15
November
2008
Endometriosis: endometrial glands and stroma that is present outside the uterus. Prevalence not known. Can be asymptomatic and found on autopsy and incidentally during surgery. But prevalence when involved with other diseases are such: 1% all women undergoing major gynecologic surgery; 1-7% tubal ligation; 12-32% reproductive age with pelvic pain undergoing laparoscopy; 9-50% laparoscopy for infertility; 50% teenagers laparoscopy for chronic pelvic pain or dysmenorrhea.
Risk factors: delayed pregnancy (so professional women might have it more). 25-35yo. Taller, thinner women. Ovarian steroids needed so rare in those menopausal or pre-menarche. Endometriosis might be a risk factor for developing ovarian cancer. The ovarian cancer risk is reduced with OCP but higher with HRT or tamoxifen.
Endometrial tissue goes on in descending order: ovaries, anterior and posterior cul-de-sac, posterior broad ligaments, uterosacral ligaments, uterus, oviducts, sigmoid colon and appendix, round ligament. Appendix in 2-4% cases. Has even been reported in breasts, spine, lungs, and extremities. Can cause adhesions.
Pain usually with menstrual period, but it can be continuous. Pelvic pain, dysmenorrheal, subfertility, deep dyspareunia, cyclical bowel or bladder symptoms, chronic fatigue. If under skin, bruising from the bleeding can be seen! On exam can mimic PID. The endometriosis tissue unlike that in the uterus contains fibrous tissue, cysts, and blood.
drjohnhong 
women_issues 
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30
July
2008
Menopause: cessation of menstrual periods. For 12 months. Mean age 51.4 years old. 5% start 40-45yo & 5% after 55yo. <40yo premature ovarian failure. STRAW staging system: -5 to +2. -5 to -3 is reproductive stage. Menopause transition: -2 early, -1 late. 0 is menopause . +1 early postmenopause. +2 late postmenopause. Early menopause transition: variable cycle length greater than 7 days change from normal (which is 21-35d). Follicular phase shortens, inhibin B falls, FSH rises. Estradiol is normal to high still from increased aromatase activity but lower progesterone in luteal phase.Late menopause transition: 2 or more skipped cycles and no periods 60 or more days. Often hot flashes occur. FSH spikes but then drops to normal.Menopause: 12mo no periods after the final period. Ovaries stop ovulating and secreting estrogen. Early menopause: first 5 yrs after final menstrual period. Accelerated bone loss and ovarian failure. hot flashes common. Late menopause: after 5 years to death.
drjohnhong women_issues Comments (0) » |
27
June
2007
Ovarian Cancer occurs in about 22,000 American women a year. More than 16,000 of them will die from the cancer, which outnumbers both cervical and uterine cancers combined. If ovarian cancer is diagnosed in the later stages (which is usually the case), the 5 year survival is on 20-30%. On the other hand if diagnosed at Stage I, it is 90-95% 5-year survival.
Risk Factors: majority of women with ovarian cancer don’t have any risk factors. But risk factors include: older age, never pregnant, infertility, family history (10-15% of cases of ovarian cancer), and Ashkenazi Jewish. BRCA 1 or 2 gene is a genetic cause of ovarian cancer (associated with breast cancer; 20-40% lifetime risk of ovarian cancer. In women with BRCA gene, prophylactic removal of ovaries and Fallopian tubes reduces the risk of ovarian cancer down to 5% (cancer can develop in the peritoneal lining despite no ovaries, or there was already an occult – meaning hidden – cancer.)
Screening: because tests are expensive and the prevalence is too low, is not cost effective to screen. Blood test for CA-125 is not recommended because it is used only to follow the course of already diagnosed ovarian cancer. Transvaginal ultrasound is not cost-effective. Doing screening also can be very misleading because a positive test is only correct 10-23% of the time. So 90% of women would have an incorrect positive test, leading to unnecessary emotional distress and surgery. Also doing CA-125 testing with transvaginal ultrasound detects 5% of cases in stage I ovarian cancer according to the PLCO study.
Clinical: 95% women do have symptoms a few month before diagnosis but they are pretty vague – such as abdominal distention, bloating, pelvic pain, constipation, nausea, anorexia, losing appetite soon after eating, and increasing abdominal girth. Statistically it appears the most important symptoms to distinguish ovarian cancer vs. IBS (irritable bowel syndrome) are: pelvic pain, bloating, increasing abdominal girth, urinary urge and frequency,
Diagnosis: CA-125 blood test, transvaginal ultrasound, pelvic examination. Ascites (fluid in the abdominal cavity) can be drained and tested for ovarian cancer. Staging of the cancer is done during surgery – usually laparoscopy Also a complete hysterectomy is done for women who don’t want to bear kids in the future. This means removing the uterus, Fallopian tubes, and ovaries. For those who want to become pregnant in the future, if the cancer hasn’t spread or involved the other ovary, surgery is more sparing – though there is a risk of the spared ovary developing cancer.
Treatment: as mentioned above surgery is needed to remove the cancer. Chemotherapy is usually recommended, though of some controversy.
drjohnhong Uncategorized, women_issues, cancer Comments (0) » |
6
May
2007
Sexual assault, or rape, occurs every 90 seconds in the US. 1 in 3 women are raped, 1 in 6 boys by age 18. 25 percent of college women have been raped. Stop the violence. In Charlottesville, Men walked in high heel shoes to “walk in her shoes ” to bring about awareness and to call for an end to this violence
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