GIC Health Articles - Three Gynecological Disorders

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Three Gynecological Disorders Affecting Working Women
Guest Editorial: John E. Buster, MD
(winter 2008)

Three gynecological diseases that commonly afflict working women include:

Endometriosis - a disease occurring in reproductive age women in which the tissue that lines the uterus, called endometrium, implants in areas outside the uterus.  These growths are highly inflamed and cause severe symptoms in some women including painful periods and intercourse, and bowel irritation.  The growths can enlarge, forming large cysts that can rupture and cause disabling abdominal pain.  The growths can cause infertility.  Other women have no symptoms at all.  The disease continues to worsen during the 30’s but usually lessens and disappears in the 40’s.  It goes into temporary remission during pregnancy or when taking oral contraceptives, and goes into permanent remission after menopause or removal of one or both ovaries.

• Tip Offs:  Women may first experience symptoms in their late teenage years or early 20’s, they experience increasingly severe menstrual cramps.   Later the disease may produce constant pain that is worse during intercourse.  Inability to become pregnant may follow.  These symptoms should trigger a visit with a gynecologist. 
• Treatment:  First line treatment is symptom relief by suppressing the disease with oral contraceptives or, if possible, with pregnancy.  Surgery to remove growths may be included.  Other drugs to produce menopause can help in some cases.   Removing the ovaries and even removing the uterus (hysterectomy) are options in severe cases.  Menopause is the only other definitive treatment outside of surgery.

Uterine fibroids - common non-cancerous tumors growing in the uterine wall afflicting reproductive age women.  They occur in 1 in 5 women and are the principal indication for 3 of every 10 hysterectomies in the United States.  They are rarely cancerous.

• Tip Offs: The most common complaints are heavy regular periods, cramping pain, lower abdominal swelling, and miscarriage.  Women may notice symptoms in their 20’s and early 30’s when they begin to have increasingly heavy but regular menses, often with cramps.  
• Treatment: Heavy bleeding can be controlled with oral contraceptives.   Abdominal surgery may be needed and in some cases the fibroids can be removed through a small incision.  The most common treatment is hysterectomy.  Fibroids can be shrunk temporarily with drugs that produce menopause, by removing the fibroids or by embolization (small particles heated under x-ray control).   They stop growing and slowly shrink after menopause.

Polycystic Ovarian Disease (PCOD) - the single most common cause of menstrual irregularity in young women.  It is a metabolic condition characterized by elevated androgens, insulin resistance, obesity, irregular ovulation, excessive hair growth and acne.  Many of these women are infertile because they do not ovulate regularly.

• Tip Offs:  Women with PCOD may have very irregular menses during teenage years or into young adulthood.  Frequently the condition is aggravated by persistent weight gain.  
• Treatment: Treatment depends on the desires of the patient.  If she wants to control facial hair, there are treatments to lessen the hormonal effects on skin and hair, usually with birth control pills.  Weight loss is the most effective treatment for irregular ovulation.  Other drugs are available to correct the level of insulin and improve ovulation in these women.

For more information visit the following websites:  American Society for Reproductive Medicine, American College of Obstetricians and Gynecologists,  Endometrioisis Association, Womenshealth.gov (polycystic ovary syndrome), and Polycystic Ovarian Syndrome Organization .

John E. Buster, M.D. is a practicing reproductive endocrinologist who sees patients at the Center for Reproduction and Infertility  at Women and Infants’ Hospital of Rhode Island in Providence and at Tufts New England Medical Center in Boston.  Clinical practice focuses on infertility, assisted reproductive technology, reproductive surgery and menopausal hormone replacement.  Dr. Buster has special expertise and international recognition for his work in preimplantation embryology, pregnancy and female hormone replacement.