What She Needs To Know About Cervical Cancer | Dr. Gloria Ivey-Crowe

January is Cervical Cancer month. The incidence of cervical cancer has decreased more than 50% in the past 30 years because of wide spread screening with the Pap smear. In 1975, the rate was 14.8 per 100,000 women in the United States. In 2006, it had been reduced to 6.5 per 100,000 women. Death from cervical cancer has also decreased significantly. The American Cancer Society estimated that in 2009, there were about 11,000 new cases of cervical cancer and about 4,000 deaths from the disease. Of the 11,000 new cases that were diagnosed, it is estimated that 50% of those women had never had a Pap smear done and another 10% had not been screened within the past 5 years.

The Pap smear is a screening test for cervical cancer. The test is performed in your healthcare provider’s office. The Pap smear is obtained when your healthcare provider performs a pelvic examination and inserts an instrument referred to as a speculum inside the vagina. The speculum may be either made of metal or plastic. The speculum opens the vagina and once it is properly positioned, allows the healthcare provider to see the cervix. The cervix is the lower portion of the uterus and contains cells on the outside and inside that are taken for further evaluation. The cells are removed with a brush that contains bristles and a flat spatula. These cells are suspended in fluid and sent to the lab.

The American Congress of Obstetricians and Gynecologists (ACOG) recommends that screening start at age 21. How frequently a Pap smear is performed is determined by the age of the patient, onset of sexual activity, prior abnormal results, medical problems that may require more frequent surveillance, and/or use of contraceptives. The interval can be increased to every three years in the woman who has had three consecutive normal Pap smears.

The causative factors for cervical cancer include exposure to the human papilloma virus (HPV), early sexual activity, cigarette smoking and multiple sexual partners. Preventive measures include use of condoms, monogamous relationships and early administration of the HPV vaccine. To date, more than 100 strains of virus have been identified. The recommendation is that both females and males are vaccinated prior to exposure to sexual activity.

New recommendations require that all persons 30 years of age and older be tested for the presence of low or high risk viral strains along with the standard screening of the Pap smear and appropriate management recommended. The risk of cervical cancer decreases with age. ACOG recommends that women continue screening until they reach 70 or have a hysterectomy which is the removal of the cervix and uterus.

The key to prevention is being consistent with your appointments and early detection of any abnormalities which may increase your risk of cervical cancer. Cervical cancer usually has no symptoms. You may feel perfectly well. However, abnormal bleeding not related to any other known causes such as fibroids, hormonal abnormalities, cervical or uterine polyps, may be a sign. Other signs include bleeding between cycles, pelvic pain, discharge with a foul odor.

The treatment for cervical cancer varies depending on the stage of cancer. It could be surgical, radiation, chemotherapy or a combination of all three. The more advanced the cancer, the more treatment required.

Your healthcare provider will determine the schedule for your routine screening. The staff at any of our locations in Reston, Ashburn or Chantilly are available for any of your healthcare needs.

What’s Up With Your Cycle? | Dr. Gloria Ivey-Crowe

The average menstrual cycle is 21 – 30 days. What is normal for one may be abnormal for another. When women are asked about the quantity of blood they lose each month, here’s where women differ on what they perceive as normal and regular. Experience teaches as beauty is in the eyes of the beholder, so is what constitutes normal and heavy bleeding.

Questions about the normalcy, frequency, duration and quantity of bleeding during the menstrual cycle is crucial information when identifying and determining the cause of menstrual irregularities.

Longer, shorter, heavy or scant cycles are considered menstrual irregularities. Most menstrual irregularities do not pose a problem to a woman’s overall health. However, prolonged irregularities may present health problems and need to be identified and corrected as soon as possible. Some solutions require no intervention while others require either a conservative or surgical approach.

The average amount of blood loss per cycle is 80cc. Many women experience much more blood loss than this each month on a regular basis. Although this amount of blood may be predictable and occurring with regular frequency, it is abnormal and may pose a serious health problem.

Identifying the cause of menstrual irregularities requires a good history, examination, blood work, pelvic sonogram and in some cases an endometrial biopsy or D&C (dlation and currettage). More common causes of menstrual irregularities are hormone imbalance, presence of endocervical/uterine polyps, fibroids, ovarian cysts, endometrial thickening, endometrial thinning or cancer.

HORMONAL IMBALANCES

Estrogen

It is not uncommon for women with more fuller figures to experience menstrual irregularities because of the presence of excess estrogen. Excess estrogen is found in adipose tissue as well from taking of exogenous estrogen from over the counter products. Women with too little or estrogen deficiencies may experience scant or no bleeding at all.

Progesterone

Progesterone helps regulate the effects of estrogen. Excess progesterone does not affect the cycle and causes breast tenderness, anxiety, depression, bloating and decreased libido. Not enough progesterone is more common and can cause problems with ovulation and therefore fertility. Too little progesterone will cause estrogen to be the more dominant hormone. This dominance of estrogen leads to excessive growing of the lining or endometrium and therefore more tissue to release during the menstrual cycle. This excessive tissue is seen as heavier bleeding, more blood clots and more blood loss.

Testosterone

Too much testosterone is associated with polycystic ovarian syndrome. The hallmark of this disorder is very irregular cycles, weight gain and excessive body hair.

Prolactin

Prolactin is the hormone responsible for milk production and lactation. Too little can lead to breastfeeding problems. Too much prolactin increases milk production but also shuts down the menstrual cycle. Excessive prolactin may also be due to pituitary tumors which are usually benign.

METABOLIC IMBALANCES

Thyroid

Women with both underactive (hypothyroidism) and overactive (hyperthyroidism) may experience menstrual irregularities. Therefore maintaining thyroid hormones in balance will help with regulation of the menstrual cycle.

Diabetes

Women with diabetes may also experience menstrual irregularities. Women may have irregular cycles, heavier periods, delayed onset and early menopause.

POLYPS, FIBROIDS, CYSTS

99% of the time, polyps in the cervix or uterus are benign in nature. Their significance is not the same as polyps in the colon. Excessive or overgrowth of the endometrium may result in the creation of a polyp and bleeding abnormalities.

Ovarian Cysts

The presence of ovarian cysts may lead to menstrual irregularities. Intact ovarian cysts may cause a variety of symptoms to include no symptoms, pain, or no cycles. If the cyst ruptures the amount of bleeding can be scant or excessive. Cysts may require observation only with no treatment, hormonal suppression with birth control pills, or surgical intervention with aspiration or if very large actual removal of the ovary.

Fibroids

More common causes of excessive bleeding is the presence of solid masses in the uterus referred to as fibroids. Fibroids are smooth muscle tissue that vary in size from mere millimeters to large oversized masses. The location of the fibroids is the main factor that impacts the amount of bleeding. The size of the fibroids impacts the amount of bloating, pain or discomfort a woman may experience.

Intramural fibroids are located in the muscle portion of the uterus and have very little effect on the amount of bleeding. Subserosal fibroids are located just beneath the surface of the uterus and also have very little impact on bleeding experienced. Submucosal and intracavitary fibroids are located within or protrude into the endometrial cavity and have a significant impact on bleeding. Pedunculated fibroids hang off the uterus and don’t affect bleeding.

Fibroids may be managed conservatively or surgically. Conservative management includes observation, application of cold or heat, or diminishing blood supply to the uterus (uterine artery embolization). Cold or hot probes can be inserted directly into the fibroid to shrink the fibroid.

Surgical removal of fibroids requires a myomectomy. Smaller submucosal fibroids can be destroyed with a hysteroscopic myomectomy or endometrial ablation. Larger fibroids are best removed with either an open or laparoscopic myomectomy.

Thickened Endometrium

Thickening of the endometrium over time can cause very heavy bleeding where a woman is needing to change her pad or tampon every hour. This amount of excessive bleeding lasting longer than a few hours to days can prove to be a health problem. Rapid loss of a large amount of bleeding over a short period of time or even loss of moderate amounts over a longer period of time may lead to anemia.

Anemia from acute or chronic blood loss may lead to fatigue, dizziness, headache, poor blood blow and ultimately excess stress on the heart. Treatment of minor anemia may require iron supplements whereas anemia which is symptomatic may require blood transfusions.

Thinning Endometrium

Thinning of the endometrium due to less estrogen causes the lining to be fragile and undergo some breakage which may cause irregular bleeding. This less estrogen may be physiologic and due to perimenopause where the amount of hormone produced by the ovaries is diminished or in menopause the production has ceased.

Cancer

Cervical cancer may present with abnormal bleeding. More commonly heavy bleeding or any abnormal bleeding that occurs after menopause may indicate endometrial cancer. All abnormal bleeding should be investigated with a possible endometrial biopsy.

The menstrual cycle and medical history are important components of a woman’s history and may prove to be the important link to solving your medical dilemma. Be sure to alert your healthcare provider to menstrual irregularities; especially any that lead to heavy and prolonged bleeding.

Ovarian Cancer: Are You Aware? | Dr. Gloria Ivey-Crowe

loudounseptoct2016_page_10Approximately 14,270 women died in 2014 from ovarian cancer. Most new cases of ovarian cancer are at a Stage 3 at the time of diagnosis, at which time the cancer has spread beyond the ovaries to the lymph nodes and outside the pelvis. Ovarian cancer ranks fifth in cancer deaths among women. Estimates for 2015;

21,290 NEW CASES – most in women over the age of 63

14,180 DEATHS

Risk factors for ovarian cancer include: family history of breast or ovarian cancer, personal history of cancer, women over the age of 55, women who have never been pregnant, women on hormone replacement therapy. Any women with a first degree relative (mother, daughter, or sister) with ovarian cancer may also have an increased risk. Women with the BRCA1 or BRCA2 gene have an increased risk of developing ovarian cancer.

The symptoms of ovarian cancer may be very subtle and confused with other illnesses. The more common symptoms associated with ovarian cancer are: bloating, pelvic or abdominal pain, difficulty eating or feeling full quickly or urinary urgency or frequency. Other related symptoms include shortness of breath, nausea, indigestion, gas, constipation or diarrhea. Diagnostic testing includes an ultrasound, CT or MRI, and blood level of CA-125. Early diagnosis, early cure!

Woman to Woman: Let’s Talk Teens & STDs | Dr. Gloria Ivey-Crowe

LoudounMayJune2016HighResNoBleeds_Page_12The inspiration for my articles comes from not only my patients, but also reviewing the health awareness calendar and perusing what health issue will be highlighted during the upcoming months. I find myself wondering who chooses what topic, why this month, why these days and why not this topic? Some months are jam-packed with awareness and some months only acknowledge a few awareness topics during the month – although there a many more days in the month with no awareness.

This May and June, the calendar is booked solid with awareness activities – so many I found it hard to make a selection. Are we more aware or open to issues in the Spring, is there less clutter in our lives or do we lose some of the awareness because we have too much going on in our lives? I chose to discuss two topics that we don’t discuss openly but still go hand in hand. April was Sexually Transmitted Disease Awareness Month. How many of you knew that?

Probably, not many because you are not worried about that ever happening to you or maybe just don’t even care. Regardless, I’m sharing a few statistics with you:
• Half of all people will have an STD/STI (Sexually Transmitted Infection) at some point in their life;
• There are 19.7 million STD/STIs each year! 1:4 teens will contract a STD
• Only 1/3 of physicians routinely test for STDs
• Not all STDs are reported therefore the numbers are higher. 15% of women who are infertile have tubal damage from having had an extensive pelvic infection.

How many STDs do you know about? If we took a poll the list would be different depending on the generation you asked. Even though we don’t hear about them, doesn’t mean they have been eradicated and don’t infect people anymore. Let’s test your knowledge:

• Gonorrhea
• Syphilis
• Chlamydia
• Hepatitis B
• Crabs
• Herpes
• HIV
• HPV (Human Papilloma Virus)
• Trichomonas

LoudounMayJune2016HighResNoBleeds_Page_13The symptoms for these infections vary and in some instances are nonexistent. The result of these infections can be life altering and devastating. Sexually transmitted infections commonly affect ages 15-35 but it is not uncommon to find these infections in our nursing homes as well. Yeah, they still are “doing it” at that age and more so without fear and therefore no use of condoms or protection. Someone you know had one, has one or doesn’t even know they have one. How many ladies have been told that their pap smear came back ok except that it showed the presence
of a virus called HPV? This STD is on the rise as compared to others. It may not be one of those other “bad” ones on the list, but did you know that there are over 100 different strains of this virus and that more than 10 of them have been linked to cervical cancer. This STD/STI is one of those quiet ones that can sneak up on you with no warning No bells or whistles or should I say drips, discharges or bumps to let you know its time for me to see my healthcare provider. A pap smear screens for cervical cancer and although dreaded by most women, this quick and simple test saves lives.

Although the treatment in most cases is very simple and may only require antibiotics; prevention of STDs/STIs is the key. How do we prevent STDs/STIs: dare I say abstinence and risk being stoned? Since that’s not an acceptable option for many, use of a condom or barrier methods of contraception would prove to be useful. Use of condoms is not 100% since the spread of infection can be via sexual, oral or other intimate contact. The use of condoms and barrier methods have proven effective in decreasing the acquisition and spreading of STIs.

The non-use of condoms not only leads to infection but pregnancy as well. May is Teen Pregnancy Prevention Awareness Month. Here are a few statistics:
• US has the highest teen pregnancy rate
• In 2012 86,000 teens ages 15-17 gave birth
• 77% of teen pregnancies are unplanned 30% end in abortion
• Interesting statistic: 82% of teens felt that teens should not have sex.

Both of these topics require some consideration and education and prevention is the key. Teen pregnancy makes us aware of so much inadequacy with regards to our teen population. Have we failed them with education regarding prevention, complications, abstinence, or contraception? Surely with statistics like that, they don’t know enough to protect themselves from disease or pregnancy.

Loudoun and surrounding counties are plagued with, dare I say, sex trafficking which makes awareness more paramount. One person sleeps with this person unprotected who has sexual relations with that person and who has sexual relations with the next one. Women you can’t judge a book by its cover or in this case no cover.

Here’s my advice, use condoms, get tested, require your partner get tested before engaging in any activities. Many of us have teenage kids or know teenage kids; look out for signs of possible sexual activity, educate them about engaging in early sex, talk to your healthcare provider for more information. Also let’s make sure our education system provides the education needed for our young kids. For those who feel if you offer info on contraception you are encouraging them to do it, remember knowledge gives us power. We may not always exert that power but no awareness leaves us vulnerable to so much more.

Don’t let our kids know more than we do. Start the conversation, listen and be proactive. Let them know if they don’t feel free to talk to you find someone who they can. Educate yourself on these diseases and don’t be afraid to entertain the thought that there are other issues on a deeper level which causes teens to seek affection and attention.

May is also Women’s Health Awareness Month. It goes without saying every day we should be aware of our health. Our number one killer of women is heart disease. Prevention with exercise, nutritional and lifestyle changes are just the start.  See a nutritionist, walk with a friend, enroll in a gym and get fit! Need help with weight loss call us to discuss our Serotonin Plus weight loss
program and watch those pounds drop off!

By Dr. Gloria Ivey-Crowe
Women Physicians of Northern Virginia
46179 West Lake Drive, Suite 350
Sterling, VA 20165
www.womenphysicians.org

It’s A Mood Thing! | Dr. Gloria Ivey-Crowe

LoudounJulAug2015_Page_12Why is it that people around us can tell when it’s “that time of the month?” Do we look different, smell different, act different or what? If we took a poll and asked people the answer to that question most would respond: SHE ACTS DIFFERENTLY. Ever wondered why that is or what is actually happening during this time? No, your body has not been taken over by “Body Snatchers” and invaded by an alien. Most women admit they don’t feel like their usual selves and feel as though they are someone else. They don’t like what they are feeling, but still can’t seem to stop the behavior or outbursts. Why is that?

Let’s talk a little anatomy and physiology. Yeah, we had to learn it, but I’m going to give you the Cliff Notes. An average menstrual cycle is 21-30 days. Most fall in the average of 28 days with two phases: follicular and luteal. During the first or follicular part of the cycle, the follicle or egg starts to develop and the uterine lining grows anticipating implantation. The second phase or luteal phase is when the egg is released or ovulated. If the stars are in alignment, the egg and sperm meet and become one, traveling down the yellow brick road to the uterus where implantation occurs. 9 months later, you get a baby!

Both of these phases are controlled by a combination of Estrogen, Progesterone or Testosterone. Most problems with bleeding, mood, irregular cycles, infertility, no cycles, can be traced back to problems with the levels of your hormones. However, we commonly associate our moods to that time of the month. So what’s really going on here?

There is a condition we know as PMS (premenstrual syndrome) and PMDD or premenstrual dysphoric disorder. Most women are familiar with PMS. PMDD is a more serious form of PMS. Both are characterized by symptoms that usually occur 7 to 10 days before the start of the menstrual cycle and a few days when it starts. Women feel bloated, have mood changes, breast tenderness, fatigue, sleep changes such as insomnia and eating changes. You are not alone when you feel like you just got to have some chocolate or CARBS! Physical symptoms may also include joint or muscle pain, headache, weight gain due to fluid retention, acne and changes in bowel habits such as constipation or diarrhea.

Mood changes are common and no doubt is what puts folks on alert that your cycle is coming. The mood changes may be irritability, labile moods,
sadness, anxiety, depression, anger or any combination of these. These changes are occurring in most instances during the luteal phase when the predominant hormone is progesterone. Hence why some women will get relief with the use of progesterone supplements during this time.

LoudounJulAug2015_Page_13Sadness, feeling down, overall dysphoria and even depressed moods can be related to hormones or low levels of serotonin. Serotonin is a neurotransmitter released in the brain. Low levels of serotonin may be associated with dysphoria, sadness or depression, so we can use supplements such as St. John’s Wort and SSRI’s. SSRIs or selective serotonin uptake inhibitors are a class of meds which make serotonin last longer.

Common medications in this class are Prozac, Zoloft, Effexor, Lexapro, Celexa, etc. A common one is Serafim or Prozac, dosed in smaller amounts than what is used for depression and has been very helpful with the control of mood swings and premenstrual emotions. There is help. SSRIs, progesterone creams and even birth control pills can regulate the imbalance. St John’s Wort, Chasteberry and essential oils all may be helpful, and exercise is always beneficial. For those who become totally debilitated by this time of the month, PMDD is the likely diagnosis and a combination of natural supplements, antidepressants, exercise and meditation may prove helpful.

Anxiety or anxiousness is normally felt by everyone at some point. However, when anxiety interferes with the ability to lead a normal life, it may become necessary to seek professional help. Anxiety may present as panic, phobias or fears, or social anxiety. Anxiety which is debilitating and paralyzing is a mental illness and requires further diagnosis. Anxiety associated with PMS or PMDD is short lived and not as overwhelming as it resolves itself after the menstrual cycle starts. Anxiety may present as feelings of fear, problems sleeping, cold or sweaty hands, shortness of breath, heart palpitations, dry mouth, inability to be still and calm, numbness or tingling in the hands or feet, nausea, muscle tension and dizziness. Triggers for anxiety may be caffeinated beverages such as energy drinks, coffee, tea, or chocolate.

So now you know there is no NEON sign flashing DANGER AHEAD! To know is to be forewarned. Speak with your healthcare provider for help and further recommendations.

Dr. Gloria Ivey-Crowe
Women Physicians of Northern Virginia
www.womenphysicians.org

How Many Pounds Have You Lost? | Women Physicians of Northern Virginia

LWMMarchApril2015small_Page_12It’s now March and if you set health and fitness goals in January, you should be able to see some results from those efforts. Hopefully, you are starting to see some inches fall off and your clothes fitting a little differently, or you’re breathing a little easier with less knee pain.

Maybe you are still trying to get it together and move money through your FSA to accommodate your new fitness plan, or just plain having trouble taking the steps or time necessary to facilitate a change. Whatever your reason for not getting started, you still have time before those coats come off. There’s no time like the present.

Everywhere you look, there’s an advertisement about the quick success with SP or the “Skinny Pill,”and we can’t wait to see results with an INSTAGRAM-like picture of weight loss. 50-60 pounds has have crept up over a couple of years but,my gosh, we want it off in one month; a month with no other lifestyle adjustments. Think about how little information is available about the long-term effects of SP – does that sound like a smart plan?

The best fitness plan should include behavior modification; a dietary review and the help of online APPs and a nutritionist. Plus, we should consider exercise with the help of a personal trainer and supplements to provide vital vitamins and nutrients. We don’t usually think of the benefits of these changes unless we are already facing medical problems. However small changes in nutrition and exercise can have large effects on medical conditions such as pre-diabetes, diabetes, hypertension, metabolic syndrome and high cholesterol.

Any elevation of blood sugar causes the pancreas to release insulin. Insulin goes into cells and binds at its receptor and absorbs carbohydrates (glucose) from the blood. The glucose is then stored in the liver and muscle for use later. Glucose in the form of carbohydrates (simple and complex) is the body’s fuel.

  • Simple carbs cause your blood sugar to spike and then drop down just as quickly, causing cravings for more in just a few hours. Examples of simple carbs are: white rice, white potatoes, sweetened soft drinks, cake, candy, cookies, chips.
  • Complex carbs give you a feeling of more energy, help with weight loss and keep you feeling fuller longer. Some examples of complex carbs are: fresh fruit, vegetables, whole grains, nuts and legumes, yogurt, sour cream, cheese & milk.

Most people are born with a finite amount of insulin. As we age, the body’s receptors may not respond as well to the insulin that is released. This leads to insulin resistance, decreased sensitivity to insulin or Type II diabetes. Individuals with Type II diabetes continue to produce insulin, while individuals with Type I diabetes produce very little or no insulin. Making lifestyle modifications such as nutrition changes and exercise can improve insulin sensitivity for both types.

Lifestyle changes also affect hypertension and high cholesterol. Hypertension or high blood pressure may have multiple causes: genetic, smoking, obesity, kidney disease, age, diet, kidney disease, birth control pills, stress or tumors. In most cases, the cause of high blood pressure is unknown.

High cholesterol may be due to genetic factors, age, sex, family history and BMI (body mass index) with men and postmenopausal women at an increased risk. Total cholesterol values should be less than 200, with “good” HDL values >59 and “bad” LDL values <100 mg/ dl. Triglycerides are fats from the foods we eat and should be less than 150mg/dl. Increased levels of triglycerides are associated with heart disease, stroke and coronary artery disease.

Change is not easy, especially since most of our eating and exercise habits have formed over the years. The results of change are well worth the effort, however. Look at the results of the clients below: these two ladies will be the first to tell you their “change” was a journey that they knew would yield sustainable weight loss for years to come.

Dr. Gloria Ivey-Crowe
Women Physicians of Northern Virginia
703.834.1071
www.womenphysicians.org

Woman to Woman What you Need to Know About Cervical Cancer

JANUARY is CERVICAL CANCER month. The incidence of cervical cancer has decreased more than 50% in the past 30 years because of wide spread screening with the Pap smear. In 1975, the rate was 14.8 per 100,000 women in

the United States. In 2006, it had been reduced to 6.5 per 100,000 women. Death from cervical cancer has also decreased significantly. The American Cancer Society estimated that in 2009, there were about 11,000 new cases of cervical cancer and about 4,000 deaths from the disease. Of the 11,000 new cases that were diagnosed, it is estimated that 50% of those women had never had a Pap smear done and another 10% had not been screened within the past 5 years.

The Pap smear is a screening test for cervical cancer. The test is performed in your healthcare provider’s office. The Pap smear is obtained when your healthcare provider performs a pelvic examination and inserts an instrument referred to as a speculum inside the vagina. The speculum may be either made of metal or plastic. The speculum opens the vagina and once it is properly positioned, allows the healthcare provider to see the cervix. The cervix is the lower portion of the uterus and contains cells on the outside and inside that are taken for further evaluation. The cells are removed with a brush that contains bristles and a flat spatula. These cells are suspended in fluid and sent to the lab.

American Congress of Obstetricians and Gynecologists recommends that women continue screening until they reach 70 or have a hysterectomy which is the removal of the cervix and uterus.

The American Congress of Obstetricians and Gynecologists (ACOG) recommends that screening start at age 21. How frequently a Pap smear is performed is determined by the age of the patient, onset of sexual activity, prior abnormal results, medical problems that may require more frequent surveillance, and/or use of contraceptives. The interval can be in- creased to every three years in the woman who has had three consecutive normal Pap smears.

The causative factors for cervical cancer include exposure to the human papilloma virus (HPV), early sexual activity, cigarette smoking and multiple sexual partners. Preventive measures include use of condoms, monogamous relationships and early administration of the HPV vaccine. To date, more than 100 strains of virus have been identified. The recommendation is that both females and males are vaccinated prior to exposure to sexual activity.

New recommendations require that all persons 30 years of age and older be tested for the presence of low or high risk viral strains along with the standard screening of the Pap smear and appropriate management recommended. The risk of cervical cancer decreases with age. ACOG recommends that women continue screening until they reach 70 or have a hysterectomy which is the removal of the cervix and uterus. The key to prevention is being consistent with your appointments and early detection of any abnormalities which may increase your risk of cervical cancer. Cervical cancer usually has no symptoms. You may feel perfectly well. However, abnormal bleeding not related to any other known causes such as fibroids, hormonal abnormalities, cervical or uterine polyps, may be a sign. Other signs include bleeding between cycles, pelvic pain, discharge with a foul odor.

The treatment for cervical cancer varies depending on the stage of cancer. It could be surgical, radiation, chemotherapy or a combination of all three. The more advanced the cancer, the more treatment required.

Your healthcare provider will determine the schedule for your routine screening. The staff at any of our locations in Reston, Ashburn or Chantilly are available for any of your healthcare needs.

www.womenphysicians.org
(703) 834-1071 for an appointment

Screen Shot 2014-01-08 at 8.10.55 AMDr. Gloria Ivey-Crowe received her M.D. de- gree from Georgetown University School of Medicine and did her residency train- ing in Obstetrics & Gynecology at George- town University Hospital. She is affiliated with the Women Physicians of Northern Virginia, an all female medical team, with offices in Reston, Ashburn and Chantilly/South Riding. Dr. Ivey-Crowe has three children. In her spare time she enjoys needlecraft and reading.

Woman to Woman – A closer look at a woman’s monthly menstrual cycle

Whether a routine or emergency visit to your healthcare provider, radiological testing, eye examinations, or a visit to the dentist, female patients are usually asked about their menstrual cycle. When did it first start (menarche), how often does it come, what is the flow like, heavy or light, and most importantly what is the date of the last menstrual cycle? How detailed the questioning will be depends on age, presence or absence of symptoms, bleeding or the lack thereof.

Over the last decade, the age of menarche has been decreasing. African American girls are starting as early as 8 years of age and the mean age for White females is 9 years of age. This decreasing age has been attributed to our increase intake of animal meat that has been injected with hormones to enhance growth. This increase in hormone, stimulates the hypothalamus-pituitary axis much sooner than expected. The ovary is stimulated much earlier, to do what is was made to do: release of an egg with the intent to procreate. This excess hormone is stimulatory to an already immature system and may signal the start of menstrual cycles.

What is too little or too much and possible causes will vary depending on the age of the female. Bleeding in females less than 21 usually is not worrisome and may simply represent cycles that have not become regular or problems with clotting. Further evaluation no matter what the age, may require additional history taking, and/or diagnostic testing to determine a possible cause. However, some of the other causes of bleeding such as pregnancy, pregnancy complications such as an ectopic or miscarriage, ovarian cysts, vaginal infections, tumors, polyps, fibroids, sexually transmitted infections, cancer of the cervix, uterus, vagina or vulva, fluctuating hormone levels, or vaginal injury, weight loss or gain, thyroid and pituitary conditions, complications of intrauterine devices, bleeding disorders, complications associated oral contraceptives, structural problems with the uterus require additional testing.

During a normal menstrual cycle, females lose a few teaspoons of blood or 10 to 80cc per cycle. The length of the cycle may vary from every 21-35 days. Cycles that occur every 21 days or less is described as polymenorrhea. Cycles that occur more than 35 days is described as oligoovulation or oligomenorrhea.Cycles for more than three months is referred to as amenorrhea. Bleeding outside of these parameters may warrant further evaluation by your healthcare provider.

Although your menstrual cycle may occur regularly, the amount of the flow may be abnormal. The frequency of your cycle as well as too much or too little flow may require further evaluation. A woman’s ovary produce estrogen, progesterone and testosterone. Each of these hormones has a different effect on your menstrual cycle. Estrogen is stimulatory and makes the endometrium or lining of your uterus grow. An increase in estrogen may cause too much growth of the endometrium. This can cause bleeding when you are not on your cycle as well as a heavier cycle.

Although a large amount of estrogen is produced in the ovaries, it is also produced in the adrenal glands as well as the skin where it is converted from testosterone. The reverse is true as well; not enough estrogen and there will be little to no growth of the endometrium. No growth of the endometrium will be evident by no regular cycle as well as very little flow. Progesterone is responsible for ovulation, maintaining a pregnancy until about 10 weeks gestation when the placenta can take over production, and keeping the effects of estrogen to a minimum. Estrogen stimulation left uncontrolled by progesterone may lead to overgrowth or thickening of the endometrium referred to as hyperplasia and in turn to endometrial cancer. Too much progesterone may lead to common symptoms of premenstrual syndrome such as feeling bloated, mood swings, weight gain, breast tenderness. The effects of low levels of progesterone may include irregular cycles, or spotting, Testosterone is necessary for estrogen production. High levels increase estrogen production and in turn the levels of progesterone are low. This may evident by lack of cycles, increase in hair growth (hirsutism), oily skin, and loss of hair around the temporal area. Therefore, women with high testosterone will not ovulate or release an egg as evident by irregular or absent cycles. Any of these imbalances may affect your menstrual cycle and the amount of blood flow.

To further discuss bleeding, your cycle or other women’s health care issues, the staff at Women’s physicians are available Monday – Friday at one of our three northern VA offices.

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Call (703) 834-1071

Dr. Gloria Ivey-CroweDr. Gloria Ivey-Crowe received her M.D. degree from Georgetown University School of Medicine and did her residency training in Obstetrics & Gynecology at Georgetown University Hospital. She is affiliated with the Women Physicians of Northern Virginia, an all female medical team, with offices in Reston, Ashburn and Chantilly/South Riding. Dr. Ivey-Crowe has three children. In her spare time she enjoys needlecraft and reading.

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