What is Pelvic Congestion?

I think the hardest part of being a woman with some struggle (fibroids, PCOS, PMS, Endometriosis etc)  is trying to understand all the things you are going through. Even after you have done surgery to  aid, some times you still struggle and there are times new issues to deal with.

My PMS tends to be different each month. One month it may be serious headaches, others mood swings, but the main problem that I had is lower back pain. This tend to occur monthly and some months worse than others. It starts somewhere deep in my left pelvic, around the hip and into the lower back. I often find it difficult to describe it to the doctor. While there are times it feels like serious pain, most times it is a dull ache and the only thing that seems to sooth it is deep tissue massage which I just want someone to do until I fall asleep.

I have seen many different doctors with my back pain and did several x-rays where nothing abnormal was revealed. I also went through Physiotherapy, but stopped after I was not showing any improvements and they felt that it was a gynecological issue. So I went back to my Gynae and he said, it is pelvic congestion. What is Pelvic Congestion? Here is what I found out:

Pelvic Pain (Pelvic Congestion Syndrome)Ovarian Vein and Pelvic Varices

What is it?

It is estimated that a third of all women will experience chronic pelvic pain during their lifetime.  Chronic pelvic pain is defined as “non-cyclic” pain lasting greater than six months. A multidisciplinary team approach is needed to treat this often complex medical condition. After a physical examination, a Pap test to rule out cervical cancer, and routine laboratory bloodwork, a cross-sectional imaging study is obtained to be certain that there is not a pelvic tumor. If the clinical symptoms are those of chronic pelvic pain, worse when sitting or standing, and sometimes also associated with varicose veins in the thigh, buttock regions, or vaginal area, the possibility of ovarian vein and pelvic varices must be considered.

Source: http://www.hopkinsmedicine.org/interventional-radiology/conditions/pelvic/

Prevalence

• Women with pelvic congestion syndrome are typically less than 45 years old and in their child-bearing years.
• Ovarian veins increase in size related to previous pregnancies. Pelvic congestion syndrome is unusual in women who have not been pregnant.
• Chronic pelvic pain accounts for 15 percent of outpatient gynecologic visits.
• Studies show 30 percent of patients with chronic pelvic pain have pelvic congestion syndrome (PCS) as a sole cause of their pain and an additional 15 percent have PCS along with another pelvic pathology.

Risk Factors

• Two or more pregnancies and hormonal increases
• Fullness of leg veins
• Polycystic ovaries
• Hormonal dysfunction

Symptoms

The chronic pain that is associated with this disease is usually dull and aching. The pain is usually felt in the lower abdomen and lower back. The pain often increases during the following times:

• Following intercourse
• Menstrual periods
• When tired or when standing (worse at end of day)
• Pregnancy

Other symptoms include:

• Irritable bladder
• Abnormal menstrual bleeding
• Vaginal discharge
• Varicose veins on vulva, buttocks or thigh.

Diagnosis and Assessment

Once other abnormalities or inflammation has been ruled out by a thorough pelvic exam, pelvic congestion syndrome can be diagnosed through several minimally invasive methods. An interventional radiologist, a doctor specially trained in performing minimally invasive treatments using imaging for guidance, will use the following imaging techniques to confirm pelvic varicose veins that could be causing chronic pain.

Pelvic venography: Thought to be the most accurate method for diagnosis, a venogram is performed by injecting contract dye in the veins of the pelvic organs to make them visible during an X-ray. To help accuracy of diagnosis, interventional radiologists examine patients on an incline, because the veins decrease in size when a woman is lying flat.

MRI: May be the best non-invasive way of diagnosing pelvic congestion syndrome. The exam needs to be done in a way that is specifically adapted for looking at the pelvic blood vessels. A standard MRI may not show the abnormality.

Pelvic ultrasound: Usually not very helpful in diagnosing pelvic congestion syndrome unless done is an very specific manner with the patient standing while the study is being done. Ultrasound may be used to exclude other problems that might be causing pelvic pain.

Transvaginal ultrasound: This technique is used to see better inside the pelvic cavity. As with a pelvic ultrasound it is not very good at visualizing the pelvic veins unless the woman is standing. However it may be used to exclude other problems.

Treatment Options

Once a diagnosis is made, if the patient is symptomatic, an embolization should be done. Embolization is a minimally invasive procedure performed by interventional radiologists using imaging for guidance. During the outpatient procedure, the interventional radiologist inserts a thin catheter, about the size of a strand of spaghetti, into the femoral vein in the groin and guides it to the affected vein using X-ray guidance. To seal the faulty, enlarged vein and relieve painful pressure, an interventional radiologist inserts tiny coils often with a sclerosing agent (the same type of material used to treat varicose veins) to close the vein. After treatment, patients can return to normal activities immediately.

Additional treatments are available depending on the severity of the woman's symptoms. Analgesics may be prescribed to reduce the pain. Hormones such birth control pills decrease a woman's hormone level causing menstruation to stop may be helpful in controlling her symptoms. Surgical options include a hysterectomy with removal of ovaries, and tying off or removing the veins.

Source: http://www.sirweb.org/patients/chronic-pelvic-pain/

The Horror of Mood Swings

Source: http://www.jonesfamilychiropractic.com/wp-content/uploads/2014/10/mood-swings2.jpg

Of lately, I have been going through some terrible mood swings. It is not that I have never gone through this. In fact, prior to having my baby and while suffering from endometriosis (unknowingly) and fibroids, my periods were very terrible and mood swings were a big part of the package so much so that it appears as normal for at least that part of the month. However, after having a baby and having been placed on birth control pills (Lindynette 20), I was at a place of peace. I wasn't really sure what had help because there are so many stories out there. There are some persons who claim that if you were having terrible period pain, it will go away once you have a baby. The solution to period pain...Have a baby! However, I met others who said that it was not true and since there are really no scientific evidence, I assumed that the no mood swings, little to no period pain, no breast tenderness, no mid-cycle pain had more so to do with the birth control pills rather than just having the baby. Also, partly so because in an attempt to avoid a period one month, I doubled up on the pills, but did not bother to finish the other pack since the occasion that I was doubling up for had passed. Instead, I waited for my period to came, following which I resumed the pill. It seemed as if my hormones went haywire.

Since then, apart from the other effects, I have been experiencing these terrible mood swings and I so decided to do a little blogging.

How is related to the Uterus
While there are may causes of mood swings, including stress and anxiety, drugs and alcohol, depression and bipolar disorder, premenstrual syndrome (PMS), menopause and premenopause are also notable causes. The latter are related to hormonal changes including low estrogen levels, which in many ways are link to issues relating to the uterus.

What are the Symptoms
When does it happen is a question that I can never really answer. You may be going quite well, the previous day or even wake up in a good mood and the next thing you know, your mood just change. Sometimes, you can identify a trigger, for example, something was said or something occured, but most of the times, for me, I am not sure when it happened. Worse, it can occur for a few days. One minute, you are laughing and the next, you are quiet and easily upset. Now imagine if you are married and/or have kids...

What are the impacts?
I think the worse impact for me is trying to maintain my 'sanity' in the midst of my marriage. You may find yourself snapping at your kids or spouse for silly things and as such may negatively affect your relations with your family.

You may become very emotional for absolutely no reason. There are times my mood swings are so terrible that everything just gets to me and arouses my anger. Not simply just one element, but everything. So for example, the house that I just finished cleaning was messed up by my daughter in just a few seconds, but it is not only that, but everything else is racing through your thoughts...the need for vacation, the dishes in the sink, the clothes to fold, the food to cook. Your spouse may try to help by doing some cleaning and folding, but it is not helping. Somehow you prefer him to leave the home with your child/children and just give you the house to yourself. Seeing people may upset you, the bark of a dog may upset you, the loud noises of the neighbour may upset and you know something is wrong because all of these things, on a regular day, will never upset you. Yes, it is indeed the horror of mood swings!

How do you manage it?

I have never sought medical help and if anyone has,I hope you will share your experiences by commenting on this blog, but there are certain little mechanisms I live by.

• I talk less during this period. To talk less prevents me from saying things I will later regret.
• I take space, which at times include a bedroom or bathroom escape. Yes, I will go in there and try to relax. Sometimes I shed a tears for the emotions I cannot understand.
• I find that I also feels better after exercise and I believe that may help if the mood swing is trigger by stress

How do you manage your mood swings?

Can Ovarian cysts cause infertility?

It is a terrible pain to want a child and to have difficulties. I think what is worse is when you have so many questions and so little answers. For example, Why am I not getting pregnant? When a doctor tells you this is normal, that is normal and cannot pinpoint exactly why you are not getting pregnant or why you are miscarrying. It is a large pill to swallow. 

Recently, I have been diving into greater research as I speak to persons and listen to their cries. Today, I want to share something on ovarian cysts and whether it can lead to infertility. You see, if we can pinpoint the cause then we can better manage it.

There are several different types of ovarian cysts and from my research, these are the two that are associated with infertility:

1. Endometriomas- are cysts caused by endometriosis, a condition in which the tissue normally lining your uterus (endometrium) grows outside the uterus. These ovarian cysts may be associated with fertility problems. 

Now I have gone through this type, but prior to knowing that I had endometriosis, the doctors were telling me the cysts I had was probably a functional cyst, which is another type not associated with infertility, and it will go away with my period. To be honest, at the end of my period, I will feel less pain and thought that they were right. However, there were times that the pain remains and when I do the ultrasound, I was told that it is hemorrhagic or has ruptured. The treatment was a sit, wait and watch. It was only during my surgery to remove fibroid that endometriosis and the associated cysts were identified. However, many persons are living with endometriosis and do not know because it is not easily identified.To identify endometriosis, a doctor may ask about your medical history, symptoms and menstruation and also do a pelvic exam. I have done numerous and they never found out. What helps to diagnose and even treat endometriosis is a surgical procedure called laparoscopy, which is a surgery that uses a thin, lighted tube put through a cut (incision) in the belly to look at the abdominal organs and pelvic organs. Sadly, many gynaes fail to mention this to you even when you suggest to them the possibility of you having endometriosis. I do not know how much such procedure costs, but I believe in researching and going to your doctor with information. If you have been suffering with ovarian cysts, you have painful (terrible) periods, infertility etc etc, ask a doctor about whether you may have endometriosis and what tests you can do to identify this especially if you have gone through numerous ultrasounds and pelvic exams without any good answers.

2. The second type of cysts that is associated with infertility is Ovarian cysts resulting from polycystic ovary syndrome.Polycystic ovary syndrome (PCOS) is a condition marked by many small cysts on your ovaries, irregular periods and high levels of certain hormones. PCOS is associated with irregular ovulation, which may contribute to problems such as infertility in some women.

Now I cannot give you my own personal experience with this type, but I know of persons who have it and here are some of the symptoms:

• Few or no menstrual period or heavy irregular bleeding- I know of persons who have not had a period for years because of this or they are not aware when it is coming. In other words, it occurs haphazardly and when it does come, it as if it wants to make up for the missing months by coming for weeks, which is outside the normal 5 days. It also tends to be heavy. Another symptom of PCOS which is very much related to this one, is infertility. A big part of getting pregnant is identifying when you are ovulating and I do not need to explain the issue here with a period that just show up when it feels like or refuse to show up at all. 
• Weight gain- This is another major complaint. You do not have to eat a thing for the weight to come and when it does, it does not want to leave. In other words, you may be dieting and exercising and the weight is still there staring you in your face and this may also lead to depression. Still, you need to watch what you eat and also exercise.
• Hair loss and Hair growth- While I have not met many persons with a hair loss problem who have PCOS, I have heard about hair growing thick and long in places other than your head. This again can lead to depression.

There are other symptoms such as acne, breathing problems and oily skin, but the above ones I have mentioned is based on report from a few friends I have spoken to.

Sadly for many of these illnesses, there is no cure. With PCOS, the treatment include having a healthy diet, exercising regularly and quit smoking. Medications include metformin and clomiphene. These are efforts to manage PCOS so that your body can ovulate which can help you to get pregnant. The silver lining is there are people with PCOS that have gotten pregnant and so there is hope. Just the same, persons after treating endometriosis have also gotten pregnant. I am an example of that and so with that I end by saying, Continue to do your research, do not lose hope and trust in God even when everything that you are doing seems to be a waste of time. 

Endometriosis: Myths or Facts

I recently found this article online and wanted to share with you because it provided some answers to the many questions I have after I found out about my endometriosis and subsequently had a surgery that removed, hopefully all of it. Here is the article as it written on the Women's Surgery Group, http://www.womenssurgerygroup.com/conditions/Endometriosis/overview.asp:


ENDOMETRIOSIS: OVERVIEW

Endometriosis is an enigmatic disease affecting about 7% of reproductive-aged women -approximately 5 million Americans. Although they may suffer significant symptoms ranging from pelvic pain to infertility, most of these women do not know that they have endometriosis,. Physicians' understanding of (1) the clinical presentation of endometriosis, (2) its proper diagnosis and staging, and (3) the management of its sequele have improved dramatically over the past few years. The result has been better, more cost-effective patient care.

Definition

Endometriosis is the presence of endometrial tissue (normally found only on the inside of the uterus) in locations outside the uterus. This tissue reacts to estrogen and progesterone. The usual location is in the pelvis (on the ovaries, fallopian tubes, uterus, or bladder), but endometriosis has also been found in sites outside the pelvis (including omentum, small intestine, appendix, anterior abdominal wall, surgical scars, diaphragm, lung, urinary tract, and musculoskeletal and neural systems). This endometrial tissue reacts to hormonal changes during the menstrual cycle, just as endometrial tissue lining the inside of the uterus reacts during the normal ovulatory cycle.

Prevalence and Incidence

The prevalence and incidence of endometriosis depends on the population of women being studied, ranging from 1 to 50%. It has been reported to occur in 10 - 15% of women undergoing diagnostic laparoscopy, 2 - 5% of women undergoing tubal sterilization, 30 -40% of infertile women having laparoscopy, and 14 - 53% of women with pelvic pain.

Pathophysiology

There are several theories that attempt to explain how endometriosis develops. The most popular theory describes retrograde menstruation through the fallopian tubes, with subsequent implantation and growth of endometrial cells contained in the menstrual blood. Other theories involve metaplasia (normal tissue in the abdominal cavity spontaneously changing to endometriosis), direct implantation of endometrial cells into the abdomen during surgery, and spread of endometrial cells from the inside of the uterus to other locations via blood vessels or lymphatics. Each of these may contribute to endometriosis in different patients. Altered immunity may also play a role.

Numerous factors seem to affect whether a woman will have this condition, the severity of the disease in any particular woman, her symptoms, and her response to treatment. These include:

• genetics (an affected sister or mother doubles the risk)
• hormonal status (higher estrogen levels and prolonged heavy menses increases risk)
• lifestyle (low body weight and cigarette smoking reduce risk by decreasing estrogen levels)
• contraceptive use (oral contraceptives possibly reduces progression of disease)
• obstetric history (pregnancy and lactation reduce risk)
• anatomic factors (cervical stenosis increases risk)
• treatment history (prior medical or surgical treatment reduces risk)
• race (caucasions are at higher risk than african-americans)
• and possibly exposure to environmental toxins, especially those which are estrogenic

Endometriosis is thought to cause infertility by distorting anatomy, creating hormonal abnormalities, altering the pelvic biochemical enviornment, influencing the immune system, interfering with sperm function, and (possibly) altering the process of embryo implantation.

Clinical Presentation

Endometriosis primarily presents with pelvic pain (about 80% of patients). About 20% of patients presenting with endometriosis are also infertile, and 5% present with a "tumor" of endometriosis in one or both ovaries (these are called endometriomas). Anywhere from 1 to 40% of patients with endometriosis will have no symptoms. Endometriosis may occur anytime after puberty, including adolescence.

The extent of a patient's pain often does not correlate with severity of her endometriosis. Pain may occur as a result any or all of the following:

• endometrial implants secreting irritating factors (e.g., histamine)
• scar tissue (adhesions)
• leaking endometriomas
• compression of other abdominal structures (e.g., bowel, ureter)
• compression of endometriotic nodules deep in the pelvis
• invasion of the urinary tract (bladder or ureters)
• invasion of the gastrointestinal tract (small bowel or colon)

Even in patients with minimal and mild disease (AFS stage I or II), endometriosis is probably associated with infertility. A cause-effect relationship most certainly exists for moderate and severe disease (AFS stage III or IV). These patients usually have adhesions, deep invasive lesions, and endometriomas. Endometriosis may also be associated with structural abnormalies and damage to the fallopian tubes. Studies overall do not, however, support an association between endometriosis and increased spontaneous abortion rates.

Endometriosis lesions occur throughout the pelvis. They tend to be more frequently in the posterior cul-de-sac and the ovary, and less frequently on the fallopian tubes. Endometriosis is almost certainly a progressive disease, but the rate of progression and nature of lesions varies from patient to patient.

Adhesions develop as a result of the inflammatory process caused by long standing endometriosis, with more extensive and dense adhesions developing over time. The worst adhesions in the most advanced cases usually involve the uterus, ovaries, and lower colon (near the rectum). Laparoscopic surgical treatment of these cases is always preferable, but demands skill, extensive experience, and patience on the part of the operating surgeon.

Pregnant with Fibroids, Pregnant after myomectomy!!

It has been a while that I have posted as I have been busy writing up my PhD dissertation, but I tried during that time to post on the issues of the uterus facebook page. The two messages that I am going to share with you in this blog was sent to me via my page a few days ago. Amazing news and it shows that if you continue to trust God, things will work out. I hold fast to the scripture that says faith without works is dead. So I encourage you to eat right, seek your doctor' advice and pray without ceasing in your quest for kids. Here are the ladies messages:

Message 1: 

Hey Rose-Ann,

Last time we spoke was in May. In June I found out I was pregnant and was due Feb7 15. In the early weeks of pregnancy I had to go to the er as I started to bleed. They called it a threatened miscarriage. Thankfully I was discharge after a few tests were done. My pregnancy was going well until last Tuesday morning at 2am my water broke. My hubby rushed me to L&b and the nurses along with my doctors worked vigorously to try and get me to 34weeks of pregnancy. My pregnancy of course was high risk due to fibroids and everyone commented that I was blessed to even get this far along. 

Well my little fella had other plans and decided to make his entrance at 31weeks on 6Dec @916am. He weighed 3lbs13ozs. He is a miracle baby I must say and all praise and thanks to God.

He has been breathing on his own and has being doing well thus far. No oxygen has been used thus far and I truly thank God.

He has to spend some time in the Nicu. I just wanted to let you know and thank you for your prayers and please continue to prayer for my Ethan that he would keep progressing.

God is indeed the greatest of physican.

Message 2:

I've been following this post for some time now and just wanted to share my story in the hopes that it helps: 

I found out earlier this year that I had two large fibroids. At the advice of my Dr. I had an open abdominal myomectomy ( surgery to remove uterine fibroids) in March of this year 2014. My doctor told us to wait six months before getting pregnant so we started trying to get pregnant after four months and we were successful on my second cycle (August 2014) which made it five months post myomectomy. 

I am now 16 weeks pregnant and I am happy that we made the decision to have the surgery done. I believe that it was because of this surgery and the Grace of God that we were able to conceive so quick. 

Although this is my third pregnancy there is a 18 year gap with me having one son that is 18 and one that is 20 years old; so this is kind of a new pregnancy and I have forgotten a lot about what those pregnancies were like. 

To answer some questions about how this pregnancy has been thus far... there was a lot of cramping initially in the first trimester as well as irritation and pain around the incision site which my doctor said was normal. 

I have had three ultrasounds so far and one revealing one tiny fibroid that my doctor said probably came after surgery and one ovarian cyst that comes and goes that they're not overly concerned about. I will go to a perinatal Dr. which is for high-risk pregnancies to have an assessment towards the end of this month to find out if I will actually be considered high risk or not and I will find out when they will schedule my C-Section. I have a tentative due date in May because after a myomectomy it is necessary to have a cesarean due to uterine rupture. I struggled with having to have a cesarean after having two very easy vaginal births but it is definitely worth the sacrifice to receive such a blessing! So I will find out a more definitive due date from the perinatologist doctor. I am 37 years old so I have to have all of the standard genetic testing which has been good news so far. I just wanted to share my story to let people know that there is life and hope after a myomectomy. I am very spiritual and I prayed to God for total healing after my surgery and he answered our prayers. Blessings, Healing and Baby Dust to you all!!!

Why can't I get pregnant?

I found this very interesting video describing some of the reasons behind fertility that I wish to share with you. Often times we are confuse about infertility or may think it is one thing when it is another. This video gives a detailed description of the reasons surrounding infertility. Please leave a comment if you find it helpful.

Your Fertility and you

It could be something different than you think:

So I have a thought today as I continue thinking about ways in which women can improve their fertility and manage the different issues of the uterus. What came to mind is Misdiagnose. For example, you may found out that you have fibroid after trying to get pregnant with no luck. Sometimes doctors fail to check you for other issues, when they found out you have one, but if you remembered my blog, you would realized that all the time I thought that fibroid was the reason for my infertility. I had done other tests, for instance, to check if my tubes were blocked and those were ok. It was only after my surgery to remove the fibroids, I found out that I also had endometriosis. I say that to say, that it might be good to get a wholistic health check, especially if you have already taken drastic measures such as surgery and are still faced with fertility issues. In the meantime, as hard this might be, try to maintain healthy weight by eating right and exercise and reduce stress levels. My prayers are still with all of you that God will bless you with the heritage of your womb. I found out something about a natural product recently, that a lady who has endometriosis and was unable to conceive, stated that at 39 years of age, she is pregnant with her first child, which she attributed to these products. I am still researching so I would say more in a later post, but what I can say now is that it helps balance hormones, which is a factor affecting many of us who are faced with issues of the uterus. If you want to hear more, you can inbox me, but I will say more in a later post.

Source: Author

When is it time to consult a fertility specialist?

Getting pregnant may not always happen as quickly as couples would like. Especially when pregnancy fails to result after months of trying to conceive, couples may want to consult an infertility doctor who can determine if either partner has a condition hindering conception. For couples that are already aware of an existing problem such as endometriosis or prior miscarriages, infertility doctors recommend seeing an expert when more than six months pass without getting pregnant. Even in the absence of a health condition, couples where the female partner is 35 years old or older should also consult a specialist after six months of unsuccessful conception. Couples in good health and of younger age can wait an additional six months before reaching out to an infertility doctor should they experience difficulties conceiving a child.

Source :http://www.chicagoinfertilitydoctor.com/835160/2014/06/13/when-is-it-time-to-consult-a-fertility-expert.html