Womens Health

Women's Health Newsletters 9/23/01 - 12/2/01



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****** Woman's Diagnostic Cyber Newsletter *******
                September 23, 2001
Every two weeks from Woman's Diagnostic Cyber

1. When to worry about an anxiety disorder
2. Living with lupus
3. Reader submitted Q&A - Irritable bowel syndrome
4. Different forms of osteoporosis
5. Insomnia among cancer patients
6. Health tip to share - Thyroid replacement on HRT
7. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

1. When to worry about an anxiety disorder
Some amount of stress or tension is beneficial. It 
stimulates us to complete necessary tasks. It may 
play a role in pushing us to better jobs or living 
situations. But when stress becomes excessive and 
our minds can no longer handle it, anxiety takes 
over control. Whenever anxiety affects our ability 
to work or carry out daily living activities, it 
becomes an anxiety disorder. 

Anxiety disorders are one of the most common 
emotional health problems. There are several 
different types: 

panic disorder (recurrent panic attacks)

obsessive-compulsive disorder (uncontrollable, 
repetitive behaviors or thoughts) 

post-traumatic stress disorder (recurrent, 
distressing dreams and flashbacks after an 
accident or violence such as rape) 

generalized anxiety disorder (persistent worry 
about everyday life events such as finances or 

phobias (specific phobias such as fear of heights 
or social phobias, also called social anxiety 

The above problems should be treated with 
counselling or drugs, both of which seem to be 
equally effective treatments. Many insurance plans 
do not cover psychologic counselling but they do 
cover anti-anxiety drugs. The real problem is that 
women with anxiety disorders have a tendency 
become addicted to alcohol or drugs, therefore as 
soon as you are identified as having an anxiety 
disorder, it is time to start addressing it, 
rather than all of the other stressful influences. 
You need to tackle it so you do not become 

Ultimately, someone who suffers from anxiety 
disorder needs to regain control over their mind 
and body's handling of stress. Medications can be 
helpful in starting to overcome anxiety disorders 
but they are never a good long term solution. 
People who use only medications to reduce anxiety 
and never learn to gain mind control over stress 
carry the anxiety disorder into their senior 
years. They have trouble ever finding peace of 

If your doctor suggests an anti-anxiety drug, ask 
about other solutions. 

When to worry about an anxiety disorder

2. Living with lupus
Systemic lupus erythematosus (SLE) is a strange 
disease. No one quite knows what causes it but it 
is classified as an auto immune disease. One's 
body becomes allergic to its own organs. The 
immune system can attack the skin, the joints, the 
kidneys, the blood cells, the heart or blood 
vessel system, the muscles, the liver or any part 
of the body. 

With skin, lupus causes disfiguring scars and hair 
loss; with the joints it produces arthritis; 
attacking the kidneys produces renal failure; 
blood cell involvement causes anemia; the heart 
being affected may cause heart failure; blood 
vessel immune changes cause hypertension and 
Raynaud's disease; muscle involvement results in 
inflammation called myositis; liver lupus is a 
type of hepatitis. 

The first symptoms of lupus can be quite variable 
all the way from fever and muscle aches to sudden 
kidney failure. In fact one of the most serious 
manifestations of lupus is kidney failure. When 
it happens, dialysis several times a week or even 
a kidney transplant may be needed. That alters 
one's life. 

As you can see, living with lupus can present 

3. Reader submitted Q&A - Irritable bowel syndrome
"What causes irritable bowel syndrome and how can 
you treat it? " 

"I am 47, menopausal, taking Prempro(R) 0.625 
mg,and have a high stress job and life." - Arlene 

Irritable bowel syndrome (IBS) is similar to a 
baby's colic except it occurs in adults. It hurts 
and it is associated with abnormal frequency of 
bowel movements; either constipation or loose, 
frequent stools. The abdominal and pelvic pain 
that accompanies IBS characteristically get worse 
or improves significantly with bowel movements. 

While no one knows the specific cause of IBS, 
whatever it is involves the nerve and muscle 
control of the large colon. There are two 
components, abnormal muscle contractions of the 
colon (too fast or too slow) and an increased pain 
sensitivity to the distension of the colon from 
bowel contents. 

Treatment is both general, to reduce or eliminate 
anything that affects bowel motility and 
distension, and specific, aimed at the predominant 
symptom of pain, diarrhea, or constipation. 
Dietary change is a mainstay of treatment to 
restore the normal bowel motility. High fiber and 
higher carbohydrate diet is used if constipation 
is a major problem. High protein diet with 
elimination of bowel muscle stimulants is used if 
diarrhea (3 stools per day or more) is the major 

Bowel stimulants that may need to be eliminated 
from the diet are: 

dairy products in lactose intolerant individuals
artificial sweeteners
gas forming vegetables (beans)
spicy foods especially hot peppers

When pain is a predominant symptom, gas forming 
foods as well as bowel stimulants should be 

Medications are used as treatment after dietary 
change stabilizes symptoms as much as possible. 
Again, the medical management depends upon what 
symptoms are the worst, although sometimes 
symptoms of constipation and diarrhea can be 

Constipation - osmotic laxatives such as 
lactulose, polyethylene glycol solution 

Diarrhea - anti diarrheal agents such as 
loperamide {Imodium(R)), diphenoxylate/atropine 
(Lomotil(R)), cholestyramine resin (Prevalite(R)) 

Pain - anticholinergic agents such as dicyclomine, 
hyoscyamine (Donnatal(R), Levsin(R)), anti anxiety 
agents, non steroidal anti inflammatory drugs 
(NSAIDs), occasionally other pain meds 

Finally, stress reduction should be attempted. No 
one denies that stress plays a role and yet there 
is not a quick, easy treatment of excessive 
stress. When it is affecting the health of the 
body though, attention must be paid to stress 
reduction techniques and activities otherwise the 
health problem produced or aggravated by stress 
will persist and worsen. 

See our instruction sheet on coping with IBS:

Coping with Irritable Bowel Syndrome

4. Different forms of osteoporosis
Did you know there are different types of 
osteoporosis? I didn't. Much medical science 
involves lumping and splitting and this proposed 
categorization makes some sense clinically. 

In the article below, bone mass deficits are 
classified into 3 different groups based on 
theories of bone modelling we know from 
experimental studies: 

1) less than normal bone mass but no tendency 
toward fractures unless there are falls, injuries 
or trauma that cause them. This equally affects 
men, women and children. 

2) low bone mass in which there is chronic bone 
pain, mainly in the lumbar spine and spontaneous 
fractures from normal physical activities of daily 
living, not injuries. This is more common in women 
than men and rare in children. 

3) low bone mass from lack of muscle strength. 
Fractures can be spontaneous or trauma induced but 
muscle strengthening helps bone strengthening to 
prevent spontaneous fractures. 

This would explain why some women with low bone 
density have moderate bone pain and others do not; 
why some women increase bone density significantly 
with weight training and weight bearing exercise 
and others do not. 

Different forms of osteoporosis

5. Insomnia among cancer patients
Everyone would expect that newly diagnosed cancer 
patients might have trouble sleeping. And indeed 
30-50% of cancer patients have insomnia within 
their first several months after diagnosis. 
Unfortunately, insomnia often persists in those 
diagnosed with cancer for a long time. From 23-44% 
describe insomnia symptoms 2-5 years after 

Patients rarely complain of sleep difficulties; 
presumably because it seems like a small problem 
next to the fear of cancer and side effects of 
treatment. For this reason it is very much an 
under appreciated problem. Other problems of 
nausea, pain and depression receive first concern. 

Insomnia can strongly affect health. It worsens 
the anxiety, fatigue and depression that already 
plagues cancer patients. There is some suggestion, 
but not definite proof, that insomnia may increase 
the death rate from cancer. It needs to be 
recognized early and treated if possible. 

The medical treatment for a cancer patient with 
insomnia consists mostly of medications to control 
pain or depression. After those are treated, 
behavioral strategies to treat insomnia rather 
than sleeping drugs, can be integrated into the 
cancer care routine. Relaxation techniques are 
helpful as well as making sure one does not get 
too much sleep one night and too little the next. 
Sleep may need to be slightly restricted to 
facilitate falling asleep. Attention also needs to 
be paid to a good sleep environment. Finally, if 
any automatic thoughts or fears creep into the 
mind at night, counselling may be indicated just 
like with any anxiety disorder. 

For a good overview of this problem, see the 
article at Breastlink.com 

Insomnia among cancer patients

6. Health tip to share - Thyroid replacement on HRT

If you have hypothyroidism and take thyroid 
replacement, when you are first placed on 
menopausal hormone replacement therapy you may 
need to have your dose of thyroid raised. There is 
a fall in serum thyroxine in women with 
hypothyroidism starting on HRT. Women without 
hypothyroidism do not have a fall in serum 
thyroxine levels when they start HRT. - FRJ 

Increased Need for Thyroxine 

If you have discovered ways of coping with a 
disease or condition and it works for you, please 
share it with us: 

Health tip suggestion form

7. Humor is healthy
The Hikers

One day, Joe, Bob and Dave were hiking in a 
wilderness area when they came upon a large, 
raging, violent river. They needed to get to the 
other side, but had no idea of how to do so. 

Joe prayed to G-d, saying, "Please G-d, give me 
the strength to cross this river." 

Poof! G-d gave him big arms and strong legs, and 
he was able to swim across the river in about two 
hours, although he almost drowned a couple of 

Seeing this, Dave prayed to G-d, saying, 

"Please G-d, give me the strength and the tools to 
cross this river." 

Poof! G-d gave him a rowboat and he was able to 
row across the river in about an hour, after 
almost capsizing the boat a couple of times. 

Bob had seen how this worked out for the other 
two, so he also prayed to G-d saying, 

"Please G-d, give me the strength and the tools, 
and the intelligence to cross this river." 

Poof! G-d turned him into a woman. 

She looked at the map, hiked upstream a couple of 
hundred yards, and then walked across the bridge. 

That's it for this time. 
Your BACKUPMD on the Net.
Frederick R. Jelovsek MD 

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****** Woman's Diagnostic Cyber Newsletter *******
                October 7, 2001
This Biweek from Woman's Diagnostic Cyber

1. Mad cow disease testing and transmission
2. Post traumatic stress disorder
3. Reader submitted Q&A - complications of surgery
4. The G-spot, is it a myth?
5. Mycoplasma and ureaplasma genital infections
6. Health tip to share - Perineal care
7. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

1.  Mad cow disease testing and transmission
Mad cow disease is more properly called bovine 
spongiform enchephalopathy (BSE). It has been a 
problem in England and Europe where cows were fed 
brain and spinal cord containing meats and bone 
meal from sheep who had a similar disease to BSE 
called "scrapie". There is good evidence that when 
people eat meat from the central nervous system in 
cows with BSE, this can produce a degenerative 
brain disease in humans which is called a variant 
Creutzfeldt-Jakob Disease or vCJD. To date no 
cases of vCJD have been found in the U.S. that I 
could find 

Our FDA department has stated that they feel 
confident that U.S. beef is  "clean" due primarily 
to early slaughter of animals, within 1 1/2 years 
of maturation. They reported none of these young 
animals have tested positive for BSE.  As of this 
writing, there have been a some positive tests in 
sheep, goats and elk and deer in the U.S.. 

Our readers ask this -- "couldn't a virus lay 
dormant, undetected during certain stages of 
development? And why don't they sample cattle by 
allowing them to mature to 2, 3 and 4 years of age 
and then test? " 

The answer is in two parts: 

1)  this disease is much differently transmitted 
than any viral or bacterial diseases with which we 
are familiar 
2) there is still much we do not know about the 
transmission of this condition 

The disease seems to be transmitted by eating a 
protein called a prion that is abnormally shaped. 
This abnormally shaped protein causes other 
proteins in the central nervous system (spinal 
cord and brain) to become abnormally shaped also. 
When enough abnormal proteins are produced,  brain 
and nervous symptoms develop in the animal or in a 
human. Testing is performed in animals by killing 
them and examining the protein tissue for these 
abnormal prions. Unfortunately there is not a 
blood test for this. The tests can pick up an 
affected animal before symptoms are apparent but 
because the induction of abnormal proteins is a 
slow process, testing cows before 30 months of age 
does not produce any positive tests. 

The disease does not seem to be transmitted 
according to classic viral transmission at all; it 
is transmitted just by ingesting the abnormal meat 
protein as far as we know. For example, infected 
cows do not transmit the disease to their calves 
by their milk or even just by the birth process. 
Most viral infections in which the virus itself is 
the transmissible agent would transmit to a fetus 
or newborn by birth or lactation.  Cooking the 
meat thoroughly would prevent virus transmission 
but it does not destroy this abnormal protein and 
therefore is not protective. 

This new and probably rare mode of disease 
transmission is very important for medical science 
but also extremely difficult to study. We do not 
know if it takes ingestion of a microgram, a 
milligram, a gram (1/30th of an ounce). 100 grams 
or more of abnormal protein. Normally, meat from 
the brain or central nervous system of beef cattle 
would not knowingly be purchased by most 
consumers. Unfortunately some butchers included 
these parts in ground beef and beef sausage which 
was the likely way the protein was consumed by 
humans. Even steaks and roasts and other solid 
beef muscle were banned in Europe for awhile 
because of the fear that cutting across the spinal 
cord could contaminate steaks. While this was a 
theoretical concern, most experts now feel this is 
not a mode of transmission and solid cuts of beef 
are still consumed up to their normal levels in 
Europe. Concern was raised about cow brain 
products in some nutritional supplements but so 
far this has again been a theoretical concern and 
no cases have been traced to this source that I 
could find. 

These are some of the reasons why the Food and 
Drug Administration in the U.S. does not think we 
do not have Mad Cow disease in our American beef 
cattle. There have been no cases of vCJD in the 
U.S. and our cattle are killed and marketed at a 
young age before any volume of abnormal protein 
could form even if they were "infected".  

The truth is they do not know for sure if the 
disease is prevalent in our beef herds. I like the 
idea to allow some cattle to mature to 3 or more 
years and then test them, but I suspect the 
prospect of culling out 10's of thousands of cows, 
raising them for another couple of years, and then 
slaughtering them for testing alone is one of 
those projects that is difficult to get funded 
until we do have a human case of variant 
Creutzfeld-Jakob disease. There have been some 
U.S. quarantines of suspected sheep herds as you 
may know but no positive cow cases. 

Mad cow disease testing and transmission

Q and A about BSE

2. Post traumatic stress disorder 
Post traumatic stress disorder (PTSD) is a series 
of recurrent high anxiety states which are due to 
a past event that caused a severe emotional 
trauma. Something like a rape, a motor vehicle 
accident, a physical assault or even an event like 
the World Trade Center attack can precipitate 
recurrent stress. 

The symptoms often start about 3 months after the 
causative event and can include: 

flashbacks or nightmares
distancing oneself emotionally from others
withdrawal from work or family responsibilities
sleeping difficulty
anger control problems
exaggerated startle response

It is normal to have many of these reactions right 
after a traumatic event, but the usual course of 
things should be for the stressful reactions to 
gradually lessen over time. If they persist beyond 
several months or they don't seem to start until 
several months after the event then PTSD should be 
suspected. If this happens to you, be sure to see 
your doctor, Zoloft(R) (sertraline) and other 
selective serotonin re-uptake inhibitors (SSRIs) 
have been an effective treatment for PTDS. 
3. Reader submitted Q&A - Complications of surgery
"Is it normal for sutures to dissolve two hours 
after having uterus removed vaginally causing 
internal bleeding and a second surgery to stop 
bleeding causing the loss of healthy ovaries and 
puncture to bladder." - Anonymous 

I don't know of sutures dissolving within two 
hours of surgery but certainly sutures can come 
off of a blood vessel. The vessel just breaks off 
where the suture was tied.  Also vessels that did 
not bleed at the time of surgery, perhaps because 
of vessel spasm, can start bleeding right after 
surgery. The most common bleeding complication 
after vaginal hysterectomy occurs within the first 
two hours following surgery. It happens about 1-2% 
of the time. 

If you had bleeding that continued, surgery had to 
be performed to stop it. If the bleeding was in 
the area of the ovary, sometimes the ovary has to 
be removed to stop the bleeding. When suturing the 
bleeding around the ovary, the blood supply to the 
ovary may become injured and the ovary would 
become gangrenous if left. In that case it would 
need to be removed. To have to remove both ovaries 
due to bleeding is unusual but it can happen. 

Bladder injury can also occur while trying to stop 
the bleeding. This does seem like too many 
complications but the anatomy gets quite distorted 
right after surgery especially with active 
bleeding taking place. I assume the bladder injury 
was recognized and repaired at the time of the 2nd 

I am sure you are concerned as to whether this 
bleeding complication and injury to the bladder 
would be due to negligence on the part of the 
doctor. No one can say for sure without being 
present at the surgery but these are complications 
that are recognized as possible and most of the 
time they would not be due negligence but rather 
just bad luck. If the complications were taken 
care of and you have no long term injury then 
there is no grounds for malpractice. You can 
always claim mental anguish as injury but most 
lawyers would not take the case with just mental 
anguish for injury. 

Perhaps there is more to the story than you 
related above. You may want to get a second 
medical opinion or even an interview with a 
reputable malpractice lawyer. 

FAQs about Hysterectomy

4. The G-spot, is it a myth?
The G-spot refers to a a small, but allegedly 
highly sensitive area on the upper (anterior) wall 
of the vagina just below the bladder. This spot 
was proposed in 1982 to be a highly erogenous spot 
whose stimulation can lead to a female vaginal 
ejaculation or a stronger, deeper orgasm. 

It appears from the review below that there is 
very little scientific evidence that such a spot 
exists. In fact almost any gentle manual 
stimulation of any point inside the vagina can  be 
sexually arousing to the point of orgasm. 
Apparently the existence of a G-spot rests only on 
one paper in which 5 of 12 women were thought to 
have one sensitive area on the anterior vaginal 

This lack of evidence does not mean that such a 
spot does NOT exist. It just means that it is 
still questionable. If a woman cannot find her "G-
spot", she should not be concerned. If she does 
not "ejaculate" with orgasm there also should not 
be any concern. Female ejaculation from the 
Skene's glands of the urethra is also an unproven 
and unlikely event. 

The G-spot: A modern gynecologic myth

5.   Mycoplasma and ureaplasma genital infections
Mycoplasma and ureaplasma are two bacteria that 
are often associated with genital track infections 
in the same sites as the sexually transmitted 
disease called chlamydia. In fact if a good 
scientific does a thorough job of culturing all 
bacteria present, they often find substantial  
(30-50%) positive cultures for ureaplasma and a 
fair number (10-20%) of positive cultures for 
mycoplasma when examining women with urinary tract 
infection symptoms, pregnancy vaginitis symptoms 
or women with infertility. 

The high incidence of positive cultures for these 
bacteria is tempered only by the fact that genital 
tract infections with pure ureaplasma or pure 
mycoplasma are not commonly found. This throws 
suspicion upon whether these bacteria even need 
treatment as causative agents, i.e., they may 
always be just opportunistic agents that occur 
primarily with other bacteria which are the ones 
needing the antibiotic treatment. On the other 
hand, such a high incidence of positive cultures 
makes many doctors think that these bacteria need 

To find out if these bacteria may be present, 
special, non routine cultures need to be 
performed. If you have: 

1) recurrent urinary tract infection symptoms but 
the urine cultures return negative 
2) unexplained infertility
3) chronic pelvic pain

then you may want to ask the doctor to perform the 
special cultures to see if mycoplasma or 
ureaplasma are present. If they are present, you 
and the doctor will then need to determine if 
antibiotic treatment is likely to be helpful. Both 
organisms seem to be very sensitive to both 
erythromycin and to tetracycline. If the cultures 
are not available, doctors sometimes just 
prescribe empirical treatment with tetracycline 
for some of the above conditions. 

 Mycoplasma and ureaplasma causing genital problems

6. Health tip to share - Perineal care
"To 'control' smell in the outside vaginal area, I 
use my grandmother's method: after a bath or a 
good wash, mix a cup of water with 2 spoons of 
good old apple cider vinegar and do a 'last' wash 
and air dry the area with a hair drier in warm to 
cool air. Keep a bottle handy of the apple cider 
vinegar in the bathroom and a cup. I transfer the 
vinegar to a nice plastic and pretty bottle that 
goes with my bathroom.  use it as frequently as 
you can. like before going to bed and in the 
morning. soon will be a nice 'habit'. If no time 
to use the hair drier, spend some time with 'for 
your use only towel' and do a nice dry. Daily 
cotton undies are a must. Save the non-cotton cute 
and expensive panties for a prelude of a wild 
night only." 

If you have a genital herpes condition use 
Listerine(R) -- yes, that's right, Listerine(R) to 
wash the affected area and use the hair drier in 
the hottest you can take. The lesions will last 
only a day or two the most. If you are home all 
day (during the outbreaks) try to do this as 
frequent as possible, like every hour. idea: drink 
plenty of fluids that way you urinate a lot and 
you have an excuse to do it. idea: cover the 
vulvar area with a towel so you don't burn a 
sensitive area. Lots of luck from an ex-sufferer" 
- Marian 

If you have discovered ways of coping with a 
disease or condition and it works for you, please 
share it with us: 

Health tip suggestion form

7. Humor is healthy
"You Know It's Time To Diet When...."

You dance and it makes the band skip.

You are diagnosed with the flesh eating virus, and 
the doctor gives you 22 more years to live. 

You put mayonnaise on an aspirin.

You go to the zoo and the elephants throw you 

Your driver's license says, "Picture continued on 
other side." 

You ran away and they had to use all four sides of 
the milk carton for your picture. 

You learn you were born with a silver shovel in 
your mouth. 

You could sell shade.

Your blood type is Ragu.

You need an appointment to attend an 'open house'. 

That's it for this time. 
Your BACKUPMD on the Net.
Frederick R. Jelovsek MD 

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****** Woman's Diagnostic Cyber Newsletter *******
                October 21, 2001
Biweekly from Woman's Diagnostic Cyber

1. Uterine anomalies in recurrent miscarriage
2. Birth control during perimenopause
3. Reader submitted Q&A - HRT side effects
4. High energy drinks are deceptive
5. Progesterone to treat PMS brings up a point
6. Health tip to share -  mouth sores
7. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

The next newsletter will be in two weeks.

1. Uterine anomalies and recurrent miscarriage

One of the causes of recurrent miscarriage is when 
the cavity of the uterus is deformed from its 
normal pear-shaped contour. These deformities can 
be acquired (impingement on the cavity by 
fibroids, polyps, scarring) or congenital from 
birth (indented, partially divided, divided). 

Regular ultrasound of the pelvis often picks these 
deformities up but it may miss as many as a third 
of them. Saline sonohysterography, which involves 
injecting saline in the cavity of the uterus can 
give a better view of the cavity shape but it 
sometimes causes uterine cramps and requires a 
physician to do the injection. A new imaging 
modality called 3-D ultrasound holds promise to be 
much better at picking up these uterine cavity 

In this study below, 3-D ultrasound imaging was 
used to identify uterine cavity shape 
abnormalities in 503 women with recurrent 
miscarriage and 3228 low risk women without 
infertility or recurrent miscarriage. They found 
that 21% of the women with recurrent miscarriage 
had uterine cavity shape abnormalities. This was 
significantly more than in the low risk women. 

The bottom line is that women with a history of 
recurrent miscarriage need to have a thorough 
assessment of the inside of the uterus. 

Uterine anomalies and recurrent miscarriage

2. Birth control during perimenopause

The perimenopause is the time before menopause 
when ovarian function, normal hormonal cyclicity 
and the ability to conceive all decline. Abnormal 
bleeding, hot flashes and mood changes may occur 
during this time, usually in the decade of the 
40's. By age 40, 33% of couples are infertile and 
at age 45, 87% of couples cannot conceive even if 
they try very hard. Those who do get pregnant, run 
a fairly high risk of having an infant with a 
congenital anomaly. 

Any woman who does not want to get pregnant during 
perimenopause cannot just rely on age changes 
alone for protection. Some women can still get 
pregnant and there is no way to know who can and 
who cannot unless no birth control is used. This 
type of "fertility roulette" is unacceptable for 
most women so the practical solution is to use 
some type of birth control. 

About 50% of women depend upon tubal sterilization 
for birth control and 20% depend upon male 
sterilization by vasectomy. This still leaves 30% 
of women who may want to use either oral 
contraceptives (if they do not smoke), 
intrauterine contraceptive devices (IUCDs), or 
barrier methods such as condoms or diaphragm. 

If you are in the perimenopause and you or your 
partner have not had a sterilization procedure, be 
sure to discuss with your physician suitable 
methods of birth control. 

Birth control during perimenopause

3. Reader submitted Q&A - HRT side effects
"Is Natural HRT better than synthetic? If so/not 
why? I'm searching for a natural HRT, because of 
side effects of synthetic HRT." - vj 

This is a tough question to answer. Even the 
concept of "natural" is not clear. The naturally 
occurring estrogens are estradiol (E2, biest), 
estrone (E1) and in pregnancy, estriol (E3, 
triest). None of them occur in nature other than 
in animals or humans. Therefore for pharmaceutical 
doses they are made synthetically from a chemical 
process. This is also true for progesterone. It is 
made synthetically. 

There are some naturally occurring substances with 
estrogen effect such as conjugated equine 
estrogens from pregnant horses and plant 
substances called phytoestrogens from soy, red 
clover and other plants. These are not 
synthetically made, just extracted and purified 
from their source. 

Conjugated estrogens have many different 
estrogenic compounds in them but the majority by 
volume is pure estrone, the same chemical compound 
that occurs in women. Phytoestrogens are not as 
potent as estradiol and estrone. They also have 
slightly different effects in women. They may help 
with osteoporosis and to some degree with hot 
flashes but they do not stimulate the vaginal skin 
to prevent dryness. 

Side effects are determined not so much by whether 
the estrogens are made synthetically or extracted 
from natural sources. They depend upon the 
specific type of estrogenic compound and your 
body's specific response to it.  

What side effects are bothering you? Bleeding 
problems vary by the dose, route  of 
administration (pill, patch, topical, shot), by 
your body size and by how far past menopause you 
are. Hot flashes vary by the dose, the specific 
compound and how well the estrogens are absorbed 
from the stomach or skin. Mood symptoms such as 
irritability or depression are often determined by 
the progesterone or progestin rather than the 
estrogen part of HRT. 

Difficulties with side effects from hormone 
replacement therapy are some of the most 
challenging problems gynecologists face. You will 
need to work closely with your doctor to try 
different forms of HRT estrogen and progesterone 
and different doses and routes of administration. 
You may need blood levels drawn to see how well 
you are absorbing the medication and changes based 
upon whatever specific side effects you have. This 
is one health problem that might be too difficult 
treat on your own. 

For more explanation, see our past article: 

What is Natural About Natural Hormone Therapy?

4. High energy drinks are deceptive
High energy drinks have made substantial sales 
gains in the last several years. Beverages like 
Red Bull, Sobe Adrenaline Rush, Whoopass, Hype, 
180 and others came on our market and promise a 
quick energy boost. Students use them to cram for 
exams, salesmen to get going, exercisers to 
increase their workouts and bar patrons to be able  
to drink more. 

These beverages basically contain caffeine, sugar, 
amino acids and sometimes vitamins. It is hard to 
find exact counts on caffeine content but most 
have in the range of 100 mg or about that of a cup 
of drip coffee, about twice as much as a Coke or 3 
times that of a Pepsi. The sugar and calorie 
amount ranges about as much as a Pepsi or Coke 
also. Taurine, an amino acid, is often an 
ingredient and one manufacturer claims it is added 
to speed up the effect of the caffeine. 

Herbal products are also in the mix. Guarana, from 
seeds of an Amazon plant, is used and has caffeine 
in it separate from the caffeine added to the 
drink and listed on the ingredients. Ginseng is 
often added and occasionally ephedra appears in 
the ingredients such as in the diet drink Metab-O-
Lite. Most experts consider the combination of 
caffeine and ephedra dangerous to anyone with high 
blood pressure or heart disease and they feel this 
combination can lead to heart attacks or strokes. 

While these high energy drinks are probably no 
worse than a cup of coffee and a Coke together, 
more than one or two can lead to caffeine toxicity 
and cause heart palpitations and nausea. 
Definitely avoid the ones containing ephedra and 
don't make a habit of mixing them with alcohol. If 
you have a problem with palpitations, avoid these 
high energy drinks altogether. If others call them 
"health drinks", at least you will know what they 

High energy drinks are deceptive

5. Progesterone to treat PMS brings up a point
Some years back, pure progesterone or synthetic 
progestins were used in an attempt to treat 
premenstrual syndrome, PMS. Most doctors are not 
currently using progesterone as treatment because 
randomized studies show no benefit. This review 
below in the British Medical Journal (BMJ) 
reaffirms that progesterone is not effective after 
analyzing scientific clinical trials treating PMS. 

So what's the news? Some disagreeing responses to 
this article caught my attention and point out 
that there is still confusion as to what 
premenstrual syndrome actually is. The BMJ accepts 
email responses to their articles and posts them.  
One nurse midwife from the U.S. indicated 
confusion as to how progesterone was not effective 
in these studies when in fact she has successfully 
used topical progesterone cream for cyclic breast 
soreness (mastalgia). She is equating cyclic 
breast soreness with PMS. 

Another woman responded that the studies must not 
have administered the progesterone "in sync" with 
a  woman's menstrual cycle because when she did 
use the progesterone "in sync",  her headaches 
were immediately controlled. Thus she equated 
cyclical headaches with PMS. 

Many women have physical symptoms or conditions 
that vary with menses and worsen in the 2nd half 
of the cycle. Lower abdominal bloating, breast 
tenderness, swelling of the legs, menstrual cramps 
and headaches are commonly cited. But without mood 
symptoms that accompany the physical symptoms, 
most doctors would not consider a diagnosis of 
PMS. The definition commonly used is: 

Premenstrual Syndrome ("PMS") is a combination of 
"physical" and "emotional" (or behavioral) 
symptoms that occurs premenstrual and is absent 
the rest of the cycle; the symptoms are severe 
enough to significantly interfere with work or 
home activities. 

PMS is not just one specific physical symptom or a 
collection of them and it is not just a specific 
or collection of psychological, mood symptoms. It 
is the COMBINATION of both physical and mood 
symptoms. Also there has to be an interval during 
the menstrual cycle in which the symptoms are 
totally absent. Otherwise what you have is really 
just a menstrual exacerbation of an underlying 
chronic physical or mood problem. 

This may seem to be "playing with words" but it is 
an important conceptual difference when conducting 
scientific studies and testing any type of 
pharmaceutical intervention. Topical progesterone 
cream may well decrease cyclic breast pain but it 
does not help the mood symptoms of PMS. 

The use of progesterone to treat PMS

6. Health tip to share -  mouth sores

"This is to respond to the lady who was 
complaining of mouth sores. I used to also suffer 
from this ailment and have found that since I 
began brushing my teeth with a baking soda based 
toothpaste, that the ulcers and sores have 
disappeared. I don't know if this will work for 
you, but it's worth a try. It's also a whole lot 
cheaper than medication or an extra visit to the 
dentist!" - Anonymous 

Mouth sores

If you have discovered ways of coping with a 
disease or condition and it works for you, please 
share it with us: 

Health tip suggestion form

7. Humor is healthy

"Cat Laws"

Law of Cat Inertia
A cat at rest will tend to remain at rest, unless 
acted upon by some outside force - such as the 
opening of cat food, or a nearby scurrying mouse. 

Law of Cat Motion
A cat will move in a straight line, unless there 
is a really good reason to change direction. 

Law of Cat Magnetism
All blue blazers and black sweaters attract cat 
hair in direct proportion to the darkness of the 

Law of Cat Thermodynamics
Heat flows from a warmer to a cooler body, except 
in the case of a cat, in which case all heat flows 
to the cat. 

Law of Cat Stretching
A cat will stretch to a distance proportional to 
the length of the nap just taken. 

Law of Cat Sleeping
All cats must sleep with people whenever possible, 
in a position as uncomfortable for the people 
involved, and as comfortable as possible for the 

Law of Cat Elongation
A cat can make her body long enough to reach just 
about any counter top that has anything remotely 
interesting on it. 

Law of Cat Obstruction
A cat must lay on the floor in such a position to 
obstruct the maximum amount of human foot traffic. 

Law of Cat Acceleration
A cat will accelerate at a constant rate, until he 
gets good and ready to stop. 

Law of Dinner Table Attendance
Cats must attend all meals when anything good is 

Law of Rug Configuration
No rug may remain in its naturally flat state for 
very long. 

Law of Obedience Resistance
A cat's resistance varies in proportion to a 
human's desire for her to do something. 

First Law of Energy Conservation
Cats know that energy can neither be created nor 
destroyed and will, therefore, use as little 
energy as possible. 

Second Law of Energy Conservation
Cats also know that energy can only be stored by a 
lot of napping. 

Law of Refrigerator Observation
If a cat watches a refrigerator long enough, 
someone will come along and take out something 
good to eat. 

Law of Electric Blanket Attraction
Turn on an electric blanket and a cat will jump 
into bed at the speed of light. 

Law of Random Comfort Seeking
A cat will always seek, and usually take over, the 
most comfortable spot in any given room. 

Law of Bag/Box Occupancy
All bags and boxes in a given room must contain a 
cat within the earliest possible nanosecond. 

Law of Cat Embarrassment
A cat's irritation rises in direct proportion to 
her embarrassment times the amount of human 

Law of Milk Consumption
A cat will drink his weight in milk, squared, just 
to show you he can. 

Law of Furniture Replacement
A cat's desire to scratch furniture is directly 
proportional to the cost of the furniture. 

Law of Cat Landing
A cat will always land in the softest place 
possible; often the midsection of an unsuspecting, 
reclining human. 

Law of Fluid Displacement
A cat immersed in milk will displace her own 
volume, minus the amount of milk consumed. 

Law of Cat Disinterest
A cat's interest level will vary in inverse 
proportion to the amount of effort a human expends 
in trying to interest him. 

Law of Pill Rejection
Any pill given to a cat has the potential energy 
to reach escape velocity. 

Law of Cat Composition
A cat is composed of Matter + Antimatter = It 
Doesn't Matter 

That's it for this time. 
Your BACKUPMD on the Net.
Frederick R. Jelovsek MD 

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****** Woman's Diagnostic Cyber Newsletter *******
                November 4, 2001
Biweekly from Woman's Diagnostic Cyber

1. Beating cancer with humor
2. Food additives - why  are they used?
3. Reader submitted Q&A - What is diverticulitis?
4. The natural limits of pregnancy testing
5. Diarrhea and E.coli food poisoning
6. Health tip to share - Exercise for low back pain
7. Humor is healthy

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

1. Beating cancer with humor
Would anything about breast cancer be humorous? 
You would think not, and yet after the initial 
shock of any medical condition, humor is known to 
reduce stress, lift a veil of depression, improve 
outlook, and even stimulate the immune system to 
help fight most diseases. Many doctors believe 
laughter can be as healing as the medicines 

The article below chronicles the response of one 
woman, a breast cancer survivor, who has found how 
humor helps her cope with her feelings. She 
creates cartoons about cancer, its treatment and 
all of the surrounding events. She feels the humor 
made her treatments less harsh. she slept better 
and was more motivated to exercise. Most of all it 
helped her connect with the people around her and 
changed their interactions to be more positive and 
upbeat with her. 

Most of our readers are aware of our slight 
attempts to interject a little humor by way of 
jokes. (Yes, I heard you thinking "very little"!)  
I realize not all of them are funny but what is 
really interesting is how there is always someone 
who is "offended" by any given joke. It is this 
degree of emotional response with "being 
offended" that I think needs comment.

We get feedback from different newsletter readers 
who write in about how they were offended at us 
making fun of:  age, weight loss difficulties, 
men, menopause, PMS, mental conditions, 
"dumbness",  body parts, or whatever. I appreciate 
the feedback and welcome these comments. But 
sometimes I feel sorry that the person who is so 
offended is taking a subject so seriously. I hope 
it is just a time in their life and not a long 
term reaction to the topic. 

I think finding a joke or any humor attempt  
offensive is much different from finding it not 
funny. People who are offended by a particular 
joke may often have a problem with their emotional 
thought processes. Whether it is unresolved anger 
over a disease or condition out of our control or 
whether it is an obsessive long term concern, it 
is harmful to one's health. I say "try to get over 

Now before someone jumps on this attitude as just 
politically incorrect or insensitive to the 
feelings of others, let me say that it doesn't 
mean you have to laugh about cancer right after a 
doctor tells you you have it. But eventually you 
should be able find the humor in the events 
surrounding this or any condition. It is part of 
the healthy adjustment process and the lack of it 
may make the condition worse. Depression and 
stress definitely suppress your own body's health 
defense mechanisms. Humor is healthy; its a 
philosphy of life.  

I guess the bottom line is if you find yourself  
"offended" by a joke or humorous attempt, examine 
your own though process to see if there is a 
chance it is your problem, not theirs. 

Hmm ...I wonder if the timing is getting better 
for those anthrax jokes?...:) 

Beating cancer with humor

2. Food additives -  why  are they used?
Did you know that there are over 400 additives and 
over 3000 flavorings that are added to foods on 
our supermarket shelves today?  Some additives 
make the food more colorful, last longer before 
spoiling, or make it more tasty. Sometimes they 
are added just to be able to produce the food more 
cheaply. In any case, the food industry tells us 
that without these additives, our selection of 
processed foods would be severely restricted 
compared to what is available today. 

It is estimated that less than 1% of additives 
really help keep food safe from bacterial 
poisoning and contamination. Most of them are used 
just for cosmetic reasons to make the food appear 
more appetizing. Even the term "natural" for an 
additive may not necessarily mean beneficial. 
Natural colors can still cause allergies and who 
would expect "natural beet coloring" in a 
strawberry product? 

Additives fall into several different groups:

colors - artificial or natural to alter appearance 
preservatives and antioxidants - prevent bacterial 
  growth or fat turning rancid 
emulsifiers, stabilizers and thickeners - modify 
  texture, spreadability 
processing aids - anti-caking, gelling or firming 
flavor enhancers - modify taste such as monsodium 
glazing agents - give a shining or polished 
flour treatments, improvers and bleaching agents - 
  for processed bread 
packing gases - inert gases, eg., nitrogen to keep 
  produce looking fresh longer 
sweeteners - aspartame, saccharin, sorbitol, 
flavors - may replace the actual ingredient such 
  as lemon, beef, tomato 

Are all of these safe? Probably not for everyone, 
but there is no answer as to which ones are 
harmful. Allergies or unusual reactions can occur 
to any chemical. The additives are tested and 
regulated to a certain degree by government 
agencies but flavors are not. 

For a list of which additives and flavors may 
cause health problems, check out this article from 
Great Britain at the surgerydoor.co.uk. It also 
covers which additives need to be listed on 
ingredient labels, and caveats about reading the 

Food additives

3. Reader submitted Q&A - What is diverticulitis?
" What is diverticulitis, it's symptoms and 
treatment? I'm 48 years old.  My menstrual cycle 
is pretty regular.  Sometimes my insides hurt more 
than usual, but not all the time.  I'm going 
through different tests right now because of 
vomiting and nausea.  So far diverticulitis and a 
precancerous polyp have been diagnosed.  Gall 
bladder tests have been normal. "  Brenda 

First come the diverticula of the colon. They are 
herniations of the bowel lining through the muscle 
of the large colon. Diverticula are thought to be 
caused by a chronic increase in intra-colon 
pressure such as that caused by constipation. 

Once diverticula form, only about 25% of the time 
do they become symptomatic. Nausea, vomiting and 
abdominal bloating along with constipation are 
often symptoms. Diverticula can become more 
symptomatic by developing bleeding or infection. 
If infection takes place, it is called 
diverticulitis. Diverticulitis often produces pain 
especially in the left lower pelvic area. If you 
were to develop fever and chills along with 
abdominal pain, you should be sure to see your 
doctor immediately. You are fortunate that the 
doctors have already looked in the colon and 
removed the precancerous polyp.                           

When diverticulitis flares, it is treated with 
antibiotics and fluids. Sometimes you may have to 
be hospitalized for an acute infection and if an 
abscess forms outside the wall of the colon, you 
may even need surgery including a surgical 
resection of the segment of colon that has the 

Dietary treatment with high fiber foods to prevent 
constipation is the mainstay treatment. It is 
hoped that reducing intra-colon pressure will 
reduce the chance of a diverticula becoming 
infected. Most prophylactic antibiotic regimens do 
not prevent recurrences of acute inflammation 
although there have been some trials with a drug 
called rifaximin. Your doctor may be aware of 
clinical trials involving other medications to 
prevent recurrences. 

See our disease profile below:

Diverticulosis and diverticulitis

4. The natural limits of pregnancy testing
If you are trying to get pregnant, when is the 
best time to begin testing? Most home pregnancy 
test kits will say to start testing as early as 
the first day of a missed period. Doctor's offices 
also tend to say the same thing. Even for very 
sensitive home pregnancy tests it is not wise to 
start checking before day 12 after ovulation. All 
of these recommendations presuppose that ovulation 
for that cycle occurred about 14 days before the 
day of the missed menses. However, ovulation can 
be very variable and unless a woman is using 
ovulation predictor tests to know for sure when 
ovulation occurs, one can never be sure that the 
period is really due on the day you think it is 

The hormone of pregnancy, HCG, is not measurable 
in the blood or urine until the pregnancy 
"implants" in the uterine lining. This takes place 
anywhere from day 6-12 after ovulation but most 
commonly on day 8. In a usual 28 day cycle, 
ovulation occurs about day 14, so day 8 after 
ovulation would be about day 22 after the last 
menstrual period (LMP). However if ovulation that 
cycle were delayed until day 23 for some reason, 
then implantation would not occur until day 31 and 
the pregnancy test would not be positive until 
about day 34 or after. This would mean that if a 
woman tested negative on day 29 after her LMP. she 
could still be pregnant that cycle. 

In the study below, very sensitive pregnancy tests 
were used to determine when pregnancy occurred in 
spontaneous cycles of 136 women trying to conceive 
who knew when their next menstrual period was due. 
They did not use any methods to detect ovulation.  
The investigators found that 10% of the actual 
pregnancies did not turn the test positive on the 
first day of a missed, expected menses. In other 
words the women actually became pregnant during 
that cycle but ovulation (or implantation) must 
have occurred later than expected. 

This study shows the natural ovulation variability 
that occurs even in a woman who considers herself 
to be regular in her menstrual cycle. 

The natural limits of pregnancy testing

5.  Diarrhea and E.coli food poisoning
Food poisoning from various bacteria is not 
common, but when it happens, it usually affects a 
large number of people at a time. In recent 
decades, a syndrome of severe, watery diarrhea due 
to food contaminated with a special strain of  E. 
Coli, strain O157:H7,  has been recognized and has 
been the cause of over 70,000 infections and 60 
deaths each year in the U.S. 

E. coli is a common human and animal bowel 
bacteria of which there are over 100 different 
strains. Most of the strains do not produce a 
toxic human response; they are normal bowel 
bacteria. Several toxic strains have been 
identified, however, and they can produce a severe 
dehydrating diarrhea and even a toxic response 
that destroys red blood cells and may result in 
complete kidney failure. 

Since first identified in the early 1980s,  E. 
Coli O157:H7 has caused outbreaks in: 

eating hamburger from a national fast food 
sandwiches made and served at a nursing home
outbreak in a child care center
contaminated roast beef
contaminated salad bar
unpasteurized apple juice
contaminated commercial dry-cured salami product
contaminated swimming pool

While diarrhea can be a sign of a cold or flu, 
signs of severe diarrhea that should alert you to 
seeking medical attention include: 

a temperature of more than 102 deg F,  38.9 deg C
bloody stools 
a dry mouth or crying without tears (severe 
unusual sleepiness, drowsiness or unresponsiveness 

Steps that you may take to prevent illness from E. 
coli contamination at home include: 

have your water checked for E. coli counts
cook any ground meat to an internal temperature of 
  160 deg F, 71 deg C 
cook any solid muscle meat cut (steak, roast) to 
  an internal temperature of 135 deg F, 57.2 deg C 
wash produce before eating with just water, 
  chlorinated water or soap 
wash counter tops, cutting boards, utensils after 
  working with raw meat just as you would with 
  chicken for salmonella 
wash hands frequently when cooking or when 
  handling diapers, litter boxes or anything 
  coming in contact with or even close to stool. 
6. Health tip to share - Exercise for low back pain
"My first issue of your letter is dated 6/3/2001. 
I didn't get to see it until we arrived home after 
a four week trip up to the Northwest Territories. 
When I downloaded the e-mail, I had forgotten I 
had subscribed to your news letter and just when I 
was about to "delete" it, the article on hip and 
leg pain or the piriformis syndrome, caught my 
eye.  Before we left on this journey, I had been 
seeing a chiropractor for my lower back and had 
absolutely no help from him. while we were gone I 
was in such misery I took too many Alleve and 
ended up at a health clinic with my stomach in 
near ulceration. My intention was to get a MRI 
upon arriving home as I told my husband, I could 
not live this way....I couldn't walk, sit or stand 
for any length of time and sleeping was anything 
but! I read the exercise to do for this problem 
and I still cannot believe it! My pain was 
alleviated so quickly I am still astounded. I have 
given the site and a copy of the exercise to 
several people and they too have seen terrific 
results. I am still stunned that this simple 
exercise is not standard procedure for every 
health care professional treating someone with 
symptoms such as mine. It was truly divine 
intervention.  Thank you for making my life pain 
free again.  If I have any tightness in my lower 
back, I immediately do the exercise and I have 
immediate relief. " -  Joanne 

(editor note - here is the exercise referred to 
from About.com - Sports Medicine for stretching 
the right piriformis muscle: 

"lay on your back, bend your knees and cross your 
right leg over your left so your right ankle rests 
on your left knee in a figure four position. Bring 
your left leg towards your chest by bending at the 
hip. Reach through and grab your left thigh to 
help pull things towards your chest. " 

To stretch the left piriformis muscle just 
substitute left for right and right for left in 
the above exercise.) 

If you have discovered ways of coping with a 
disease or condition and it works for you, please 
share it with us: 

Health tip suggestion form

7. Humor is healthy

1. Both take up too much space on the bed.
2. Both have irrational fears about vacuum 
3. Both mark their territory.
4. Neither tells you what's bothering them.
5. The smaller ones tend to be more nervous.
6. Neither does any dishes.
7. Neither of them notice when you get your hair 
8. Both like dominance games.
9. Both are suspicious of the postman.
10. Neither understands what you see in cats.


1. Dogs do not have problems expressing affection 
in public. 
2. Dogs miss you when you're gone.
3. Dogs feel guilty when they've done something 
4. Dogs admit when they're jealous.
5. Dogs do not play games with you-except fetch 
(and they never laugh at how you throw.) 
6. You can train a dog. 
7. Dogs are easy to buy for. 
8. The worst social disease you can get from dogs 
is fleas. 
9. Dogs understand what "no" means. 
10. Dogs mean it when they kiss you. 

That's it for this time. 
Your BACKUPMD on the Net.
Frederick R. Jelovsek MD 

Back to top

****** Woman's Diagnostic Cyber Newsletter *******
                November 18, 2001
Biweekly from Woman's Diagnostic Cyber

1. Teens and cancer
2. Diagnosis of uterine fibroids 
3. Reader submitted Q&A - Atherosclerosis plaque 
4. Multiple Sclerosis - What is it?
5. Hemorrhoids - the symptoms and treatment
6. Health tip to share - Preventing overeating
7. Humor is healthy

Spread the word! Send a copy of this newsletter
to someone you know.

Note: Some of the long URLs may not wrap as a
hyperlink and you may need to cut and paste.

1. Teens and cancer

Children may not understand a disease such as 
cancer. Teens understand it but think they are 
indestructible. If you tell a teen that sun 
exposure can lead to skin cancers and melanoma 
they either tune you out or just file it in a "not 
applicable to me" mind folder. But more and more 
teens are developing skin cancers. The clinics 
that see and manage skin cancer including 
melanomas note a rise in the number of younger 
patients they are seeing. 

One study showed that the percent of time that 
teens routinely practiced sun-protection behaviors 
on sunny days were: 

wearing sunglasses (32%) 
wearing long pants (21%)
staying in the shade (22%)
applying sunscreen (31%)

It is the sunburn part of skin sun exposure that 
is the most damaging. Once  skin damage occurs, 
subsequent sun exposure can induce cancerous 
change even without further burning. 

If you have a teen, be sure to reinforce the 
cancer hazards of ignoring sun protection 
behavior. Also help them check the back of their 
neck, their back and even the back of their legs 
where they may not be able to see moles or 
pigmented skin lesions that have enlarged or 
darkened in color, or whose borders have become 

Teens and cancer

Sun protection behaviors in teens

2. Diagnosis of uterine fibroids 

The tools used to diagnose uterine fibroids are 
the pelvic exam, ultrasound imaging, 
sonohysterography (injection of fluid into the 
uterus), magnetic resonance imaging (MRI), 
hysteroscopy (looking into the uterus with a 
scope). and laparoscopy.  The following site, All 
About Myomectomy, contains some good explanations 
of how the above tools are used to determine all 
about fibroids; how many, how big they are, where 
in the uterus they are located and how likely they 
are to be producing the symptoms that are 
bothering you. 

This latter determination is important because as 
many as 5-10% of women and possibly as high as 25% 
of women have uterine fibroids
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