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.
PMS treatment:PMSis 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. Additional medications such as oral contraceptives, progesterone pills or progesterone patches, and pulsed gonadotropin-releasing hormone or an agonist (leuprolide) can be given. However, this likely should only be ordered by the specialist (gynecologist or endocrinologist) in those cases where it is needed based on specific blood tests to that would point in that direction. Every 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:
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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.
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