One in ten women affected by endometriosis during their reproductive years

It’s important to talk to your provider about symptoms, especially any pain you experience.
It’s important to talk to your provider about symptoms, especially any pain you experience.

Amy Metzer, CNM, MSN

Despite the fact that endometriosis is a relatively common condition affecting an estimated 176 million women worldwide, there is a surprising lack of awareness about its symptoms, impact and management.

Endometriosis occurs when tissue that is similar to the lining of the uterus develops outside the uterus. However, while the tissue that builds up within the uterus is shed from the body during menstruation, there is no place for the tissue outside the uterus to go, which may result in inflammation, pain, scar tissue and adhesions on other organs, infertility and bowel problems.

Because some pain or discomfort during menstruation is relatively common, many women may chalk up what they feel as “normal” period pain, when in fact it is a sign of endometriosis. That’s why it’s important to talk to your provider about symptoms, especially any pain you experience.

In addition to pain during menstruation, symptoms of endometriosis may also include:

  • heavy bleeding
  • pain during ovulation
  • pain during or after sex
  • chronic pelvic pain
  • pain during urination or bowel movements during menstruation
  • difficulty getting pregnant

Endometriosis impacts a woman’s physical health, as well as her mental and social well-being. We can help you manage your symptoms.

Treatment options may include medications to manage symptoms, or surgery to remove scar tissue and adhesions. Pregnancy may relieve symptoms of endometriosis, but they typically return after childbirth.

We work closely with all of our patients who have endometriosis to develop a care plan based on their unique situations and goals. For example, the treatment for a woman who wants to have children versus one who does not or who is finished having children can be quite different. The severity of symptoms can also vary tremendously, and may change over time, so regular exams and discussions help to ensure you benefit from the most effective treatment.

If you have symptoms of endometriosis or need help managing this condition, call us for an appointment.

Do something sweet for yourself this Valentine’s Day: Schedule your annual well-woman checkup

Are you due for your annual well-woman checkup?
Are you due for your annual well-woman checkup?

Anne Vaillant, CNM

The time is near for chocolates and flowers, but we suggest you do something sweet for yourself in honor of Valentine’s Day this year.

Women often put caring for themselves on the back burner as they strive to care for those around them. That’s why we encourage you to do something for yourself this February and take time to schedule any health appointments you may be due for.

While most women don’t require a Pap smear every year, annual well-woman checkups are an important way for you to stay on top of your health.

 What to Expect

During this appointment, we’ll review any changes to your health over the past year. We’ll talk about changes in your medical or family history, your menstrual cycle and sexual health, as well as any risk factors you have. In addition, we’ll discuss your concerns and questions about issues that impact your health, ranging from family planning and birth control to your relationships, safety and mental well-being.

The appointment will include a physical exam, measuring height and weight, blood pressure and temperature, as well as a clinical breast exam and pelvic exam.

We’ll also perform or recommend additional screenings or tests that are indicated, such as a Pap smear, bone density screening, mammogram or blood tests for things such as sexually transmitted diseases, diabetes, and iron and vitamin D levels.

Regular exams and screenings can help us detect problems when they’re developing or in their earliest stages, when they are easiest to treat. We will discuss your risk factors and history and develop a customized screening schedule or care plan for you.

If you need to schedule your annual well-woman checkup, call us for an appointment today.

Prevention and early detection of cervical cancer is possible with vaccines and vigilance

Dr. Lydia Lormand

January is Cervical Cancer Awareness Month. Cervical cancer is one of the most preventable cancers with appropriate screening. That’s why awareness is so important.

The two most important things that women can do to prevent cervical cancer are to get the human papillomavirus (HPV) vaccination series and to have regular Pap smears and HPV screening. The main cause of cervical cancer is HPV infection; however, because not all women received the vaccines and because the vaccine doesn’t protect against every type of HPV, regular screening is also essential.

There are several FDA-approved vaccinations for the prevention of HPV-caused cervical and other cancers, which should ideally be administered before the patient is sexually active. The Centers for Disease Control (CDC) currently recommends that 11- and 12-year-olds receive two doses at least 6 months apart. The vaccines have been found to provide up to 100% protection against two types of HPV, and up to 97% for the other five types.

Regular Pap smears and HPV screening help us detect precancerous changes in the cervix that allow us to treat the infection before cancer develops or to treat it in its earliest stages.

Depending on your risk factors, as well as your prior Pap smear results, we will discuss how often you should have Pap smears. Even if you do not need a Pap smear every year, we still recommend yearly pelvic exams as another form of screening.

HPV infection is very common, but in most cases, the infection clears itself. When it doesn’t clear, or if it becomes chronic, it can lead to certain cancers, including cervical cancer. Other risk factors for cervical cancer include:

  • smoking
  • a weakened immune system
  • certain sexually transmitted infections, such as chlamydia
  • having a male sexual partner who has had multiple sexual partners
  • a personal history of dysplasia of the cervix, vagina or vulva
  • early age (under 18 years old) at which you first had sex

If you have questions about the HPV vaccine, or need to schedule your Pap smear and HPV screening, call us for an appointment.

Preparing for pregnancy: 5 health and family considerations

Preparation can help set the stage for a healthy pregnancy and delivery.

Dr. Jacqueline S. Kates

Thinking about having a baby? A little preparation goes a long way in setting the stage for a healthy pregnancy. Before you start trying to conceive, it’s a good idea to talk to your women’s health provider about your health and risk factors.

Consider these five key health questions:

  1. Are you in good general health? Levels of fitness, nutrition and stress can affect fertility and a healthy pregnancy. It’s worth taking time to address these issues in advance, making lifestyle changes such as exercising, following a healthy diet rich in folic acid and other important nutrients, and catching up on missed immunizations.
  2. Do you have any pre-existing conditions that may lead to a complicated pregnancy? Conditions like asthma, depression/anxiety, diabetes, high blood pressure and others can affect pregnancy. This doesn’t mean you shouldn’t get pregnant, but we can help you have a plan in place before conception for how best to manage these conditions during pregnancy.
  3. What unhealthy habits need to be kicked? Smoking and tobacco use, alcohol consumption and drug use should be stopped before trying to get pregnant. In addition to affecting the fertility of both men and women, these things have a serious impact on a developing pregnancy. It may be challenging to quit once you’re pregnant, so it’s best to do it in advance. Talk to us for support and strategies.
  4. What prescription and over-the-counter medications, vitamins, and herbal supplements are you taking? Again, some medications can affect fertility, so we may need to make changes before you start trying to conceive. Also, some medications and supplements can be harmful during pregnancy, so we’ll work with you to either wean you off medications or transition you to something else.
  5. Are there any red flags in your family medical history? Certain genetic conditions run in families. We can test for some conditions in advance so you’ll know your risk level before getting pregnant, or develop a plan for testing during pregnancy.

In addition to health issues, consider big picture questions as well. Babies are amazing, and they can also be all-consuming, especially in the early years. Ask yourself the hard questions. Are you ready to make lifestyle changes necessary to be a parent? Are you financially able to care for a child? Do you have the support you need from a partner or others? What impact do you expect a child to have on your home life, career and family?

When you are ready to start trying to conceive, call us for an appointment. We’ll work with you to a personalized care plan.

Knock Out PMS: Help is available for symptoms ranging from mild to intense

We can help you develop a plan to knock out your PMS symptoms
We can help you develop a plan to knock out your PMS symptoms

Amy L. Metzger, CNM

Premenstrual syndrome, more commonly called PMS, is common fodder for jokes, but for many women, it’s no laughing matter. It’s hard to pin down exactly how many women are affected, but it’s likely that 75 to 90 percent of women experience PMS in some form during their lifetimes, and symptoms range from mild to intense.

While the exact cause of PMS is unknown, it seems to be the result of cyclical hormonal changes and chemical changes in the brain. There is also no test to diagnose PMS––instead, women are often tested to rule out other causes, like pregnancy, endometriosis or cancer, when symptoms arise.

While we don’t really know what causes PMS, and why some women experience it and some don’t, it is a true medical condition. Unfortunately, many women are made to feel like they are being dramatic about how bad they feel. Everyone is different, and each person’s experience can change over time. The good news is there are things we can do to lessen its impact.

PMS Symptoms

PMS typically occurs just past mid-cycle, between ovulation and the onset of menstruation, and can last from a couple days to a week or more.

Symptoms of PMS are many and include emotional and behavioral problems such as tension, anxiety, mood swings and depression, appetite changes and cravings, insomnia and trouble concentrating.

Physical symptoms can include muscle and joint pain and cramping, breast tenderness, fluid retention and bloating, fatigue, headaches, acne, constipation, diarrhea and more. Most women with PMS experience several symptoms each month.

We ask women to keep a journal of their symptoms for a few months. When we see a pattern to the symptoms, and rule out other causes, PMS is the most likely diagnosis. For women with extreme symptoms, especially the emotional and behavioral ones, the diagnosis may be premenstrual dysphoric disorder (PMDD).

Lifestyle Improvements

We can also use the journal to help pinpoint triggers. For example, if you get headaches a few days before your period, we may recommend cutting back on caffeine the week before your period to see if that helps.

Lifestyle changes you can make that may relieve or at least lessen your PMS symptoms, include:

  • Eating smaller, more frequent meals and limiting salt intake
  • Regular exercise, like walking for 30 minutes a day
  • Getting enough sleep
  • Yoga and massage
  • Limiting caffeine and alcohol
  • Not smoking
  • Eating a healthy diet that’s rich in calcium

You may need to experiment to find out what works best for you. If your symptoms are severe enough to impact your daily life––you regularly miss school, work or other activities–– and nothing you’ve tried is working, it’s time to talk your women’s health provider.

Medical Treatment for PMS

Medical treatment varies based on each woman’s symptoms and their severity:

  • Antidepressants can help women with mood symptoms. Some can be taken daily, and others only in the two weeks prior to each period
  • Nonsteroidal anti-inflammatory (NSAIDS), such as ibuprofen or naproxen, can help relieve muscle, joint and breast pain
  • Diuretics can help with swelling and bloating
  • Hormonal contraceptives, like the pill, can relieve or lessen a range of symptoms

If you have symptoms that disrupt your life every month before your period, come and see us. We’ll work with you to develop a plan to treat your specific symptoms so you can have as little disruption to your life as possible.