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Dr. Melissa Kushlak on 10 gynecological symptoms you should never ignore

Dr. Melissa Kushlak on 10 gynecological symptoms you should never ignore

Hoping that gynecological symptoms will simply disappear may not be your best strategy. Symptoms, if not treated, can potentially affect your fertility and be harmful to your health. While gynecological issues are uncomfortable to discuss, it’s best not to avoid these conversations.

In her Boulder Community Health (BCH) online lecture, Melissa Kushlak, DO, FACOOG, MPH of Boulder Women’s Care described the 10 Gynecological symptoms that women, no matter their age, should never ignore:

1.Postmenopausal bleeding

2. More than one period a month

3. Heavy periods

4. Missing periods for months

5. Painful periods

6. Vulvar itching

7. Premenopausal painful intercourse

8. Postmenopausal painful intercourse

9. Abnormal lesions

10. Bloating, increasing pant size, difficulty eating—Ovarian Cancer

"It's important to have an exam and share your history with your health care provider if you experience any of these symptoms. Your care provider may order laboratory tests, imaging or want to do further testing based on their findings on exam," said Dr. Kushlak.

Video: Watch “10 Gynecological Symptoms That Should Never Be Ignored”

1. Postmenopausal bleeding

Dr. Kushlak emphasized that the number one symptom that women should never ignore is postmenopausal bleeding. She noted, “There can be many causes. But we never want to ignore this, because it can be an early warning sign of endometrial or uterine cancer.”

Treatment will vary depending on what your evaluation reveals. Dr. Kushlak explained treatments are based on the diagnosis and may include:

  • Pre-cancerous cells or cancer. “Pre-cancerous cells can often be treated medically with progesterone therapy. If cancer cells are found, you’ll be referred to a gynecologic oncologist. If caught early, it can often be treated and cured with surgical and potentially medical management,” Dr. Kushlak stated.
  • Drop in estrogen. If the bleeding is coming from the vagina, rather than the uterus, it may be due to a drop in estrogen resulting in vaginal atrophy. Dr. Kushlak said, “This can be treated with vaginal estrogen therapy. There are also newer vaginal laser treatments available that work well.”
  • Infection. If an infection is present, it will need to be treated.
  • HRT. Sometimes the bleeding is a result of hormone replacement treatment (HRT) dosages needing to be adjusted.
  • Fibroids. Fibroids can cause bleeding and can be treated with medication or surgically, often minimally invasively. Medications don’t eliminate fibroids but may shrink them.
  • Organ disease. Adjacent organs may have a disease that need to be treated.
  • Current medication/supplements. Anticoagulant therapy and dietary supplements may require dosage adjustments.

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2. More than one period a month—Frequent periods

Women do generally visit their doctors when they are experiencing periods more often than normal,” said Dr. Kushlak. There are many reasons this occurs, including a reaction to external sources (hormonal contraception, hormone replacement therapy, Tamoxifen), hormonal imbalance (thyroid disease), structural abnormalities (polyps, fibroids), pregnancy, systemic causes (liver disease, coagulopathy—when the body’s ability to form clots is impaired), or it may be age related (adolescence or perimenopause).

Treatment will vary depending on what your evaluation reveals such as:

  • Polyps and Fibroids. Polyps may need to be removed surgically; this is an in-office procedure. Bleeding associated with fibroids can be treated medically with hormonal contraception. “If we are trying to preserve the uterus, we may perform a surgery to remove the fibroid(s). For smaller and/or easier to reach fibroids it is often possible to use minimally invasive surgery. Minimally invasive surgery avoids a larger incision and speeds up recovery,” said Dr. Kushlak.
  • Hysterectomy. A hysterectomy is a surgical procedure that removes the uterus and cervix. Having a hysterectomy can help you live a more enjoyable life, especially if you suffer from constant pelvic pain or heavy and irregular bleeding. If you're at a higher risk for uterine cancer, a hysterectomy can lower this risk and potentially be lifesaving. However, once the uterus and cervix are removed, women lose the ability to become pregnant, and they will no longer menstruate.

    “There are multiple surgical options. The one that’s right for you depends on various factors, including the size of your uterus. Surgery may be done through the vagina, however there are also minimally invasive robotic and laparoscopic options available,” Dr. Kushlak explained. “Robotics provide greater dexterity and precision for the surgeon.”

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3. Heavy periods

A heavy period is defined as being prolonged or by excessive bleeding. One way to know if you’re experiencing excessive bleeding is if you’re changing your tampon or pad more often than you normally have or if you are using more than one product at the same time.

Causes and treatment are similar to those described for frequent periods.

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4. Missing periods for months

Dr. Kushlak explained that missing a period and not having a period are very different. Often, she is asked by parents, “Is it ok that my that my daughter hasn’t had her period yet?” To this she responds, “If she is 15 or younger, this is normal. If she is older, we will want to look a little further.” She also noted, “It’s important not to ignore missing periods as this can be an indicator of other more serious health issues. The period is considered a vital sign for women.”

For women who have not had a period for three months, or maybe six months if they typically have infrequent periods, “the cause,” said Dr. Kushlak, “is often polycystic ovarian syndrome (PCOS).” There are many treatments available, but they’ll be different for those women who are looking to become pregnant than for those who are not.

Other causes that she noted include:

  • Hyperprolactinemia (high levels of the hormone prolactin)
  • Thyroid disease
  • Primary ovarian failure (also known as early menopause)
  • Intrauterine adhesions (may be caused by a previous surgery)

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5. Painful periods

“Painful periods,” said Dr. Kushlak, “fall into two categories. Emergent and non-emergent.”

Emergent is when you experience significant sharp pain, and this pain often requires an emergency room visit. Causes include:

  • Ovarian torsion (a twisted ovary cutting off ovary blood supply)
  • Ectopic pregnancy (a pregnancy growing outside the uterus)
  • Tubo-ovarian abscess (a pocket of pus that forms an infection of the fallopian tube and ovary)

Non-emergent may be chronic and occur over time. Causes include:

  • Endometriosis (similar tissue that lines the inside of the uterine wall begins to grow outside the uterus)
  • Adenomyosis (uterus glands growing into the muscles)
  • Fibroids
  • Ovarian cysts
  • Infection
  • Urologic causes
  • GI causes

Your health care provider may prescribe medication-based treatments such as pain relievers or hormonal birth control for endometriosis, adenomyosis, fibroids and ovarian cysts. However, surgery may be necessary if you are experiencing ovarian torsion, an ectopic pregnancy, a tubo-ovarian abscess, endometriosis or adenomyosis. Alternative treatments such acupuncture and pelvic floor therapy can also be explored.

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6. Vulvar itching

Dr. Kushlak said, “Vulvar itching can be annoying, however, there are treatments that your health care provider can offer to alleviate the itching.” She added, “On-the-other-hand, this itching can be a sign of more serious conditions that may be pre-cancerous or cancerous.”

Your health care provider may prescribe topical steroids, topical estrogen or infection specific treatments to relieve the itching. In other cases, continued monitoring or surgery may be recommended.

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7. Premenopausal painful intercourse

“Premenopausal painful intercourse,” said Dr. Kushlak, “may occur suddenly or may be chronic. Sometimes the cause is anatomic, or it may result from abuse or stress.”

Anatomic factors include ovarian cysts, endometriosis, and pelvic organ prolapse, which is when one or more of the pelvic organs slip down from their normal position. Other medical conditions that cause painful intercourse include vulvodynia (chronic pain around the opening of the vagina), infection and hormonal contraception.

Medical treatments are an option for many issues. However, depending on the situation, surgery may be necessary. Sex therapy, acupuncture and pelvic floor therapy are some alternative options that are helpful in some cases.

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8. Postmenopausal painful intercourse

“Painful postmenopausal intercourse,” said Dr. Kushlak, “can have medical causes such as atrophy, infection, vulvodynia or anatomic causes, including pelvic organ prolapse or narrowing of the vagina’s opening.” Therapy is similar to those described above for premenopausal painful intercourse, however, vaginal laser treatment may also be a viable option. Dr. Kushlak explained, “Lasers, like the Mona Lisa or Diva laser, can help increase vaginal collagen, strengthen tissues and reduce pain.”

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9. Abnormal lesions

Dr. Kushlak noted you can also have abnormal lesions. She said, “The big takeaway here is that it’s important, just like with self-breast exams, to regularly look and feel to know what is and isn’t normal for your vagina and to let your health care provider know of any changes you notice.”

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10. Bloating, increasing pant size, difficulty eating—Ovarian cancer

“Ovarian cancer is known as the silent killer. Typically, there are no symptoms until the cancer is at an advanced stage,” Dr. Kushlak said. She added, “Your family history -- ovarian, colon, breast cancers -- can give you an indication that you should be screened for ovarian cancer.” Symptoms that are commonly noticed are bloating, suddenly needing a larger pant size, difficulty eating and feeling full quickly.

“If there is a strong suspicion of ovarian cancer, you will be referred to a gynecologic oncologist. Typically, medical treatments such as chemotherapy and radiation combined with surgical treatments will be recommended,” said Dr. Kushlak.

Make an appointment

Dr. Kushlak provides a full spectrum of women’s health services and expertly performs minimally invasive surgery, including da Vinci® robotic-assisted surgery.

Please visit the Boulder Women’s Care website or call 303-747-4280 to schedule an appointment with Melissa Kushlak, DO, FACOOG, MPH.

Click here to view/download a PDF of slides shown during her lecture.

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