Gyno Groupie

Commonly patients present with irregularities in their menstrual period, irritability or mood swings, bloating, fluid retention or weight gain, hot flashes, or decreased libido…wondering if their ‘hormones are out of balance’?  Unfortunately, there’s not always an easy answer to that question, but as Gynecologists, it does cause us to consider two common ‘hormonal’ conditions that could explain such symptoms:  Polycystic Ovarian Syndrome, and the Perimenopause.

Polycystic Ovarian Syndrome is characterized by menstrual irregularities (chronic anovulation) and signs of androgen excess (hair growth, acne), and is the most common ‘hormonal abnormality’ affecting reproductive aged women.  Nearly 1 in 15 women are affected, half of those women being overweight or obese.  Many women with PCOS have had a long history of irregular menstrual periods, dating as far back as they can remember.  The irregularities can vary between skipped periods to frequent periods, flow may be light to heavy, and short or prolonged in duration.  Some women describe light cramping/a sensation of pelvic ‘fullness’ or bloating (like their period is ‘about to start’), in the months of skipped periods.  Others describe a feeling of emotional ‘tension’, while in wait for that unknown date when their period will start.  Though the cause of PCOS is unknown, genetic inheritance may play a role.

At 15 years old I remember asking myself, “Is this what they mean by menstrual ‘cramps’?”  The term ‘cramp’ just seemed too mild to explain the horrid, 1 or 2 day experience, which regularly preceded the start of my monthly  period.  Back pain, ‘front’ pain, nausea, and sweats…felt more like a suffering from the flu…with an elephant stepping on my back!... than what I’d describe as menstrual ‘cramps’.  The usual ‘mother’s home remedies’ like a heating pad, hot tea, or over-the-counter pain reliever, hardly ever seemed to do enough, but I adhered to the regimen every month anyway…What else was I going to do?

As a Gynecologist, I now know the significance of the menstrual ‘cramps’.  In our rhythmic, monthly, hormonal cycle, and in response to the rise in our ovarian hormones (estrogen and progesterone), our ovaries form the ‘dominant follicle’, which releases the fertilizable egg for that month.  At the same time, the uterine lining develops a thick, shaggy layer (like a shag carpet) to enhance implantation of a fertilized egg (egg fertilized by a male sperm=pregnancy.)  On the other hand, if no egg fertilization occurs (no pregnancy), the ovarian hormones decline, allowing for release/shedding of the previously developed thickened uterine lining tissue (representing our ‘menstrual flow’), and the obvious sign of menstrual bleeding.

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The use of estrogen/progesterone containing Birth Control Pills have long been known to slightly increase one’s risk for Venous Thromboembolic  events (i.e., deep vein blood clots.)  Recent reports have put into question additional increased risk by use of BCPs containing the progesterone, dropserinone (Yasmin, Yaz, Beyaz, and their generics.)  Available studies on this issue are inconsistent,  some studies showing a fractional increased risk, others showing no increased risk.  In comparing risks of VTE, the increased risk from any Birth Control Pill (3-9/10,000) is still significantly less than the increased risk of VTE in pregnancy (5-20/10,000), and the immediate post-delivery time period (40-65/10,000)…  According to the FDA’s advisory committee, the benefits of all contraceptive methods still outweigh the risks.

drsuzyyhall

(See WXYZ's interview with Dr. Suzanne Hall on their recent story on Yaz

at http://www.wxyz.com/dpp/news/health/mom-warns-birth-control-killed-her-daughter)

I often jokingly comment to my patients, “No matter what our skin color is on the outside, We’re all the same color on the ‘inside’…literally.” And it’s the truth. From an anatomical perspective, our inner organs are all the same color, despite skin color or race!