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Annual GYN visits can discover conditions such as ovarian cysts, fibroids, and cancer so it’s very important to schedule and keep those yearly appointments. Annual visits aren’t something most women look forward to, but it is one of the most important things a woman can do for her overall health. During these visits your doctor may discover conditions that could otherwise go undiagnosed. Without annual appointments, the condition may have progressed to a much more serious stage by the time of a diagnosis. Early detection of many conditions leads to a more optimistic prognosis. As a woman ages her healthcare needs change, and so does her annual OB/GYN appointment. During various stages of a woman’s life, her doctor focuses on different areas of her health. Below is a breakdown of what you can expect throughout the years. The Early Years – Teens and Young Adults According to the American College of Obstetricians and Gynecologists (ACOG), a teen girl should begin seeing a gynecologist between the ages of 13 and 15. Often, parents may feel this is too young or unnecessary, but these years are an important time. Usually, at this age, the first visit is more of a discussion as most girls will not need a pelvic exam. Among the topics her doctor will discuss is her menstrual cycle and any problems she may be experiencing with it. Also, whether she is sexually active or not, her doctor will equip her with knowledge by discussing contraceptives, and sexually transmitted disease prevention, including HPV, (Human papillomavirus) which is the most common sexually transmitted infection (STI) in the United States, between the ages of 15-25 years. Beginning appointments at this age, can also help a young woman get comfortable with an OB/GYN she can trust. ACOG also recommends that young women should begin having a Pap smear at the age of 21. This important test is a simple procedure that tests for abnormal cervical cells, which can lead to cervical cancer. The Family Planning Years – Early 20s to Mid 40s This is the stage of life where your annual exam will include checking your blood pressure and sometimes your BMI (body mass index). Your doctor will also do a breast exam, an abdominal exam, and a pelvic exam. You and your doctor will discuss your family medical history and will talk with you about any of your concerns. Contraception and Fertility In addition, preventing pregnancy or becoming pregnant is one of the main topics discussed during annual appointments at this stage of life. Contraception options, fertility options, and preconception counseling become a main focus. There also may be labs or screenings that need to be done. Also, according to the American Cancer Society women should begin getting annual mammograms at 40 years old; unless there is a family history or other issue that warrants starting them sooner. In fact, many doctors recommend getting your baseline mammogram at 35 years old. Your doctor will write you a mammogram order at your annual appointment. Annual GYN Visits During the Menopause Years – Mid 40s to Mid 50s According to the National Institute on Aging, on average, women are 51 years of age at natural menopause. However, a woman is considered to have reached menopause after she has missed her menstrual cycle for 12 consecutive months. There is no reliable way to predict the exact menopause age. Women have been known to start menopause as young as 40 and as late as 60 years old. Perimenopause Perimenopause, the transition phase right before menopause, during which some of the symptoms commonly associated with menopause occur, can begin 4-7 years prior to actual menopause. The average woman experiences perimenopause at approximately 46 years of age. This differs for each woman, and many have entered perimenopause even sooner. This is the stage in life where your annual appointments will consist of you and your doctor discussing things such as your menstrual cycle changes, menopause symptoms, hormone options, and sex drive, among other things. Also as in previous years, your doctor will still perform a pap smear, pelvic exam, abdominal exam, a breast exam and will provide an order for your annual mammogram. The Later Years – Mid 50s and Beyond In this age range, while your doctor will continue to perform and discuss many of the previous items mentioned, more changes are happening to a woman’s body that are significant. Increased hormonal changes may cause conditions such as: Bone Density Another issue your doctor may discuss is bone health. Once a woman stops having her period, the ovaries decrease the amount of estrogen produced and there is some bone loss, which can lead to osteoporosis- which can increase fracture risk. Your doctor may also suggest a baseline bone density test, especially if you have a strong family history of osteoporosis. In addition, you may discuss exercise and diet strategies to help protect your bones. Pelvic Organ Prolapse A common condition a woman of this age group may experience is pelvic organ prolapse. When the muscles and ligaments supporting a woman’s pelvic organs weaken, the pelvic organs can drop lower in the pelvis, creating a bulge in the vagina (prolapse). Women most commonly develop pelvic organ prolapse years after childbirth, after a hysterectomy, or after menopause. At your annual appointment, your doctor can diagnose the stage of the prolapse and recommend treatments and procedures available to correct this issue. Our OB/GYNs Can Help Annual GYN visits are crucial so while a woman may also have appointments with a general practitioner throughout her lifetime, it’s critical that she sees her OB/GYN annually. A woman’s body is remarkable and very complex. Therefore, she requires an expert in a woman’s special anatomy to help keep her healthy through all the incredible stages of her life. Schedule your appointment today with one of our board-certified OB/GYNs. Call us at 770.720.7733 or schedule an appointment online.

How Old is My Vagina?

Diane /

Have you ever looked ‘down there’ and wondered if your vaginal age is in line with your actual age? Does it look the same as other women your age? Many women spend thousands of dollars over the years to preserve their youthful appearance, but mostly on what is noticeably obvious to others. Usually not their vaginas. Your vagina may rarely be seen by others, or maybe quite a lot – but most likely somewhere in between. As a woman ages, her body goes through many changes. This includes her vagina. Vaginas are a soft tissue canal, and the vaginal opening is part of the vulva, which also includes the clitoris, labia and pubic mound. The internal vaginal canal connects the vulva to the cervix and uterus. Throughout a woman’s lifetime, the vagina looks and feels different. Since vaginal health is important for your overall health, every woman should be aware of what is normal for each age. As OB/GYNs and experts in female vaginal health, here is what you can expect your vagina to be like at every age and stage of your life. Your Vagina From Late Teens Through Your 20s A woman’s vagina is at its peak in the late teens to 20s with a surge of the sex hormones estrogen, progesterone and testosterone. Estrogen keeps a woman’s vagina lubricated, elastic and acidic which helps it remain in optimal vaginal health. The vagina is surrounded by two sets of skin folds known as the inner labia and outer labia. The outer labia contain a layer of fatty tissue. In late teens and into a woman’s 20s, the outer layer thins and may appear smaller. Another noticeable truth for many women is that her sex drive is usually at its strongest during her 20s. If sexually active, especially if sex is frequent, she may experience urinary tract infections (UTI) as bacteria travel from the vagina to the urethra. To help minimize the risk of developing a UTI, it’s recommended to urinate as soon as possible after sex to help force bacteria out of the vagina. A common saying among OB/GYNs is that the female vagina is self-cleaning. As it cleans itself, it produces a white or clear discharge. Hormonal changes during the menstrual cycle affect the amount of discharge the vagina produces. Unless you’re having symptoms such as pain during sex, itching, a foul-smelling discharge or burning, your vagina needs little maintenance in your 20s, other than a daily washing of your vulva with very mild soap and water. Your Vagina in Your 30s During your 30s, your inner labia may darken due to hormone changes. If you become pregnant, vaginal discharge may increase and appear milky. It may have a mild odor, but should not be green, yellow or smell bad or fishy. After giving birth, your vagina may lose some of its elasticity and stretch more than usual. Over time, many vaginas will return to almost prebirth size. For some, the vagina may stay more stretched than it was before giving birth. Kegel exercises can help by strengthening pelvic floor muscles and restoring vaginal tone. Oral contraceptives may cause vaginal changes such as increased vaginal discharge, vaginal dryness and breakthrough bleeding. These symptoms often resolve on their own. If they persist, consult your gynecologist. You may need to try a few different oral contraceptives until you find one that works for you. Your Vagina in Your 40s During your 40s, you may begin perimenopause, which is the time before you stop menstruating. Perimenopause causes your vagina to go through significant changes. As estrogen levels in your body decrease, your vaginal walls become thinner and drier. This is known as vaginal atrophy and may cause: Vaginal irritation Vaginal burning Painful sex Vaginal itching Vaginal discharge Burning during urination Vaginal shortening of the canal. Having regular sex helps slow the progression of vaginal atrophy by keeping it elastic and increasing blood flow to the vagina. Over-the-counter vaginal moisturizers or applying a vaginal estrogen cream may also help combat vaginal dryness. See your gynecologist for advice on improving vaginal atrophy. Another change during your 40s is that you may notice your pubic hair may thin or turn gray or white. Your Vagina in Your 50s and Beyond By age 50, most women have stopped menstruating and her estrogen levels are quite low or depleted. Her vulva may appear smaller. Vaginal atrophy is a widespread problem for many women in their 50s. Low estrogen may change the acidity in your vagina. This may increase your risk of infection due to bacteria overgrowth. Low estrogen doesn’t only impact your vagina, it can affect your urinary tract. Atrophy may occur in your urethra and lead to urine leakage, overactive bladder and urinary frequency. See your gynecologist if you are experiencing any of these problems. Hormone replacement therapy helps reduce the symptoms of vaginal and urinary atrophy. There are several options available to help reduce menopausal symptoms such as hot flashes, night sweats, mood changes, anxiety, etc. Discuss hormone replacement therapy with your gynecologist if you are experiencing any of these menopausal symptoms. Vaginal Prolapse Menopausal women are at risk of vaginal prolapse, especially if they have given birth vaginally or had prolonged labor. Vaginal prolapse occurs when all or part of the vaginal canal falls into the vaginal opening. Vaginal prolapse often involves other organs such as the bladder, rectum and uterus. Vaginal prolapse symptoms may include vaginal discomfort, a heavy sensation in the pelvis and pain in the lower back. Vaginal prolapse treatments are pelvic floor exercises, insertion of a supportive device to hold the prolapsed area in place, or if prolapse is more bothersome or severe, surgery may be the best option. So, What is Your Vagina’s Age? Most likely your vagina is right on track with your own age. If you’re in your 20s, 30s, 40s, or 50s and beyond, you can typically expect your vagina to be similar to others your age. However, there are many exceptions, and

Infertility Education, OB

How Many Eggs Do I Have?

Diane /

If only women could replenish their ovarian reserve by running to the grocery store and picking up a carton of eggs. Unfortunately, it’s not that easy. And what’s worse is that once a woman’s eggs are gone, they’re gone. So How Many Eggs Does a Woman Have Throughout Her Lifetime? Let’s start at the beginning. That is, with a fetus. It may be shocking to know that a fetus starts with around 6 million eggs. However, by the time that ‘baby’ reaches 40, only 10% of her eggs will remain. At menopause, a woman will only have around 25,000. So how and why does this happen? And what does this mean for your fertility chances? In this article, we break down a female’s egg count by the ages. Egg Count of a Fetus and at Birth As we mentioned, a fetus has around 6 million eggs. These eggs, called oocytes, are steadily reduced when that baby is born, she only has 1 to 2 million eggs left. No new eggs are produced after the fetus stage. Before Puberty Only about 300,000 eggs remain by the time a female with ovaries reaches puberty, as prior to puberty more than10,000 eggs die each month. Of the 300,000 eggs before puberty, only around 300 to 400 will be ovulated during a woman’s reproductive lifetime. After Puberty Finally, some good news! After puberty, the number of eggs that die each month actually decreases. Each month, one egg is selected by your body to become the dominant follicle. This follicle contains the one egg that is ovulated that month and represents your one chance to conceive. (Although in some cases there are exceptions, resulting in fraternal twins.) The eggs not chosen as the dominant follicle die off. Every month, you ovulate one egg and the rest die, and that cycle continues until menopause when there are no eggs left. In Your 30s Fertility begins to decrease anywhere from age 28 to 32. After age 37, it declines more rapidly so that by the time you reach 40, you’re likely to be down to less than 10% of your pre-birth egg count. In Your 40s There is no definitive answer when it comes to determining how many eggs you have left when you hit your 40s. Because certain factors, like smoking, can reduce your number of eggs, there is no one-size-fits-all. Research has shown that the average woman has less than a 5% chance of getting pregnant per menstrual cycle in her 40s. Also taken into account is that, while the average age of menopause is the U.S. is 51, some women will reach menopause earlier. After menopause, a woman has less than 100 eggs left, making the chances of getting pregnant very slim. What Does This Mean for Fertility? While these statistics, give you a general idea of how many eggs a woman has during different stages of her life, they are simply generalizations. There are certain risk factors, such as smoking, chemotherapy and radiation, that can cause a faster rate of egg loss. If you’re in a higher risk category, you may have fertility concerns or may even experience early menopause or ovarian failure. Know Your Egg Count So, how many eggs do you have? That question is one that should be given much consideration if you’re planning on conceiving. Thankfully, our OB/GYNs can help you determine your ovarian reserve. By knowing your egg count, you can better prepared for future decisions. Make an Appointment Today Our compassionate OB/GYNs are here to help you. Make an appointment today for preconception counseling by calling 770.720.7733 or simply schedule an appointment online.

Pelvic Organ Prolapse Education, Pelvic Reconstruction Education, Sexual Health, Shallow Vagina Education, Vaginal Lengthening Education

19 Reasons for a Low Sex Drive

Diane /

If you find yourself asking, ‘What happened to my sex drive?’ you’re not alone. It’s a common problem for women, especially after giving birth or as they age. But there are many other reasons for a low sex drive, ranging from hormonal imbalances to lack of self esteem. That said, there is help available. 19 Reasons for a Low Sex Drive 1. Hormonal imbalances: The three hormones that impact a woman’s sex drive and reproductive organs are estrogen, progesterone and testosterone. 2. Menstrual cycle: Irregular periods or a lack of a menstrual cycle can wreak havoc on natural hormonal processes, causing a reduced sexual desire. 3. Age: Testosterone, progesterone and estrogen levels diminish as women age and enter menopause, causing lowered sexual interest, loss of muscle mass, compromised bone health and vaginal dryness that can lead to painful intercourse. As these hormone levels decrease, so does libido. 4. Antidepressants or other medications: Prescription drugs have side effects, and often includes a reduced sexual desire. Sexual dysfunction and even genital numbness may be attributed to some currently prescribed antidepressants. Blood pressure medications, antihistamines and sleep aids are just a few that can interfere with sexual desire. Always give your doctor a complete list of medications you are taking. 5. Lack of quality sleep: Fatigue and irritability can cause drowsiness, irritability and fatigue, which can cause a lack of sexual desire. 6. Birth control: Some oral contraceptives fool the body into believing it is pregnant by neutralizing the very hormones that enhance libido. If you notice a sudden disinterest in sex after starting birth control, speak to your doctor. 7. Alcohol, smoking or drug abuse: Smoking restricts blood flow to the body. The clitoris, labia and vagina become engorged with blood during sexual arousal, just like a man’s penis, so restricting this flow also restricts sensation and response to physical stimulation. Alcohol is a depressant. It dehydrates the body, dulls sensitivity and causes loss of vaginal lubrication. 8. Giving birth: Immediately after giving birth, a woman’s hormones cause an uproar in her body. Physical trauma to the vaginal area, possible postpartum syndrome and the exhaustion and stress of caring for a newborn amplify a lack of interest in sex. These issues may only last a few weeks or months, but if sexual desire remains low or nonexistent for longer, consult your doctor. 9. Genital conditions: Pelvic organ prolapse, tissue deterioration, fecal incontinence, urinary problems, atrophy and a small vaginal opening are only a few of the physical problems that can decrease sexual desire. If you experience pain with intercourse, or prolapse or incontinence is disruptive, seek treatment from a urogynecologist, a specialist in advanced female pelvic reconstruction. 10. Vaginal dryness: Many physical conditions — including giving birth, hormone imbalances or aging — can cause vaginal dryness. It often can cause painful intercourse, which in turn leads to a lack of desire. 11. Surgery: A hysterectomy with or without removal of the ovaries decreases the hormones necessary for sexual gratification. 12. Major health conditions: Cancer, high blood pressure, neurological disorders, hypothyroidism, diabetes, arthritis, infertility and coronary artery disease — along with the medications and procedures necessary to correct these issues — are just a few disorders that can lessen sexual desire. 13. Anemia: Low iron levels caused by heavy periods can result in anemia. Anemia reduces red blood cells and compromises a protein called hemoglobin whose job is to push oxygen from your lungs to all your body parts, including the pelvic area. Since blood is vital to the labia, clitoris and vagina to enhance erotic sensitivity, anemia can greatly subdue bedroom pleasure and cause fatigue, weakness and sexual apathy. 14. Depression or low self-esteem: Either of these emotional conditions can affect performance or pleasure by causing disinterest, especially if medication is being used to control the issue. If a woman lacks confidence, she may shy away from physical contact, robbing herself of the gratification of a healthy sex life. 15. History of sexual abuse: Rape, assault and molestation can have a devastating effect on the psyche. Without counseling, the aftermath of these experiences can leave lifelong psychological scars, and it is understandable that a woman may avoid any future sexual encounters. 16. Trauma: Psychological trauma such as post-traumatic stress disorder (PTSD) can follow any highly disturbing event. Just as with sexual abuse, the repercussive emotions following the death of a loved one, a divorce, violence, being the victim of a crime, etc. may lead to sexual dysfunction and a lower sex drive. 17. Relationship problems: Constant tension and conflict with a loved one can slowly chip away at even the strongest of relationships. Anger and unresolved issues ultimately make their way into the bedroom, negatively impacting any activity that is still, or no longer, going on there. 18. Stress: Worries about health, finances or other everyday problems cause physical and mental tension. If a woman is unable to relax and enjoy sex, orgasm is impossible and frustration is inevitable, causing her to lose interest altogether. 19. Poor communication: Optimal sexual performance does not come naturally. It’s a learning process for both partners. Many couples avoid telling each other what pleases them in the bedroom. Whether it is due to shyness, fear of shock or ridicule, women sometimes avoid telling their mates what they prefer and, in time, come to dread intimacy altogether. How Can I Get Help? In order to get to the root of the problem, an honest discussion with your OB/GYN is necessary, as well as a list of any medications you are currently taking. Your doctor will ask relevant questions to find out whether the problem is physical or emotional. After an examination of the genital area, blood tests may be required to determine hormonal levels. Once a diagnosis is made, your doctor will move forward to correct the problem. It may be as simple as a change or alteration in medication or a new prescription. If surgery is indicated, most physical corrections are minimally invasive, can be done in our office and the recovery time is usually short. Get Your Sex Life Back So if you find yourself asking yourself,

GYN Problems Patient Stories, PCOS Education

My Life with PCOS – A Patient’s Story

Diane /

Elizabeth was diagnosed with PCOS at just 23, even though she’d had symptoms since she was 11. Polycystic ovary syndrome (PCOS) is a health problem that affects 1 in 10 women of childbearing age. PCOS can happen at any age after puberty, but most women don’t discover they have it until their 20s and 30s – when they have problems getting pregnant. We were fortunate to hear Elizabeth’s story which includes her struggles of living with symptoms of PCOS and finding a doctor that would take her symptoms seriously. Heavy Bleeding and Painful Periods Elizabeth was in the sixth grade and 11 years old when she had her first period, which is a relatively normal age to experience your first menstrual cycle. “It may be odd that I can remember the exact month and year that I got my first period. Maybe it’s because I didn’t realize I had started my period. And when my mom confirmed that’s what it was, I couldn’t stop crying,” Elizabeth recalls. “I don’t remember having considerable pain, but my mom would have to pick me up from school because my period would surprise me, and I would bleed through my pants. It was terribly embarrassing.” – Elizabeth Even though Elizabeth’s periods were very irregular and spaced out, she experienced no other symptoms so her mom figured they would become regular and ’even out’ as Elizabeth entered high school. However, Elizabeth couldn’t help but notice she was the only one of her friend group to have problems. “Is this normal”, Elizabeth began to question. My Pediatrician Classified Me as Overweight, But Provided No Help Unfortunately, Elizabeth’s symptoms didn’t ‘even out’ at all – in fact, they got worse. Her symptoms included weight gain and very painful periods. “My self-esteem plummeted. I was classified as overweight by my pediatrician, and I was noticeably larger than my friends,” she explains. The most frustrating part was that it didn’t seem to make sense. After all, she was very physically active. She lifted weights, played rugby and even carefully watched her diet. Heavy bleeding and severe pain plagued Elizabeth during her menstrual cycle, which came only every three to four months. She and her mom just assumed it was irregular due to her active lifestyle. However, that didn’t explain the intense pain and heavy bleeding. In fact, they were so severe that she couldn’t attend school, go outside, or even move during the first day of her menstrual cycle. “It was so bad. My mom would take the day off of work to tend to me, because I was in so much pain. Over-the-counter pain medication wouldn’t even take the edge off. I would just rock back and forth on the couch all day, dragging myself to the bathroom to change my menstrual pad or to vomit.” – Elizabeth I Just Learned to Live with the Pain and Heavy Bleeding Elizabeth said she learned to just deal with the symptoms and found ways to work around them. It was mainly the first day of her cycle that she was out-of-commission, so on those days, her teachers and coaches were very understanding and would let her go home without any penalties. Again, Elizabeth and her mom hoped her symptoms would simply ‘level out’ as Elizabeth became older. As Elizabeth was preparing to go off to college, she knew she had to do something. If the first day of her period fell on a day where she had class or an exam, she would be in major trouble. She had heard birth control could help ease the pain and bleeding of periods, so she scheduled an appointment with the school’s GYN. The gynecologist ran bloodwork and performed an annual exam. The results shocked Elizabeth – the bloodwork revealed that she had high testosterone levels! After Elizabeth spoke to her mother about her results, Elizabeth discovered her mom had polycystic ovary syndrome. “You’d think this is when I would be diagnosed with PCOS, right? Unfortunately, my GYN at the time told me it would be useless to do further testing since, as she put it, ‘I didn’t want to have kids yet and I was going on birth control anyway.’” Finally, the GYN at Cherokee Women’s Health Diagnosed Me With PCOS As Elizabeth was attending college, she noticed her pain and heavy bleeding were relieved, but she was very fatigued, and was eventually diagnosed with depression. After graduation, Elizabeth moved to Woodstock, GA, where she discovered Cherokee Women’s Health Specialists. After visiting a gynecologist and having more bloodwork tests, she was diagnosed with polycystic ovary syndrome. “Even though I suspected I had PCOS for a while, it was a major relief to get a formal diagnosis. I was much kinder to myself and was excited to finally stop suffering from my symptoms.” Receiving a Treatment Plan for PCOS Her doctor discussed the different treatment options, and together they chose the best option for her situation. Each patient diagnosed with PCOS has different symptoms and is in various phases of life. Discussing the treatment plans with your physician is the best way to manage and control your PCOS symptoms to be able to enjoy the best quality of life. Our GYNs Can Help Diagnose Female Health Issues Polycystic ovary syndrome is not a health condition that can go away, so make an appointment with your gynecologist. They will help rule out other potential causes and come up with a treatment plan. At Cherokee Women’s Health, our board-certified OB/GYNs are very experienced in diagnosing and treating symptoms of PCOS. schedule an appointment online or call us today at 770.720.7733.

GYN Problems Patient Stories, Pelvic Pain Education

Pelvic Pain – Your Mother Was Wrong

Diane /

Adrian came to my office this morning for a GYN visit. She is one of hundreds of women who visit our office every year looking for relief from pelvic pain. Adrian’s story is also common. “Period pain is a normal part of being a woman,” Adrian’s mother told her when she reached adolescence and the pain first began. Adrian believed it. “I experienced intense monthly pain around her pelvic area throughout my teens. When I entered my twenties, I missed work for a day or two every month because the pain was so bad. I didn’t make a big deal about it because I truly believed my pain was “normal.” – Adrian Pelvic Pain is Not “Normal” Adrian recently visited Cherokee Women’s Health after moving to the area. Like most women, she had formed a bond with her former OB, and the switch was hard. But not every GYN focuses on treating pelvic pain, and Adrian’s OB had been no exception. Pelvic pain is a complicated condition which can arise not just from the reproductive organs, but from the urinary tract or bowel as well. A woman might have more than one condition, each with a different cause. Causes of Pelvic Pain Include: Describing Your Pain is Key To Successful Treatment Part of successful treatment is answering questions, which helps your GYN understand your health history: A history of sexual abuse can also lead to symptoms of pelvic pain, whether from actual physical damage or the emotional trauma. Tools For Diagnosing Pelvic Pain Potential Treatments for Pelvic Pain In Adrian’s case, I diagnosed a longtime history of endometriosis. She seemed genuinely surprised at the range of treatment options available for her, and chose to try birth control pills as a first step. This week Adrian returned for follow-up, happy to report that the “normal” pain she had lived with all her life was gone! Don’t Suffer with “Normal” Pelvic Pain If you’re experiencing pelvic pain, help is available. Call our office at 770.720.7733 or schedule an appointment online today.

Miscarriage

Diane /

Miscarriage Miscarriage Miscarriage is a heartbreaking loss that many couples endure. Many women are left wondering if it was something they did wrong or if they will still be able to have a child. The doctors and staff at Cherokee Women’s Health Specialists are here for you to answer any of your questions and guide you along the way. A miscarriage is the loss of a baby before the 20th week of pregnancy. About 15-25% of recognized pregnancies will end in a miscarriage. More than 80% of miscarriages occur within the first three months of pregnancy. Miscarriages are less likely to occur after 20 weeks’ gestation, which are termed late miscarriages. Read Miscarrige Articles Listed below are some common questions about miscarriage to help you understand the signs, causes, and treatment options. What Are the Symptoms of a Miscarriage? Symptoms of a miscarriage include: Bleeding which progresses from light to heavy Severe cramps Abdominal pain Fever Weakness Back pain If you experience the symptoms listed above, contact your physician right away. He or she will tell you to come in to the office or go to the emergency room. What Causes Miscarriage? Most miscarriages happen when the unborn baby has fatal genetic problems. Usually, these problems are unrelated to the mother. Other causes of miscarriage include: Infection Medical conditions in the mother, such as diabetes or thyroid disease Hormone problems Immune system responses Physical problems in the mother Uterine abnormalities Drug or alcohol abuse A woman has a higher risk of miscarriage if she: Is over age 35 Has certain diseases, such as diabetes or thyroid problems Has had three or more miscarriages Cervical Insufficiency A miscarriage sometimes happens because there is a weakness of the cervix, called an incompetent cervix, which cannot hold the pregnancy. A miscarriage from an incompetent cervix usually occurs in the second trimester. There are usually few symptoms before a miscarriage caused by cervical insufficiency. A woman may feel sudden pressure, her “water” may break, and tissue from the fetus and placenta may be expelled without much pain. An incompetent cervix can usually be treated with a “circling” stitch in the cervix in the next pregnancy, usually around 12 weeks. The stitch holds the cervix closed until it is pulled out around the time of delivery. The stitch may also be placed even if there has not been a previous miscarriage if cervical insufficiency is discovered early enough, before a miscarriage does occur. How Is a Miscarriage Diagnosed and Treated? Your doctor will perform a pelvic exam, an ultrasound test and blood work to confirm a miscarriage. If the miscarriage is complete and the uterus is empty, then no further treatment is usually required. Occasionally, the uterus is not completely emptied, so a dilation and curettage (D&C) procedure is performed. During this procedure, the cervix is dilated and any remaining fetal or placental tissue is gently removed from the uterus. As an alternative to a D&C, certain medications can be given to cause your body to expel the contents in the uterus. This option may be more ideal for someone who wants to avoid surgery and whose condition is otherwise stable. Blood work to determine the amount of a pregnancy hormone (hCG) is checked to monitor the progress of the miscarriage. When the bleeding stops, usually you will be able to continue with your normal activities. If the cervix is dilated, you may be diagnosed with an incompetent cervix and a procedure to close the cervix (called cerclage) may be performed if the pregnancy is still viable. If your blood type is Rh negative, your doctor may give you a blood product called Rh immune globulin (Rhogam). This prevents you from developing antibodies that could harm your baby as well as any of your future pregnancies. Can a Miscarriage Be Prevented? Usually a miscarriage cannot be prevented and often occurs because the pregnancy is not normal. If a specific problem is identified with testing, then treatment options may be available. Your doctor will discuss any treatment options with you. How Long Will I Have to Wait Before I Can Try Again? Each patient is different, so discuss the timing of your next pregnancy with your doctor. Your doctor may recommend waiting a certain amount of time (from one menstrual cycle to 3 months) before trying to conceive again. To prevent another miscarriage, your health care provider may recommend treatment with progesterone, a hormone needed for implantation and early support of a pregnancy in the uterus. Taking time to heal both physically and emotionally after a miscarriage is important. Above all, don’t blame yourself for the miscarriage. Counseling is available to help you cope with your loss. Pregnancy loss support groups may also be a valuable resource to you and your partner. The staff at Cherokee Women’s Health Specialists can provide you with more information about these resources. Read Our Patients’ Stories of Miscarriage and Hope Sheila suffered multiple multiple miscarriages, then gives birth to her healthy baby boy Samuel, her miracle rainbow baby. Jamie shares her story of loss and healing and how seeking — and giving support — helped not only other women, but herself as well. Miscarriage Resources You may find the following resources helpful in your recovery process: Perinatal Bereavement of Palliative Care. Email them at northsidepnl@gmail.com or call them at 770.224.1817. You may find the following resources helpful in your recovery process: H.E.A.R.T. Strings Support Group Hope Empathy Alliance Resources Teamwork Perinatal Bereavement of Palliative Care. Email them at northsidepnl@gmail.com or call them at 770.224.1817. Miscarriage Education

GYN Problems

Endometriosis – Facts Every Woman Should Know

Diane /

Endometriosis is the third leading cause of infertility in women of childbearing age. This disease affects 1 in 10 females from the ages of 15 to 44. It impacts more than 11% of women in the U.S. alone and is often times not diagnosed until a woman is in her 30’s or 40’s, so they may have it and not even know. The inside of your uterus (womb) has a lining of tissue called the endometrium. This is similar to that thin layer of skin-type material attached to the shell you sometimes see when you peel a hard-boiled egg. When you have a normal menstrual cycle, this uterine lining thickens to get your uterus ready to house a baby. Its purpose, if fertilization occurs, is to keep an embryo latched on to itself for nine weeks, providing nourishment until the mother’s blood supply through the placenta can take over the job. If pregnancy doesn’t happen that month, menstrual blood sloughs away that barrier and your body begins to rebuild a new one in preparation for the possibility of pregnancy the next time. With endometriosis, endometrial tissue grows and attaches itself in different places outside of your uterus where it doesn’t belong. Like the one in your womb, this tissue is stimulated during the menstrual cycle, but it doesn’t break down. Instead, it remains, causing pain, irritation, and possible scarring which can eventually lead to adhesions, a type of scarring that can cause different organs to fuse together. Endometrial tissue can be found in: In very rare cases, it has even been found on skin, and in the lungs and brain. What are the Symptoms of Endometriosis? Many women have none. Others may suffer a little discomfort, while yet others may experience extreme, debilitating effects. Symptoms include: What Are the Health Risks of Endometriosis? Although endometriosis is neither contagious nor cancerous, left alone it can continue to expand in places where growths should not appear. Unchecked, this may lead to the following problems: Who Can Get Endometriosis? Any female who has begun to menstruate can get endometriosis. In the past, women were often not diagnosed until 30 or 40 years old. Now, doctors know to be on the lookout much earlier, starting in the teens to 20’s. Although endometriosis is not overly picky about which woman’s body it chooses to inhabit, you have a greater likelihood of suffering from it if you have: What Causes Endometriosis? No one really knows although research is intense and ongoing. Some theories include: How is it Diagnosed? The only way endometriosis is diagnosed is that it must be seen at the time of surgery. When someone presents with symptoms of endometriosis, initial workup may entail: Surgery is then performed as necessary. Is There a Cure? There is no cure, but endometriosis can be treated and managed. Options depend on your particular issues and symptoms, and whether you still want to become pregnant. They range from medication to surgery. What Are the Treatments? Your doctor will most likely try the following: How Can I Make Sure I Don’t Get Endometriosis? There is no way to prevent endometriosis, but there is a possibility of reducing your odds by using estrogen-lowering birth control, limiting caffeine and alcohol which raise estrogen, exercising regularly, and maintaining ideal body weight. How Can Cherokee Women’s Health Specialists Help Me? Our entire practice focuses solely on women and their unique biology. We are trained in every aspect of women’s health care and have three board–certified, doubly accredited urogynecologists holding certification in Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This means that we can diagnose, understand, and treat all feminine problems with the most up-to-date knowledge and innovations known to modern medicine. To further discuss endometriosis, call us at 770.720.7733 or schedule an appointment online.

Bleeding Education, Menopause and Hormone Therapy

PMS Explained

Diane /

PMS (premenstrual syndrome) affects most women at one time or another. In fact, it’s estimated that three out of four women suffer from PMS regularly. What is PMS? Premenstrual syndrome refers to a cluster of physical and emotional changes a woman undergoes during the two weeks before bleeding actually occurs. This time frame is referred to as the ‘luteal cycle’. At the onset of her period, symptoms usually disappear. What Are the Symptoms of PMS? Symptoms of PMS are numerous and may include any or all of the following: What Causes PMS? The exact cause has not been pinpointed, but lowering levels of the sex hormones, estrogen and progesterone are believed to be key factors. Serotonin, a neurotransmitter responsible for feelings of well-being and happiness, also drops. Though this is a natural process, and necessary to prepare the body for reproduction, the monthly depletion can cause a hormonal imbalance, wreaking havoc on women physically and emotionally. If you are experiencing extreme discomfort and PMS is negatively affecting you physically and psychologically, do not hesitate to see your doctor. What is Dysphoric Menstrual Syndrome? Most women have mild to moderate cases of PMS which can be annoying, or at most, uncomfortable. These symptoms cause little or no disruption in their daily routines, and usually does not warrant medical help. However, about 5% of women with PMS suffer from what is categorised as dysphoric menstrual syndrome (PMDD), which is a far more severe and negatively impacts their lives. These women require more aggressive psychological or medicinal intervention. The criteria to meet the diagnosis of PMDD is that the patient has at least five of the emotional symptoms mentioned above during their luteal cycle. The presence of these symptoms is usually more exaggerated. These are a few that we look for: Approximately another 20% meet the definition of ‘subthreshold’ PMDD, meaning that they may be monitored diligently to avoid full-blown PMDD. This particular disorder is classified as ‘menstrually related mood disorder’ (MRMD) and may also need some medicinal or psychological treatment. Like PMS, hormone dissipation during the menstrual cycle may be the underlying cause. Are There Any Tests That Accurately Diagnose PMS? There are no specific lab tests to diagnose premenstrual syndrome. Instead, we’ll need to study your medical history to establish if you are suffering from it. It is very important to be completely truthful so that we can help you. We know that some of these symptoms may be frightening to you, and perhaps, at times, embarrassing to discuss, but getting the full picture allows us to give you the best and most effective advice and care. Keeping a diary of your symptoms for a few months helps. Three of the main things we look for are: Even jotting down specific odd thoughts and ideas, levels of fatigue, etc., can be helpful. This allows us to properly determine which hormonal imbalance is affecting you more and enable us to deal with the more troublesome symptoms accordingly. Remember to list the dates as these symptoms occurred, and exactly when menstruation itself began and ended. Can PMS be Treated? Mild to moderate PMS can be fairly easily managed with a few lifestyle changes and over-the-counter pain relievers. Heating pads or warm baths may help with pain, and ice packs with headaches. Topical rubs and ointments can reduce inflammation and joint pain. You may be advised to limit or completely eliminate salt, alcohol, caffeine, sugar and any artificial sweeteners as they contribute to many sleep and anxiety issues. Other recommendations to help alleviate PMS symptoms are: Some herbs and supplements may counteract PMS symptoms, although some have not been studied fully so it’s always best to get these from a healthy diet instead. Before taking them, it is recommended that you speak to your physician. Though they may help, the medications you already take may interact with them and cause adverse, sometimes dangerous interactions. Here is a list of the vitamins, herbs and supplements and the symptoms they may alleviate: For more severe PMS, your doctor may prescribe one or more of the following: How Can Cherokee Women’s Health Specialists Help Me? Because we deal with women’s health issues daily, we are aware of the debilitating effects of PMS. We would never minimize the detrimental influence it can have on you and yours. We are here to offer counsel, diagnosis, empathy, and treatment, using all our expertise and knowledge of the most up-to-date information medical science has to offer. Our staff includes three doubly accredited urogynecologists with the outstanding certification in OB/GYN and Female Pelvic Medicine and Reconstructive Surgery (FPMRS). This qualifies us to diagnose and treat all your female-related problems. Additionally, our staff includes specialists in other fields related to a women’s unique needs. To book an appointment to further discuss your PMS symptoms, call 770.720.7733.

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