PMS is common – 80% of women report symptoms that occur during their cycle that “forecast” the start of their period and 40% of women seek medical assistance for their symptoms. These symptoms include: depression, angry outbursts, irritability, anxiety, social withdrawal, breast tenderness, bloating, headaches, and swelling.  Sound familiar?

When these symptoms happen most months but go away within the first few days of bleeding, you probably fit the diagnosis of mild to moderate premenstrual syndrome. However a small percentage of women do experience symptoms that impact their daily lives.  These women experience fatigue or sometimes, insomnia, extreme changes in appetite, severe anxiety, difficulty concentrating, and/or a marked decreased interest in normal home and work activities. This may be a more serious condition called Pre-menstrual Dysphoric Disorder or PMDD.

What causes this?
As with many complicated disorders, researchers don’t really know what causes premenstrual syndromes.  The current consensus among researchers is that PMS and PMDD are probably caused by normal hormone functions in a woman and are not hormonal imbalances. There may be some link between the sex hormones (estrogen and progesterone) and neurotransmitters like serotonin, but the research continues.

How do I know if I have PMS or PMDD?
There is no specific blood test to diagnose PMS or PMDD. Your provider will do a routine exam to check for any abnormalities that may be causing your symptoms, such as a thyroid disorder or depression.

The best thing that you can do to help your provider is to keep a diary of your symptoms. There are several tools available (i.e. Calendar of Premenstrual Experiences ) to help you keep a daily record and to help you and your provider develop a treatment plan.

Is there anything that will help my symptoms?
There are several changes that you can make on your own to try and improve your PMS symptoms, including dietary changes and vitamin supplements. Dietary changes include: decreasing or avoiding caffeine intake, eating a balanced diet, adequate water intake, and decreased high-salt foods. There are some vitamin and mineral supplements that have been researched and are thought to help as well.

Alternative therapies that help many women include relaxation techniques, guided imagery, yoga, aerobic exercise, and massage/reflexology. These activities all help in stress reduction which may improve PMS symptoms. Your provider may also recommend a psychiatric professional in certain cases, which has proven very helpful in teaching coping skills to deal with the cyclic changes that are happening.

There are also several prescription drug options that you and your provider may consider.

You are not ALONE!
It is okay to ask for help with your PMS symptoms. There is no magic pill to fix PMS, but you and your provider can work together to stop PMS from interfering with your life.

By:  Allison Nissen, CNM

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What is it?
Polycystic ovarian syndrome is a common hormonal disorder that is clinically characterized by irregular menstrual cycles, lack of regular ovulation, abnormal facial hair growth, infertility, obesity and polycystic ovaries (enlarged, cystic ovaries). This disorder affects approximately 6% of all reproductive age women. Recent evidence indicates that polycystic ovarian syndrome is a disorder characterized by insulin resistance and a compensatory elevated insulin level, which are found in both the overweight and non-overweight women with the syndrome.

Diagnosis
The diagnosis of polycystic ovarian syndrome is typically made by your physician by taking your history, doing a physical exam, performing an ultrasound and measuring some of your hormone levels. Once the diagnosis is established treatment options can be discussed. If you are not trying to get pregnant the best therapy is weight reduction if you are overweight and birth control pills to regulate your menstrual cycle. 

Treatment
Traditional therapy for women with infertility secondary to polycystic ovarian syndrome has been ovulation induction using clomiphene citrate as a first line agent. Due to this recognition regarding insulin levels and resistance, the use of insulin sensitizing agents such as metformin (Glucophage®) for ovulation induction have recently been studied with promising results. Frequently clomiphene citrate and metformin are used together. Insulin-lowering agents for ovulation induction in women with Polycystic Ovarian Syndrome are an attractive alternative due to their low cost, minimal side effects and decreased risk for multiple pregnancies compared with other agents.

Since the use of metformin for ovulation induction in women with polycystic ovarian syndrome is relatively new, the best method for ovulation induction is yet to be determined. The physicians at MUSC and Southeastern Fertility Center individualize patient care and your treatment may involve the use of metformin alone or in combination with other medications.

by:  John Schnorr, M.D.

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IUDs are the most effective birth control method. Unfortunately, some women are afraid to use the IUD because of incorrect things they have heard from friends or in the newspaper. Here are the answers to some of the most common questions I get about the IUD.

What is an IUD?
IUD stands for Intrauterine Device. It is a small device in the shape of a “T” that is placed in the uterus during an office visit. There are two kinds of IUD.
• The Copper IUD has no hormones but instead uses copper to stop a pregnancy from occurring. It can stay in for 10 years.
• The Mirena IUD releases the hormone levonorgestrel (same as in some birth control pills) into the uterus to stop pregnancy from occurring. It can stay in for 5 years.

How does the IUD stop pregnancy?
IUDs may work in more than one way. Studies suggest that IUDs interfere with the sperm’s ability to reach the egg.

How well do IUDs work?
IUDs are as good at preventing pregnancy as getting your tubes tied. If 100 women use the IUD for one year, only 1 woman will get pregnant. Unlike getting your tubes tied, you can still get pregnant after using an IUD.

What are the side effects of IUDs?
The copper IUD may cause some women to have more bleeding during and between their periods. It may also cause some more cramping in the first few months that you use it.

The Mirena IUD also causes some irregular bleeding during the first few months of use. After that, many women have very light bleeding or no bleeding at all.

Does the IUD cause serious infection?
No. If you have an infection like gonorrhea or Chlamydia when the IUD is put in, you may be at increased risk for infection during the first month that you are using it. This is why your doctor may want to screen you for infection before placing the IUD. After that, your risk is similar to that of the general population.

Will the IUD make me sterile?
No. Most women who have their IUD removed are able to get pregnant quickly if they don’t start another birth control.

Can I still get an IUD even if I haven’t given birth before?
Yes. Even women who have never been pregnant or given birth can safely have an IUD.

by:  Angela Dempsey, M.D.

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There is no doubt that the most effective way to prevent unplanned pregnancy is to use birth control before having sex. However, occasionally, women find themselves in a situation where they need a back up method after unprotected sex. Maybe the condom broke… or you realized you forgot to take your pill yesterday… or you got back with an ex-boyfriend before you restarted your birth control. Things like this happen. Now, there is a birth control designed for use after unprotected sex. Here are some answers to frequently asked questions about Plan B…

How does Plan B (emergency contraception) work?
Plan B contains levonorgestrel, the same hormone found in some birth control pills but at a slightly higher dose. It prevents pregnancy in one of two ways…
1. Keeps the egg from leaving the ovary.
2. Keeps the sperm from meeting the egg.

How can I get Plan B?
If you are over 18 years old, you can ask for it at your local pharmacy. You don’t need a prescription. If you are under 18, ask your doctor for a prescription that you can have with you at home in case you need it.

How do I take Plan B?
Each pack of Plan B contains 2 pills. You take both pills at the same time as soon as possible after unprotected sex. You can take Plan B up to 5 days after unprotected sex but it works best the SOONER you take it.

How well does Plan B work?
If 100 women take Plan B after unprotected sex during the fertile part of their cycle, fewer than 8 will get pregnant. Your chances that Plan B will work are higher the sooner you take it after unprotected sex.

What happens if I get pregnant after taking Plan B?
Plan B does not harm a pregnancy or cause birth defects. If you are pregnant after taking Plan B, see your doctor right away to discuss your options.

Does Plan B cause abortion?
No. Plan B has no effect if you are already pregnant. It prevents pregnancy by keeping the egg from leaving the ovary or by keeping the sperm from meeting the egg.

Can I use Plan B as my primary birth control?
It is not harmful to take Plan B multiple times. However, it is far more effective to prevent pregnancy by using many other forms of birth control before you have sex. Your doctor can help you figure out which birth control might be best for you.

by:  Angela Dempsey, M.D.

Request an appointment with a MUSC provider.

Infertility is very common.  Studies show that approximately one in nine couples in the United States have infertility at some time in their life.  The sad part about those statistics is that only 50% of these patients actually seek treatment.  Of those who do seek treatment, ultimately over 90% will conceive, making it vital that patients with infertility seek treatment.

Infertility is typically defined as one year of regular sexual intercourse without conception.  Signs that infertility may be happening to you would include irregular menstrual cycles in which you actually miss a menstrual cycle for an entire month, significant pelvic pain with your menstrual cycles, a history of sexually transmitted diseases, and/or a prior history of pelvic surgery.

If you are over 35 years of age, there is also mounting evidence that it would be beneficial to you to seek care for infertility if you have been trying to conceive for six months or more.  In women over 35 years of age, we have an increased concern about egg quality and egg number which can be quickly assessed with your OB/GYN.

A frequent comment by patients is that they have been having regular intercourse for several years, however, have not been "trying" to get pregnant.  Studies very clearly show that patients do not need to "try" to get pregnant but rather regular intercourse, once to twice per week, should be adequate for a patient to conceive within a year without another form of birth control.

I look forward to discussing this topic further.

by:  John Schnorr, M.D.

The birth control pill was invented in 1960 and many improvements have been made over the years. Women who are thinking about starting birth control pills have many questions about possible effects. Below are some answers to the most frequently asked questions about the birth control pill.

Will the pill make me gain weight?
The pill does not make you fat. Most women who use the pill do not experience a change in weight. Getting older, exercising less, and changes in your diet are more likely to cause weight gain than your birth control pills.

Will using the pill now hurt my chances of becoming pregnant in the future?
No. The pill works by suppressing ovulation, or the formation of an egg each month. As soon as you stop taking the pill, you will be able to form an egg each month and potentially become pregnant. If you do experience difficulty getting pregnant after stopping the pill, see your doctor because there are other reasons that you might be having difficulty.

What are the side effects of the pill?
Most women do not have side effects while taking the pill. Some women will have nausea and mild headaches during the first few weeks. These side effects almost always go away after the first month and may be better if you take the pill just before going to bed.

If I have bleeding between periods, does that mean the pill is not working?
Some women have small amounts of bleeding between periods called breakthrough bleeding. This is not harmful and usually disappears after the first few months. It doesn’t mean your pill is not working. However, forgetting or skipping pills can lead to breakthrough bleeding and increase your chance of getting pregnant. It is very important to take the pill every day.

Does the pill cause blood clots?
Pills may cause a small increase in the risk of blood clots, but the risk is much less than during pregnancy. Blood clots among healthy women are rare whether or not they take the pill.

Does the pill cause cancer?
Using the pill does not increase your risk of breast cancer and actually protects against cancer of the ovary and uterus. Pap smears and yearly exams are still important when you use the pill.

If you are not happy with the pill for whatever reason, see your doctor to discuss all the other options available for birth control including the ring, patch, injection, implant, and intrauterine device.

by:  Angela Dempsey, M.D.