September is Ovarian Cancer Awareness Month — an opportunity to increase awareness so that women reduce their risks of the disease and detect it sooner, and so that we can all encourage public education and continued research.

According to the American Cancer Society, in 2018, an estimated 22,240 women in the U.S. will be diagnosed with ovarian cancer, and approximately 14,070 women will die from it. Women most at risk for ovarian cancer are in their 50s and 60s.

Fortunately, the rate at which women are being diagnosed has been gradually decreasing over the past two decades. Unfortunately, there is still no adequate screening test for ovarian cancer that is available, and the disease is hard to detect in its early stages when it is most treatable.

Therefore, it’s important for women to be aware of the possible warning signs and symptoms of ovarian cancer as well as to assess their reproductive history and family history of the disease. Ovarian cancer symptoms are often subtle and can be easily confused with other issues.

Ovarian Cancer Symptoms

• Bloating
• Pelvic or abdominal discomfort
• Frequent need to urinate

Assess Your Reproductive and Family History

Research shows a link between the number of menstrual cycles a woman has had in her lifetime and increased risk of developing ovarian cancer. A woman is at greater risk if she:

• Began menstruating before age 12
• Has never given birth
• Never took birth control pills (oral contraceptives)
• Has experienced infertility
• First gave birth after age 30
• Experienced menopause after 50

Also, be aware that approximately one in four women diagnosed with ovarian cancer has a strong family history of the disease, and the greatest risk factor is an inherited mutation in one of two BRCA genes. However, women who have a grandmother, mother, daughter or sister with ovarian cancer but no known genetic mutation still are at greater risk of developing the disease.

How to Reduce Ovarian Cancer Risk

Although ovarian cancer can’t be prevented, women can talk to their healthcare providers and identify the best steps to take to help reduce risk. If ovarian cancer runs in the family, a consultation with a genetic counselor may be recommended.

Here are examples of non-surgical approaches a gynecologist may recommend:

• Take oral contraceptives: When used for five or more years, women can cut their risk of developing ovarian cancer in half in comparison to women who have never used them.
• Breastfeed: Breastfeeding is linked to a reduced risk of ovarian cancer, likely because a woman ovulates less often when she is pregnant or breastfeeding.
• Lose weight: Studies have discovered a link between obesity and ovarian cancer. A 2009 study in the journal Cancer found that obesity was associated with a nearly 80 percent higher risk of ovarian cancer among women between the ages of 50 to 71 who had not taken hormones after they entered menopause.
• Reassess hormone replacement therapy: Studies show that using estrogen and progestin for five years or longer increases the risk of ovarian cancer in women who have not had a hysterectomy. If a woman has had a hysterectomy and has used estrogen for more than 10 years, her risk also increases.

A gynecologist may also recommend a surgical procedure such as:

• Hysterectomy: Removing the uterus can decrease the risk of ovarian cancer by 33 percent.
• Prophylactic bilateral salpingo oophorectomy: This procedure to remove the ovaries and fallopian tubes can significantly reduce the risk of ovarian cancer.
• Tubal ligation: Having the fallopian tubes tied can reduce risk by up to 67 percent.

Hopeful News Regarding Ovarian Cancer

Finally, be aware of this good news regarding ovarian cancer: according to the American Cancer Society, familial genetic research is beginning to offer clues about how the disease develops. Eventually, this is expected to lead to new therapies that could be used to prevent or treat ovarian cancer. Learn more.

A fibroid is a type of non-cancerous tumor that forms in the uterus. Fibroids — also called uterine fibroids — consist of smooth muscle cells and connective tissue and can range from pea-sized to grapefruit-sized. An estimated 20 to 80 percent of women in their childbearing years have fibroids, although many women do not know it.

The reason fibroids develop is still not fully understood. However, what is known are the types of women most at risk of developing them. Women most at risk are:

• African-American
• Nearing menopause
• Obese

Symptoms of Uterine Fibroids

Some women have no symptoms at all, while others’ symptoms are severe. And although every woman experiences a unique set of symptoms, some of the more common ones include:

• Abnormal bleeding
• Frequent need to urinate
• Heavy or prolonged menstrual periods
• Lower back pain
• Painful intercourse
• Pelvic pain

Fibroids Are Usually Found During a Pelvic Exam

Fibroids are most often discovered during routine pelvic exams. However, only about one-third of fibroids are large enough to be detected during an exam. If a gynecologist believes a woman may have fibroids but does not detect them during a pelvic exam, the doctor may schedule an imaging test such as an x-ray, ultrasound or MRI.

Examples of other possible tests a gynecologist may recommend are:

• Hysteroscopy: A procedure in which an instrument called a hysteroscope is inserted into the vagina so the gynecologist can see the canal of the cervix and the inside of the uterus.
• Endometrial Biopsy: A procedure in which the doctor numbs the cervix, inserts a thin tube into the cervix and gently suctions out a tissue sample from the uterine lining.
• Hysterosalpingography: A type of x-ray exam that uses dye and records images of the uterus and fallopian tubes.

Deciding to Treat Fibroids or Wait

Most fibroids stop growing or may even shrink as a woman approaches menopause, so a gynecologist may recommend waiting and monitoring fibroids versus treating them. However, if a woman has fibroids that are very large or are causing pain and severe symptoms, a gynecologist may recommend treatment.

When deciding whether or not to treat fibroids, it’s important for a woman to communicate closely with her doctor and discuss things such as:

• Overall health
• Severity of symptoms
• Available medications, procedures or therapies
• Plans for future pregnancies

Types of Treatment

If the gynecologist and patient decide to move forward with treatment, there are surgical, minimally invasive and non-surgical options that can include:

Surgical

• Hysterectomy: Surgical removal of the uterus, which also removes the fibroids
• Myomectomy: Removes the fibroids, but leaves the uterus intact so a future pregnancy is possible

Minimally Invasive

• Uterine artery embolization: A process in which the arteries supplying blood to the fibroids are identified and then embolized (blocked). Because the blood supply to the fibroids is blocked, the fibroids shrink.
• Endometrial ablation: The lining of the uterus is removed or destroyed.

Non-Surgical

• Anti-hormonal agents: A gynecologist may prescribe an anti-hormonal agent, like progestin, or a gonadotropin-releasing hormone (GnRH) agonist. These medications cause estrogen and progesterone levels to fall, which stops menstruation. This in turn causes fibroids to shrink. Additionally, it can improve associated anemia. While these prescriptions can help reduce symptoms of fibroids, they are often used temporarily or prior to surgery or embolization to help with pain or symptom relief.

For More Information

Visit womenshealth.gov to read frequently asked questions and to learn more about fibroid treatment methods. If you are experiencing any symptoms, schedule an appointment with one of our physicians today.

This causes the organ or organs that they are supporting — whether that’s the vagina, uterus, bladder, urethra, small bowel or rectum — to shift position and put pressure on the vagina. In some cases, these tissues can cause so much pressure that they protrude out of the vagina.

There are a variety of reasons pelvic floor muscles can become weak, making pelvic prolapse more likely. For instance, if a woman:

• Has given birth vaginally, and the labor was long or the baby was very large
• Has had a hysterectomy
• Is post-menopausal; women who are post-menopause have lower levels of estrogen which causes the muscles and soft tissues of the pelvis to weaken
• Is obese
• Experiences chronic coughing
• Strains almost every time she has a bowel movement

Vaginal Prolapse Symptoms

If you think you might have pelvic organ prolapse, one or some of these symptoms may be familiar to you:

• Difficulty with bowel movements
• Heaviness or pressure in the pelvic area
• Lower back pain
• Pain during intercourse
• Tissue protruding from the vagina or a feeling that it could
• Urinary problems from incontinence to chronic urge to urinate to urine retention

Pelvic organ prolapse can worsen over time, so it’s important to make an appointment to see a doctor if you are experiencing any of these symptoms.

Non-Surgical POP Treatment Options

If your prolapse is not causing pain or interfering with your daily life, your doctor may suggest no treatment, exercises or non-surgical treatment. One non-surgical option frequently used to treat POP is a pessary, which is a small device that fits inside the vagina and helps support the pelvic organs.

A pessary must be fitted to each woman, and there is no scientific method available to determine the perfect size a patient needs. For that reason, after the first fitting, a woman will need to return to the doctor several days later to have it checked. If the pessary is working well, the woman will likely not need to return for several months. A pessary can be used on an ongoing basis, and it’s estimated that about half of the women who have one continue to use it. However, they must be cared for and used correctly. Otherwise, problems can occur, such as bleeding or vaginal infections.

Kegel exercises are another non-surgical care method that may be recommended by a doctor to help strengthen the pelvic floor. The National Institutes of Health offers instructions on how to perform Kegel exercises.

Pelvic Organ Prolapse Surgery

There are several surgical solutions for patients who have pelvic organ prolapse. The particular procedure depends on factors such as a woman’s unique anatomy and whether or not she wants to be sexually active. Here are some examples:

• Anterior Vaginal Prolapse Repair: Lifts the front vaginal wall back into the body so the bladder has support
• Apical Suspension: Repairs the top of the vagina and helps maintain sexual function
• Posterior Vaginal Prolapse Repair: Repairs a bulge in the back wall of the vagina

A doctor may be able to perform these procedures laparoscopically, using small incisions in the vagina or abdomen. This can help shorten recovery time.

For More Information

For more details about pelvic organ prolapse and surgical procedures for POP, visit the American College of Obstetricians & Gynecologists (ACOG).

Polycystic ovarian syndrome (PCOS) is a common hormonal disorder that affects about 5 to 10 percent of all women. It is also the leading cause of infertility in women — although many people have never heard of it.

PCOS causes the ovaries to produce an excess of “male” hormones called androgens. With PCOS, the ovaries can also grow larger and form small cysts on their outer edges. All this can interfere with a woman’s menstrual cycle, which can cause infertility.

It is estimated that about half of women who have PCOS don’t know they have it. Part of the reason it’s hard to recognize and diagnose is because the primary symptoms of PCOS are quite common. They include:

• Acne
• Excess facial or body hair
• Fatigue
• Missed, irregular or heavy periods
• Mood changes
• Weight gain

PCOS Can Increase Health Risks

If a woman experiences these symptoms, they can be easy to ignore, since they are often very mild. However, untreated PCOS can lead to increased risk for certain diseases and serious health issues, so it’s important to recognize the symptoms and see a doctor if a woman believes she may have it. Undiagnosed and untreated PCOS can lead to increased risk of:

• Diabetes
• High blood pressure
• High cholesterol
• Uterine cancer (due to irregular periods)

Mental health can also be affected. Early in 2018, a study reported that women with PCOS are more likely to develop mental health disorders. The same study also suggests that women who have it may have a slight increased risk of giving birth to children with attention deficit hyperactivity disorder (ADHD) and autism.

Doctors Can Perform Tests and Offer Treatments

No one knows exactly why some women get PCOS and others don’t. But what experts do agree on is that getting diagnosed and treated sooner rather than later is the best way to lower your chances of health problems in the future and to get relief right now.

Because PCOS can be difficult to diagnose and treat, a doctor may perform several tests or refer you to other specialists to get you the help you need. Your doctor may:

• Perform blood tests to measure your hormone levels
• Schedule an ultrasound to see if there are cysts on the ovaries
• Prescribe diabetes medication called metformin that can help control the symptoms of PCOS
• Prescribing birth control pills to keep hormones balanced and to get your menstrual cycle back on track

What You Can Do on Your Own

Although it is not possible to avoid developing PCOS, some experts recommend a high protein, low carb diet along with weight loss if a woman is obese.

These experts point out that obesity contributes to insulin resistance, which increases androgen, and in turn can worsen the symptoms of PCOS. For some women, even losing 10 pounds could make a significant difference in reducing or eliminating PCOS symptoms. Additionally, if a woman who is obese is having problems getting pregnant, the weight loss could help increase the chance of pregnancy.

Finally, if you think you, your daughter or another family member or friend may have PCOS, it’s better to seek out expert advice from a doctor sooner rather than later. You’ll feel better, and you’ll be proactively taking steps to stay as healthy as possible as you move towards the future.

For More Information, visit PCOS Awareness Association.

Cervical Health Awareness Month, recognized in January each year, is designed to raise awareness around cervical cancer. It is an excellent opportunity to ensure the girls and women you care about are taking steps toward prevention.

Approximately 13,000 women in the U.S. are diagnosed with cervical cancer every year. However, there are many things that can be done to prevent the disease including vaccination, screenings, awareness and prevention.

About HPV and the HPV Vaccine

Most cases of cervical cancer are caused by human papillomavirus (HPV), a common infection that spreads through sexual activity. Nearly 79 million Americans have HPV, but most have no symptoms and do not know they have been infected.

Fortunately, an HPV vaccine is available. Ideally, both male and female children should get the HPV vaccine at age 11 or 12. However, women can receive the vaccine up to age 26 and men up to age 21.  It is given in a series of either two or three shots depending on age.

About Cervical Cancer Screening

Even if a woman has been vaccinated against HPV, she still needs to have regular screenings for cervical cancer. This screening is done by examining cells taken from a woman’s cervix during a Pap test and should begin at age 21.

In the lab, clinicians look for signs of precancerous changes (cell abnormalities on the cervix that could become cancerous if left untreated). If found, these cells are then tested for the HPV virus at the same time. If positive for HPV, follow-up screening should continue every three to five years, until a woman reaches age 65 and has had normal test results for several years.

Be Aware of Risk Factors

In addition to screenings and vaccination, awareness and avoidance of risk factors can help reduce the risk of cervical cancer. Risk factors include:

• Using birth control pills for five or more years
• Being a smoker
• Having had a sexually transmitted infection (STI)
• Having HIV or other immune system disorder
• Having had three or more biological children
• Having had more than one sexual partner

While you may not be able to change all of these conditions, you should change the ones you can, such as stopping smoking, practicing safe sex by using a condom or having fewer sexual partners.

Finally, take this opportunity during Cervical Health Awareness Month to reach out to the women and girls in your life to encourage them to see their doctor for HPV screening and vaccination.