Treatment Options for Heavy or Prolonged Menstrual Periods

>> Thursday, October 30, 2014

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Heavy or prolonged menstrual periods, or menorrhagia, is the most common type of abnormal bleeding that women experience.  Periods are considered heavy if there is enough blood to soak a pad or tampon every hour for several consecutive hours.  Sometimes, it's nighttime bleeding that requires getting up to change pads or tampons or passing large blood clots.  And, when our periods last longer than 7 days with heavy bleeding, not spotting.  All of this can interfere with sleep and daily activities and lead to anemia, causing symptoms such as fatigue and shortness of breath.

As we have discussed, a balance between estrogen and progesterone regulates the buildup of the endometrial lining of the uterus, which is shed during menstruation.  If a hormone imbalance occurs, this lining can thicken too much, causing many menstrual irregularities.

Certain drugs, including anti-inflammatory medications like aspirin, and anticoagulants or blood thinners can contribute to heavy or prolonged menstrual bleeding.  Also, if someone has a blood coagulation disorder from birth, such as Von Willebrand's disease, the blood doesn't clot well.  There are other inherited disorders as well that can cause abnormal menstrual bleeding. The good thing is these are usually identified at the same time as the first period, because it will be very heavy.

There are a number of other medical conditions, including pelvic inflammatory disease (PID), thyroid problems, endometriosis, and liver or kidney disease, that may be associated with menorrhagia.  Also, fibroids, polyps or other noncancerous tumors of the uterus, and things like Adenomyosis, which is a condition that causes the glands from the lining of the uterus to become imbedded in the muscular wall of the uterus.  Of course, the worst case scenario would be some kind of female cancer like uterine, ovarian, or cervical cancer.  These are rare, but possible, causes of heavy menstrual bleeding.  Other medical conditions can prevent normal blood clotting, including liver, kidney, or thyroid disease, and bleeding or platelet disorders.

Treatment for menorrhagia once you have identified the reason, may include one or more of the following things:

  • The nonsteroidal anti-inflammatory drugs such as ibuprofen and naproxen can reduce the amount of blood loss and help with pain.
  • Lysteda (tranexamic acid), a non-hormonal medication that can also be prescribed to you because it promotes blood clotting and will significantly decrease blood loss.
  • Birth control pills or hormone therapy is a common method used to stabilize the endometrial lining of the uterus, regulate menstrual cycles, or correct hormonal imbalances.
  • The IUD Mirena is used for heavy bleeding and also prevents pregnancy.  It works by local progesterone absorption, not systemic absorption.  That means no hormone goes into the blood stream, so it doesn't affect or change our own hormone balance.  In fact women continue to ovulate and have their own natural hormone fluctuations.  Because this local absorption thins the lining of the uterus (endometrium), it makes periods very light, or absent.  This makes it a wonderful method for helping with heavy or irregular menstrual bleeding.  It is also effective in preventing pregnancy because it thickens the cervical mucus, or discharge, so much that the sperm cannot pass through the cervix to fertilize the egg.  This is a good choice for women who do not want surgery or who cannot or don't want to take hormones.

Many women have chosen more permanent procedures when they are done having children.  Endometrial ablation can be done in several ways like freezing, hot thermal balloon ablation, electro-cautery, and hot water.  This effectively cauterizes the endometrial lining so it won't build up monthly any more.  It can last 3-5 years and occasionally can be permanent.  It is considered a semi-permanent way to stop heavy menstrual or frequent/continuous vaginal bleeding.
Hysterectomy, which is complete removal of the uterus, as it is the uterus that bleeds.  Ovaries produce all the female hormones and can be removed, but if there is no pain problems, it is best to leave them for hormone support. 

Many women who have continuous or irregular bleeding can also have odor problems.  This happens because the vagina maintains health by being slightly acidic.  Blood is a higher, physiological pH and this will cause a rise in vaginal pH.  When this happens, yeast and abnormal vaginal bacteria overgrows and this brings abnormal odors and could lead to yeast or bacterial infections.

UsingWaterWorks during this time to rinse out the excess blood would help keep away unwanted orders.  It is safe to use daily, uses no chemicals and is FDA cleared to help with vaginal odor. :)

I hope you have a wonderful week and stay safe!

Dr. Susan L. Boyd, MD


Cysts and Ovarian Cancer

>> Friday, October 24, 2014

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Good morning to all of you. I hope you are all feeling well and looking forward to the day. Over the past couple weeks, we've been discovering how our ovaries work and what it means when we are told we have cysts. We've learned that cysts do not necessarily mean cancer or that you are more likely to get cancer.

We have learned that, before menopause, we make cysts called follicular cysts (or follicles) every single month. Our eggs mature in these. Then, once we ovulate or release the egg, all the rest of the follicles shrink up and go away. In a normal menstrual cycle, the balance between the hormones estrogen and progesterone regulate the buildup of the uterine lining (the endometrium), so that it doesn't get overly thick or come out at the wrong time. Without this precise synchronization, it can cause prolonged, irregular or excess bleeding or miscarriages.

So many of us worry about getting cancer or have friends and family members who have died because of it. It is just so scary! Some cancers are genetically linked, but the majority are not and have no hereditary or genetic link.

It is important to note that most ovarian cysts, whether cancerous or benign, cause very slight or no symptoms. So what changes should we look for in our body? Is it pain, extreme weight loss or weight gain, or weakness and fatigue? Or perhaps sharp stabbing and shooting pains down our legs or in our lower back and vagina? Well, when women reflect after being diagnosed with cancer, they often agree on some of these symptoms:

  • Persistent abdominal bloating, indigestion or nausea
  • Changes in appetite or feeling full sooner
  • Feelings of pressure in the pelvis or lower back that can make you feel like you have to pee or poop more often
  • Sometimes there are changes in bowel movements like diarrhea or constipation
  • Feeling like your pants are too tight, but you are not gaining weight
  • Feeling tired or low energy for no reason

What's scary is that all these same symptoms can also occur with many things like benign cysts, uterine fibroids, Irritable Bowel Syndrome and diverticulitis. Women may also feel pelvic pain when they have chronic problems like endometriosis, interstitial cystitis (chronic bladder inflammation), painful periods or painful sex. And any severe or persistent pelvic pain can cause nausea and vomiting.

Whether benign or cancerous, ovarian pain becomes worse when the ovaries become enlarged, or are bumped/pinched during sex or when having a bowel movement. The left ovary sits right next to the colon and, when it is enlarged from a benign or follicular cyst, it can be bumped as the colon moves when we are passing gas or getting ready to go poop. Both benign or malignant cysts can pop and bleed or they can flip over and block their own blood flow, which is called torsion.

Getting back to 'square one'… can we know if we have ovarian cancer? Uterine cancer and cervical cancer cause abnormal bleeding, and breast cancer causes lumps or breast retractions, but ovarian cancer is so silent.

It may be helpful to know that ovarian cancer is very rare, with less than 1% of women getting it. We are more likely to die of heart disease, lung cancer, breast or skin cancer.

Certain risk factors may make some women more likely to get cancers (ask your doctor for specific tests along with the annual exam and Pap smear):

  • Menopause, although due to the increase of hormone use and growth hormone in our food we are seeing cancer at younger ages; we are seeing an increase in breast and ovarian cancer as early as 22 years old when it was unheard of 20 years ago
  • Smoking
  • Obesity
  • Never having had children
  • Not breastfeeding
  • Taking fertility drugs for many years
  • Family history of ovarian, breast, thyroid or colorectal cancer or any cancer yourself
  • Note: Birth control pills and hormone replacement therapy, because they rest your ovaries, can actually reduce the risk of ovarian cancer

If you ask for an ultrasound along with specific blood tests called tumor markers, it can help diagnose early cancer. The ovary should not show any cyst and a blood test called a CA-125 should read in the normal range. If either one are abnormal, then further testing should be done. Tests like CT scans, Doppler flow studies, or MRI can see the ovaries better and define any growth. They can also see the lymph nodes to evaluate them for cancer as well. Other blood tests include CBC, Chemistry panel and Tumor markers such as LH, CEA, FSH, and HCG, plus estradiol and testosterone. Tumor markers test for the different types of cancer - whether ovarian or not. The blood tests for cancer are becoming more sophisticated and specific every year.

The different types and classifications of tumors are:

  • Epithelial cell tumors that start from the cells on the surface of the ovaries; these are the most common type of ovarian tumors
  • Germ cell tumors that start in the cells that produce the eggs and can either be benign or cancerous
  • Stromal tumors originate in the cells that produce female hormones

Treatment really depends on the type of cancer and how early or late it is discovered. It is up to the Cancer Specialist to make the decision as to whether chemotherapy, radiation, surgery, or a combination of these would be most helpful.

So, to summarize, it is comforting to know that Ovarian Cancer is rare, but the difficulty in screening and lack of symptoms can make it hard to detect early. Most are found at an advanced stage, and that is why most women do not survive, not because it can't be cured.

Some women will notice an increase in vaginal discharge with a hormone active cyst or when a large cyst ruptures. Since the vagina likes to maintain a slightly acidic or low pH, any increase or change in vaginal discharge can change the normal flora and raise the pH to a more alkaline environment.

This can cause unwanted odors, and most abnormal vaginal odors won't go away with bathing. The worst thing to do is douche, as this can further disrupt the vaginal environment and make it harder/longer to heal. Never wash inside your vagina with soap either. If you feel you need to clean inside the vagina, only use plain water, as it will not disrupt the natural self-cleaning ability.

WaterWorks is a natural, easy way to accomplish feminine hygiene every day, inside and out. It can be used after your period, after sex, or everyday to rinse out discharge and erase unwanted odors. Since it is FDA cleared to help remove vaginal odor, it is the best way to stay feeling confident and fresh without the use of medicine or chemicals. If you think you have an infection, you need to see your doctor for cultures and for that you may need medicine. It is still safe to use WaterWorks while you are being treated for infection.

Hope you all have a safe, happy weekend :)

Dr. Susan L. Boyd, MD


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


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


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.


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


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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