STRESS

What happens when you are stressed?
Stress is what you feel when you have to handle more than you are used to. When you are stressed, your body responds as though you are in danger. It makes hormones that speed up your heart, make you breathe faster, and give you a burst of energy. This is called the fight-or-flight stress respones
Some stress is normal and even useful. It can help if you need to work hard or react quickly. For example, it can help you win a race or finish an important job on time.
But if stress happens too often or lasts too long, it can have bad effects. It can be linked to headaches, an upset stomach, back pain, or trouble sleeping. It can weaken your Immune system, making it harder to fight off disease. If you already have a health problem, stress may make it worse. It can make you moody, tense, or depressed. Your relationships may suffer, and you may not do well at work or school.
WHAT CAN YOU DO ABOUT STRESS
good news is that you can learn ways to manage stress. To get stress under control:
Find out what is causing stress in your life.
Look for ways to reduce the amount of stress in your life.
Learn healthy ways to relieve stress.
How do you figure out your stress level?
Sometimes it is clear where stress is coming from. You can count on stress during a major life change such as the death of a loved one, getting married, or having a baby. But other times it may not be so clear why you feel stressed.
It may help to keep a stress journal. Get a notebook and write down when something makes you feel stressed. Then write how you reacted and what you did to deal with the stress. Keeping a stress journal can help you find out what is causing your stress and how much stress you feel. Then you can take steps to reduce the stress or handle it better
HOW CAN YOU REDUCE YOUR STRESS
Stress is a fact of life for most people. You may not be able to get rid of stress, but you can look for ways to lower it.
Try some of these ideas:
Learn better ways to manage your time. You may get more done with less stress if you make a schedule. Think about which things are most important, and do those first.
Find better ways to cope. Look at how you have been dealing with stress. Be honest about what works and what does not. Think about other things that might work better.
Take good care of yourself. Get plenty of rest. Eat well. Do not smoke. Limit how much alcohol you drink.
Try out new ways of thinking. When you find yourself starting to worry, try to stop the thoughts. Work on letting go of things you cannot change. Learn to say “no.”
Ask for help. People who have a strong network of family and friends manage stress better.
Sometimes stress is just too much to handle alone. It can help to talk to a friend or family member, but you may also want to see a counselor.
How can you relieve stress?
You will feel better if you can find ways to get stress out of your system. The best ways to relieve stress are different for each person. Try some of these ideas to see which ones work for you:
Exercise. Regular exercise is one of the best ways to manage stress. Walking is a great way to get started.
Write. It can help to write about the things that are bothering you.
Let your feelings out. Talk, laugh, cry, and express anger when you need to.
Do something you enjoy. A hobby can help you relax. Volunteer work or work that helps others can be a great stress reliever.
Learn ways to relax your body. This can include breathing exercises, muscle relaxation exercises, massage, aromatherapy, yoga, or relaxing exercises like tai chi and qi gong.
Focus on the present. Try meditation, imagery exercises, or self-hypnosis. Listen to relaxing music. Try to look for the humor in life. Laughter really can be the best medicine.

Diabetes testing

Doctors use special tests in diagnosing diabetes and also in monitoring blood sugar level control in known diabetics.

If the patient is having symptoms but are not known to have diabetes, evaluation should always begin with a thorough medical interview and physical examination. The healthcare provider will about symptoms, risk factors for diabetes, past medical problems, current medications, allergies to medications, family history of diabetes or other medical problems such as high cholesterol or heart disease, and personal habits and lifestyle.

A number of laboratory tests are available to confirm the diagnosis of diabetes.

Finger stick blood glucose: This is a rapid screening test that may be performed anywhere, including community-based screening programs.

• A fingerstick blood glucose test is not as accurate as testing the patient's blood in the laboratory but is easy to perform, and the result is available right away.
  
  
• The test involves sticking the patient's finger for a blood sample, which is then placed on a strip. The strip goes into a machine that reads the blood sugar level. These machines are only accurate to within about 10% of true actual laboratory values.
  
  
• Fingerstick blood glucose values may be inaccurate at very high or very low levels, so this test is only a preliminary screening study. This is the way most people with diabetes monitor their blood sugar levels at home.

Fasting plasma glucose: The patient will be asked to eat or drink nothing for 8 hours before having blood drawn (usually first thing in the morning). If the blood glucose level is greater than or equal to 126 mg/dL without eating anything, they probably have diabetes.

• If the result is abnormal, the fasting plasma glucose test may be repeated on a different day to confirm the result, or the patient may undergo an oral glucose tolerance test or a glycosylated hemoglobin test (often called "hemoglobin A1c") as a confirmatory test.
  
  
• If fasting plasma glucose level is greater than 100 but less than 126 mg/dL, then the patient has what is called impaired fasting glucose, or IFG. This is considered to be pre-diabetes. The patient does not have diabetes, but they are at high risk of developing diabetes in the near future.

Oral glucose tolerance test: This test involves drawing blood for a fasting plasma glucose test, then drawing blood for a second test at two hours after drinking a very sweet drink containing 75 grams of sugar.

• If the blood sugar level after the sugar drink is greater than or equal to 200 mg/dL, the patient has diabetes.
  
  
• If the blood glucose level is between 140 and 199, then the patient has impaired glucose tolerance (IGT), which is also a pre-diabetic condition.

Glycosylated hemoglobin or hemoglobin A1c: This test is a measurement of how high blood sugar levels have been over about the last 120 days (the average life-span of the red blood cells on which the test is based).

• Excess blood glucose hooks on to the hemoglobin in red blood cells and stays there for the life of the red blood cell.
  
  
• The percentage of hemoglobin that has had excess blood sugar attached to it can be measured in the blood. The test involves having a small amount of blood drawn.
  
  
• A hemoglobin A1c test is the best measurement of blood sugar control in people known to have diabetes. A hemoglobin A1c result of 7% or less indicates good glucose control. A result of 8% or greater indicates that blood sugar levels are too high for too much of the time.
  
  
• The hemoglobin A1c test is less reliable to diagnose diabetes than for follow-up care. Still, a hemoglobin A1c result greater than 6.1% is highly suggestive of diabetes. Generally, a confirmatory test would be needed before diagnosing diabetes.
  
  
• The hemoglobin A1c test is generally measured about every three to six months for people with known diabetes, although it may be done more frequently for people who are having difficulty achieving and maintaining good blood sugar control.
  
  
• This test is not used for people who do not have diabetes or are not at increased risk of diabetes.
  
  
• Normal values may vary from laboratory to laboratory, although an effort is under way to standardize how measurements are performed.

Diagnosing complications of diabetes

If you or someone you know has diabetes, the patient should be checked regularly for early signs of diabetic complications. The healthcare provider can do some of these checks; for others, the patient should be referred to a specialist.

• The patient should have their eyes checked at least once a year by an eye specialist (ophthalmologist) to screen for diabetic retinopathy, a leading cause of blindness.
  
  
• The patient's urine should be checked for protein (microalbumin) on a regular basis, at least one to two times per year. Protein in the urine is an early sign of diabetic nephropathy, a leading cause of kidney failure.
  
  
• Sensation in the legs should be checked regularly using a tuning fork or a monofilament device. Diabetic neuropathy is a leading cause in diabetic lower extremity ulcers, which frequently lead to amputation of the feet or legs.
  
  
• The healthcare provider should check the feet and lower legs at every visit for cuts, scrapes, blisters, or other lesions that could become infected.
  
  
• The patient should be screened regularly for conditions that may contribute to heart disease, such as high blood pressure and high cholesterol.

Diabetes

Diabetes mellitus (DM) is a set of related diseases in which the body cannot regulate the amount of sugar (specifically, glucose) in the blood.

Glucose in the blood gives you energy to perform daily activities, walk briskly, run for a bus, ride your bike, take an aerobic exercise class, and perform your day-to-day chores.

• From the foods you eat, glucose in the blood is produced by the liver (an organ on the right side of the abdomen near your stomach).
  
  
• In a healthy person, the blood glucose level is regulated by several hormones, including insulin. Insulin is produced by the pancreas, a small organ between the stomach and liver. The pancreas secretes other important enzymes that help to digest food.
  
  
• Insulin allows glucose to move from the blood into liver, muscle, and fat cells, where it is used for fuel.
  
  
• People with diabetes either do not produce enough insulin (type 1 diabetes) or cannot use insulin properly (type 2 diabetes), or both (which occurs with several forms of diabetes).
  
  
• In diabetes, glucose in the blood cannot move into cells, so it stays in the blood. This not only harms the cells that need the glucose for fuel, but also harms certain organs and tissues exposed to the high glucose levels.

Type 1 diabetes: The body stops producing insulin or produces too little insulin to regulate blood glucose level.

• Type 1 diabetes comprises about 10% of total cases of diabetes in the United States.
  
  
• Type 1 diabetes is typically recognized in childhood or adolescence. It used to be known as juvenile-onset diabetes or insulin-dependent diabetes mellitus.
  
  
• Type 1 diabetes can occur in an older individual due to destruction of pancreas by alcohol, disease, or removal by surgery. It also results from progressive failure of the pancreatic beta cells, which produce insulin.
  
  
• People with type 1 diabetes require daily insulin treatment to sustain life.

Type 2 diabetes: The pancreas secretes insulin, but the body is partially or completely unable to use the insulin. This is sometimes referred to as insulin resistance. The body tries to overcome this resistance by secreting more and more insulin. People with insulin resistance develop type 2 diabetes when they do not continue to secrete enough insulin to cope with the higher demands.

• At least 90% of patients with diabetes have type 2 diabetes.
  
  
• Type 2 diabetes is typically recognized in adulthood, usually after age 45 years. It used to be called adult-onset diabetes mellitus, or non-insulin-dependent diabetes mellitus. These names are no longer used because type 2 diabetes does occur in younger people, and some people with type 2 diabetes need to use insulin.
  
  
• Type 2 diabetes is usually controlled with diet, weight loss, exercise, and oral medications. More than half of all people with type 2 diabetes require insulin to control their blood sugar levels at some point in the course of their illness.

Gestational diabetes is a form of diabetes that occurs during the second half of pregnancy.

• Although gestational diabetes typically goes away after delivery of the baby. Women who have gestational diabetes are more likely than other women to develop type 2 diabetes later in life.
  
  
• Women with gestational diabetes are more likely to have large babies.

Metabolic syndrome (also referred to as syndrome X) is a set of abnormalities in which insulin-resistant diabetes (type 2 diabetes) is almost always present along with hypertension, high fat levels in the blood (increased serum lipids, predominant elevation of LDL cholesterol, decreased HDL cholesterol, and elevated triglycerides), central obesity, and abnormalities in blood clotting and inflammatory responses. A high rate of cardiovascular disease is associated with the metabolic syndrome.

Pre-diabetes is a common condition related to diabetes. In people with pre-diabetes, the blood sugar level is higher than normal but not high enough to be considered diabetic.

• Pre-diabetes increases your risk of developing type 2 diabetes and of heart disease or stroke.
  
  
• Pre-diabetes can typically be reversed without insulin or medication by losing a modest amount of weight and increasing your physical activity. This weight loss can prevent, or at least delay, the onset of type 2 diabetes.
  
  
• An international expert committee of the American Diabetes Association redefined the criteria for pre-diabetes, lowering the blood sugar level cut-off point for pre-diabetes. Approximately 20% more adults are now believed to have this condition and may develop diabetes within 10 years if they do not exercise or maintain a healthy weight.

About 17 million Americans (6.2% of adults in North America) are believed to have diabetes. About one third of diabetic adults do not know they have diabetes.

• About 1 million new cases occur each year, and diabetes is the direct or indirect cause of at least 200,000 deaths each year.
  
  
• The incidence of diabetes is increasing rapidly. This increase is due to many factors, but the most significant are the increasing incidence of obesity and the prevalence of sedentary lifestyles.

Complications of diabetes

Both forms of diabetes ultimately lead to high blood sugar levels, a condition called hyperglycemia. Over a long period of time, hyperglycemia damages the retina of the eye, the kidneys, the nerves, and the blood vessels.

• Damage to the retina from diabetes (diabetic retinopathy) is a leading cause of blindness.
  
  
• Damage to the kidneys from diabetes (diabetic nephropathy) is a leading cause of kidney failure.
  
  
• Damage to the nerves from diabetes (diabetic neuropathy) is a leading cause of foot wounds and ulcers, which frequently lead to foot and leg amputations.
  
  
• Damage to the nerves in the autonomic nervous system can lead to paralysis of the stomach (gastroparesis), chronic diarrhea, and an inability to control heart rate and blood pressure during postural changes.
  
  
• Diabetes accelerates atherosclerosis, (the formation of fatty plaques inside the arteries), which can lead to blockages or a clot (thrombus). Such changes can then lead to heart attack, stroke, and decreased circulation in the arms and legs (peripheral vascular disease).
  
  
• Diabetes predisposes people to high blood pressure and high cholesterol and triglyceride levels. These conditions independently and together with hyperglycemia increase the risk of heart disease, kidney disease, and other blood vessel complications.

In the short run, diabetes can contribute to a number of acute (short-lived) medical problems.

• Many infections are associated with diabetes, and infections are frequently more dangerous in someone with diabetes because the body's normal ability to fight infections is impaired. To compound the problem, infections may worsen glucose control, which further delays recovery from infection.
  
  
• HYPOGLOCEMANIA or LOW BLOOD SUGAR occurs from time to time in most people with diabetes. It results from taking too much diabetes medication or insulin (sometimes called an insulin reaction), missing a meal, doing more exercise than usual, drinking too much alcohol, or taking certain medications for other conditions. It is very important to recognize hypoglycemia and be prepared to treat it at all times. Headache, feeling dizzy, poor concentration, tremors of hands, and sweating are common symptoms of hypoglycemia. You can faint or have a seizure if blood sugar level gets too low.
  
  
• Diabetic ketoacidosis is a serious condition in which uncontrolled hyperglycemia (usually due to complete lack of insulin or a relative deficiency of insulin) over time creates a buildup in the blood of acidic waste products called ketones. High levels of ketones can be very harmful. This typically happens to people with type 1 diabetes who do not have good blood glucose control. Diabetic ketoacidosis can be precipitated by infection, stress, trauma, missing medications like insulin, or medical emergencies like stroke and heart attack.
  
  
• Hyperosmolar hyperglycemic nonketotic syndrome is a serious condition in which the blood sugar level gets very high. The body tries to get rid of the excess blood sugar by eliminating it in the urine. This increases the amount of urine significantly and often leads to dehydration so severe that it can cause seizures, coma, and even death. This syndrome typically occurs in people with type 2 diabetes who are not controlling their blood sugar levels, who have become dehydrated, or who have stress, injury, stroke, or are taking certain medications, like steroids.

Signs and symptoms of pelvic pain

Pelvic pain can have many different causes. For example, pain can be caused by a gynecologic condition such as endometriosis, uterine fibroids, ovarian cysts and pelvic adhesions. It also can be the result of an intestinal, urinary or muscular problem. Pelvic pain can even be a manifestation of stress or depression.
Common reasons for pelvic pain include:
Pelvic Adhesions: Adhesions are bands of scar tissue that bind organs together. They are created by previous infections such as appendicitis or pelvic inflammatory disease, by pelvic or abdominal surgery or by endometriosis. Symptoms from adhesions include generalized pelvic discomfort or localized pain. Adhesions can be difficult to diagnose, however in some cases, the uterus and ovaries feel bound together on pelvic examination. A definitive diagnosis of adhesions is usually made during surgical exploration, frequently via laparoscopy. Surgery to cut bands of scar tissue can relieve pain. However, sometimes the adhesions re-form.
Uterine Fibroids: Fibroids are non-cancerous (benign) growths that develop within the uterus. Most women with fibroids have no symptoms and don't need treatment. When symptoms occur, women should seek medical attention.
Ovarian Cysts: Cysts are closed sacs that contain fluid, semifluid or solic material.
Irritable Bowel Syndrome: This is a very common cause of pelvic pain. It may be associated with diarrhea, constipation or a combination of both. Symptoms of bloating and discomfort may be relieved by a bowel movement. Stress and diet can aggravate the condition. The gynecology provider may make a referral to a gastrointestinal specialist for diagnosis and treatment.
Bladder Problems: Pelvic pain may be triggered by a bladder condition. Pain associated with the need to urinate frequently or urgently may need to be evaluated by a urologist.
Myofacial Trigger Points: Chronic pain can be created by spasm of the muscles that line the pelvis. On pelvic examination, there may be tenderness and tightness in particular muscles. Experts in anesthesiology and pain management specialize in relieving this type of pain.
Depression: Recurring or chronic pain can cause some women to feel depressed. These feelings are normal. In some cases, pelvic pain can be a symptom of depression or anxiety. Help is available from your health care provider and from mental health professionals.
Endometriosis: This is a condition in which the lining of the uterus (endometrium) grows outside the uterus. The lining can attach to the ovaries, fallopian tubes, intestines or other structures in the pelvis. It may cause pelvic pain, especially during menstruation. Hormones of the menstrual cycle cause the endometriosis to bleed each month. This can be painful and result in the formation of pelvic adhesions, also known as scar tissue. Blood trapped in the ovary can build up into a cyst. This is called an endometrioma.

Mensrual cycle in Women

The female reproductive system is a wonderfully complex system involving continuous communication between the brain centers and the ovary. Hormones secreted by the hypothalamus, the pituitary, and the ovary are the messengers that regulate the monthly cycle.
The Hypothalamus and the Pituitary
The hypothalamus is located centrally in the brain and communicates by way of an exchange of blood with the pituitary gland. Several neuroendocrine agents, or hormones, are produced by the hypothalamus. The one which is important for reproduction is called gonadotropin releasing hormone or better known as GnRH. It is released in a pulsatile fashion every 60 to 120 minutes.
GnRH stimulates or causes the pituitary gland to produce the hormone responsible for starting follicle, or egg, development and causing the level of estrogen, the primary female hormone, to rise. This hormone is follicle stimulating hormone (FSH). Leutinizing hormone (LH), the other pituitary hormone, aids in egg development and maturation, and causes ovulation.
The Ovary
The main function of the ovaries is the production of eggs and hormones. At birth, the ovaries contain thousands of immature eggs. No new eggs will be developed. These eggs are constantly undergoing a process of development and loss. Most will die without reaching maturity. This process of egg loss occurs at all times, including before birth, before puberty and while on birth control pills. It is a constant process of egg depletion.
As the levels of FSH and LH in the blood increase with puberty, the eggs begin to mature and a collection of fluid, or the follicle, begins to develop around each. The first day of menses is identified as cycle day one. Estrogen is at a low point. Therefore, the pituitary secretes FSH and LH, a process which actually begins before the onset of your menses. These hormones in turn stimulate the growth of several ovarian follicles, each containing one egg. The number of follicles that develop each month is unique to each individual. One follicle will soon begin to grow faster than others. This is called the dominant follicle.
As the follicle grows, blood levels of estrogen rise significantly by cycle day seven. This increase in estrogen begins to inhibit the secretion of FSH. The fall in FSH allows the withering away of smaller follicles. They are, in effect, starved of FSH.
Ovulation
When the level of estrogen is sufficiently high, it produces a sudden release, or surge, of LH, usually around day thirteen of the cycle. This LH peak triggers a complex set of events within the follicles that result in the final maturation of the egg and follicular rupture with egg extrusion. The rupture, called ovulation, takes place 28 to 36 hours after the onset of the LH surge and 10 to 12 hours after LH reaches its peak. The cells in the ovarian follicle that are left behind after ovulation undergo a transformation and become the so called corpus luteum. In addition to estrogen, they now produce high amounts of progesterone to prepare the lining of the uterus for implantation.
The Luteal Phase
The luteal phase, or second half of the menstrual cycle, begins with ovulation and lasts approximately 14 days -- typically 12 to 15 days. During this period, changes occur that will support the fertilized egg, which is called an embryo should pregnancy result. The hormone responsible for these changes is progesterone and it is manufactured by the corpus luteum. Under the influence of progesterone, the uterus begins to change its character, creating a highly vascularized bed for a fertilized egg. If a pregnancy occurs, the corpus luteum produces progesterone until about 10 weeks gestation. Otherwise, if no embryo implants, the circulating levels of hormone decline with the degeneration of the corpus luteum, the lining of the uterus, called the endometrium, degenerates and bleeding results.
The Uterus
The lining of the uterus, or endometrium, prepares each month for the implantation of an embryo. This preparation occurs under the influence of estrogen and progesterone from the ovary. If no pregnancy develops, the endometrium is shed as a menstrual period, about fourteen days after ovulation.

Treatment of fibroid

Treatment options for fibroids can range from no treatment at all to surgery. Unless fibroids are causing excessive bleeding, discomfort or bladder problems, treatment usually isn't necessary.
Women with fibroids should be evaluated periodically by their health care provider to review symptoms, follow the fibroid size and conduct abdominal and pelvic examinations to assess uterine size.
The following are treatment options for fibroids:
Medical Therapy
Medical treatments currently available for fibroids may improve certain symptoms, but do not make fibroids go away. Medical treatment may be recommended for women with heavy bleeding caused by fibroids before they decide to have a surgical procedure. Women with pressure symptoms caused by large fibroids will not benefit from any medicines currently available. Several promising new drugs that will treat the fibroids themselves and not just the symptoms are currently being developed and tested in clinical trials.
Oral Contraceptive Pills and Progestational Agents (Provera, medroxyprogesterone acetate)
Women with heavy menstrual periods and fibroids are often prescribed hormonal medications to try to reduce bleeding and regulate their menstrual cycle. The medications will not cause fibroids to shrink nor will it cause them to grow at a faster rate. If the medication has not improved your bleeding after three months, consult your doctor. Women over the age of 35 who smoke should not use oral contraceptive pills.
GnRH Agonists (Lupron)
GnRH agonists are a class of medications that temporarily shrinks fibroids and stops heavy bleeding by blocking production of the female hormone, estrogen. Lupron is the most well known of these drugs. Although Lupron can improve fibroid symptoms, it causes unpleasant, menopausal symptoms such as hot flashes and with long-term use, leads to bone loss.
Lupron is recommended only for very specific cases. For example, a woman with very heavy bleeding and serious anemia will likely need a blood transfusion at the time of fibroid surgery. However, if she takes Lupron for two to three months before surgery to make her periods temporarily stop, along with an iron supplement, her anemia will improve and she may not need a blood transfusion. In rare instances, Lupron may be recommended to women with very large fibroids -- greater than 10-12 centimeters -- prior to fibroid surgery. It is important to note that Lupron should not be used solely for the purpose of shrinking fibroids unless surgery is planned because fibroids will re-grow to their original size and symptoms will return as soon as a woman stops taking Lupron.
Intrauterine Devices (IUD)
Although intrauterine devices (IUD) are typically used to prevent pregnancy, they have non-contraceptive benefits as well. An IUD that releases a small amount of hormone into the uterine cavity has been shown to decrease bleeding caused by fibroids. An IUD can be inserted during a routine office appointment. Ask you doctor for more information about this treatment option.
Myomectomy
This procedure involves removing the fibroids while preserving the uterus. For women with problematic fibroids who want to have children, myomectomy is the best treatment option. The procedure can be performed several different ways depending on the size, number and location of the fibroids. For example, fibroids located within the uterine cavity can be removed using a hysteroscope, called a hysteroscopic myomectomy. Some fibroids can be removed via several small incisions through which a viewing instrument called a laparoscope and several miniature surgical instruments are used. A laparoscopic myomectomy involves removing fibroids located on the outer aspect of the uterus. Most myomectomies are performed by making an incision across the lower abdomen during an abdominal myomectomy. This allows for the removal of all types and sizes of fibroids and for the reconstruction of the uterus to its former size and contour.
Myomectomy is very effective treatment, but fibroids can re-grow. The younger a woman is at the time of myomectomy and the more fibroids she had, the more likely she is to develop fibroids in the future. Women nearing menopause are the least likely to have problems from recurring fibroids.
Hysterectomy
Hysterectomy is a major surgical procedure in which the uterus is removed. Many women choose hysterectomy to definitively resolve their fibroid symptoms. After hysterectomy, menstrual bleeding stops, pelvic pressure is relieved, frequent urination improves and new fibroids cannot grow. A woman can no longer become pregnant after a hysterectomy.
There are several different surgical approaches. A vaginal hysterectomy involves removing the uterus through an incision in the vagina. An abdominal hysterectomy is performed through an incision on the lower abdomen. A laparoscopic hysterectomy is accomplished through four tiny incisions on the abdomen. The type of hysterectomy will depend on the size of the uterus and several other factors.
The ovaries are not necessarily removed during a hysterectomy. Women should discuss the pros and cons of ovarian removal with their physicians.
Uterine artery embolization (UAE)
This relatively new treatment is an alternative to open surgery for fibroids. Embolization is a technique that blocks the blood flow to the fibroids, causing them to shrink and die. This also often decreases menstrual bleeding and symptoms of pain, pressure, urinary frequency or constipation.
UAE is performed in a radiology suite rather than an operating room. A substance is released into the blood vessels leading to the fibroids, blocking the blood flow. Women receive pain medicine but are not completely asleep. After the procedure, patients experience pain for one to three days but are able to return to work and full activities in one week. Ninety percent of women report improvement in both pelvic pressure and heavy bleeding. However, UAE has been performed for only five years, so there is little information about long-term results. Since the procedure is still quite new, we discourage its use for women who have not completed childbearing.

diagnosis of fibroid

Fibroids can be diagnosed in a number of ways including:

Pelvic Examination -- During a routine gynecologic exam, a physician is able to feel the size and shape of the uterus. If the uterus is enlarged or irregularly shaped, then fibroids may be present. Several tests can be performed to confirm the diagnosis.

Ultrasonography -- Sound waves are used to create an image of the uterus and ovaries.

Saline Hysterosonography -- Also called water ultrasound. Fluid is placed inside the uterus and an ultrasound is performed. This test is very useful for identifying fibroids within the uterine cavity.

Magnetic Resonance Imaging (MRI) -- A large magnet is used to create very detailed images of the uterus and other pelvic structures. This expensive test is reserved for special circumstances when the precise location of fibroids is needed.

Hysteroscopy -- A slender "telescope" is inserted through the vagina and cervix into the uterine cavity to allow a physician to see fibroids inside the uterus.