Adrenal Fatigue | Bio-Identical Hormone Therapy | Bladder / Urinary Health | Bone Health | Breast Thermography | Contraception | Endometriosis | Genetic Screening | High Cholesterol (Hyperlipidemia) | Hormonal Imbalance | HPV (Abnormal Pap Smears) | Infections | Inflammation | Insulin Resistance | Menopause | Metagenics | Polycystic Ovarian Syndrome | Premenstrual Syndrome (PMS / PMDD) | Sexual Health & Libido | Symptomatic Menopause | Thyroid Dysfunction | Ultrasound | Urinary Incontinence | Uterine Fibroids | Vaginismus | Vulvodynia
Wellness and health depend upon support of the adrenal gland. The adrenal gland makes cortisol which is responsible for helping the body cope with stressors. Stress is anything that impacts the body: chemical, emotional, physical or environmental stressors can all contribute.
When cortisol levels are less than optimal, conditions related to increased inflammation and altered metabolism may occur, such as acute illnesses, surgeries, hormone imbalances, thyroid problems, fibromyalgia, allergies, even coronary artery disease. Altered cortisol levels affect the immune system, making people more susceptible to infections, fatigue, and chronic pain. Low cortisol levels can affect our metabolism and sugar balance, which then influences our appetite, weight control, and energy level.
Supporting one’s adrenal gland is a long-term commitment to lifestyle changes by reducing stress, living an active lifestyle, making healthy dietary choices. Some women also require adrenal support creams, which are not supposed to be long-term but used to support the body to give the energy needed to make the changes needed for life.
Bio-Identical Hormone Therapy
While our office has been prescribing bio-identical hormone therapy (BiHT) for 25 years, public interest in BiHT started to take off in 2002 when a large study called the Women's Health Initiative (WHI) was halted after researchers discovered an increased risk of breast cancer, heart attack, stroke and other problems in post-menopausal women taking a conventional FDA-approved combination of non-bio-identical estrogen and progesterone hormone replacement therapy (HRT). Many women stopped HRT, and some went looking for alternatives.
Unlike conventional hormone therapy, which uses synthetic or animal-based prescriptions, BiHT are biochemically the same as those made by the ovaries during a woman's reproductive years. The term "bio-identical" does not indicate the source of the hormone, but rather refers to the chemical structure. In order for a replacement to fully replicate the hormones which were originally naturally produced and present, the chemical structure must exactly match the original. BiHT is able to follow normal metabolic pathways so that essential active metabolites are formed.
Bio-identical hormones include estradiol (E2), estriol (E3), progesterone, testosterone, dehydroepiandrosterone (DHEA) and pregnenolone. Our patients work with a variety of compounding pharmacies, including the local Western Massachusetts Compounding Center (http://www.wmccpc.com/#!bhrt-compounding/cfhl/), located in nearby West Springfield, Massachusetts. These compounding specialists work together with our providers to create customized BiHT that provides the needed hormones in the most appropriate
strength and dosage form to meet each person's specific needs.
Typically, a patient has an initial Bio-Hormone Consultation visit at our office to discuss family and personal medical history, as well as specific symptoms and concerns. We then refer for bloodwork to check hormone levels, and these results are used to create a customized plan to treat symptoms and improve quality of life. Follow-up visits, including close monitoring and medication adjustments, are essential. Our providers see patients from all walks of life for Bio-Hormone visits; one need not be a post-menopausal woman to take advantage of this type of therapy.
Bladder / Urinary Health
Bladder leakage is a very common symptom, affecting over 30 million women nationally. Symptoms can range from leakage when coughing, laughing or exercising (stress incontinence) to urgency and urinary frequency (urge incontinence). These symptoms can be slightly bothersome or totally debilitating. For some women, the risk of public embarrassment keeps them from enjoying activities with their family and friends. Urine loss can also occur during sexual activity and cause emotional distress. Often, women think leaking is a normal part of aging or an acceptable consequence of pregnancy and childbirth, simply adding a box of pads to their shopping list each week. The reality is that leakage is not a normal part of aging and should not be tolerated, especially when there are treatments available to improve quality of life. Our office helps to evaluate for these concerns via urodynamic testing to achieve an appropriate diagnosis. We additionally recommend and assist in implementation of a variety of treatments including bladder retraining, referrals for physiotherapy, as well as use of devices including the InTone and ApexM. These devices empower our patients to strengthen their pelvic musculature and relieve their urinary symptoms.
For more information regarding Urodynamic testing in this office, as well as treatments utilizing the InControl Medical family of devices, please see our Urinary Incontinence page.
Bones play many roles in the body. They provide structure, protect organs, anchor muscles and store calcium. Adequate calcium consumption and weight bearing physical activity build strong bones, optimizes bone mass, and may reduce the risk of osteoporosis later in life.
By adulthood, the average woman has acquired most of her skeletal mass. A decline in bone mass occurs in older adults, increasing the risk of osteoporosis. It is important for young girls to reach their peak bone mass in order to maintain bone health throughout life. A person with high bone mass as a young adult will be more likely to have a higher bone mass later in life. Inadequate calcium consumption and physical activity early on could result in a failure to achieve peak bone mass in adulthood.
Osteoporosis or "porous bone" is a disease of the skeletal system characterized by low bone mass and deterioration of bone tissue. Osteoporosis leads to an increase risk of bone fractures typically in the wrist, hip and spine.
- Bone Mineral Densitometry Scan (BMD) BMD is a test used to determine whether you have, or are likely to develop, osteoporosis. The test is painless, brief and uses X-Ray technology to view a single area and create two number scores. The T-Score result compares your bone density to those of a young person, and the Z-Score compares your bone density to other people in your age group. A T-Score of -2.5 indicates osteoporosis.
- Diet and Supplements Calcium and Vitamin D are important supplements to maintain bone health. Many studies show that most Americans are not getting the recommended amount of these supplements. Dairy products are excellent sources of calcium. Other dietary sources of calcium include dark green leafy vegetables (collard greens, broccoli, bok choy and spinach), almonds, beans and soy products (tofu, soy milk, tempeh). Canned sardines and salmon with bones are also high in calcium. If getting enough dietary calcium is difficult, supplements are available.Adequate amounts of vitamin D are necessary for your body to absorb calcium properly and for your bones to stay healthy. Skin makes vitamin D from sun exposure; however climate and dermatological concerns can limit exposure. Therefore, it makes sense to get adequate amounts of vitamin D from fortified foods or supplements.Additional recommendations for bone health include limiting sugar intake; some studies show that a high-sugar diet can reduce the calcium content in bones. If you drink alcohol, don't have more than one drink per day. In addition, avoid excessively high protein, phosphorus and sodium intake. Remember, following a healthy diet and getting regular exercise are important preventive measures in reducing your risk of developing osteoporosis.
- Treatment for Low Bone Mass There are a variety of pharmaceutical treatments available for low bone mass, including estrogen and other hormone replacement therapies, and a class of medications called Bisphosphonates. These medications are used to assist in maintaining bone mass and to reduce the risk of fracture. Medications, dosing, and side effect profiles vary from daily or weekly oral pills, to twice yearly in-office injections. Our providers are well versed in all available treatments, and our group is happy to work with you to help maintain bone health.
Our office partners with X to Rays to offer a specialized type of breast screening called Thermography. For more detailed information, please visit our Breast Thermography page.
- EC (Emergency Contraception) Emergency contraception, also called the morning-after pill, is a high dose of the hormone progestin taken up to 5 days (120 hours) after intercourse to help prevent pregnancy after a condom break or forgotten birth control pills. It works by delivering a short, high burst of synthetic hormones, delaying ovulation and altering the development of the uterine lining. EC is available over-the-counter, by brand names such as Next Choice, Plan B and Ella.
- IUDs An IUD, or intrauterine device, is a form of contraception that is inserted into the uterus by your medical provider. IUDs are an effective, popular choice for longer-term contraception and for those who are not able to take hormonal birth control. Our office is proud to offer all three IUD options; call to schedule an IUD consultation visit and find out more about which is right for you.
- Mirena The Mirena IUD is a hormone-releasing, T-shaped plastic device. The stem contains the progestin levonorgestrel, which is released continuously over a period of five years at a rate of 20mcg per day. The Mirena has an efficacy rate of 99.8%, making it comparable to sterilization via tubal ligation. Normal fertility returns within a few months after removal, with 80% of women conceiving within 12 months.
- Paragard The Paragard IUD is a T-shaped piece of plastic with a copper wire wrapped around the 'arms' of the T, or with copper sleeves on the arms or stem of the device. The arms of the T help to anchor the device in the uterus. These devices have a lifespan of up to 10 years after insertion, have an overall efficacy rate of 99.2%, and are able to be removed at any time, restoring full normal fertility. They are also suitable for use as an emergency contraceptive
- Skyla The Skyla IUD is a hormone-releasing, T-shaped plastic device. The stem contains the progestin levonorgestrel, which is released continuously over a period of three years at a rate of 14mcg per day. Like its cousin device Mirena, the Skyla has an efficacy rate of 99.8%, making it comparable to sterilization via tubal ligation. Skyla is recommended and marketed to younger women who have not yet had children and whose uterus may require its smaller size.
- Hormonal Hormonal birth control includes a variety of methods that use hormones to provide contraception. These hormones are administered in different ways, including injection (DepoProvera), oral birth control pills, the patch (Ortho Evra) and the ring (Nuva Ring). There are two types of hormonal birth control: combined methods, which contain both synthetic estrogen and synthetic progesterone (progestin) and progestin-only methods (the injection and the minipill are examples of progestin-only methods). In general, hormonal methods of birth control are over 99% effective if taken perfectly, and around 95% effective with "typical use". Combined methods stop ovulation, thicken the cervical mucus, and thin the uterine lining. Progestin-only methods thicken the cervical mucus and thin the uterine lining, but most women continue to ovulate while using these methods. Our providers are well versed in all methods of contraception and are happy to discuss which option is best for you.
- Non-Hormonal Non-hormonal birth control (NHBC) encompasses all types of birth control that do not involve taking hormones. As with hormonal birth control, the end result is to prevent pregnancy. There are a wide range of options for NHBC as well as a wide range of success rates. Some methods don't even require leaving the house, such as the fertility awareness method or withdrawal, while others may require a trip to your local drug store for condoms or contraceptive sponges.
Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus grows elsewhere in the pelvis, most commonly involving the ovaries, bowel or other pelvic structures. Symptoms often include severe pain, gastrointestinal symptoms, pain with sexual activity and fertility problems. It is diagnosed via exam, ultrasound and exploratory surgery, if needed. Treatments include hormonal contraception and pain medications.
Our office utilizes a variety of cutting-edge technologies to assist patients in evaluating for hereditary and sporadic cancers. We routinely review personal and family cancer histories to ensure we are recognizing all risk factors, and we refer for screening exams as appropriate.
- BREVAGen BREVAGen is a screening test that can help determine a person's risk of developing breast cancer. In some cases, those who develop breast cancer have a strong family history; this can be caused by inheriting a gene mutation. Several mutations may be involved, most commonly found in the genes known as BRCA1 and BRCA2. While a genetic test that examines these specific genes can determine whether any mutations exist, only 5-7% of cancers develop because of an inherited mutation. More than 80% of people diagnosed have little or no family history of the disease. This is known as sporadic breast cancer. Researchers know that certain risk factors, such as a woman's current age, age at her first menstruation, age at first child birth and her number of breast biopsies, can affect her chances of getting sporadic breast cancer. But now, a link has also been discovered between the disease and the presence of specific genetic markers called Single Nucleotide Polymorphisms (SNPs). The BREVAGen test uses this information to help determine your risk of developing breast cancer.Diagnosed early, the survival rate for breast cancer is 95%. Detected at later stages, it drops to just 41%. Early detection and having personalized care based on your individual risk is vital to beating the disease.Testing consists of two parts: reviewing information and cell sampling. During the first part, you'll be asked a series of questions to determine your Clinical Risk of developing the disease. Next, your provider will swab your cheek so that the laboratory can analyze specific genetic markers on your DNA. Test results return from the lab, and your provider will review them with you and help create a personalized breast health plan based on your individual risk and laboratory results.
Click here for Brevagen Video
- Myriad myRisk™ Previously, our office worked with Myriad Laboratories to offer COLARIS® and BRACAnalysis® testing. These genetic tests assess a person's risk of developing hereditary colorectal cancer and a woman's risk of developing hereditary uterine cancer. In addition, these tests complete sequencing of the BRCA1 and BRCA2 genes and an additional procedure to identify five common large rearrangements in the BRCA1 gene, which can contribute to breast and ovarian cancer.Recently, science has given much more insight regarding genetically linked cancers and now we offer Myriad myRisk™ testing, which captures more mutation carriers than BRACAnalysis® and COLARIS® combined. Research suggests that Myriad myRisk testing increases mutation discovery by 40% to 50%.Myriad myRisk testing:
- Blends the patient's genetic testing status and their personal or family history of cancer into clinically actionable risk assessment and follow-up.
- Generates a report that is simple, clear and easy to use.
- Delivers exact medical management recommendations to patients based on guidelines developed by leading medical organizations.
- As with other tests, myRisk testing consists of two parts: reviewing information and specimen obtaining. During the first part, you'll fill out a simple form asking a series of questions to determine your personal history of developing disease. Next, your provider will send you to the lab for simple blood work, which the laboratory will use to analyze specific genetic markers on your DNA. Tests results return from the lab in 2-4 weeks, and your provider will review them with you and help create a personalized breast health plan based on your individual risk and laboratory results.
High Cholesterol (Hyperlipidemia)
This is a condition when there are elevated lipids, or fat in your blood stream. There are three components to cholesterol levels: HDL (high-density lipoprotein), considered ‘good cholesterol’, LDL (low-density lipoprotein), considered ‘bad cholesterol’, and triglycerides. A lipoprotein helps to bind to lipids and transport them and can be either high or low density. When a person has higher levels of HDL helps by removing the bad cholesterol from the body, which decreases chances of heart disease. This is done by increasing dietary intake of omega 3 fatty acids like olive oil, fish oil, flax oil, tree nuts, and avocados. LDL can collect along the walls of your arteries causing blockages, atherosclerosis which can lead to heart disease and stroke, which is why a lower LDL is desirable.
There are two broad types of trans fats found in foods: naturally-occurring and artificial trans fats. Naturally-occurring trans fats are produced in the gut of some animals, and foods made from these animals (e.g., milk and meat products) may contain small quantities of these fats. Artificial trans fats (or trans fatty acids) are created in an industrial process that adds hydrogen to liquid vegetable oils to make them more solid. Processed foods created with hydrogenated fats like cookies, baked goods, crackers, margarines, icings, fried foods, and snack foods can all contribute to elevated LDL levels.
Triglycerides are the byproduct of fats from the foods we eat and can also be produced from some carbohydrates. They are actually the fat circulating in our blood and can lead to atherosclerosis, heart disease, and diabetes.
Cholesterol levels and the ideal balance between them can be improved by avoiding processed foods and bad oils, limiting carbohydrate overload, increasing daily intake of foods and oils rich in omega 3 fatty acids, and increasing regular physical activity or exercise.
Hormones are created by the body’s endocrine glands, such as the thyroid, ovaries, pancreas, and adrenal gland. They are very potent chemical messengers in the body that travel through the bloodstream carrying information to organs and tissues. It takes only a small amount to initiate action within a cell. Only cells that are sensitive to that hormone, called the target cell, will respond to the chemical signal. Once in the cell, hormones help govern growth, development, and mental and physical functioning throughout life.
All hormones are inter-related and every cell in the body depends upon adequate levels. Hormones can become imbalanced at any time, whether an over production or underproduction due to chemical, physical, emotional, and environmental stress or by the effects of normal aging. In women, the primary contributors to hormonal imbalances are estrogen and progesterone.
As the body does not store most hormones within the cells, it must constantly monitor hormone levels to release them precisely at the right time when they are needed. Because of the intricate communication process between hormones and cells, problems often involve a series of hormones. This disruption in hormone production by one gland or glands can then cause other gland systems to malfunction.
HPV (Abnormal Pap Smears)
Human papillomavirus, or HPV, is a common virus. The sexually-transmitted, high-risk strains of HPV can cause abnormal cell growth on the cervix, or the opening of the uterus. These abnormalities are detected via Pap smear. Abnormal Pap smear results can vary from mildly to severely abnormal, and response depends upon the severity of the result. Typically your provider will recommend evaluating with a brief in-office procedure called a colposcopy and biopsy. After those results are available, your provider will meet with you to make a personalized treatment plan, including repeat evaluation at regular intervals.
We reserve time in our schedule to work in patients with infection symptoms. For this type of office visit, patients leave a small urine sample, have vital signs checked and have a pelvic examination. This exam includes swabs for infection if indicated, and for certain types of infections, we use a two-swab, in-office treatment applying anti-yeast and anti-bacterial agents to help speed healing.
- Non STIs
- Atrophic Vaginitis Atrophic Vaginitis is a condition caused by the thinning of the vaginal wall tissue and increased vaginal pH due to decreased estrogen levels at or after menopause. Typical infection symptoms include dryness, burning, itching, irritation, lack of discharge and pain with intercourse. Treatment with estrogen (either oral or topical) is prescribed after infection is confirmed via in-office swab.
- Bacterial Vaginosis Bacterial Vaginosis is an overgrowth of several bacteria that normally exist in the vagina. It can develop when an external factor (such as sexual activity) disrupts the balance between beneficial and harmful bacteria. Typical infection symptoms include itching or irritation, green/grey discharge, pain with intercourse and odor. Treatment with an antibiotic (either oral or vaginal) is prescribed after infection is confirmed via in-office swab.
- Urinary Tract Infections UTIs are caused by bacteria in the urinary system, including the bladder, ureters and urethra. Despite being common, UTIs should receive prompt medical attention, as they can spread to the kidneys and become very serious. Risk factors can include sexual activity, pregnancy, being menopausal, dehydration and differences in anatomy. Urinary infections are diagnosed via sterile urine sample analyzed in-office or in a laboratory, and treatment is via common antibiotics. Increasing hydration and avoiding caffeine, which can irritate the bladder, are other common recommendations.
- Yeast Infection Yeast is an overgrowth of Candida in the vagina or on the vulva. It can develop when an external factor (like dietary changes, antibiotic use or using soap/detergents on the area) disrupts the balance between beneficial and harmful flora. Typical infection symptoms include itching or irritation, white/clumpy discharge and pain with intercourse. Treatment with an antifungal (either oral or vaginal) is prescribed after infection is confirmed via in-office swab.
- Sexually Transmitted Infections
- Chlamydia Chlamydia is a common infection caused by a particular type of bacteria. It does not typically present with symptoms, though symptoms may include abnormal discharge, pain with intercourse or bleeding after intercourse. Testing is performed via urine sample or cervical swab, and treatment is with oral antibiotics. A test of cure is recommended post-treatment to confirm infection has resolved.
- Gonorrhea Gonorrhea is a common infection caused by a particular type of bacteria. It does not typically present with symptoms, though symptoms may include abnormal discharge, pain with intercourse or bleeding after intercourse. Testing is performed via urine sample or cervical swab, and treatment is with injected antibiotics. A test of cure is recommended post-treatment to confirm infection has resolved.
- Herpes Simplex Virus (HSV) HSV is a common infection that causes "cold sores" or "fever blisters" in the oral area (known as "oral herpes") and similar symptoms in the genital area ("genital herpes"). There are two types: HSV-1 and HSV-2. According to the Centers for Disease Control and Prevention, "At least 45 million people ages 12 and older, or one out of five adolescents and adults, have had genital HSV infection." Typical infection symptoms include itching, followed by red bumps that ulcerate or break open, which may be uncomfortable. Symptoms typically resolve in 7-10 days. Diagnosis is made via visual exam and perhaps swab or blood work, and antiviral medications can be prescribed to reduce the severity and duration of symptoms.
- HIV HIV is the virus that causes AIDS. It is rare and very serious. It does not usually have symptoms for 10 or more years after exposure. Testing is performed via bloodwork, and antiretroviral therapy is possible, though there is no cure.
- Human Papillomavirus (HPV) HPV is a common infection that causes abnormal cell growth on the vulva or cervix. There are two types of HPV: those that cause external growths (warts) and those that cause internal growths, which manifest as abnormal pap smears. Typical infection symptoms for genital warts include clumpy or bumpy growths on the vulva. Diagnosis is made via visual exam and perhaps confirmed with biopsy. Treatments include self-applied or office-administered cream or liquid.The type of HPV which affects the cervix has no symptoms. Diagnosis is made via abnormal Pap smear, followed by colposcopy with biopsy to sample the tissue. Treatment includes preparations such as TCA and/or Fluoroplex.
- Syphilis Syphilis is a rare but serious infection caused by a particular type of bacteria. It presents in three stages, the first of which is characterized by an open sore or chancre. Testing is performed via bloodwork, and antibiotic treatment is possible in early stages.
- Trichomoniasis Trich is a common infection caused by a particular type of protozoa. Typical infection symptoms include abnormal frothy discharge, itching or irritation and urinary symptoms. Testing is performed via in-office or laboratory swab, and treatment is with oral antibiotics. A test of cure is recommended post-treatment to confirm infection has resolved.
Inflammation happens as a natural process of the body, where white blood cells fight off infection caused by foreign substances like viruses and bacteria. When the body is impacted by stress, including viral or bacterial infections, emotional, physical, chemical environmental stressors, it reacts by trying to fight. Diet greatly affects the immune system and this inflammation response, especially when we are eating inflammatory or highly processed food items.
A diet high in hydrogenated fats, white starches, refined sugars, and high fructose corn syrup, which are found in most processed and packaged foods, causes the body to react with inflammation. White blood cells try to process the LDL from these foods, in an attempt to protect the blood vessels from being affected. In the process, the white blood cells convert the LDL to a toxic (oxidized) form, a chemical reaction that causes inflammation. When inflammation becomes chronic it can block hormones and affects cells from functioning normally. It can also cause increased clinical risks of serious medical problems, including heart disease, diabetes, cancers, Alzheimer’s, autoimmune disorders, joint and muscle aches and pains, and obesity.
Insulin resistance, also known by the terms pre-diabetes, syndrome X, or metabolic syndrome, is when the body produces insulin but does not respond to it. Carbohydrates are sugars; they are the energy source for the body. With carbohydrate intake, the pancreas then produces insulin to help these sugars get into the cells. This is a very precise process to keep your bodily functions in tune and working smoothly. When a person eats too many simple carbohydrates and refined sugars, they enter the blood stream quickly, causing a high volume of insulin to be produced. Over time, with repeated high consumption of carbohydrates and sugar, the body needs to make more and more insulin to keep up. This builds a resistance as the pancreas is triggered to make an ever increasing amount of insulin. This cycle leads to increased hunger, weight gain, slowed metabolism, and increased risk of serious medical problems such as heart disease, dementia, and cancer.
Treatments include prescription medication to decrease chances of long term damage, but this condition can be easily prevented or even reversed with a good diet, vitamins, supplements, and physical activity or exercise.
Menopause is defined as the final menstrual period and is usually confirmed when a woman has missed her period for 12 consecutive months (with no other obvious causes). It is a normal, natural life event. Once you have gone through menopause, you can't get pregnant anymore, and hormone levels will remain low rather than changing with your cycles.
Physical changes begin years before the final menstrual period. This transition phase is called perimenopause and may last for 4 to 8 years. The average age of menopause is 51, but it can happen as early as 40 or as late as 55.
There can be a lot of concern about menopause, and it can cause uncomfortable symptoms. But there are many ways to treat symptoms and stay active and strong. Common symptoms include hot flashes, night sweats, sleep changes and libido changes. Our providers are familiar with a wide range of treatments for these and more symptoms, and we are happy to discuss alternatives with you at your next visit.
We have long worked with the Metagenics company and believe in their approach to nutrigenomics (the field of science dedicated to increasing genetic potential through nutrition). For more information, please see our Metagenics page.
Polycystic Ovarian Syndrome
Poly-Cystic Ovarian Syndrome or PCOS is one of the most common female endocrine disorders, affecting up to 1 in 10 women. It is characterized by infrequent or prolonged menstrual periods, hirsutism, acne and obesity. PCOS is often recognized by changes in the menstrual cycle and androgenic-like changes such as abnormal hair growth. Other symptoms include difficulty becoming pregnant or unexplained weight gain.
Although the exact cause of PCOS is unknown, at the cornerstone of this condition is often metabolic dysfunction associated with poor glucose control and insulin resistance, which can lead to increased cardiovascular and diabetic risk. Metabolic dysfunction can be managed with both pharmacological and non-pharmacological methods. Early diagnosis and treatment may reduce the risk of long-term complications, such as Type 2 Diabetes and heart disease. Treatments include hormonal medications to reduce androgens, regulate menses and treat insulin resistance. Medications can also be used to target particularly bothersome symptoms, such as excess hair growth.
Premenstrual Syndrome (PMS / PMDD)
Pre-menstrual syndrome is a constellation of symptoms experienced 7-10 days before the onset of a period. Symptoms can continue for 3-4 days into menses, and can include depression, anxiety, bloating, fatigue, gastrointestinal distress, breast tenderness, sleep disturbance, trouble concentrating, food cravings, acne, puffiness in hands or feet, weight changes and more. These symptoms can range from mild to debilitating.
If the depression is debilitating, affecting a person’s daily activities like work and personal relationships, it is termed pre-menstrual dysphoric disorder, or PMDD. This is a severe form of PMS that affects a small subset of the population.
Treatments are available and range from diet and lifestyle changes to prescription medications, including hormones and psychotropic medications. Symptoms can often be helped with a good diet, vitamins, supplements, and physical activity or exercise.
Sexual Health & Libido
- Female Sexual Dysfunction Female sexual dysfunction includes disorders of desire, arousal and orgasm, as well as dyspareunia and vaginismus. Hypoactive sexual desire is defined as a persistent lack of desire for sexual activity and sexual fantasies. Female arousal disorder is a chronic inability to develop and maintain sexual excitement and genital lubrication. Orgasm disorder is a persistent delay or absence of orgasm following normal sexual excitement and stimulation. Finally, sexual pain disorders include dyspareunia, which is defined as recurrent complaints of genital pain associated with sexual intercourse. Vaginismus, a subset of pain disorder, is an involuntary contraction of the perineal muscles when vaginal penetration is attempted.
- Treatments For desire dysfunction, patients should be encouraged to make "dates" for sexual activities. Such planning can help to create sexual anticipation, which in turn promotes sexual desire.For arousal dysfunction, patients should be advised to try non-coital massage. Sensual massage without genital stimulation (where one partner provides stimulation while the other partner receives pleasure and gives feedback as to what feels good) can give couples a "model" for sexual activity. These exercises are aimed at promoting relaxation, enhancing communication and heightening physical and sexual feelings. Couples can also use erotic materials, such as videos and books, to enhance stimulation and provide distraction from life stresses.With orgasmic dysfunction, many women complain not necessarily of anorgasmia, but rather that it takes them too long to reach orgasm, that it seems like too much work for them and their partners. The physician should explain the importance of direct clitoral stimulation by the patient or her partner. This can be provided orally, manually and/or with a vibrator, with additional mental stimulation through the use of fantasy and sexual communication. The patients can also be instructed in the correct way to perform Kegel exercises, which can be used during intercourse to enhance orgasm.Patients with dyspareunia and vaginismus must be evaluated carefully to eliminate any possible physical causes. After ruling our physical etiologies, the physician can recommend the use of vaginal lubricants (e.g., Astroglide, Replens) and specific intercourse positions to decrease friction and minimize deep thrusting. Other helpful suggestions include using graduated vaginal dilators to desensitize the fear response to penetration and promote better muscle tone and accommodation; taking a warm bath before sexual activity; and using topical lidocaine or nonsteroidal anti-inflammatory drugs before intercourse.
Menopause is the cessation of the ovaries actively producing the hormones, progesterone, estrogen and testosterone which interact to coordinate a woman’s menstrual cycle. The average age of menopause is 51, but can occur at any age in women who have had their ovaries removed. Perimenopause is the decline in the production of these hormones which typically occurs between the ages of 45-55.
When there is an imbalance in these hormones whether it is the signal from the brain or the ovaries, symptoms can occur at any age most commonly experienced during puberty, postpartum, and menopause.
There are several conditions that are associated with the hormonal imbalance of progesterone, estrogen, and testosterone such as polycystic ovarian syndrome (PCOS), endometriosis, breast disease and menstrual irregularities.
Women can experience a variety and intensity of symptoms such as hot flashes, mood swings, insomnia, trouble concentrating, low libido and vaginal dryness.
The thyroid helps to maintain the body’s metabolic rate and keeps the body warm. Every cell in the body depends on adequate thyroid hormones to function.
The brain produces thyroid stimulating hormone (TSH) which triggers the thyroid gland to produce T4 and some T3. The T4 is converted into T3 in your tissues, which is the “spark plugs” to making energy in our cells. This rate of turnover is your metabolism and heat produced within the body.
Any stressor, whether chemical, emotional, physical or environmental can affect the thyroid’s function and inhibit the body’s ability to convert T4 to T3 effectively in the tissues. Other contributors that can affect this process include vitamin and mineral deficiencies, medications, inflammation, diet, and estrogen/progesterone imbalance.
Hypothyroidism is the underproduction of the thyroid hormones, T4 and T3, which often leads to other hormone imbalances. Some signs of hypothyroidism are fatigue, weight gain, thinning hair, brittle breaking nails, feeling cold, and constipation.
Hyperthyroidism is less common and is the overproduction of these thyroid hormones. Some signs of hyperthyroidism include racing heart, palpitations, weight loss, fatigue, and feeling overly warm all the time.
Ultrasonography is a diagnostic imaging technique used for visualizing internal body structures, including the uterus, ovaries, bladder and other pelvic and abdominal organs, for possible pathology or lesions.
Compared to other prominent methods of medical imaging, ultrasonography has several advantages. It provides images in real-time (rather than after an acquisition or processing delay), it is portable, and it does not use harmful ionizing radiation.
Our office has an ultrasound technologist on staff, and she is skilled at obtaining imaging necessary to evaluate pelvic structures and assist in ruling out pathology. Ultrasound appointments at our office take approximately half an hour and are part of a complete pelvic ultrasound scan, necessitating the patient to arrive with a full bladder, have external imaging taken, and then have internal images to follow. Our providers review all information obtained in detail to allow you to make the best medical choices possible.
Our office is pleased to work with InControl Medical to offer information on two non-surgical, drug-free treatments for female urinary incontinence. InTone and Apex are innovative treatments that use patented muscle stimulation algorithms, biofeedback and active resistance to help increase muscle strength in the pelvic floor. The devices send a calming signal to the detrusor muscle, thus retraining muscle to create more functional voiding and decreasing spasm. For more information, please see our page on urodynamic testing and treatment of urinary incontinence at http://www.gyngroup.com/urinary-incontinence.aspx
Uterine fibroids are benign (not cancerous) growths that develop from the muscle tissue of the uterus. They also are called leiomyomas or myomas. The size, shape and location of fibroids can vary greatly. They may be present inside the uterus, on its outer surface or within its wall or attached to it by a stem-like structure. A woman may have only one fibroid or many of varying sizes. A fibroid may remain very small for a long time and suddenly grow rapidly, or grow slowly over a number of years. Fibroids are diagnosed via physical exam and confirmed via ultrasound. Treatment is not usually necessary unless the fibroids are causing abnormal bleeding or pain, but monitoring them is typically recommended to document stability. If treatment becomes necessary, medication and surgical intervention are possible.
Vaginismus is an involuntary reflex tightening of the pelvic floor muscles. This can make activities such as tampon insertion, penetrative sexual intercourse or gynecological examinations extremely painful or even impossible. It can range in severity, duration and can have both physical and mental components. Treatments are suggested based upon the contributing factors and can include pelvic floor physical therapy, either self-directed or with a medical provider.
Vulvodynia is a complex chronic pain disorder characterized by stinging, burning, swelling and soreness on the vulva. It can sometimes be limited to particular areas (such as the introitus, and this facet of Vulvodynia is called vulvar vestibulitis). Vulvodynia can be caused by an irritation to the nerve endings, a long-lasting vulvovaginal infection or an inflammatory condition contributing to long-term pain. Diagnosis is made via in-office exam, and treatments range from local anesthetics and hormonal creams to pelvic floor therapy, including biofeedback and trigger-point therapy.