Dive into the world of obstetrics and gynecology to learn why it’s important for women to schedule regular checkups.
Women have many reasons to see an OB/GYN. The “obstetrics” part relates to care of pregnant women and their unborn babies, while “gynecology” focuses on non-pregnancy aspects of a woman’s reproductive health, such as treatment of endometriosis, cancers, sexually transmitted infections and other conditions.
With so much that could go wrong, it’s important for women to see an OB/GYN for their health needs. Consider if you need to make an appointment as six area OB/GYNs explain multiple elements of their profession.
Endometriosis and Infertility
According to Dr. Bryan Taylor, an OB/GYN at Mercyhealth Hospital-Rockton Avenue, in Rockford, six to 10 percent of women experience endometriosis, a painful condition in which the endometrial glands grow where they’re not supposed to – outside the uterus.
“We don’t exactly know why in every case, but there’s always research going on, especially in regards to treatments and medication,” Taylor says. The symptoms of endometriosis vary, but typically, painful periods (dysmenorrhea) is a given. Chronic pelvic pain, pain with intercourse and infertility can also result.
“It really depends where the endometrial glands land outside the uterus,” Taylor explains. “It can be a number of locations, but the most common sites are the ovaries, in front of and behind the uterus or on the uterus itself. The glands can also land on the colon, the bowel or the bladder, which can cause bowel or bladder issues as well.”
In order to truly diagnose endometriosis, a physician has to surgically intervene by taking a biopsy, Taylor explains. Since it’s best to avoid surgery, if possible, Taylor usually begins treatment by prescribing patients an oral contraceptive. Stronger drugs are available, but he tries to avoid them as much as possible.
If the medications don’t seem to work for a patient, surgery might be necessary.
“We go in with the scope, evaluate where the endometriosis is, take a biopsy, and try to sect out any areas we do see,” Taylor says. “Sometimes, the implants are really, really deep and we can’t always get to them. So the recurrence rate is actually pretty high. That’s why we try not to do surgery – because a lot of patients six months to a year later will have a recurrence and the pain starts up again.”
But, Taylor has noticed that pregnancy can oftentimes improve a patient’s symptoms of endometriosis. It’s not a guarantee, but sometimes the endometrial glands can suppress, relocate or disappear following a pregnancy.
However, endometriosis and infertility are oftentimes linked. Patients with endometriosis who experience infertility can undergo surgery to remove scar tissue to increase their chances of getting pregnant, Taylor says.
Dr. Gregory Granzeier, an OB/GYN at Mercyhealth-Roscoe (Ill.), says infertility is a couple’s inability to conceive after one year of unprotected intercourse. It affects 10 to 15 percent of all couples.
“For these patients, I like to do a thorough history and physical exam, paying close attention to menstrual cycle,” Granzeier says. “I’ll do a work-up on the partner as well. The rule of thumb is 1/3rd of the time it’s male factor, 1/3rd of the time it’s female factor, and 1/3rd of the time it’s probably some overlap of the two.”
If a woman is not having normal menstrual cycles, which should come anywhere from 21 to 35 days after the first day of a woman’s last period, Granzeier will work to determine the cause. It may just be an abnormally functioning thyroid or an elevated prolactin level.
“Those are both pretty easy to crack,” Granzeier says. “If it’s thyroid disease that’s causing a woman not to ovulate, correction of that usually causes her to go back into normal cycles. If her prolactin hormone is irregular, we can treat it with medication.”
Another common reason for women not to ovulate is polycystic ovarian syndrome (PCOS). Classic symptoms include higher levels of androgen hormones (male sex hormones), which can cause hair growth on a woman’s chin, face or lower abdomen. PCOS is oftentimes associated with patients who have a high body mass index, Granzeier says.
“If a person has PCOS, a few things can help,” he adds. “One, there’s weight loss. A lot of times, when a woman gets closer to her ideal body weight, she’ll start going back into normal menstrual cycles. Another way to treat PCOS is with a medication, Metformin, that we use to treat diabetes.”
If none of these reasons are behind the infertility, Granzeier can do a laparoscopic surgery to view a woman’s ovaries, fallopian tubes and pelvic anatomy. If he finds an anatomical problem, he can work on correcting it. If a patient still isn’t able to conceive, Granzeier will send them to a fertility doctor.
“Unfortunately, some patients don’t end up having successful pregnancies, but the majority do,” he says.
Pregnancy Complications and Miscarriages
For 25 years, Dr. Cynthia Palabrica worked at a high-risk pregnancy center in Milwaukee. Now, the OB/GYN has brought her expertise to Beloit Health System.
“I’m really happy I made the transition,” she says. “There is a huge difference between practicing in a big city and practicing in a small community. I think the ability to be personal and have a greater exchange with your patient occurs in a smaller facility.”
When it comes to pregnancy complications, certain women are automatically considered at risk, such as women with diabetes, advanced maternal age, or a family history of chronic hypertension. If complications arise, Palabrica may instruct these patients to bed rest, or refer them to an outside pregnancy care center.
Patients with these risk factors aren’t at a higher risk of having a miscarriage, Palabrica explains. But, their chances of having a premature baby or developing preeclampsia – a complication characterized by high blood pressure – are much higher. Preeclampsia can potentially affect a woman’s organs, particularly the kidneys or liver, leading to life-threatening conditions for both the mother and the baby.
That’s why it’s especially important for pregnant women to control their diabetes, hypertension and other risk factors, Palabrica says. She recommends all women start taking prenatal vitamins before they even become pregnant, in addition to eating healthy and exercising regularly.
When it comes to miscarriages, Palabrica explains they aren’t “more common” these days. Rather, they’re more identifiable.
“Years ago, you missed two-plus periods before you even considered the possibility of being pregnant and now, we find out the moment after conception,” she says. “In addition to that, there’s the availability of a test that will determine whether you’re carrying a male or female fetus as early as six weeks. I find this to be a hard thing because now you’re mourning the loss of your son or daughter when 20 years ago, you never would have even known. If you talk to women who have children, you’ll by and large find that most of them have had at least one miscarriage.”
Palabrica recommends women see an OB/GYN after missing two periods.
If a patient has a miscarriage, Palabrica avoids asking the patient to make a decision right away. Instead she outlines the ways to proceed and sends the patient home for a week.
“That gives them some time to assimilate the information that the pregnancy is going to be a loss,” she says. “When they come back, I tell them I personally prefer to let nature take its course, especially if it’s early in the pregnancy. I think it’s better if they can pass the pregnancy on their own. I try to never take someone to the operating room unless it’s necessary.”
However, patients can also opt for surgical evacuation of the uterus. Either way, once the pregnancy has passed, Palabrica monitors the patient on a weekly basis until the uterus is back to normal.
Regardless if you’re pregnant or not, Palabrica recommends scheduling a check-up with your OB/GYN.
“If you want to have somebody make sure those organs which comprise the lower half of your abdomen are working the way they should be, then truly, you need to see a gynecologist,” she says.
As an OB/GYN at OSF Saint Anthony Medical Center, in Rockford, Dr. Rashida Randeree follows patients through the circle of life. She sees babies being born. She counsels teenagers about sexual health. She treats women, young and old, who need surgeries or medications.
“You’re dealing with the entire spectrum, so the field is very rewarding,” she says. “You really go through the good times and difficult times.”
Thus, Randeree’s job can’t be solely delivering babies – something that’s always joyful. She also needs to have difficult conversations with patients, especially when they’re diagnosed with a gynecological cancer or sexually transmitted infection (STI). And lately, there’s been a resurgence of gonorrhea, chlamydia and syphilis – all STIs with typically painful symptoms.
“We need to be promoting awareness,” Randeree says “Syphilis is one of those diseases that was almost eradicated, and now we’re seeing it again. And the only treatment is penicillin, so if a patient is allergic to penicillin, these individuals need to undergo desensitization therapy.”
More commonly, however, Randeree treats patients for bacterial vaginosis – a vaginal infection caused by an overgrowth of bacteria; Human Papilloma Virus (HPV) – a virus that can lead to cervical cancer if left untreated; and Herpes – a virus that causes painful lesions to develop.
When diagnosing an STI, Randeree tries to prepare her patients for the news.
“I say to them, ‘Look, this is what I think it is, but we’ll do a confirmatory test,’” she says.
Then, she puts her patient on a prophylactic antibiotic, depending on the symptoms, thus beginning treatment while simultaneously waiting for the test results to come back. That way, painful symptoms can subside faster.
Though no one wants to hear they have an STI, most are quickly treatable with medication, Randeree says, even though not all are curable, such as Herpes and HIV.
“I think patients have to understand that no matter what, we’re going to treat them,” she says. “We’re going to take care of them. We’re going to get them through this. And what I find is that patients are compliant with treatment, especially if it’s something that’s treatable, like gonorrhea or chlamydia. As long as they refrain from intercourse with their partner for a specified period of time and their partner is concurrently treated, they should get better quickly.”
Randeree encounters many patients who are nervous about seeing an OB/GYN, regardless if they require testing for STIs. But scheduling regular appointments with your OB/GYN is important.
“It’s about helping you and educating you,” Randeree says. “We’re not here to judge you. We’re here to give you the best care we can provide.”
Genetic Testing for Gynecological Cancers
Even though Dr. Keith Martin is the Chief Medical Officer at FHN, he still works two days a week in a clinical role as an OB/GYN.
“I feel that in order to be effective in my administrative role, I need to be able to connect with the providers in the trenches,” he says. “Plus, the relationship with patients is what I cherish the most. We participate in defining moments of people’s lives and that’s quite a privilege.”
As an OB/GYN, part of Martin’s job involves examining patients for gynecological cancers. Worldwide, cervical cancer is the most common gynecological cancer found in women, but uterine/endometrial cancer is the most common in the U.S., making it the cancer Martin treats most commonly.
There are different types of uterine cancers, but in general, an abnormality develops in the inner lining of the uterus (endometrium). In an advanced disease process, the cancer will spread to adjacent organs.
Risk factors include obesity, hypertension, diabetes, smoking and the number of menstrual cycles over a lifetime. Treatment typically involves surgery and/or chemotherapy, radiation therapy or hormone therapy. The No. 1 symptom for detecting uterine cancer is abnormal vaginal bleeding.
“That’s our first clue, in most cases,” Martin says. But genetic testing is becoming a game-changer in identifying patients at risk. “I think the most exciting part about uterine cancer these days, for us as physicians, is that the genetic link has now actually become something we can get closer to quantifying for individual patients. In my career, that’s been the biggest leap, in my mind, to help women with this disease.”
Martin explains that certain individuals have an elevated risk for developing uterine cancer based on their family history, and now, these patients can be identified through genetic testing.
“That’s what’s exciting,” he says. “Now, we can take a blood sample and have the genes analyzed. If we do detect any mutations that increase an individual’s risk for uterine cancer, we follow them differently, obviously. We don’t say to them ‘Come back in five years.’ We’re going to screen them regularly.”
Even though FHN is a rural hospital, Martin and his colleagues are able to identify people they feel may benefit from genetic cancer screening. According to Martin, there are 28 known mutations that link to eight major gynecological cancers.
“There are certain mutations that we are able to pick up on and get these folks referred on to genetic counselors and subspecialists who can watch them closely,” he says. “I am very proud because not every center is doing this.”
It’s important because the earlier a cancer is diagnosed, the more likely the patient is to achieve better outcomes, Martin says. Fortunately, however, uterine cancer is usually treated successfully.
“It’s one of the cancers we tend to do very, very well with,” Martin says. “But, it’s important that as women become more educated, they share this information with their children. If they carry a mutation, that’s important for their kids to know. This is something you should talk about with your own physician.”
Any person who receives a diagnosis of cancer will have their life impacted forever, says Dr. Timothy Durkee, OB/GYN at SwedishAmerican Health Systems, A Division of UW Health. In his line of work, he’s diagnosed endometrial/uterine, breast, cervical, ovarian, vulvar and vaginal cancers, among others.
“The initial impact of the diagnosis rightfully alarms and worries a patient,” Durkee says. “After the initial diagnosis and treatment, the patient will forever be concerned whether or not the cancer will return. The patient’s coping mechanisms and sense of determination can help to deal with this life challenge.”
Like Dr. Martin, the most common cancer Durkee finds is uterine cancer. Usually, patients tend to have comorbidities with obesity, hypertension or Type II diabetes, all linked to higher levels of female steroid hormone. Based upon the stage of the cancer, Durkee or a gynecological oncologist can develop a treatment plan involving surgery, chemotherapy, radiation therapy or a combination of these treatments.
After treatment, Durkee continues to post-operatively treat the patient by monitoring for a recurrence of the disease.
“Recurrences depend on the stage of the cancer,” Durkee says. “The earlier cancers obviously are at a very high cure rate approaching 90 percent. We talk about cure rate as a 5-year survival. As the stage of cancer increases, the survival rate falls, but there’s a caveat to that. It’s not only the stage of the cancer, it’s also the biology of the tumor. Meaning, how aggressive is it?”
Uterine cancers that resemble a woman’s native endometrial tissue are easier to treat, Durkee explains. Grade 1 tumors more closely resemble the native endometrial tissue, whereas a grade 3 tumor does not.
“So it’s almost better to have a moderate-stage grade 1 tumor, versus an early-stage grade 3 tumor,” he adds.
When it comes to genealogical cancers, Durkee says it’s important to know your family history. Ask your physician about genetic testing. In addition, keep your blood pressure under control, eat healthy and exercise regularly.
And be sure to see your gynecologist for regular checkups.
“It’s important all women see a physician proficient at performing a gynecological examination, that patients examine themselves and be attuned to their bodies, and that when something appears to be wrong, they see a physician,” Durkee says. “Fortunately, for the vast number of patients with complaints, most will not result in a diagnosis of cancer.”