The Concise Encyclopedia of Women's Sexual and Reproductive Health: An A-to-Z Guide of Conditions, Treatments, and Quality Care for Every Day

by Deborah Mitchell

Overview

• Comprehensive information on the health challenges today's women face throughout life, all in an easy-to-follow, A-to-Z format

• Guidelines for finding the best possible specialist for your reproductive and sexual health needs, whether you are seeking a gynecologist, genetic counselor, endocrinologist, or midwife

• Includes helpful "what to ask your doctor" checklists and timetables for medical exams and screenings

• An overview of the state of women's health today—from such conditions as amenorrhea to infertility to premature ovarian failure to breast cancer—including the latest research and resources

Product Details

ISBN-13:	9781429964586
Publisher:	St. Martin's Publishing Group
Publication date:	03/03/2009
Series:	Healthy Home Library
Sold by:	Macmillan
Format:	eBook
Pages:	352
File size:	1 MB

About the Author

Deborah Mitchell is a widely published health journalist. She is the author or coauthor of more than three dozen books on health topics, including The Complete Book of Nutritional Healing, A Woman's Guide to Vitamins, Herbs, and Supplements, and A Concise Encyclopedia of Women's Sexual and Reproductive Health—all available from St. Martin's Paperbacks.

DEBORAH MITCHELL is a widely published health journalist. She is the author or coauthor of more than three dozen books on health topics, including eight books for the St. Martin’s Press Healthy Home Library series, as well as THE WONDER OF PROBIOTICS (coauthored with John R.Taylor, N.D.), FOODS THAT COMBAT AGING, YOUR IDEAL SUPPLEMENT PLAN IN THREE EASY STEPS, and WHAT YOUR DOCTOR MAY NOT TELL YOU ABOUT BACK PAIN (coauthored with Debra Weiner, M.D.).

Read an Excerpt

CHAPTER 1

AMENORRHEA

The absence of menstruation during puberty or later in a woman's life is called amenorrhea. This condition occurs in two forms, primary and secondary amenorrhea. The absence of menstruation and secondary sexual characteristics (pubic hair, breast development) in females by age fourteen or the absence of menstruation with normal development of secondary sexual characteristics in girls by age sixteen is primary amenorrhea. This affects less than 3 percent of adolescent girls. Females who were menstruating but then stop for three consecutive months or longer have secondary amenorrhea. Some experts qualify this definition by excluding the cessation of menstruation associated with pregnancy, lactation, use of birth control pills, or menopause; however, the first definition is the one more commonly used. Secondary amenorrhea is much more common than the primary form and typically is not serious.

Amenorrhea is a symptom of an underlying condition (see "Causes and Risk Factors") rather than a disease, and so additional symptoms may occur depending on what that condition is. Symptoms often associated with amenorrhea include headache, milky discharge from the nipples, hot flashes, sleep problems, severe anxiety, and excessive hair growth on the face and/or torso.

CAUSES AND RISK FACTORS

For some adolescent girls, the cause of primary amenorrhea is unknown. The most common reasons are heredity, poor nutrition, or an endocrine problem (e.g., hypothyroidism or a pituitary tumor). Other causes include a hormonal imbalance, eating disorders (e.g., anorexia nervosa, bulimia), extreme obesity, and excessive exercise. Young girls who take part in intensive physical training prior to puberty, which is common among gymnasts and ballet dancers, can delay the start of menstruation by up to five months for every year of training they have done.

Secondary amenorrhea may be caused by many of the same factors associated with the primary form, although the most common cause of secondary amenorrhea is pregnancy. Other causes include lactation, the use of certain medications (e.g., antidepressants, antipsychotics, chemotherapy drugs), chronic illness, uterine fibroids, premature menopause, use of birth control pills, menopause, and polycystic ovary syndrome.

DIAGNOSIS

To determine the cause of amenorrhea, your health care provider may run blood tests to determine the levels of hormones secreted by the ovaries (estrogen) and the pituitary gland (prolactin, luteinizing hormone [LH], thyroid-stimulating hormone [TSH], and follicle-stimulating hormone [FSH]), all of which have an impact on menstruation. He or she may also order an ultrasound of the pelvic area to identify any abnormalities, including polycystic ovaries, or an MRI or CT scan of the head to see if the pituitary or hypothalamus is causing the amenorrhea. Other tests that are sometimes ordered include thyroid function, hysteroscopy (to visually inspect the inside of the uterus), and saline infusion sonography or hysterosalpingogram, both of which allow the clinician to examine the uterus.

PREVENTION AND TREATMENT

Ways to prevent and treat amenorrhea often coincide. Eating a balanced diet, for example, can both prevent amenorrhea and help restart the menstrual cycle in women who have nutritional deficiencies or who have been dieting excessively. Excessive vigorous exercise (e.g., regular long-distance running or gymnastics) may cause your periods to stop, while a moderate exercise program may help restore them. Amenorrhea caused by excessive stress may be resolved if you adopt ways to effectively manage stress.

If excess secretion of prolactin (hyperprolactinemia) is causing amenorrhea, then medications such as bromocriptine or pergolide may be used to restore function to the ovaries. If ovary function cannot be restored, hormone replacement therapy may be needed to resolve estrogen deficiency and help maintain bone density. Women who need their estrogen deficiency resolved but who do not want to become pregnant may be prescribed oral contraceptives.

A natural supplement approach to amenorrhea can include gamma-linolenic acid (GLA), an essential fatty acid that comes mainly from plant-based oils. Linoleic acid, which is found in cooking oils, is converted into GLA in the body. GLA supplements are available as borage oil, black currant seed oil, and evening primrose oil. These essential fatty acids help reduce inflammation and support hormone production. Some experts recommend taking 1,000 to 1,500 mg one or two times daily.

OTHER HELPFUL INFORMATION

Although premature cessation of your menstrual cycle has an upside (who misses tampons, pads, and cramps?), the downside is the potential loss in bone density and the accompanying increased risk of osteoporosis if you experience amenorrhea for more than three to four months. To help prevent damage to your bone health, talk to your health care provider about correcting the lack of periods and make sure you get adequate calcium, vitamin D, and magnesium through diet and supplements.

CHAPTER 2

BACTERIAL VAGINOSIS

Bacterial vaginosis is the most common vaginal condition experienced by women of childbearing age. It is not an infection but rather an imbalance of the bacteria that live in the vagina in which there is an increase in the number of "bad" bacteria as compared with the "good" bacteria. This imbalance is often but not always accompanied by vaginal odor, pain, itching, burning, and a vaginal discharge. In fact, many women who have bacterial vaginosis are not aware they have the condition. It is difficult to say how many women have bacterial vaginosis at any one time, largely because about half of women don't have symptoms, and because the infection keeps coming back after the initial episode has been treated successfully.

CAUSES AND RISK FACTORS

Bacterial vaginosis is caused by a loss of the protective acid-producing bacteria (the "good" bacteria) called lactobacilli in the vagina. These bacteria produce a natural disinfectant called hydrogen peroxide, which combines with chlorine in the cervix to produce yet another chemical that fights against bad bacteria. When lactobacilli numbers decline, there is not enough hydrogen peroxide produced, and the end result is that bacteria, including those that cause bacterial vaginosis (e.g., Gardnerella vaginalis and anaerobic bacteria, which require no oxygen) take over. Some studies show that women with bacterial vaginosis have up to a thousand times more anaerobic bacteria than women without the condition.

What experts are not certain about is what causes the number of lactobacilli to decline. Although bacterial vaginosis is not a sexually transmitted disease, sex does play a role. It may be that some men have semen that kills lactobacilli while others do not. Women who are not sexually active and lesbians also get bacterial vaginosis, so health care professionals know that sexual activity is not the only way to contract this disease.

Women who use an IUD are at greater risk of getting bacterial vaginosis (20 percent) than those who use other methods of birth control (6 percent). Routine douching is also associated with a greater risk for the disease.

DIAGNOSIS

Your doctor can diagnose bacterial vaginosis by your signs and symptoms and by taking a sample of fluid from your vagina for testing while doing a pelvic examination. To make the diagnosis, your clinician is looking for several factors, including:

• Clue cells (cells from the wall of the vagina), which are unique to bacterial vaginosis

• Vaginal pH value greater than 4.5, which is an indication because when the pH-lowering lactobacilli are not present, pH levels rise

• A white or gray-white vaginal discharge that sticks to the vaginal walls

• A positive whiff test, which is an indication because of the smell of the proteins produced by the anaerobic bacteria

PREVENTION AND TREATMENT

Although bacterial vaginosis is not considered to be a sexually transmitted disease (in fact, infected women's sexual partners do not need to be treated), it can be transmitted via sexual activity. Therefore one way to prevent bacterial vaginosis is to abstain from sex. Another is to have a sexual relationship with one partner and remain faithful to each other. If you have sex outside of a monogamous relationship, always use condoms. Other preventive measures include having regular pelvic exams and not douching. If you do get bacterial vaginosis, you should finish the entire course of medication, even if you feel better before you complete it.

Bacterial vaginosis is treated with antibiotics, most often either clindamycin or metronidazole. Both drugs are available as pills or in vaginal forms (gel or cream). The problem with these drugs is that neither one can eliminate bacterial vaginosis. In fact, the condition often returns and needs to be treated again. That's because researchers have yet to find a way to successfully maintain healthy levels of lactobacilli in the vagina (but see "Self-Help and Complementary Care"). Twenty-five percent of women will have a recurrence within four to six weeks of treatment, and up to 80 percent of women who have had bacterial vaginosis will get another episode within a year of treatment.

SELF-HELP AND COMPLEMENTARY CARE

Some studies show that use of probiotics — "good" bacteria such as Lactobacillus acidophilus, L. rhamnosus, and L. fermentum — can restore lactobacilli levels in the vagina. Use of a probiotic supplement may be used both to prevent bacterial vaginosis, especially recurrence, and as a treatment strategy.

OTHER HELPFUL INFORMATION

If you are pregnant and have symptoms of bacterial vaginosis or if you have had a premature delivery or a low-birth-weight baby in the past, you should be tested for bacterial vaginosis and be treated if you have it. The same antibiotics can be used for both pregnant and nonpregnant women, although the amount of medication you take if you are pregnant may differ from the amount you would be prescribed if you were not pregnant.

CHAPTER 3

BREAST CANCER

"You've got breast cancer" are among the most frightening words any woman can hear, yet when this disease is caught early, those fears can often be defused. In fact, the American Cancer Society reported in 2007 that U.S. breast cancer deaths declined by 2.2 percent per year from 1990 to 2004, partly due to earlier detection and treatment advances. These statistics are encouraging, but we can do more.

Breast cancer is a disease that develops in the breast tissue, usually in the ducts (tubes that transport milk to the nipple) and lobules (glands that produce milk), depending on the type of cancer (see "Types of Breast Cancer"). Early breast cancer usually does not cause any pain or other symptoms. However, if you notice any change in how your breast(s) or nipple(s) look or feel (e.g., a change in the shape or size, red or swollen areas, scaly or tender nipple or areola, a lump or thickening in or near the breast or under the arm, discharge from the nipple), you should see your health care professional as soon as possible. Inflammatory breast cancer, which occurs in less than 2 percent of all cases of invasive breast cancer, is unique because it does not produce a lump or mass. Instead, inflammatory cells attack the skin and lymph vessels and cause the breast to become red, warm, and swollen, and the skin of the breast may look like the peel of an orange.

The National Cancer Institute estimates that 182,460 new cases of breast cancer will have developed in the United States in 2008 and that 40,480 women will die of the disease. Most cases of breast cancer occur in women older than sixty.

TYPES OF BREAST CANCER

Breast cancer is categorized according to whether it is invasive or noninvasive, as well as to the part of the breast that it affects.

• Invasive ductal carcinoma (IDC) is the most common type of breast cancer, accounting for 80 percent of invasive breast cancers. IDC begins in a duct and then invades the fatty tissue of the breast, after which it may spread to other parts of the body (metastasize).

• Invasive lobular carcinoma (ILC) begins to grow in the lobules (milk-producing glands) and can spread to other parts of the body. About 10 percent of invasive breast cancers are ILCs.

• Ductal carcinoma in situ (DCIS) is a noninvasive breast cancer and the most common of this type. It represents about 20 percent of all new breast cancer cases and is characterized by cancer cells inside the ducts that have not spread into surrounding tissue.

• Lobular carcinoma in situ (LCIS) begins in the lobules and stays within their walls. Women who have this type of cancer have a higher risk of developing an invasive breast cancer.

• Inflammatory breast cancer is an aggressive and uncommon type of breast cancer, making up 1 to 6 percent of all breast cancer cases. Rather than a lump or mass in the breast, this type of breast cancer is characterized by swelling, discoloration, warmth, and tenderness of the affected breast.

CAUSES AND RISK FACTORS

The likely causes of breast cancer are closely associated with its risk factors, which we talk about below. That is, breast cancer may be caused by genetic factors (e.g., family history, race, mutations), lifestyle/diet (e.g., high fat intake, lack of exercise, obesity), hormones (e.g., age of first menstruation and menopause), and environment (e.g., exposure to toxins, radiation). With that in mind, consider the following risk factors:

• Age. The chance of developing breast cancer increases as women get older. The risk is 1 in 233 for women in their thirties; by age eighty-five, the chance is 1 in 8.

• Personal history of breast cancer. If you had breast cancer in one breast, you have an increased risk of developing it in the other breast.

• Presence of abnormal cells. If you have certain types of abnormal breast cells (e.g., atypical hyperplasia or lobular carcinoma in situ), you are at increased risk of developing breast cancer.

• Family history. Women who have a mother, sister, or daughter with the disease are at increased risk, and the risk is greater if the disease developed in these family members before age forty. Having relatives with both breast and ovarian cancer also increases risk.

• Race. Breast cancer affects white women more than Hispanic, Asian, or African American women.

• Age of first menstruation. Women who had their first menstrual period before age twelve are at increased risk.

• Age of menopause. Women who go through menopause after fifty-five are at increased risk.

• Gene mutations. Changes in certain genes, including BRCA1 and BRCA2, increase risk.

• Giving birth. Women who have never given birth are at increased risk.

• Radiation exposure. Exposure to radiation therapy to the chest before age thirty increases the risk of breast cancer.

• Dense breast tissue. Older women who have dense breast tissue are at increased risk.

• Obesity. Being overweight or obese after menopause increases risk.

• Alcohol. The risk of developing breast cancer increases as intake of alcohol rises.

• Dietary fat. A high intake of dietary fat, especially saturated and trans fats, may play a role in breast cancer.

• Being sedentary. Lack of physical activity may increase risk of the disease.

DIAGNOSIS

Diagnosis of breast cancer typically goes through stages. If you or your health care provider detects a lump or other abnormality either with screening mammography or physical exam, the next step is usually a referral for a diagnostic mammogram, ultrasound, or other type of imaging procedure. Diagnostic mammography is an X-ray exam of the breasts that involves taking more than the usual two views taken during screening mammography. The goal of diagnostic mammography is to identify the exact size and location of the breast abnormality and to image the lymph nodes and area surrounding it. Often, diagnostic mammography can help show if the abnormality is highly likely to be benign.

If the abnormality appears to be noncancerous, the doctor or radiologist may recommend that you return for a follow-up mammogram in about six months. If, however, the abnormality looks suspicious, your health care provider may order an ultrasonogram or a biopsy. Ultrasonography can indicate whether a mass is solid or filled with fluid (cystic). Generally, cancers are solid and cysts are benign. A biopsy is the only definitive way to identify whether the abnormality is cancerous. Between 65 and 80 percent of breast biopsies uncover a benign condition. If you have breast implants, your physician may order a breast MRI. A ductogram may be ordered if you have experienced abnormal nipple discharge and your health care provider suspects your ducts are involved.

(Continues…)

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Excerpted from "A Concise Encyclopedia of Women's Sexual and Reproductive Health"
by .
Copyright © 2009 Lynn Sonberg Book Associates.
Excerpted by permission of St. Martin's Press.
All rights reserved. No part of this excerpt may be reproduced or reprinted without permission in writing from the publisher.
Excerpts are provided by Dial-A-Book Inc. solely for the personal use of visitors to this web site.

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Table of Contents

ALSO BY THE AUTHOR,
COPYRIGHT,
INTRODUCTION,
HOW TO USE THIS BOOK,
PART I: Reproductive and Sexual Diseases and Conditions,
PART II: Tests, Surgeries, Procedures, and Devices,
PART III: Getting What You Need: Quality Health Care,
GLOSSARY,
APPENDIX,