Trouble “Down Below”
Despite cutting-edge medical advances, gyno ailments often go unresolved (or worse, misdiagnosed). Here’s what you need to know about these vexing conditions.
By Stacey Colino, Women’s Health
Some mysteries, such as the Bermuda Triangle or the contents of a Twinkie, are fun to ponder. But trying to figure out why you’re doubled over with cramps or swapping out supersize tampons every hour? Not so much. Sadly, millions of women (and a whole lot of docs) are perplexed by pelvic problems. Learn how to help your physician spot and deal with the down-there maladies that affect women the most.
6.3 Million Suffer from Endometriosis
When Senie Byrne, 25, of Manassas, Virginia, was 15 her periods were accompanied by vomiting and cramps so bad she would often pass out from the pain. She went from doctor to doctor until finally, at age 21, she found out she had endometriosis, a uterine disease that can take a decade to diagnose.
When a woman has endometriosis, the uterine lining (the one you’re supposed to shed each month during your period) gets stuck elsewhere. It can travel down through your cervix and vagina, but also up through your fallopian tubes, where it can attach to your bowel, bladder, or ovaries. The latter path can disrupt hormonal cycles and lead to thick scarring, inflammation, and heavy bleeding during menstruation, says Tommaso Falcone, M.D., chairman of obstetrics and gynecology at the Cleveland Clinic. It can also result in killer cramps, painful sex, diarrhea, or constipation—or no aches at all.
“The peculiar thing is that the amount of pain you’re in may have no correlation to the amount of endometriosis you have,” says ob-gyn Mary Jane Minkin, M.D., of the Yale University School of Medicine.
But even pain-free patients are at risk of a troubling side effect: infertility. About 38 percent of infertile women can blame endometriosis, according to the American College of Obstetricians and Gynecologists, often because of scarring or inflammation. Endometrial tissue also releases fluid that can mess with egg-sperm interaction. The best way to preserve fertility is to catch and treat the problem early.
Scientists aren’t sure exactly what causes endometriosis, but they do know that genetics plays a leading role in risk (if your mom or sister has it, your chances increase sixfold); exposure to pollutants such as dioxin, a chemical used in pesticides and bleached paper, might also be a prime risk factor. For now, the only way to score a definitive diagnosis is through surgery.
“To be sure, we have to physically see this tissue living where it doesn’t belong,” explains ob-gyn Shari Brasner, M.D., of the Mount Sinai School of Medicine in New York City. This procedure involves general anesthesia and a camera exploring the inner abdomen and pelvis. If a physician finds any wayward tissue, it can often be removed right then, though it can grow back. The good news: Less-invasive diagnostic procedures (including in-office biopsies and blood tests to measure inflammation levels) should be available within three to five years, says Falcone.
Of course, after getting the diagnosis, you still have to live with the condition, which can come and go or persist for as long as you menstruate. Birth control can decrease the pain and bleeding, and hormone-manipulating drugs such as danazol and Lupron can shrink the growths by “turning off” the ovaries. (Similarly, “pregnancy will keep endometrial tissue quiet because your hormones aren’t cycling,” says Brasner.) Scientists are now studying how anti-progesterone and breast-cancer drugs may help.
If Rx medicines don’t yield relief, alternative treatments like acupuncture may ease pain. And if nothing else works, more surgery may be in order. But the crucial thing is for each endometriosis patient to receive a tailored health plan that lets her move past the pain and get on with her life.
5 to 7 Million Have Polycystic Ovarian Syndrome (PCOS)
Its calling cards are irregular periods, acne, excessive facial and body hair, and weight gain. But each of those symptoms could signal a variety of issues, especially during teenage years, when PCOS—the most common hormonal illness in young women—typically first strikes. That’s why many patients spend years searching for a diagnosis, says Andrea Dunaif, M.D., an endocrinologist at Northwestern University in Chicago. And that’s worrisome because women with PCOS—especially if it’s left untreated— are at increased risk for type 2 diabetes, heart disease, and endometrial cancer.
Though the root causes remain unknown, PCOS happens when the ovaries produce an unusually high amount of male hormones like testosterone, which tamper with ovulation and in many cases, the body’s sensitivity to insulin. For Katy Teer, 32, of St. Clair Shores, Michigan, the condition led to strange facial hair and an ever-expanding waistline, starting at age 13. “I rarely had normal periods, but doctors always blamed that on my weight,” she says. At age 28, she finally got a diagnosis. Because there’s no definitive blood or imaging test, Katy’s docs looked at three criteria: irregular periods, elevated male hormones, and ovarian cysts seen on ultrasounds.
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PCOS has no cure or FDA-approved drug—docs can only treat the major symptoms. Oral contraceptives can help suppress male hormones and normalize cycles, says Richard S. Legro, M.D., an ob-gyn at the Penn State College of Medicine. And physicians often use spironolactone, a kidney drug, off-label to nix unwanted hair growth. PCOS patients who struggle with fertility are also sometimes prescribed Clomid, a drug that induces ovulation; the diabetes med metformin is often given to help restore regular cycles and reduce diabetes risk.
If that sounds like a lot of pills, it is. But PCOS symptoms, especially weight gain, can also be controlled through diet and exercise. “Many patients find that a diet moderate in carbs and high in lean protein helps them handle their hunger and consume fewer calories,” says Hillary Wright, R.D., a nutrition counselor in Boston and author of The PCOS Diet Plan. Plus, “losing just 5 to 10 percent of your weight can lead to the resumption of normal periods and lower male hormone levels,” says Dunaif.
As with every illness, the most important step is working together with your M.D. on a plan that’s right for you. Once Katy Teer started taking metformin and a low-dose birth-control pill, her day-today life became much more manageable. “I lost more than 40 pounds,” she says. “I’m still overweight, even though I walk four miles a day, but I stopped getting facial hair, my periods are more regular, and my blood pressure is under control.” So is her fertility: In 2007, she became a mother.
124 Million May Have Uterine Fibroids
Fibroids’ main symptom, bigtime bloat, can make you look knocked up when you’re not. And like endometriosis and PCOS, they can cause extra-heavy bleeding and gutwrenching cramps during your period, as well as constant pressure on your bladder or rectum. That said, some sufferers show zero symptoms.
Doctors aren’t sure what causes these balls of muscle (which can range from the size of a grape to a honeydew melon) to grow in the uterus, but new research suggests that exposure to phthalates (chemicals found in plastics and personal-care products) may play a part. Because fibroids feed on estrogen, they can become a nuisance during pregnancy, when female hormone levels run high, says Lissa Rankin, M.D., an ob-gyn in Mill Valley, California. They also share living space with the fetus, increasing the risk of miscarriage or preterm birth.
While fibroids are relatively simple to diagnose—usually with an ultrasound or MRI— deciding on a treatment isn’t so easy. Birth-control pills and hormone-disrupting meds can shrink the masses, but the ultimate fix is a hysterectomy— a drastic step for young women. However, there are newer, less severe treatments that can help eliminate fibroids: myolysis (laser removal), myomectomy (surgical removal), and uterine artery embolization (the injection of foam into arteries to cut off fibroids’ blood supply). Also showing early promise are two noninvasive experimental treatments: radiofrequency ablation, which uses heat energy to destroy any unwarranted growths, and MRI-guided ultrasound surgery, which blasts fibroids into smithereens.