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Irregular Menstrual Cycles

Why do I have irregular cycles?  How can we treat irregular cycles?

There’s a long list of possibilities causing the menstrual cycles to vary from the usual 28 to 35 days periods and lasting 4 to 7 days that most women usually experience.

Of course once we rule out pregnancy, a gynecology exam can help us zero in on the cause and develop a treatment plan.

A change in hormone levels from stress, weight gain or illness or other disruptions in a woman’s routine can affect the menstrual cycle.  If the thyroid or other glands are not functioning properly, one sign may be problems of the menstrual cycle.

Polyps or dangling growths in the lining of the uterus  and fibroids, also known as leiomyoma are knots or growths of the muscle layer of the uterus may cause heavy bleeding and bleeding between cycles.  These growths are usually benign.

Endometriosis or adenomyosis can occur when the lining tissue of the uterus starts to growth outside the uterus or into the wall of the uterus.  These may cause abnormal bleeding as well as pain during the cycles and painful intercourse.

Other causes include polycystic ovary syndrome which can be seen on ultrasound, pelvic infections caused when bacteria enters the genital tract usually during sexual intercourse, bleeding disorders such as Von Willebrand’s disease,  and cervical or upper uterine cancer.

A history of use of medication such as blood thinners, skipped or late birth control pills would give us the answer also.

Pelvic examination may help us determine if there are fibroids of the uterus or any large ovarian cysts.   A Pelvic ultrasound will locate abnormalities of the thickness of the lining of the uterus or polycystic ovaries.  The Pap test will help us determine if there is pre-cancer or cancer of the cervix.  A complete blood count, blood sugar, thyroid hormone test, or other hormone tests may be very helpful.

Hysteroscopy, scoping the inside of the uterus with a directed biopsy tells us if there are polyps, pre-cancer or uterine cancer. The polyps can be removed and sometimes fibroids can also be scrapped away.  Young women may not need this step to determine the cause of the abnormal bleeding.

If all the results so far are normal or unremarkable, a daily pill of estrogen and progestin or progestin only may be all that’s needed to return the cycles to a regular and short interval.

Laparoscopy, a surgery to look inside the pelvis may be required if the cycles remain irregular to locate and treat endometriosis.

Fibroids can be treated with surgery to remove them, or a procedure to block their blood supply, or in some cases with anti-estrogen medications.

Menopause or premature ovarian failure, when the ovaries stop working, may lead to absent or very infrequent cycles.

 

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The Affordable Care Act/Obamacare

What is this Obamacare?  What if I have a pre-existing condition, such as diabetes?

 

The Patient Protection and Affordable Care Act or Obamacare was signed into law March 2010.  The aim of the law is to increase access to medical care and ensure high quality care. The estimates are that there were about 65 million people in the US without healthcare coverage when this became law. Texas had the highest rate of uninsured people followed by Florida.

 

The health law is rolling out in phases through 2018.

 

  • Young people can be covered under the parent’s insurance up to age 26.

 

  •  Preventive care (well woman exams, mammograms) is covered without co-pay.

 

  •  Insurance companies must publicly justify rate increases of 10 percent or more before raising premiums.

 

  • Insurance companies are required to spend at least 80 percent of customer premiums on healthcare and quality improvement or issue a rebate to policyholders.  Quite a few people have already received a rebate check from their insurance carrier.

 

  • Insurance companies are no longer allowed to place lifetime limits on coverage and they’re not allowed to rescind coverage except in cases of fraud.

 

  •  And starting next year, insurance companies can no longer deny coverage to individuals based on preexisting medical conditions such as diabetes, or heart disease.

 

The centerpiece of the healthcare reform law, the online health insurance exchanges unveiled Oct. 1 where Americans can shop for health insurance plans at http://www.healthcare.gov/

 

On the exchanges, people will find out if they are eligible for federal subsidies to help pay for insurance premiums and out-of-pocket costs such as deductibles, or if they are eligible for Medicaid, the federal-state health insurance program for the poor.

 

For the physician the great part of the Affordable Care act is the incentives for people to get preventive services, get checkups, find things early, get it taken care of, fill their prescriptions and follow the doctor’s advice so that you don’t end up back in the hospital. Physicians see people come in to the office or ER with advanced stage diseases/ problems that there may be little or nothing that can be done.  If these people had the ability to afford healthcare or had come in earlier, the problems could have been taken care of simply and completely. It breaks your heart to watch someone suffer, die of a problem that with all the technical advances in medicine could have been avoided.

 

It should be pointed out the Affordable Care Act does not mean the government will be doing your pelvic exams or the cost of insurance will be going up for the people who already have insurance.  As millions more people enter the healthcare market and purchase insurance with or without government subsidies, the overall cost of insurance is spread out over more individuals.  Right now, when a very sick person is admitted to the hospital without insurance coverage, the cost of that care is eventually passed on to everyone else who does have insurance in greater costs overall.  The sick person is not working, is not contributing to society.  Healthy people obviously do not utilize as much healthcare, so costs for everyone goes down.

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Sexually transmitted diseases: Silent Infections

Do I really need to use condoms since I only have sex with my partner?  And he is _________ (fill in the blank here)

 

It would be wonderful if we could tell who has a sexually transmitted disease (STD) by just looking or talking to a person.  Unfortunately most people who have a STD don’t realize it.  It is worth saying again that the Head Bacteria or the Head Virus does not know that this person is a good kind, hardworking special individual from a good family, etc and will not tell the other bugs to stay away from this person and wait for someone to come along more deserving of a disease.

Since the days of the sexual revolution of the late 20th century, the number of STDs has skyrocketed.  There’s genital herpes, chlamydia, syphilis, molluscum contagiosum, gonorrhea, hepatitis, human papilloma virus, AIDs, and on and on.  Most of these diseases are silent, you don’t have any signs or symptoms of the infection at least initially and they can be passed on to a sexual partner without any symptoms as well.  Some of these diseases are treatable, others are not.

It’s been said that when we have sex with someone, we’re having sex with everyone that person has had sex with for the past number of years, and everyone they have had sex with and on.  Depending on the person’s history it may be very crowded in that room.

The only protection we have is knowledge, education, and good common sense.  Talk with your partner and sound out his or her attitude about STD prevention.  A waving red flag is someone saying something like nice people like the two of you don’t get STDs.  Understand the person’s attitude and feelings about having other sexual partners or casual sexual relationships.  Even if you and the partner have already engaged in sexual activity consider starting the use of condoms; it could be the one thousand and one time that you have sex that you will pick up the HIV virus.

Everyone who is sexually active should be tested for any all diseases that can be tested.  You may want to accompany your partner to the doctor or clinic and sit with him to receive the results of regular testing.

When we think about all the various STDs and the way they can harm us, you may be so worried you don’t even want to shake hands with other people.  If we plan, use that good common horse sense, and have some frank open discussions we can’t help but be safe.

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Sexually transmitted diseases: Chlamydia

Should we use condoms until my partner is treated for Chlamydia?

Frequently, patients ask if it is ok to still have intercourse with a partner who has not been treated as long as the couple uses condoms.  A visualization technique to consider would be imagining having intercourse with the partner with a condom right after he has rolled his member around in fresh wet mud mixed with animal droppings.  That romantic image should cause at least some hesitation.

Chlamydia is a sexually transmitted disease (STD)  that can infect both men and women and can cause permanent damage to a woman’s reproductive organs. It is known as a ‘silent’ infection because most infected people have no symptoms.  It can be easily treated and cured with antibiotics.

Persons with Chlamydia should abstain from having sex for seven days after a single dose antibiotic, or until completion of a seven-day course of antibiotic, to prevent spreading the infection to partners.

Even if you have been treated, you can get infected again if you have sex with an infected person. It is a very common STD, especially among young people.

Some infected women have an abnormal vaginal discharge or a burning sensation when urinating. Untreated infections can spread upward to the womb and fallopian tubes (tubes that carry the egg from the ovaries to the womb), causing pelvic inflammatory disease (PID). PID can be silent, or it can cause symptoms such as abdominal and pelvic pain. Even if PID causes no symptoms initially, it can lead to infertility (not being able to get pregnant) or ectopic pregnancies (pregnancies that settle in the fallopian tubes.)

In pregnant women, untreated Chlamydia has been associated with pre-term delivery, and can spread to the baby, causing eye infections or pneumonia.

There are laboratory tests to diagnose Chlamydia. Specimens for testing are obtained from swabbing the cervix or collecting a urine sample.

Persons with Chlamydia should be retested about three months after treatment of an initial infection, regardless of whether they believe that their partners were successfully treated.

Using latex condoms correctly, and with each episode of sexual intercourse. can reduce the risk of getting or giving Chlamydia. The surest way to avoid Chlamydia is to abstain from vaginal, anal, and oral sex or to be in a long-term monogamous relationship with a partner who has been tested and is known to be uninfected.

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Sexually transmitted diseases: Herpes

I have what?!   What is genital herpes?

Genital herpes is a STD (sexually transmitted disease) caused by the herpes virus type 1 or type 2. It is quite common as studies have shown 1 in 6 people up to the age of 49 years have type 2 herpes.

Most individuals infected with herpes have little or no symptoms, or they mistake the signs for some other condition.  An outbreak may appear as blisters around the genitals, the anus or the mouth.  The blisters break and leave sores that could take up to two to four weeks to heal.

A first time outbreak, however may present with symptoms such as fever, body aches and swollen lymph glands.  Repeat outbreaks are usually shorter duration and less severe than the first outbreak of genital herpes.

Type 1 herpes infections of the genital area can be caused when someone gives “special attention” to her partner through mouth to genital contact when there is a fever blister present.    If the person with genital herpes touches their sores or the fluids from the sores, the virus may be transferred to another part of the body.

The first outbreak may occur as early as 2 weeks after having sexual contact with an infected person, and symptoms can last from 2 to 3 weeks.

A pregnant woman with genital herpes may be advised to take antiviral medication from 36 weeks gestation through delivery to reduce the risk of an outbreak.  If there is an outbreak present during labor, the pregnant woman may undergo a Cesarean section to reduce exposure of the infant.

If a person feels a recurrent outbreak coming because of tingling or odd sensation in that usual area or there are sores present, he should not have sexual intercourse with his partner until all sores have completely healed.  Even without symptoms, a person can still pass the herpes virus to others.

Although there is no cure for herpes, the antiviral medications may prevent or shorten the outbreak episode.