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Endometriosis

Navigating Endometriosis: Symptoms, Diagnosis, and Treatment Options

As women, it is never easy to hear that our physical health is compromised, especially when it comes to our reproductive system. For those who have been diagnosed with endometriosis, uncertainty about what comes next can feel overwhelming. Whether you’ve been diagnosed with endometriosis or you know someone who has, accurate information is key. The more informed you are on the topic, the more supported you will feel. In fact, understanding the causes, symptoms, and treatment options can provide you with a clear path forward.

What Is Endometriosis?

Endometriosis Diagram

Endometriosis is a disorder in which tissue very much like the tissue that creates the lining of your uterus, known as the endometrium, develops in areas other than the uterus. Tissue growth can occur in areas it should not, including reproductive organs like the fallopian tubes and ovaries, as well as other pelvic tissue. Though uncommon, this tissue can even be found in areas outside the pelvic organs.

During endometriosis, the endometrial-like tissue takes on the functions and characteristics of your true endometrial tissue. As a result, the tissue will thicken, break down, and bleed during the menstrual cycle. The problem this presents is that there is no way for the tissue to exit your body. Normal pelvic tissue surrounding this foreign, trapped tissue can get inflamed and create scar tissue. Adhesions, which are bands of fibrous tissue, can develop and cause endometrial tissue that develops on organs to stick together. In addition, if tissue grows on the ovaries, cysts can form called endometriomas. Women with endometriosis can also experience severe pain during their menstrual cycle and could develop fertility issues.

Women with endometriosis may not notice the condition for some time, especially if they are prone to painful menstrual cramps or other discomforts. Eventually, however, most women do notice a significant difference in the severity of their menstrual pain, usually leading to a visit to their gynecologist. The good news is that once endometriosis is diagnosed, there are effective treatments available.

Endometriosis: Symptoms and Causes

Endometriosis Symptoms
Unfortunately, many women hesitate to explore medical concerns until they start to impact daily life, especially as they pertain to the reproductive system. A primary reason endometriosis so often goes undiagnosed is due to a delay in reaching out for healthcare. Fortunately, regular visits with your gynecologist can help you feel more comfortable opening up to your doctor and seeking treatment for any minor or major concerns.

If you’re concerned about a potential issue with your reproductive health, knowing the symptoms and causes of endometriosis can help you make the decision to seek treatment, understand the condition, and explore your treatment options.

Symptoms

There are a variety of symptoms associated with endometriosis, the most common of which is pelvic pain that heightens during the menstrual cycle. The pain can be worse than usual and can also increase over time.

Other symptoms to look for include:

  • Excessive Bleeding – Occasional heavy menstrual periods could occur, as well as bleeding between periods.
  • Painful Periods – Also known as dysmenorrhea, pelvic pain and cramping could begin days before a menstrual cycle and continue to last for as long as 1-2 weeks. In addition to pelvic pain, you may also experience abdominal pain and lower back pain.
  • Urinary and Bowel Pain – If you experience unusual pain while urinating or having a bowel movement, especially during a menstrual period, this could be an indicator of endometriosis.
  • Pain with intercourse – A common symptom of endometriosis is pain during or after sex.
  • Infertility – Endometriosis-related infertility is often detected when a woman seeks infertility treatment.
  • Additional Symptoms – Endometriosis can also cause fatigue, nausea, constipation, bloating, or diarrhea.

It is beneficial to look for these additional symptoms beyond pelvic pain because while pelvic pain is often the reason many women discover their diagnosis, this symptom presents itself differently from case to case. Some women have mild endometriosis and experience severe pain, while others have advanced endometriosis with little to no pain. Everyone has a different pain tolerance, and the way endometriosis affects you can be drastically different compared to someone else.

Causes

There is still some uncertainty when it comes to the exact cause of endometriosis, and researchers have not identified a single cause that can trigger the condition. However, while the root cause is still uncertain, scientists have developed several theories.

Some possible explanations for endometriosis include:

  • Transformation of peritoneal cells. Also known as “induction theory,” experts believe that hormones or immune factors may support the transformation of peritoneal cells into endometrial-like cells.
  • Retrograde menstruation. In some cases, menstrual blood with endometrial tissue may continue on into the abdominal cavity via the fallopian tubes instead of being eliminated from the body. The cells may stick to the internal cavity walls and the associated organs, and with nowhere to go, this tissue could continue to build layers, thicken, and cause pain.
  • Transformation of embryonic cells. Estrogen and other hormones can transform embryonic cells into endometrial-type cells during puberty, which can then implant into the abdominal cavity.
  • Endometrial cell transport. Endometrial cells are transported to other parts of the body through blood vessels or tissue fluid and may wind up in the abdominal cavity.
  • Surgical scar implantation. Endometrial cells may attach to a surgical incision, especially after surgeries involving the pelvic organs.
  • Immune system issues. Immune disorders could also cause endometriosis. The body may be unable to identify and eliminate endometrial tissue developing in places it should not.
  • Genetics. Family history may also play a role in your likelihood of developing this condition. Women who have a close relative with this condition are more prone to having it themselves.

What Are the Four Stages of Endometriosis?

Endometriosis Symptoms

If you or a loved one have recently received an endometriosis diagnosis, it is important to understand the four stages of endometriosis: minimal, mild, moderate, and severe. Understanding these stages can help you understand what to expect as you and your physician discuss treatment. There are a variety of factors used to determine the stage, including the location, number, size, and depth of the endometrial implants. It is beneficial to keep in mind that the pain you may experience during your menstrual cycle does not determine your endometriosis stage.

Stage One: Minimal

When a person is diagnosed with stage one or minimal endometriosis, the lesions caused by endometriosis are small, and the implants are shallow. Individuals with stage one may experience inflammation in the area.

Stage Two: Mild

Individuals with stage two endometriosis have mild lesions and endometrial tissue is implanted fairly shallow. This stage is considered mild endometriosis.

Stage Three: Moderate

Individuals who are in the moderate stage may have more lesions than seen in the previous stages. The endometriosis implants are typically deeper within both the pelvic lining and the ovaries.

Stage Four: Severe

Individuals in this stage likely have deep implants on both the ovaries and the pelvic lining. In many cases, there are lesions that could extend to the fallopian tubes and portions of the bowel region. There could also be cysts on one or both of the ovaries due to repetitive cycles of the endometriosis cells thickening, shedding, and becoming trapped.

The Diagnosis Process

Endometriosis can have similar symptoms to other conditions, including ovarian cysts, pelvic inflammatory disease, and even irritable bowel syndrome. This can prolong diagnosis and often requires a variety of tests to ensure accuracy. These delays can be significant; it can take some cases 4 to 11 years for a diagnosis from the onset of symptoms. Ongoing research and support are needed to ensure this timeframe can be significantly reduced so that accurate diagnosis can be given and the right treatment implemented. It can be frustrating, but patience and open communication with your healthcare team can help minimize the delay in proper diagnosis.

Things that are likely to occur during the diagnosis process include:

  • A detailed medical history. Your doctor will likely explore any personal or family history of endometriosis, as there is an increased risk of developing endometriosis if a close family member also has the condition. Your doctor will complete a general health assessment to ensure your signs and symptoms aren’t connected to a different long-term disorder.
  • A physical exam. Your doctor will complete a detailed pelvic examination to search for cysts or scars behind the uterus. A speculum and light will be used to see inside the vagina and cervix, helping the doctor determine the severity of your condition, as well as possibly rule out other conditions that may share other symptoms.
  • Ultrasound imaging. A transvaginal or abdominal ultrasound can be used to provide clear images of your reproductive organs. An ultrasound helps identify cysts and lesions.
  • Laparoscopic imaging. This is a minor surgical procedure that provides an opportunity to directly view endometriosis. Once a person is diagnosed with this condition, the same procedure can be used to remove the tissue.

Treatment Options

Female hormone therapy

The main goal of endometriosis treatment is to alleviate pain and help you learn to cope with the physical and emotional challenges that can be associated with this condition. Which treatment is best for you will depend on your age, the severity of your symptoms, the severity of the condition itself, and any plans for future pregnancies. There are medications, alternative therapies, and surgeries that can be considered.

Medications

Medications can help you control the symptoms of endometriosis.

Hormonal options and medications include:

  • Birth Control – Hormonal suppression can help reduce the symptoms associated with this condition, which can include using estrogen and progesterone birth control options such as oral birth control pills, patches, Nexplanon, IUD, a vaginal ring, or the birth control shot. These medications can help you experience less painful periods.
  • GnRH Medications – Gonadotropin-releasing hormone medications stop the hormones associated with your menstrual cycle. This essentially puts your reproductive system on hold to help relieve pain.
  • Danazol – Also known as Danocrine, this medication stops the production of hormones that cause a period. Individuals on this medication may have an occasional menstrual period, or they may stop entirely.

It is important to note that these medications are not recommended for those who are trying to get pregnant. In addition, if the medication is stopped in an attempt to become pregnant, endometriosis symptoms can come back. Your medical professional will discuss the details of these options with you. For pain relief, doctors commonly prescribe over-the-counter pain relief and non-steroidal anti-inflammatory drugs (NSAIDs) like acetaminophen and ibuprofen.

Surgery

Endometriosis Surgery

Surgery can be an effective way to help relieve endometriosis pain and improve your ability to become pregnant. There are always risks associated with any form of surgery, so it is beneficial to discuss this treatment option with your provider. Endometriosis is a chronic disease, so surgery is not often the final solution. Symptoms may return within a few years, or they may not.

Surgical treatments include:

  • Laparoscopy – This procedure can be used to diagnose and treat endometriosis. A surgeon makes a small cut into the abdomen and inserts a thin tube-like tool called a laparoscope into your body, which uses a high-definition camera to identify lesions so they can be accurately removed through the tube.
  • Hysterectomy – In severe cases, removing the uterus may be suggested due to scar tissue and the extent of endometriosis in the pelvic area.

Alternative Therapies

Not everyone wants to turn to medications or surgery to experience relief. Some patients may experience symptom relief through holistic treatments and delay surgical procedures for a time.

These treatments may include:

  • Acupuncture
  • Herbal medication
  • Dietary changes
  • Pelvic floor muscle therapy
  • Heat therapy

Endometriosis FAQs

Whether you have just received an endometriosis diagnosis or believe you may be experiencing symptoms of endometriosis, the answers to these common questions could shed some light on what to expect.

Can I Get Pregnant if I Have Endometriosis?

Endometriosis can make it more difficult to become pregnant, but pregnancy is not impossible. Your chances of becoming pregnant largely depend on the severity of your condition, as well as your treatment options. It may be recommended to try to conceive sooner than later, as this condition often worsens over time.

What Are the Risk Factors Associated with Endometriosis?

Common risk factors include a family history of endometriosis, when you started having your period, the length of your menstrual cycle, and any defects in your uterus or fallopian tubes. Having a close family member with the condition or menstruating before the age of 11 can increase your chances of developing endometriosis. Long menstrual cycles and uterine or fallopian tube defects can increase the chances that excess tissue will develop in the abdominal cavity.

Can Endometriosis Go Away on its Own?

Yes, in some cases. Lesions can get smaller, and you may only have a few of them. Menopause can also help alleviate or eliminate endometriosis since the body no longer produces estrogen. However, for most, this condition needs ongoing treatment to relieve pain and prevent the condition from worsening.

Let Us Support You

Endometriosis awareness can help individuals and their families better prepare and face this diagnosis. Currently, it can take years for an accurate endometriosis diagnosis, which can mean years of pain and discomfort that can only worsen over time. At Arizona Gynecology Consultants, women’s health is our top priority. We continue to strive for advancements in the diagnosis and treatment of this condition. View our Arizona gynecology services and book an appointment.

Editor’s Note: This article was originally published April 12, 2020 and was updated October 2, 2023.

References :

  1. Agarwal, S. K., Chapron, C., Giudice, L. C., Laufer, M. R., Leyland, N., Missmer, S. A., Singh, S. S., & Taylor, H. S. (2019). Clinical diagnosis of endometriosis: A call to action. American Journal of Obstetrics and Gynecology, 220(4), 354.e1–354.e12. https://doi.org/10.1016/j.ajog.2018.12.039
  2. ?Mayo Clinic. (2018, July 24). Endometriosis – Symptoms and Causes. Mayo Clinic; Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
  3. Wadood, A. (2019, July 2). Endometriosis. Healthline; Healthline Media. https://www.healthline.com/health/endometriosis
  4. ?What are the symptoms of endometriosis? (n.d.). Https://Www.nichd.nih.gov/. https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/symptoms
  5. ?Heitmann, R. J., Langan, K. L., Huang, R. R., Chow, G. E., & Burney, R. O. (2014). Premenstrual spotting of ?2 days is strongly associated with histologically confirmed endometriosis in women with infertility. American Journal of Obstetrics and Gynecology, 211(4), 358.e1–358.e6. https://doi.org/10.1016/j.ajog.2014.04.041
  6. ?Surrey, E. S., Soliman, A. M., Johnson, S. J., Davis, M., Castelli-Haley, J., & Snabes, M. C. (2018). Risk of Developing Comorbidities Among Women with Endometriosis: A Retrospective Matched Cohort Study. Journal of Women’s Health, 27(9), 1114–1123. https://doi.org/10.1089/jwh.2017.6432
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.
Urinary Incontinence

What You Need to Know About Urinary Incontinence

Let’s face it; some medical concerns are a bit harder to share than others. One concern that is often pushed under the rug is urinary incontinence. This complication can impact both men and women, and the possible triggers for this issue are numerous. What is most soothing is the fact that it can often be completely treatable or at the very least manageable.

What is urinary incontinence?

Simply put, it is the leaking of any urine that you are unable to control. It is hard to gather specific statistics because of an assumed level of reserve due to embarrassment; this can impact your medical situation and your emotional, psychological, and social life. It ultimately keeps a person from thoroughly enjoying their life. Millions of Americans are affected by this issue, so there is no reason to feel shame or embarrassment. The faster an individual finds an excellent treatment plan, the sooner they can return to regular life.

Understanding Risk for Incontinence

Understanding Risk for IncontinenceWhen it comes to the risk of developing urinary incontinence, the chances vary drastically. Some symptoms of UI can point to larger issues that may need to be seriously addressed, while others may be milder and more temporary. The good news is that for most, these risks can be resolved quickly, leading to an only temporary risk of developing urinary incontinence. Risks can include:

  • Pregnancy, the form of delivery, and number of children.
  • Post-menopause or instances where you may have a drop in your estrogen levels.
  • Prostate issues, especially for men.
  • Poor health, such as diabetes, stroke, high blood pressure, or obesity.

What Are the Symptoms of UI?

The truth is that these symptoms can vary depending on the type of UI you may have. The basic concept is that there is a miscommunication between your brain and your bladder. Your bladder stores the urine, and the muscles in your lower pelvis are responsible for holding tight. When ready, your brain sends a signal to the bladder, the muscles contract, and urine is forced through the urethra. When it comes to dealing with urinary incontinence, it can impact a variety of these steps. There are four most common types of urinary incontinence.

Stress Urinary Incontinence (SUI)

This result is from weak pelvic muscles. It is the stress caused by physical pressure versus mental stress. It is one of the most common instances of UI. The common symptoms include small amounts of urine escaping while exercising, walking, bending, lifting, sneezing, and coughing. These symptoms can range from mild, moderate to severe. How is UI treated? For this type, there is no medical specific treatment. Lifestyle changes may help, as well as utilizing Kegel exercises to strengthen your pelvic walls. With today’s advancement in technology, all you need is a small device and a smartphone to conveniently exercise your pelvic walls. This condition is usually caused by pregnancy or childbirth, menopause, hysterectomy, age, or obesity.

Overactive Bladder (OAB)

This is another common form of UI. This is also known as the “urgency” incontinence. Your body essentially gives you a little warning when it comes to needing to urinate. You could suddenly feel an urge due to shifting position, hearing running water, or even during sex.

What are the symptoms of UI?

In this case, your bladder tells you it needs to empty, even when it isn’t full. You can’t control or ignore the symptoms of this form of a UI. It can hit unexpectedly, leaving your life and daily activities interrupted, often without a moment’s notice. This impacts at least 30% of men and 40% of women in the U.S. alone. This can be caused by cystitis, which is an inflammation of the lining of the bladder. It can also be caused neurologically through multiple sclerosis, stroke, and Parkinson’s.  An enlarged prostate can also cause it.

Mixed SUI and OAB

This sounds exactly how it is. You’re impacted in part by both the most common issues of UI. You may “leak” a bit at times unexpectedly, following a good sneeze or even a laugh. You may also feel the sudden, undeniable urge to pee without a moment’s notice.

Overflow Incontinence

This is where your body makes more urine than it can hold, or your bladder may be full but for whatever reason can’t empty. This is rare in women and is most often found in men with prostate problems. This is typically created through a blockage or obstruction caused by an enlarged prostate, a tumor pressing onto the bladder, urinary stones, or constipation.

Total Incontinence

While less likely, certain individuals may have to deal with this form of UI. It can be caused by various factors, including anatomical defects from birth, a spinal cord injury that impacted the communication between the brain and the bladder, or a fistula. A fistula is a tube or channel that develops between the bladder and a nearby area, usually the vagina.

General Symptoms of Incontinence

Symptoms of IncontinenceThe good news is that not all these symptoms are long-term. Many are short-term and potentially treatable. There are some general symptoms, including vaginal infections, irritations, medication use, constipation, general mobility, and UTI (urinary tract infection) that are often common causes.

Temporary Symptoms of Incontinence

Sometimes, all fingers can point toward your diet when it comes to issues with UI. Different foods, drinks, and medicines can all affect your urinary continence. Drinks such as alcohol, caffeine, and carbonated drinks can impact your body differently. This also includes artificial sweeteners, spicy foods, sugar, acid, even chocolate!

Potential Complications of UI

Dealing with a UI can impact many different facets of your life. You may also develop skin problems. This could include sores, rashes, and infections caused by the skin being wet or damp most of the time. This can lead to complications with any wound healing and can promote fungal infections. Prolapse is rare but still a risk to consider, especially if your UI goes untreated. This is when a part of the vagina, bladder, or urethra falls into the entrance of the vagina, typically due to an extremely weak pelvis wall. In an instance such as this, surgical intervention will be necessary.

When Should I See a Doctor?

The short answer is the sooner, the better! If you notice an increase in frequency that can’t be easily explained, such as a dramatic increase in water intake, it may be a sign of a larger concern. This especially becomes a concern when it starts to impact the overall quality of your life. If you find yourself restricting activities such as going out for dinner, having drinks with friends, enjoying outdoor adventures or sports, this is no good!

You shouldn’t have to limit your social interactions due to urinary concerns. Your quality of life should be your number one priority. There is no reason to suffer in silence, especially because there are numerous remedies to many different UI issues. You’ll also want to consider your age. The speed at which you may make it to and from the bathroom can vary with age, weight, and other mobility factors. You’ll want to be aware of additional risks of falling and other injuries when trying to race against a sometimes unpredictable clock. There is also the risk that your UI is a sign of a much larger issue. You’ll want to handle these issues early on before they lead to more serious complications down the line.

Urinary Incontinence Diagnosis

Wondering how UI is diagnosed? Many different methods can be used to determine if you have a UI and what form you may be experiencing. These methods vary, so it is best to try to explain your situation as well as possible to your medical professional. This may help put the focus on what is most likely impacting you.

Bladder Diary

This may seem a bit silly at first, but it can help pinpoint precisely what form of UI you may be dealing with. You’ll want to keep track of how much you drink to start. You may want to specially note if your intake has suddenly increased or decreased for whatever reason. You’ll also want to keep track of when urination occurs, as well as if you experienced any incontinence throughout the day. Even the smallest leak can interrupt your day, so keeping track of the small nuances can make a huge difference.

Physical Exam

Your doctor may not necessarily ask you about your bladder health. The largest stigma with UI is the feeling of embarrassment, but if you don’t share with your doctor, they will not be able to help you. When getting your physical exam, be sure to share your concerns with your doctor. Millions of Americans struggle with UI issues, so there is no reason to be shy. Upon your physical exam, your doctor can check for the strength of your vaginal walls, or for men, any risk of having an enlarged prostate.

Urinalysis

This will help determine if you have any signs of infection or abnormalities.

Blood

Simple blood work can rule out many potential issues, especially when it comes to kidney function, which can impact your urinary health.

Postvoid Residual (PVR) Measurements

This test can help determine how much urine is left in the bladder after urination. For those who suffer from an overactive bladder or one that tends to overflow, this could finally lead you and your medical professional in the right direction for treatment.

Pelvic Ultrasound

If a typical physical examination doesn’t provide enough information, a pelvic ultrasound may be the next best step. This creates an image of your pelvic area that can help pinpoint any abnormalities or inconsistencies that may not have been initially discovered.

Stress Test

This form of testing can include testing your body’s ability to react to sudden pressure.

Urodynamic

This test determines how much pressure your bladder and urethra can withstand.

Cystogram

This x-ray focuses explicitly on the bladder to check for any abnormalities or concerns that wouldn’t be found in a typical exam.

Treatments for Urinary Incontinence

How is UI treated? There are many different methods when it comes to treating UI. Many of these treatments will vary depending on the severity of your condition. These treatments can range from at-home activities to surgical intervention. Some of the most common forms of treatment include:

Bladder Training

This can involve a few different types of exercises. Most commonly, they are:

  • Delay-control urge—This is feeling the need to urinate but training your body to wait, even if it is only for short periods at first.
  • Double voiding—This is the process of urinating, waiting, and then urinating again.
  • Toilet timetable—Sometimes routine is key. This bladder training is structured so that you create specific times in which to use the bathroom, for example, every two hours. This makes a predictable routine for your body to follow.

Medications

Medicine is rarely used alone. It is often paired with other techniques or exercises to improve UI symptoms. Medicines often prescribed include:

  • Anticholinergics—This is a medicine that can be used to calm an overactive bladder.
  • Topical estrogen—This helps reinforce the tissues in the urethra and vaginal areas. It can also help to lessen symptoms caused by UI.
  • Imipramine—A tricyclic Dealing with complications in such an intimate part of your body can lead to depression, anxiety, and a desire to pull away from certain social interactions. It is important to allow your medical professional in so that they can try to alleviate some of these issues.

You May Have Urinary Incontinence, But So What?

Talking to doctor about Urinary IncontinenceMillions of Americans deal with some form of UI every day. This number is hard to measure due to the feeling of embarrassment that stops many from sharing their experience. The truth of the matter is that many people deal with various forms this condition may present itself in. Whether you feel you go to the bathroom too much, too little, or just too unexpectedly, there are various exercises and treatments that could help alleviate your symptoms. What matters most is your ability to be open and honest with your health care professional. You may feel you are alone, but in fact, you are with a great majority of people who experience similar issues. Break the silence and give yourself the opportunity to truly live life to its fullest. You should never feel chained to the restroom.

Life is too short to let UI stop you from living each day to the max.

 

Editor’s Note: This article was originally published August 7, 2017 and was updated May 27, 2021.

Low Estrogen: What It Means and What Symptoms to Look For

Low Estrogen: What It Means and What Symptoms to Look For

Estrogen plays a significant role in a woman’s life. Estrogen contributes to reproductive health as well as regulating aging. Most women understand that estrogen levels usually decrease during perimenopause or menopause, a sign that they are leaving the childbearing years behind.

Sometimes, it can happen early, such as when a woman over-exercises on a regular basis (exercise addiction), or she suffers from an eating disorder like anorexia, and her body can no longer maintain estrogen levels.

Decreasing estrogen levels, although considered a normal part of menopause, may cause adverse effects to a woman’s body and her health.

Estrogen in the Body

Estrogen is most notably responsible for the sexual development of girls during puberty. These levels of estrogen fluctuate throughout a woman’s lifetime up until menopause, when low levels of estrogen completely prevent menstruation and ovulation.

Estrogen also regulates:

  • Changes in breast tissue during adolescence and pregnancy
  • Menstrual cycles
  • Body weight, by helping control metabolism
  • Development and growth of healthy bone tissue
  • Healthy cardiovascular activity

With so many effects on various parts of the body, it is important that estrogen levels maintain a healthy standard. Low estrogen levels can be a sign of age, but seriously low levels can have lasting negative effects.

Causes for Concern

Any condition that impairs the ovaries can reduce estrogen production. The most common risk factor for women is age. As women age, perimenopause and menopause cause the body to produce less estrogen. Estrogen levels can also decrease for various other reasons, including:

  • Premature ovarian failure
  • Congenital conditions: Turner syndrome
  • Thyroid disorders
  • Excessive exercise
  • Being severely under or overweight
  • Chemotherapy
  • Low functioning pituitary gland

Other unique cases can include excessive exercising and eating disorders such as anorexia. If a woman is more than 15 percent underweight, the body can no longer maintain normal estrogen levels. In order to maintain healthy levels of estrogen, a woman should maintain a healthy diet, lifestyle, and weight.

Physical Symptoms of Low Estrogen

Effects and Symptoms

As women approach the age of 40, they may wonder what symptoms to look for that herald decreasing levels of estrogen. Estrogen depletion can bring on a combination of hormonal and biochemical fluctuations that can lead to changes in the brain and nervous system.

Irregular Periods

Estrogen is the critical hormone in regulating a woman’s period and menstrual cycle. Low estrogen levels can cause irregular periods, including shorter or longer periods, light or heavier flow, spotting, or missed periods altogether.

Infertility

Low estrogen directly affects ovulation. Without estrogen, ovulation will not occur making it difficult to become pregnant. This is considered infertility.

Hot Flashes and Night Sweats

The most common symptoms and probably the least liked, hot flashes and night sweats can go on for a long time: 7 to 11 years. They are caused by the hypothalamus which controls body temperature. When estrogen levels start going down, the hypothalamus can no longer regulate body temperature and even the slightest change can cause hot flashes or night sweats to bring the temperature down, or chills to bring it back up.

Insomnia and Fatigue

Estrogen produces serotonin, a neurotransmitter in the brain that triggers melatonin, a hormone that helps a person sleep. Once a woman goes into menopause, the depleted estrogen levels produce less serotonin and by extension, less melatonin. With the night sweats that interrupt sleep, fatigue and insomnia become the new normal.

Mood Swings

Hormonal imbalances, that often make teenagers moody and difficult, are back during menopause, making women grumpy. Add lack of sleep and it can get worse. Mood swings – laughing, crying, anger and upset – at the drop of a hat – are all part of the package.

Depression and Difficulty Focusing

Serotonin also affects mood and social behavior, as well as memory, sexual desire and function.  With lowered serotonin levels, depression, not just mood swings, can occur and it becomes more difficult to recover from it. Memory lapses and trouble focusing or concentrating are two more symptoms of low estrogen and serotonin levels. Some experts believe that they put women at a greater risk for Alzheimer’s and dementia.

Physical Symptoms of Low Estrogen

The brain and nervous system are not the only parts of a woman that are affected by menopause and lowered estrogen levels. Of course, the reproductive system’s ability decreases with age as ovary function and estrogen levels go down. But the skin, heart, bones and urinary systems are also affected.

Dry Everything and Low Sexual Desire

Dry skin, dry eyes and a dry vagina are more signs of menopause and low estrogen levels. These can be allayed with moisturizing fluids, such as lotion, eye drops and lubricant (in that order). Unfortunately, reduced sexual desire comes from decreased estrogen and serotonin levels. Menopause also makes the vaginal walls thinner and they lose elasticity, coupled with vaginal dryness, sex can be painful.

The skin loses its moisture-holding abilities as well as its elasticity, leading to dryness, itching, and an increase in wrinkling and sagging. Also, it becomes more susceptible to injury, such as bruising, due to thinning of the skin and it doesn’t heal as quickly. Researchers are beginning to study the lack of estrogen as a possible connection to melanoma, a serious type of skin cancer.

The Heart Connection

As women get older, they become more vulnerable to cardiovascular issues, such as heart attacks, strokes, or other heart-related problems. Hypertension, or high blood pressure is the biggest cardiovascular risk for women in and after menopause. Normally estrogen increases levels of nitric oxide, which is a very powerful dilator of blood vessels, and dilated blood vessels are conducive to healthy blood pressure.

Lowered estrogen levels make hypertension an increasingly bigger factor in women.

Though this may not start until just before perimenopause, it can quickly increase until about age 60, when the new level of blood pressure stabilizes to a new norm.

The Beautiful Bones

After the age of 30, new bone production cannot keep up with bone loss and once menopause hits and estrogen levels decrease, women have an increased risk for low bone mineral density, osteopenia and osteoporosis. This bone density loss can lead to weakening of the bones and an increased risk for fractures and other injuries.

The Urinary System

No laughing matter, incontinence is one of the signs of decreased estrogen levels. Just as with the vaginal walls, the reduced levels of estrogen cause the urethra walls to thin, dry and lose elasticity. This causes the incontinence when coughing, laughing, sneezing or lifting heavy objects. It also leads to feeling the need for frequent urination and an increased risk for developing UTIs.

Weight Gain

Estrogen plays a significant role in weight management and how the body stores fat. During perimenopause and menopause low estrogen contributes to weight gain. Specifically women store more fat in their thighs and hips, which can change during menopause. Eating a healthy diet and exercising regularly can help combat weight gain with low estrogen levels.

Diagnosis and Treatment for Low Estrogen

If any of the above-noted symptoms appear, the first step is to get a physical exam by a trusted physician who can review your medical history and symptoms. It may be necessary to do a blood test to check hormone levels. The doctor may also recommend additional tests to rule out other conditions that might be causing symptoms similar to low estrogen.

Synthetic Hormone Treatment

Hormone Replacement Therapy or HRT is sometimes recommended for women who do not have high blood pressure or other cardiovascular problems. There are various types of HRTs available, including one that combines estrogen with progesterone, a hormone that maintains pregnancy. There are side effects that need to be considered, but these can be discussed with a doctor, to determine which HRT is best.

Sometimes all that is needed are serotonin-boosting antidepressants for those women who end up suffering from depression more than the other symptoms.

Estrogen Therapy

Estrogen therapy is recommended by a doctor or medical expert. In some cases, small amounts of estrogen can be used to combat those who have had small changes in their estrogen levels, such as women who have had their ovaries removed. In other instances, estrogen therapy may be used to treat certain symptoms of perimenopause and menopause.

Natural Treatments

Natural remedies include natural food and soy supplements, maintaining a healthy weight and, in some cases, decreasing the intensity or frequency of exercise. Soy or soybean isoflavones are, at best, an alternative treatment for HRT, and at worst, a controversial treatment with increased risk for breast cancer. It’s best to speak to your doctor or healthcare professional before adding this or any supplement to your diet.

Exercise and eating foods rich in calcium and adding vitamin D supplements during and after menopause is a good way to maintain and increase bone density. Low-fat milk, cheese and dairy products, green leafy vegetables like broccoli, cabbage and okra, as well as soybeans and soy products such as tofu, are great for getting the extra calcium needed. It is important to remember that exercise must also be sufficient, but not excessive. Too much exercise and too little body fat can further decrease levels of estrogen.

Estrogen Overview

Reduced estrogen levels can cause many problems for women, including an increased risk of serious conditions, including heart disease, osteoporosis (softening of bone tissue), and obesity. However there are ways to lessen the symptoms and the impact of lower estrogen levels to a woman’s overall wellbeing, including her physical, emotional, and sexual health.

The sooner a woman can be screened for low estrogen levels, the better chance she has at combatting the negative effects listed above. AZGYN’s Gynecology Services and Minimally Invasive Procedures can be the solution for many women. They provide an assortment of general health practices and specialized services by expert staff and surgeons.

If you are a woman and suspect you have low estrogen levels, contact us for help today.

What Are The Signs of Perimenopause

What Are The Signs of Perimenopause?

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Perimenopause is the stage before menopause, also known as menopause transition. As the female body begins to transition into menopause, it also produces less estrogen. This natural transition indicates the end of reproductive years, until eventually the female body no longer produces eggs. During perimenopause, women still have their periods, but the cycles’ durations can change, becoming longer, shorter, or skipped altogether.

Once a woman has not had a period in 12 consecutive months, perimenopause is over, and menopause has begun. The signs of perimenopause are a result of decreasing estrogen, and can be uncomfortable and unexpected. For women approaching menopause, it is important to understand what the signs of perimenopause are. Seeking the right professional counsel and treatment can help make your perimenopause experience more tolerable.

When Does Perimenopause Start?

The change of life that occurs with perimenopause is different for every woman. Typically, the process begins when a woman is in her 40s, but can occur as early as her 30s. Changes in the body due to hormonal fluctuations mark the beginning of perimenopause. However, the true beginning of perimenopause is at birth. At birth, every woman has the total number of eggs she will ever have in each ovary. During puberty, the body ovulates and prepares itself for reproduction. During perimenopause, the opposite takes place. As perimenopause takes place, the body has depleted its supply of eggs ending the natural reproductive cycle. It is important to be honest with your healthcare provider and loved ones if you feel you are in perimenopause.

How Long Does Perimenopause Last?

Perimenopause lasts until menopause begins, which is after 12 consecutive missed periods. In years, perimenopause typically lasts for four years, but some women may only experience perimenopause for a few months, or it may last up to 10 years.

Estrogen During Perimenopause

Changing levels in circulating oxygen throughout the female body are the direct cause of perimenopause. During puberty and a woman’s natural reproductive years, estrogen within the body rises and falls at regular intervals. Two hormones specifically control estrogen: follicle-stimulating hormones (FSH) and luteinizing hormones (LH). Various amounts of FSH and LH control regular ovulation, causing the egg to fall during ovulation. Ultimately, this process is what causes pregnancy, but if pregnancy does not occur, the cycle begins again. Changes in these two hormones during perimenopause alter the cycle completely, until menstruation ceases to occur.

What Are Early Signs of Perimenopause?

Perimenopause might seem to happen unexpectedly, but there are early signs that indicate perimenopause. Symptoms vary among women, and never occur to the same degree. It is important for woman to be observant of their bodies as they approach common perimenopause age. Some of these early symptoms of perimenopause may include:

  • Breast tenderness
  • Worsening premenstrual syndrome
  • Changing cholesterol levels
  • Fatigue
  • Mood swings
  • Vaginal dryness
  • Discomfort during sex
  • Urine leakage
Perimenopause

Women who are unsure if they are experiencing perimenopause should consult their doctor. A doctor can usually diagnose perimenopause based on symptoms alone, otherwise a blood test may be helpful. Blood tests will measure hormone levels, but while hormone levels are changing, it is common practice to take several blood tests at different times for comparison.

What Are Common Symptoms of Perimenopause?

Perimenopause is a biological change in hormones, however common life changes due to aging also play a role in perimenopausal symptoms. A woman should understand what are the symptoms of perimenopause specifically, and differentiate between lifestyle changes such as children leaving, changes in careers, or death or illness of parents common at this time.

  • Perimenopause periods: Irregular cycles and spotting instead of a period characterize perimenopause periods. Changes in periods may include shorter or longer cycles, heavy or lighter flows, spotting, or skipping periods altogether. A change of seven days or more indicates perimenopause, while a change of 60 days or more indicates late perimenopause. 
  • Hot flashes: Most women believe that hot flashes are only characteristic of menopause, but they often begin in perimenopause. Hot flashes can vary from a slight feeling of warmth to an overwhelming feeling of consumption by fire, inside and out. A significant hot flash can induce facial and upper body redness, swelling, chills, visible perspiration, and even confusion. 
  • Decreasing fertility: Irregular ovulation inevitably means that the likelihood of conception and pregnancy decreases. However, even during perimenopause pregnancy is not impossible. Pregnancy is still possible until a woman hasn’t had a period for 12 consecutive months. 
  • Changes in sexual function: Significant changes in a woman’s body will often cause changes in sexual function such as lower sex drive and a decrease in arousal. Vaginal dryness and changes in bladder function can also contribute to changes in sexual function. Restoration of sexual drive should occur after perimenopause has passes. 
  • Nausea: Perimenopause nausea is a result of varying levels of estrogen in the body. When levels of estrogen are particularly high, nausea is highest as well. In some women, this may require rehabilitation through medication or other treatment. 
  • Loss of bone: Loss of bone is also known as osteoporosis. Osteoporosis is a common occurrence as men and women age, but there is a direct link between decreasing estrogen levels and loss of bone.

These are the most common symptoms of perimenopause, but physicians do not consider all signs harmless. In order to rule out other conditions, a woman should consult her doctor if she experiences any other changes in bleeding, such as:

  • Heavy periods with blood clots
  • Periods that last several days longer than usual
  • Spotting between periods
  • Spotting after sex
  • Periods that occur close together

Any of these symptoms can be a result of other issues within the body not associated with perimenopause.

What Are My Perimenopause Treatment Options?

Perimenopause is a natural occurrence within the female body, but treatment is available for symptoms that get in the way of daily functioning. Doctors recommend improving general health and well-being through regular exercise and following a healthy diet, but other treatment options are available.

  • Hormone therapy: Hot flashes are one of the biggest concerns. Hormone therapy, in the form of pills, skin patches, gels or creams, can often alleviate the symptoms.
  • Vaginal estrogen: A vaginal estrogen cream applied directly to the tissue can help alleviate vaginal dryness, discomfort during intercourse, and some urinary problems.
  • Antidepressants: Antidepressants can help alleviate both mood swings and hot flashes.

Perimenopause occurs in all women, as early as their 30s or anytime throughout their 40s. If symptoms are mild, perimenopause may go unnoticed. Perimenopause has officially ended when a women has missed 12 consecutive periods, known as menopause. The most common symptoms of perimenopause include hot flashes, irregular periods, a decrease in fertility, nausea, and changes in sexual function.

Perimenopause is a natural occurrence within the female body. However, it is still important to consult your doctor when these changes occur. Specialists at AZ Gyn can provide early screening for women with low estrogen and treatment for perimenopause. AZ Gyn’s Gynecology Services and Minimally Invasive Procedures assist women towards attaining optimal health, including the treatment of perimenopausal and menopausal symptoms, enabling relief through compassionate, personalized care.

You Should Know These 5 Facts About Birth Control

You Should Know These 5 Facts About Birth Control

Estimates state that more than 99% of the country’s women aged 15 to 44 who have ever had sexual intercourse have used some form of birth control. It’s well past time for a frank discussion on some of the lesser-known facts about birth control every woman should know.

  1. There Is A Wide Variety Of Birth Control Methods

Birth control these days is about more than just the pill and condoms; in fact, a wider variety of options exists than ever before, with over a dozen methods approved for use in the United States alone. Here’s a look at some of the most popular, non-permanent methods:

  • Birth Control Pill

    The birth control pill has long been the most popular method of hormonal birth control for both teenage girls and women. It’s effective when women use it correctly, and can offer positive hormonal side effects for many, such as lightened menstrual periods and their associated pain.

  • Male Condom

    Condoms are the only method that also provides some protection against sexually transmitted infections. This barrier method of birth control has the added benefit of producing almost no side effects for women not allergic to latex.

  • IUD

    Both medicated and copper IUDs provide a barrier to implantation of an embryo into the uterine lining, while the medicated IUD also prevents sperm from reaching the egg, making it even more effective at preventing pregnancy without much chance of user error.

  • Injectable

    Commonly known as “the shot,” injectable methods of birth control feature a hormonal shot when, if given on the proper schedule, prevents pregnancy for up to three months at a time.

  • Other Methods

    Several other methods of birth control exist, though less than two percent of the population uses them. Options include vaginal rings, implants, patches, emergency contraception, barrier methods such as the female condom and diaphragm, and spermicidal methods like vaginal jelly and foam.

What is the preferred form of birth control in your state? Find out here.

 

  1. Most Women And Teenage Girls Aren’t Utilizing The Most Effective Methods

    Most women between 15 and 44 aren’t using the most effective methods of birth control. In fact, the most popular method used by family planning providers is the IUD, though only about seven percent of all women in the US use it. Health care professionals also suggest it for teenage girls for its long-term efficacy, zero chance of user error, and reversibility. Once women receive education about all the methods available to them, over 75% chose the IUD, a drastic increase from the national average.

  1. Different Methods Have Different Side Effects

    Chances are you’ve heard a TV announcer read the side effects list of the advertised birth control method and wondered to yourself if all the side effects are really worth it. While it’s true that most hormonal forms of birth control have potential side effects produced by the different hormones used – and their levels – they have different, and even positive, effects on the user. Combined hormone methods utilize estrogen and progestin, and tend to have a slightly more pronounced signs and symptoms, at least at first. Progestin-only methods skip the estrogen, a trade-off that minimizes hormonal side effects but slightly decreases the efficacy rate.

  1. The Side Effects Truly Are Minimal

    You’ve likely heard one friend or another citing the negative effects of her birth control method, including weight gain, irritability, and altered periods. However, for most women – that is, women without additional health concerns – most side effects decrease in severity and eventually disappear over time. The series of adjustments your body needs to make to incorporate the hormones involved will lessen, and weight loss is even possible at this stage.

  2. Find A Method That Works For You

    Of course, you shouldn’t stick with a birth control method that’s making you miserable – all the FDA-approved methods available in the US are effective and you have a wealth of options available. Try a hormonal method with lower levels of hormones, or an IUD without hormones. If you’re having trouble taking your birth control regularly, switch to a method with less hands-on time. The important thing is making your birth control work for you, so it can have its desired effect – pregnancy prevention.

Birth Control Isn’t Taboo

Birth Control As mentioned above, when more women learn about all the types of birth control available to them, they tend to make different choices that better fit their lifestyles. Discussion regarding your reproductive health isn’t – and shouldn’t be – taboo. Learn about the different methods of birth control that may work for you, and after you make your choice, research the side effects, risks, and how to properly use them.

Deciding when and if you want to get pregnant is one of the most significant health decisions you can make, and talking about your options with a women’s healthcare provider like Arizona Gynecology Consultants is a great first step.

What Is Seborrheic Vulvitis FAQs For Women - Arizona Gynecology Consultants

What Is Seborrheic Vulvitis? FAQs for Women from Women’s Health Professionals

“Do you have vulvar itching that sometimes gets worse with exercise, heat, sex, stress or hormone changes? Do you suffer from ‘chronic yeast infections’ but symptoms seem to return shortly after being treated with pills and creams?

“You may not be suffering from a yeast infection but a condition called seborrheic vulvitis.  Seborrheic vulvitis can be caused by a yeast organism called malassezia globosa.  It lives on all of us and has a job but can sometimes overpopulate causing intense itching, burning, irritation, and even small tears called fissures.  

“Seborrheic vulvitis is not worrisome or contagious but it is bothersome symptoms CAN be treated with the right medications.” 

Wende Scholzen, WHNPWende Scholzen, WHNP
Arizona Gynecology Consultants Women’s Health Nurse Practitioner

What Is Seborrheic Vulvitis?

Seborrheic vulvitis is a form of seborrheic dermatitis that effects the vulva (external female genitals). It is quite common in women, is not considered a serious condition, and can be treated. The condition may also be referred to as vulvovaginitis, or seborrheic dermatitis.

What Is Seborrhea (Seborrheic)?

Seborrhea is defined as “an excessive and/or abnormal discharge from the sebaceous glands.” The sebaceous glands are simply the small glands in your skin that secrete oil (sebum) onto hair follicles to lubricate the hair and surrounding skin. Seborrheic simply means that the condition is directly related to the overactivity of these glands.

What Is Vulvitis?

Vulvitis is inflammation of the vulva, the external parts of female genitalia, including the labia majora and labia minora. Seborrheic vulvitis usually affects the outer skin, closer to where hair follicles are present. However, it can spread to the inner anatomy from outside genitalia.

Symptoms of Vulvitis? 

  • Itching (increasing in intensity and constant)
  • Pain or burning sensations in the vulva area
  • Redness and swelling of the lips of the vagina and vulva area
  • Dry, cracking skin in the vulva area
  • Vaginal discharge
  • Blisters or sores on the vulva area
  • Thick, scaly patches of skin or flaking near and on the vulva

What About Vaginal Itching that Is Not a Yeast Infection? 

Many women who complain of vaginal itching to their gynecologist and women’s health professional adamantly explain that they don’t believe that the chronic dryness and itching is related to a yeast infection – which can have similar symptoms. And those women are often correct.

In many cases, vaginal itching – if it is not due to a yeast infection – is due to some form of dermatitis. The dermatitis could be considered contact dermatitis, if it is due to a reaction from coming into contact with irritating substances such as:

  • Vaginal lubricants
  • Spermicides
  • Latex condoms
  • Latex diaphragms
  • Chemicals in clothing (dyes, laundry detergents, etc.)
  • Scented toilet paper
  • Tampons or sanitary pads
  • Shampoo, soaps or hygiene products

If the symptoms of itching or burning are localized to just the outer parts of the vulva, the condition is more likely to be dermatitis related, rather than a serious condition affecting the interior female genitalia.

Vulvitis: Is It Contact Dermatitis or Seborrheic Dermatitis?

When your gynecologist or women’s health nurse practitioner narrows down the symptoms to dermatitis, the next step is to determine what the cause of the dermatitis is. In many cases the dermatitis surrounding the vulva is found to contact dermatitis – caused by the vulva coming into contact with allergens.

In these cases, the treatment could be as simple as cutting out the allergens and irritants and treating the existing vulvitis with anti-inflammatory medications or creams.

Malassezia Globosa Vulvar Infection 

Malassezia Globosa Vulvar Infection - CDC

Malassezia Fungus (Source: phil.cdc.gov)

Is the cause of symptoms actually seborrheic dermatitis of the vulva, particularly due to malassezia globose? Then, your doctor may choose to prescribe medications to get rid of the fungus. Your doctor may also try to treat the existing inflammation and any damage, scratching or infection that has occurred in the vulvar area.

Talk to Your Women’s Health Doctor

It is so important for women to feel comfortable and trust in talking to their doctor about their vaginal health. It is all too common for women to worry themselves about what women’s health symptoms could be, instead of just sharing with their doctor their worries.

Seborrheic vulvitis is the perfect example of this; the condition is very common and not serious, but because the condition shares symptoms with many more serious conditions, many women fear the worst. If you have vaginal or vulvar itching, burning or other symptoms, speak to your doctor to sort out the cause, instead of guessing.

Find Answers to Women’s Health FAQs

What Are Congenital Uterine Anomalies - Arizona Gynecology Consultants

What Are Uterine Anomalies?

A congenital uterine anomaly is a uterus malformation that occurs during embryonic development. In the earliest stages of the life cycle, a woman’s uterus forms in two separate halves that grow together over time. Any small missteps in this development cycle can lead to a misshapen or malformed uterus, creating uterine problems later in life.

Congenital uterine anomalies happen to less than 5 percent of women. However, about 25 percent of women who miscarried have some sort of congenital uterine anomaly. Congenital uterine anomalies mostly occur due to random variations during embryonic development, but some uterine anomalies can result from in-utero exposure to certain substances.

For example, baby girls exposed to diethylstilbestrol (synthetic estrogen) are more prone to develop congenital uterine anomalies than others. Doctors often used this medication between 1938 and 1971 to help prevent miscarriages and premature births. Today, there are no known risk factors proven to increase the potential of developing a congenital uterine anomaly.

Types of Congenital Uterine Anomalies

Ultrasound is one of the most-used methods for diagnosing the type of uterine anomaly present in a patient. Doctors will use ultrasound imaging to determine how the patient’s uterus developed and what type of complications the anomaly may present later in life. Different anomalies will produce different effects and lead to varying long-term health complications.

Septate Uterus

One of the most common types of uterine anomalies, a septate uterus, describes a uterus with a normal uterine surface, but with two endometrial cavities. This anomaly occurs when the two halves of the uterus only partially combine during fetal development.

Bicornuate Uterus

The other most common uterine anomaly is a bicornuate uterus. Like the septate uterus, a bicornuate uterus has two endometrial cavities and one external uterine surface. However, a bicornuate uterus has an indented and abnormal uterine surface.

Arcuate Uterus

This uterine anomaly describes a uterus with a 1 cm or smaller indentation in the endometrial cavity.

Unicornuate Uterus

A unicornuate uterus develops only on one side. During fetal development, a baby girl’s uterus develops in two halves that gradually combine to form a single uterus. This anomaly occurs when only one half develops.

Didelphys Uterus

This uterine anomaly describes when the two halves of a developing uterus never combine, resulting in two separately developed halves.

Müllerian Anomalies

This congenital disorder affects about 4 percent of females and occurs during fetal development. This condition results from a malformation of the process of developing Müllerian ducts in the female reproductive system.

These conditions are more than just uterine anomalies, and kidneys often suffer as a result. A woman with a Müllerian anomaly may be missing a kidney, leading to additional medical complications later in life.

Symptoms of Uterine Anomalies

One common thread shared by all the different possible uterine anomalies is that most are asymptomatic. Some women may experience increased pain and discomfort during menstrual cycles, but for the most part, these anomalies do not create significant symptoms on their own.

However, the resulting symptoms often interfere with pregnancy and contribute to lost pregnancies and infertility. Many women do not discover they have a uterine anomaly until they undergo screening for infertility or miscarriage.

After one or more miscarriages, a woman may decide to have a screening to determine the cause, and this is the point when doctors diagnose most uterine anomalies. Women who do experience negative symptoms typically report inconsistent periods or no periods, but the most commonly reported symptoms relate to pregnancy.

Identifying Uterine Anomalies

Doctors use ultrasound imaging to determine which type of uterine anomaly a patient has, and treatment can include many options. Uterine anomaly surgery is a viable option for some women, as it may help restore uterine function and allow for a healthy pregnancy.

However, some anomalies are more difficult to treat, often leading to more significant medical complications. Doctors may also use hysterosalpingograms or MRI procedures to help diagnose uterine anomalies.

Treating Uterine Anomalies

Most uterine anomalies will not require treatment, but treatment generally involves surgery for uterine anomalies. After a positive diagnosis for a uterine anomaly, a women’s surgery specialist will advise the patient about her options.

Most corrective surgery is minimally invasive with little risk, but physicians will recommend surgery only if the uterine anomaly:

  • Prevents pregnancy
  • Results in miscarriage
  • Causes significant pain

Women who have a septate or bicornuate uterus may have the septum wall between the two endometrial cavities removed to restore healthy uterine function. In the case of a unicornuate uterus, the surgeon may remove the undeveloped portion of the uterus, and the patient could possibly have a viable pregnancy using the intact portion. Women at greater risk for premature delivery may require a cervical cerclage to prevent premature cervical dilation.

Is Surgery Right for Me?

Physicians only recommend surgery for a uterine anomaly if the condition prevents pregnancy or prevents the woman from maintaining a pregnancy to full term. In some cases, uterine anomalies can prevent a placenta from attaching correctly, resulting in a miscarriage.

Here are some vital facts to know about uterine anomalies an pregnancy:

  • A woman with a septate uterus has a 25 to 47 percent chance of experiencing a miscarriage.
  • A woman with a bicornuate uterus will have a higher risk of going into preterm labor.
  • Someone with a unicornuate uterus will have about a 37 percent chance of experiencing a miscarriage, and about a 17 percent chance of preterm labor.

Other medical issues, including cervical insufficiency and uterine fibroids, can also interfere with pregnancy and full-term delivery. It’s up to the individual to decide whether her anomaly warrants surgical intervention.

Ultimately, a uterine anomaly may result in only a slightly higher risk of miscarriage for a small malformation, but more significant uterine anomalies can make pregnancy or maintaining a pregnancy to full term impossible. Women should consult their physicians if they have trouble conceiving or experience a sudden onset of symptoms that could indicate a uterine anomaly.

Learn More About Infertility Problems and Testing

How Long Does Menopause Last on Average - Arizona Gynecology Consultants

How Long Does Menopause Last on Average?

This entry was posted in Menopause and tagged , on by .

The menopausal transition, or simply “menopause,” is a normal part of female aging. Once you start the transition, you’ll probably want to know exactly how long symptoms will last.

While every woman is different, here’s what to expect on average.

About Menopause

Estrogen Levels During Menopause Ages Graphic - Arizona Gynecology ConsultantsAll women experience menopause, with several different symptoms.[1]Sussman, M., Trocio, J., Best, C., Mirkin, S., Bushmakin, A. G., Yood, R., Friedman, M., Menzin, J., & Louie, M. (2015). Prevalence of menopausal symptoms among mid-life women: findings from … Continue reading The symptoms vary from woman to woman, and menopause is as unique a journey as the woman herself.

Menopause symptoms may include:

  • Hot flashes
  • Chills
  • Sleep problems / insomnia
  • Mood Swings / irritability
  • Pain during sex / vaginal dryness
  • Depression
  • Dry skin, dry eyes or dry mouth
  • Urinary urgency (a pressing need to urinate more frequently)

In few cases, women don’t have trouble with these symptoms. Once the menopausal transition is complete, you will no longer have to worry about periods or getting pregnant.

Hot Flashes

For most women, menopause is a relief that feels freeing in many ways. Getting through the transition, however, can be trying.

Knowing about how long your symptoms will last can help you focus on the light at the end of the tunnel. While you’re going through abrupt hot flashes and night sweats that keep you awake at night as well as irritability from lack of sleep, knowing that you’re just X amount of days from it being over can ease your mind.

 

Related Reading: Identify the Signs of Menopause [Infographic]

 

While there is no guarantee of exactly how long the transition will last, you can get a good idea of where you are on the journey by understanding the process and studying an average timeline.

The Average Timeline for Menopause

The menopause age range varies by more than a decade. The average age is 51, but menopause can start in women from their mid-40s to late 50s. Most women experience the menopause stage in this age range, while some report symptoms into their 60s. [2]Gold E. B. (2011). The timing of the age at which natural menopause occurs. Obstetrics and gynecology clinics of North America, 38(3), 425–440. https://doi.org/10.1016/j.ogc.2011.05.002

Natural menopause happens in three stages:

  • Perimenopause
  • Menopause
  • Postmenopause

Sometimes perimenopause is confused with menopause. Perimenopause is when a woman starts to have hot flashes, night sweats and vaginal dryness. This can start as early as the 30’s or as late as the 60’s. This is considered either early or premature menopause and late menopause, and can occur for a variety of reasons, such as surgeries or hormonal changes.

Some women in perimenopause may also have the following symptoms:

  • Breast tenderness
  • Worsening of premenstrual syndrome (PMS)
  • Irregular periods or skipping periods
  • Periods that are heavier or lighter than usual

Additional symptoms may include:

  • Racing heart
  • Headaches
  • Joint and muscle aches and pains
  • Changes in libido (sex drive)
  • Difficulty concentrating, memory lapses (often temporary)
  • Weight gain
  • Hair loss or thinning

These symptoms are normal as part of the loss of estrogen production.[3]Iqbal, J., & Zaidi, M. (2009). Understanding estrogen action during menopause. Endocrinology, 150(8), 3443–3445. https://doi.org/10.1210/en.2009-0449 However, if these are new symptoms after starting perimenopause, consult your doctor in order to rule out other health issues.

Menopause that occurs before the age of 45, regardless of the cause, is called early menopause. Menopause that occurs at 40 or younger is considered premature menopause. Perimenopausal symptoms and age will be as individual as each woman. Talk to your doctor if you’re not sure whether you’re beginning the menopausal transition. 

Contributing Factors 

Primary Ovarian Insufficiency (POI) is another cause of premature menopause. With POI, younger women under 40, who have occasional  or no periods, and elevated levels of follicle-stimulating hormone (FSH), will have fewer eggs in their ovaries. This means lower estrogen levels as well and can cause bone density issues.

Happy womenAccording to the SWAN (Study of Women Across the Nation) study, smoking, either as a current smoker or former smoker, can also cause early onset of perimenopausal symptoms, such as hot flashes and night sweats, by at least two years.[4]Whitcomb, B. W., Purdue-Smithe, A. C., Szegda, K. L., Boutot, M. E., Hankinson, S. E., Manson, J. E., Rosner, B., Willett, W. C., Eliassen, A. H., & Bertone-Johnson, E. R. (2018). Cigarette … Continue reading Being overweight, stressed, depressed, or anxious can also start the ball rolling early. Ethnicity also plays a factor. African American women have a longer period of hot flashes – almost 11 years, while Japanese and Chinese women had half the time of dealing with hot flashes.[5]McKnight, K. K., Wellons, M. F., Sites, C. K., Roth, D. L., Szychowski, J. M., Halanych, J. H., Cushman, M., & Safford, M. M. (2011). Racial and regional differences in age at menopause in the … Continue reading

How Long is Menopause?

The perimenopausal stage can last from 10 months to four years on average, but has been known to last up to 10 years. It involves the body gradually decreasing in estrogen production until the last year or two, when estrogen levels drop dramatically. Perimenopause officially ends when a woman does not have her period for 12 consecutive months. 

Stages and symptoms of menopause

The woman is now at menopause. This is a point in time, rather than a period of time. The period of time after menopause is called postmenopause. Perimenopausal symptoms, such as hot flashes and night sweats may continue for another few months or even years after menopause has been reached. 

Other symptoms that may continue are sleep problems, cognitive issues, mood changes and muscle and joint pain. Vaginal dryness is a symptom that will continue and tends to get worse with age. Although, less than 30% of women experience it during perimenopause and only half experience it in postmenopause.

So, how long does menopause last? From the start of perimenopause to the final cessation of all menopausal symptoms, the average transition takes between two and 10 years. There are some women who go through the process more quickly or more slowly than the median time.

If you experience early or late menopause, you may need to add or subtract a year or two to this average timeline. Every woman should rely on medical professionals to assess symptoms, estimate the duration and prescribe treatments for symptom relief.

Do You Have Early or Late Menopause?

Figuring out if you’re going through the transition early or late can help you gain a better understanding of how long menopause will last. If you start having irregular periods in your mid-40s, you may be experiencing early or premature menopause.Menopause Infographic

Heavy bleeding, spotting, a period after a year of no periods, or periods that are noticeably longer or shorter than normal can all signal early menopause, especially in combination with other common menopausal symptoms. 

If you are 55 or older and still haven’t noticed menopause symptoms, your doctor may diagnose you with late-onset menopause.

Late menopause may actually have some health benefits, while early menopause could potentially cause problems. During menopause, the production of estrogen and progesterone by the ovaries declines. In early-onset menopause, this cessation may cause problems such as osteoporosis. The longer your ovaries produce estrogen and progesterone, the longer you can avoid osteoporosis.[6]Papadakis, G., Didier, H., Gonzalez-Rodriguez, E., Vollenweider, P., Waeber, G., Marques-Vidal, P.M., Lamy, O., (2016). The Benefit of Menopausal Hormone Therapy on Bone Density and Microarchitecture … Continue reading

If you’re still having periods in your late 50s and 60s, see your doctor. Each woman’s reproductive system is different, so don’t be alarmed until you’ve spoken to a doctor.

Treating Menopause Symptoms

You may experience one or several symptoms, or hardly any symptoms at all. You may not notice perimenopausal symptoms until you’ve almost reached the menopause phase. Your entire transition could finish in just a few years, or could last longer than a decade.

Everyone is unique, and there is no concrete answer. It takes seeing a primary doctor to evaluate your symptoms, locate where you are on the general timeline, and estimate how much longer you will have to put up with symptoms.

obgynWhile you are combating symptoms for an unknown period of time, look into common forms of relief. If you have medical conditions exacerbating the symptoms of menopause, such as arthritis, chronic pain, anxiety or depression, your doctor can help address these issues to potentially reduce menopause symptoms.

Menopause is a normal part of life, and several tried-and-true treatment options exist to help control and tolerate common symptoms. You can maintain your desired lifestyle while experiencing menopause with a tailored treatment plan. We have expert women’s health services, if you are seeking a gynecologist in Phoenix. Talk to us about your symptoms and concerns, especially if your perimenopausal symptoms negatively affect your quality of life. We’re here to help.

References

References
↑1 Sussman, M., Trocio, J., Best, C., Mirkin, S., Bushmakin, A. G., Yood, R., Friedman, M., Menzin, J., & Louie, M. (2015). Prevalence of menopausal symptoms among mid-life women: findings from electronic medical records. BMC women’s health, 15, 58. https://doi.org/10.1186/s12905-015-0217-y
↑2 Gold E. B. (2011). The timing of the age at which natural menopause occurs. Obstetrics and gynecology clinics of North America, 38(3), 425–440. https://doi.org/10.1016/j.ogc.2011.05.002
↑3 Iqbal, J., & Zaidi, M. (2009). Understanding estrogen action during menopause. Endocrinology, 150(8), 3443–3445. https://doi.org/10.1210/en.2009-0449
↑4 Whitcomb, B. W., Purdue-Smithe, A. C., Szegda, K. L., Boutot, M. E., Hankinson, S. E., Manson, J. E., Rosner, B., Willett, W. C., Eliassen, A. H., & Bertone-Johnson, E. R. (2018). Cigarette Smoking and Risk of Early Natural Menopause. American journal of epidemiology, 187(4), 696–704. https://doi.org/10.1093/aje/kwx292
↑5 McKnight, K. K., Wellons, M. F., Sites, C. K., Roth, D. L., Szychowski, J. M., Halanych, J. H., Cushman, M., & Safford, M. M. (2011). Racial and regional differences in age at menopause in the United States: findings from the REasons for Geographic And Racial Differences in Stroke (REGARDS) study. American journal of obstetrics and gynecology, 205(4), 353.e1–353.e3538. https://doi.org/10.1016/j.ajog.2011.05.014
↑6 Papadakis, G., Didier, H., Gonzalez-Rodriguez, E., Vollenweider, P., Waeber, G., Marques-Vidal, P.M., Lamy, O., (2016). The Benefit of Menopausal Hormone Therapy on Bone Density and Microarchitecture Persists After its Withdrawal, The Journal of Clinical Endocrinology & Metabolism, Volume 101, Pages 5004–5011, https://doi.org/10.1210/jc.2016-2695
Identify The Signs And Symptoms Of Menopause - Arizona Gynecology Consultants

Clinical and Holistic Remedies for Menopause

Have you entered pre-menopause? Or are you already dealing with menopause?

Looking for ways to deal with the onslaught of changes your body is dealing with?

To illustrate the signs and symptoms of menopause, we have taken the time to produce an expansive, helpful infographic that features not only signs that menopause may be starting, but also clinical and holistic ways of alleviating these symptoms.

Signs Symptoms and Holistic Clinical Remedies for Menopause Infographic - Arizona Gynecology

Learn Even More About Menopause