Friday, March 25, 2011

Menstrual Migraines: Causes and Treatments

Women who have migraines during their cycles should consult a physician

By Beth Helgerson, MD
Obstetrician/Gynecologist


Migraine headaches are a very common ailment. In fact, it’s believed that 12% of the population suffers from chronic headaches. Migraine headaches are more common in women, and although the mechanisms are not fully understood, oftentimes migraine headaches can be associated with the menstrual cycle.

Migraine headaches do not have specific diagnostic imaging studies that are recommended, but rather diagnosis is made based on history and physical exam.  Usually, migraine headaches are recurrent, and consist of:

• A prodrome, or “pre-headache,” which can consist of food cravings, mood changes, muscle stiffness, fatigue and other symptoms;
• An aura, which can consist of visual disruptions, tingling, numbness, confusion and other symptoms;
• The headache, which can be debilitating and can affect the entire body;
• The postdrome, or “post-headache,” which can include lower or higher mood levels, fatigue, poor concentration and other symptoms.

Not all migraine episodes include all phases. You can read more about the anatomy of a migraine headache here.

For many women, declining estrogen levels can be a trigger for migraine headache.

Examples of this would include:

 • The beginning of a menstrual cycle – the beginning of the bleeding phase of a menstrual cycle is a low estrogen timeframe compared to the rest of the cycle. 
• During postpartum, which is associated with diminished estrogen levels.
• During perimenopause, when there are wide fluctuations of estrogen levels from day to day in many women, and this can be a trigger for migraine.
• Women taking combination birth control pills will also have decreased estrogen levels during the placebo pills. 

There are three primary treatment options for migraines:

1. Medications. Migraine headaches can be treated with rapid onset triptan medications such as Imitrex. These are medications that are felt to promote vasoconstriction, and also block pain pathways within the brain. When given early in the headache sequence, they can prevent the headache. 

2. Prevention. If triptan medicines are inadequate, patients and their physicians should consider prevention. Prevention options may include extended regimen, combination contraceptive options, and also the possibility of supplemental estrogen during the menstrual cycle. Certainly risks of estrogen have to be considered. Some women are at increased risk of side effects that can be serious, and this should be discussed with a physician. 

3. Transdermal or transvaginal delivery of estrogen. Some women will find that transdermal or transvaginal delivery of estrogen may be more effective than oral medications.  Oral medications are more fluctuant than the transdermal or transvaginal approach, and this can also be considered with one’s physician. 

In summary, menstrual migraines can very much impact the quality of life of women and those they care for. There are options for treatment, and prevention should also be considered. Talk with your physician about the most appropriate treatment options for you.

Dr. Beth Helgerson is an Obstetrician/Gynecologist at the Appleton and Waupaca locations of Women’s Care of Wisconsin. Contact Dr. Helgerson at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at www.womenscareofwi.com.

Monday, March 7, 2011

What Women Should Know About Permanent Birth Control Procedures

There are safe alternatives to hysterectomies and tubal ligations to avoid pregnancies

By Marley Kercher, MD
Obstetrician/Gynecologist


I have the privilege of taking care of women throughout every stage of their lives. This means annual exams, prenatal/pregnancy care, birth control, menopause management and elimination of incontinence issues. A satisfying part of my job is empowering women by helping them prevent unwanted pregnancies when their families are complete.

Some women think the only permanent options to avoiding pregnancies are hysterectomies, tubal ligations and vasectomies. Within the last five years, there have been two different in-office procedures created that provide permanent birth control and do not include any of the above. These procedures are called Essure and Adiana.

In addition to these procedures, an ablation procedure called NovaSure can be done, also in the office, to significantly reduce or completely eliminate menstrual cycles, adding to the quality of life for women.

Essure & Adiana
Essure and Adiana are permanent birth control procedures that work with your body to create a natural barrier against pregnancy.

They offer women what no birth control ever has:
• No surgery, burning or anesthesia
• No hormones
• No slowing down to recover
• Performed in less than 30 minutes
• Trusted by hundreds of thousands of women and doctors for over five years

Both procedures are permanent and are NOT reversible. Therefore, you should be sure you do not want children in the future.

Unlike other permanent birth control, these procedures do not require cutting into the body or the use of radiofrequency energy to burn the fallopian tubes.

Instead, in the case of Essure, I insert a soft, flexible coil through the body’s natural pathways (vagina, cervix, and uterus) and into your fallopian tubes. The very tip of the device remains outside the fallopian tube, which provides us with immediate visual confirmation of placement.

With Adiana, a tube is also inserted into the fallopian tubes and a small amount of radiofrequency energy is applied to the lining of the tubes. Then, a biocompatible silicon matrix material is inserted at this site.

During the three months following the procedure, your body and the inserts work together to form a natural barrier that prevents sperm from reaching the egg. During this period, you must continue using another form of birth control (other than an IUD).

After three months, we have you come back into the office to verify you’re protected.  The test uses a dye and special type of x-ray to ensure both that the inserts are in place and that the fallopian tubes are completely blocked.

NovaSure
The NovaSure procedure is a quick, safe, simple, one-time endometrial ablation treatment. This minimally invasive procedure controls heavy bleeding by using energy to remove the lining of the uterus. The average treatment time is about 90 seconds and only needs to be performed once to lighten or stop your periods.

Without the side effects of hormones or the risks of hysterectomy, NovaSure has a quick recovery time so you can get back to your life sooner. Most women experience no pain after the procedure, and can return to work and regular activities the next day.

If you are considering permanent birth control, please consult with your physician on the best solution for your needs.

Dr. Marley Kercher is an Obstetrician/Gynecologist at the Neenah location of Women’s Care of Wisconsin. Contact Dr. Kercher at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at www.womenscareofwi.com.

Friday, March 4, 2011

Adolescent Gynecology: When to See a Doctor

Young women should see their doctors to discuss pap smears, STDs and birth control methods

By Amber Post, MD
Obstetrician/Gynecologist


Many teens and parents wonder what an appropriate age is to start seeing a gynecologist.  There is not one correct answer for everyone, however there are many reasons why now might be the right time! Young women should consider making an appointment if they have heavy or painful periods, want to prevent pregnancy, are worried they are pregnant, are sexually active, or if they have reached age 21.

What can I expect at my first visit?
The first visit begins with discussing your health history. The physical exam will include a breast exam and a pelvic exam. The pelvic exam may include a pap smear or STD testing if necessary.  We will then discuss the results.

The Pap Smear
A pap smear is a brushing of cells from the cervix to detect cervical cancer.  Your pap result will be one of the following:

• Normal
• ASCUS (atypical squamous cells of unknown significance)
• LGSIL (low-grade squamous intraepithelial lesion)
• HGSIL (high-grade squamous intraepithelial lesion
• AGC (atypical glandular cells)
• Cancer

If your pap was abnormal, the most likely next step is colposcopy. With colposcopy we visualize the cervix through a magnifier to identify the abnormal area. If necessary we also do a biopsy. Abnormal cervical cells are graded on a scale from CIN-I to CIN-III. Low-grade lesions such as CIN-I often will heal on their own. Your follow-up will depend on your age and the severity of the lesion. Typically this means repeating your pap and possibly colposcopy every 6-12 months. Most CIN II and all CIN III lesions should be excised. Most commonly this is done by a LEEP.  With LEEP we remove the entire abnormal area.

Abnormal pap smears are caused by the HPV virus. The type of HPV that affects the cervix is sexually transmitted. There are many types of HPV, but there are a few types that cause the majority of cervical cancers. We will often test for these “high-risk HPV” during your pap. You can protect yourself from HPV by practicing safe sex and getting vaccinated.

STD
Another common concern for adolescents is sexually transmitted disease (STD). There are many different types of sexually transmitted disease, some of which can cause long-term problems such as pelvic inflammatory disease and infertility. An exam is recommended if you have any of the following symptoms:

• Burning
• Sores
• Bumps
• Rash
• Blister
• Discharge
• Itching
• Pain
• Redness
• Swelling

The most common STDs are gonorrhea, chlamydia, and trichomonas. These STDs may cause an increase in vaginal discharge. If not treated early they can cause PID. Herpes tends to cause painful blisters or ulcers. More serious STDs include HIV, syphilis and hepatitis, which may be asymptomatic at first. Your best protection from STDs is to use a condom every time you have sex.

Birth Control
There are several safe and effective ways to prevent pregnancy, including barrier methods, hormonal methods and sterilization. Only abstinence is 100% effective.

Barrier methods include the male and female condom, diaphragm, cervical cap, sponge and spermicide. Overall these are the least effective at preventing pregnancy.

Hormonal methods include birth control pills, NuvaRing, contraceptive patch, Depo Provera, Implanon and IUD. Often they make your period more predictable, lighter, and less painful.

 - Birth control pills are taken once a day, preferably around the same time each day. They contain estrogen and progesterone.
- The NuvaRing is inserted vaginally by you and is worn for 3 weeks. It is then removed for one week, which is when you will get your period.
- The contraceptive patch is applied for one week at a time for three consecutive weeks, then left off the week you will get your period. The dosing is less predictable, therefore it is not recommended if you weigh more than 175 pounds. There is also a possible increased risk of blood clots with this method.
 - Depo Provera is an injection given in the clinic every 3 months. Most women stop getting their period, though some will have irregular bleeding. Another potential side effect is weight gain.
- Implanon is a rod is inserted under the skin of your arm that lasts for 3 years. This has also been associated with irregular bleeding. 
- The Mirena IUD is inserted into your uterus and lasts for 5 years. Insertion can be more difficult prior to having children. Most women have very light or no menstrual bleeding. 
- The copper IUD lasts for 10 years but may increase your menstrual bleeding.

Emergency Contraception 
If you fear your birth control may have failed, such as missed pills or a broken condom, emergency contraception is available. It is now approved to be used as late as 5 days after unprotected sex. The sooner you take it, the better it works. It is taken in two doses and is 75-89% effective. Nausea is a common side effect.

Whatever your concerns are for yourself or your child, younger women should definitely consider seeing a gynecologist as soon as they have issues or questions. Education and preventive care is the best way to ensure a healthy body now and in the future.

Dr. Amber Post is an Obstetrician/Gynecologist at the Neenah and Oshkosh locations of Women’s Care of Wisconsin. Contact Dr. Post at 920-729-7105 or meet her here.

About Women’s Care of Wisconsin
The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. From adolescence through menopause and beyond, you can depend on us. Meet our providers and learn more about gynecology, pregnancy care, infertility, procedures and surgery, incontinence, osteoporosis, menopause and more at www.womenscareofwi.com.