Author Archives: Dr. Kelly Roy, MD

About Dr. Kelly Roy, MD

Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS Dr. Kelly Roy is a specialist in surgical gynecology and advanced laparoscopy (and hysteroscopy). She is a long-time resident of Arizona and obtained her Bachelor of Science degree in Biomedical Engineering at Arizona State University before finishing her Doctorate of Medicine at the University of Arizona in 1997. Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001. Well known for her teaching and surgical ability, she is on the faculty at the residency program at both Banner University Medical Center and Saint Joseph’s Hospital in central Phoenix and is a Clinical Assistant Professor of Medicine at the University of Arizona College of Medicine, Phoenix Campus. Dr. Roy has taught advanced surgical techniques to medical students, residents, fellows and colleagues for over 15 years. Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today. Read More About Dr. Kelly Roy, MD   |   WebMD Profile   |   Health.USNews.com Profile |  Current Obstetrics and Gynecology Reports: TFA with the Sonata System

Dealing With the Emotional Side of Infertility

Dealing With the Emotional Side of Infertility

This entry was posted in Health FAQs and tagged , on by .

Infertility can be a long and lonely road that doesn’t seem to have any end in sight. Additionally, it’s not something exclusive to those women who have never successfully become pregnant; infertility can affect anyone at any point in their childbearing years. For example, some women who became pregnant with ease earlier in life may later find that pregnancy seems impossible to achieve.

Regardless of how long infertility has lasted when attempt after attempt is unsuccessful, it can be an upsetting experience. For some women, it can seem as if they are destined to continue living the same experience over and over. Science tells us, though, that no matter how many failed attempts you experience, there’s still a chance of conception.

Let’s explore the emotional side of infertility and learn how hope and optimism can prevail.

The Emotional Roller Coaster of Infertility

Amidst all the ups and downs of hopeful optimism and feelings of defeat, women who experience infertility can find themselves at their lowest point. The repeated disappointment alone is enough to affect anyone’s mood, but when you add irrational feelings of failure, guilt, and shame, infertility can start to weigh heavy on your overall well-being. Furthermore, these are just the feelings we impart on ourselves.

Consider the external pressures from partners, parents, friends, news and entertainment media, and even social media; just going to the grocery store can be upsetting when it seems like everyone can reproduce but you. In this way, infertility can affect a woman’s mental health, confidence level, and self-worth.

Unfortunately, this is not an ideal environment for conception. While these feelings are common and are likely temporary, they can be detrimental to both your physical and mental well-being. Staying healthy and positive is optimal for anyone trying to conceive, but the time after an unsuccessful attempt can leave you exasperated and forlorn, awaiting the next window for conception to open.

Then there’s the two-week wait before you can take a pregnancy test. These two weeks can seem like an eternity, especially if you are hyper-obsessed with conceiving and worrying about every possible sign your body is giving you that might indicate you are pregnant. The anticipation and worry over failing again can easily lead to sadness or even anxiety and depression.

Suggested Reading: How to Treat Infertility

Techniques for Dealing with Infertility

If you feel that the emotional rollercoaster of infertility is causing or contributing to anxiety, depression, or both, it is recommended you speak with a professional counselor about how you are feeling. In addition, there are strategies for coping with the emotional stress of infertility that can help you deal with the emotional ups and downs of infertility. There are several recommended techniques that can help ease the emotional impact, alongside scheduling an appointment with Arizona Gynecology Consultants to provide a fresh perspective and insight into your infertility. In the meantime, try some of the following suggested practices.

Identify Feelings and Fears and Acknowledge Them

Keep a journal of your feelings and be honest with yourself. If you’re angry or sad, find a way to express your aggression in a healthy manner. It’s okay to cry; just don’t allow the sadness to consume you. Your feelings are legitimate, and you should not suppress them. Rather, you should release them when you need to and then move on about your day.

Put another way, after you’ve recorded your thoughts and feelings regarding your infertility in a journal, make a point of addressing them briefly and then leaving them there. Constantly rethinking your infertility is not healthy, so set aside a 20-minute time period each day to discuss how you feel with your partner or a friend. When you’re finished, try not to overthink it for the rest of the day.

Explore Healthy Hobbies and Pastimes

Physical activity and enjoyable hobbies

One way to keep your mind off your infertility and improve your mental health is to find active ways to spend your time and make it a point to do things you enjoy. Physical activity and enjoyable hobbies can improve your mood and morale. Physical activity can also be a great way to improve your physical health, expend energy during the day and help you sleep better at night, all of which can help improve your chances of conception. Finding ways to help others can also promote positive feelings and generate happiness within.

Create More Intimacy

If your relationship with your partner has been narrowed down to scheduled sex when it’s time to ovulate, consider the value of creating intimacy. Maintaining intimacy with your partner throughout the month can involve focusing on pleasure, not just conception. Work on maintaining closeness before, during, and after sex, as scheduled sex that is based only on ovulation can lead to feelings of abandonment by both partners. What’s more, intimacy doesn’t have to end with sex. Make a point to spend time being close both in and out of the bedroom to stay connected within your relationship.

Know Infertility Is Not Your Fault

Sometimes, it seems like everyone else can get pregnant without even knowing what luteinizing hormones are, let alone needing to take them to trigger ovulation. It can seem like your body is failing you, and it can be easy to blame yourself for your unsuccessful attempts to conceive. Remember: you didn’t do anything wrong. Allowing negative self-talk to take over and tank your self-esteem is not conducive to conception. The best way to expend your energy is by educating yourself on the facts about infertility and practicing new ways to cope with unsuccessful attempts.

Self-Care Is Essential

Taking time to relax, eat properly, exercise, and sleep well are all ways you can optimize your chances of getting pregnant. A worn-out body that is depleted of energy, vitamins, and nutrients does not create an ideal environment for conception. Take prenatal vitamins and make sure you are getting plenty of folic acid, then participate in activities for health, relaxation, and enjoyment, however that looks for you.

Stay Optimistic But Realistic

It is important to maintain a sense of optimism despite the challenges and setbacks of infertility. Set realistic goals that can provide you with a sense of achievement and also improve your chances of conception, such as eating better or getting more sleep. Achieving these short-term goals can make you feel accomplished and improve your outlook on your situation.

Find Your Flock

Joining a support group

One of the most effective ways to cope with any hardship is to find others who are experiencing the same issues. Joining a support group with other women experiencing infertility can minimize the loneliness and desperation many women feel when trying to conceive for long periods of time. Hearing that others are feeling the same things you are feeling can help you confront the stigma, self-guilt, and shame so often associated with infertility. You can also exchange ideas and learn new things about treatments and methods that can increase fertility. Plus, the ability to relate to another individual is a powerful mood booster.

Explore Your Options – Because You Do Have Options

If you’ve been struggling with infertility on your own, schedule an appointment with a knowledgeable gynecology practice like Arizona Gynecology Consultants. Your doctor can hone in on specific circumstances that may explain why you have not been able to get pregnant. Identifying and addressing an underlying issue may be all it takes to get on the path to optimizing your efforts to get pregnant.

Extenuating Infertility Stressors

While the above tips are great ways to adjust the way you approach thinking about infertility, there are a number of external factors you have much less control over that may create stress. These involve social stressors, financial stressors, and relationship stressors.

Social Stressors

Social stressors include a variety of ways people can make you feel when attending social events at which they are faced with a number of reminders about their infertility. For example, your parents or your partner’s parents may point out how long you’ve been trying to get pregnant in front of others or place pressure on you to have a child soon. Other family members may comment on how everyone else in the family has had a child except you. Social stressors could also involve facing friends, family members, and even strangers who have successfully carried a child while you are still waiting to get pregnant.

If you have discussed your infertility experience with others and have not established your boundaries, they may ask you for updates when you least expect it. In many cases, women aren’t prepared to talk about infertility in casual or public conversations and often would rather not address the subject.

Talking with friend

While it’s important to talk about your experiences and how you’re feeling, and you certainly have nothing to be ashamed of, if you don’t feel comfortable talking about infertility, set boundaries and don’t discuss it. Whether it’s your family, your in-laws, other friends, or strangers, politely change the subject or honestly let them know you would prefer to talk about it at a different time. Depending on your comfort level, you might suggest they call you later to discuss it in private.

Talking to your partner about how you both will respond to friends and family mentioning your infertility will make sure you’re both on the same page. Furthermore, talking about it beforehand and having a plan can allow your partner to save you from those moments when the conversation gets uncomfortable. Just remember to set a firm, clear boundary and stick to it.

Financial Stressors

Depending on your insurance, the root cause of your infertility, and the treatments you choose, infertility can certainly add a medical expense. Of course, the cost is worth it, but that doesn’t eliminate the extra expenses infertility can incur. Whether you realized ahead of time the financial changes fertility treatment would create for your budget or had no idea the potential cost of treatment, infertility almost always means you’ll need to reconsider your budgeting tactics.

If left undiscussed or unaddressed, the financial burden of infertility can weigh heavily on a relationship. Financial changes are normal with any change in your health, but it’s important not to let them come between you and your partner. Talk about ways you can offset the cost of infertility treatments and be practical about budgeting for medical bills. It is also important to maintain sight of the financial costs of infertility and keep in mind the potential expenses related to the multiple-birth pregnancies that are common with treatments like in-vitro fertilization (IVF) may end up costing you more for delivery down the road.

First and foremost, be sure to begin your infertility journey with some clarity regarding the cost of fertility treatments. The average cost of IVF is about $12,000, but depending on the geographical region, it can be significantly higher or lower than these averages. Also, this does not include testing or diagnosis costs. Spending this much money out of your household budget can understandably create stress and problems for couples dealing with infertility. It is important to keep an open line of communication and talk to a professional counselor if it seems to be a problem too big for the two of you to handle.

Relationship Stressors

Pressure from the outside world and from each other can bring about a great deal of stress in a relationship. Make sure you set aside time to nurture your relationship with your partner outside of infertility in order to maintain a loving and intimate relationship throughout your infertility experience. Remember that your partner might be feeling some of the same feelings you are feeling. However, they may not share your exact feelings, and that’s okay.

Relationship Stressors

The important thing is to acknowledge your partner’s feelings are valid and don’t get upset if they don’t have the same reaction you do when attempts fail or new treatments become available. Tell your partner how you feel and be honest about it. If you find you’re having trouble communicating with your partner about your infertility experience, you may want to talk to a mental healthcare provider to obtain marital counseling to get through this difficult time in your relationship.

Fertility Resources

There are so many great resources for women and couples going through infertility. These resources can provide information, support, and help in a variety of ways and cover many facets of the infertility journey. They can also be a great way to educate yourself, your partner, and your friends and family about infertility and what you’re going through personally.

Here are our favorite resources for those experiencing infertility:

Arizona Gynecology Services

maintain hope and positivity through

Above all, make sure you are constantly checking on your mental health, both for yourself and your partner. If you feel overwhelmed, depressed, constantly anxious, or unsafe, speak to a professional immediately. If you’re looking to gain a new perspective on your infertility journey, seek an appointment for Arizona gynecology services. Our approach to infertility and treatment options can help you maintain hope and positivity through one of life’s most daunting journeys.

References :

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3043157/
  2. https://www.webmd.com/baby/glossary-of-fertility-terms
How Stress Can Result in Infertility

The Connection Between Stress and Infertility

This entry was posted in Health FAQs and tagged , on by .

It’s common for women to become stressed as their attempts to conceive continue, but many women are unaware that stress may directly influence their ability to become pregnant. In theory, becoming pregnant is a remarkably simple process. However, for the more than one in five women in the US who continue to experience infertility after a year of trying to conceive, pregnancy can become a complex issue.

Your friends and family may have offered advice with good intentions, and you may even have tried their suggestions to no avail, causing you to become more and more stressed as pregnancy does not occur. What you might not know is that this stress may be contributing to issues with your reproductive health.

Understanding Stress

Stress is defined as our natural physical and mental response to a worrying situation or event. Of course, everyone experiences stress at some level, and we all react to it differently. In any situation you find difficult or uncomfortable, you should expect to feel some amount of stress. Stress isn’t always bad, but chronic stress can cause physical and mental health issues and may even prevent you from participating in activities you enjoy.

When you add the stress of not being able to conceive to the regular stresses in your daily life, it’s easy to see how stress and infertility can be a vicious cycle. These issues can cause women to experience negative mental health symptoms like depression or anxiety or even isolate themselves from friends and family. When dealing with stress and infertility, it’s important to find healthy ways to manage stress and address the root cause of your infertility.

It’s important to note that you are not alone. Nearly 12 percent of married women have problems conceiving or sustaining a pregnancy. The same study notes that women should have a strong support system throughout their treatment for infertility. While difficulty conceiving can be stressful, with proper counseling and support, you can improve your overall mental and physical health and boost your chances of achieving pregnancy.

How Stress Impacts a Woman’s Reproductive System

It is important to note that while stress itself isn’t the sole cause of infertility, it can significantly affect your overall health, including your reproductive system. For example, you must be ovulating to become pregnant; however, when you become stressed, stress hormones are released and begin to disrupt the signal between the brain and ovaries. This can interfere with ovulation, preventing you from being able to conceive.

Stress can also disrupt or halt your periods, and this irregularity can make it difficult to time your attempts to conceive. In addition, you may experience stress-related conditions that affect the pH balance in the vaginal area, leading to yeast infections, bacterial vaginosis, and more. These conditions may not directly cause infertility, but if left untreated, they can seriously affect your reproductive health.

There are several other aspects of your reproductive health that may be affected by stress over infertility.

Sex

Sex can be a great source of stress relief, and for couples not using in vitro fertilization (IVF), it is essential for conception. However, work, infertility, and other life matters can prevent you from having the time or energy to have sex, increasing your stress.

planning sex around your ovulation

One solution to consider is to stop planning sex around your ovulation with the goal of becoming pregnant and go back to having sex for mutual pleasure, connection, and fun. Reducing the pressure surrounding sex can help you get back to enjoying this time spent with your partner and reduce the stress it causes. Another idea is to change up the timing of when you’re having sex with your partner to keep things fun and allow yourself to have sex when you want it versus when you believe you should have it.

Sleep

Lack of sleep can impact anyone’s mental, emotional, and physical health. As mentioned, stress and lack of sleep can cause irregularities in your menstrual cycle, which can cause difficulty conceiving. Not sleeping enough can also make you more tired throughout the day and can cause depression and anxiety, leading to decreased libido.

If you’re struggling to sleep enough due to stress, there are a few strategies to consider:

  • Avoid using your phone or computer right before sleeping
  • Drink herbal tea before bed and avoid caffeine
  • Use your bed strictly for sleeping and sex
  • Don’t include a TV or workstation in your bedroom

By improving your sleep, you’ll feel more energized throughout the day, and your menstrual cycles may become more normal.

Diet

It’s incredibly common for stressed individuals to eat more favorite foods in an attempt to cope. However, gaining weight as a result of increased stress and poor diet may affect your fertility. While the cause is still not fully understood, overweight women are less likely to conceive. Weight also impacts male fertility, as being overweight can cause a male’s sperm count to drop.

Eating Healthy

On the other hand, being underweight can also impact your reproductive system. If you’re significantly underweight, you could suffer from amenorrhea, which means you lack a menstrual cycle. Without a menstrual cycle, you won’t ovulate, meaning you can’t become pregnant.

To combat the excessive weight gain or excessive weight loss that can prevent pregnancy, consider addressing stress and eating a balanced diet. Look for whole foods like lean proteins, whole grains, fruits, vegetables, and healthy fats.

Exercise

Exercise is known to promote a healthy weight while also functioning to reduce your stress. If you can exercise for at least two and a half hours every week, you’re doing enough to stay healthy. If you’re overweight, diet and exercise are great strategies to keep your weight in a good range to improve your fertility. It’s equally important not to overdo your exercise routine, as too much can make you tired and sore, both of which can affect your ability to conceive.

Exercise can provide several benefits even outside of improved reproductive health, including:

  • Reduces blood pressure
  • Improves sleep
  • Reduces your odds of suffering from heart disease
  • Improves your energy throughout the day
  • Releases stress

What to Avoid When You Want to Conceive

While humans have created many ways of reducing stress, not all of them are healthy, particularly if you’re looking to become pregnant. Avoid these common ways of combating stress if you’re trying to conceive.

Alcohol

Alcohol should be avoided when trying to conceive. It may be natural to want a drink when you’re stressed, but alcohol can increase women’s risk for miscarriage. For men, alcohol can negatively influence sperm count. Both you and your partner should refrain from alcohol while trying to conceive.

Smoking

Smoking is another common way people relieve stress, though it is much less prevalent than it was in the past. However, smoking and exposure to your partner’s smoke can negatively impact the vital hormones essential for reproduction and can actively damage components of the reproductive system. In addition, nicotine can damage the DNA in your partner’s sperm.

Caffeine

While you don’t need to avoid caffeine entirely, you should avoid drinking a large amount daily. High caffeine intake may cause you to take longer to become pregnant and can also increase your risk of miscarriage. In addition, pregnant women are advised to abstain from high doses of caffeine because it may lead to low birth weight. If you drink more than one or two cups of coffee per day, cutting back may help.

Suggested Reading: Infertility Q&A

Reducing Stress to Increase Chance of Pregnancy

Infertility can be a daunting situation for any woman, and it’s normal to have questions or concerns regarding how you’re approaching it. As mentioned, when you feel stressed while experiencing infertility, it’s important to make lifestyle changes to decrease stress and increase your odds of getting pregnant. Fortunately, there are several other things you can do to manage your stress and improve your fertility.

Speak With a Counselor or Therapist

The last thing you want to do when you’re stressed is to bottle it up and let it get worse. If you need to speak with a professional about your emotional and mental state, consider meeting with a counselor or therapist. This gives you the freedom to fully express how you’re feeling about your infertility and what’s causing you to stress and begin to address ways to tackle both.

Yoga

Yoga

Many women choose to participate in yoga to release stress and improve physical health. Performing certain yoga postures releases tension in the body and encourages you to focus on your breathing, both excellent methods of reducing stress. Yoga also teaches you to take care of your body, which is easy to forget in your typical daily life.

Practice Mindfulness

Mindfulness is the practice of focusing on the present moment, not prior mistakes or potential situations. By focusing on something in the present moment, you spend less time worrying about what may happen in the future. Pregnancy and infertility can both become stressful for women, and it’s easy to ruminate over thousands of possibilities but focusing on what’s truly important right now can provide you with perspective and reduce stress.

Write Down Your Thoughts

Write Down Your Thoughts

It’s natural to want to bottle up your emotions and thoughts pertaining to infertility, and you may not be processing these thoughts rationally. By writing them down, you’re able to see what you’re thinking from a different angle. If you’re meeting with a therapist, you can bring in your writing for the therapist to better understand how you think.

Writing daily can help you process what you’re going through and identify negative thought patterns as well as ways you’re exacerbating your stress. Keeping your thoughts contained within can only increase your stress, and if you’re not quite ready to talk about them with others, write them down in a personal journal.

Suggested Reading: What Can You Do About Low Estrogen Levels?

Schedule a Wellness Exam to Learn More

A wellness exam can illuminate factors that may be affecting your conception journey. Arizona Gynecology Consultants are proud to assist women with various women’s health problems, including infertility. We’ve seen the effects stress can have on reproductive health, which is why we’re committed to helping women manage their stress levels, identify the root causes of infertility, and manage both.

There’s no shame in infertility, feeling stressed about conceiving, or anything else related to women’s health. Having trouble conceiving is common and doesn’t mean you’re less than anyone else. For women who have spent years trying to become pregnant, stress may be among the underlying reasons for your struggle. Stress and infertility are challenging to address, but we can help.

We’ll assess your situation and work diligently to provide the resources and education you need to stay healthy and pursue pregnancy, however that looks for you. If you’d like to schedule a wellness exam, contact our team today.

References :

  1. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6016043/
  2. https://www.webmd.com/baby/features/infertility-stress
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4456969/
  4. https://www.cdc.gov/reproductivehealth/infertility/index.htm
  5. https://www.apa.org/news/press/releases/2019/08/stress-anxiety
  6. https://www.sciencedirect.com/science/article/abs/pii/S1743609515301442?via%3Dihub
Preventive Care Screenings Every Woman Needs

Preventive Care Screenings Every Woman Needs

This entry was posted in Ask An Expert and tagged on by .

As a woman, you face a variety of unique health risks that can impact your life immensely if they are left untreated. By visiting a women’s healthcare provider on a regular basis, you can receive essential care and undergo necessary screenings as recommended by your provider. These tests can identify any potential issues early on, and your doctor can provide treatment and care as soon as possible to limit your risk of complications.

No matter your age or where you are in life, scheduling regular preventive screenings and tests performed is essential to stay as healthy as possible. This brief guide to the most important preventive tests that every woman should schedule can help you determine which tests you can expect as you age. Here’s everything you might want to know about essential preventive care screenings for women.

Preventive Care for Women

First, it’s important to note that women’s health screenings are a component of preventive healthcare. Preventive healthcare for women is a form of medical care that focuses on preventing and identifying serious potential health issues that can occur in females. Preventive care is especially important for women as they age because their healthcare needs change quite drastically throughout their lives.

For example, the kind of care and tests a woman needs at the ages of 21-29 looks much different than the kinds of issues women 55 and older experience. From breast cancer screenings to STD tests, preventive care can help women of all ages prevent the onset of certain conditions and identify others at an early stage. With prevention and early detection, you can limit your risk of experiencing harmful or fatal women’s health diseases.

Essential Preventive Care Screenings for Women

There are a variety of preventive tests and screenings all women need, even if they are relatively healthy. Preventive care screenings can identify serious issues such as cervical cancer and breast cancer, which can often exist without symptoms and go undetected until screening takes place. Essential preventive care appointments you should schedule include the following.

Well-Woman Care (Primary)

A well-woman visit is an important exam that differs from your annual physical or check-up. Instead of focusing on your overall physical health, a well-woman exam prioritizes the unique traits of a woman and her health. This includes planning and performing preventive care and screenings for women based on age, risk factors, and the general health of the breasts, uterus, vagina, cervix, and other organs.

Well-woman visits prioritize the individual needs of each patient. It is at this appointment that a woman and her healthcare provider can discuss concerns, wellness goals, or potential screenings. Well-woman visits are recommended for women of all ages so that they can keep up with their overall health and wellness.

Mammograms (Breast Cancer Screenings)

Breast cancer screenings

Breast cancer screenings, termed mammograms, are completed using a tool known as a mammography unit. A mammogram uses X-rays to take a picture of the inside of a woman’s breast so experts can examine it for any potential issues, such as masses or tumors. Regular mammogram screenings are important to detect any signs of breast cancer as early as possible.

While they are most recommended for women aged 40 and over, women of any age who believe they are at risk or are experiencing symptoms of breast cancer should consult with their women’s healthcare provider and schedule a mammogram. Women aged 40 to 44 should consider scheduling yearly mammograms, while women 45 and over should definitely schedule annual mammograms. Once women reach 54, they may consider switching to semi-annual mammograms.

Cervical Cancer Screenings

According to healthcare experts like the Centers for Disease Control and Prevention (CDC), a woman should begin scheduling cervical cancer screenings once she reaches the age of 21. It’s recommended that women continue to screen for cervical cancer every three years thereafter to ensure the cervix is still healthy and cancer-free.

To screen for cervical cancer, physicians use a method known as a Pap smear. A Pap smear uses a small tool to scrape the cervix and the area around it for cells that healthcare experts can then test for potential abnormalities. In most cases, the cells collected during a Pap smear will be run through a Pap test and HPV test. A Pap test searches for any signs of cancer, including precancerous cells that are changing shape and may become cancerous if not addressed. The HPV test then checks for the presence of the human papillomavirus, which can cause genital warts and abnormal cell changes that may become cancer.

STD Tests

STD tests, including screenings for chlamydia and gonorrhea, are also important tests for women to schedule regularly when they are sexually active. Because women often do not experience symptoms when they have an STD, regular checks are critical, regardless of how you feel. The longer you go with an untreated STD, the higher your risk of developing long-term issues such as infertility or other diseases. If you are sexually active, schedule regular STD testing at your next well-woman check.

Blood Pressure Screenings

Blood Pressure Screenings

Your blood pressure plays a crucial role in your overall health. When your blood pressure is high, your heart must work harder to pump blood throughout your body. This can cause internal stress on blood vessels and the thickening of your heart’s ventricles, which can increase your risk for heart attacks and strokes. Regular blood pressure screenings are especially important for women who are on birth control, as many varieties are known for increasing blood pressure.

Bone Density Tests

Studies have found that because women go through such a large number of hormonal changes over the years, they face a high risk for osteoporosis later in life. Osteoporosis has been linked to low estrogen levels, which are known to occur after menopause. Because of this, scheduling bone density screenings is especially critical during perimenopause or if you are known to have low estrogen levels. In most cases, bone density tests are performed by using a bone density scan, which is a low-energy X-ray usually done on your spine or forearm.

Thyroid Screenings

Thyroid tests are another important form of preventive care that many women overlook as they begin experiencing other women’s health concerns. Because thyroid issues can begin to appear in young women even before they begin menstruating, it’s crucial that you have regular blood tests performed that evaluate your thyroid and its function. Both hyperthyroidism and hypothyroidism are often genetically linked and can affect a woman’s menstrual cycle and overall health.

Colorectal Cancer Screenings

According to the National Cancer Institute, colorectal cancer is one of the most common cancers seen in women today. This makes preventive screenings crucial so that any signs of the disease can be identified and treated as early as possible. The older a woman gets, the more significant the risk of colorectal cancer is, which is why most experts recommend screenings beginning around the age of 40. If your healthcare provider identifies precancerous masses, they can be treated or removed before they become dangerous.

HIV Screenings

HIV is a virus that causes AIDS, a disease that affects men and women alike by slowly weakening the immune system and associated organ function over time. Because there is no cure for AIDS, medication can only assist with slowing its progression. Having regular HIV screenings is imperative to protect your health and the health of those you love. If you’re sexually active, you face the risk of transmitting HIV through unprotected sex. Don’t hesitate to get tested for STDs and HIV, regardless of if you show symptoms.

Folic Acid Tests

Folic acid is a form of vitamin B-9 that plays a crucial part in helping the body create new cells, as well as assisting in their growth and function. For women who are looking to get pregnant or women who are already pregnant, folic acid is also vital in helping the baby to grow and develop. When a pregnant woman has a folic acid deficiency, the growing fetus has an elevated chance of developing defects. To ensure you and your baby stay healthy, don’t forget to have your folic acid levels checked.

What Tests Should a Woman Schedule Every Year?

Routine Blood Work

While some tests should be scheduled every few years or only at certain ages, there are specific screenings some women should have done annually to keep up with their health. These include:

  • Well-woman visits
  • Blood pressure screenings
  • Cholesterol screenings
  • Thyroid screenings
  • STD tests
  • Routine blood work

Tests by Age

Once you’ve learned about the various preventive tests and screenings you need to stay healthy, you may feel intimidated by the thought of scheduling your next appointment. Fortunately, the team here at Arizona Gynecology Consultants is prepared to guide you and help you plan for what’s best for your unique needs. If you want to begin planning, here are the screenings and preventive care actions recommended for each age group and how often you need them performed:

18 and Under:

  • Receive HPV vaccinations on the recommended schedule to prevent HPV and the cancers it can cause
  • Have routine blood work done as well as blood pressure and cholesterol checks on an annual basis
  • Have your thyroid levels checked at least once
  • Have STD tests performed annually if you are sexually active or every time you are concerned about symptoms or sexual partners

21 – 29:

  • Begin regular visits with a gynecologist
  • Schedule a well-woman visit yearly
  • Have your first Pap smear performed and continue Pap smears with HPV tests once every three years
  • Have STD tests performed annually if you are sexually active or every time you are concerned about symptoms or sexual partners
  • Perform folic acid tests, especially if you’re looking to get pregnant or are pregnant
  • Have routine blood work done annually, as well as blood pressure and cholesterol checks
  • Have your thyroid levels checked at least once

30 – 39:

  • Schedule a well-woman visit yearly
  • Have a Pap smear with HPV test performed every three years
  • If you have concerns about breast cancer, talk to your clinician about scheduling a mammogram
  • Have STD tests performed annually if you’re sexually active with multiple or changing partners or any time you are concerned you may have an STD
  • Have routine blood work, blood pressure checks, and cholesterol checks performed annually
  • Schedule a thyroid screening

40 – 50:

  • Consider having yearly mammograms to screen for breast cancer from ages 40 to 44
  • Schedule yearly mammograms beginning at 45
  • Begin screening for colorectal cancer around the age of 45, and continue to do so every few years
  • Schedule a well-woman visit yearly
  • Have routine blood work, blood pressure checks, and cholesterol checks annually
  • Schedule a thyroid screening

50 – 65:

  • Continue screening for colorectal cancer every few years
  • Schedule your yearly well-woman visit
  • Schedule yearly mammograms until you reach 55 when you can consider switching to semi-annual mammograms
  • Consult with your clinician to determine whether you need any unique tests performed due to menopause and whether you still require Pap smears
  • Begin having bone density scans performed by 60 if you haven’t already
  • Have routine blood work done annually, as well as blood pressure and cholesterol checks

65+:

  • Have bone density scans performed as regularly as your doctor sees fit
  • Schedule your yearly well-woman visit
  • Keep up with your routine blood work, blood pressure, and cholesterol checks
  • Continue screening for colon cancer
  • Discuss mammograms with your doctor to determine whether you still require regular screening

Arizona Gynecology Consultants: Preventive Care Experts

Women's Preventive Care Experts

Here at Arizona Gynecology Consultants, your unique health needs are our priority. We understand just how important it is for women to stay healthy as they age, which is why we are dedicated to helping women at all stages of life to receive the proper screening and care.

Arizona Gynecology Consultants offers gynecology services in Phoenix and in our other locations across the valley, including well-woman visits and primary care for women. We also offer guidance for scheduling the proper preventive care services you need to stay healthy.

To learn more about how the team at Arizona Gynecology Consultants can help you stay healthy, contact us today to book an appointment.

Resources:

  1. https://medlineplus.gov/ency/article/007462.htm
  2. https://medlineplus.gov/ency/article/007467.htm
  3. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5643776/
  4. https://seer.cancer.gov/statfacts/html/common.html
  5. https://www.hopkinsmedicine.org/health/wellness-and-prevention/womens-preventive-care-infographic
Is It Time for a Mammogram?

Is It Time for a Mammogram?

This entry was posted in Ask An Expert and tagged , on by .

Many women ask about when to get a mammogram. Adults in the US are subject to frequently changing guidance regarding many health screening procedures – particularly those involving women. So, it’s no surprise that many women wonder if it’s time to get a mammogram as they approach their 40s. It’s not uncommon for women who have never had a mammogram to have additional questions surrounding the procedure, as well.

Most women in this age range lead busy and hectic lives, and for some, preventative health care is often far down on the to-do list. However, as women approach middle age, it becomes more important to speak to a doctor about scheduling a mammogram appointment in the future. For women over the age of 40, the time to schedule a mammogram may be right now, especially for those with a family history of breast cancer and those who are otherwise considered to have a high risk for developing breast cancer.

Learn more information about scheduling a mammogram from your friends at Arizona Gynecology Consultants.

Should I Get a Mammogram?

The decision to get a mammogram should be made during a consultation with a doctor. This decision should consider your personal medical history, family history of breast cancer, and other risk factors. The answer to this question is a personal one, and there are determining factors that can suggest the recommended window you should get a mammogram, such as age, genetic predisposition, self-examination, and your doctor’s physical examination. Consult with your doctor to determine the ideal timing for your mammogram screening.

For patients who are within the 40+ age range, have a family history of breast cancer, or have the breast cancer gene, now is a good time to have that conversation with your healthcare provider. In addition, if you are using hormones, if you’ve had breast surgeries, or if you’ve had a cancer diagnosis in the past, share this information with your doctor.

Why Mammograms Are So Important

Mammograms are important because they can detect early signs of breast cancer more effectively than self-check breast exams and doctor breast exams. In fact, mammograms can catch breast cancer long before a lump is apparent, when it’s much easier to treat. The purpose of a mammogram is to identify abnormalities in the breast and determine if additional testing such as another mammogram and/or a biopsy, is necessary to identify or rule out potential cancerous tissue. There are four changes in breasts that mammograms can identify—calcifications, masses, asymmetries, and distortions—all of which are potential indications of cancer.

Mammograms are crucial for finding small cancers early when prospective treatment outcomes are the best. Breast cancer can potentially be an aggressive disease and can advance significantly in a short time. Therefore, monthly self-exams are also important for identifying potential issues between mammograms. Women who are familiar with the way their breasts normally feel can detect symptoms and abnormalities more easily, but it is also critical to get mammograms, especially if you haven’t been conducting regular self-exams.

When combined to form a comprehensive breast care routine, self-check breast exams, annual doctor’s exams, and mammograms are all effective tests, even for those who do not have an increased risk of breast cancer. Tests establish the healthy norm and make it easier to tell when slight differences occur.

Should I Get a Mammogram FAQ

Women Over 40

Consider the following information to determine whether you should ask your doctor about scheduling a mammogram.

Q: At What Age Should You Start Getting Regular Mammograms?

A: As a general guideline, women over the age of 40 and those at higher risk of breast cancer can benefit from routine mammograms. Women under 40 with a family history of breast cancer or other risk factors may need to start getting mammograms earlier. In general, it is important for women 35 and up to talk to their doctor to determine the right screening plan for them.

Q: How Often Should a Woman Get a Mammogram?

A: The frequency of mammograms is also a matter of professional medical recommendation and can vary depending on an individual’s age, health history, and other risk factors.

Here are some general guidelines:

  • Most women aged 40 to 74 need only get a mammogram every two years.
  • Women at elevated risk due to strong family history, genetic predisposition, prior chest radiation, or other risk factors may need to start getting mammograms earlier, have them more frequently, or have additional screening tests such as magnetic resonance imaging (MRI).

It is important to note that these are just general guidelines. Your doctor may have a different recommendation based on your unique medical situation.

Q: At What Age Do You No Longer Need a Mammogram?

A: Women aged 75 and older may be able to schedule less frequent mammograms or stop them altogether. However, again, women in this age group should discuss the continued need for mammograms with their doctor, as the benefits and risks may change with age. In general, depending on a patient’s medical history, women aged 75 and older may not need to continue their routine exams.

How Fast Can Breast Cancer Develop?

While the rate of cancer growth and development of cancer tissues is specific to the individual patient and depends on a multitude of factors, a study suggests that the average breast cancer doubles in size in about 1.5 years. However, some cancers in the study took under two months to double. This indicates that cancers are unique, so some cancers are much more aggressive and grow much faster. Thus, it is a possibility that cancer that developed after a mammogram screening could be aggressive enough to progress significantly between mammograms.

Interval Cancers

Interval cancers are breast cancers that are discovered in between mammograms. These are typically volatile cancers that may be at a higher stage or grade and larger in size when discovered than those cancers detected in screening. This is because they have developed rapidly within the 11 to 23 months between routine mammograms.

Breast Awareness

It should be noted that women who are “breast aware” are more likely to detect changes in the breast tissue or notice other symptoms when between mammogram screenings. If they can identify masses early enough, these women have better prognosis than those patients who are not breast aware and do not perform regular self-breast exams. This indicates the importance of monthly self-checks and familiarization with one’s own body, even if you are receiving routine mammograms.

Getting Your First Mammogram

If you’ve determined that you are in or near the correct age bracket to get a mammogram or are otherwise at risk of developing breast cancer, it’s time to have a conversation with your doctor. Together, you can determine the right time to start routine mammograms and establish a schedule for regular mammogram screening over time. Then, you’ll schedule an appointment for your first mammogram screening.

There is research-based evidence that indicates mammograms should be, whenever possible, scheduled during the first week of the patient’s menstrual cycle. While this is not always practical or possible, especially for women getting their first breast cancer screening, mammogram results may be more accurate when performed during the first half of the menstrual cycle. One reason for this is that this is when breast tissue is less dense since it is more difficult to detect breast cancer through dense breast tissue.

Preparing For a Mammogram

After you schedule your mammogram, it is important not to allow yourself to become nervous or upset as your appointment day approaches. Most mammograms serve to reassure those that receive them that no cancer is present. Only about two to four mammograms per 1,000 result in a breast cancer diagnosis.

If you’ve scheduled an appointment, the doctor or medical practice conducting the mammogram screening will go over the procedure and may recommend certain actions to take leading up to the appointment. Some recommendations for preparing for the appointment are below.

Before a mammogram, you should:

  • Avoid using antiperspirants, deodorants, powders, creams, perfumes, or lotions on the armpits or under the arm on the day of the exam, as they can show up as white spots on the x-ray and interfere with results.
  • Wear a two-piece outfit since clothing will need to be removed above the waist.
  • Bring a list of questions to ask the radiologist or technologist.

It is also important to tell the technologist at the onset of the exam if there have been any recent changes or issues with your breasts, if you have breast implants, if you are breastfeeding, if you think you might be pregnant, or if you have trouble standing still alone and/or use a cane to walk or stand.

What to Expect at a Mammogram Exam

Mammogram Exam

Once the mammogram is ready to begin, you and the technician will be the only ones in the room. You will be asked to undress and given a wrap to wear during the exam. To get a high-quality image, the breasts must be compressed or flattened. The technologist will place your breast on the machine, and it will be pressed between the machine and an upper plate made of plastic. The plate is lowered to compress the breast for 10 or 15 seconds per image.

The technician will take a minimum of two images of each breast, though more images may be needed if the breasts are larger or if you have implants. The technician will reposition the breast and re-compress it to take images of each side. The sequence is then repeated on the other breast. There may be discomfort or slight pain during the compression. If you feel pain, you should notify the technician so the compression can be adjusted to be more comfortable.

During the exam, it’s important to relax and take deep breaths. Mindful breathing is typically all that is necessary to get you through this quick and relatively painless procedure. Any minor discomfort is well worth detecting breast cancer early, which can often have a more favorable outcome than leaving cancer unchecked and untreated.

After the Mammogram Exam

Your healthcare provider will receive the full results of the mammogram screening after it is completed. If you have not heard from your doctor within ten days, you should call the provider or the facility where the exam took place. Patients who have online access to their medical records may also be able to review the results there. Mammography facilities, however, must provide patients with a summary of their results in an easy-to-understand format within 30 days. Go over the results with your healthcare provider and ask questions if there is anything you do not understand.

Schedule a Consultation

Schedule Mammogram Reminder

Arizona Gynecology Consultants recommends that women over 40 schedule regular mammograms every two years. If you have a family history of breast cancer or another risk factor, consult with one of our physicians to create a custom mammography schedule that addresses those risks.

Our experienced professionals are proud to support breast health and breast health education. Preventative care is the best way to identify breast cancer and other breast health issues as early as possible for the best prognosis. If you are over 40 and have not yet scheduled a mammogram, or are otherwise concerned with your breast health, contact Arizona Gynecology Consultants and schedule a consultation.

Sources

  1. https://www.cancer.gov/types/breast/research/interval-breast-cancer
  2. https://www.cancer.org/cancer/breast-cancer/screening-tests-and-early-detection/mammograms/mammogram-basics.html
  3. https://www.mayoclinic.org/tests-procedures/mammogram/expert-answers/mammogram-guidelines/faq-20057759
  4. https://pubs.rsna.org/doi/abs/10.1148/radiol.10100974
  5. https://breast-cancer-research.biomedcentral.com/articles/10.1186/bcr2092
Dispelling Birth Control Myths

Dispelling Birth Control Myths

This entry was posted in Birth Control and tagged on by .

Unfortunately, birth control myths circulate throughout the web. But, with the right information, you can make informed choices regarding contraceptive care.

Myth: There Are Few Methods of Birth Control, and Women Are Severely Restricted in Their Choices

While the responsibility to use birth control rests almost exclusively on women, we are fortunate in that there are many methods of birth control from which to choose. Each option works in different ways, and the method that works best for your lifestyle should be strongly factored into your choice.

Consider these popular options, all readily available from a healthcare provider:

  • Permanent Birth Control – There are surgical procedures available that will prevent a person who can ovulate from becoming pregnant, including tubal ligation or removal of the fallopian tubes.
  • Implant – A small rod is placed underneath the skin in your upper arm by a healthcare provider, where it dispenses hormones that prevent pregnancy.
  • Intrauterine Device (IUD) – A small, t-shaped device is placed into your uterus by a healthcare provider. Some dispense hormones, and some act as a physical deterrent to pregnancy.
  • The Shot – This is an injection of the hormone progestin that must be given by a medical professional.
  • Vaginal Ring – A flexible ring containing hormones is inserted into the vagina for three weeks at a time each month.
  • The Patch – A sticker-like patch is applied almost anywhere on the skin every week. It releases hormones via the skin.
  • The Pill – This is an oral medication taken at the same time each day that releases progesterone and estrogen to prevent pregnancy.
  • Emergency Contraception – This is an oral medication (sometimes a copper IUD) that can be administered up to five days following unprotected sex to prevent implantation.
  • Condom – Either polyurethane or latex, condoms are a physical barrier between the two partners.
  • Spermicide – These sperm-killing chemicals can come in the form of foams, film, or suppositories and can be placed in the vagina or used with a condom
  • Fertility Awareness – Also termed natural family planning, this occurs when a woman tracks her cycle and avoids sex during the period when she is most likely to conceive.
  • Pull-Out Method – This often-ineffective method involves removing the penis from the vagina prior to ejaculation.

Choosing the birth control method or methods that will most easily fit into your routine requires research and a discussion with a healthcare provider.

Myth: Birth Control Will Cause Cancer

Though there is some truth behind this myth, the statement itself is misleading. Some studies suggest there is a potential link between birth control pills, specifically the triphasic pill, and an increased risk of cervical cancer and breast cancer. A 2017 study found a mild increase in the rates of breast cancer in women using oral contraceptives; however, this study could not control all other risk factors because it was a prospective study. The overall risk of breast cancer remains low. There is also evidence that hormonal birth control can reduce the risk of endometrial cancer, colorectal cancer, and ovarian cancer.

Dispelling Birth Control Myths

Myth: IUDs Are Unsafe to Use

An intrauterine device (IUD) is a small plastic or copper t-shaped object that is inserted by a healthcare professional into the uterus to prevent sperm from reaching an egg and to prevent the implantation of a fertilized egg. IUDs that contain hormones may also prevent ovulation. Either form is a safe and effective method of birth control that has a 99% success rate of preventing pregnancy. That means that for every 100 women that use an IUD, less than 1 of them will get pregnant each year.

This myth likely arises from several high-profile cases of pelvic infection and subsequent infertility that resulted from the strings of one type of IUD. These issues occurred 30 years ago. Fortunately, in response, modern devices were created to eliminate the risk of infection, and this myth is no longer true.

Myth: Birth Control Pills Cause Birth Defects in Babies

Birth control pills are highly effective at preventing pregnancy when taken as directed. However, they are not 100% effective. This means that pregnancy may occur for teen girls and women even if the pill’s instructions are followed. If a pregnancy does occur, the birth control pill will not harm the growing fetus.

There was previously some concern about other medications that used progesterone, but these claims have never been substantiated by scientific studies. Taking birth control while pregnant is not recommended, but no harm will come to the fetus if you continue taking the pills. Even if it takes weeks or months for you to notice a pregnancy while taking birth control pills, the fetus will not be affected.

Myth: Birth Control Means Using a Hormonal Method

People frequently assume that birth control means hormonal forms of pregnancy prevention. There are many hormonal methods of birth control, including pills, implants, patches, and the hormonal IUD. Still, for some people, hormonal birth control methods are not possible because they will not or cannot use them. Fortunately, these are not the only methods available.

Though many of the commonly known methods are hormonal, there are multiple options to choose from if you are attempting to avoid a hormonal route. Some of these routes are equally as successful at preventing pregnancy as hormonal birth control. The copper IUD contains no hormones but remains 99% effective at preventing pregnancy, a rate even more effective than the hormonal birth control pill. Condoms are non-hormonal and aid in STD prevention.

Fertility planning is another method of non-hormonal birth control. The woman keeps track of their menstrual cycle and avoids sex during her most fertile days to prevent pregnancy. If you have recently given birth and choose to breastfeed, this can be a viable option for birth control as it has a high success rate under some circumstances.

Myth: Birth Control Pills Are Unsafe Because They Cause Blood Clots

A serious side effect associated with birth control pills is an increased risk of thrombotic complications like myocardial infarction, stroke, and venous thromboembolism (VTE). This side effect is more commonly known as a blood clot in the heart, limbs, brain, and groin. The potential risk factor increases for women that are in midlife, those who smoke, and those who have a risk of heart disease.

These side effects can be life-altering or even deadly. However, the risk of blood clots with birth control is low. It is true that the risk can be higher for women that take the pill, but the increase is only marginal. To fully understand the increase, consider that the risk of a blood clot while taking the pill is lower than the risk during pregnancy, delivery, and post-partum—just one in 3,000.

Myth: You Should Not Consider an IUD if You Have Not Already Had Children

IUDs are extremely successful at preventing pregnancy, with over a 99% success rate. Better yet, they offer long-term pregnancy prevention. For these reasons, IUDs should be included in any birth control conversation that you have with your gynecologist. This myth arose because a woman’s cervix and uterus will be slightly larger after giving birth, so IUD implantation and use may be more comfortable after childbirth. This is an old myth, IUDs are safe and effective even if you have not had any children.

Myth: All Birth Control Pills Work the Same

Myth: All Birth Control Pills Work the Same

There are two distinct types of birth control pills: progesterone-only pills and combination estrogen and progesterone pills.

Progesterone-only pills are known as the mini pill. Progesterone alters the lining of the uterus, so it is less favorable for embryo implantation and changes the cervical mucus so sperm cannot move as easily to the egg. These are most frequently prescribed to breastfeeding mothers because they are at a higher risk for stroke but can be given to almost any woman. This type of pill may simply be a personal preference for some women.

Combination estrogen and progesterone pills contain both hormones. This difference in the amount of progesterone is what can cause the various side effects, so a doctor may need to adjust the dose to ensure a positive experience with the medication. Estrogen results in the suppression of luteinizing hormone (LH), which signals the ovaries to release eggs. Therefore, a reduction in LH will prevent eggs from progressing to the uterus, where they would be fertilized. The effects of progesterone on the cervical mucus, endometrium, and motility are also included with the combination pill. Recent alterations to the pills have also included shorter placebo intervals and longer periods of hormones so the woman can experience fewer menstrual periods.

Myth: Birth Control Increases the Risk of Stroke

There are some risks involved with taking hormonal birth control, but they are not blanket risks and will not apply to everyone. There are specific risk factors that can make a stroke more likely to develop from birth control use.

These risk factors include:

  • Obesity
  • Certain types of migraines
  • Smoking over the age of 35
  • A history of cardiovascular disease

There are avenues that can be taken to mitigate these risks, like using non-hormonal birth control or birth control that does not contain estrogen. Choosing the best birth control method for you should involve your own research and a conversation with a medical professional. However, it is important to note that the risks associated with pregnancy could be higher than the risks associated with birth control. The United States’ maternal mortality rate is increasing, making it one of the few countries where it is currently more dangerous to go through a pregnancy and childbirth than it was generations ago.

Myth: Birth Control Can Affect Your Fertility Even After You Stop Using It

Infertility is defined as the inability to get pregnant after one year of having sex without a contraceptive or barrier. The timeline might be shortened to six months if the woman is 35 years or older. Birth control does not cause infertility, but when the birth control method is stopped, the effects may stop immediately or diminish over time as the hormones leave your system. The exact timeline of your fertility return will depend on the individual and the type of birth control used. Fertility can return immediately, but it could take a few months for fertility to return as the body removes the birth control hormones.

This myth arose because of birth control’s questionable history. Studies were fraught with both a lack of consent and a lack of full disclosure. The hushed side effects and lack of informed consent made women wary of birth control, even more so in 1974 after the Dalkon Shield intrauterine device did cause infertility. Fortunately, contraception has become much safer and no longer has permanent effects on fertility.

Even if you chose a permanent form of birth control, like tubal ligation, you could still become pregnant. The uterus and ovaries are left intact, but the route an egg travels from the ovary to the uterus is broken. Therefore, IVF is a remaining option for you to carry a child that is biologically yours.

Myth: The Only Purpose of Birth Control Is Pregnancy Prevention

The primary purpose of birth control is to prevent pregnancy, but there are other uses. Women with heavy or painful periods can take hormonal birth control to help prevent excessive or long-term bleeding. Birth control methods like the pill, shot, patch, implant, and hormonal IUD can all cause shorter, lighter periods. They can also regulate menstrual cycles or even eliminate bleeding altogether, depending on the individual and type of birth control.

In this way, birth control can also improve some symptoms related to:

  • Ovarian cysts
  • Menstrual migraines
  • Hormonal acne
  • Uterine fibroids
  • Endometriosis
  • Polycystic ovary syndrome

Myth: Your Body Needs to Take a Break From Birth Control

Almost all types of birth control are safe to use continuously for as long as you choose. Birth control is essentially putting your menstrual cycle on a temporary pause. Choosing to begin pregnancy attempts is the only reason to take a break from birth control.

The only exception to this rule is the Depo-Provera injection. Because it has been linked to bone mineral loss, it is only recommended to be used continuously for two years. However, if you have concerns about the length of time that you will be or have been on birth control, you should have a conversation with a healthcare professional about more permanent forms of birth control, like tubal ligation.

Understanding Birth Control Myth vs Fact

Understanding Birth Control

Birth control has existed for decades, and many untrue myths have been in existence ever since. Though there may have been some truth to these myths when birth control was first developed, multiple advancements have been made that make birth control a safe and effective way to prevent unplanned pregnancies. Hormonal or non-hormonal, pills or implants, temporary or permanent—with a variety of options, there is a choice that is best for you and your lifestyle.

Using the latest methods and techniques, we establish a specialized plan for patients. With extensive knowledge of women’s health care, our doctors, surgeons and clinical specialists are ready to discuss any questions related to our gynecology services in Phoenix.

Sources:

What Causes Heavy Periods?

What Causes Heavy Periods?

This entry was posted in Ask An Expert and tagged on by .

From your first period, you’ll need to find a means of controlling heavy menstrual bleeding that meets your preferences, potentially including a pad, a tampon, or a menstrual cup. You’ll need to keep it accessible when your period is getting close, as well as some extra pants readily available in the event of a surprisingly heavy flow. Some women may also need to keep some pain relief medication on hand to reduce cramps and other uncomfortable symptoms.

Unfortunately, there is a population of women that will experience a consistently heavy flow beyond that experienced by most women, diagnosed as menorrhagia (heavy menstrual bleeding. An abnormally heavy flow should be evaluated by a healthcare professional to determine the underlying cause. Potential causes include polyps, fibroids, hormone imbalance, adenomyosis, and von Willebrand’s disease.

Is Heavy Menstrual Bleeding Serious?

Heavy menstrual bleeding can affect your daily life, hindering you from accomplishing the tasks you have for the day. As mentioned, severe blood loss can also cause symptoms of anemia, a medical condition that develops when you have too little iron in your body. This depletion of iron can be life-threatening without corrective treatment.

Even if you do not develop anemia, it is still important to see a healthcare professional about menorrhagia. Some of the underlying causes of heavy bleeding, including cancer, require early medical intervention. So, although heavy bleeding may affect anywhere from 27% to 54% of people who menstruate, its common nature should not override the severity.

What is Menorrhagia?

Menorrhagia

There is a significant difference between normal menstrual bleeding and menorrhagia, or heavy menstrual bleeding. Though any large amount of bleeding is a concern, most women will not experience heavy enough or prolonged enough bleeding to be considered menorrhagia. The bleeding must be severe enough that you cannot maintain your usual activities during your period due to blood loss and cramping.

Signs and symptoms of menorrhagia include:

  • A flow heavy enough to soak through one or more sanitary pads or tampons every hour for three or more consecutive hours.
  • The need to use double sanitary protection to contain your menstrual flow.
  • Waking up in the middle of the night to change your sanitary protection.
  • Periods lasting for a week or longer.
  • Passing blood clots that are a quarter size or bigger. The blood may be pink, red, brown, or rust-like in color.
  • Losing more than 80 milliliters of blood during your period, compared to the typical 35-40 milliliters lost by most women.
  • Restricting your daily activities because of the heavy menstrual flow.
  • Anemia symptoms like fatigue, tiredness, or shortness of breath.

Along with anemia, you could also notice symptoms of a condition called pica. These symptoms include pale skin, hair loss, and the urge to eat non-food items (hair, paper, dirt, and more). Contacting your provider is important if you experience any of these symptoms.

How Do I Know If I Have Menorrhagia?

Unfortunately, many people that experience heavy menstrual bleeding do not get medical help because they assume their periods are supposed to be uncomfortable and inconvenient. Their concerns may have been dismissed by family members that experience similar symptoms or even healthcare providers that did not take their concerns seriously. However, your flow should never require you to accept inconvenience or restrict activities long-term.

During your period, you should be able to:

  • Wear a standard absorbency pad or tampon for three to four hours without changing it for a new one.
  • Wear a single sanitary product without needing to double up (two pads or two tampons at the same time) at any point.
  • Leave your home for a few hours without planning to bring extra bags of pads or clothing changes.
  • Live your life as you normally do, without avoiding public places or missing work.

If your period is disrupting your life, it is time to visit your healthcare provider and start working on a plan to find and treat the cause.

What is the Cause of a Heavy Menstrual Bleeding?

What is the Cause of a Heavy Period?

Heavy menstrual bleeding can be caused by many different conditions, ranging from hormone imbalances to medical conditions and even stress.

Hormone Imbalance

Hormones like estrogen and progesterone are produced by your body and regulate your menstrual cycle. If these hormones are not produced in the right amounts at the right time, heavy periods can result. There are medical conditions that will affect your hormones and can cause imbalances that result in heavy menstrual bleeding. These include:

Thyroid Disease

The thyroid gland is wrapped around the trachea in the front of the neck. It makes and stores hormones essential for the function of every cell in the body. Along with the menstrual cycle, these hormones help regulate blood pressure, heart rate, body temperature, and how food is converted to energy. Thyroid disease is a general term used when the thyroid fails to make the proper level of hormones, whether it is too much (hyperthyroidism) or too little (hypothyroidism). The cause of the disease will dictate treatment, but it can include medication, surgery, and radioactive iodine.

Anovulation

Anovulation occurs when an ovum, or egg, fails to release from your ovary during your menstrual cycle. It is a common cause of infertility, as an egg is required for pregnancy. A build-up of the uterine lining and insufficient levels of progesterone from anovulation can cause heavy bleeding. Treatment for this condition depends on your specific hormone imbalance but can include managing your stress, medication, and hormone injections.

Polycystic Ovary Syndrome (PCOS)

PCOS is a hormonal disorder that is common among women of reproductive age. It is caused by the ovarian overproduction of androgens; male sex hormones typically present in women in small amounts. This disorder is normally characterized by fluid-filled sacs that form on the ovaries if the ovary fails to release an egg.

Treatment depends on whether you want to become pregnant or not. If you do want to become pregnant, treatment options include medication to induce ovulation and surgery. Birth control is a common treatment for those that do not want to become pregnant.

Infection

Some infections, including sexually transmitted infections (STI), can result in heavy menstrual bleeding.

Chlamydia

Caused by an infection of a bacteria called Chlamydia trachomatis, chlamydia is an STI that can cause heavy menstrual cycles. It can also cause inflammation of the cervix, which results in spotting between periods. Chlamydia is treated with antibiotics.

Gonorrhea

Gonorrhea is caused by an infection of the bacteria Neisseria gonorrhoeae and is commonly a co-infection with chlamydia. Like chlamydia, it can also cause irritation of the cervix that results in bleeding in between cycles. Gonorrhea is also treated with antibiotics.

Chronic Endometriosis

Though the exact cause of endometriosis is unknown, it is believed to be retrograde menstruation, where menstruation blood flows from the uterus back through the fallopian tubes and into the pelvic cavity. This condition can cause very heavy or very light menstrual flow. Endometriosis is treated with hormone therapy, surgical treatments, and pain medications.

Noncancerous Growths in the Uterus

Even though these growths are benign and noncancerous, they can still cause cells to grow improperly in your uterus, which can result in heavy menstrual bleeding.

Polyps

Uterine polyps, or endometrial polyps, are growths in the inner lining of the uterus (endometrium). The polyps are caused by an overgrowth of endometrial tissue, may be round or oval, and can range from a few millimeters to a few centimeters. Polyps can cause your menstrual cycle to become irregular or heavy. Treatment for polyps depends on their location and size, but they are frequently surgically removed.

Uterine Fibroids

Uterine fibroids, also termed leiomyomas, are growths composed of connective and muscle tissue from the wall of the uterus. They are rounded growths that can grow as a single nodule or in a cluster. They can cause painful and excessive menstrual bleeding. There are many treatments for fibroids, including medication and surgical removal, but they can also be left in place if they are nonsymptomatic.

Adenomyosis

Adenomyosis occurs when tissue from the endometrium grows and pushes into the uterine wall, enlarging the uterus. The uterus can grow to double or triple the normal size because of the extra tissue. The enlarged uterus will then cause abnormally high blood volume during your period. Pain medication, hormonal birth control, and a hysterectomy are treatment options for adenomyosis.

Uterine Cancer

Heavy menstrual bleeding can be caused by cancers of the reproductive system. Uterine cancer is a general term that covers all cancers of the uterus, including endometrial cancer and uterine sarcoma. About 3% of cisgender women will be diagnosed with uterine cancer, and of these, most will develop endometrial cancer. Treatment for uterine cancer is typically a hysterectomy to remove all the cancerous tissue.

Heavy Menstrual Bleeding and Other Medical Conditions

Heavy menstrual bleeding can be a symptom of various medical conditions, including non-bleeding disorders and bleeding disorders.

Von Willebrand Disease

This common blood disorder is genetically inherited and prevents your blood from clotting properly. It is like hemophilia, but it usually causes less severe symptoms. The condition may be treated with medication, specifically birth control, to help reduce the blood loss during your period.

Liver Disease

Liver disease refers to any condition that can affect or damage your liver. Because your liver filters out mutated hormones, an improperly functioning liver can cause heavy or clotted menses. Treatment for liver disease depends on the underlying reason for the liver disease and how far it has progressed, but the options include medication, lifestyle changes, and a liver transplant.

How Is the Cause of Heavy Menstrual Bleeding Diagnosed?

The first step to getting a diagnosis is scheduling an appointment with your healthcare provider. You can prepare for this appointment by gathering this information and ensuring the information is thorough.

Questions they may ask during this appointment include:

  • What age did you first get your period?
  • How long do your periods normally last?
  • Do you have family members with a history of heavy menstrual bleeding?
  • What birth control are you currently taking, and what is your pregnancy history?
  • What other symptoms are you experiencing?
  • How are you managing your periods?

Once your provider has gathered your history, they will run a series of tests depending on which conditions are determined to be most likely from your answers.

The possible tests include:

  • Blood test
  • Pap smear
  • Sonohysterogram
  • Hysteroscopy
  • Endometrial biopsy
  • Ultrasound
  • Magnetic resonance imaging (MRI)

Menorrhagia FAQs

So, should you speak with your gynecologist about your heavy periods? How can you tell your period is heavy enough to be classified as menorrhagia? Learn more about menorrhagia with these FAQs.

Q: What Does a Normal Period Look Like?

A: There are no strict guidelines for how a period should look because everyone is different. However, while a “normal” period is hard to define, there are general parameters for a typical period. Most cycles last for 28 days, with four to five days of bleeding. The total blood loss should be 35 mL to 40 mL, and the blood clots should be occasional and smaller than a quarter.

Q: What Is Considered a Heavy Menstrual Bleeding?

A: A standard volume of blood loss for a heavy period is 80 milliliters of blood during the period with a duration of seven or more days. If you soak through one or more tampons or pads per hour for several hours or need to wear more than one menstrual product at a time to control the bleeding, you likely have a heavy period.

Q: Should Heavy Menstrual Bleeding Affect My Daily Life?

A: While all people with a period must make a few small accommodations if they want to avoid bleeding on their clothing, your period should not consistently affect your daily life. What’s more, you should not need to schedule your day around your period. If the volume of the bleeding that occurs during your menstrual cycle interferes with your social plans, daily activities, or work life, it is time to see a doctor and find the cause of the bleeding.

Q: What Usually Causes Chronic Heavy Menstrual Bleeding?

A: There is an extensive list of potential causes of excessive uterine bleeding, and a conversation with a healthcare provider may be required to discover the cause of your heavy bleeding. They will be able to administer diagnostic tests and hopefully find answers.

Common culprits are:

  • Hormone imbalance
  • Bleeding disorders
  • Noncancerous growths
  • Platelet disorders
  • Sexually transmitted infections

You Don’t Have to Settle For the Inconvenience of Heavy Periods

Talking to doctor about Heavy menstrual bleeding

Just because you have lived your life up until now, accepting that heavy periods are normal does not mean you have to continue to do so. Even if your family has convinced you that they are to be endured or previous medical professionals have dismissed your concerns, speaking with trustworthy healthcare providers can result in a diagnosis and treatment plan that completely changes your quality of life.

Sources

  1. Menorrhagia (heavy menstrual bleeding) – Symptoms and causes – Mayo Clinic
  2. Heavy Menstrual Bleeding (Menorrhagia): Causes & Treatment (clevelandclinic.org)
  3. Polycystic Ovary Syndrome (PCOS) | Johns Hopkins Medicine
  4. Anovulation: Signs, Symptoms, Causes & Treatment (clevelandclinic.org)
  5. Uterine Polyps: Causes, Symptoms, Diagnosis & Treatment (clevelandclinic.org)
  6. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6500811/
Side Effects of Untreated Uterine Fibroids

Side Effects of Untreated Uterine Fibroids

This entry was posted in Health FAQs and tagged , on by .

Having a uterus can be a naturally stressful situation. Between menstruation, potential childbearing, and the various complications that can occur, it can be difficult to determine what is a normal burden of having a uterus and what is a complication that should be addressed. Uterine fibroids are one such example. Though fibroids are often harmless, they sometimes need to be addressed to keep you safe and comfortable.

What Are Uterine Fibroids?

Simply put, uterine fibroids are growths that occur in and around the uterus. Some people experience fibroids inside the uterine walls, while other times they appear on the outside of the uterus. They can even occur in the muscle tissue of the uterus. The cause of uterine fibroids is generally unknown, though experts believe that there is likely a genetic aspect involved. High levels of estrogen can also contribute to uterine fibroids.

Untreated Uterine Fibroids

Many individuals do not know that they have uterine fibroids, and therefore they go untreated for a long period of time. Others learn that they have fibroids but opt to leave them alone rather than try to eliminate them.

For the most part, people with uterine fibroids do not have severe symptoms. It is entirely possible to have fibroids and continue with life as usual, at your regularly-scheduled pace. However, this is not always the case.

Untreated Uterine Fibroids

What Is the Sonata® Treatment?While some patients may not experience any symptoms of uterine fibroids, others may experience heavy bleeding and pelvic pain. This pain can range in intensity, and is often chronic, as a painful fibroid will continue to cause pain until it is treated. Thus, for many people, leaving fibroids untreated means handling ongoing uterine or pelvic pain.

In some situations, untreated uterine fibroids may lead to difficulty conceiving a child. Some people suffer miscarriages at least partially due to uterine fibroids, as well. If you are having trouble conceiving or carrying a child, consult your gynecologist or OB GYN and ask if you may have uterine fibroids. Since fibroids often cause very few symptoms, they may be silently contributing to your difficulty conceiving or carrying a fetus to term.

Sonata Treatment is a minimally invasive option for treating symptomatic uterine fibroids. It has been approved by the U.S. Food and Drug Administration (FDA), making it a viable and effective option for fibroid treatment in the United States.

Other symptoms of untreated uterine fibroids include:

  • Constipation
  • Pain or soreness in the lower back
  • A feeling of abdominal fullness
  • Frequent urination
  • Pain during intercourse

Because uterine fibroids tend to have these fairly generic symptoms—if any at all—it is best to go to your doctor if you notice any changes in your reproductive health. Pain, abnormal bleeding, and new discomfort are all reasons to see a doctor to rule out fibroids and other medical conditions.

What Happens if Fibroids Go Untreated?

You usually do not need to worry about what happens if fibroids are not treated. If you don’t suffer significant symptoms that interfere with your daily life because of your uterine fibroids, you may opt to leave them untreated. In many cases, patients live with uterine fibroids without realizing it. Uterine fibroids are generally not dangerous, and do not require treatment unless the patient is in pain or experiencing difficulty conceiving.

risk of anemia

The most significant risk of leaving uterine fibroids untreated is the risk of anemia. Because many fibroids cause significant bleeding, it is easy for your red blood cell count to drop below safe levels. Anemia is a serious condition that can affect your overall health. If you choose to leave your fibroids untreated, monitor your iron levels with your doctor to be sure that you do not become anemic.

Uterine fibroids are also associated with high estrogen levels. If your estrogen levels drop, your fibroids may shrink or go away entirely. Many people experience this phenomenon during perimenopause and menopause. If you are taking medications that increase your estrogen level, your doctor may make a switch to help the fibroids disappear.

Overall, it is safe to leave uterine fibroids untreated if they aren’t causing you pain and are not causing unwanted effects on your reproductive health.

Reducing Your Risk of Developing Uterine Fibroids

Unfortunately, not much is known about the cause of uterine fibroids. Though there seems to be a genetic component, it is difficult for doctors to predict when someone is at risk for uterine fibroids. However, there are some situations that seem to increase a person’s chance of developing uterine fibroids, and addressing them may help lower your risk.

Address Your Weight

Obesity and being overweight can contribute to uterine fibroids. If your doctor believes that your weight is causing these issues, they should work with you to develop a care plan that makes you comfortable and addresses the issue.

Balance Your Diet

Balance Your Diet

Your diet may also contribute to fibroid development. Consuming significant amounts of red meat, alcohol, or caffeine may increase your risk of developing uterine fibroids. If you consume high levels of these substances, you can reduce your risk of fibroids by cutting back on these foods and opting for alternatives.

Check For Infections

Can untreated infections cause fibroids? Yes, if you have a UTI or other reproductive system infection, be sure to treat it quickly. Always work with your care provider before making any significant changes to your diet or lifestyle. Because uterine fibroids are so unpredictable, making changes may not immediately affect your condition. Your doctor will be able to help you create a plan that is right for you.

Avoid Side Effects of Untreated Uterine Fibroids

Uterine fibroids have very few symptoms. Many individuals learn that they have fibroids after they test positively for anemia. Others experience heavy bleeding, uterine pain, or discomfort. In fact, there is no singular, telltale indication that fibroids are present, but your doctor may test for anemia as a way to determine if fibroids are a possibility. Historically, uterine fibroids have been removed using procedures such as hysterectomies and myomectomies. More recently, non-surgical solutions to uterine fibroids have been developing.

Breast Exams Are Necessary for Overall Health

Why Breast Exams Are Necessary for Overall Health

This entry was posted in Ask An Expert and tagged , on by .

Your personal health should be a top priority. No matter what your lifestyle may be, it is important to make sure you are protecting yourself from major health risks and diseases whenever you can. This can help you live a longer, healthier, happier life.

Breast health is a major aspect of your wellbeing, and if you have breasts, you should be sure to monitor them regularly. This can help you and your physician catch any abnormalities or concerns early, when you may be able to prevent serious issues from developing. Unfortunately, people with breasts are not always given the proper tools and resources to take care of themselves. This lack of information or direction can lead to serious health problems that can even be life-threatening if left untreated.

There are several easy ways for you to take care of your breasts from the comfort of your own home. By doing so, you are taking charge of your health and wellness and improving your chances of catching any issues before they become serious.

Basic Facts About Breast Health

Breast cancer is a serious issue all over the world. Unfortunately, many patients develop symptoms of breast cancer without realizing it. This can lead to delays in diagnosis or even misdiagnosis depending on the circumstances. It is vitally important for everyone with breasts to understand what is normal and what is not when it comes to breast health and wellness.

We’ve assembled a list of normal breast conditions you should experience regularly. If your breasts deviate from these benchmarks, you should schedule an appointment with your doctor or with a specialist to investigate your breast health.

Breasts Remain Constant

Unless you are pregnant or breastfeeding, your breasts should not change much. However, keep in mind that it is difficult to say how your breasts should look or feel, because everyone’s body is different. While some people should be alarmed if their breasts become lumpy, others have developed naturally lumpy breasts due to perimenopause or other normal conditions. Remember: breast health is not one size fits all.

You know your body best, so the best way to establish a healthy breast benchmark is to assess your breasts and get an idea of how they look and feel. Then, understand that the look and feel of your breasts should remain the same. If you notice sudden changes, you should schedule an appointment with your doctor.

Standard Temperatures

breasts should remain the same temperature

Your breasts should remain at roughly the same temperature as the rest of your body. If you notice that your breast or part of your breast is warm to the touch, it may be a sign of inflammation. Inflammation can indicate mastitis or other concerning conditions. On the other hand, inflammation may simply be a sign of a pulled muscle in your chest or similar.

Regardless of the scenario, be sure to see a physician if you notice a temperature difference between your breasts and the rest of your body. Similarly, schedule an appointment if there is a lasting temperature difference from one part of your breast to another. Though it may not be a serious situation, it is best to be safe and have it checked.

Normal Nipple Conditions

Most people do not discharge any fluid from their nipples unless they are currently or have recently been breastfeeding or pregnant. If you notice discharge when you have not recently been pregnant or breastfeeding, you may want to consult with your doctor. If you have bloody nipple discharge, you should see a doctor right away whether or not you are pregnant or breastfeeding. Blood discharged from the nipples is never normal and should always be cause for concern.

No Armpit Swelling

The breasts and armpits are not only located near one another—they are also closely linked. Your armpits are the site of several lymph nodes. When you are sick or fighting disease, your lymph nodes often become swollen, inflamed, or sensitive. Under normal conditions, the lymph nodes in your armpit should not cause pain, tenderness, or any other issues.

If you notice swelling in your armpits, it may be a sign that something is happening in your breasts. This is a key indication that you should see a doctor, especially if the issue persists for more than a few days.

Remember: Breasts Can Hurt

Many people believe that pain is an automatic indication of a problem. However, this is not always the case. If you experience breast tenderness or pain, it is likely nothing to worry about. Many people experience breast pain during and before menstruation. Clothing and increased activity levels can also cause some breast pain. Usually, minor breast pain has a simple and innocuous cause.

If you notice that you are experiencing breast pain that is not related to menstruation, or your breast pain only affects one breast and not the other, you should see a doctor. A localized examination may help to rule out problems.

Perform a Self-Breast Exam

Perform a Self-Breast Exam

One of the best ways for you to keep your breasts healthy is by performing a self-examination on your own breasts. Because you have intimate knowledge of your own body and easy access to your breasts, a self-examination can alert you to any changes or concerns that may arise. As mentioned, every body is different, and you know yours best.

While your doctor will examine your breasts at least annually, you should check your own at least once per month. Many people opt to do their breast exams while they are menstruating, as it is a good reminder that it is time to check in. However you would like to schedule your self examinations, just remember to be thorough and perform an exam once per month.

How to Perform a Self-Breast Exam

It is not only important to perform regular breast examinations, it is also important to do them correctly. If you have never been taught how to properly examine breast tissue, you may miss key indicators of serious disease.

Step 1: Choose a Position

You can perform your breast exam in several different positions, depending on what is more comfortable for you and what gives you easiest access to all of your breast tissue. Each option is equally beneficial.

Laying Down

When you lay down on your back on a bed or on the floor, your breast tissue will naturally spread out across your chest. This gives you equal access to all areas of your breast and allows you to be thorough. However, some individuals prefer to see what they are doing, and laying down may not give you a sufficient vantage point.

Standing

When you stand for your breast exam, you will need to be able to raise your arm over your head so it is important to perform your exam in a space where there is room to assume this position. Standing allows you examine your breasts in their natural position, where it can be easier to determine what feels normal and what does not.

Shower

Many people opt to perform their breast exams while standing in the shower. Though the process is the same as standing anywhere else, the shower offers a private location where the breasts are already exposed. The warm water and soap can also be gentle on the skin, and allow the process to be more comfortable.

No matter the position that you choose, be sure you are able to perform a thorough check of your breast tissue.

Step 2: Inspect Visually

The first step for a breast exam is to inspect your breasts visually. Use a mirror in a room with good lighting. You should be looking for shape changes, dimpling, or swelling. Please note that most people have breasts that are asymmetrical. A difference in size between your two breasts is not a concern unless the difference has changed drastically since your last exam.

Inspect Manually

Step 3: Inspect Manually

When you have finished your visual exam, you can begin to inspect your breasts manually. Begin with light pressure and move around your breast tissue in a circular motion until you have inspected all areas. Repeat this with medium and then heavy pressure to ensure that you have assessed all areas of your breast. Perform the entire process again with your arm raised, then move on to the other breast.

You should be looking for lumps, abnormal areas, discharge, nipple redness, or spots that have changed since your last breast exam. If you feel something strange or abnormal that concerns you, schedule an appointment with a clinic or doctor’s office to have it examined. Though it may ultimately be something innocuous, it is always better to be safe than sorry.

Why Inspect Monthly?

Some people wonder monthly breast exams are necessary. The fact is, breast cancer and other diseases can be aggressive, and a significant amount of change can happen in as little as a month. Monitoring over time can also help clue you in to slower changes in your breasts. What’s more, these examinations are free and very easy. It only costs you about five minutes of your time, and there is no invasive testing or inconvenient doctor’s appointments. A self-breast exam is free, simple, and a great way to take care of your health and safety.

You should still continue to get regular physical exams and mammograms done by a doctor in accordance with your age and health status. Self-inspections should not replace professional care, but they can help you catch issues early, while they are still treatable. If you neglect caring for your body and breasts, a minor concern can quickly develop into a life threatening conditions that is both painful and costly to manage.

Trust Arizona Gynecology Consultants

Trust Arizona Gynecology Consultants

The professional team at Arizona Gynecology Consultants is here to support you in breast and overall health. We are passionate about providing accessible, approachable healthcare, and we look forward to supporting you in your journey. For more information, please contact us online today.

What Is Advanced Minimally Invasive Surgery for Women?

What Is Advanced Minimally Invasive Surgery for Women?

This entry was posted in Procedures and tagged on by .

Minimally invasive surgery is gaining popularity in gynecologic practices across the country. When performing a minimally invasive surgery, surgeons will first look for natural access points, such as through the vagina, in order to decrease incision sizes. When an incision is needed, the incision will be no greater than the size of a dime.[1]Mori, K. M., & Neubauer, N. L. (2013). Minimally invasive surgery in gynecologic oncology. International Scholarly Research Notices, 2013. http://dx.doi.org/10.1155/2013/312982 This enables minimally invasive gynecological surgery patients to experience a more comfortable and less painful procedure, a shorter recovery time, a decrease in bleeding and scarring, and increased affordability.

What Can a Minimally Invasive Procedure Treat?

Minimally invasive procedures are becoming more common for treating a variety of gynecological issues. Procedures that once required large incisions and extensive recovery times are now being achieved through minimally invasive means, leading to a better experience for the patient. Depending on the issue you are experiencing, you may want to discuss minimally invasive options with your doctor and determine together if a minimally invasive gynecological surgery is right for you.

These are some of the most common gynecological issues that can be treated with minimally invasive procedures.

Ovarian Cysts

Developed in the ovaries, ovarian cysts can occur when abnormal ovarian pockets fill with fluid. Small cysts typically go away on their own, but larger cysts can cause irregular periods, pain during intercourse, chronic abdominal and back pain, and bloating. Larger ovarian cysts will often need to be surgically removed—potentially using a minimally invasive procedure.

Uterine Fibroids

Often found in women during their prime conception years, fibroids are noncancerous growths on the outside of the uterus. On some occasions, fibroids can cause heavy bleeding, causing the patient to become anemic. If you are considering having your fibroids removed, it is worth noting that uterine fibroid removal commonly utilizes robotic surgery.[2]Holloway, R. W., Patel, S. D., & Ahmad, S. (2009). Robotic Surgery in Gynecology. Scandinavian Journal of Surgery, 96–109. https://doi.org/10.1177/145749690909800205

Hysterectomy

A hysterectomy is a non-reversible sterilization surgery in which your doctor will remove part or all of the uterus. Often this surgery is performed to treat uterine conditions that have not responded to other types of treatment. A laparoscopic surgery is a common minimally invasive procedure used to perform a hysterectomy.

Vaginal Prolapse

A “prolapse” occurs in a woman’s body when their pelvic organs slip out of place. This can cause discomfort, pressure, a bulge in the vagina, or bladder incontinence. Both laparoscopic surgery and robotic surgery can be used as treatment.

Vaginal Reconstruction

As the vagina endures the effects of childbirth and menopause, skin tissue can loosen, causing changes in vaginal appearance, lowering libido, and creating bladder incontinence. If you have recently given birth or are experiencing a lack of confidence in your sexuality due to the appearance of your vagina, talk to your doctor about vaginal reconstruction. These types of surgeries can address both medical and aesthetic issues, leading to better quality of life and even increased self-confidence.[3]Karcher, C., & Sadick, N. (2016). Vaginal rejuvenation using energy-based devices [Review of Vaginal rejuvenation using energy-based devices]. International Journal of Women’s Dermatology, … Continue reading

Cervical Dysplasia

Cervical dysplasia is caused by the growth of precancerous cells on the surface of the cervix that are caused by human papillomavirus (HPV). There are no symptoms for cervical dysplasia, but if left untreated, precancerous cells can spread and multiply, leading to cervical cancer.[4]Klobucar, A., Hrgovic, Z., Bukovic, D., Caric, V., Grgurevic-Batinica, A., & Hrgovic, I. (2004). The treatment of cervical dysplasia with laser. Medicinski Arhiv, 58(6), 355-357. … Continue reading Multiple minimally invasive treatments are available to treat cervical dysplasia. Talk to your doctor to determine which one is right for you.

Endometriosis

Endometriosis is a very painful condition in which tissue is formed on the outside of the uterus instead of the inside. Most commonly, endometriosis can be treated with a non-invasive laparoscopic surgery. Your doctor will determine which non-invasive surgery is right for your needs.

What Are the Most Common Gynecological Surgeries?

Common Gynecological Surgeries

If you have a qualifying gynecological issue, you and your doctor will discuss your options and decide which treatment plan is best suited for your needs. If a gynecological surgery is necessary, your doctor will likely suggest a minimally invasive procedure to improve your recovery time and your outcome. However, there are a variety of technologies and techniques your doctor may recommend when formulating your treatment plan.

These are some of the most common gynecological surgeries.

Hysteroscopy

In this minimally invasive procedure, doctors are able to see inside your uterus by inserting a scope for visualization into your vagina, through your cervix, and into your uterus. This procedure does not require any incisions and can be performed for both diagnostic and treatment purposes, including the treatment of polyps, female genital abnormalities, scarring or other abrasions, issues relating to contraception or following a miscarriage, and abnormal bleeding.[5]Centini, G., Troia, L., Lazzeri, L., Petraglia, F., & Luisi, S. (2016). Modern operative hysteroscopy. Minerva Ginecologica, 68(2), 126-132. https://pubmed.ncbi.nlm.nih.gov/26930389/

In many cases, only local anesthesia is needed for this procedure, if any is needed at all. However, in some rare cases, general anesthesia may be needed. Patients are typically able to leave shortly after the procedure with only minimal side effects, such as cramping or light bleeding.

Vaginal Surgery

Vaginal surgery is the least invasive form of minimally invasive surgery. It is typically used for woman who have experienced damage to the vaginal area after giving birth or women who are going through menopause and are looking to restore elasticity. This type of surgery utilizes the vaginal opening to repair or reconstruct the vagina. Results from this surgery could include an improved vaginal appearance, a reduction of pain, or increased functionality. With this method of surgical procedure, doctors will not need to make any incisions and there is an overall lower risk of surgical complications.

What Is Advanced Minimally Invasive Surgery?

Advanced minimally invasive surgery is a specialized form of surgery that requires the use of advanced equipment and technology. These devices often require additional specialization and training on the part of the surgeon and are only available at select surgical centers. These are the most common advanced minimally invasive surgeries.

Robotic Surgery

This advanced form of minimally invasive treatment allows your surgeon to operate with greater precision and accuracy. In a robotic-assisted surgery, your doctor will use a control console to control a human-like robotic hand, which is able to perform more precise movements with a much greater range of motion than an actual human hand. While the procedure is in progress, the doctor will be able to see your anatomy on a 3D screen, allowing for much greater visibility.

Laparoscopic Surgery

Most often performed during the removal of the uterus or during a hysterectomy, a laparoscopic surgery is a minimally invasive procedure in which your doctor will make a few very small incisions into your abdominal region. Through these incisions, your doctor will then insert tubes, which will be used as tools during the procedure. These tubes have cameras attached to them, providing your doctor a full view of your internal organs, leading to better accuracy and less opportunity for error. Once the doctor is completed with the operation, the small incisions can easily be sutured and treated for a seamless recovery.

In comparison to a typical hysterectomy, laparoscopic surgery is much quicker and requires less recovery time and a decreased hospital stay. On average, a patient will only need to spend one day in the hospital after the procedure and will be almost fully recovered two weeks after surgery compared with the eight weeks that is typical of a conventional hysterectomy. Patients will also experience much less pain and lose less blood, decreasing the risk of complications and increasing patient satisfaction. A shorter recovery time and quicker hospital stay also allows patients to get back to their daily routines much more quickly. In addition, due to the smaller incisions, patients will notice less scarring afterward.[6]Mayo Foundation for Medical Education and Research (MFMER) (2022). Minimally invasive gynecologic surgery – Overview. Mayo Clinic. Retrieved March 27, 2022, from … Continue reading

Is Minimally Invasive Surgery the Best Choice for You?

Benefits of Minimally Invasive Surgery

Deciding if minimally invasive surgery is the right decision for your gynecological care can be a difficult, but ultimately rewarding, decision. Choosing to undergo a minimally invasive gynecological procedure can lead to multiple benefits to both your health and your self-esteem. We’ve listed the most commonly cited advantages.

Shorter Recovery Time

Undergoing an invasive surgery takes time, and an extensive amount of time is usually needed to recover. Typically, patients who undergo an invasive procedure have a fairly long hospital stay of three to eight days on average. Minimally invasive surgeries, on the other hand, are typically same-day procedures, meaning you can go home the same day as the procedure. Because a minimally invasive surgery produces a smaller wound, the skin will also be able to heal much faster, making recovery time as quick as two weeks. With a quicker recovery time, your life and independence can safely return to normal, without the interruption on your life or daily routine.[7]Mori, K. M., & Neubauer, N. L. (2013). Minimally invasive surgery in gynecologic oncology. International Scholarly Research Notices, 2013. https://doi.org/10.1155/2013/312982

Less Risk for Infection

Since the wound is smaller and heals faster, there is less risk of infection. A smaller wound is also easier to nurse and can help you avoid some of the precautions necessary with a larger or more exposed wound.

Decreased Scarring

As compared with large abdominal scars, the incisions made in minimally invasive procedures are no bigger than a dime. Only one or two stitches is needed to close them. Scarring is therefore minimized, and scars will often not be visible after healing is complete.

Less Prescription Medications

Patients who undergo invasive surgeries are often put on multiple medications that can cause unwanted side effects like constipation, slowed breathing, confusion, drowsiness, and even dependency. It is not uncommon for patients to have a hard time weaning off these medications after their recovery period is over. Fortunately, less invasive procedures typically require fewer pain relieving medications taken for a much shorter period of time.

Increased Confidence

After undergoing minimally invasive procedures, patients often notice increased confidence. Whether it be following a reconstructive vaginal surgery, birth, menopause, or a surgery to help a painful or potentially embarrassing sexual problem, minimally invasive surgery can leave patients feeling confident and better than ever about their sexuality and femininity.

Minimally invasive surgery is becoming popular among gynecologists nationwide. This less-invasive procedure is performed through a small incision or natural access points, such as the vagina, and typically leads to shorter recovery time, decreased bleeding, and decreased scarring.

Is Minimally Invasive Surgery Right for You?

Minimally Invasive Surgery Options

Based on your situation, your doctor will recommend the best treatment option or combination of options for your situation. Advanced and minimally invasive surgery options allow women with challenging gynecological issues to receive a customized surgical treatment plan to achieve their individual goals. Contact us if you would like to discuss your options with one of our providers.

References

References
↑1 Mori, K. M., & Neubauer, N. L. (2013). Minimally invasive surgery in gynecologic oncology. International Scholarly Research Notices, 2013. http://dx.doi.org/10.1155/2013/312982
↑2 Holloway, R. W., Patel, S. D., & Ahmad, S. (2009). Robotic Surgery in Gynecology. Scandinavian Journal of Surgery, 96–109. https://doi.org/10.1177/145749690909800205
↑3 Karcher, C., & Sadick, N. (2016). Vaginal rejuvenation using energy-based devices [Review of Vaginal rejuvenation using energy-based devices]. International Journal of Women’s Dermatology, 2(3), 85–88. https://doi.org/10.1016/j.ijwd.2016.05.003
↑4 Klobucar, A., Hrgovic, Z., Bukovic, D., Caric, V., Grgurevic-Batinica, A., & Hrgovic, I. (2004). The treatment of cervical dysplasia with laser. Medicinski Arhiv, 58(6), 355-357. https://pubmed.ncbi.nlm.nih.gov/15648233/
↑5 Centini, G., Troia, L., Lazzeri, L., Petraglia, F., & Luisi, S. (2016). Modern operative hysteroscopy. Minerva Ginecologica, 68(2), 126-132. https://pubmed.ncbi.nlm.nih.gov/26930389/
↑6 Mayo Foundation for Medical Education and Research (MFMER) (2022). Minimally invasive gynecologic surgery – Overview. Mayo Clinic. Retrieved March 27, 2022, from https://www.mayoclinic.org/departments-centers/minimally-invasive-gynecologic-surgery/overview/ovc-20424071
↑7 Mori, K. M., & Neubauer, N. L. (2013). Minimally invasive surgery in gynecologic oncology. International Scholarly Research Notices, 2013. https://doi.org/10.1155/2013/312982
When Should an Ovarian Cyst Be Surgically Removed?

Should an Ovarian Cyst Be Surgically Removed?

Regardless of its size or level of severity, discovering an ovarian cyst can be a stressful and confusing experience for any woman—especially if the cyst is causing you severe discomfort in your day-to-day life. However, the way a cyst is treated or even if it needs to be treated varies from situation to situation.

Ovarian cysts are relatively common (occurring in between 8% and 18% of women) [1]Ross, E.K. (2013). Incidental Ovarian Cysts: When to Reassure, When to Reassess, When to Refer. Cleveland Clinic Journal of Medicine; 80(8): 503–514. Retrieved from 2013 article., both pre- and post-menopausal. However, most of these cysts are benign, meaning that they’re non-cancerous. [2]Abduljabbar, H. S., Bukhari, Y. A., Al Hachim, E. G., Alshour, G. S., Amer, A. A., Shaikhoon, M. M., & Khojah, M. I. (2015). Review of 244 cases of ovarian cysts. Saudi medical journal, 36(7), … Continue reading In rare circumstances, though, it’s also possible for a cyst to become cancerous or to cause severe complications for the patient. Whenever a twisted ovary or rupture occurs, this can be extremely painful, and the patient must receive immediate medical care.

With so many possibilities, you might be unsure how to proceed after the discovery of an ovarian cyst. To start, take any recommendations by your doctor into serious consideration. They’ll be able to give you a clearer idea of your cyst’s condition and whether treatment is necessary.

When Should an Ovarian Cyst Be Surgically Removed?

Fortunately, in the case of most ovarian cysts, surgery isn’t a necessary treatment. [3]Imperial College London. (2019, February 5). Ovarian cysts should be ‘watched’ rather than removed, study suggests. ScienceDaily. Retrieved February 20, 2022 from … Continue reading The majority of these types of cysts can resolve on their own, often without symptoms or complications. However, there are a few situations where ovarian cyst removal may be the best course of action. For example, suppose the cyst is on the larger side, is actively growing, is non-functional, causes pain, or continues throughout more than two menstrual cycles. In that case, your gynecologist might suggest surgical removal.

In some cases, a cyst can be removed using a procedure known as an ovarian cystectomy. However, the ovary itself won’t be removed during this procedure. There are other times when removing the entire ovary may be the safest path to take. When just the affected ovary is removed, and the other remains intact, this is known as an oophorectomy.

Though rare, some cystic mass may be cancerous. [4]Jayson, Elise C Kohn, Henry C Kitchener, Jonathan A Ledermann, Ovarian cancer, The Lancet,Volume 384, Issue 9951,2014,Pages 1376-1388,ISSN 0140-6736,https://doi.org/10.1016/S0140-6736(13)62146-7. You can expect to be referred to a gynecologic cancer specialist in these instances. The surgical treatment needed in these cases can differ. However, you may need to receive a total hysterectomy. In other words, the ovaries, uterus, and fallopian tubes will all need to be removed. Other cancerous cysts are best treated with radiation or chemotherapy.

If the ovarian cyst develops after the start of menopause, your gynecologist will likely recommend surgical removal.

Functional Cysts Vs. Non-functional Ovarian Cysts

The distinction between functional and non-functional ovarian cysts is important to keep in mind, as it can dramatically influence the best course of treatment.

Functional Cysts (Follicular and Corpus Luteum)

Functional cysts come in two forms: follicular cysts and corpus luteum cysts. Both of these ovarian cysts form during someone’s menstrual cycle.

A follicular cyst may develop when an egg can’t be released from the follicular sac (where an egg grows). More often than not, follicular cysts will resolve on their own in no more than two menstrual cycles.

If the follicular sac releases an egg, but there’s a buildup of fluid, this is a corpus luteum cyst. Although these ovarian cysts often resolve on their own, they can be more painful than a typical follicular cyst. It’s even possible that they will result in bleeding.

As a whole, functional cysts are a benign type of growth. If the functional cyst is small and not causing any symptoms or pain, treatment likely won’t be needed. However, your gynecologist may prescribe birth control bills when menstrual problems or pain are involved, as this can stop new cysts from forming.

Periodic ultrasound studies can be used to monitor the cyst to ensure that it resolves on its own.

Non-Functional Cysts (Dermoid, Cystadenoma, Endometrioma, & Malignant)

When a woman develops a non-functional ovarian cyst, it isn’t a result of releasing an egg or her menstrual cycle. Although most non-functional cysts are non-cancerous, that isn’t always the case.[5]M A Pascual, L Hereter, F Tresserra, O Carreras, A Ubeda, S Dexeus, Transvaginal sonographic appearance of functional ovarian cysts., Human Reproduction, Volume 12, Issue 6, Jun 1997, Pages … Continue reading

Non-functional ovarian cysts also come with several potential complications, including a twisted ovary or rupture. Other times, the non-functional ovarian cyst may be large enough that this alone causes the patient pain or discomfort.

There are four types of non-functional ovarian cysts, and those are:

  • Dermoid
  • Cystadenoma
  • Endometrioma
  • Malignant

Non-Functional Ovarian Cysts

Dermoid cysts are typically benign, although they can rupture or twist the ovary. [6]Mobeen S, Apostol R. Ovarian Cyst. [Updated 2021 Jun 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: … Continue reading They’re also present from the patient’s birth rather than developing later in life. These cysts are composed of hair, skin, muscle, or organ tissue.

Cystadenomas are large cysts that develop on the outside of the ovaries. Despite their size and the discomfort they can cause, they are typically benign. Similarly, endometriomas are usually benign cysts, although they develop due to an excess of uterine lining tissue.

As a woman ages, her cysts may become cancerous or malignant. This is a rare situation, but a “watch and wait” strategy is the best way to catch the problem early. When a patient experiences persistent ovarian cysts (especially after menopause), her doctor must perform routine ultrasound screenings to check for tumors or signs of cancer.

How Big Does an Ovarian Cyst Have to Be to Get It Removed?

Most ovarian cysts are relatively small, often with little to no symptoms or pain. However, if one of these cysts grows to a larger size, this can cause complications and necessitate surgical removal. Surgery often isn’t necessary until an ovarian cyst has grown to 50 to 60 millimeters in size or approximately 2 to 2.4 inches.

Still, these measurements aren’t a rigid guide to when a cyst should be removed. For example, for a simple benign cyst, your doctor might prefer not to surgically remove it until it’s larger than 4 inches. On the opposite hand, if an ovarian cyst is cancerous, it will need to be removed even if it’s of a much smaller size.

Ovarian Cyst Removal Side Effects and Risks

Like any surgical procedure, there are potential risks or side effects to having an ovarian cyst surgically removed. [7]Henes, M., Engler, T., Taran, F. A., Brucker, S., Rall, K., Janz, B., & Lawrenz, B. (2018). Ovarian cyst removal influences ovarian reserve dependent on histology, size and type of operation. … Continue reading

Some of the most common risks of ovarian cyst removal surgery are that:

  • It may not control the pain, despite removal.
  • The ovarian cysts return (after cystectomy).
  • An infection develops.
  • Scar tissue builds up at the surgical site—on the fallopian tubes, ovaries, or in the patient’s pelvis.
  • Damage is done to the bladder or bowel.

Ovarian Cyst Removal Recovery Time

The anticipated recovery time after ovarian cyst removal surgery depends on whether the patient had a laparoscopy or a laparotomy.

Laparoscopy involves a small incision and has a shorter recovery time. Usually, the patient can return to their day-to-day activities within a day. They should avoid strenuous exercise or activity for around a week, though.

If there’s any suspicion of cancer, a laparoscopy won’t be the most appropriate surgical option. So instead, some patients will have a laparotomy performed. This procedure gives an improved view of the female pelvic organs and abdominal muscles, involving a larger incision in the abdomen.

After receiving a laparotomy, the patient could remain in the hospital for approximately two to four days. It will also take around four to six weeks to return to their usual activities.

The Cost of Ovarian Cyst Removal Surgery

Like recovery time, the cost of ovarian cyst removal depends on the type of surgery the patient has received. In addition, whether or not the patient has health insurance coverage is also essential in determining cost.

If the patient has health insurance, the cost of their surgery usually consists of a copay and coinsurance rate of between 10% and 50% (sometimes more). However, if the cyst removal surgery is medically necessary, health insurance providers will generally cover it.

Alternatively, if the patient doesn’t have health insurance, it will typically cost between $7,000 and $15,000 to have ovarian cysts surgically removed. Depending on the patient’s location and the hospital used, the cost can vary.

Although some hospitals may charge as little as $6,500 for surgery, the figure can be several thousand dollars higher with a doctor’s fee.

If you’re an uninsured or cash-paying patient, many care providers will offer a discount of up to 30% (or more).

How Well Does Ovarian Cyst Removal Surgery Work?

How Well Does Ovarian Cyst Removal Surgery Work? 

 

If the patient receives an oophorectomy, the current cysts have been removed—so, there won’t be any risk of new ovarian cysts developing in the future.

However, a cystectomy preserves the ovary (and the patient’s fertility if this is a concern). This means that new cysts can develop in the future, whether they form on the same ovary or the opposite one.

Your doctor may prescribe birth control pills to reduce the chances of new ovarian cysts developing. [8]Grimes DA, Jones LB, Lopez LM, Schulz KF. Oral contraceptives for functional ovarian cysts. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD006134. DOI: … Continue reading

Ovarian Cyst Treatment & Removal by Arizona Gynecology Consultants

At Arizona Gynecology Consultants, we are a team of experienced gynecology professionals in the Phoenix and Mesa areas. If you’re currently struggling with ovarian cysts, we offer both general care and minimally invasive surgical procedures.

We treat many women’s health conditions, including primary care, menopause, abnormal bleeding, pelvic pain, hormone replacement, and more. AZGYN even offers several no-incision medical treatments, including for abnormal uterine bleeding or uterine fibroid treatments.

* Editor’s Note: This article was originally published Jun, 2017 and has been updated Feb, 2022.

References

References
↑1 Ross, E.K. (2013). Incidental Ovarian Cysts: When to Reassure, When to Reassess, When to Refer. Cleveland Clinic Journal of Medicine; 80(8): 503–514. Retrieved from 2013 article.
↑2 Abduljabbar, H. S., Bukhari, Y. A., Al Hachim, E. G., Alshour, G. S., Amer, A. A., Shaikhoon, M. M., & Khojah, M. I. (2015). Review of 244 cases of ovarian cysts. Saudi medical journal, 36(7), 834–838. https://doi.org/10.15537/smj.2015.7.11690
↑3 Imperial College London. (2019, February 5). Ovarian cysts should be ‘watched’ rather than removed, study suggests. ScienceDaily. Retrieved February 20, 2022 from www.sciencedaily.com/releases/2019/02/190205185156.htm
↑4 Jayson, Elise C Kohn, Henry C Kitchener, Jonathan A Ledermann, Ovarian cancer, The Lancet,Volume 384, Issue 9951,2014,Pages 1376-1388,ISSN 0140-6736,https://doi.org/10.1016/S0140-6736(13)62146-7.
↑5 M A Pascual, L Hereter, F Tresserra, O Carreras, A Ubeda, S Dexeus, Transvaginal sonographic appearance of functional ovarian cysts., Human Reproduction, Volume 12, Issue 6, Jun 1997, Pages 1246–1249, https://doi.org/10.1093/humrep/12.6.1246
↑6 Mobeen S, Apostol R. Ovarian Cyst. [Updated 2021 Jun 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560541/
↑7 Henes, M., Engler, T., Taran, F. A., Brucker, S., Rall, K., Janz, B., & Lawrenz, B. (2018). Ovarian cyst removal influences ovarian reserve dependent on histology, size and type of operation. Women’s health (London, England), 14, 1745506518778992. https://doi.org/10.1177/1745506518778992
↑8 Grimes DA, Jones LB, Lopez LM, Schulz KF. Oral contraceptives for functional ovarian cysts. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD006134. DOI: 10.1002/14651858.CD006134.pub4. Accessed 21 February 2022.