These symptoms are most often the result of excessive production of prostaglandins in the uterus which lead to increased uterine contractions during menses. This also affects the intestines, therefore leading to many of the other symptoms associated with the cramping. Very rarely are the symptoms related to other female gynecologic issues such as endometriosis, which gives symptoms of worsening pelvic pain over time with and without menses, or pelvic infections.

To determine if your daughter needs to be evaluated by a physician, you need to evaluate whether it is impacting her life. If she is missing school, sports events or other social activities due to the pain, it is time to see a physician. The physician will evaluate her medical history, especially how her cycles have progressed since she began menstruating. Honesty about sexual history is also very important, in order to rule in/out the possibility of pelvic infections.

Many young women are intimidated by going to the gynecologist, but most of the evaluation for painful periods in the adolescent woman involves discussion. An exam is very important, but does not always require a pelvic exam. The physician determines this after discussing the patient’s symptoms. A pelvic ultrasound may need to be performed for further evaluation, but many times this is not necessary either.

First line treatment for painful periods is Non-steroidal anti-inflammatory medications (NSAIDS) such as Motrin or Aleve. These tremendously reduce the prostaglandin levels that develop within the uterus, therefore decreasing the painful cramps. Ideally, the NSAIDS are started 1-2 days prior to the onset of menses and are continued for 3-4 days into the menses. If your daughter fails NSAID therapy after 2-3 months, the next step would be trying hormonal contraception such as birth control pills (OCPs). OCPs work by both suppressing ovulation which in turn decreases prostaglandin production in the uterus as well as by decreasing blood flow during menses.

Painful periods can really interrupt a young woman’s life and the treatment can be simple, with very little risk. If your daughter is experiencing these issues, please discuss this with your pediatrician or make an appointment for her to see a gynecologist. She will be happy you did.

Preparing for the Endometrial Ablation Procedure

At Associated OBGYN we use multiple endometrial ablation technologies.  Hands down the best procedures appear to be Novasure and Thermachoice.  The basic idea is to destroy the endometrial lining that women shed each month down to the base layer.  This will then prevent the lining from being able to regenerate each month.  Not all women are able to undergo endometrial ablation.  Contraindications include women that desire to become pregnant, bleeding between cycles, enlarged uterus > 12 weeks size and large fibroid tumors of the uterus.  The first step is to perform an in office ultrasound to check the endometrial cavity.  After making sure the uterus is appropriate, a simple sample of the endometrial lining is taken while in the office.  The endometrial biopsy is a great way to make sure the patient will be able to tolerate the in office endometrial ablation.  The reason we perform the endometrial biopsy is to make sure there is no precancerous growth in the lining of the endometrium.  As long as the menstrual cycles are regular the chance of precancerous cell is very rare.  Most women at this point are placed on a low dose oral contraceptive pill to thin out the lining to reduce the time and pain of the procedure.

The Endometrial Ablation Procedure

On the day of the procedure women come in to the office like they would as for an office exam.  One hour prior to the procedure the patient will receive medication to reduce pain and anxiety.  Once the medication has taken effect, the patient is seen in the examination room where numbing medication is place within the cervix to reduce the pain.  15 minute later the doctor with gently dilate the cervix and place a small camera to evaluate the endometrium cavity.  Once the cavity is found to be normal a Novasue device is placed within the cavity.  A test is performed to make sure the integrate of the cavity has not been disrupted.  An energy source is activated for approximately 60 seconds.  Most women describe the pain similar to uterine contraction in labor.  After the 60 seconds most doctors will look back inside the uterus to make sure the entire cavity has been ablated.

Recovery from the Endometrial Ablation Procedure

After a short period of time the patient is sent home with a driver to rest and take Motrin to reduce the cramping for 24 hours.  Most women will experience a slight watery discharge or minimal bleeding for 4 weeks.  At associated OBGYN, we’ve performed over a hundred procedures without any significant problems. Most insurance companies cover the procedure.   Over 50 % of the women will not have any further periods.  The remaining 50% of the patients will have mild menstrual cycles that are significantly lighter and shorter with reduced PMS symptoms.

In summary I would have to say that there is no other gynecological procedure that is so simple, yet has such a positive effect on a woman’s life. If you have any further questions about endometrial ablation, please do not hesitate to ask one of our gynecologists.

Mastitis may occur when bacteria from the skin get into the breast duct through a cracked or sore and inflamed nipple. Risk factors for mastitis include: a cracked or sore nipple, having a history of mastitis previously, breast engorgement (resulting from skipped feedings or changes in feeding schedules), or incomplete emptying of the breasts.

Treatment for mastitis includes warm compresses to the area before nursing, gentle massage, ibuprofen (Motrin), continuation of nursing or pumping and antibiotic use. Mastitis is not a reason to discontinue nursing. If the breast is not emptied the infection may worsen.

If you have a concern that you have this condition you should see your health care provider for an exam and probable treatment with antibiotics. The diagnosis of this condition can be made by your history and physical exam with the aid of your obstetrician.

We’d like to thank all the moms who participated in our recent Facebook contest.  We had a lot of cute entries and it was so fun to see some of of the babies.  Our team has delivered at lot of babies over the years, so it was like a walk down memory lane.  To us, each and every baby is special.

The winner of our contest was Marianne Brooks from Waterford, Michigan.  Her picture of son Aiden was the clear winner.  We have to admit that Aiden in a pumpkin patch is pretty darn cute.  Aiden, who was delivered by Dr. Corsi, received 58 votes and 35 likes.

Babies submitted by doctor delivering:

• Dr. Robins = 1
• Dr. Jewell = 4
• Dr. Corsi = 5
• Dr. Kondratenko = 2
• Dr. Helmick = 1

Click on any of the images below to see some of our entries.  Aiden, our winner, is the first cutie.

Prolia is recommended for women who have osteoporosis with multiple risk factors for fracture, already have experienced an osteoporotic fracture, are intolerant to current medications, or have experienced a significant decline in bone mineral density (BMD) despite treatment.

Prolia’s method of action is different than the Bisphosphonate medications, however, attains a similar result.  Through an immunologic pathway, it binds to RANK Ligand and inhibits the osteoclast cell formation, function and survival.  The osteoclast cell is responsible for bone resorption: it eats away at bone thus decreasing bone mineral density.

Benefits of Prolia

• Initial 3 year studies on women with osteoporosis showed that treatment with Prolia resulted in a 68% reduction in vertebral fractures, a 40% reduction in hip fractures, and a 20% reduction in nonvertebral fractures (ie: wrist).
• A recent 5 year study soon to be published revealed a 35% reduction in nonvertebral fractures for women with a T-score < -2.5 (the level used to diagnose osteoporosis via a Dexa-bone densitometry machine).
• Treatment with Prolia also revealed a 6.4% increase in BMD at the hip, 5.2% increase in BMD at the femoral neck (the thinnest part of the hip bone), and 8.8% increase in BMD at the vertebral spine.
• Patients switching from treatment with Fosamax to Prolia enjoyed an increase in BMD when compared to patients who continued taking Fosamax.

Additional Data Points for Prolia

• Bone biopsies revealed normal bone architecture and quality in both cortical and trabecular bone.  These results are as good, if not better, than the results seen with trreatment using the Bisphosphonate medications.
• Atypical femur fractures seen rarely with the Bisphosphonates have NOT been reported with Prolia.
• There have been 2 reported cases of osteonecrosis of the jaw in patients treated with Prolia, a rare complication seen with Bisphosphonate treatment.
• Gastrointestinal side effects commonly seen with the Bisphosphonates are not seen with Prolia.
• The most common side effect of Prolia (which is 2-3%) therapy is an increase in infection risk.
• A slight increase in skin rash, skin infection, ear infection, and urinary tract infections  have been reported over placebo treatment.

Prolia is given in our office a subcutaneous injection 2 times per year and is covered by many insurance programs.  If you have osteoporosis, you may want to discuss this treatment option with your family doctor or gynecologist.

Almost every one of us has known a close family member or friend that has been affected by breast or ovarian cancer. We have seen the devastation that it has taken on patients and their loved ones. In the past many families would have generations of women affected with either breast or ovarian cancer. With many years of research, the medical field has been able to find a major piece of the hidden puzzle.

BRCA 1 and 2 Gene Mutation

All cancer results from an accumulation of mutations in genes that normally control cell division. Most of these mutations are acquired during a person’s lifetime. In some individuals, an initial mutation in a critical gene is inherited. Approximately 7% of breast cancer and approximately 14% of invasive ovarian cancer results from such genetic mutations passed down from either the father or the mother. The majority (approximately 84%) of hereditary breast and ovarian cancer results from inherited mutations in two genes called BRCA1 (52%) and BRCA2 (32%). Although sometimes referred to as the “breast cancer genes,” BRCA1 and BRCA2 are also associated with the majority of hereditary cancers of the ovary.

Who is at Risk for Breast and Ovarian Cancer?

As a gynecologist and obstetrician, I ask my patients detailed questions focusing on both the mother’s and the ‘s father side of the family. Many times people have a misconception that these gene mutations can only come from the mother’s side of the family. This is far from being true. An individual has an equal risk from obtaining the gene mutation from the mother or the father. As a health care provider, I look for red flags that tell us someone is at risk. Individuals with a personal history of, or a close blood relative (1st, 2nd, or 3rd degree in the maternal or paternal lineage) with, any one of the red flags is at increased risk of HBOC.

Risk factors and red flags include a family history of:

• Ovarian cancer
• Breast cancer < age of 50
• Two primary breast cancer in one family
• Triple negative breast cancer
• Pancreatic cancer with another HBOC cancer
• Ashkenazi Jewish ancestry with another HBOC cancer
• Family history of a previous identified family member

Why We Test for BRCA

It has been estimated that in a general OBGYN practice, at least one in every ten women are at risk. One of my most memorable experiences that I had was when I met with was a patient who had a paternal aunt with breast cancer at 55 and a paternal cousin with breast cancer at 40. The most effective way to evaluate the patient would be to test the affected family members for the gene mutation. If the family members are unable to be tested, then the unaffected patient should undergo testing. For the above mention patient, she underwent testing and was found to be positive for the BRACA2 mutation.

With this gene mutation, a patient has a 50% chance of developing breast cancer by age 50 and up to 87% chance of developing breast cancer the age of 70 (compare to 8% of general population). With regards to ovarian cancer, A BRAC affected patent has a 44 % of developing ovarian cancer.

Many people are hesitant to be tested because they believe the misconception that there is nothing that can be done about cancer. This is far from the truth. Medical and surgical management is used very effectively in identifying and reducing cancer. The National Comprehensive Cancer Network (NCCN) recommends the initiation of clinical breast examinations, mammography, and MRI at age 25 for BRCA1/2 mutation carriers. For ovarian cancer screening, NCCN recommends pelvic examination, pelvic ultrasound and CA 125 blood test every 6 months. Early detection helps to reduce cancer deaths. It has been shown that oral contraceptives reduce the risk of ovarian carcinoma in both BRCA carriers and non-carriers. Studies have shown, women with mutations in BRCA1 or BRCA2 that demonstrated that the use of oral-contraceptives for 6 or more years was associated with a 60% reduction in the hereditary risk of ovarian cancer. Selective estrogen receptor modulators (SERMs), like tamoxifen, can decrease the risk of breast cancer in high risk patients. One study reported that tamoxifen reduced breast cancer incidence by 62% among healthy women with BRCA2 mutations.

For surgical management, Prophylactic oophorectomy reduces the risk of ovarian cancer by up to 96% in women with BRCA mutation. Prophylactic oophorectomy has also been shown to reduce the risk of breast cancer by up to 68% in women with BRCA1 and BRCA2 mutation. Prophylactic mastectomy has been shown to reduce the risk of breast cancer in high risk women by more than 90% and studies have demonstrated that prophylactic mastectomy specifically reduces the risk of breast cancer in women with mutations in BRCA1 or BRCA2 by 89.5% to 100%. Such decisions must be highly discussed between the patient and physician in an individualized manor.

Knowledge is Power!

Women with significant family history can make informed decisions to reduce the risk of developing cancer. Not only are they at risk, but the family members that they are raising are at risk. In the above mentioned patient that was diagnosed with BRACA mutation she decided to undergo surgical intervention by removal of both fallopian tubes and ovaries because she decided she wouldn’t be bearing any additional babies. The final pathology report showed early cancer that was contained! If this had continued to grow without the surgery the prognosis would have been bleak.

Without this test, she would have been another statistical death. Now she can live a full life and enjoy interacting with her grandchildren as they grow up! Priceless!!!

Enter the Cutest Baby Contest

If you’ve looked around our offices you’ll see lots and lots of pictures of babies. We’re proud of each and every child we’ve helped deliver over the years. Each mom, dad, and baby is important to us. Now we want to take those cute faces and turn them into something fun!

Submit Your Baby’s Picture and Win $100

Did one of our doctors delivered your bundle of joy? Think your baby is the cutest baby of them all? Then submit your baby’s pictures and let the Facebook community vote. The baby with the highest number of votes will receive an American Express gift card.

All Ages Are Eligible

We’re not restricting this contest to babies delivered this year. If one of our doctors delivered your child, you are eligible. We don’t care if Dick is ten or Jane is five, we consider this to be a more the merrier type of event. We’re looking forward to seeing the baby picture and we can’t wait to take a walk back through memory lane.

Submit a baby picture of your child and let the voting begin!

As we move closer to the holidays, many pregnant women do wonder if it is safe to travel. For women having an uncomplicated pregnancy, we typically restrict travel beyond 32 weeks of pregnancy. We recommend no driving to a destination that is further than two hours away from the hospital and we recommend against flying at this time.

Some may call this overly cautious, but we obstetricians do not. The reason for the restriction is due to a a higher incidence of preterm labor and the bag of water breaking prematurely (premature preterm rupture of membranes) at and beyond this gestation. The actual flying and driving are not harmful to the pregnancy. Even if a woman is full term, the concern is that labor could occur and that it may be unsafe to attempt to make it back to their preferred hospital.

Also, some cruise lines have more stringent restrictions for pregnant travelers. The Disney Cruise Line, for example, states “ Women who have entered their 24th week of pregnancy as of their embarkation date will be refused passage due to safety concerns. Neither a physician’s medical statement nor a waiver of liability will be accepted. In addition, Disney Cruise Line cannot be held responsible or liable for any complications relating to pregnancy at any stage.”

Before planning your vacation or holiday travel, review any restrictions prior before booking your travel. And if you’re planning a vacation when you are pregnant, have the last hoorah before 32 weeks of pregnancy.

I grew up watching advertisements for these douching products. The advertisements are quite convincing. “If you do not feel so fresh”, or “have a monthly odor’, this could be your cure. The truth is we cannot make our vaginas smell like a bouquet of flowers.

There are healthy bacteria found in the vagina called bacterial flora, which keep the vaginal PH stabile in the vagina. If there is an interruption in this healthy bacteria ( and a change in the pH) an infection can occur. The infections can present with a variety of symptoms including a change in discharge, vaginal itching or burning and odor. Douching is never, ever recommended because it can strip away the healthy bacteria and thus can make women more prone to infections.

Dr. OZ used one of my favorite quotes on his show. He said “the vagina is a self- cleaning oven”. This is true. If a woman has symptoms of a vaginal infection, the infection should be evaluated and treated. Over the counter medications can be quite effective if the correct infection is being treated. If symptoms persist despite over the counter medications than evaluation by a medical professional is recommended.

Since the 1980’s there has been an increase in the number of pertussis cases, especially among teens and infants. The problem is that the majority of severe effects that can be caused by pertussis mainly affect children under the age of 1 year. Children don’t receive the vaccine until the age of 2 months. Therefore it is important as parents and caregivers of these children to protect them by vaccinating ourselves.

The results of an infant contracting pertussis can be severe cough leading to the inability to breathe, difficulty eating, dehydration, pneumonia, seizures, brain disease and even death. The highest rate of hospitalizations required for those exposed to pertussis were in children less than 1 year of age.

In order to prevent this from occurring to your infant, the Center for Disease Control (CDC) as well as the American College of Obstetricians and Gynecologists (ACOG) recommend re-vaccination with the Tdap vaccine (tetanus, diphtheria and acellular pertussis). The ideal timing of this vaccine would be prior to pregnancy, during preconception counseling. However, in most cases it is offered immediately after delivery while the mother and infant are still in the hospital. It is not recommended to be given during pregnancy, under most circumstances, based on a theoretical risk of the vaccine to the growing fetus.

Keep in mind, while vaccinating the mother is of utmost importance the CDC and ACOG both also recommend that the father of the baby, as well as any care givers, get re-vaccinated as well. They can receive their vaccinations from their primary care physician or the health department in their area.

Vaccines play a very important role in the young life of our newborn children and with pertussis cases continuing to rise, this is just another way that we as parents can continue to protect our children.

For additional information on Pertussis, visit National Center for Biotechnology Information at http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002528/.