baby (fetus). HCG Levels increase quickly in the first 14 to 16 weeks following your last menstrual period, peak around the 14th week following your last menstrual cycle, and then decreases slowly.

After delivery, hCG levels are no longer detectable in your bloodstream.

Guideline to hCG levels during pregnancy:
hCG levels in weeks from LMP (gestational age)* :

3 weeks LMP: 5 - 50 mIU/ml

4 weeks LMP: 5 - 426 mIU/ml

5 weeks LMP: 18 - 7,340 mIU/ml

6 weeks LMP: 1,080 - 56,500 mIU/ml

7 - 8 weeks LMP: 7, 650 - 229,000 mIU/ml

9 - 12 weeks LMP: 25,700 - 288,000 mIU/ml
13 - 16 weeks LMP: 13,300 - 254,000 mIU/ml
17 - 24 weeks LMP: 4,060 - 165,400 mIU/ml
25 - 40 weeks LMP: 3,640 - 117,000 mIU/ml
Non-pregnant females: <5.0 mIU/ml

Postmenopausal: <9.5 mIU/ml

* These numbers are just a GUIDELINE-- every woman’s level of hCG can rise differently. It is not necessarily the level that matters but rather the change in the level.

REFERENCES

American College of Obstetricians and Gynecologists. Medical Management of Tubal Pregnancy. Practice Bulletin Number 3, December 1998. Washington, D.C. ACOG, 1998
http://www.labtestsonline.org
http://www.hcglab.com/