More About Ovarian Cysts

>> Wednesday, October 15, 2014

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I hope you all had a good week. Last week I was explaining how the ovaries function in hopes it will help you understand that having an ovarian cyst can just mean that they are functioning normally.

The eggs (or ova) form and then mature in clear, fluid-filled cysts. When they reach the size of a large cherry, they "pop" to release the egg into the fallopian tube - a process called ovulation. If the ova is fertilized, then it will implant and pregnancy occurs. If it doesn't, it will pass from the body or dissolve. Once ovulation has occurred, all the remaining developing ova shrivel up, and within 14 days our period comes and the entire process will repeat itself.

But sometimes the developing ova do not shrivel up and will continue to grow and fill with clear or straw-colored fluid until they are the size of a tennis ball or even as large as a soccer ball!!

Mucinous cyst adenomas are similar to the enlarged follicular cysts and behave the same, but do not originate from ovulation. Both of these types of cysts are rarely painful unless they "pop", causing many women to pass out and end up at the emergency room. This is usually not life threatening unless a blood vessel is torn during the rupture, causing internal bleeding.

Torsion is another complication of these benign cysts, which is most likely to happen when they are no larger than the size of a golf ball. Torsion is when the ovary literally flips over on itself, twisting off the blood flow. This is an emergency because not only is it extremely painful, but will cause the ovary to die from lack of blood flow if not surgically corrected as quickly as possible.

'Benign' cysts means they are not cancerous. Benign cysts do not change to 'malignant' (meaning cancerous) cysts, and women with benign cysts are not at a higher risk for making malignant cysts.

There are other forms of benign cysts like Dermoid cysts, also known as mature teratomas. These cysts are known for the hair, fat, muscle, bone and teeth that can be found in them. Hemorrhagic cysts are cysts that have clear fluid and blood clots in them. Women with endometriosis are at risk for making cysts called Endometriomas or "Chocolate cysts". These are cysts filled with old, brownish appearing blood and endometrium that has come from the back flow of period blood into the Fallopian tubes and onto the ovaries. When they rupture it looks like chocolate syrup pouring out and that is why they were nicknamed Chocolate cysts.

Most cysts are identified by ultrasound. Ultrasound is very good at characterizing cysts as benign or malignant, and can identify simple fluid filled cysts from the other types. If simple, fluid filled cysts are 5 cm or less in size they can resolve on their own and you may never need surgery.

Sometimes women notice an increase in discharge when small cysts rupture or leak. This is usually a thin, watery, odorless fluid.
It is always best to see your doctor if you notice changes in your menstruation, pain with sex or when using the restroom, walking or exercising, increase in need to urinate, or a feeling of fullness in your abdomen or pressure on your bladder.
I hope this helps answer your worries and questions about ovarian cysts. There is so much more on this subject but I wanted to simplify it for you a little bit.

Take care and have a safe and happy week.

Dr. Susan L. Boyd, MD

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Why Do Our Ovaries Make Cysts…..and Are They OK?

>> Friday, October 3, 2014

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Why do the ovaries make cysts? What do they mean? Does it mean cancer, or that you can get cancer easier than someone who never gets them?

Well, we have two ovaries and two Fallopian tubes that transport the egg or embryo from the ovaries to the uterus. Ovaries are small - about the size and shape of a pecan. Every single month, the eggs (or ova) start maturing and are released at ovulation. But, our hormones stimulate both ovaries, and they both start developing eggs. So, they race each other until one of the follicular cysts holding an egg pops, and the egg is released. At that moment, all the other follicular cysts carrying eggs shrivel up and go away. For example, there could be five cysts on your right ovary and four on your left ovary during any month. We can ovulate on our right ovary four months in a row and then maybe an egg on the left 'wins', so we ovulate on the left. That might happen three months in a row on the left, or it could switch back and the right ovary pops out the egg.

We may think, "Ohh, the ovaries switch back and forth every month from right to left; they take turns." But that's not how it really happens. It's a race, and our body doesn't care which wins, because the ovaries are identical and are both affected each month by the same hormones. They work like one organ even though they are two.

The follicular cysts, when mature, are about the size of a cherry just before the egg is released. They have an egg in them and are filled with clear, water-like fluid. As mentioned, once one ruptures, all the remaining ones shrivel and dissolve. The cyst that popped out the egg transforms into a Corpus Luteum cyst. This cyst then produces our female hormone called progesterone. Without progesterone, we would all miscarry every pregnancy. Progesterone has the job of keeping the uterine lining in place for exactly 14 days. At that point, if there is no pregnancy hormone in our blood stream, the Corpus Luteum cyst dissolves and our period comes as the uterine lining is released.

If there is pregnancy hormone present in the blood, the Corpus Luteum will stay to produce progesterone for about 13 weeks - the entire first trimester of pregnancy - so we don't miscarry. After 13 weeks, the placenta takes over this job, so the Corpus Luteum will dissolve. Some women never make this cyst or it will only stay for 14 days despite being pregnant, and they will, therefore, miscarry every pregnancy. Once we know this, we can supplement progesterone to make up for the absent Corpus Luteum.

Now the reason I took the time here to explain this to all of you is because I have so many patients who come into my office after having an ultrasound at the ER or primary care doctors office and have been told, "You have cysts on your ovaries." Then are instructed to go see their gynecologist. Some women were told this 10 years ago and come in for the exam and tell me they have a cyst but never went back to a doctor to follow-up. So they worry it is still there and getting bigger.

Remember, we form multiple cysts every single month, and as I explained above, these cysts form, and as we ovulate, they all dissolve away. Then it repeats the next month until we arrive at menopause. So all cysts are not bad, they are normal.

I hope this explains and helps you to understand why cysts are supposed to be there and come and go. I will continue this teaching with next blog because I'm not done. Okay?

Have a wonderful week. Be safe and happy.

Dr. Susan Boyd, MD

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Three Everyday Habits That Could Be Dangerous To Women

>> Thursday, September 25, 2014

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More and more of us are opting to wear heels on a daily basis, and this could be bad news for our health. High heels affect our posture, put pressure on our joints, and can lead to a range of conditions including arthritis, hammer toes, and back pain.

Women often carry heavy bags and/or children, and shifting their weight back and forth from hip to hip can cause serious back and hip problems. While you may not feel the effects right now, lugging around a heavy thing and shifting its weight can lead to serious back and neck pain as well as poor posture. Don’t wait until the damage is done – do your health a favor and try clearing out all non-essential items, switching to a smaller bag and placing children in strollers and balanced carriers. Otherwise you will pay later.

It is thought that more than 70% of women are wearing the wrong bra size. However, wearing a badly fitted bra can not only affect the look of your clothes, but research suggests it can cause a range of health problems including back, shoulder and neck and breast pain, breathing difficulties, poor posture, skin irritation, circulation problems and even irritable bowel syndrome. Rather than guessing your size, make sure you get measured to ensure you are getting the support you need.

Hope you have a wonderful week and stay safe out there. Browse our website and check out WaterWorks. It should be a part of every woman's feminine hygiene routine.

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Why Can't I Lose Weight?

>> Wednesday, September 17, 2014

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We live in a time where we are all focused on health & diet. We are bombarded on a daily basis by friends and family that are extremely health conscious. It can be confusing. Should I eat a no-carbohydrate diet, low-carbohydrate diet, low-fat, no-fat, low-glycemic, the blood type diet, the Bible diet, the Hindu diet, hormone free, non-GMO, vegetarian, lacto-vegetarian or raw-diet? It is all very exhausting and time consuming to figure it all out.

Then we have to worry about exercise. We all know how many methods and intensities of exercise we can participate in. Some feel that anaerobic exercise like weight lifting is the best; others feel exercise should be fun, so they play sports, whether team or individual.

Most of us feel the guilt and pressure put on us from others, and this can be much more unhealthy than not exercising or changing your diet. In fact, it can discourage us and cause us to freeze up and do nothing. It's just too much pressure! At some point, we have all promised ourselves to start a new diet and exercise program, only to find that by the end of the week we have gained weight, and feel much worse. Why is that? We don't realize that there is much more to weight loss, metabolic control and well-being than just food and exercise. Most of have been taught wrong - eat less and exercise more. We look back to the day when we could basically starve ourselves for three days and lose 5-10 pounds even without exercising. Now that doesn't work, and it's so frustrating.

It's important to know that stress can be damaging to both our physical and mental health, and it also can play a role in weight loss. Stress increases cortisol, and will fight against weight loss. In fact, it can cause weight gain. It is more powerful than any food we put into our mouths.

Today, more women than ever are overly obsessed with weight and feel they need a “perfect” body for their own satisfaction or just to be accepted and loved. Research findings published in the journal Obstetrics & Gynecology found that 16 per cent of normal or underweight women studied believed themselves to be overweight! This often leads to "yo-yo" dieting or popping diet pills, which in turn can completely confuse our metabolism. While these methods may work for a time, they may flip our metabolism around, and every time we try these "starvation" techniques, it will make it harder and harder to lose weight. In fact, it may actually cause weight gain.

Another consequence of stress (and the pressures of looks and weight) on women is emotional eating. Once we begin a new diet and active lifestyle, if we don't see immediate results we quickly become emotionally upset and we give up. The truth is, we did not gain the weight overnight, so we cannot expect to lose it overnight.

Another aspect to keep in mind is sleep. Not only can lack of sleep make us look and feel our worst, but insufficient sleep can also increase stress on our bodies and increase cortisol levels. This can lead to increased accidents, calorie consumption and heart disease. When we are tired, we are more likely to reach for sweets and carbohydrates because we need energy to stay awake and alert. Lack of sleep can also affect blood pressure, blood sugar and our moods.

Not only are women more likely to compromise their sleeping habits to care for children and others, they are also prone to putting their own wants and needs at the bottom of the list. To avoid running yourself into the ground, learn to sometimes say no to those requests and commitments that are less than essential, and make sure you set aside some “me” time each week to do something enjoyable just for you.

Have a great week,
Dr. Susan L. Boyd, MD

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Dangers of Laparoscopic Surgery vs. Hysterectomies

>> Thursday, September 11, 2014

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Many women have hysterectomies for various reasons like heavy bleeding, endometriosis, extreme pelvic pain, fibroids tumors, adenomyosis, and endometrial cancer. Uterine cancer, adenomyosis and uterine fibroids can cause the uterus to abnormally enlarge.

A hysterectomy is a major surgery and requires many weeks of recovery. Of course, many women work outside the home and some are the primary income providers, so taking too much time off to recover from surgery can be a big deal.

So there has been a push towards expansion of minimally invasive surgeries like laparoscopic and robotic techniques. This advance in technology has brought forth many devices quickly and the controversy behind some devices for gynecologic procedures has intensified. Some devices were designed to remove fibroids and large uteruses through a laparoscopic incision by grinding it into small pieces. Prior to these devices, there was no way to do this except through a traditional vertical or horizontal incision. The thinking was that, with smaller incisions and laparoscopic procedures, women could heal faster and spend less time in the hospital.

New technology is hard to resist - patients demand it from their doctors, and many doctors use it to promote their practices and increase business. Many times this enthusiasm from both sides creates short cuts in pre-operative evaluations, pushing aside the traditional protocols. These protocols were set in place to ensure patient safety during operative procedures. But even with a thorough pre-operative evaluation small or hidden cancers can be missed.

We even see huge billboards advertising procedures for fibroids or enlarged uterus removal. They may show a picture of a woman's tummy with a very long incision from the ribs down past the belly-button and stopping at the pubic bone. No one would want that if they can have same surgery done with only three or four 1-2 inch incisions. I sure wouldn't. But the truth is, we rarely use vertical incisions because most of these surgeries can be accomplished with the horizontal "Bikini Cut" incision called a pfanensteil incision.

The new devices are made to fit through the small laparoscopic incisions. With the help of an assistant to hold the fibroid or uterus through one laparoscopic incision, the device is placed through a second incision. It is then placed directly on the fibroid or uterus and can then be turned on to grind the tissue until all the fibroids or the entire uterus is removed.

Just as quickly as it rose in popularity, it's popularity fell away. This happened because it became the focus of many serious complications. During the procedure, many undetected cancers were reported to be found. Once opened and ground up, cancerous tissue can spill into the abdomen and pelvis, resulting in the spread and rapid advancement of the cancer. Manufacturers have recalled devices from hospitals and surgery centers.
We all love technology, as it can make our life so much easier, and hopefully we will see a return of a similar, but much safer, type of device.

Dr. Susan Boyd, MD

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What causes pelvic pain and how to relieve it.

>> Thursday, August 21, 2014

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Many women experience pain in their bodies. It comes and goes and can be cyclic, relating to menstrual periods and ovulation. Other pain can include migraines, breast pain, lower back pain and deep or superficial pelvic pain. It doesn't matter if it's cyclic or relatively constant - pain brings fear and disrupts our ability to enjoy life. Today we're going to focus on pelvic pain.

Pelvic pain can be dull and achy, sharp, steady, intermittent, crampy, and sometimes just feel like a deep pressure or heaviness. It can be triggered by menstrual cycles, sex, and even having a bowel movement or urinating, and it can worsen when sitting or standing for long periods of time. The pain may have obvious origins like painful periods, endometriosis or ovarian cysts. But for some women, it is not so obvious and can be so frustrating.

PCS (pelvic congestion syndrome) is one cause of pelvic pain that is common, but not well-known or talked about too much. In fact, you may never have heard of this before. There is no immediate treatment for PCS, and it can go on for years without being diagnosed. Pelvic congestion syndrome is also known as pelvic venous insufficiency. With PCS, the pelvis become swollen from the back flow of blood (similar to varicose veins in our legs). This prevents normal blood flow through the pelvis, creating congestion, and this causes pain and other symptoms. The condition is associated with ovarian and pelvic vein dilatation where the veins are stretched beyond normal dimensions. This over-stretching can cause permanent damage.

In normal veins, blood flows from the pelvis up toward the heart by way of the ovarian veins, and it is prevented from flowing backwards by valves within the vein. When the ovarian veins are damaged, the valves do not close properly, resulting in back flow of blood.

Weight gain and pregnancy can worsen this condition because increased pressure and stress on the pelvis affects the ovarian veins. This, along with the increase of estrogen in pregnancy and weight gain, causes the vessels to over-stretch and weaken.
The pain with PCS can worsen when sitting or standing, and it is relieved with lying down. It can sometimes be associated with varicose veins in the thighs, buttock regions, or vaginal area. Some women experience pain with urination and during or after sexual activity. This can worsen to the point where you may have constant pain or sharp, stabbing pain, even while laying down resting.

Problems with orgasms during sex can be a cause of PCS. This is because sexual excitement increases blood flow to the pelvis, and orgasm releases the buildup of blood, similar to what we can visibly see in a man who is excited. Increased blood flow to the pelvis will cause an erection in a man, which quickly goes away as pelvic circulation normalizes.

It is important to go see your doctor for a definite diagnosis of your pain and to rule out other causes. Abdominal and pelvic ultrasound is an important tool in the diagnosis of PCS because it can eliminate other common causes of pain and evaluate blood flow. CT Scans and MRI are helpful, but only if ultrasound is unable to see everything or to delineate an abnormality better. Pelvic venography is considered the most definitive imaging modality for diagnosing PCS because it can identify the abnormal veins and the reversal of blood flow within the affected veins.

This may seem strange, but physical therapy and relaxation techniques can be amazingly beneficial. Applications of heat and cold to your abdomen, stretching exercises and massage may help the pain because it can increase your circulation. Kegel exercises may also be helpful, but if the pain is caused from difficulty achieving an orgasm, sexual therapy and evaluation is crucial. Pain relievers that decrease inflammation like aspirin, ibuprofen (Advil, Motrin IB) or acetaminophen (Tylenol) may provide partial relief from your pelvic pain. Sometimes a prescription pain reliever may be necessary. Pain medication alone, however, rarely solves the problem of chronic pain and is not recommended long-term.

Laparoscopic surgery is an excellent way to evaluate pelvic congestion and to determine if there are other factors involved that can't be seen by any other means (i.e. extensive scarring, adhesions or endometriosis).

It is important to see your doctor and not continue to suffer with the pain. It could be easily corrected, or it may take some time and multiple treatments, but waiting may be making it worse and harder to treat as time goes on.

I hope you have a wonderful week and stay safe.

Dr. Susan Boyd, MD

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What Causes Dyspareunia (Painful Sex for Women)?

>> Thursday, July 17, 2014

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Dyspareunia is painful sex due to medical or psychological causes. This can affect up to one-fifth of women at some point in their lives, but, luckily, the causes are often reversible.

The diagnosis of dyspareunia is made when the patient complains of recurrent or persistent vulvar, vaginal or deep pelvic pain before, during, or after sexual intercourse. When pain occurs, it distracts from feeling pleasure and excitement. Both vaginal lubrication and vaginal dilation decrease. When the vagina is dry and undilated, thrusting of the penis is painful.

Many times the original source of pain (a healing episiotomy, for example) is gone but, because we anticipate that we will still feel pain, we stress and tighten our pelvic muscles and cannot relax. This can cause continued pain and is the most common reason for emotional pain.

Complaints of sexual pain will typically fall into one of three categories:

1) When there is pain during initial penetration, it is usually associated with a range of factors like insufficient lubrication from too little foreplay or by a drop in estrogen levels from menopause or breastfeeding. When there is a lack of estrogen, it causes pain from inability to make the natural lubrication or "wetness" when sexually excited. And, the vagina also can't stretch normally or at all. This is called vaginal atrophy, which is the thinning, fragility, shrinkage and dryness of the vaginal tissues. Of course, this causes pain when trying to let the erect penis in.

Pain with penetration can also come from injury due to pelvic surgery, female circumcision, child birth, episiotomy or a congenital birth defect like a thickened hymen.

Chronic skin irritation from yeast, urinary tract or bacterial infection, and eczema that occurs around the vagina and urethra can also cause pain during sex.

Disorders like interstitial cystitis, Lichen Sclerosis, external yeast infections and (rarely) Sjögren's syndrome can also cause excruciating pain and vaginal dryness.

Medications that inhibit desire or arousal and cause a decrease in vaginal lubrication (and resulting increasing pain with sex) include: antidepressants, high blood pressure medications, sedatives, antihistamines and certain birth control pills. You can talk to your doctor about these and hopefully change them if needed.

2) Younger women with dyspareunia seem to have pain with pressure on the outside around the labia, pubic bone and vulvar area where most of the hair grows - causing a burning or a cutting type of pain.

3) Deep pain that comes with pushing deep inside and thrusting against the cervix may be more pronounced with certain sexual positions. This can be caused by infections (of the vagina, lower urinary tract, cervix or fallopian tubes), chlamydia, gonorrhea, coliform bacteria, PID (pelvic inflammatory disease), endometriosis, surgical scar tissue, uterine and vaginal prolapse, pelvic congestion, irritable bowel syndrome, retroverted uterus, uterine fibroids, cystitis, diverticulitis, appendicitis, hemorrhoids, ovarian cysts or other tumors.

Because there are numerous physical conditions that can contribute to pain during sex, a careful physical examination and medical history are always indicated.

It can help a lot if you know where you like to be touched so that it feels good. Try to add pleasant, sexually exciting experiences such as bathing together or mutual caressing without intercourse.

Lots of kissing on the lips and all over each other's body, including oral sex may relax and lubricate the vagina. Oral sex may also be an alternative, as it may be pleasurable without pain at all. Trying a change in your sexual positions may also help. Be sure to talk about what feels good and what doesn't. If you need your partner to go slow, say so. Don't rush. Longer foreplay can help stimulate your natural lubrication. And you may reduce pain by delaying penetration until you feel fully aroused. Lots of couples just don't talk out of embarrassment, shyness or awkwardness about telling your partner what you like and what you don't like (or what hurts).

Remember, if you are embarrassed about vaginal odor or discharge, you can talk to your gynecologist and check out WaterWorks if you do not have an infection that needs to be treated. WaterWorks is FDA cleared for clearing vaginal odor and for routine feminine hygiene. It is a safe way to cleanse your vagina so you can feel confident during sex.
I hope you are all well and happy. Take care and be safe out there.

Dr. Susan L. Boyd, MD

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