Women with polycystic ovarian syndrome (PCOS) have an increased risk for heart disease and possibly heart attacks compared to other women of the same age and weight, studies show. Specifically, the indications of cardiovascular disease include sub-clinical hardening of the arteries and signs of significant vascular impairment, including irregularities of the cells lining the arteries and blood vessels and increased thickness and decreased compliance of arterial walls. While the main focus of PCOS specialists is treating infertility, menstrual irregularities and unwanted hair, it’s important for women and their physicians to pay attention to the increased cardiovascular risk that accompanies PCOS as well, said Dr. Pinar Kodaman, a reproductive endocrine specialist who focuses on reducing cardiovascular risks for PCOS patients through lifestyle modification and medication. Dr. Kodaman is part of the multidisciplinary team at the Yale Polycystic Ovarian Syndrome Program that treats all aspects of PCOS.
Cardiovascular disease remains the most common cause of death among women, and risk of death from a heart attack increases with age, especially in the United States where there is a high incidence of obesity, a key contributor to heart disease.
At least 50% of women with PCOS in the U.S. are obese, 40% are insulin resistant, and 10% have type II diabetes. Insulin resistance, coupled with the body’s tendency to compensate by producing even more insulin, is one of the major factors in the development of Metabolic Syndrome, and this condition exacerbates elevated lipids in the blood, obesity, glucose intolerance and unwanted facial and body hair among women with PCOS.
PCOS is also associated with increased oxidative stress, high blood pressure, elevated levels of homocysteine, an amino acid in the blood that is an indicator of higher risk of heart disease, and dyslipidemia (an imbalance of lipids in the blood), all of which also contribute to cardiovascular risk. Interestingly, even young and lean women with PCOS tend to have unfavorable cardiovascular risk profiles, Dr. Kodaman said.
The studies on cardiovascular illness and death among PCOS patients are limited; however, the cardiovascular risks associated with the syndrome are clear.
The medical management of PCOS includes therapy for failure to ovulate or irregular ovulation, unwanted body and facial hair, as well as treatment of endometrial hyperplasia, a condition in which the lining of the uterus grows too much. In addition, obesity, dyslipidemia, hypertension, and insulin resistance should also be addressed if present. Lifestyle modification with diet and exercise are first line treatments, followed by insulin sensitizers, such as metformin, for insulin resistance and statin drugs, like Lipitor, for dyslipidemia. Statins may have additional beneficial roles in decreasing oxidative stress and improving hyperandrogenemia and other biochemical disorders of PCOS.
PCOS is the most common endocrine disease affecting women of reproductive age. Up to 10 million women in the United States have PCOS, a condition characterized by hyperandrogenism (excessive secretion of male sex hormones that results in unwanted facial and body hair) and oligomenorrhea (irregular menstrual periods). Frequently, the ovaries also have a polycystic appearance on ultrasound, which appears as multiple small follicles around the perimeter of the ovary. The cause of PCOS is unknown and researchers are actively investigating it.
PCOS occurs shortly after puberty and consists of altered gonadotropin secretion favoring luteinizing hormone production, which stimulates the ovaries to produce increased levels of androgens (male sex hormones). In addition, at the level of the ovary, the follicles make less estrogen and luteinize prematurely, thereby failing to ovulate.
While PCOS is an endocrine disorder affecting women during their reproductive years, its consequences continue to have detrimental effects in the postmenopausal years. A recent a study found that postmenopausal women with clinical features of PCOS had a greater incidence of cardiovascular events. Therefore, it is imperative that PCOS be diagnosed in a timely fashion and treated effectively across the lifespan.
Monday, April 13, 2009
Nutrition and PCOS
While the causes of PCOS remain unclear, most experts believe insulin plays a major role in its development. The majority of PCOS patients have decreased insulin insensitivity, causing high levels of insulin or what is commonly known as insulin resistance. Approximately 50% of women affected by PCOS are overweight.
Risk Factors
Insulin resistance places an individual at increased risk for:
• Abnormal carbohydrate metabolism – raising the likelihood of developing type II diabetes
• Heart disease due to:
– Increased levels of LDL or “bad” cholesterol
– Decreased levels of HDL or “good” cholesterol
– Increased levels of triglycerides
– Increased blood pressure
• Significant weight gain and difficulty losing weight
• Low self-esteem
Lifestyle Modifications
Diet
Diet and exercise have been established as the first line of defense against PCOS. Studies show that a 5%-10% weight loss may substantially improve the metabolic and reproductive abnormalities associated with PCOS while lowering the risk of heart disease and type II diabetes. A registered dietitian (RD) can help customize a balanced diet, low in fat and moderate in carbohydrates, to help you achieve and maintain your weight loss goals. The RD will evaluate your current diet, lifestyle and risk factors and
establish a nutrition plan specific to your individual needs.
The following factors will be considered:
• Current height and weight
• Ideal body weight (IBW)
• Age, overall health and medical history
• Current medications or supplements taken
• Current eating patterns, food preferences and dietary customs
Exercise
Evidence clearly supports the importance of physical activity for women affected by PCOS; exercise may be just as important as diet in treating the disorder. Both aerobic exercise and strength conditioning can be effective in:
• Improving lipid levels
• Improving insulin insensitivity
• Lowering blood pressure
• Improving self-esteem
• Managing weight
• Aiding in prevention and treatment of chronic disease
An RD can help develop a customized exercise plan based on your preferences and lifestyle pattern.
Health Risks of PCOS
Women with PCOS are at increased risk fordeveloping a number of long-term health problems. At the Yale PCOS Program, we seek to address these risks before they become serious medical issues, with a combination of lifestyle modifications and medical interventions.
• Endometrial Hyperplasia – A thickening of the endometrium (uterine lining) can cause heavy or irregular bleeding, and may lead to pre-cancerous changes in the endometrium that could develop into endometrial cancer.
• Cardiovascular Disease Risk – Women with PCOS have a greater chance of developing Metabolic Syndrome – a cluster of risk factors that raise the likelihood of a heart attack or stroke later in life.
These factors include:
• Obesity – approximately 50% of women with PCOS in the US are obese
• Dyslipidemia – increased total cholesterol, triglycerides or both and decreased HDL (good cholesterol)
• Elevated blood pressure (hypertension)
• Insulin resistance – 40% of women with PCOS are insulin resistant
• Type II diabetes – affects 10% of women with PCOS
• Sleep apnea – can present as disturbed sleep, frequent sleep interruptions, restlessness, snoring, and daytime fatigue and sleepiness
Given these risk factors, women with PCOS have a seven-fold increased risk for heart attack and are four times more likely to have a stroke compared to women without PCOS.
• Breast Cancer – Some studies indicate that there is a correlation between PCOS and breast cancer, but the evidence so far is inconclusive.
Women with PCOS are encouraged to visit the Yale PCOS Program for a complete metabolic assessment and risk profile. Your initial examination will include a complete medical history, physical exam with BMI measurement, pelvic ultrasound and all appropriate lab tests. Once we have assessed your risk, we will tailor an individualized plan to meet your specific needs.
Cosmetic Concerns and Symptoms of PCOS
Cosmetic concerns are common in women with PCOS. While not hazardous to health, they may be a source of significant psychological distress. The Yale PCOS Program helps women manage bothersome cosmetic concerns with medical interventions, lifestyle modifications, and psychological support and counseling.
Hirsutism
Hirsutism is the excess growth of coarse, visible body hair, which can be evident on the upper lip, around the jaw, on the cheeks, and sometimes on the chest, stomach and upper thighs. Increased male hormone levels and insulin contribute to hirsutism in women with PCOS. Treatments include:
• Anti-androgens* (Flutamide, Finasteride and Spironolactone) – to decrease the male hormone’s effect on hair growth
• Vaniqa (Eflornithine) cream – to reduce facial hair
• Birth control pills* – to decrease production of male hormones
• Non-pharmacological options – such as shaving, bleaching, waxing, electrolysis and laser hair removal
Acne
Acne is common in women with PCOS and is caused by elevated male hormone and insulin levels. Treatments include:
• Anti-androgens* – to counter the effects of the male hormone on skin
• Benzoyl peroxide – a common over-the-counter ingredient used in creams and lotions to treat mild to moderate acne
• Topical retinoids* – prescription creams formed from Vitamin A that help unclog pores and increase cell turnover
• Topical antibiotics – creams, lotions or gel pads that reduce inflammation by killing bacteria
Hyperpigmentation
Hyperpigmentation (Acanthosis nigricans) causes thickened, darkened skin patches that commonly affect the nape of the neck, armpits, skin under the breasts, and the groin. Insulin resistance causes this condition, which improves with adequate treatment of the underlying endocrine disorder. Treatment may include:
• Weight loss
• Dietary/pharmaceutical control of insulin resistance (such as Metformin)
• Topical exfoliants (e.g., lactic acid, tretinoin, urea-based medications)
Hair loss
Hair Loss (Androgenic alopecia) in women with PCOS is commonly due to a male hormone imbalance.
Treatments include:
• Minoxidil (Rogaine) – the only FDA-approved treatment for female pattern baldness, used topically on the scalp
• Anti-androgens* (Finasteride) – to counter the effects of the male hormone on hair loss
Excessive body weight
Approximately 50% of women with PCOS are overweight, due to an imbalance in caloric intake and caloric expenditure.
Management options include:
• Nutritional counseling – Individualized nutritional plans are created based on the patient’s preferences to ensure long-term compliance
• Physical activity counseling – Detailed assessment of patient’s lifestyle and individualized counseling to achieve optimal caloric expenditure
• Therapy – For certain patients, medical and/or surgical weight loss (bariatric surgery) and psychological counseling may be considered; treatment plans are individualized
* For women who are not pregnant and are not trying to get pregnant
Weight problems, cosmetic concerns, and distress regarding body image and infertility can be a source of tremendous stress for women with PCOS. Studies have identified that women with PCOS may be more likely to suffer from anxiety and depression. Chronic stress itself may contribute to some of the symptoms of PCOS (such as irregular menses) and be detrimental to fertility success. In recognition of the importance of the emotional component of PCOS, the Yale PCOS Program offers psychological support and counseling to complement medical, nutritional and lifestyle management strategies, and to help improve overall well-being in women of all ages diagnosed with PCOS. Psychological counseling options are available on site with our experienced counselor to help patients cope with:
• Menstrual irregularities
• Concerns related to self-image resulting from weight-related problems, acne, excessive body hair or hair loss
• PCOS-related infertility
Adolescents with PCOS may be especially prone to psychological and emotional distress from symptoms of PCOS. We offer a comprehensive program of psychological counseling and support for adolescents and their families to help cope with a PCOS diagnosis.
Signs and symptoms of polycystic ovarian syndrome (PCOS) can often be seen as a girl progresses through puberty. Although irregular menstrual cycles are part of the normal course of puberty, girls with PCOS are more likely to exhibit exaggerated symptoms such as:
• Irregular menstrual cycles for longer than a year
• Increased androgen production resulting in unwanted hair growth or scalp hair loss
• Increased body mass and insulin resistance
• Delay of more than two years between onset of puberty and occurrence of menses
• Early appearance of pubic hair prior to puberty
• Heavy uterine bleeding
• Acne
• Depression
• Weight gain
At the Yale PCOS Program, our medical practitioners include Ob/Gyns specializing in adolescent medicine. During a young woman’s first appointment, we strive to establish a physician/patient relationship that ensures the patient’s and family’s comfort and confidence in discussing any health issues and concerns. Discussions are individualized to the adolescent’s needs and include a review of:
• Normal pubertal development and menstruation
• Healthy eating habits and body image
• Preventive healthcare including the HPV vaccine and reproductive hygiene (including pregnancy and sexually transmitted infection prevention, if appropriate)
• PCOS-related concerns
Assessment of PCOS-related symptoms consists of a thorough medical evaluation, including a detailed medical history, nutritional assessment, physical examination, laboratory testing and an abdominal ultrasound (if appropriate). Treatment is individualized to the needs of each adolescent and tailored to her life stage. Similar to adult women, therapies for adolescents with PCOS include:
• Lifestyle modifications including diet and exercise to lessen the
symptoms of PCOS by improving insulin insensitivity and lipid levels, managing weight, and increasing self-esteem
• Birth control pills to regulate menstrual cycles and reduce androgen levels, which improves acne and excessive body hair, and may have a beneficial effect on overall body image
• Insulin sensitizing agents such as Metformin to lower insulin levels and improve metabolic problems associated with PCOS
• Anti-androgen treatments to decrease unwanted hair growth
when non-medical treatments are ineffective
• Psychological support for adolescents and families to help cope
Hirsutism
Hirsutism is the excess growth of coarse, visible body hair, which can be evident on the upper lip, around the jaw, on the cheeks, and sometimes on the chest, stomach and upper thighs. Increased male hormone levels and insulin contribute to hirsutism in women with PCOS. Treatments include:
• Anti-androgens* (Flutamide, Finasteride and Spironolactone) – to decrease the male hormone’s effect on hair growth
• Vaniqa (Eflornithine) cream – to reduce facial hair
• Birth control pills* – to decrease production of male hormones
• Non-pharmacological options – such as shaving, bleaching, waxing, electrolysis and laser hair removal
Acne
Acne is common in women with PCOS and is caused by elevated male hormone and insulin levels. Treatments include:
• Anti-androgens* – to counter the effects of the male hormone on skin
• Benzoyl peroxide – a common over-the-counter ingredient used in creams and lotions to treat mild to moderate acne
• Topical retinoids* – prescription creams formed from Vitamin A that help unclog pores and increase cell turnover
• Topical antibiotics – creams, lotions or gel pads that reduce inflammation by killing bacteria
Hyperpigmentation
Hyperpigmentation (Acanthosis nigricans) causes thickened, darkened skin patches that commonly affect the nape of the neck, armpits, skin under the breasts, and the groin. Insulin resistance causes this condition, which improves with adequate treatment of the underlying endocrine disorder. Treatment may include:
• Weight loss
• Dietary/pharmaceutical control of insulin resistance (such as Metformin)
• Topical exfoliants (e.g., lactic acid, tretinoin, urea-based medications)
Hair loss
Hair Loss (Androgenic alopecia) in women with PCOS is commonly due to a male hormone imbalance.
Treatments include:
• Minoxidil (Rogaine) – the only FDA-approved treatment for female pattern baldness, used topically on the scalp
• Anti-androgens* (Finasteride) – to counter the effects of the male hormone on hair loss
Excessive body weight
Approximately 50% of women with PCOS are overweight, due to an imbalance in caloric intake and caloric expenditure.
Management options include:
• Nutritional counseling – Individualized nutritional plans are created based on the patient’s preferences to ensure long-term compliance
• Physical activity counseling – Detailed assessment of patient’s lifestyle and individualized counseling to achieve optimal caloric expenditure
• Therapy – For certain patients, medical and/or surgical weight loss (bariatric surgery) and psychological counseling may be considered; treatment plans are individualized
* For women who are not pregnant and are not trying to get pregnant
Weight problems, cosmetic concerns, and distress regarding body image and infertility can be a source of tremendous stress for women with PCOS. Studies have identified that women with PCOS may be more likely to suffer from anxiety and depression. Chronic stress itself may contribute to some of the symptoms of PCOS (such as irregular menses) and be detrimental to fertility success. In recognition of the importance of the emotional component of PCOS, the Yale PCOS Program offers psychological support and counseling to complement medical, nutritional and lifestyle management strategies, and to help improve overall well-being in women of all ages diagnosed with PCOS. Psychological counseling options are available on site with our experienced counselor to help patients cope with:
• Menstrual irregularities
• Concerns related to self-image resulting from weight-related problems, acne, excessive body hair or hair loss
• PCOS-related infertility
Adolescents with PCOS may be especially prone to psychological and emotional distress from symptoms of PCOS. We offer a comprehensive program of psychological counseling and support for adolescents and their families to help cope with a PCOS diagnosis.
Signs and symptoms of polycystic ovarian syndrome (PCOS) can often be seen as a girl progresses through puberty. Although irregular menstrual cycles are part of the normal course of puberty, girls with PCOS are more likely to exhibit exaggerated symptoms such as:
• Irregular menstrual cycles for longer than a year
• Increased androgen production resulting in unwanted hair growth or scalp hair loss
• Increased body mass and insulin resistance
• Delay of more than two years between onset of puberty and occurrence of menses
• Early appearance of pubic hair prior to puberty
• Heavy uterine bleeding
• Acne
• Depression
• Weight gain
At the Yale PCOS Program, our medical practitioners include Ob/Gyns specializing in adolescent medicine. During a young woman’s first appointment, we strive to establish a physician/patient relationship that ensures the patient’s and family’s comfort and confidence in discussing any health issues and concerns. Discussions are individualized to the adolescent’s needs and include a review of:
• Normal pubertal development and menstruation
• Healthy eating habits and body image
• Preventive healthcare including the HPV vaccine and reproductive hygiene (including pregnancy and sexually transmitted infection prevention, if appropriate)
• PCOS-related concerns
Assessment of PCOS-related symptoms consists of a thorough medical evaluation, including a detailed medical history, nutritional assessment, physical examination, laboratory testing and an abdominal ultrasound (if appropriate). Treatment is individualized to the needs of each adolescent and tailored to her life stage. Similar to adult women, therapies for adolescents with PCOS include:
• Lifestyle modifications including diet and exercise to lessen the
symptoms of PCOS by improving insulin insensitivity and lipid levels, managing weight, and increasing self-esteem
• Birth control pills to regulate menstrual cycles and reduce androgen levels, which improves acne and excessive body hair, and may have a beneficial effect on overall body image
• Insulin sensitizing agents such as Metformin to lower insulin levels and improve metabolic problems associated with PCOS
• Anti-androgen treatments to decrease unwanted hair growth
when non-medical treatments are ineffective
• Psychological support for adolescents and families to help cope
What is Endometriosis?
The name comes from the word "endometrium," which is the tissue that lines the uterus. During a woman's regular menstrual cycle, this tissue builds up and is shed if she does not become pregnant. Women with endometriosis develop tissue that looks and acts like endometrial tissue outside the uterus, usually on other reproductive organs inside the pelvis or in the abdominal cavity. Each month, this misplaced tissue responds to the hormonal changes of the menstrual cycle by building up and breaking down just as the endometrium does, resulting in internal bleeding.
Unlike menstrual fluid from the uterus which is shed by the body, blood from the misplaced tissue has nowhere to go, resulting in the tissues surrounding the endometriosis becoming inflamed or swollen. This process can produce scar tissue around the area which may develop into lesions or growths. In some cases, particularly when an ovary is involved, the blood can become embedded in the tissue where it is located, forming blood blisters that may become surrounded by a fibrous cyst.
A staging system has been developed by the American Society of Reproductive Medicine (formerly the American Fertility Society). The stages are classified according to the following:
Stage Level of Severity
Stage I minimal
Stage II mild
Stage III moderate
Stage IV severe
The stage of endometriosis is based on the location, amount, depth, and size of the endometrial implants. Specific criteria include:
* the extent of the spread of the implants
* the involvement of pelvic structures in the disease
* the extent of pelvic adhesions
* the blockage of the fallopian tubes
The stage of the endometriosis does not necessarily reflect the level of pain experienced, risk of infertility, or symptoms present. For example, it is possible for a woman in Stage I to be in tremendous pain, while a woman in Stage IV may be asymptomatic. In addition, women who receive treatment during the first two stages of the disease have the greatest chance of regaining their ability to become pregnant following treatment.
The causes of endometriosis are still unknown, although many theories abound. One theory suggests that during menstruation some of the tissue backs up through the fallopian tubes into the abdomen, a sort of "reverse menstruation", where it attaches and grows. Another theory states that certain families may have predisposing genetic factors to the disease. Current research is also looking at the role of the immune system in activating cells that may secrete factors which stimulate endometriosis.
How is endometriosis diagnosed?
For many women, simply having a diagnosis of endometriosis brings relief. Diagnosis begins with a gynecologist evaluating a patient's medical history and a complete physical examination including a pelvic exam. A diagnosis of endometriosis can only be certain when the physician performs a laparoscopy (a minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic area, the physician can often determine the locations, extent, and size of the endometrial growths.).
Other examinations which may be used in the diagnosis of endometriosis include:
Biopsy- a procedure in which tissue samples are removed (with a needle or during surgery) from the body (often during a laparoscopy) for examination under a microscope; to determine if cancer or other abnormal cells are present.
Ultrasound- a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs.
Computed tomography (CT or CAT scan)- a non-invasive procedure that takes cross-sectional images of internal organs; to detect any abnormalities that may not show up on an ordinary x-ray.
Magnetic resonance imaging (MRI)- a non-invasive procedure that produces a two-dimensional view of an internal organ or structure.
What can be done to ease the pain of endometriosis?
Simple tips that can help ease the pain of endometriosis include rest, relaxation, and meditation; warm baths; prevent constipation; regular exercise; use of hot water bottle or heating pad on your abdomen.
Treatment for endometriosis
Specific treatment for endometriosis will be determined by your physician based on:
- Your overall health and medical history
- Current symptoms
- Extent of the disease
- Your tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
- Your desire for pregnancy
In general, treatment for endometriosis may include
- "Watchful waiting" - to observe the course of the disease
- Pain medication - such as ibuprofen or other over-the-counter analgesics
- Hormone therapy, including:
- Gonadotropin-releasing hormone agonist (GnRH agonist), which stops ovarian hormone production, creating a sort of "medical menopause"
- Danazol, a synthetic derivative of testosterone (a male hormone)
- Oral contraceptives, with combined estrogen and progestin (a synthetic form of progesterone) hormones, prevent ovulation and reduce menstrual flow
- Progesterone alone
Surgical techniques which may be used to treat endometriosis include:
Laparoscopy- (also used to help diagnose endometriosis) a minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic area, the physician can often remove the endometrial growths.
Aparotomy- a more extensive surgery to remove as much of the displaced endometrium as possible without damaging healthy tissue.
Hysterectomy- surgery to remove the uterus and possibly the ovaries.
Sometimes a combination of therapies are used, such as conservative surgery (laparoscopy or laparotomy), along with hormone therapy.
Some women also benefit from alternative treatments used in conjunction with other medical and surgical therapies for the treatment of endometriosis.
These include:
- Traditional Chinese medicine
- Nutritional approaches
- Homeopathy
- Allergy management
- Immune therapy
It is important to discuss any/all of these treatments thoroughly with your physician, as some may conflict with the effectiveness of others.
Where are endometrial implants often found?
Endometriosis is most often found in the ovaries, but can also be found in other places (indicated above in purple), including:
- The fallopian tubes
- Ligaments that support the uterus
- The internal area between the vagina and rectum
- Outer surface of the uterus
- In the lining of the pelvic cavity
Occasionally, the implants are found in other places, such as:
- Intestines
- Rectum
- Bladder
- Vagina
- Cervix
- Vulva
- Abdominal surgery scars
While any woman may develop endometriosis, the following women seem to be at an increased risk for the disease:
- Women who have first-degree relative (mother, sister, daughter) with the disease
- Women who are giving birth for the first time after age 30
- Caucasian women
- Women with an abnormal uterus
The following are the most common symptoms for endometriosis, however, each individual may experience symptoms differently.
Symptoms of endometriosis may include:
- Pain, especially excessive menstrual cramps which may be felt in the abdomen or lower back
- Pain during intercourse
- Abnormal or heavy menstrual flow
- Infertility
- Fatigue
- Painful urination during menstrual periods
- Painful bowel movements during menstrual periods
- Other gastrointestinal problems (i.e., diarrhea, constipation, and/or nausea)
It is important to note that the amount of pain a woman experiences is not necessarily related to the severity of the disease - some women with severe endometriosis may experience no pain, while others with a milder form of the disease may have severe pain or other symptoms
Vitamin D: Sunlight Can Be Good for You
Evidence is growing that Vitamin D is crucial to many aspects of health—and that deficiency is extremely common, even in seemingly healthy people. The vitamin’s best-known role is in building bone, but low levels also appear to be associated with diabetes, heart disease, and infertility, among other diseases. “When you start looking at the data, the health benefits of D appear to be at every cellular level, in multiple organs,” said Lubna Pal, M.B.B.S., director of the Reproductive Aging and Bone Health Program.
Pal and her colleagues studied the health records of over 400 healthy pre-menopausal women and found that an astonishing 79% of them had low vitamin D levels. She found a link between low vitamin D levels and abnormal levels of blood sugar, insulin, inflammatory markers, and body mass. Such markers are associated with a higher risk of cardiovascular disease and diabetes. Women who were not Caucasian had lower levels of vitamin D, while more physically active women had higher levels.
In a previous study, Pal checked levels of vitamin D in the ovaries of 84 women undergoing fertility treatments. Almost two-thirds of the women had low levels, and those who achieved pregnancy had, on the average, higher levels of vitamin D than those who didn’t.
Vitamin D is made by the skin when touched by sunlight; it is also found in some foods. “We’re becoming more under-the-shade workers [and are] not getting our daily allowance,” said Pal. She suggests spending 10 minutes in the sun each day.
PCOS in Adolescents
Signs and symptoms of Polycystic Ovarian Syndrome (PCOS) can be seen during a girl’s pubertal transition. Although the normal pubertal course involves irregular menstrual cycles, increased androgen production, and increased body mass and insulin resistance, these processes are often exaggerated in girls with PCOS. A delay of greater than two years between the onset of puberty and the occurrence of menses may indicate PCOS. Furthermore, one early sign of PCOS may be the early appearance of pubic hair in young girls, prior to puberty. Adolescents with PCOS can present with a variety of symptoms which tend to start gradually, and can include irregular menstrual cycles, heavy uterine bleeding, acne, depression, weight gain, unwanted hair growth, or scalp hair loss.
One of the hallmarks of PCOS is irregular menstrual cycles. While it is normal for a young woman to experience irregular menstrual cycles for the first 6 to 12 months after her first menses, it is abnormal if the irregularity persists beyond 12 months. These young women deserve evaluation to determine a cause of their irregular cycles. In the past, young women were often prescribed oral contraceptives (birth control pills) to regulate their menstrual cycle, without any evaluation. However, due to the long-term health risks associated with PCOS, the ability to make this diagnosis in adolescents will hopefully improve the long-term health of these young women.
Similar to adult women, medical therapies for adolescents with PCOS include birth control pills, insulin sensitizing agents, and anti-androgen treatments. Treatment is individualized to the needs of each patient, and is tailored to where she is in her pubertal course.
Yale PCOS Program: A “One-Stop Shop” for Women with PCOS
Because Polycystic Ovarian Syndrome (PCOS) affects more than just the ovaries, Yale experts are teaming up to form a PCOS center for excellence. Clinicians at the Yale Program for PCOS will not only treat PCOS but also address problems that may accompany this diagnosis including fertility problems, body weight and body image issues, high cholesterol, insulin resistance and risk for diabetes, high blood pressure and risk for heart disease. The result will be what Dr. Pinar Kodaman, calls a “more holistic approach.”
“Beyond improving the overall health of women with PCOS, our goals are to help the patients take charge of PCOS,” says Dr. Lubna Pal, director of the Yale PCOS Program. During a single convenient appointment, patients will undergo evaluation by our team of expert physicians and nutritionists. Management strategies will be individualized to the needs of each patient. Risk profiles for heart disease and diabetes will be determined through detailed assessments, including tests that reflect the most advanced research into the disorder. Health goals will be identified (target weight, cholesterol, blood pressure, blood sugar, vitamin D level) and our team will work with each patient to ensure that these goals are met.
Each of the Yale Ob/Gyn physicians at the Yale PCOS Program brings her own expertise to the table:
Adolescents and teenagers with symptoms of PCOS (such as menstrual irregularities, excessive facial and body hair and acne) will benefit from Dr. Beth Rackow’s expertise in adolescent gynecology and menstrual disorders.
Utilizing combinations of lifestyle modifications and medications, Dr. Kodaman will focus on reducing risks for cardiovascular disease while Dr. Pal concentrates on issues of insulin resistance and diabetes.
Dr. Stephen Thung, a Yale Maternal-Fetal Medicine specialist with a special interest in the management of gestational diabetes and hypertension in pregnancy (common in women with PCOS), joins the team as a resource for preconception consultation for patients deemed at high risk for pregnancy-related problems.
Amy Krystock, a registered dietitian, employs a total lifestyle modification approach, utilizing customized diet and exercise programs for women with PCOS.
Dorothy Greenfeld, LCSW, provides an invaluable resource for psychological support, helping patients overcome the stress of PCOS symptoms and diagnosis.
By combining our efforts and expertise, we hope to be able to address the health needs of women of all ages diagnosed with PCOS. “I can foresee a teenager with PCOS being cared for at our center through her reproductive years into menopause,” says Dr. Pal.
“Beyond improving the overall health of women with PCOS, our goals are to help the patients take charge of PCOS,” says Dr. Lubna Pal, director of the Yale PCOS Program. During a single convenient appointment, patients will undergo evaluation by our team of expert physicians and nutritionists. Management strategies will be individualized to the needs of each patient. Risk profiles for heart disease and diabetes will be determined through detailed assessments, including tests that reflect the most advanced research into the disorder. Health goals will be identified (target weight, cholesterol, blood pressure, blood sugar, vitamin D level) and our team will work with each patient to ensure that these goals are met.
Each of the Yale Ob/Gyn physicians at the Yale PCOS Program brings her own expertise to the table:
Adolescents and teenagers with symptoms of PCOS (such as menstrual irregularities, excessive facial and body hair and acne) will benefit from Dr. Beth Rackow’s expertise in adolescent gynecology and menstrual disorders.
Utilizing combinations of lifestyle modifications and medications, Dr. Kodaman will focus on reducing risks for cardiovascular disease while Dr. Pal concentrates on issues of insulin resistance and diabetes.
Dr. Stephen Thung, a Yale Maternal-Fetal Medicine specialist with a special interest in the management of gestational diabetes and hypertension in pregnancy (common in women with PCOS), joins the team as a resource for preconception consultation for patients deemed at high risk for pregnancy-related problems.
Amy Krystock, a registered dietitian, employs a total lifestyle modification approach, utilizing customized diet and exercise programs for women with PCOS.
Dorothy Greenfeld, LCSW, provides an invaluable resource for psychological support, helping patients overcome the stress of PCOS symptoms and diagnosis.
By combining our efforts and expertise, we hope to be able to address the health needs of women of all ages diagnosed with PCOS. “I can foresee a teenager with PCOS being cared for at our center through her reproductive years into menopause,” says Dr. Pal.
What is PCOS?
The Yale PCOS Program
A focus on needs of women with PCOS … aiming for a “healthier you”
Polycystic Ovarian Syndrome (PCOS) is:
- The commonest endocrine disorder affecting 6-10% of reproductive age women.
- A “label” that spans the reproductive life span of a woman, i.e. from adolescence to menopause!
- A pre-morbid condition with implications for:
Health of the Woman
Risk for:
- Diabetes
- CVD/stroke
- Cancer of endometrium/Breast
Infertility
Risk for:
- Miscarriage
- Complications of pregnancy including gestational diabetes and pregnancy induced hypertension
Children Born to Women with PCOS
Risk for:
- Higher prevalence of obesity/insulin resistance and dyslipidemia in children of women with PCOS
- Higher prevalence of PCOS in daughters of women with PCOS
PCOS AND RELATED MORBIDITIES ARE NOT INEVITABLE!
Yale Program for PCOS aims to provide comprehensive assessment and an individualized care to the needs of women with PCOS. We have assembled a multidisciplinary team of highly trained clinicians, researchers, nutritionists and nurses whose goal is to help women “shed” the diagnosis of PCOS!
A focus on needs of women with PCOS … aiming for a “healthier you”
Polycystic Ovarian Syndrome (PCOS) is:
- The commonest endocrine disorder affecting 6-10% of reproductive age women.
- A “label” that spans the reproductive life span of a woman, i.e. from adolescence to menopause!
- A pre-morbid condition with implications for:
Health of the Woman
Risk for:
- Diabetes
- CVD/stroke
- Cancer of endometrium/Breast
Infertility
Risk for:
- Miscarriage
- Complications of pregnancy including gestational diabetes and pregnancy induced hypertension
Children Born to Women with PCOS
Risk for:
- Higher prevalence of obesity/insulin resistance and dyslipidemia in children of women with PCOS
- Higher prevalence of PCOS in daughters of women with PCOS
PCOS AND RELATED MORBIDITIES ARE NOT INEVITABLE!
Yale Program for PCOS aims to provide comprehensive assessment and an individualized care to the needs of women with PCOS. We have assembled a multidisciplinary team of highly trained clinicians, researchers, nutritionists and nurses whose goal is to help women “shed” the diagnosis of PCOS!
Cryoablation
Icy therapy for uterine bleeding
For some women, a quick office procedure may be all it takes to stop abnormal uterine bleeding. That procedure is cryoablation, a technique that uses liquid nitrogen to freeze the inner lining of the uterus to stop chronic bleeding in women for whom other treatments haven’t worked and who don’t want hysterectomies. “It’s a great procedure for select people who want to retain their uterus, or don’t want a big abdominal surgery,” says Dr. Pinar Kodaman, one of Yale’s cryoablation specialists.
Many other ablation techniques involve heating the uterine lining, or endometrium; they often require general or spinal anesthesia. But in cryoablation, the cold itself serves as anesthesia.
The procedure takes about fifteen minutes. The patient is given local anesthesia at the cervix, then the doctor inserts a slender liquid nitrogen probe which touches the inner uterus and forms an “iceball.” An assistant uses ultrasound to help the doctor direct the probe accurately and freeze just enough tissue. The patient goes home shortly afterward, and generally needs only ibuprofen for discomfort.
After cryoablation, about 90% of women report an improvement in their bleeding, though about two-thirds continue to have periods. Women who want their periods to stop altogether, Dr. Kodaman says, should consider getting a hysterectomy.
She cautions that while it is still possible to get pregnant after cryoablation, it is very unsafe to do so, and women considering the procedure should have completed childbearing. “They should always have a good form of contraception,” she says.
For some women, a quick office procedure may be all it takes to stop abnormal uterine bleeding. That procedure is cryoablation, a technique that uses liquid nitrogen to freeze the inner lining of the uterus to stop chronic bleeding in women for whom other treatments haven’t worked and who don’t want hysterectomies. “It’s a great procedure for select people who want to retain their uterus, or don’t want a big abdominal surgery,” says Dr. Pinar Kodaman, one of Yale’s cryoablation specialists.
Many other ablation techniques involve heating the uterine lining, or endometrium; they often require general or spinal anesthesia. But in cryoablation, the cold itself serves as anesthesia.
The procedure takes about fifteen minutes. The patient is given local anesthesia at the cervix, then the doctor inserts a slender liquid nitrogen probe which touches the inner uterus and forms an “iceball.” An assistant uses ultrasound to help the doctor direct the probe accurately and freeze just enough tissue. The patient goes home shortly afterward, and generally needs only ibuprofen for discomfort.
After cryoablation, about 90% of women report an improvement in their bleeding, though about two-thirds continue to have periods. Women who want their periods to stop altogether, Dr. Kodaman says, should consider getting a hysterectomy.
She cautions that while it is still possible to get pregnant after cryoablation, it is very unsafe to do so, and women considering the procedure should have completed childbearing. “They should always have a good form of contraception,” she says.
HPV Vaccine
This initial obstetrician–gynecologist office visit is an ideal time to discuss preventive health care, including availability of the quadrivalent human papillomavirus vaccine. This vaccine has been approved for administration to females aged 9–26 years. Although maximally effective if received prior to exposure to HPV, it is also beneficial for females who are already sexually active. This vaccine offers protection against HPV genotypes 16 and 18, which cause over 70% of cervical cancers, and against HPV genotypes 6 and 11, which cause 90% of genital warts. Currently, protection is considered to last at least five years; the need for a booster is not yet determined. Regardless of vaccination status, cervical cytology screening recommendations are unchanged: cervical cancer screening is not indicated until one has been sexually active for three years or reaches 21 years of age.
Pediactric and Adolescent Gynecology
The American College of Obstetricians and Gynecologists recommends that a young woman’s first visit with an obstetrician–gynecologist occur between the ages of 13 and 15. This first visit allows time to establish a relationship between physician and patient and to discuss issues of a confidential nature. Important topics to review include normal pubertal development and menstruation, healthy eating habits and body image, safety, and prevention of pregnancy and sexually transmitted diseases. The extent of the examination should be tailored to the patient’s age and relevant history.
Routine preventive health care may identify gynecologic problems in infants, children, and adolescents; these disorders are often different from the problems that affect adult women. Common gynecologic disorders in these age groups range from vaginal discharge to menstrual disorders, from pelvic pain to congenital anomalies of the reproductive tract, and from abnormal puberty to amenorrhea. Children and adolescents with gynecologic problems have unique needs and require specialized evaluation, treatment, and follow–up by a gynecologist with expertise in these disorders.
At Yale Reproductive Endocrinology, we offer evaluation and treatment of a vast array of gynecologic conditions that can affect children and adolescents. All examinations are age–appropriate and, if necessary, an examination under sedation can be performed in the pediatric operating room at Yale–New Haven Hospital. If further consultation is needed, the vast resources of the Yale–New Haven Children’s Hospital are available. Educational resources are made available for patients and their families. Our goal is to provide sensitive and comprehensive care, as well as a multidisciplinary approach, if indicated.
Monday, March 30, 2009
Minimally Invasive Surgical Options
Developments of new surgical techniques and advances in surgical equipment allow us to perform more and more surgical procedures using laparoscopy and hysteroscopy. These novel procedures have revolutionized the approach to the majority of gynecological disorders. We can now perform the majority of surgeries without the need for large incisions into the abdominal wall and therefore, most often, patients can go home on the day of surgery and recover to full activity in approximately two weeks after surgery.
Our physicians have extensive experience in these procedures and are considered the best in their field.
These minimally invasive techniques offer many alternatives to hysterectomy for many women suffering from:
- Uterine fibroids
- Severe endometriosis
- Chronic pelvic pain
- Painful menstrual cycles (dysmenorrhea)
- Uterine thickening (adenomyosis)
Advanced laparoscopic procedures performed at Yale Reproductive Endocrinology include:
- Laser excision of endometriosis
- Laser and harmonic scalpel used in treatment of pelvic and abdominal adhesions, myomectomies
- Supra-cervical and total laparoscopic hysterectomies
- Removal of the ovaries
- Removal of ovarian cysts with preservation of the ovaries
- Laparoscopic treatment of pelvic pain including presacral neurectomies and uterosacral nerve ablations.
Advanced hysteroscopic procedures include, among others:
- Endometrial ablation
- Resections of fibroids
- Resections of intrauterine adhesions
- Removal of polyps
- Corrections of tubal obstructions
- Evaluations of fallopian tubes (falloposcopy)
Our physicians have extensive experience in these procedures and are considered the best in their field.
These minimally invasive techniques offer many alternatives to hysterectomy for many women suffering from:
- Uterine fibroids
- Severe endometriosis
- Chronic pelvic pain
- Painful menstrual cycles (dysmenorrhea)
- Uterine thickening (adenomyosis)
Advanced laparoscopic procedures performed at Yale Reproductive Endocrinology include:
- Laser excision of endometriosis
- Laser and harmonic scalpel used in treatment of pelvic and abdominal adhesions, myomectomies
- Supra-cervical and total laparoscopic hysterectomies
- Removal of the ovaries
- Removal of ovarian cysts with preservation of the ovaries
- Laparoscopic treatment of pelvic pain including presacral neurectomies and uterosacral nerve ablations.
Advanced hysteroscopic procedures include, among others:
- Endometrial ablation
- Resections of fibroids
- Resections of intrauterine adhesions
- Removal of polyps
- Corrections of tubal obstructions
- Evaluations of fallopian tubes (falloposcopy)
Pregnancy Loss
What is pregnancy loss?
Pregnancy loss is the death of an unborn baby at any time during pregnancy. It is estimated that pregnancy loss occurs in over half of all early pregnancies. Most of these occur so early that the mother does not even know she is pregnant. Although 15 to 20 percent of diagnosed pregnancies are lost in the first or second trimesters of pregnancy, nearly all occur during the first trimester. Only about 1 percent of diagnosed pregnancies are lost after 16 weeks.
Pregnancy loss includes:
Blighted ovum - pregnancy loss before 8 weeks in which the egg is fertilized but never develops into an embryo.
Miscarriage - early pregnancy loss, also called spontaneous abortion
Ectopic pregnancy - the development of the fetus outside the uterus, in a fallopian tube, cervical canal, or the pelvic or abdominal cavity
Molar pregnancy - an abnormal development of placental and fetal tissues, occurring in about one out of 1,000 to one out of 1,500 pregnancies
Stillbirth - when the fetus dies before birth.
What causes pregnancy loss?
The vast majority of pregnancy losses are due to genetic or chromosomal abnormalities. However, other factors can also play a role in pregnancy loss. These include, but are not limited to, the following:
- Abnormal embryo development
- Hormone problems in the mother including low levels of progesterone or abnormal thyroid function
- Diabetes in the mother (especially in women who have poorly controlled blood glucose levels)
- Abnormalities of the uterus including scar tissue inside the uterus, abnormal formation or shape of the uterus, or myomas (fibroid tumors)
- Incompetent cervix - the opening to the uterus cannot stay closed during pregnancy.
- Infection (including organisms such as cytomegalovirus (CMV), mycoplasma, chlamydia, and ureaplasma, as well as listeriosis and toxoplasmosis)
- Antifetal antibodies - the mother's immune system recognizes the fetus as a foreign body and rejects it.
- Autoimmune diseases (conditions such as lupus erythematosus in which the body makes antibodies against one's own normal body chemicals; other autoimmune problems include antiphospholipid antibody syndrome)
- Cigarette smoking (there is an association with pregnancy loss and cigarette smoking)
- Exposure to toxic substances and chemicals such as anticancer drugs (studies are conflicting about the relationship of substances such as anesthetic gases, alcohol, and caffeine to pregnancy loss; exposure to video display terminals, or computer screens, has not been shown to be related to pregnancy loss)
Some women have recurrent problems in which pregnancy loss occurs over and over, usually three or more times. It is often difficult to find a cause for recurrent losses and couples may need additional testing for genetic or chromosomal problems.
Fortunately, most pregnancy losses are usually isolated events. A woman with a spontaneous early pregnancy loss has an 80 to 90 percent chance of a normal pregnancy the next time she conceives.
Why is pregnancy loss a concern?
Some pregnancy losses do not cause any problems, while others may be very serious and life threatening for the mother, if untreated. However, the most difficult part for most families is the emotional stress of the loss itself.
The loss of a baby at any time in pregnancy can be emotionally and physically difficult for the mother and other members of the family. For some families, the timing of the loss in the pregnancy may make the experience more or less difficult. For example, an early loss, before the mother even knew she was pregnant may not be as stressful as a loss later in pregnancy, after feeling fetal movement or seeing the fetus on ultrasound examination. However, parents may have strong feelings and sadness whenever a loss occurs.
Parents often experience a grief reaction to a loss, including feelings of the following:
* Shock, numbness, denial, and confusion
* Anger, guilt, searching and yearning
* Disorientation, depression, withdrawal, lack of energy
* Reorganization, resolution
These are normal responses to loss and may take months and sometimes years to work through. Experience with grieving families has found the following to be helpful:
* Seeing or holding (this is especially important in later pregnancy losses and with babies who die with a birth defect)
* Remembrances (including a lock of hair, hand or footprint, photographs, naming of the baby)
* Counseling (with a professional who is experienced in bereavement counseling)
* Memorial or funeral service
What are the symptoms of pregnancy loss?
Vaginal bleeding is the most common symptom of pregnancy loss. In later pregnancy, a woman with a stillborn may no longer feel fetal movements. However, each type of loss has specific symptoms. Also, each woman may exhibit different symptoms or the symptoms may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
How is pregnancy loss diagnosed?
In addition to a complete medical history and physical examination, diagnosis of pregnancy loss is usually based on laboratory tests, with reported symptoms aiding in the diagnosis. Tests used to diagnose pregnancy loss may include:
* Pregnancy blood tests for the hormone human chorionic gonadotrophin (hCG)
* Ultrasound - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs.
Treatment for pregnancy loss:
Specific treatment for pregnancy loss will be determined by your physician based on:
* Your pregnancy, overall health, and medical history
* Gestational age of the fetus
* Your tolerance for specific medications, procedures, or therapies
* The type of pregnancy loss
* Your opinion or preference
Once pregnancy loss occurs, the uterus must be emptied of all the fetal tissues to prevent further complications. Counseling and support of the family is important. Your physician can help you find resources and support organizations that can help after pregnancy loss.
Pregnancy loss is the death of an unborn baby at any time during pregnancy. It is estimated that pregnancy loss occurs in over half of all early pregnancies. Most of these occur so early that the mother does not even know she is pregnant. Although 15 to 20 percent of diagnosed pregnancies are lost in the first or second trimesters of pregnancy, nearly all occur during the first trimester. Only about 1 percent of diagnosed pregnancies are lost after 16 weeks.
Pregnancy loss includes:
Blighted ovum - pregnancy loss before 8 weeks in which the egg is fertilized but never develops into an embryo.
Miscarriage - early pregnancy loss, also called spontaneous abortion
Ectopic pregnancy - the development of the fetus outside the uterus, in a fallopian tube, cervical canal, or the pelvic or abdominal cavity
Molar pregnancy - an abnormal development of placental and fetal tissues, occurring in about one out of 1,000 to one out of 1,500 pregnancies
Stillbirth - when the fetus dies before birth.
What causes pregnancy loss?
The vast majority of pregnancy losses are due to genetic or chromosomal abnormalities. However, other factors can also play a role in pregnancy loss. These include, but are not limited to, the following:
- Abnormal embryo development
- Hormone problems in the mother including low levels of progesterone or abnormal thyroid function
- Diabetes in the mother (especially in women who have poorly controlled blood glucose levels)
- Abnormalities of the uterus including scar tissue inside the uterus, abnormal formation or shape of the uterus, or myomas (fibroid tumors)
- Incompetent cervix - the opening to the uterus cannot stay closed during pregnancy.
- Infection (including organisms such as cytomegalovirus (CMV), mycoplasma, chlamydia, and ureaplasma, as well as listeriosis and toxoplasmosis)
- Antifetal antibodies - the mother's immune system recognizes the fetus as a foreign body and rejects it.
- Autoimmune diseases (conditions such as lupus erythematosus in which the body makes antibodies against one's own normal body chemicals; other autoimmune problems include antiphospholipid antibody syndrome)
- Cigarette smoking (there is an association with pregnancy loss and cigarette smoking)
- Exposure to toxic substances and chemicals such as anticancer drugs (studies are conflicting about the relationship of substances such as anesthetic gases, alcohol, and caffeine to pregnancy loss; exposure to video display terminals, or computer screens, has not been shown to be related to pregnancy loss)
Some women have recurrent problems in which pregnancy loss occurs over and over, usually three or more times. It is often difficult to find a cause for recurrent losses and couples may need additional testing for genetic or chromosomal problems.
Fortunately, most pregnancy losses are usually isolated events. A woman with a spontaneous early pregnancy loss has an 80 to 90 percent chance of a normal pregnancy the next time she conceives.
Why is pregnancy loss a concern?
Some pregnancy losses do not cause any problems, while others may be very serious and life threatening for the mother, if untreated. However, the most difficult part for most families is the emotional stress of the loss itself.
The loss of a baby at any time in pregnancy can be emotionally and physically difficult for the mother and other members of the family. For some families, the timing of the loss in the pregnancy may make the experience more or less difficult. For example, an early loss, before the mother even knew she was pregnant may not be as stressful as a loss later in pregnancy, after feeling fetal movement or seeing the fetus on ultrasound examination. However, parents may have strong feelings and sadness whenever a loss occurs.
Parents often experience a grief reaction to a loss, including feelings of the following:
* Shock, numbness, denial, and confusion
* Anger, guilt, searching and yearning
* Disorientation, depression, withdrawal, lack of energy
* Reorganization, resolution
These are normal responses to loss and may take months and sometimes years to work through. Experience with grieving families has found the following to be helpful:
* Seeing or holding (this is especially important in later pregnancy losses and with babies who die with a birth defect)
* Remembrances (including a lock of hair, hand or footprint, photographs, naming of the baby)
* Counseling (with a professional who is experienced in bereavement counseling)
* Memorial or funeral service
What are the symptoms of pregnancy loss?
Vaginal bleeding is the most common symptom of pregnancy loss. In later pregnancy, a woman with a stillborn may no longer feel fetal movements. However, each type of loss has specific symptoms. Also, each woman may exhibit different symptoms or the symptoms may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
How is pregnancy loss diagnosed?
In addition to a complete medical history and physical examination, diagnosis of pregnancy loss is usually based on laboratory tests, with reported symptoms aiding in the diagnosis. Tests used to diagnose pregnancy loss may include:
* Pregnancy blood tests for the hormone human chorionic gonadotrophin (hCG)
* Ultrasound - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs.
Treatment for pregnancy loss:
Specific treatment for pregnancy loss will be determined by your physician based on:
* Your pregnancy, overall health, and medical history
* Gestational age of the fetus
* Your tolerance for specific medications, procedures, or therapies
* The type of pregnancy loss
* Your opinion or preference
Once pregnancy loss occurs, the uterus must be emptied of all the fetal tissues to prevent further complications. Counseling and support of the family is important. Your physician can help you find resources and support organizations that can help after pregnancy loss.
Endometriosis
Check out the Yale Program for Endometriosis Facebook Page:
http://www.facebook.com/pages/Yale-Program-for-Endometriosis/55776207899?ref=ts
Pelvic Pain
What is pelvic pain?
Pelvic pain is a common complaint among women. Its nature and intensity may fluctuate, and its cause is often obscure. In some cases, no disease is evident. Pelvic pain can be categorized as either acute, meaning the pain is sudden and severe, or chronic, lasting over a period of months or longer. Pelvic pain may originate in genital or extragenital organs in and around the pelvis, or it may be psychological, which can make pain feel worse or actually cause a sensation of pain, when no physical problem is present.
What causes pelvic pain?
Pelvic pain may have multiple causes, including:
- Inflammation or direct irritation of nerves caused by acute or chronic trauma, fibrosis, pressure, or intraperitoneal inflammation
- Muscular contractions or cramps of both smooth and skeletal muscles
- Psychogenic factors, which can cause or aggravate pain
Some of the more common sources of acute pelvic pain, or pain that occurs very suddenly, may include:
- Ectopic pregnancy - a pregnancy that occurs outside the uterus
- Pelvic inflammatory disease (PID) - an infection of the reproductive organs
- Twisted or ruptured ovarian cyst
- Miscarriage or threatened miscarriage
- Urinary tract infection
- Appendicitis
- Ruptured fallopian tube
Some of the conditions which can lead to chronic pelvic pain, pain that may last for several months or longer, may include:
- Menstrual cramps
- Endometriosis
- Uterine fibroids - abnormal growths on or in the uterine wall
- Adhesions - scar tissue between the internal organs in the pelvic cavity
- Endometrial polyps - protrusions attached by a small stem in the uterine cavity
- Cancers of the reproductive tract
This long-term and often unrelenting pain may cause a woman's defenses to break down, resulting in emotional and behavioral changes. This occurrence is often termed "chronic pelvic pain syndrome."
What are the different types of pelvic pain?
The following are examples of the different types of pelvic pain most commonly described by women, and their possible cause or origin. Always consult your physician for a diagnosis.
Localized Pain - may be due to an inflammation
Colicky Pain - may be caused by spasm in a soft organ, such as the intestine, ureter, or appendix
Sudden onset of Pain - may be caused by a temporary deficiency of blood supply due to an obstruction in the circulation of blood
Slowly-developing Pain
may be due to inflammation of the appendix or an intestinal obstruction
Pain involving the Entire Abdomen
may suggest an accumulation of blood, pus, or intestinal contents
Pain aggravated by movement or during examination
may be a result of irritation in the lining of the abdominal cavity
How is pelvic pain diagnosed?
Diagnostic procedures and tests will be performed in order to determine the cause of the pelvic pain. In addition, your physician may ask you questions regarding the pain such as:
- When and where does the pain occur?
- How long does the pain last?
- Is the pain related to your menstrual cycle, urination, and/or sexual activity?
- What does the pain feels like (i.e., sharp, dull, etc.)?
- Under what circumstances did the pain begin?
- How suddenly did the pain begin?
Additional information about the timing of the pain and the presence of other symptoms related to activities such as eating, sleeping, sexual activity, and movement can also help the physician in determining a diagnosis.
Diagnostic tests for pelvic pain:
In addition to a complete medical history and physical and pelvic examination, diagnostic procedures for pelvic pain may include:
- Blood tests
- Pregnancy test
- Urinalysis
- Culture of cells from the cervix
- Ultrasound - a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs.
- Computed tomography (CT) - a non-invasive procedure that takes cross-sectional images of the internal organs; to detect any abnormalities that may not show up on an ordinary x-ray.
- Magnetic resonance imaging (MRI) - a non-invasive procedure that produces a two-dimensional view of an internal organ or structure.
- Laparoscopy - a minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic area, the physician can determine the locations, extent, and size of the endometrial growths.
- X-ray - electromagnetic energy used to produce images of bones and internal organs onto film.
Treatment for pelvic pain:
Specific treatment for pelvic pain will be determined by your physician based on:
- Your overall health and medical history
- Extent of condition
- Cause of the condition
- Your tolerance for specific medications, procedures or therapies
- Expectations for the course of the condition
- Your opinion or preference
Treatment may include:
- Antibiotic medications
- Anti-inflammatory and/or pain medications
- Relaxation exercises
- Oral contraceptives (ovulation inhibitors)
- Surgery
- Physical therapy
If a physical cause cannot be found, pelvic pain may be diagnosed as a psychological defense or coping mechanism for some type of trauma. In some cases, psychotherapy is recommended. In other cases, physicians may recommend a multi-disciplinary treatment utilizing a number of different approaches including nutritional modifications, environmental changes, physical therapy, and pain management.
Pelvic pain is a common complaint among women. Its nature and intensity may fluctuate, and its cause is often obscure. In some cases, no disease is evident. Pelvic pain can be categorized as either acute, meaning the pain is sudden and severe, or chronic, lasting over a period of months or longer. Pelvic pain may originate in genital or extragenital organs in and around the pelvis, or it may be psychological, which can make pain feel worse or actually cause a sensation of pain, when no physical problem is present.
What causes pelvic pain?
Pelvic pain may have multiple causes, including:
- Inflammation or direct irritation of nerves caused by acute or chronic trauma, fibrosis, pressure, or intraperitoneal inflammation
- Muscular contractions or cramps of both smooth and skeletal muscles
- Psychogenic factors, which can cause or aggravate pain
Some of the more common sources of acute pelvic pain, or pain that occurs very suddenly, may include:
- Ectopic pregnancy - a pregnancy that occurs outside the uterus
- Pelvic inflammatory disease (PID) - an infection of the reproductive organs
- Twisted or ruptured ovarian cyst
- Miscarriage or threatened miscarriage
- Urinary tract infection
- Appendicitis
- Ruptured fallopian tube
Some of the conditions which can lead to chronic pelvic pain, pain that may last for several months or longer, may include:
- Menstrual cramps
- Endometriosis
- Uterine fibroids - abnormal growths on or in the uterine wall
- Adhesions - scar tissue between the internal organs in the pelvic cavity
- Endometrial polyps - protrusions attached by a small stem in the uterine cavity
- Cancers of the reproductive tract
This long-term and often unrelenting pain may cause a woman's defenses to break down, resulting in emotional and behavioral changes. This occurrence is often termed "chronic pelvic pain syndrome."
What are the different types of pelvic pain?
The following are examples of the different types of pelvic pain most commonly described by women, and their possible cause or origin. Always consult your physician for a diagnosis.
Localized Pain - may be due to an inflammation
Colicky Pain - may be caused by spasm in a soft organ, such as the intestine, ureter, or appendix
Sudden onset of Pain - may be caused by a temporary deficiency of blood supply due to an obstruction in the circulation of blood
Slowly-developing Pain
may be due to inflammation of the appendix or an intestinal obstruction
Pain involving the Entire Abdomen
may suggest an accumulation of blood, pus, or intestinal contents
Pain aggravated by movement or during examination
may be a result of irritation in the lining of the abdominal cavity
How is pelvic pain diagnosed?
Diagnostic procedures and tests will be performed in order to determine the cause of the pelvic pain. In addition, your physician may ask you questions regarding the pain such as:
- When and where does the pain occur?
- How long does the pain last?
- Is the pain related to your menstrual cycle, urination, and/or sexual activity?
- What does the pain feels like (i.e., sharp, dull, etc.)?
- Under what circumstances did the pain begin?
- How suddenly did the pain begin?
Additional information about the timing of the pain and the presence of other symptoms related to activities such as eating, sleeping, sexual activity, and movement can also help the physician in determining a diagnosis.
Diagnostic tests for pelvic pain:
In addition to a complete medical history and physical and pelvic examination, diagnostic procedures for pelvic pain may include:
- Blood tests
- Pregnancy test
- Urinalysis
- Culture of cells from the cervix
- Ultrasound - a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs.
- Computed tomography (CT) - a non-invasive procedure that takes cross-sectional images of the internal organs; to detect any abnormalities that may not show up on an ordinary x-ray.
- Magnetic resonance imaging (MRI) - a non-invasive procedure that produces a two-dimensional view of an internal organ or structure.
- Laparoscopy - a minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic area, the physician can determine the locations, extent, and size of the endometrial growths.
- X-ray - electromagnetic energy used to produce images of bones and internal organs onto film.
Treatment for pelvic pain:
Specific treatment for pelvic pain will be determined by your physician based on:
- Your overall health and medical history
- Extent of condition
- Cause of the condition
- Your tolerance for specific medications, procedures or therapies
- Expectations for the course of the condition
- Your opinion or preference
Treatment may include:
- Antibiotic medications
- Anti-inflammatory and/or pain medications
- Relaxation exercises
- Oral contraceptives (ovulation inhibitors)
- Surgery
- Physical therapy
If a physical cause cannot be found, pelvic pain may be diagnosed as a psychological defense or coping mechanism for some type of trauma. In some cases, psychotherapy is recommended. In other cases, physicians may recommend a multi-disciplinary treatment utilizing a number of different approaches including nutritional modifications, environmental changes, physical therapy, and pain management.
Fibroids
Fibroids are the most frequently seen tumors of the female reproductive system. Fibroids, also known as uterine myomas, leiomyomas, or fibromas, are firm, compact tumors that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus. It is estimated that between 20 to 30 percent of women of reproductive age have fibroids, although not all are diagnosed. Some estimates state that up to 75 percent of women will develop fibroids sometime during their childbearing years, although only about one-third of these fibroids are large enough to be detected by a physician during a physical examination.
What are fibroids?
Fibroids are the most frequently seen tumors of the female reproductive system. Fibroids, also known as uterine myomas, leiomyomas, or fibromas, are firm, compact tumors that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus. It is estimated that between 20 to 50 percent of women of reproductive age have fibroids, although not all are diagnosed. Some estimates state that up to 30 to 77 percent of women will develop fibroids sometime during their childbearing years, although only about one-third of these fibroids are large enough to be detected by a physician during a physical examination.
In more than 99 percent of fibroid cases, the tumors are benign (non-cancerous). These tumors are not associated with cancer and do not increase a woman's risk for uterine cancer. They may range in size, from the size of a pea to the size of a softball or small grapefruit.
What causes fibroid tumors?
While it is not clearly known what causes fibroids, it is believed that each tumor develops from an aberrant muscle cell in the uterus, which multiplies rapidly because of the influence of estrogen.
Who is at risk for fibroid tumors?
Women who are approaching menopause are at the greatest risk for fibroids because of their long exposure to high levels of estrogen. Women who are obese and of African-American heritage also seem to be at an increased risk, although the reasons for this are not clearly understood.
Research has also shown that some factors may protect a woman from developing fibroids. Some studies, of small numbers of women, have indicated that women who have had two liveborn children have one-half the risk of developing uterine fibroids compared to women who have had no children. Scientists are not sure whether having children actually protected women from fibroids or whether fibroids were a factor in infertility in women who had no children. The National Institute of Child Health and Human Development is conducting further research on this topic and other factors that may affect the diagnosis and treatment of fibroids.
What are the symptoms of fibroids?
Some women who have fibroids have no symptoms, or have only mild symptoms, while other women have more severe, disruptive symptoms. The following are the most common symptoms for uterine fibroids, however, each individual may experience symptoms differently.
Symptoms of uterine fibroids may include:
- Heavy or prolonged menstrual periods
- Abnormal bleeding between menstrual periods
- Pelvic pain (caused as the tumor presses on pelvic organs)
- Frequent urination
- Low back pain
- Pain during intercourse
- A firm mass, often located near the middle of the pelvis, which can be felt by the physician
In some cases, the heavy or prolonged menstrual periods, or the abnormal bleeding between periods, can lead to iron-deficiency anemia, which also requires treatment.
How are fibroids diagnosed?
Fibroids are most often found during a routine pelvic examination. This, along with an abdominal examination, may indicate a firm, irregular pelvic mass to the physician. In addition to a complete medical history and physical and pelvic and/or abdominal examination, diagnostic procedures for uterine fibroids may include:
X-ray - electromagnetic energy used to produce images of bones and internal organs onto film
Transvaginal ultrasound (also called ultrasonography) - an ultrasound test using a small instrument, called a transducer, that is placed in the vagina
Magnetic resonance imaging (MRI) - a non-invasive procedure that produces a two-dimensional view of an internal organ or structure
Hysterosalpingography - x-ray examination of the uterus and fallopian tubes that uses dye and is often performed to rule out tubal obstruction
Hysteroscopy - visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina
Endometrial biopsy - a procedure in which a sample of tissue is obtained through a tube which is inserted into the uterus
Blood test - to check for iron-deficiency anemia if heavy bleeding is caused by the tumor.
Treatment for fibroids:
Since most fibroids stop growing or may even shrink as a woman approaches menopause, the physician may simply suggest "watchful waiting." With this approach, the physician monitors the woman's symptoms carefully to ensure that there are no significant changes or developments and that the fibroids are not growing.
In women whose fibroids are large or are causing significant symptoms, treatment may be necessary. Treatment will be determined by your physician(s) based on:
- Your overall health and medical history
- Extent of the disease
- Your tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
- Your desire for pregnancy
In general, treatment for fibroids may include:
Hysterectomy
Hysterectomies involve the surgical removal of the entire uterus. Fibroids remain the number one reason for hysterectomies in the United States.
Conservative Surgical Therapy
Conservative surgical therapy uses a procedure called a myomectomy. With this approach, physicians will remove the fibroids, but leave the uterus intact to enable a future pregnancy.
Gonadotropin-releasing Hormone Agonists (GnRH agonists)
This approach lowers levels of estrogen and triggers a "medical menopause." Sometimes GnRH agonists are used to shrink the fibroid, making surgical treatment easier.
Anti-hormonal Agents
Certain drugs oppose estrogen (such as progestin and Danazol), and appear effective in treating fibroids. Anti-progestins, which block the action of progesterone, are also sometimes used.
Uterine Artery Embolization
Also called uterine fibroid embolization, uterine artery embolization (UAE) is a newer minimally-invasive (without a large abdominal incision) technique. The arteries supplying blood to the fibroids are identified, then embolized (blocked off). The embolization cuts off the blood supply to the fibroids, thus shrinking them. Physicians continue to evaluate the long-term implications of this procedure on fertility and regrowth of the fibroid tissue.
Anti-inflammatory Painkillers
This type of drug is often effective for women who experience occasional pelvic pain or discomfort.
Irregular Uterine Bleeding
Every year approximately 180,000 women in the United States undergo hysterectomies for treatment of abnormal uterine bleeding. And many more women with this condition forego hysterectomies and either suffer silently or rely on relatively ineffective hormonal treatment. But Yale Reproductive Endocrinology has expertise with a number of alternative outpatient or office-based surgical procedures that offer relief, including endometrial cryoablation and thermal ablation.
Hormonal Imbalance
Hormonal imbalance may be caused by abnormalities in the secretion of estrogen, progesterone, as well as androgens. Depending on the type of abnormality, patients may experience a wide array of symptoms, including hot flushes, vaginal dryness, depression, abnormal vaginal bleeding, and excessive hair growth. Our practice offers a wide array of tests depending on patients' needs and state-of-the-art treatment.
Ovulatory Disorders
Ovulatory disorders are common in reproductive age women and constitute the most common cause of menstrual abnormalities. In addition to causing discomfort due to irregular bleeding, ovulatory disorders are also common causes of infertility.
Ovulatory disorders may result from problems in the ovary as well as abnormalities in the pituitary gland and hypothalamus in the brain. Another common cause of ovulatory dysfunction associated with hirsutism is polycystic ovary syndrome.
Yale Reproductive Endocrinology offers state-of-the-art approaches for the diagnosis of underlying causes of ovulatory disorders as well as their treatment. Experts at Yale Reproductive Endocrinology are recognized nationally and internationally for their scientific contributions in the pathogenesis, diagnosis and treatment of ovulatory disorders and authored many peer reviewed articles.
Ovulatory disorders may result from problems in the ovary as well as abnormalities in the pituitary gland and hypothalamus in the brain. Another common cause of ovulatory dysfunction associated with hirsutism is polycystic ovary syndrome.
Yale Reproductive Endocrinology offers state-of-the-art approaches for the diagnosis of underlying causes of ovulatory disorders as well as their treatment. Experts at Yale Reproductive Endocrinology are recognized nationally and internationally for their scientific contributions in the pathogenesis, diagnosis and treatment of ovulatory disorders and authored many peer reviewed articles.
Hypoandrogenism and Excessive Hairiness (Hirsutism)
What is excessive hairiness?
Excessive hairiness, also known as hirsutism, is characterized by abnormal hair growth on areas of skin that are not normally hairy. Although the condition can affect both men and women, it usually only presents a problem to women.
What causes excessive hairiness?
Excessive hairiness tends to run in families, especially in families of Mediterranean descent. The excessive hairiness in children and women may be caused by pituitary or adrenal glands disorders. In addition, women may develop excessive hairiness after menopause. Anabolic steroids or corticosteroids, and certain medications, also may cause excessive hairiness.
How is excessive hairiness diagnosed?
Although diagnosis of excessive hairiness can be diagnosed with a medical history and physical examination, finding the underlying cause for the condition may include blood tests, if an endocrine disorder is suspected.
Treatment for excessive hairiness:
Specific treatment for excessive hairiness will be determined by your physician based on:
- Your age, overall health, and medical history
- Extent of the condition
- Cause of the condition
- Your tolerance for specific medications, procedures, and therapies
- Expectation for the course of the condition
- Your opinion or preference
Treatment may include:
- Removing the hair by shaving, plucking, waxing, depilatories, electrolysis, bleaching, or laser surgery
- Medication (to control any underlying endocrine disorder)
Excessive hairiness, also known as hirsutism, is characterized by abnormal hair growth on areas of skin that are not normally hairy. Although the condition can affect both men and women, it usually only presents a problem to women.
What causes excessive hairiness?
Excessive hairiness tends to run in families, especially in families of Mediterranean descent. The excessive hairiness in children and women may be caused by pituitary or adrenal glands disorders. In addition, women may develop excessive hairiness after menopause. Anabolic steroids or corticosteroids, and certain medications, also may cause excessive hairiness.
How is excessive hairiness diagnosed?
Although diagnosis of excessive hairiness can be diagnosed with a medical history and physical examination, finding the underlying cause for the condition may include blood tests, if an endocrine disorder is suspected.
Treatment for excessive hairiness:
Specific treatment for excessive hairiness will be determined by your physician based on:
- Your age, overall health, and medical history
- Extent of the condition
- Cause of the condition
- Your tolerance for specific medications, procedures, and therapies
- Expectation for the course of the condition
- Your opinion or preference
Treatment may include:
- Removing the hair by shaving, plucking, waxing, depilatories, electrolysis, bleaching, or laser surgery
- Medication (to control any underlying endocrine disorder)
Acne
Hyperandrogenism is the detection of excess androgen (a masculine steroid hormone). The most common clinical presentation of hyperandrogenism in reproductive-aged women is acne or hirsutism.
Acne
What is acne?
Acne is a disorder of the hair follicles and sebaceous glands. With acne, the sebaceous glands are clogged, which leads to pimples and cysts.
Acne is very common - nearly 17 million people in the US are affected by this condition. Acne most often begins in puberty. During puberty, the male sex hormones (androgens) increase in both boys and girls, causing the sebaceous glands to become more active - resulting in increased production of sebum.
How does acne develop?
The sebaceous glands produce oil (sebum) which normally travels via hair follicles to the skin surface. However, skin cells can plug the follicles, blocking the oil coming from the sebaceous glands. When follicles become plugged, skin bacteria (called Propionibacterium acnes, or P. acnes) inside the follicles, cause inflammation. (The basic acne lesion is called a comedo.)
Acne progresses in the following manner:
1. Microcomedo: blockage of the hair follicle, which is too small to see
2. Blackheads:(a semisolid, black plug): blockage of the hair follicle in which the plug can be seen
3. Whiteheads (a semisolid, white plug): blockage of the hair follicle in which the plug cannot be seen
4. Infection and irritation cause pustules (pimples or zits) to form.
Eventually, the plugged follicle bursts, spilling oil, skin cells, and the bacteria onto the skin surface. In turn, the skin becomes irritated and pimples or lesions begin to develop.
Acne can be superficial (pimples without abscesses) or deep (when the inflamed pimples push down into the skin, causing pus-filled cysts that rupture and result in larger abscesses).
What causes acne?
Rising hormone levels during puberty may cause acne. In addition, acne is often inherited. Other causes of acne may include the following:
- Hormone level changes during the menstrual cycle in women
- Certain drugs (such as corticosteroids, lithium, and barbiturates)
- Oil and grease from the scalp, mineral or cooking oil, and certain cosmetics may worsen acne
- Bacteria inside pimples
Acne can be aggravated by squeezing the pimples or by scrubbing the skin too hard.
What are the symptoms of acne?
Acne can occur anywhere on the body. However, acne most often appears in areas where there is a high concentration of sebaceous glands, including the following:
- Face
- Chest
- Upper back
- Shoulders
- Neck
The following are the most common symptoms of acne. However, each child may experience symptoms differently.
Symptoms may include:
- Blackheads
- Whiteheads
- Pus-filled lesions that may be painful
- Nodules (solid, raised bumps)
The symptoms of acne may resemble other skin conditions. Always consult your child's physician for a diagnosis.
Treatment of acne:
Specific treatment will be determined by your child's physician based on:
- Your child's age, overall health, and medical history
- Severity of the acne
- Your child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
The goal of acne treatment is to minimize scarring and improve appearance. Treatment for acne will include topical or systemic drug therapy. Depending upon the severity of acne, topical medications (medications applied to the skin) or systemic medications (medications taken orally) may be prescribed by your child's physician. In some cases, a combination of both topical and systemic medications may be recommended.
Topical medications to treat acne:
Topical medications are often prescribed to treat acne. Topical medication can be in the form of a cream, gel, lotion, or solution. Examples include:
Benzoyl Peroxide
Kills the bacteria (P. acnes)
Antibiotics
Helps stop or slow down the growth of P. acnes and reduces inflammation
Tretinoin, Adapalene
Stops the development of new acne lesions (comedones) and encourages cell turnover, unplugging pimples
Systemic medications to treat acne:
Systemic antibiotics are often prescribed to treat moderate to severe acne, and may include the following:
- Doxycycline
- Minocycline
- Tetracycline
- Treatment for severe, cystic, or inflammatory acne:
Isotretinoin (Accutane®), an oral drug, may be prescribed for individuals with severe, cystic, or inflammatory acne to prevent extensive scarring. Isotretinoin reduces the size of the sebaceous glands that produce the skin oil, increases skin cell shedding, and affects the hair follicles, thereby reducing the development of acne lesions. Isotretinoin can clear acne in 90 percent of patients. However, the drug has major unwanted side effects, including psychiatric side effects. It is very important to discuss this prescription medication with your child's physician.
Pituitary/Hypothalamic Failure
The anterior (front) lobe of the pituitary gland makes up 80 percent of the gland's weight. It releases a variety of hormones that affect growth, physical and sexual development, and other endocrine glands. Oversecretion or undersecretion of certain hormones by the anterior lobe of the pituitary gland will cause other endocrine glands to over- or underproduce certain hormones, as well.
What is hypopituitarism?
Hypopituitarism, also called an underactive pituitary gland, is a condition that affects the anterior (front) lobe of the pituitary gland - usually resulting in a partial or complete loss of functioning of that lobe. The resulting symptoms depend on which hormones are no longer being produced by the gland. Because the pituitary gland affects the other endocrine organs, effects of hypopituitarism may be gradual, or sudden and dramatic.
What causes hypopituitarism?
Hypopituitarism, in children, is often caused by a benign (non-cancerous) pituitary tumor, an injury, or an infection. However, often no exact cause can be determined.
What are the symptoms of hypopituitarism?
Symptoms vary depending on what hormones are insufficiently produced by the pituitary gland. The following are common symptoms associated with reduced production of certain hormones:
Insufficient Gonadotropins Production (Luteinizing Hormone and Follicle-Stimulating Hormone)
In premenopausal women, this leads to absent menstrual cycles, infertility, vaginal dryness, and loss of some female characteristics. In men, this deficiency leads to impotence, shriveling of testes, decreased sperm production, infertility, and loss of some male characteristics.
Insufficient Growth Hormone Production
This usually produces no symptoms in adults. In children, this deficiency can lead to stunted growth and dwarfism.
Insufficient Thyroid-Stimulating Hormone Production
This usually leads to an underactive thyroid and may cause confusion, cold intolerance, weight gain, constipation, and dry skin.
Insufficient Corticotrophic Production
This rare deficiency leads to an underactive adrenal gland, resulting in low blood pressure, a low blood sugar level, fatigue, and a low tolerance for stress.
Insufficient Prolactin Production
This rare deficiency may cause an inability to produce breast milk after childbirth in some women.
The symptoms of hypopituitarism may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
How is hypopituitarism diagnosed?
The symptoms of several underactive glands may help your child's physician diagnose hypopituitarism. In addition to a complete medical history and physical examination, diagnostic procedures for hypopituitarism may include:
Computed Tomography Scan (Also Called a CT or CAT Scan)
A diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
Magnetic Resonance Imaging (MRI)
A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Blood Tests
To measure hormone levels.
Bone X-rays of the Hand
To determine bone age.
Treatment for hypopituitarism:
Specific treatment for hypopituitarism will be determined by your child's physician based on:
- Your child's age, overall health, and medical history
- Extent of the disease
- Your child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
Treatment of hypopituitarism depends on its cause. The goal of treatment is to restore the pituitary gland to normal function, producing normal levels of hormones. Treatment may include specific hormone replacement therapy, surgical tumor removal, and/or radiation therapy.
What is hypopituitarism?
Hypopituitarism, also called an underactive pituitary gland, is a condition that affects the anterior (front) lobe of the pituitary gland - usually resulting in a partial or complete loss of functioning of that lobe. The resulting symptoms depend on which hormones are no longer being produced by the gland. Because the pituitary gland affects the other endocrine organs, effects of hypopituitarism may be gradual, or sudden and dramatic.
What causes hypopituitarism?
Hypopituitarism, in children, is often caused by a benign (non-cancerous) pituitary tumor, an injury, or an infection. However, often no exact cause can be determined.
What are the symptoms of hypopituitarism?
Symptoms vary depending on what hormones are insufficiently produced by the pituitary gland. The following are common symptoms associated with reduced production of certain hormones:
Insufficient Gonadotropins Production (Luteinizing Hormone and Follicle-Stimulating Hormone)
In premenopausal women, this leads to absent menstrual cycles, infertility, vaginal dryness, and loss of some female characteristics. In men, this deficiency leads to impotence, shriveling of testes, decreased sperm production, infertility, and loss of some male characteristics.
Insufficient Growth Hormone Production
This usually produces no symptoms in adults. In children, this deficiency can lead to stunted growth and dwarfism.
Insufficient Thyroid-Stimulating Hormone Production
This usually leads to an underactive thyroid and may cause confusion, cold intolerance, weight gain, constipation, and dry skin.
Insufficient Corticotrophic Production
This rare deficiency leads to an underactive adrenal gland, resulting in low blood pressure, a low blood sugar level, fatigue, and a low tolerance for stress.
Insufficient Prolactin Production
This rare deficiency may cause an inability to produce breast milk after childbirth in some women.
The symptoms of hypopituitarism may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
How is hypopituitarism diagnosed?
The symptoms of several underactive glands may help your child's physician diagnose hypopituitarism. In addition to a complete medical history and physical examination, diagnostic procedures for hypopituitarism may include:
Computed Tomography Scan (Also Called a CT or CAT Scan)
A diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
Magnetic Resonance Imaging (MRI)
A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Blood Tests
To measure hormone levels.
Bone X-rays of the Hand
To determine bone age.
Treatment for hypopituitarism:
Specific treatment for hypopituitarism will be determined by your child's physician based on:
- Your child's age, overall health, and medical history
- Extent of the disease
- Your child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
Treatment of hypopituitarism depends on its cause. The goal of treatment is to restore the pituitary gland to normal function, producing normal levels of hormones. Treatment may include specific hormone replacement therapy, surgical tumor removal, and/or radiation therapy.
Hyperprolactinemia
Hyperprolactinemia is a hypothalamic-pituitary condition of elevated serum prolactin in non-pregnant women. Hyperprolactinemia may affect menstrual cycle and ovulation. It may also cause infertility and loss of libido. On occasions hyperprolactinemia may be caused by a small tumor in the pituitary and may damage the surrounding organs such as the optic nerves. Therefore, the timely diagnosis and treatment of hyperprolactinemia is quite important. Our practice collaborates with Medical Endocrinology Pituitary Program and Neurosurgery together offering state-of-the-art testing and treatments for hyperprolactinemia.
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder affecting young women. This condition is associated with infertility, absent or irregular menstrual cycle and increased activity of testosterone (“male hormone”). Most women with PCOS have also other hormonal and metabolic problems such as elevated level of insulin and cholesterol. In the long term, women with this condition are at increased risk of cardiovascular diseases and diabetes. Our center offers extensive state-of-the-art testing and treatments of PCOS. We are also developing new therapies designed to treat symptoms and to protect from long-term consequences of this disorder.
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