FAQ’s

Premenstrual Syndrome (PMS) is a disorder experienced by many women. This syndrome has many associated symptoms. One of these symptoms is bloating. This often begins approximately 1 to 2 weeks prior to menses and is characterized by bloating and weight gain. Often women notice a significant reduction in their weight immediately after menses.

Initial treatment for PMS is lifestyle changes such as exercise and changing your diet to decrease salt, caffeine, and chocolate intake. If you have a significant amount of bloating prior to your menses and it is affecting your daily life, your physician may prescribe a diuretic to be taken during the second half of your menstrual cycle. This is known as a “fluid pill” in lay terms and is often used to treat people with high blood pressure. A common diuretic used for premenstrual bloating is spironolactone. To date, studies on diuretics have been conflicting, and it is not clear if they truly help premenstrual bloating. Although no good studies support their use, many women report improvement in symptoms with the use of birth control pills.

What you are describing is a normal pattern of menstruation and a normal menstrual period. A normal menstrual period last about 5 to 7 days, the bleeding is heaviest during the first couple of days and then slows for the remaining 3 or 4 days. As your bleeding slows, the blood clots. This could be what you are seeing. Another possibility is that you are seeing a portion of the uterine lining (endometrium) which is the tissue that is shed during menstruation. In short, you should be reassured that your period is normal. Because you are of reproductive age, you should make certain that your diet is rich in folic acid and that you are getting enough calcium and iron. You might consider supplementing your diet with these vitamins and minerals.

Females should have their first gynaecological exam by the age of 20, or when they become sexually active. At this point they should begin having yearly pap smears and pelvic exams. Many paediatricians are comfortable taking care of their patients’ gynaecological problems. If this is the case, your paediatrician may continue to see you for your gynaecological exams. If you or your paediatrician feel that it would be more comfortable for you to see a gynaecologist, you may be given a referral to one. Should your gynaecological issues become more difficult, seeing a gynaecologist may be to your benefit.

Periods are also known as menstrual cycles. The onset of menstrual cycles (menarche) occurs during the teenage years. Menstruation continues until a women is in her 50s and reaches menopause. The average age for starting periods is 12 to 16 years of age, with a median age of 13. Primary amenorrhea is a condition where a woman fails to start her menstrual cycles. If you have other signs of puberty, such as breast development or pubic hair, but fail to start your menses by the age of 16, you should see a physician. If you have no signs of puberty by age 14, you should see a physician

Lichen sclerosus is a benign inflammatory condition of the skin of the vulva. It can occur in women of any age, but is most common in postmenopausal women. Symptoms include itching and burning with associated pain during intercourse. The surface of the vulvar skin is often extremely thin and may have a paper-like appearance. Because of this, the skin may tear during intercourse and cause pain or bleeding.

Standard initial treatment of lichen sclerosus is application of creams containing high-potency steroids to the affected area. The most common steroid cream is known as clobetasol or Temovate. This cream should be applied to the area twice a day for approximately 2 to 3 weeks, then tapered to once a day, and finally down to occasional use. Most women notice an improvement in symptoms within 1 month of use of the steroid cream. This treatment may be continued on a long-term basis.

Other possible treatments of lichen sclerosus include topical testosterone or progesterone. These treatments, however, are not as effective as steroids. Additionally, your physician may recommend surgically excising the scar tissue often associated with lichen sclerosus. Again, this treatment is not as effective as topical steroids.

Home remedies for lichen sclerosus include keeping the skin over the affected area clean and dry, lubricating the skin with K-Y jelly or vegetable oil, or using sitz baths or warm water soaks.

Fibrocystic changes of the breasts are very common, especially from the ages of 20 to 50, and are thought to be directly related to estrogen. Fibrocystic breast masses usually occur on a cyclic basis in relation to the menstrual cycle. They can be quite painful and often appear rapidly with the onset of menses, and then disappear afterward.

The most important characteristic of a fibrocystic lesion of the breast is that it resolves on its own. If your masses/cysts do not resolve, especially after a menstrual cycle, you need to see your physician so that the mass can be further evaluated to assure that it is not a cancerous lesion. This evaluation may necessitate cyst aspiration or biopsy of the mass.

Often people with fibrocystic changes of the breasts notice associated breast tenderness. This pain may be alleviated by wearing a tight bra for support. Although there is no good evidence to support its use, many physicians advocate use of vitamin E and reduction of caffeine to alleviate some of the symptoms.

If you have cysts under the skin, rather than in your breast tissue, you may need other treatments. You should see your physician to exclude this possibility.

It is thought that 45% to 75% of women experience yeast infections (also known as vulvovaginal candidiasis) in their lifetime. It is thought that 45% to 75% of women experience yeast infections (also known as vulvovaginal candidiasis) in their lifetime. In over 80% of cases, infection is caused by an orgainism known as Candida albicans. This is a fungus that resides in the vagina of a significant number of women. Several situations allow overgrowth of Candida albicans including recent antibiotic use, pregnancy, and diabetes.

The signs and symptoms of a vaginal yeast infection often include itching, a thick white vaginal discharge often described as being similar to cottage-cheese, and redness of the vulvar and vaginal areas.

Treatment of a yeast infection is variable. The most common treatment involves using a topical antifungal cream in the vaginal area (such as Gyne-Lotrimin or Monistat). An applicator full of cream is placed in the vagina at bedtime from 1 to 7 days. The medication can be obtained over-the-counter, but should only be used by someone who has been diagnosed by a physician or has had similar symptoms in the past where a diagnosis was made. An oral treatment is now available by prescription and is given as a single dose. This is known as Diflucan. After a single treatment with this medication, symptoms often resolve in 3 to 4 days.

If you have chronic yeast infections, your physician may start you on a monthly regimen of treatment, usually for a total of 6 months.

Blood in the urine is called hematuria and should never be ignored. It is important to determine exactly where the blood is coming from. In women, the blood may appear to be in the urine when it is actually coming from the vagina or rectum. Discoloration from drugs or foods can mimic hematuria. A catheterized urine sample is an important diagnostic test to make sure that the discoloration is really blood and that the bleeding is coming from the bladder. Also, there is a condition called microscopic hematuria, in which the urine has microscopic amounts of blood that cannot be seen with the naked eye. In the majority of cases tests will be negative and no treatment is necessary. However, before you can make this diagnosis, other more serious causes must be eliminated.

The most common cause of hematuria is a bladder infection, which is more common during pregnancy. Other possible causes include:

• Kidney or bladder stones

• Tumors in the urinary tract (urethra, bladder, ureter, or kidney)

• Infection in the kidney (pelonephritis)

• Infection in the urethra (urethritis)

• Trauma (Fracture of the pelvis, bruised kidney, etc.)

• Surgical procedures, including catheterization, circumcision, surgery, and renal biopsy

• Certain drugs can also cause hematuria

• anticoagulants

• cyclophosphamide

• metyrosine

• oxyphenbutazone

• phenylbutazone

• thiabendazole

Depending on the particular situation, tests that may be used to isolate the cause of the blood include:

• Blood studies such as a CBC

• Urinalysis

• Cystoscopy

• Kidney biopsy

• IVP

• Abdominal ultrasound

• CT scan of the abdomen

Blood in the urine should never be ignored. It is important to see your physician and have the problem isolated and treated.

Blood in the stool or bloody bowel movements is also known as rectal bleeding. Most of the time rectal bleeding is due to non-serious conditions such as hemorrhoids or anal fissures (anal tears). However, certain serious conditions may present as rectal bleeding. These conditions include rectal cancer, colon cancer, polyps, and inflammatory diseases such as Crohn’s disease or ulcerative colitis to name a few.

It is of utmost importance to contact a doctor if you notice blood in your stool. If you are over 40, there is an increased risk of colon cancer. If your physician is concerned about the blood in your stool and there are no obvious causes (such as hemorrhoids), he or she may order several tests for further evaluation. These tests include anoscopy, examination of the anal canal and lower rectum for hemorrhoids and tears. If the results are normal, he may order a sigmoidoscopy or colonoscopy. Both of these tests involve placing a light into the rectum with a camera attached so that the inside of your rectum and colon can be viewed. If any suspicious lesions are present, your physician may biopsy them.

Always contact a physician if you experience rectal bleeding.

Sodium intake is variable in most people. The recommended daily allowance of sodium is 60 to 120 mEq. However, the body rapidly clears sodium from the urine and therefore attempts to keep a constant amount in the body. During pregnancy, sodium levels decrease slightly. This is because of the increased rate of urination that is seen with pregnancy. However, it is not necessary to increase salt intake during pregnancy.

Dysplasia is considered a precancerous cell type. However, if the dysplasia is classified as low-grade squamous dysplasia, then about 30% of the time, the abnormal cells will disappear without treatment.

Stress affects our bodies in ways that we do not yet understand. Scientists know that many types of stress activate the body’s endocrine (hormone) system, which in turn can cause changes in the immune system, the body’s defense against infection and disease (including cancer). On the positive side for women, there is some evidence that women who breast-feed their infants produce lower levels of stress response hormones, such as adrenalin and cortisol, than do women who bottle-feed.

This is one of the most important questions, but its answer is dependent on a couple of factors which one should consider – First, it is dependent on your age. Since you are continuing to have periods, I am assuming that these are “natural” periods and that you are not menopausal. If this is true, then having a small cyst on the ovary is not uncommon. In fact, you make a cyst each month as your follicle develops and you ovulate. If the cyst is classified as a simple cyst, meaning that it is fluid filled and doesn’t have any solid tissue included in it, no other treatment or follow-up is needed. If you were menopausal, the treatment would also be based on the size and type of the cyst. If the cyst is simple (no solid component) and less than 4.0 to 5.0 cm in size, the likelihood that the cyst is a cancer is extremely unusual. In some cases it might be helpful to obtain a CA-125 blood test. If this test is in normal range, the cyst is simple and small, and there is probably no reason to seek any additional treatment. You also asked whether you should talk with your gynaecologist. Absolutely, you should always feel free to talk with your physician about any concern that you have.

Endometriosis is a condition in which tissue that normally lines the inside of the uterus (the endometrium) spreads and implants in areas outside of the uterus. Often the site of the implantation is somewhere in the abdominal cavity. In patients with endometriosis, these implants of endometrium grow on a cyclic basis just as the normal endometrium does. When the normal endometrium sheds during your menstrual cycle causing your period, so do these endometrial implants. They can cause a small amount of bleeding within your abdominal cavity which results in pain.

Symptoms of endometriosis are often described as menstrual cramping and pain that begins before the onset of menstrual bleeding, and continues through the menstrual cycle. The severity of endometriosis often does not correlate with the degree of pain experienced with endometriosis. Often women with a small amount of endometriosis will have significant cyclic pain, and often women with a large amount of endometriosis will have minimal pain. Endometriosis is often seen in women who previously had pain-free menstrual cycles, and have gradually noticed a worsening in their pain.

The definitive diagnosis of endometriosis can only be made through surgery where the endometriotic lesions can be seen and sometimes biopsied to make the diagnosis.

Bladder infections or urinary tract infections are also known as cystitis. Women often notice an abrupt onset of symptoms, which include burning with urination, urinating more frequently than usual, and abdominal pain. If a urinary tract infection has spread to the kidneys (also known as pyelonephritis) a woman may experience fever and back pain.

Urinary tract infections are caused by spread of bacteria that normally reside in the rectum into the urethra and bladder. Several situations increase your risk of getting a urinary tract infection, among them, recent intercourse, delayed emptying of your bladder after intercourse, and use of a diaphragm.

Many women with one urinary tract infection will have multiple urinary tract infections. Your physician will grow out your urine before and after treatment to be sure treatment is completely irradicating the bacteria. Additionally, it may be helpful to empty your bladder completely after each episode of intercourse. The ultimate treatment for recurrent urinary tract infections will be up to your doctor. She may recommend staying on a medicine that suppresses bacteria consistently, taking medication after intercourse, or taking medication as soon as you notice symptoms.

A mammogram is an important screening tool used in the prevention of breast cancer. Breast cancer is the second leading cause of death for women. Appropriate screening for this deadly disease is of utmost importance.

Several guidelines for mammographic screening are recommended. For women with no family history of breast cancer and no prior history of breast cancer, initial screening is recommended at 40 years of age. Although the benefit of breast cancer screening in the 40s is still under debate, the American College of Gynecology recommends starting to screen patients at the age of 40. Between 40 and 49 years of age screening is recommended every 1 to 2 years. The benefit of breast cancer screening in the 50 to 69 age group has been clearly established. Women in this age group should receive yearly mammograms. Over age 70, the benefit of breast cancer screening has not been clearly established. Due to the increasing risk of breast cancer with age, however, most physicians still advocate yearly screening after 70 years of age.

You should have your first screening mammogram by age 40. Discuss the frequency of subsequent mammograms with your physician.

This a very common question asked by many women who are currently taking oral contraceptives. Women who use oral contraceptives have no reduction in their fertility once they stop taking the pill. There are a number of myths or misconceptions about the use of oral contraceptives. For example, you do not have to stop the pill or switch pills after a certain period of time. In fact, there is no reason to stop the pill until you are ready to have children. Furthermore, there is some evidence that using oral contraceptives actually helps to preserve a woman’s future fertility. For example, women taking oral contraceptives have a reduced incidence of endometriosis and have a reduced incidence of ovarian cyst formation. Unless you experience side-effects with the pill or you are ready to become pregnant, you should continue your oral contraceptives without fear of them reducing your future fertility

If your periods are normally every 28 days, then you will ovulate on Day 14. With that in mind, you would ovulate on the 10th. Again, if your periods occur every 28 days, your next period would be on the 25th. The home pregnancy test will detect pregnancy on or about the time for your next period. I would wait and see if your period starts on time. If it does, then obviously you are not pregnant. If it doesn’t, then repeat the pregnancy test.