Dear kswank: Gosh, you have been given several treatments which should cover for yeast/candida vaginal symptoms, and the metronidazole gel for treating bacterial vaginosis (BV). Given this one would hope that both infections would abate.
In terms of your contraceptive method, women who wear the NuvaRing have the same healthy vaginal pH as Pill users, but they may have 2-3 times more hydrogen peroxide producing lactobacilli (Vernes, 2004). One study has shown that several subtypes of vaginal yeast can adhere to the NuvaRing (Camacho, 2007), but an increased risk for yeast infections has not been reported. Should a Ring user develop yeast, use of either a cream or suppository antifungal medication does not decrease the Ring's effectiveness as a birth control method (Verhoeven, 2004).
You might want to wait until 72 hours after the end of the treatment and see if the "chunky", non-irritating discharge subsides. It can take a while for the vaginal ecology to return to its usual balance. It not, return to your GYN for follow up.
Dear jwhittington: You are correct, a thickened uterine lining is more common as a teen or a perimenopausal women. The common feature is fewer ovulations. As you may have read, endometrial hypertrophy means an overgrowth of the lining of the uterus. Another term for this is endometrial hyperplasia.
Simply stated, if the uterine lining is like grass or lawn, estrogen is like the fertilizer (causes a thickening of the lining or hypertrophy), and progesterone is like the lawnmower (keeps the lining thin by three different mechanisms). This is why DepoProvera (high dose synthetic progesterone) brings about a thin lining, and why birth control pills (relatively progesterone dominant) bring about shorter, lighter periods. It is also why women who miss ovulations (no progesterone produced) are at a greater risk for endometrial hypertrophy/hyperplasia and endometrial cancer. The most common reasons for a woman to not be ovulating (no lawn mower activity so thicker lawn) are being heavy set or being early perimenopausal.
Endometrial hypertrophy is a common cause of heavy and prolonged bleeding. The diagnosis can be made by ultrasound or endometrial biopsy. The ultrasound image measures the thickness of the lining ("endometrial stripe"); with hypertrophy it is usually more than 12-15 mm. I had a patient once with a stripe of 30mm! The endometrial biopsy takes a sample of lining tissue and the pathologist can then make a very accurate diagnosis base upon the cells seen under the microscope. The treatment for simple hyperplasia/hypertrophy which does not contain abnormal cells is synthetic progesterone pills or shots. This shrinks down the too thick lining.
jwhittington, there can be many other reasons for missing enough ovulations to develop a too-thick lining. You might want to ask your GYN if they think you have a predisposing condition (eg low thyroid, overweight, pituitary problem, etc) which is the culprit. As an aside, lots of polyps growing out of the uterine lining can also create the appearance of a too-thick lining.
Dear karruda: Both Anon_6061 and georgiagail have given you correct information. A LEEP can either take a thin slice of tissue off the face of the cervix or make a deeper excision of tissue. Since your LEEP specimen apparently did not have abnormal cells left on the cervix that is good news. You had a surgical treatment rather than waiting to see if your high risk HPV resolved on its own--this is preferred.
As you can read in the reference by Anon_6061, HPV has now been linked to certain types of cancer in the throat. The usual way HPV gets into the oral cavity would be oral sex. Cancer of the tongue is most commonly caused by cigarette smoking--not HPV. Smoking even increases one's risk of abnormal PAP smears and cervical cancer as nicotine can be found in cervical secretions.
Dear Anon: I would agree with you, both the mammogram and breast ultrasound reports sound reassuring. Having said that however, one of the rules is that any palpable lumps that do not vary over a menstrual cycle (eg "hormonal lumps") need to have a definitive diagnosis. Mammograms, depending upon the type might miss up to 15% of cancers. Adding an ultrasound should decrease the number of "misses".
It seems like your primary GYN practice is being very conscientious in referring you to a breast surgeon for a second opinion. Some providers would not do that despite recommendations that any palpable lumps get a definite diagnosis.
If you would be so kind, would you write us all back and let us know what your breast surgeon says/ Other women with similar questions will be very interested in your answer.
Dear smjpain: The loss of the physical, and persona,l support of your pelvic floor PT must be devastating. It sounds like the vaginal redness and pain have increased to the point where it is difficult to do the needed vaginal massage and dilation. So seeing your GYN or the GYN Pain specialty clinic in an attempt to treat any yeast or spotting/tearing may be your best bet. Perhaps you remember the reader who had chronic vaginal skin splits every time she attempted intercourse. In her case she had to undergo many treatments until improvement arrived. The same might occur for you.
That your PT promises to resume care is a good sign. She has done a lot to validate then improve your vaginal/vulvar symptoms. I just wish that a magic cure could be found which would erase your inflammation and pain.
Dear samced: The ingredients of Femaprin include vitamin B6 and Vitex/chasteberry. A literature search at the National Library of Medicine site did not find studies about Femaprin. When a search is done for the active ingredient there were two studies. One did not show a statistical improvement, this more current study did:
Clin Exp Obstet Gynecol. 2006;33(4):205-8. Double-blind, placebo-controlled study of Fertilityblend: a nutritional supplement for improving fertility in women. Westphal LM, Polan ML, Trant AS. Source
Department of Gynecology/Obstetrics, Stanford University School of Medicine, Stanford, CA 94305, USA. Abstract PURPOSE:
To determine the impact of nutritional supplementation on female fertility. METHODS:
A double blind, placebo-controlled study of the effects of FertilityBlend for Women, a proprietary nutritional supplement containing chasteberry, green tea, L-arginine, vitamins (including folate) and minerals, on progesterone level, basal body temperature, menstrual cycle length, pregnancy rate and side-effects. RESULTS:
Ninety-three (93) women, aged 24-42 years, who had tried unsuccessfully to conceive for six to 36 months, completed the study. After three months, the FertilityBlend (FB) group (N = 53) demonstrated a trend toward increased mean mid-luteal progesterone (P(ml)), but among women with basal pretreatment P(ml) < 9 ng/ml, the increase in progesterone was highly significant. The average number of days with luteal-phase basal temperatures over 98 degrees F increased significantly in the FB group. Both short and long cycles (< 27 days or > 32 days pretreatment) were normalized in the FB group. The placebo group (N = 40) did not show any significant changes in these parameters. After three months, 14 of the 53 women in the FB group were pregnant (26%) compared to four of the 40 women in the placebo group (10%; p = 0.01). Three additional women conceived after six months on FB (32%). No significant side-effects were noted. CONCLUSION:
Nutritional supplements could provide an alternative or adjunct to conventional fertility therapies
Samced, you mentioned a history of irregular periods which now have become just very light spotting. Once pregnancy is ruled out there are several POSSIBLE explanations for a "too-light" flow" in a woman not using hormonal forms of birth control:
1. Lowered estrogen levels--this is more likely to be the case in a woman around the time of menopause.
2. Elevated prolactin levels---prolactin is produced from the pituitary gland. Levels can be elevated from a benign pituitary adenoma or from certain psychiatric medications.
3. Missed ovulations--with a missed ovulation the lining of the uterus does not shed all at once. This can result in a missed flow, a too-light flow (just part of the top layer is shed), or even prolonged/erratic flows.
Both reasons number 2 and 3 can also be linked to a history of irregular periods. You could certainly choose to try conceiving with this supplement. If you have not conceived within six months I would really urge you to see a GYN. Some basic blood tests could you you a much more accurate answer as to to the cause of your too light flows--and your fertility.
Dear rach: tlkittycat is correct, but here are a couple of possible explanations which you might want to ask about. If you happen to be on some kind of hormonal birth control (pill/patch/ring/Mirena) the most likely explanation would be "normal" breakthrough bleeding/spotting due to the hormones in the birth control. However, if you are not using hormones then the following is my best GUESS.
You mentioned that the spotting began about cycle day 14 (cycle day 1 being the first day of your last period). Given this specific timing the most likely cause would be bleeding with ovulation. Right before ovulation there is a brief spike of estrogen. When this level drops back down to normal, the sharp decline can destabilize the lining of the uterus leading to spotting/bleeding. Some women have this sign of ovulation every month; others only rarely. Fortunately the amount is usually scant and brief in duration.
Some other possible causes of erratic spotting can include a new chlamydia infection (unlikely if you are both monogamous). polyps of the lining of the uterus (way more common in midlife women), or missed/erratic ovulations (usually there will be a history of missed/irregular periods).
If your erratic bleeding persists, or you develop other symptoms (eg pelvic pain from an infection or ovarian cyst) see your GYN or local family planning clinic. Hopefully, since it never happened before, this is an isolated episode of ovulation-linked spotting.
Dear An: A literature search at the National Library of Medicine site yielded 118 citations on edema (swelling) following treatment for varicose veins. Here is the most recent of those:
Phlebology. 2012 Mar;27 Suppl 1:139-42. Lymphatic complications after varicose veins surgery: risk factors and how to avoid them. Pittaluga P, Chastanet S. Source
Riviera Vein Institute, Nice, France. firstname.lastname@example.org
Lymphatic complication (LC) after varicose veins (VVs) surgery is an annoying event with a variable frequency in the literature. METHOD:
Retrospective study reviewing all surgeries carried out for VVs from January 2000 to October 2010. Postoperative LC we reported: lymphatic fistula, lymphocele including the minor ones and lymphoedema [SWELLING---JHH>. RESULTS:
During the period studied, 5407 surgical procedures for VVs were performed in 3407 patients (74.7% women) with a mean age of 53.4 years. A postoperative LC occurred in 118 cases (2.2%): lymphocele on limb in 1.3%, inguinal LC (fistula or lymphocele) in 0.7% and a lymphoedema in 0.2%. The population with a LC was older (59.6 vs. 53.3 years, P < 0.05), had a higher frequency of C4-C6 (22.0% vs. 6.5%, P < 0.05), a higher incidence of obesity (31.4% vs. 5.4%, P < 0.05) and was more often treated by a redo surgery or a crossectomy stripping (48.3% vs. 13.4% and 38.1% vs. 21.8%, respectively, P < 0.05). We have observed a dramatic decrease in incidence of LC after January 2004 (1.3% vs. 5.3%, P < 0.05) corresponding to a new surgical practice for the treatment of VVs: stripping, crossectomy and redo surgery at the groin were less frequent (74.6% vs. 7.7%, 74.6% vs. 0.2% and 11.3% vs. 0.1%, respectively, P < 0.05), while isolated phlebectomy was more often performed during this period (78.4% vs. 8.4%, P < 0.05). CONCLUSION:
LC after VVs surgery is not rare but frequently limited to lymphocele on limbs. Older age, more advanced clinical stage and obesity were associated with a higher frequency of LC. A mini-invasive and selective surgery has significantly reduced the occurrence of LC .
An_250582, it is not clear what type of procedure was used for your surgery. If you feel that your vascular surgeon is not hearing your concern you can certainly choose to get a consult and second opinion from another surgeon who does this procedure.
Dear missjennifer: There is enough hormone in the NuvaRing for four weeks of contraceptive protection. But by this Thursday it should be removed. Then, most likely, you will have some type of bleed just like what you would have had after three weeks of use followed by a week away from the hormones.