Women's
Health - Other Common Conditions The above table contains links
to sites with some other common conditions regarding women's health issues. I
am only dealing with the subjects below that have not been dealt with elsewhere.
Premenstrual Syndrome (PMS)
This common condition causes a great deal of distress to women 7 to 10 days prior
to their period. There are symptoms of fluid retention, mood swings, stress and
anxiety, premenstrual depression, headaches and painful swollen breasts.
With PMS progesterone seems to be metabolized in a subtle different way thus causing
the above symptoms (Ref.1, p.1932). When the menstrual period starts, the premenstrual
symptoms usually disappear within hours because of the hormonal switch. Some women
are plagued by dysmenorrhea with painful menstrual periods. This is common in
teenagers, but normalizes often in the early twenties. Dr. Lee et al. (Ref.24)
explains that cortisol is often increased in patients with PMS due to increased
stress. High cortisol levels reduce progesterone production and also compete with
common hormone receptor sites between the two hormones. The end result is that
higher than usual progesterone cream dosages are required for treatment of PMS.
PMS treatment: PMS is partially responding to a
nutritional changes and nutritional counseling with a view of changing to the
zone diet plan
(Ref. 2) would be a good first step. With well balanced intake
of protein and reduction of sugar hyperinsulinism is corrected, a hormone balance
is achieved and many patients feel much improved. Otherwise the physician can
order water pills for the few days before the period when fluid retention is a
problem. Dr. Lee (Ref. 24) recommends to treat from day 10 to 12 until day 26
to 30 of each cycle with 40mg of progesterone cream in two divided doses (morning
and night) and this can be increased in a crescendo like pattern until symptoms
are controlled. The least amount needed to control symptoms is suggested. Other
treatments such as oral contraceptives, progesterone pills and pulsed gonadotropin-releasing
hormone or an agonist (leuprolide) have been tried, but are not as well tolerated
as Dr. Lee's bioidentical progesterone cream. Dr. Lee explains in chapter 10 of
Ref. 25 that most symptoms of PMS are identical to the side-effects of estrogen
excesses. PMS in his opinion is an estrogen dominance condition where at any time,
particularly in the second half of the cycle too much estrogen is circulating.
Many of these women have anovulatory cycles so that they do not have a corpus
luteum in any of their ovaries that would produce progesterone to balance the
estrogen effects. It follows from this that natural progesterone cream treatment
once or twice daily in the second half of the cycle (day 13 to 26) would be the
most logical approach for treatment. Dr. Lee has done this and had remarkable
results with this simple natural therapy. The dosage is 30 to 40 mg initially
for 2 to 3 cycles, then can be tapered to 20 mg to 25 mg daily from day 13 to
26 of each cycle. The treating physician should check thyroid levels (T3, T4 and
TSH levels) to rule out borderline hypothyroidism, which, if present would also
have to be treated with thyroid replacement. Sometiomes a specialist (gynecologist
or endocrinologist) may be required in those cases that are more difficult to
control. Each patient needs to be treated according to her unique underlying problem.
Gynecological
Cancer I have dealt with gynecological cancer in other chapters
in more detail. Here are the links:
Pelvic
Pain Acute pelvic pain is a topic that is seen in the Emergency
Room of a hospital fairly frequently.Ref.22 (p. P2295) lists 24 various conditons
that can cause pelvic pain. Some of the life threatening conditions are a ruptured
tubal pregnancy,a pelvic abscess
that may have opened up causing acute peritonitis. Ovarian
cyst pain can be caused from bleeding into it,
from rupture or from a rapidly enlarging tumor or cancer. On the other hand infections
inside the uterus (endometritis)
or from PID / STD
(PID caused by STD) can cause pelvic pain as well. In an early pregnancy a spontaneous
abortion can cause excruciating pelvic pain and is often associated with profuse
vaginal bleeding. In later pregnancy pelvic pain can be associated with placental
problems (infarct, placenta abruptio), with premature
labor or with severe
preeclampsia. Pelvic adhesions from prior pelvic surgery, appendectomy
or perforated diverticulitis can cause
pelvic pain as well. Endometriosis
and ovarian cancer
as well as primary dysmenorrhea
can also cause pelvic pain. Diagnostic tests for investigating
pelvic pain: Obviously the treating physician will want to refer many
of these patients to a gynecologist for a pelvic pain diagnosis and to pinpoint
the cause of pelvic pain. Several tests are available, from pelvic examination
to ultrasound and MRI scan. Several other X-ray methods are also available. Often,
even with these methods, the gynecologist comes to a point where only a laparoscopic
procedure will show the pathology that underlies the pelvic pain. Treatment
of pelvic pain:The gynecologist will offer the specific treatment for
the condition identified. This may involve some hormones, a surgical procedure
or reassurance. Sometimes no cause can be found and only pain relieving medication
can be offered.
Vaginitis
Introduction: The exact frequency of vaginitis
among women is unknown. However, physicians and health plans know that it leads
to 10 million office visits throughout the U.S. per year as one of the most common
reasons for a woman to seek the advice of a physician. Before I deal with
the various forms of vaginitis I would like to review the causes of vaginal infections.
Normally, there is an intricate balance between the bacteria that normally live
in the vaginal flora and the main bacteria called Lactobacilli, which
make up the majority of 70% of the bacterial flora producing the chemical milieu
in the vagina. The milieu is slightly acidy (pH of around 4.0) and there is hydrogen
peroxide released constantly in small amounts from the Lactobacilli as
well. This double effect limits the growth of other bacteria and the vaginal wall
is accustomed to this milieu. The other 30 % of bacteria normally present in the
vaginal secretion of a woman are the following (in descending order): Gardnerella
vaginalis, Ureaplasma urealyticum, Mycoplasma hominis, Bacteroides species,
group B beta hemolytic streptococci, anaerobic Gram-positive rods, Gram-negative
aerobes and a few others. (Ref.15, p. 400). Apart from bacteria, there are
also yeast organisms, called Candida albicans, that are a normal part
of the vaginal secretions. They are normally there, are non invasive as they are
kept at bay by the acidy milieu and hydrogen peroxide released from the Lactobacilli
(Ref.15, p. 400 and Ref. 23, p.2657). The interesting fact is that most
of the pathogens in clinical vaginitis in humans are already there in the normal
vaginal flora. The difference between normal and abnormal lies in the balance
of the flora, the pH, the bacterial count and whether or not the vaginal wall
gets inflamed. The cause of bacterial vaginosis,
which is one of the common forms of vaginitis, is a tremendous overpopulation
of the vaginal flora where the total pathogen count per Gram of vaginal secretion
has skyrocketed from the normal 10,000 count to 100 billions, a 7 log difference.
No wonder that the woman affected by this has symptoms! (Ref.15, p. 400). Symptoms
of vaginitis: Although it is not possible to diagnose what kind
of vaginitis a patient has, based on symptoms alone, there are fairly specific
symptoms that are associated with certain bacteria, but not others. The
final diagnosis in case of a lack of clinical response has to wait till one or
more cultures have been taken and were examined in a laboratory. This can serve
the clinician as an additional guidance as to what specific treatment to order.
General symptoms for all of the vaginitis cases are abnormal vaginal discharge,
vaginal burning, vaginal itchiness and pain with sexual intercourse (called "dyspareunia").
Here is a table with the most common pathogens that cause vaginitis and
the most common features.
| Common
types of vaginitis, symptoms, diagnostic tests and treatment |
| Type of vaginosis: | Signs
and symptoms: | Diagnostic
tests: | Treatment:
| | bacterial
vaginosis | copious green, malodorous
discharge, less itiching | pH ›
4.5; clue cells and decreased lactobacilli | metronidazol
(Flagyl) or clindamycin | | fungal
vaginitis | white cottage cheese-like discharge,
itching and burning | on slide: KOH preparation
shows fungi; culture methods confirm Candida albicans | butaconazole
(Femstat), clotrimazole (Canesten) or oral fluconazole |
| tricho-moniasis | very
painful and swollen,discharge with pus | trichomonads
that move, as well as clue cells | metronidazole
(Flagyl) orally | | atrophic
vaginitis | atrophic vaginal mucosa is inflamed
on inspection | FSH and LH high in blood (menopause) | estrogen
vaginal cream or oral tablets | Some of the
vaginitis cases are chronic or chronically recurring. For instance, with Candida
albicans, commonly known as yeast vaginitis, the hormone changes with from
taking the birth control pill or the changed hormone milieu with pregnancy can
cause fairly sudden flare-ups of yeast vaginitis that tend to be more chronic
recurrent. In cases where the immune system is weakened, such as in AIDS patients
or other immune suppressed patients, a referral to a gynecologist for ongoing
management of Candida vaginitis may be needed. Diagnostic tests: Some
of the diagnostic tests are listed in the table above. However, there are many
possible underlying bugs that may be the main culprit. The diagnosis is based
on a combination of clinical findings on examination, the history from the patient
and possible cultures that may or may not be taken. Treatment of
vaginitis: Although the table above gives some indication how
various types of vaginitis are being treated, there are many details that are
beyond the scope of this text. For instance, there are often initial treatment
protocols and there are secondary treatment regimens that the physician might
use (Ref.15, p. 402), if "plan A" does not work. In the case of a yeast
vaginitis the patient may have tried some over-the-counter nystatin cream or nystatin
tablets. The physician may next use butoconazole in a cream, if the initial therapy
failed. After some swabs to see that no other pathogens were present, the physician
may subsequently follow this by a course of fluconazole (150 mg tablets, once
per day) for one or several weeks. At the same time there terconazole could be
added as a cream intravaginally. However, the gynecologist has some other methods
available as a tool such as the "triple dye" treatment, which occasionally
is used and directly applied during a gynecological examination. At the same time
efforts are perhaps directed at rebalancing the vaginal flora by life style changes.
A lesser known fact is that smoking dysbalances the vaginal flora among other
negative health impacts and this adds another reason why you need to quit smoking,
if you do so now. Add to this a low sugar diet and low starch diet (Ref.
2) including yoghurt in your food intake (Lactobacillus source) and you are well
on your way to a recovery from chronic recurrent vaginal yeast infections.
Weight
Gain Weight gain is a common complaint in general practice,
particularly in women who tend to be more weight and health conscious than their
male counterparts. Women tend to gain weight more in the hip and thigh regions
and around their breasts. This is different from males who accumulate fat around
the waist. Weight gain is a complex life style problem that involves attitudes,
lack of exercise and eating the wrong food groups, coupled often with hidden denial.
I have shown in a separate chapter regarding this topic that weight reduction
and lifelong control of it through dietary changes is only one of the treatment
modalities to counteract weight gain. Other parts are regular exercise and the
internal hormonal adaptation that takes place when you commit yourself to a zone
diet meal plan. This treats the insulin resistance, which from a medical point
of view is the silent underlying cause of the weight problem as the hypoglycemic
reactions are what makes people crave starch and sugar containing food. The reward
of this change in diet and starting to exercise are improved emotional feelings,
fitness and the internal satisfaction to know that you have achieved something
that is easier than many people believe. This will pay dividends as you will be
staying younger looking for years to come and you will stay energetic until a
ripe old age (the longevity bonus of a diet/exercise program). If at this
point you are still interested in learning more about this possibility, go to
this link: Health, nutrition and
fitness. |
