Common Health Problems for Women

Harry Watters, D.O., is a board-certified Obstetrician/Gynecologist in Visiting Specialist program at Page Hospital.

Question: Can you tell me more about endometrosis, heavy menustration, cystocele and uterine fibroids?

Answer: Many women speak in hushed tones about certain female health conditions, and many women suffer in silence. But speaking up about pain or something that seems abnormal can help your physician diagnose conditions that can be hard to pinpoint but are important to treat.

These are four women's health conditions that just aren't discussed enough: endometriosis, heavy menstruation, cystocele, and uterine fibroids.

Endometriosis
Women who have endometriosis suffer from misplaced uterine tissue. The substance that lines their uterus is found outside the uterus, usually on the ovaries, fallopian tubes, the bowels or other organs, where it develops into non-cancerous growths.

Like the healthy tissue inside the uterus, the misplaced tissue also responds to the ebb and flow of hormones during a woman's cycle-except that when the tissue is ready to shed during a woman's menstrual cycle, it can't leave the body. The cause of endometriosis is unknown, but the risk increases until menopause, when estrogen levels naturally decline.

Symptoms include severe menstrual cramps, pelvic or rectal pain, pain during sex, infertility and abnormal bleeding. But those affected may not realize they have endometriosis.

Thankfully, treatment options can ease symptoms. Depending on the severity of the condition, surgical, medical and alternative treatments are available. Common treatments include surgical removal of the tissue or medication, such as oral contraceptives, to suppress estrogen. But because doctors aren't sure exactly what causes endometriosis, there is no complete cure.

Heavy Menstruation
Heavy, abnormal uterine bleeding is perhaps the most significant problem women face.  Usually occurring in women after age 35, this problem can affect all women, even those in their 20s.  As women complete their child bearing they often are ready to start living a life of greater freedom and choices.  Unfortunately, this problem of heavy bleeding is a prison that restricts women from enjoying free time and family outings.
 
The normal menstrual flow should last 3-4 days and be relatively mild.  When women bleed five days or greater or find themselves needing to deal with a heavy flow or blood clots, they can become anemic (week and tired).  They can find themselves reacting to normal daily events in a very abnormal way. 

Fortunately, science and medicine has blended their talents to treat this condition quickly and easily through an easy out-patient procedure called an endometrial ablation. With endometrial ablation, most women experience substantial improvements in bleeding, with over half having no further periods and the remainder having a marked reduction in bleeding with periods. 

As a gynecologist with 25 years experience, I have performed this 20-minute procedure more than 700 times. Women are sent home after surgery with Tylenol or Motrin and only mild discomfort. This procedure is 95 percent successful for our patients and there is not time away from home, work or family.

Cystocele
Women with severe cystocele often arrive in the doctor's office, panic-stricken, with the sensation that their vagina is "falling out." Actually, it's the bladder that droops into the vagina due to a weakening in the wall between the two organs.

Symptoms of cystocele, often called "fallen bladder," range from the obvious feeling of pelvic organs bulging into your vagina to more subtle pressure in the pelvis, painful sex, irregular bleeding and incontinence.

The condition commonly occurs in postmenopausal women, when a decrease in estrogen can lead the connective tissue of the pelvis to stretch, but it can affect women of any age. Risk factors include vaginal birth, muscle tone problems, obesity and chronic respiratory issues.
Treatment isn't always necessary if the cystocele is mild. In a moderate case, a device called a pessary can be inserted into the vagina to hold the bladder in place. But surgery remains an option in the most severe cases. Women can sometimes control symptoms by maintaining an appropriate weight level, not smoking and doing Kegel exercises.

Uterine Fibroids
Fibroids are benign growths that develop in the wall of the uterus. They can occur inside the uterine cavity, in the muscle of the uterus or on the outer surface of the uterus.

Symptoms and treatment vary depending on the size and location of the fibroid. Fibroids that are large and press on adjacent structures like the bladder may cause pressure, pain or urinary frequency. Symptoms also can include infertility and miscarriage.

Fibroids usually grow in women of childbearing age and are more common in African-American women, overweight women and women who have not given birth.

Treatment is based on a woman's symptoms and lab results. Fibroids can be detected through ultrasound, X-ray, CT scan or magnetic resonance imaging. Surgery is sometimes needed to confirm the presence of fibroids. The good news? Many women with fibroids don't have painful symptoms or excessive bleeding, and don't require treatment.

Treatment options range from over-the-counter painkillers to surgery such as hysterectomy (removal of the uterus) or myomectomy (removal of the fibroids alone), to uterine fibroid embolization, a procedure that shrinks fibroids by preventing blood from flowing to the tumor.