Women's monthly symptoms may indicate more serious conditions

by Military Health System Communications Office

FALLS CHURCH, Va. — When women think about all the symptoms associated with their monthly period – weight gain, pain, cramps – they may think these issues are just part of being female. But that’s not always the case. During Women’s Health Month, providers stress the first step to finding treatment and easing symptoms is getting evaluated.

“If women have painful periods that impact their lifestyle either at home or at work, such as pelvic pain, painful intercourse, or infertility, they should get evaluated by a gynecologist or doctor,” said Dr. Amy Asato, chief of the women’s health clinic at Fort Belvoir Community Hospital in northern Virginia.

Two common but often undiagnosed diseases many women live with are endometriosis and polycystic ovary syndrome. Neither disease has a specific known cure, but symptom-driven treatment is available.

Endometriosis is a condition that causes the tissue lining to develop outside of the uterus. Endometriosis lesions are typically located in the pelvis, but can occur in other areas of the body where they don’t belong. Air Force Reproductive Endocrinologist and Infertility Specialist Lt. Col. Kathleen O'Leary said genes and other factors can play a role in the cause of endometriosis. The risk increases for women with a family history of endometriosis. Women who started their period before age 11, have a family history of endometriosis, or have short menstrual cycles are at increased risk for the condition. Women who have heavy menstrual cycles that last more than seven days are also at risk.

“Diagnosis can be delayed because many of the symptoms of endometriosis overlap with other gynecological or gastrointestinal conditions,” said O’Leary. Surgery is often required for a definitive diagnosis, but that’s not always the case, she added. “The combination of signs and symptoms and certain imaging studies can be helpful to make a presumptive, nonsurgical diagnosis of endometriosis.”

According to the Department of Human Health Services’ Office of Women’s Health, the most common symptom is pain. This can be experienced as menstrual cramps, lower back or pelvic pain, intestinal pain, bowel movement pain, or pain after sex. Other symptoms include bleeding and spotting, infertility, and stomach digestive problems, such as diarrhea, constipation, or nausea – especially during periods.

Asato said the first line of defense in treating endometriosis is usually hormonal birth control. Other treatment options include over-the-counter and prescribed pain medications and surgery. The severity of the disease and its symptoms doesn’t always correlate with the amount of pain a woman experiences, said Asato. Someone with a severe case of endometriosis may never feel symptoms, sometimes only finding the disease during surgery for something else. Others may present with less severe endometriosis, yet experience more pain. When looking at possible treatments, physicians will consider a patient’s age, desire to have kids, severity of symptoms, and severity of the condition.

Polycystic ovary syndrome, also known as PCOS, is a disorder caused by an imbalance of reproductive hormones, which can prevent a woman’s ovaries from producing eggs normally or releasing eggs during ovulation. According to the Office of Women’s Health, women with PCOS can experience irregular periods, either not knowing when she’ll get her period or missing it all together, which can then cause infertility or the formation of cysts.

“With PCOS, people usually come to us, the gynecologists, because they’re having irregular periods, infertility, or abnormal hair growth,” said Asato. These symptoms often lead doctors to order blood work that shows elevated hormones, she said.

According to the National Institutes of Health, several factors have been found to be related to PCOS. These include insulin resistance, overproduction of male hormones, weight, and family history. Some symptoms include pelvic pain, acne or oily skin, and excess hair growth on the face, chest, stomach, or thighs. NIH describes the most common symptom among women with PCOS as trouble getting pregnant.

“Having knowledge about the signs and symptoms of PCOS and endometriosis can help patients approach their doctors sooner to get evaluated and get symptomatic treatment,” said O’Leary. PCOS can affect reproductive and lifelong health, so getting a timely diagnosis and managing symptoms to prevent associated problems, like diabetes, obesity, and infertility, is important.

Similar to endometriosis, treatment can include hormonal birth control, which helps regulate periods, and anti-androgen medication, said O’Leary. For women who are obese or overweight, losing weight can also help alleviate PCOS symptoms. Women with PCOS who want to become pregnant should speak with their doctors about options, such as ovulation induction and lifestyle changes to help with fertility.

“Some conditions affecting women’s health, like endometriosis and PCOS, should not be taken for granted,” said Asato. “There are symptoms that come up and women will say, ‘Oh, that’s just how it is and we have to deal with it,’ but that shouldn’t be the case. There may be specific issues that are going unrecognized that can actually be treated.”

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