Hysterectomy

Alternative Names

Vaginal hysterectomy; Abdominal hysterectomy; Supracervical hysterectomy; Radical hysterectomy; Removal of the uterus
Definition
A hysterectomy is a surgical removal of the uterus, resulting in the inability to become pregnant (sterility). It may be done through the abdomen or the vagina.

Description

Hysterectomy is an operation that is commonly performed. There are many reasons a woman may need a hysterectomy. However, there are nonsurgical approaches to treat many of these conditions. Talk to your doctor about nonsurgical treatments to try first, especially if the recommendation for a hysterectomy is for a cause other than cancer.

During a hysterectomy, the uterus may be completely or partially removed. The fallopian tubes and ovaries may also be removed. A partial (or supracervical) hysterectomy is removal of just the upper portion of the uterus, leaving the cervix intact.

A total hysterectomy is removal of the entire uterus and the cervix. A radical hysterectomy is the removal of the uterus, the tissue on both sides of the cervix (parametrium), and the upper part of the vagina.

A hysterectomy may be done through an abdominal incision (abdominal hysterectomy), a vaginal incision (vaginal hysterectomy), or through laparoscopic incisions (small incisions on the abdomen — laparoscopic hysterectomy).

Your physician will help you decide which type of hysterectomy is most appropriate for you, depending on your medical history and the reason for your surgery. Robotic hysterectomy surgery is not yet widely available in the United States.

Why the Procedure is Performed

Hysterectomy may be recommended for:

Tumors in the uterus like uterine fibroids or endometrial cancer
Cancer of the cervix or severe cervical dysplasia (a precancerous condition of the cervix)
Cancer of the ovary
Endometriosis, in those cases in which the pain is severe and not responsive to nonsurgical treatments
Severe, long-term (chronic) vaginal bleeding that cannot be controlled by medications
Prolapse of the uterus
Complications during childbirth (like uncontrollable bleeding)
Risks

The risks for any anesthesia are:

Reactions to medications
Problems breathing
The risks for any surgery are:

Bleeding
Infection
Other risks that are possible from a hysterectomy include:

Injury to nearby organs, including the bladder or blood vessels
Injury to bowel
Pain with intercourse
Outlook (Prognosis)

Most patients recover completely from hysterectomy. Removal of the ovaries along with the uterus in premenopausal women causes immediate menopause, and estrogen replacement therapy may be recommended.

Some women worry that their sexual function will be decreased after removal of the uterus. Researchers have found that sexual function after a hysterectomy depends most on sexual function before the surgery. If a woman had good sexual function before the surgery, she will continue to have good sexual function afterward. If you experience a new decrease in your sexual function after hysterectomy, talk to your health care provider about possible causes.

Recovery

The average hospital stay depends on the type of hysterectomy performed, but is usually from 2 to 3 days. Complete recovery may require 2 weeks to 2 months. Recovery from a vaginal or laparoscopic hysterectomy is faster than from an abdominal hysterectomy, and may include less pain.

Intravenous and oral medications are used after the surgery to relieve postoperative pain. A catheter may remain in place for 1 to 2 days to help the bladder pass urine. Moving about as soon as possible helps to avoid blood clots in the legs and other problems.

Walking to the bathroom as soon as possible is recommended. Normal diet is encouraged as soon as possible after bowel function returns. Avoid lifting heavy objects for a few weeks following surgery. Sexual intercourse should be avoided for 6 to 8 weeks after a hysterectomy.

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Abdominal CT scan

Definition

An abdominal CT scan is an imaging method that uses x-rays to create cross-sectional pictures of the belly area. CT stands for computed tomography.

See also: CT scan

How the Test is Performed

You will be asked to lie on a narrow table that slides into the center of the CT scanner. Usually, you will lie on your back with your arms raised above the head.

The health care provider may inject a dye into one of your veins. This helps certain diseases and organs show up better on the images.

Once inside the scanner, the machine's x-ray beam rotates around you. Small detectors inside the scanner measure the amount of x-rays that make it through the abdomen. A computer takes this information and creates several individual images, called slices.

You must be still during the exam, because movement causes blurred images. You may be told to hold your breath for short periods of time.

The actual scan time only takes a few minutes, although the entire procedure usually takes much longer.

How to Prepare for the Test

Tell the health care provider if you have any allergies or have had difficulty with previous CT scans.

If contrast or sedation is used, you may also be asked not to eat or drink anything for 4-6 hours before the test.

Since x-rays have difficulty passing through metal, you will be asked to remove jewelry and wear a hospital gown during the study.

How the Test Will Feel

The x-rays are painless. Some people may have discomfort from lying on the hard table.

Contrast give through an IV may cause a slight burning sensation, a metallic taste in the mouth, and a warm flushing of the body. These sensations are normal and usually go away within a few seconds.

Why the Test is Performed

An abdominal CT rapidly creates detailed pictures of the belly area. The test may be used to:

Study blood vessels
Identify masses and tumors, including cancer
Look for infections, kidney stones, or appendicitis
What Abnormal Results Mean

The CT scan may show the following:

Abdominal aortic aneurysm
Abscesses
Acute bilateral obstructive uropathy
Acute cholecystitis
Acute unilateral obstructive uropathy
Addison's disease
Amebic liver abscess
Appendicitis
Bilateral hydronephrosis
Bowel wall thickening
Carcinoma of the renal pelvis or ureter
Cholangiocarcinoma
Choledocholithiasis
Cholelithiasis
Chronic bilateral obstructive uropathy
Chronic cholecystitis
Chronic pancreatitis
Chronic unilateral obstructive uropathy
Complicated UTI (pyelonephritis)
Cystinuria
Cysts
Echinococcus
Enlarged lymph nodes
Enlarged organs
Gastrointestinal or bowel obstruction
Glucagonoma
Hairy cell leukemia
Hepatocellular carcinoma
Histoplasmosis; disseminated
Hodgkin's lymphoma
Islet of Langerhans' tumor
Multiple endocrine neoplasia (MEN) II
Nephrocalcinosis
Nephrolithiasis
Non-Hodgkin's lymphoma
Ovarian cancer
Pancreatic abscess
Pancreatic carcinoma
Pancreatic pseudocyst
Pancreatitis
Pheochromocytoma
Primary hyperaldosteronism
Pyelonephritis – acute
Pyogenic liver abscess
Renal cell carcinoma
Retroperitoneal fibrosis
Sclerosing cholangitis
Stones (bladder, kidney, liver, gall bladder)
Testicular cancer
Tumors
Unilateral hydronephrosis
Ureterocele
Wilms' tumor
Wilson's disease
Zollinger-Ellison syndrome
Additional conditions under which the test may be performed include the following:
Acute renal failure
Alcoholic liver disease (hepatitis/cirrhosis)
Atheroembolic renal disease
Chronic glomerulonephritis
Chronic renal failure
Cushing syndrome
Cushing syndrome caused by adrenal tumor
Injury of the kidney and ureter
Medullary cystic kidney disease
Multiple endocrine neoplasia (MEN) I
Polycystic kidney disease
Reflux nephropathy
Renal artery stenosis
Renal vein thrombosis
Skin lesion of histoplasmosis
Risks

An abdominal CT scan is usually not recommended for pregnant women, because it may harm the unborn child. Women who are or may be pregnant should speak with their health care provider to determine if ultrasound can be used instead.

CT scans and other x-rays are strictly monitored and controlled to make sure they use the least amount of radiation. CT scans do create low levels of ionizing radiation, which has the potential to cause cancer and other defects. However, the risk associated with any individual scan is small. The risk increases as numerous additional studies are performed.

In some cases, a CT scan may still be done if the benefits greatly out weigh the risks. For example, it can be more risky not to have the exam, especially if your health care provider thinks you might have cancer.

The most common dye used is iodine based. A person who is allergic to iodine may have nausea, sneezing, vomiting, itching, or hives. Rarely, the dye may cause anaphylaxis (a life-threatening allergic response).

Considerations

A CT scan provides a better picture of internal organs than traditional x-rays. The benefits of an abdominal CT scan usually far outweigh the risks of radiation exposure.
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Cystitis – noninfectious

Alternative Names

Abacterial cystitis; Radiation cystitis; Chemical cystitis; Urethral syndrome – acute
Definition
Noninfectious cystitis is irritation of the bladder that is not caused by a urinary tract infection.

Causes
Noninfectious cystitis is most common in women of childbearing years. The exact cause of noninfectious cystitis is often unknown. However, it has been associated with the use of bubble baths, feminine hygiene sprays, sanitary napkins, spermicidal jellies, radiation therapy to the pelvis area, and chemotherapy with certain types of medications, and other irritants.

Certain foods such as tomatoes, artifical sweeteners, caffinated products, chocolate, and alcohol can cause irritative bladder symptoms.

See also: Interstitial cystitis

Symptoms

Pressure in the lower pelvis
Painful urination
Frequent need to urinate
Urgent need to urinate
Decreased ability to hold urine
Need to urinate at night
Abnormal urine color — cloudy
Blood in the urine
Foul or strong urine odor
Additional symptoms that may be associated with this disease:

Pain during sexual intercourse
Penile pain
Flank pain
Fatigue
Exams and Tests

A urinalysis may reveal red blood cells (RBCs) and some white blood cells (WBCs).

A urine culture (clean catch) or catheterized urine specimen will reveal whether you have a bacterial infection.

If the cystitis is related to radiation or chemotherapy, urine tests and cystoscopy (use of lighted instrument to look inside the bladder) may be needed.

Treatment
The goal of treatment is to manage the symptoms.

Medical Treatments:

Anti-cholinergic drugs can help improve bladder contraction and emptying. Possible side effects include slowed heart rate, low blood pressure, increased thirst, and constipation.
Muscle relaxants (such as diazepam) and alpha 1-blockers (prazosin) may be used to reduce the strong urge to urinate or need to urinate frequently.
Surgery is rarely performed unless a person has severe urinary retention or significant blood in the urine.
Diet:

Avoid fluids that irritate the bladder such as alcohol, citrus juices, and caffeine.
Other therapies:

Bladder exercises to re-establish a pattern of regular and complete urination may help. Bladder training exercises involve developing a schedule of times when you should try to urinate, while trying to delay urination at all other times. One method is to force yourself to urinate every 1 to 1 and 1/2 hours, despite any leakage or urge to urinate in between these times. As you become skilled at waiting this long, gradually increase the time intervals by 1/2 hour until you are urinating every 3 to 4 hours.
Pelvic muscle strengthening exercises called Kegel exercises are used primarily to treat people with stress incontinence. However, these exercises may also help relieve symptoms of urgency related to long-term (chronic) noninfectious cystitis. Performing the exercises properly and regularly increases the method's success.
Electrical stimulation to the pelvis may be used as a treatment for noninfectious cystitis, but this is controversial.
Outlook (Prognosis)

Although most cases of cystitis are uncomfortable, they usually resolve over time.

Possible Complications

Ulceration of bladder wall
Urethral stricture
Diminished bladder capacity
Bladder cancer
Anemia
When to Contact a Medical Professional

Call your health care provider if you have symptoms of cystitis, or if you have been diagnosed with cystitis and symptoms worsen or new symptoms develop, especially fever, back or flank pain, and vomiting.

Prevention

Avoid using items that may be irritants such as bubble baths, feminine hygiene sprays, sanitary napkins or tampons (especially scented products), and spermicidal jellies.

If you need to use such products, try to find those that do not cause irritation for you.

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Aase syndrome

Synonyms: Aase-Smith syndrome, Hypoplastic anemia/Triphalangeal thumb syndrome

Definition

Aase syndrome is a rare disorder that involves anemia and certain joint and skeletal deformities.

Causes

Most cases of Aase syndrome occur without a known reason and are not passed down through families (inherited). However, some cases have been shown to be inherited as an autosomal dominant and autosomal recessive traitn.

The anemia associated with Aase syndrome is caused by underdevelopment of the bone marrow, which is where blood cells are formed.

Symptoms

• Absent or small knuckles
• Cleft palate
• Decreased skin creases at finger joints
• Deformed ears
• Delayed closure of fontanelles (soft spots)
• Droopy eye lids
• Inability to fully extend the joints from birth (contracture deformity)
• Mildly slowed growth
• Narrow shoulders
• Pale skin
• Triple-jointed thumbs
• Exams and Tests

Tests that may be done include:

• Bone marrow biopsy
• Complete blood count (CBC)
• Echocardiogram
• X-rays

Treatment

Blood transfusions are given in the first year of life to treat anemia. Prednisone has also been used to treat anemia associated with Aase syndrome, but it should only be used after reviewing the benefits and risks with a doctor who has experience treating anemias.

A bone marrow transplant may be necessary if other treatment fails.

Outlook (Prognosis)

The anemia tends to improve with age.

Possible Complications

Complications related to anemia include weakness, fatigue, and decreased oxygenation of the blood.

Heart problems can lead to a variety of complications, which depend on the specific defect.

Severe cases of Aase syndrome have been associated with still birth or early death.

When to Contact a Medical Professional

Call your health care provider if you notice possible signs of Aase syndrome in your child. Genetic counseling is recommended if there is a family history of Aase syndrome.

Prevention

There is no known prevention.

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Aarskog syndrome

Definition

Aarskog syndrome is an inherited disease that affects a person's height, muscles, skeleton, genitals, and appearance of the face. Inherited means that it is passed down through families.

Causes

Aarskog syndrome is a genetic disorder. It affects mainly males, but females may have a milder form. The condition is caused by changes (mutations) in a gene called "faciogenital dysplasia" (FGDY1).

Symptoms

Belly button that sticks out
Bulge in the groin or scrotum (inguinal hernia)
Delayed sexual maturation
Delayed teeth
Downward palpebral slant to eyes
Hairline with a "widow's peak"
Mildly sunken chest (pectus excavatum)
Mild to moderate mental problems
Mild to moderate short stature which may not be obvious until the child is 1 – 3 years old
Poorly developed midportion of the face
Rounded face
"Shawl" scrotum, testicles that have not come down (undescended)
Short fingers and toes with mild webbing
Single crease in palm of hand
Small, broad hands and feet with short fingers and curved-in 5th finger
Small nose with nostrils tipped forward
Top portion of the ear folded over slightly
Wide groove above the upper lip, crease below the lower lip
Wide-set eyes with droopy eyelids
Exams and Tests

Genetic testing for mutations in the FGDY1 gene
X-rays
Treatment

Moving the teeth (orthodontic treatment) may be done for some of the abnormal facial features.

Support Groups

The MAGIC Foundation for Children's Growth is a support group for Aarskog syndrome and can be found at www.magicfoundation.org.

Outlook (Prognosis)

Some people may have mild degrees of mental slowness, but affected children usually have good social skills. Some males may have problems with fertility.

Possible Complications

Cystic changes in the brain
Difficulty growing in the first year of life
Poorly aligned teeth
Seizures
Undescended testicle
When to Contact a Medical Professional

Call your health care provider if your child has delayed growth or if you notice any of the symptoms described here. Seek genetic counseling if there is a history of Aarskog syndrome in your family. Contact a genetic specialist if your doctor thinks you or your child may have Aarskog syndrome.

Prevention

Prenatal testing may be available for those with a family history of the condition or known mutation of the gene.

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Premenstrual syndrome

Alternative Names

PMS
Definition
Premenstrual syndrome (PMS) refers to a wide range of physical or emotional symptoms that typically occur about 5 to 11 days before a woman starts her monthly menstrual cycle. The symptoms usually stop when menstruation begins, or shortly thereafter.

See also: Premenstrual dysphoric disorder (PMDD)

Causes

An exact cause of PMS has not been identified. However, it may be related to social, cultural, biological, and psychological factors.

PMS is estimated to affect up to 75% of women during their childbearing years.

It occurs more often in women:

Between their late 20s and early 40s
Who have at least one child
With a family history of a major depression
With a history of postpartum depression or an affective mood disorder
The symptoms typically get worse in the late 30s and 40s as a woman approachs the transition to menopause.

As many as 50-60% of women with severe PMS have an underlying psychiatric disorder (premenstrual dysphoric disorder).

Symptoms

A wide range of physical or emotional symptoms have been associated with PMS. By definition, symptoms are considered to be PMS-related if they occur during the second half of the menstrual cycle (14 days or more after the first day of the menstrual period) and are absent for about 7 days after a menstrual period ends (during the first half of the menstrual cycle).

The most common symptoms include:

Headache
Swelling of ankles, feet, and hands
Backache
Abdominal cramps or heaviness
Abdominal pain
Abdominal fullness, feeling gaseous
Muscle spasms
Breast tenderness
Weight gain
Recurrent cold sores
Acne flare-ups
Nausea
Bloating
Constipation or diarrhea
Decreased coordination
Food cravings
Less tolerance for noises and lights
Painful menstruation
Other symptoms include:

Anxiety or panic
Confusion
Difficulty concentrating
Forgetfulness
Poor judgment
Depression
Irritability, hostility, or aggressive behavior
Increased guilt feelings
Fatigue
Slow, sluggish, lethargic movement
Decreased self-image
Sex drive changes, loss of sex drive
Paranoia or increased fears
Low self-esteem
Exams and Tests

There are no physical examination findings or lab tests specific to the diagnosis of PMS. It is important that a complete history, physical examination (including pelvic exam), and in some instances a psychiatric evaluation be conducted to rule out other potential causes for symptoms that may be attributed to PMS.

A symptom calendar can help women identify the most troublesome symptoms and to confirm the diagnosis of PMS.

Treatment

Exercise and diet changes can help relieve symptoms. It is also important to maintain a daily diary or log to record the type of symptoms you have, how severe they are, and how long they last. You should keep this “symptom diary” for at least 3 months. It will help your doctor make an accurate PMS diagnosis and recommend appropriate treatment.

Nutritional supplements may be recommended. Vitamin B6, calcium, and magnesium are commonly used.

Your doctor may recommend a low-salt diet and avoiding simple sugars, caffeine, and alcohol. Regular aerobic exercise throughout the month helps reduce the severity of PMS symptoms.

Aspirin, ibuprofen, and other nonsteroidal anti-inflammatory drugs (NSAIDs) may be prescribed if you have significant pain, including headache, backache, menstrual cramping, and breast tenderness.

Birth control pills may decrease or increase PMS symptoms.

In severe cases, antidepressants may be helpful. The first options are usually antidepressants known as selective serotonin-reuptake inhibitors (SSRIs). Cognitive behavioral therapy may be an alternative to antidepressants.

Patients who have severe anxiety are sometimes given anti-anxiety drugs.

Diuretics may help women with severe fluid retention, which causes bloating, breast tenderness, and weight gain.

Bromocriptine, danazol, and tamoxifen are drugs that are occasionally used for relieving breast pain.

Outlook (Prognosis)
Most women who receive treatment for specific symptoms related to PMS have significant relief.

Possible Complications
PMS symptoms may become severe enough to prevent women from maintaining normal function.

Women with depression may note increasing severity of symptoms during the second half of their cycle and may require associated medication adjustments. The suicide rate in women with depression is significantly higher during the latter half of the menstrual cycle.

See also premenstrual dysphoric disorder (PMDD).

When to Contact a Medical Professional

Call for an appointment with your health care provider if PMS does not go away with self-treatment measures, or if symptoms occur that are severe enough to limit your ability to function.

Prevention

Some of the lifestyles changes often recommended for the treatment of PMS may actually be useful in preventing symptoms from developing or getting worse.

Regular exercise and a balanced diet (with increased whole grains, vegetables, fruit, and decreased or no salt, sugar, alcohol, and caffeine) may prove beneficial.

The body may have different sleep requirements at different times during a woman’s menstrual cycle, so it is important to get adequate rest.The cause of premenstrual syndrome is not known but severe symptoms have been shown to be responsive to lifestyle changes.

Getting exercise several times a week, eating a balanced diet, getting adequate sleep, and reducing or eliminating caffeine and alcohol are some of the changes most often recommended.

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HbA1c

Alternative Names

Glycated hemoglobin; Glycosylated hemoglobin; Hemoglobin – glycosylated; A1C; GHb; Glycohemoglobin; Diabetic control index
Definition

HbA1c is a test that measures the amount of glycated hemoglobin in your blood. Glycated hemoglobin is a substance in red blood cells formed when blood sugar (glucose) attaches to hemoglobin.

How the Test is Performed

Blood is drawn from a vein, usually from the inside of the elbow or the back of the hand. The puncture site is cleaned with germ-killing medicine (antiseptic). The health care provider wraps an elastic band around the upper arm to apply pressure to the area and make the vein swell with blood.

Next, the health care provider gently inserts a needle into the vein. The blood collects into an airtight vial or tube attached to the needle. The elastic band is removed from your arm. Once the blood has been collected, the needle is removed, and the puncture site is covered to stop any bleeding.

In infants or young children, a sharp tool called a lancet may be used to puncture the skin and make it bleed. The blood collects into a small glass tube called a pipette, or onto a slide or test strip. A bandage may be placed over the area if there is any bleeding.

How to Prepare for the Test

No special preparation in necessary.

How the Test Will Feel

When the needle is inserted to draw blood, you may feel moderate pain, or only a prick or stinging sensation. Afterward, there may be some throbbing.

Why the Test is Performed

Your doctor may order this test if you have diabetes. It is used to measures your blood sugar control over several months. It can give a good estimate of how well you have managed your diabetes over the last 2 or 3 months.

You have more glycated hemoglobin if you have had high levels of glucose in your blood. In general, the higher your HbA1c, the higher the risk that you will develop problems such as:

Eye disease
Heart disease
Kidney disease
Nerve damage
Stroke
This is especially true if your HbA1c remains high for a long period of time.

The closer your HbA1c is to normal, the less risk you have for these complications.

Normal Results

An HbA1c of 6% or less is normal.

Normal ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What Abnormal Results Mean

Abnormal results mean that your blood glucose levels have not been well-controlled over a period of weeks to months. If your HbA1c is above 7%, it means that your diabetes control may not be as good as it should be.

High values mean you are at greater risk of diabetes complications. If you can bring your level down, you decrease your chances of long-term complications.

In the past few years, doctors and diabetes experts have said you should try to keep your HbA1c level below 7%. However, researchers are finding that keeping the HbA1c below 7% may not be as helpful as they used to think.

Ask your doctor how often you should have your Hb A1c tested. Usually, doctors recommend testing every 3 or 6 months.

Risks

Veins and arteries vary in size from one patient to another and from one side of the body to the other. Obtaining a blood sample from some people may be more difficult than from others.

Other risks associated with having blood drawn are slight but may include:

Excessive bleeding
Fainting or feeling light-headed
Hematoma (blood accumulating under the skin)
Infection (a slight risk any time the skin is broken)
References

American Diabetes Association.

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Vaginal wall repair

A/P repair; Vaginal wall repair; Anterior and/or posterior vaginal wall repair; Anterior and/or posterior colporrhaphy
Definition

Anterior vaginal wall repair is a surgical procedure that tightens the front (anterior) vaginal wall to repair the sinking of the bladder into the vagina (cystocele) or the sinking of the urethra into the vagina (urethrocele).

Description

To perform the anterior vaginal repair, the doctor makes a surgical cut through the vagina to release part of the front (anterior) vaginal wall that is attached to the base of the bladder.

Tissue between the vagina and bladder is folded and stitched to bring the bladder and urethra into the right position. There are several different versions of this procedure that may be necessary, based on the amount of bulging or sinking.

This procedure may be performed using general or spinal anesthesia. You may have a foley catheter in place for 1 – 2 days after surgery.

You will be given a liquid diet immediately after surgery, followed by a regular diet when your normal bowel function has returned. Your health care provider may prescribe stool softeners and laxatives to prevent straining with bowel movements, because this can cause stress on the area where surgery was performed.

A similar procedure can be performed on the back (posterior) wall of the vagina to repair a rectocele.

Why the Procedure is Performed

This procedure is used to repair the vaginal wall sinking (prolapse) or bulging (herniation) that occurs with urethrocele or cystocele. This surgery by itself does not treat stress incontinence. Another procedure is needed in women who have stress urinary incontinence along with a cystocele.

In mild cases of cystocele, your doctor may recommend trying pelvic floor muscle exercises (Kegel exercises) first, before using surgical treatment. In some women, a device placed in the vagina to hold up the prolapse (pessary) can be used to avoid surgery.

Risks

Risks for any anesthesia are:

Problems breathing
Reactions to medications
Risks for any surgery are:

Bleeding
Infection
Injury to surrounding structures
Possible complications from anterior vaginal repair include:

Inability to urinate
Injury to the bladder
Urinary tract infection
Outlook (Prognosis)

Women treated with this procedure for cystocele have an excellent chance that the prolapse will be cured. This improvement will usually last for years — but in some cases the tissue weakens with time, and other procedures may be necessary to treat the symptoms.

Recovery

You should avoid activities that cause an increase in abdominal pressure, such as straining, sneezing, and coughing for several weeks to months after your surgery. You should avoid any activities that require lifting or straining.

You may need to take stool softeners or gentle laxatives to prevent constipation and straining with bowel movements. Your doctor may recommend that you avoid sexual intercourse until you have healed.

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Excessive or unwanted hair in women

Alternative Names

Hypertrichosis; Hirsutism; Hair – excessive (women)
Definition

The normal amount of body hair varies widely among women. When coarse, dark hairs grow where women typically do not grow dark hair, such as the lip, chin, chest, abdomen, or back, the condition is called hirsutism.

Causes

Excessive hair growth in women is usually from too much male hormone (androgen). A common cause is polycystic ovarian syndrome (PCOS). In most cases, however, the specific cause is never identified. It tends to run in families. In general, hirsutism is a harmless condition. But many women find it bothersome, even embarrassing.

If hirsutism develops suddenly and is accompanied by other typical male features, such as deepening voice, acne, or increased muscle mass, it may be caused by a more serious disorder. These causes, such as hormone-secreting tumors or cancer, are rare.

Rare causes include:

Tumor or cancer of the adrenal gland.
Tumor or cancer of the ovary
Cushing’s syndrome
Congenital adrenal hyperplasia
Hyperthecosis
Medications (testosterone, danazol, anabolic steroids, glucocorticoids, cyclosporine, minoxidil, phenytoin)
Home Care

There are a variety of ways to remove unwanted hair:

Bleaching — lightening hair to make it less noticeable.
Hair removal — shaving, plucking, waxing, or chemical depilation.
Electrolysis — using electrical current to damage individual hair follicles so they do not grow back. This is expensive and requires multiple treatments.
Laser hair removal — using laser to damage individual hair follicles so they do not grow back. This is expensive and requires multiple treatments.
Weight loss — in overweight women, weight loss can decrease male hormone levels and reduce hair growth.
Birth control pills and anti-androgen medications can also help reduce hair growth. A doctor must prescribe these medications.

When to Contact a Medical Professional

Call your doctor if:

The hair grows rapidly.
The hair growth is associated with male features such as acne, deepening voice, increased muscle mass, and decreased breast size.
You are concerned that medication may be worsening unwanted hair growth.
What to Expect at Your Office Visit

Your doctor will perform a physical examination, including a pelvic examination if appropriate. The doctor will ask questions such as:

Do other members of your family also have excessive amounts of hair?
What medications are you taking?
Have your periods been regular?
Are you pregnant?
Have you noticed other signs of excess male hormones such as increased muscle mass, deepening voice, acne, or decreased breast size?
Diagnostic blood tests may be performed to measure levels of :

Testosterone
Dihydroepiandrosterone sulfate (DHEA-S)
Luteinizing hormone (LH)
Follicle stimulating hormone (FSH)
Prolactin
17-hydroxyprogesterone
If a tumor is suspected, x-ray tests such as a CT scan or ultrasound may be recommended.

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Aortic arch syndrome

Alternative Names

Subclavian artery occlusive syndrome; Carotid artery occlusion syndrome; Subclavian steal syndrome; Vertebral-basilar artery occlusive syndrome

Definition

Aortic arch syndrome refers to a group of signs and symptoms associated with structural problems in the arteries that branch off the aortic arch. The aortic arch is the top part of the main artery carrying blood away from the heart.

Causes

Aortic arch syndrome problems are most often associated with trauma, blood clots, or malformations that develop before birth. The arteries' defects result in abnormal blood flow to the head, neck, or arms.

In children, there are multiple types of aortic arch syndromes, including:

Congenital absence of a branch of the aorta

Isolation of the subclavian arteries

Vascular rings

Symptoms

Symptoms vary according to the affected artery, but may include:

Neurological changes such as:

Dizziness

Blurred vision

Weakness

Blood pressure changes

Breathing problems

Numbness of an arm

Reduced pulse

Transient ischemic attacks

Treatment

Surgery is usually required to treat the underlying cause of aortic arch syndrome.

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