Endometriosis — what it is and what to do about it

Endometriosis — what it is and what to do about it

by Shazah Khawaja, MD, FACOG

endometriosis pain in woman's abdoment

What is endometriosis?

Endometriosis is a chronic gynecologic disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus in other parts of the abdomen. As a condition that occurs in 6–10 percent of women of reproductive age, endometriosis represents a significant health problem for millions (maybe as high as 6.5M) of U.S. women.

If you’re still reading, you’re probably one of them, or you may know someone who has had to deal with these common endometriosis symptoms:

  • Painful periods (dysmenorrhea).
  • Pain during intercourse.
  • Pain with bowel movements or urination.
  • Excessive bleeding.
  • infertility.
  • Other symptoms, which may include fatigue, diarrhea, constipation, bloating or nausea, especially during menstrual periods.

Clearly, this is not a fun list. The symptoms or clinical manifestations of endometriosis are variable and unpredictable in both presentation and course. It can vary greatly from woman to woman.

One thing to keep in mind is that the pain associated with endometriosis may not correlate with the stage of the disease. In other words, a woman experiencing significant endometrial pain may not necessarily be in a deep stage of the disease, and the opposite may also be true for someone else. There may be some association with the depth of infiltration of endometrial lesions. Painful defecation during menses and painful sexual intercourse are the most predictable symptoms of deeply infiltrating endometriosis.

According to U.S. Department of Health & Human Services’ Office on Women’s Health, other health problems women experience with endometriosis can include, allergies, asthma, chemical sensitivities, autoimmune diseases (these can include multiple sclerosis, lupus, and some types of hypothyroidism), chronic fatigue syndrome and fibromyalgia.

There is some good news: Endometriosis isn’t a fatal disease. In some cases, endometrial cells create cysts that can rupture and bleed. While this is serious and may sound a bit like cancer, endometriosis isn’t cancer. However, ovarian cancer does occur at higher than expected rates in women with endometriosis. Some studies suggest that endometriosis increases this risk, but it’s still relatively low, according to Mayo Clinic. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in women who have had endometriosis.

Who is likely to get endometriosis?

Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis often end temporarily with pregnancy and end permanently with menopause, unless you’re taking estrogen.

Endometriosis is especially common among women in their 30s and 40s, but I’ve also treated patients in their 20s that had the disorder. Statistically, it is racially neutral, meaning there appears to be no racial predisposition to endometriosis. Research suggests a familial association of endometriosis. Patients with an affected first-degree relationship have a seven- to ten-fold increased risk of developing the disorder.

How do we diagnose endometriosis?

A definitive endometriosis diagnosis can only be made by a diagnostic laparoscopy procedure. Your doctor will then order a histology (a study of the microscopic structure of tissues) of the lesions removed during the surgery.

Before recommending a diagnostic laparoscopic procedure, your doctor will talk to you about your symptoms and do or prescribe one or more of the following to find out if you have endometriosis:

  • Pelvic exam.
  • Imaging test (ultrasound or MRI).
  • Prescription medicine. If your doctor does not find signs of an ovarian cyst during an ultrasound, he or she may prescribe:
    • Hormonal birth control (which may help lessen pelvic pain during your period).
    • Gonadotropin-releasing hormone (GnRH) agonists, which block the menstrual cycle and lower the amount of estrogen your body makes. GnRH agonists also may help pelvic pain.

If your pain gets better with hormonal medicine, you probably have endometriosis. But, these medicines work only as long as you take them. Once you stop taking them, your pain may come back.

How do you treat endometriosis?

There is currently no cure for endometriosis, but several different treatment options can help manage symptoms and improve your chances of getting pregnant. Talk to your doctor about your treatment options.

It is important to note that the best course of action for you will be greatly informed by whether you are or wish to remain fertile. Other important factors include your age, how severe your symptoms are and how severe the disease is.

Endometriosis treatments will vary depending on whether the focus of your care is for pain or more for fertility concerns. For pain, there are three possible approaches:

  • Pain medications (NSAIDS, opioids).
  • Hormone therapy (birth control pills, progesterone, progestin, GnRH agonists).
  • Surgical treatment (laparoscopy, others).

Endometriosis is different for every woman. My colleagues and I at our practice, NCMA Women’s OB/GYN Center, first seek to treat the whole person, rather than address presenting symptoms only. In many cases, we will recommend laparoscopy to remove growths as a way to also improve fertility in women who have mild or minimal endometriosis.

Although studies show improved pregnancy rates following this type of surgery, the success rate is not clear. For some, we recommend in vitro fertilization (IVF) as the best option to improve fertility.

Even though the use of hormones in IVF is successful in treating infertility related to endometriosis, other forms of hormone therapy are not as successful. The American College of Obstetricians and Gynecologists does not recommend using oral contraceptive pills or GnRH agonists to treat endometriosis-related infertility. The use of these hormonal agents prevents ovulation and delays pregnancy, so this risk means you and your doctor must be on the same page about your risks and health goals.

The hormones used during IVF do not cure endometriosis lesions, which means that pain may recur after pregnancy and that not all women with endometriosis are able to become pregnant with IVF. The relationship between the extent of disease and the degree of symptoms, the effects on fertility, and choosing the best treatment, remains a challenge for many patients.

For more information, the NIH’s Eunice Kennedy Shriver National Institute of Child Health and Human Development offers excellent information on endometriosis treatment options.

Shazah Khawaja, MD, of NCMA Women’s OB/GYN Center

Shazah Khawaja, MD, FACOG, is a physician with NCMA Women’s OB/GYN Center in Santa Rosa, Calif.

Women’s health volunteerism: Delivering care around the globe, where it’s needed most

NCMA’s Suzi Saunders, CNM, on providing care to women in countries where access is challenging, like Haiti and the Philippines

NCMA’s Suzi Saunders, CNM, on providing care to women in countries where access is challenging, like Haiti and the Philippines

Photo by Suzanne Saunders, CNM

I have been a certified nurse midwife for 21 years. Having worked with NCMA Women’s OB/GYN Center for nearly 18 of those years, I’m very happy to continue my work both in Sonoma County and in sometimes faraway locales where adequate care is scarce.

I truly love women’s health. And let me tell you, there is nothing like holding a brand new baby in your hands!

I have long had an interest in providing care to women in countries where access is challenging. In addition to my master’s in nursing at Emory University, I also completed a master’s in public health, with a focus on international health concerns. My public health program emphasized the need for sustainable programs that had a lasting effect rather than “Band-Aid”-type efforts. Most programs rely heavily on donated supplies, and on volunteer labor to sustain them over time. I knew I wanted to make an impact, but wasn’t sure how to get started.

My first adventure became a family adventure

On the advice of a local colleague, I looked into two programs that had lengthy histories in their host countries, and had made significant impacts on local maternal health. The one I chose in 2011 was with Mercy in Action. It is located in Olongapo, Philippines, which was a nice coincidence, as my brother lived a few hours from there! I wanted my kids to be a part of my efforts. Although they were too young at the time to participate directly, by traveling there with me they could understand why it was important to me. In addition, I wanted them to realize how different life can be outside the U.S. By choosing this project, I could start my adventures as a volunteer, as well as get the kids involved.

I participated in a two-week intensive training on providing care in a low-resource environment, in addition to hiking to remote areas to provide needed prenatal and post-partum care to rural Filipina women. It was an amazing learning experience! My kids stayed with family, and while they were not with me, I did my work. They still had a lengthy trip in a developing nation. They were 5 and 10 at the time, and have never forgotten it.

On the ground in Haiti

Two years later, I went to Hinche, Haiti, with a group called Midwives for Haiti. It is a non-governmental organization (NGO) based in rural Haiti for the last 25 years. A midwife colleague had been there, and highly recommended the work they were doing.

After some vigorous fundraising, two labor nurses and I flew into the unknown. Haiti is the most dangerous country in the Western Hemisphere to have a baby, due to factors such as:

  • difficult access for rural women,
  • very few providers per thousand population,
  • a preference for home delivery due to costs, and
  • a high rate of risk factors such as preeclampsia and malnutrition.

In the U.S., midwives are often in a position of protecting normal pregnant women from having a disturbed or interventive birth. In Haiti, many, many births are high risk, and many more women need intervention than actually get it.

Midwives for Haiti has three main directives:

  1. To teach as many Haitians as possible the profession of midwifery. The more providers there are in the country, the more women have access to care.
  2. To support the mobile midwife service. These are a group of 5–6 midwives that go to a rural village every day, for a total of about 25 communities a month. This is typically the only way the women in those villages will ever get prenatal care.
  3. To train the “matwons,” which are traditional or “granny” midwives, working in remote areas but typically without much medical knowledge. The mobile midwives work closely with the matwons, to encourage them to give the best care they can, and to refer high risk women back to them.
Suzanne Saunders, CNM, Haiti, newborn baby and mother

Suzanne Saunders (L) loves her volunteer work.

The conditions in Haiti cannot be more different than here, and can be quite shocking if you have not traveled to truly desperate, developing nations. I saw and experienced things you might only see once, or never, in an entire career in the U.S. We had a patient die of pre-eclamptic complications the second day of our trip, which would have been fairly easily treated and dealt with here. It’s crushing to know that every woman you treat knows a friend or family member (often several) who has died of childbirth complications. The ambivalence toward newborn babies that might not even survive their first six months is heartbreaking.

Watching what Midwives for Haiti can do on a shoestring budget is a bright light in all of this! They train 20–30 midwives a year, who then go and serve their own communities for years and years. They send midwives out into the villages to give women much-needed prenatal care. And support the home-based Matwons in their quest to provide home birth. All of this has made a significant impact on maternal and infant mortality in their corner of Haiti. I am very satisfied that their program meets many criteria of sustainability in the NGO realm, and have seen with my own eyes the impact they are having.

Going back to Haiti

I went back to Haiti two years later and it was just as powerful. The supplies and medicines we brought were eagerly distributed as needed. Our work felt important, in a way that is hard to describe. It is incredibly hard work, under ridiculous conditions (think, rare running water—in the hospital!, think 90+ degrees with nary a fan, think riding in a rattle-trap jeep over washboard roads for two hours to reach the mobile clinic, think mosquitos that are trying to kill you!). But fulfilling in a way that first world health care isn’t.

I am hoping to go again in December after a bit of fundraising. If you are able to contribute, please visit our GoFundMe campaign. We will be so grateful.

Every dollar goes to teaching students, purchasing meds and supplies to bring along, and to the very small staff that keeps it all running. Believe me, they make every dollar work double time! Certain supplies are highly desirable, as are certain medications.

Most needs are simple, like

  • sutures,
  • Tylenol/ibuprofen,
  • cloth diapers,
  • blood pressure cuffs, and
  • other basics.

A basic kit of equipment is put together for each midwife student, to make sure they are prepared for their training and first months of work afterwards.

If any of you have donations of medical supplies, and/or funds to purchase said supplies, they are very warmly and happily accepted.

Suzi Saunders, CNM
NCMA Women’s OB/GYN Center

When it comes to hormone therapy, you have options

Menopause care may include hormone therapy treatment

Your body’s hormone levels go through significant changes during the menopause transition, and resulting hormonal imbalances can create uncomfortable physical symptoms and mood swings. Fortunately, hormone therapy (HT) enables menopausal women to substitute for the hormones that are reduced during this transition to relieve symptoms and achieve long-term health advantages. Our physicians will talk with you about the risks and benefits of hormone therapy to help you find the options that best fit your individual body and lifestyle.

In recent years, the media has spotlighted menopause and HT helping to increase general awareness, but it is still important to filter the available information in the context of scientific-based research and peer-reviewed evidence from medical professionals.

Quick facts:

  • The term “hormone therapy” covers both traditional hormone therapy (HRT) and natural (bioidentical) hormone replacement therapy (BHRT), as well as estrogen and combined estrogen/progesterone treatment.
  • BHRT makes use of hormones that are identical to human hormones, and HRT makes use of synthetic hormones that have a slight physical variation to bioidentical hormones, but serve the similar purpose of replacing hormones lost during menopause.
  • Nearly all modern hormone medications are derived from the same plant sources.

Your physician at NCMA Women’s OB/GYN Center will personalize your HT treatment after accounting for various health benefits and risks based on your symptoms and lifestyle. Not all women will be candidates for HT, and medications and other health factors can affect eligibility.

Learn more about hormone therapy from National Institutes of Health.

Chemotherapy no longer required in 70 percent of breast cancer cases

New study says no chemotherapy needed to treat common breast cancer

A 21-gene test performed on tumors could enable most patients with the most common type of early breast cancer to safely forgo chemotherapy, according to a landmark study published in the New England Journal of Medicine.

Loyola Medicine oncologist Kathy Albain, MD, is among the main co-authors of the study and a member of the clinical trial's steering committee. First author is Joseph Sparano, MD, of Montefiore Medical Center in Bronx, N.Y. The study was published in conjunction with its Sunday, June 3 presentation at the plenary session of the American Society of Clinical Oncology 2018 meeting in Chicago.

"With results of this groundbreaking study, we now can safely avoid chemotherapy in about 70 percent of patients who are diagnosed with the most common form of breast cancer," Dr. Albain said. "For countless women and their doctors, the days of uncertainty are over."

Dr. Albain, the Huizenga Family Endowed Chair in Oncology Research at Loyola University Chicago Stritch School of Medicine, has conducted research with the 21-gene test and also used it in her practice for years.

The test examines 21 genes from a patient's breast cancer biopsy sample to determine how active they are. The tumor is assigned a "recurrence score" from 0 to 100; the higher the score, the greater the chance the cancer will recur in distant organs and decrease survival. If patients with higher scores receive chemotherapy, this risk of recurrence will be significantly reduced, enabling more patients to be cured.

Previously, the challenge doctors and patients have faced is what to do if a patient has a mid-range score. It was uncertain whether the benefit of chemotherapy was great enough to justify the added risks and toxicity. Previous studies demonstrated that patients with low scores (10 or lower) did not need chemotherapy, while women with high scores (above 25) did require and benefit from chemotherapy.The new study examined the majority of women who fall in the intermediate range of 11 to 25.

The study enrolled 10,273 women who had the most common type of breast cancer (hormone-receptor positive, HER-2 negative) that had not spread to lymph nodes. Researchers examined outcomes of the 69 percent of patients who had intermediate scores on the 21-gene test.

Patients were randomly assigned to receive chemotherapy followed by hormonal therapy or hormone therapy alone. Researchers examined the chemotherapy and non-chemotherapy groups for several outcomes, including being cancer free, having cancer recur locally or to distant sites in the body and overall survival.

For the entire study population with gene test scores between 11 and 25 — and especially among women aged 50 to 75 — there was no significant difference between the chemotherapy and no chemotherapy groups. Among women younger than 50, outcomes were similar when gene test scores were 15 or lower. Among younger women with scores 16 to 25, outcomes were slightly better in the chemotherapy group.

"The study should have a huge impact on doctors and patients," Dr. Albain said. "Its findings will greatly expand the number of patients who can forgo chemotherapy without compromising their outcomes. We are de-escalating toxic therapy."


Story Source: See this article on Science Daily: "More breast cancer patients can safely forgo chemotherapy: Study." ScienceDaily. ScienceDaily, 3 June 2018. www.sciencedaily.com/releases/2018/06/180603193614.htm. Materials provided by Loyola University Health System. Study published in the New England Journal of Medicine.

Focus on health risks for new mothers for Preeclampsia Awareness Month

May is Preeclampsia Awareness Month and NCMA Women’s OB/GYN Center joins with the Preeclampsia Foundation to help raise awareness. This year the foundation’s efforts are on postpartum preeclampsia as 97 percent of maternal deaths related to preeclampsia and other hypertensive disorders of pregnancy occur within just six weeks of delivery, a time when most new mothers might think the danger has passed.

A woman can develop preeclampsia after her baby is born, regardless of whether she experienced high blood pressure during her pregnancy. With such alarming statistics related to postpartum preeclampsia, it very important that a new mother remain vigilant and continue to monitor her heart health and blood pressure even after delivery.

Understanding preeclampsia

Postpartum preeclampsia is a serious condition related to high blood pressure. Women who have just delivered a baby are most at risk, although it has no effect on the baby. There is no known cause for preeclampsia to manifest in pregnant women. In many cases, women diagnosed with preeclampsia see symptoms abate following delivery, but the Preeclampsia Foundation emphasizes that ‘delivery is not a cure’. In some cases, symptoms begin during pregnancy, but some patients may not be symptomatic until after the baby is born. Postpartum preeclampsia most commonly occurs within the first seven days after delivery although new mothers remain at risk for up to six weeks following delivery.

Know the warning signs

Early diagnosis and being vigilant to symptoms followed by quick response is imperative to saving lives. Symptoms include (and can be complicated by lack of sleep, postpartum depression and/or simple lack of awareness about the signs):

  • nausea
  • swelling in hands/feet
  • severe headache
  • seeing spots or other vision changes
  • shortness of breath

When a patient thinks they are experiencing warning signs of postpartum preeclampsia, the first thing to do is go to the Emergency Department, request to be seen by an OB, and report that they have recently given birth. The first seven days after delivery is when women who experience preeclampsia are at highest risk. Effectively controlling high blood pressure is key to avoiding very serious health risks that include; seizures, stroke, organ damage and sometimes death.

About NCMA Women’s OBGYN Center

Our provider team of expert OB/GYN physicians, certified nurse midwives, family nurse practitioners, and medical assistants provides unmatched care to patients in our region. As women proudly serving women, we understand the needs and expectations of our patients. For more information, visit our website or call 707-579-1102.

New study says de-stress and enhance memory with dark chocolate

Feeling stressed? Get your happy on with dark chocolate

New research shows there might be health benefits to eating certain types of dark chocolate. Findings from two studies being presented today at the Experimental Biology 2018 annual meeting in San Diego show that consuming dark chocolate that has a high concentration of cacao (minimally 70% cacao, 30% organic cane sugar) has positive effects on stress levels, inflammation, mood, memory and immunity. While it is well known that cacao is a major source of flavonoids, this is the first time the effect has been studied in human subjects to determine how it can support cognitive, endocrine and cardiovascular health.

Lee S. Berk, DrPH, associate dean of research affairs, School of Allied Health Professions and a researcher in psychoneuroimmunology and food science from Loma Linda University, served as principal investigator on both studies.

"For years, we have looked at the influence of dark chocolate on neurological functions from the standpoint of sugar content -- the more sugar, the happier we are," Berk said. "This is the first time that we have looked at the impact of large amounts of cacao in doses as small as a regular-sized chocolate bar in humans over short or long periods of time, and are encouraged by the findings. These studies show us that the higher the concentration of cacao, the more positive the impact on cognition, memory, mood, immunity and other beneficial effects."

The flavonoids found in cacao are extremely potent antioxidants and anti-inflammatory agents, with known mechanisms beneficial for brain and cardiovascular health. The following results will be presented in live poster sessions during the Experimental Biology 2018 meeting:

Dark Chocolate (70% Cacao) Affects Human Gene Expression: Cacao Regulates Cellular Immune Response, Neural Signaling, and Sensory Perception

  • This pilot feasibility experimental trial examined the impact of 70 percent cacao chocolate consumption on human immune and dendritic cell gene expression, with focus on pro- and anti-inflammatory cytokines. Study findings show cacao consumption up-regulates multiple intracellular signaling pathways involved in T-cell activation, cellular immune response and genes involved in neural signaling and sensory perception — the latter potentially associated with the phenomena of brain hyperplasticity.

Dark Chocolate (70% Organic Cacao) Increases Acute and Chronic EEG Power Spectral Density (μv2) Response of Gamma Frequency (25-40Hz) for Brain Health: Enhancement of Neuroplasticity, Neural Synchrony, Cognitive Processing, Learning, Memory, Recall, and Mindfulness Meditation

  • This study assessed the electroencephalography (EEG) response to consuming 48 g of dark chocolate (70% cacao) after an acute period of time (30 mins) and after a chronic period of time (120 mins), on modulating brain frequencies 0-40Hz, specifically beneficial gamma frequency (25–40Hz). Findings show that this superfood of 70 percent cacao enhances neuroplasticity for behavioral and brain health benefits.

Berk said the studies require further investigation, specifically to determine the significance of these effects for immune cells and the brain in larger study populations. Further research is in progress to elaborate on the mechanisms that may be involved in the cause-and-effect brain-behavior relationship with cacao at this high concentration.


Story Source:

Materials provided by Loma Linda University Adventist Health Sciences Center. Note: Content may be edited for style and length.


Read this article on Science Daily: Loma Linda University Adventist Health Sciences Center. "Dark chocolate consumption reduces stress and inflammation: Data represent first human trials examining the impact of dark chocolate consumption on cognition and other brain functions." ScienceDaily. ScienceDaily, 24 April 2018. www.sciencedaily.com/releases/2018/04/180424133628.htm.

Pasta and rice hastens menopause according to new study

high dietary intake of refined carbs, such as pasta and rice, may instead help to hasten menopause

Fish and Legumes May Delay Onset of Menopause

A diet rich in fish and legumes may help to delay the natural menopause, while high dietary intake of refined carbs, such as pasta and rice, may instead help to hasten it, suggests the first UK study of its kind, published online in the Journal of Epidemiology & Community Health.

Several genetic, behavioral, and environmental factors are thought to be involved in the timing of the menopause, and some studies have implicated diet.

To explore this further, the researchers drew on participants from the UK Women's Cohort Study, involving more than 35,000 women between the ages of 35 and 69 from England, Scotland, and Wales.

The women provided information on potentially influential factors such as weight history, physical activity levels, reproductive history, and use of hormone replacement therapy (HRT).

They also estimated the quantities of 217 foodstuffs they ate every day by completing a food frequency questionnaire. The food items were collated into groups according to their culinary uses.

Further information on when the women had gone through the menopause naturally was gathered four years later.

In all, some 14,000 women provided information at both time points, and the final analysis included the 914 who had gone through the menopause naturally after the age of 40 and before the age of 65.

The average age at menopause was 51, and certain foods seemed to be associated with its timing.

Each additional daily portion of refined carbs — specifically pasta and rice — was associated with reaching the menopause 1.5 years earlier, after taking account of potentially influential factors.

But each additional portion of oily fish and fresh legumes (eg peas, beans) was associated with a delay of more than three years. Higher intakes of vitamin B6 and zinc (mg/day) were also associated with later menopause.

Similar results emerged when the analysis looked at particular groups. For example, eating meat was associated with menopause arriving almost a year later than a vegetarian diet.

Among those who weren't vegetarian, upping daily portions of savoury snacks was associated with the arrival of the menopause almost 2 years earlier, while higher intake of oily fish and fresh legumes was linked to later menopause of more than 3 and nearly 1.5 years, respectively.

Similarly, among mothers, higher intake of oily fish and fresh legumes was associated with later menopause, while additional daily portions of pasta, rice, and savoury snacks were associated with earlier menopause.

Among childless women, eating more grapes and poultry was significantly associated with later menopause.

Egg maturation and release are adversely affected by reactive oxygen species, so a high intake of legumes, which contain antioxidants, may counter this, preserving menstruation for longer, suggest the researchers, in a bid to explain the findings. And omega 3 fatty acids, which are abundant in oily fish, stimulate antioxidant capacity in the body.

On the other hand, refined carbs boost the risk of insulin resistance, which can interfere with sex hormone activity and boost oestrogen levels, both of which might increase the number of menstrual cycles and deplete egg supply faster, they say.

Vegetarians consume a lot of antioxidants too, but they are also likely to eat a lot more fibre and less animal fat than carnivores, both of which are associated with low oestrogen levels, which may also alter the timing of the menopause, suggest the researchers.

This is an observational study, and as such, can't prove causality. Food Frequency Questionnaires are subject to faulty recall, and the study sample was also more affluent and health conscious than average, all of which might have influenced the findings.

But women who go through the menopause early are at increased risk of osteoporosis and heart disease, while those who go through it late are at increased risk of breast, womb, and ovarian cancers, so timing matters, say the researchers.

And they conclude: "Our findings confirm that diet may be associated with the age at natural menopause. This may be relevant at a public health level since age at natural menopause may have implications on future health outcomes."


Story Source:

Materials provided by BMJ. Note: Content may be edited for style and length.


Journal Reference:

  1. Yashvee Dunneram, Darren Charles Greenwood, Victoria J Burley, Janet E Cade. Dietary intake and age at natural menopause: results from the UK Women’s Cohort Study. Journal of Epidemiology and Community Health, 2018; DOI: 10.1136/jech-2017-209887

Read this article on Science Daily: " ScienceDaily. ScienceDaily, 30 April 2018.  www.sciencedaily.com/releases/2018/04/180430212400.htm .

Research addresses concern over hormonal contraceptive side effects

The vast majority of women will use some method of contraception during their lifetime. Despite there being 37 million in the United States who are currently on birth control, many still worry about potential side effects. Women face several options when it comes to birth control, so potential side effects often factor into their decision. Depression is a common concern for many women, but a new study by researchers at The Ohio State University Wexner Medical Center is putting patients at ease. It found there’s no evidence to support a link between hormonal birth control and depression.

“Depression is a concern for a lot of women when they’re starting hormonal contraception, particularly when they’re using specific types that have progesterone,” said Dr. Brett Worly, lead author of the study and OB/GYN at Ohio State Wexner Medical Center. “Based on our findings, this side effect shouldn’t be a concern for most women, and they should feel comfortable knowing they’re making a safe choice.”

Worly and his team reviewed thousands of studies on the mental health effects of contraceptives. They included data tied to various contraception methods, including injections, implants and pills. Similarly, researchers reviewed studies examining the effects of hormonal birth control on postpartum women, adolescents and women with a history of depression, all with the same conclusion: there is insufficient evidence to prove a link between birth control and depression.

“Adolescents and pregnant moms will sometimes have a higher risk of depression, not necessarily because of the medicine they’re taking, but because they have that risk to start with,” said Worly. “For those patients, it’s important that they have a good relationship with their healthcare provider so they can get the appropriate screening done — regardless of the medications they’re on.”

Worly said patient concerns are valid, and he wants women to continue having open and honest discussions with their doctor about which options work for them.

“We live in a media-savvy age where if one or a few people have severe side effects, all of a sudden, that gets amplified to every single person,” he said. “The biggest misconception is that birth control leads to depression. For most patients that’s just not the case.”

Most women have tried at least one method of contraception in their lives, with nearly 37 million women in the United States currently using birth control. Sixty-seven percent of current users have opted for a non-permanent hormonal method such as an oral pill, but among those, 30 percent have discontinued their use due to dissatisfaction with potential side effects.


Story Source: Read this article on Science Daily: The Ohio State University Wexner Medical Center. “No link between hormonal birth control and depression: Research eases fear around hormonal contraceptive side effects.” ScienceDaily. ScienceDaily, 26 February 2018. www.sciencedaily.com/releases/2018/02/180226085756.htm.

Robotic gynecologic surgery now available in Santa Rosa

 

Our most notable robotic-assisted procedures are hysterectomies for the treatment of a variety of conditions.NCMA’s Women’s OB/GYN is excited to announce new services offered by Tara Bartlett, D.O., and Melissa Seeker M.D., gynecological surgeons. Together, Dr. Bartlett and Dr. Seeker started the gynecologic robotics program at Memorial Hospital with a focus on a minimally invasive approach for benign hysterectomies.

Using the da Vinci® surgical system for robotic procedures each surgeon is able to be  100% in control of the robotic platform, which offers high definition 3D views and translates our hand movements into small, precise movements of the advanced EndoWrist® instruments. That means we have enhanced vision, dexterity and precision and our patients experience faster operating times, small incisions, reduced length of stay, and less conversion to open procedures on tough cases with scar tissue or fibroid uterus.

The Women’s OB/GYN Medical Group now offers robotic-assisted minimally invasive surgery for patients with:

  • heavy menstrual bleeding
  • uterine fibroids or adenomyosis
  • genetic cancer syndromes such as BRCA or Lynch Syndrome
  • endometriosis or chronic pelvic pain
  • ovarian cysts

Dr. Bartlett and Dr. Seeker’s most notable robotic-assisted procedures are hysterectomies for the treatment of the above listed conditions. For more information visit the robotics section of our website and to schedule a consultation, please call our office at 707-579-1102.

Study reveals no increase in risks for women who eat and drink during labor

At most US maternity units, women in labor are put on nil per os (NPO) status -- they're not allowed to eat or drink anything, except ice chips. But new nursing research questions that policy, showing no increase in risks for women who are allowed to eat and drink during labor.

At most US maternity units, women in labor are put on nil per os (NPO) status — they’re not allowed to eat or drink anything, except ice chips. But new nursing research questions that policy, showing no increase in risks for women who are allowed to eat and drink during labor. The study appears in the March issue of the American Journal of Nursing, published by Wolters Kluwer.

“The findings of this study support relaxing the restrictions on oral intake in cases of uncomplicated labor,” write Anne Shea-Lewis, BSN, RN, of St. Charles Hospital, Port Jefferson, N.Y., and colleagues. Adding to the findings of previous reports, these results suggest that allowing laboring women to eat and drink “ad lib” doesn’t adversely affect maternal and neonatal outcomes.

No Increase in Complications with ‘Ad lib’ Oral Intake During Labor

The researchers analyzed the medical records of nearly 2,800 women in labor admitted to one hospital from 2008 through 2012. At the study hospital, one practice group of nurses and doctors had a policy of allowing laboring women to eat and drink ad lib (ad libitum, or “as they please”). Another four practice groups kept all patients NPO (nil per os, or “nothing by mouth”).

Recommendations to restrict oral intake during labor reflect concerns over the risk of vomiting and aspiration (inhalation) in case general anesthesia and surgery are needed. However, with advances in epidural and spinal anesthesia, the use of general anesthesia during labor has become rare (and, if needed, much safer than before).

The study compared maternal and child outcomes in about 1,600 women who were kept NPO (except for ice chips) with 1,200 who were allowed to eat and drink ad lib during labor. The two groups were “sufficiently equivalent” for comparison. The women’s average age was 31 years. Before delivery, a “preexisting medical condition” complicating pregnancy was identified in 14 percent of the NPO group compared with 20 percent of the ad lib group.

Even though the women in the NPO group started out with fewer medical problems, they had a significantly higher incidence of complications during labor and birth, compared with the ad lib group. The women in the NPO group were also significantly more likely to give birth via unplanned cesarean section.

Other outcomes — including requiring a higher level of care after delivery and the newborns’ condition as measured by Apgar score — were not significantly different between groups. Analysis using a technique called propensity score matching, comparing groups of women with similar risk factors, yielded similar results.

The findings add to those of previous studies suggesting that restrictions on eating and drinking during labor could be safely relaxed in uncomplicated cases. “Yet in keeping with current guidelines, most obstetricians and anesthesiologists in the United States continue to recommend restrictions on oral intake for laboring women,” Anne Shea-Lewis and colleagues write.

“Our findings support permitting women who are at low risk for an operative birth to self-regulate their intake of both solid food and liquids during labor,” the researchers add. They note some limitations of their study, especially the fact that the women weren’t randomly assigned to NPO or ad lib groups.

The authors hope their study will lead to reconsideration of current recommendations to keep women NPO during the “often long and grueling” process of labor and delivery. “Restricting oral intake to a laboring woman who is hungry or thirsty may intensify her stress,” Anne Shea-Lewis and colleagues conclude. “Conversely, allowing her to eat and drink ad lib during labor can contribute to both her comfort and her sense of autonomy.”

Story Source:

Read this article on Science Daily: Wolters Kluwer Health. “Ice chips only? Study questions restrictions on oral intake for women in labor.” ScienceDaily. ScienceDaily, 23 February 2018. www.sciencedaily.com/releases/2018/02/180223151852.htm.


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