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Fibroids – What you need to know

About one-third of Canadian womxn will develop uterine fibroids by the age of 30. The number climbs to seven out of 10 by the time womxn reach 50. These benign (non-cancerous) tumors grow in the uterus, or off of the uterus on stalks within the pelvic cavity. They can range in size from as small as a pea to as large as a grapefruit. Some womxn may never know they have them unless they are caught by a routine exam, and they may never cause adverse effects in their day-to-day life. 

However, for some womxn fibroids can have some severe symptoms, including: pelvic pain, heavy menstrual bleeding, bleeding for longer than seven days, low iron (anemia), large clots, pain in the legs or back, pain during sex, and a higher risk of infertility.   For symptomatic womxn, 20% to 50% experience a considerable social and economic impact on their lives. 

Since fibroids affect such a large number of womxn, they ought to be classified as important health concern – right? Yet, the reality is very little research has been successful in determining the cause of these tumors, or keeping track of their numbers. Medical researchers have a long way to go to better understand fibroids, and perfect less invasive procedures to remove them or lessen their effects on womxn’s reproductive health. 

Fibroids themselves are not dangerous, since they are non-cancerous in nature. However, the resulting symptoms can be extremely dangerous. Severe anemia might require multiple blood transfusions. Fibroids might prevent a womxn from becoming pregnant, or a pregnancy might be lost due to miscarriage.  Severe pelvic pain might mean missed days at work or social engagements.

As a course of action, womxn are often told that if the fibroids are not causing any discomfort or issue, they can be left alone. It is believed that fibroids may shrink a little after menopause, but can still cause problems because the tumor may calcify and harden. 

Choosing to remove fibroids might mean removing the uterus as well. One in four Canadian womxn over the age of 45 have had a hysterectomy, and at least one third of those did so because of fibroids.  Hysterectomy is rare in younger womxn, but for those experiencing extreme pain from fibroids, endometriosis, or adenomyosis, a hysterectomy can provide relief from a lifetime of future pain. 

Fibroids Affect Black Womxn Disproportionately

Black womxn are nearly guaranteed to have fibroids in their lifetime – the likelihood of a black woman having fibroids by the time she is 50 years old is a staggering 90%. They are also much more likely to have recurring fibroids or suffer from complications from them. 

We don’t know enough about why fibroids develop in the first place, why black women get them more frequently and with more severity than other races, and exactly how they affect fertility.

Fibroids affect fertility

Depending on where they are located within the uterus, fibroids can prevent implantation of an embryo, and can cause problems with the ability to become pregnant or can result in miscarriage. They can also prevent conception by obstructing the fallopian tubes, which will not allow the embryo to pass into the uterine cavity and implant on the endometrial lining.

Fibroids can also cause problems during pregnancy. These include placental abruption (detachment of the placenta, causing bleeding and loss of pregnancy, or pre-term birth), abnormal growth of the pregnancy occurring from fibroids affecting blood flow or the size of the fibroids, preventing the baby from growing properly, pre-term labor. Early labor may lead to an early delivery of the baby, and result in possible developmental problems for the child.

Active monitoring might be dangerous

Womxn are frequently told that if the fibroids are not causing any severe symptoms, they can be left alone. Womxn are left thinking that they don’t need to treat them until or unless there is a problem – by the time they become a problem, however, many doctors are only able to remove them through invasive, open procedures, frequently recommending hysterectomy over myomectomy (fibroid removal).

“Fibroids will continue to grow,” says Dr. Natalya Danilyants. “That’s a very important point. A lot of patients that come see me with very big fibroids, they have known about these fibroids for many years, but they were told ‘Just leave them; if they don’t bother you, don’t bother them,’ but that’s not the right approach. Eventually, these fibroids are going to cause symptoms. For women who are planning to have children, you don’t want to wait to get to the point where your fibroids are large. Those large fibroids can cause irreversible damage to the uterus.”

If you have a concern about fibroids, ask your doctor for an ultrasound, to get a better idea of where the fibroid is growing, how quickly, and how big it is currently. Also, be sure to tell your doctor about any symptoms you’re experiencing: fatigue, pelvic pain, pain during sex, excessive bleeding – and whether these things are new, or getting worse. A baseline is important in any health care concern – but especially so with fibroids that will keep on growing and might become problematic. 

See your doctor if you have:

  • Pelvic pain that doesn’t go away
  • Overly heavy, prolonged or painful periods
  • Spotting or bleeding between periods
  • Difficulty emptying your bladder
  • Unexplained low red blood cell count (anemia)
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Choosing to be child-free

When it comes to choosing a form of contraception that suits our needs, for most women it’s a case of trial and error.  Using the birth control pill can be tricky to remember to take at the same time every day, and gives some women intolerable side effects.  Condoms are easy enough to use, but are a bit fiddly in the throes of passion, and might give some women an allergic reaction or cause discomfort. The Depo-Provera shot is safe and convenient, but does cause some negative side effects like nausea or wonky menstrual cycles, and it needs to be repeated every three months. Hormonal intrauterine devices (IUDs) are long-lasting, effective birth control, which has the added benefit of reducing the flow of your period (score!). It does require an office procedure with your ObGyn, and it can cause some pain and cramping initially, and for several months following insertion. 

Tubal ligation is an effective form of contraception and it is considered permanent. A person could, however, get pregnant in the future with in vitro fertilization. Depending on the technique used and the age of the woman, the 10-year failure rate is under five per cent. Tubal ligation also may carry other benefits including reducing the risk of ovarian cancer, depending on the technique used.

For women and femmes who choose to remain child free, tubal ligation is a popular, permanent choice. Being granted access to the procedure, however, is a challenge with which many women under 30 struggle

For young patients, a gynecologist might recommend an IUD because there is a chance of regretting the decision in the future if something permanent like tubal ligation is chosen. Studies have estimated that the rate of regret for tubal ligation can be somewhere between four and 20 per cent, and is higher in women under the age of 30. 

But there’s an important distinction to be made here:  the rate of regret is higher among women who have already had children and wish to have more; the rate of regret of women among who have never wanted children is very low (six per cent). 

In a recent interview with CityNews, a leading gynecologist explained the disparity. “Women who want child-free living don’t change their minds,” says Dr. Dustin Cotescu, Family Planning Specialist at McMaster University. “People who have one or two children may decide later that they would like to have more. People might think that they’re causing harm in performing a tubal on a woman with no children; in fact those women are at lower risk of regret.” 

The push-back is so common that some child-free people have termed the experience of discussing their desire for tubal ligation and being faced with these dismissive phrases as being “bingo-ed”.  From the patronizing “you’re too young to make such a permanent decision,” to the delaying “you might change your mind,” to the downright paternalistic “what if you meet a man who wants kids,” all of these comments ignore the person’s gender identity, sexual identity, and most importantly, body autonomy and personal choice.

The reality remains, the choice should be up to the patient. Medicine, at its best, is meant to be shared decision making, and the decision for a tubal ligation is no exception. If you are convinced you desire a child-free life, it might be prudent to prepare yourself with research, answers to common health professional “bingo” statements, and firm up your resolve. It is your body, after all, and your choice. 

The official stance of the Society of Obstetricians and Gynecologists of Canada is that if you are fully informed on the risks, benefits, and alternatives, and you still choose a tubal ligation, then a doctor should offer this to you regardless of your age or if you’ve had children before. In practice, however, many women report being unable to access the surgery, largely through delays or redirections from their health care professionals. 

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Post-partum depression

by Dr. Tanya Tulipan, Psychiatrist
Reproductive Mental Health Services, IWK Health Centre, Halifax

Post-partum Depression (PPD) is the most common medical complication of pregnancy.  About one in nine womxn will experience PPD, a condition so common that experts recommend that every new mom be screened for it.  And yet, only one in three womxn with PPD gets the help that they need.

Why is it so hard for womxn to get help?  One problem is getting an accurate diagnosis.  The symptoms of PPD include sadness, mood swings, irritability, sleep changes, appetite changes, low energy and motivation, guilt and low self-esteem.  Some of those symptoms can also be “normal” in a new mom. After all, who sleeps well with a baby? Many new moms say that they don’t have much energy, that they feel guilty a lot, and that they can be cranky sometimes.  Moms, their friends, their family, and their doctors can sometimes be dismissive of symptoms by saying, “it’s just the hormones,” or, “it’ll get better once the baby sleeps”. And sometimes that’s true. Other times, however, these are symptoms of a serious illness.

Fighting the stigma

There’s also the stigma of mental illness.  Even though PPD is a medical condition, a lot of people are worried to admit that they could have it.  Moms are worried that people will think that they are unfit mothers, or that they don’t love their babies.  Worse, what if they think that she has PPD and will hurt her baby? While it’s true that PPD, in its severe forms, can make it difficult for mothers to bond with their babies, it is a treatable condition.   It has nothing to do with your worth or ability as a mom.

It is really important to get the right diagnosis and treatment.  Depression is a serious illness no matter when it happens. When it happens to a mother, it affects not only her health, but also the health of her whole family.  Partners of depressed mothers are at risk of depression too. Babies with severely depressed moms, if it’s left untreated, can develop attachment disorders and are at long-term risk of mental illness.

What to do if you suspect you have PPD

So how does a mom figure out if she has PPD?  There are lots of ways to get help with that. A good place to start is with your family doctor, midwife or obstetrician.  You can also talk to your public health nurse, doula or family resource centre worker. They are trained to recognize the early signs of PPD, and know how to access care.  There are also online resources, like caringtogether.ca and Postpartum Support International at postpartum.net.

Treatments may include medications and alternative therapies

If you are diagnosed with PPD, you will likely be treated by your family doctor, a therapist or a psychiatrist.  The two mains forms of treatment are psychotherapy (talk therapy) and antidepressant medication. Your care provider can help you figure out which treatment is best and safest for you and your baby.  Most antidepressants can be safely taken while breastfeeding.

Other activities that can help the psychotherapy and medication to work include exercise, yoga, mindfulness, meditation, and bright light therapy.  Getting as much as rest as you can, seeing friends, and making time to connect with your partner will also help in your recovery. These things are not enough on their own to treat PPD, but they do act as “boosters” and make up an important part of your treatment plan.

Pay attention to your body

If you have a new baby and you aren’t feeling like yourself, pay attention to those feelings.  Everyone gets tired and cranky sometimes. But if you notice that:

  • you are sad or irritable most of the time
  • you can’t sleep even when your baby sleeps
  • you aren’t feeling as connected to your baby as you thought you would be
  • you aren’t enjoying things the way that you used to
  • you feel very guilty, like a burden, or worthless
  • you have thoughts that your baby would be better off without you

Then please reach out for help.  Remember that PPD is a treatable medical condition.  You deserve to be healthy and to enjoy your family!

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6 Reasons Your Vagina Hurts

Experiencing pain during intercourse is very common. Nearly three quarters of womxn have pain during intercourse – medically termed dyspareunia – at some time during their lives. For some womxn, the pain is only a temporary problem; for others, it is a long-term problem.

There are a lot of potential causes of dyspareunia. It can be related to an underlying cause that needs to be treated.

  1. An infection, like pelvic inflammatory disease or a yeast infection.
  2. Endometriosis, which can be especially worse around the time of your period, but if left untreated, can cause pain all the time.
  3. Lichen sclerosis, a skin condition treated with topical steroids.
  4. Vaginal atrophy due to lack of estrogen, which is most common in the population of women after menopause.

But sometimes after seeing multiple doctors and ruling out those common causes, you’re still left with pain during intercourse. That’s when we often end up using terms that describe the symptom, rather than the underlying cause:

5. Vulvodynia, which is chronic, otherwise unexplained pain at the
opening of the vagina, or
6. Vaginismus, the involuntary spasming of the pelvic floor muscles.

These issues, when present for a while, fall under the term chronic pelvic pain.

Acupuncture is a treatment option for vulvodynia

Treatment of vulvodynia and vaginismus requires ruling out and treating any other underlying cause, but sufferers can benefit from a multi-disciplinary approach. One approach suggests re-wiring the brain to stop interpreting normal touch as painful.

This includes cognitive behavioural therapy, mindfulness meditation, sex therapy, pelvic floor physiotherapy, along with medications to control muscle spasms, topical anasthetics, or even sometimes injections of pelvic floor muscles with Botox. It’s important to note that some of these treatments are only offered from pain specialists.

Another approach to treating vulvodynia and painful sex includes acupuncture.  According to a study published in the Journal of Integrative Medicine, more than one-third of womxn report regular pain during sex. The study aimed to discover whether targeted acupuncture could improve womxn’s pain during sex.  

The subjects were split into groups: One received generalized acupuncture two times per week for five weeks, the other received more targeted acupuncture to areas supporting the pelvic region. In the group receiving targeted acupuncture, reports of vulvar pain and dyspareunia were significantly reduced, and womxn’s self-reported scores suggested significant improvement in sexual functioning in those receiving targeted acupuncture versus those who received generalized acupuncture.

Trying different positions may help lessen the pain

Couples who are trying to overcome painful sex might try a variety of positions in order to relieve pain. If a womxn’s pain is experienced with deep penetration, any position in which the womxn is on top and better able to control the depth of penetration is likely going to feel more pleasurable for both partners. Side-lying or spooning is another less-penetrative option.  Avoiding penetration altogether and concentrating on mutual masturbation or oral sex can also be a satisfying experience.

If you’re experiencing chronic vaginal pain, you should know two important things: It’s not your fault, and there is help. See your family doctor to rule out any treatable underlying causes, and maybe ask to be referred to a pelvic floor physiotherapist.  These specialists are trained in the pelvic floor muscles and structures that support your sexual function. They can help create an individualized care plan and help you get back to feeling more like yourself.

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Multiple Sclerosis in Women

It was a diagnosis seven years in the making.  

Ever since the birth of her son in 2011, 46-year-old actress Selma Blair says that she had been experiencing a variety of neurological oddities. She sought help from a number of different doctors, but her concerns were repeatedly dismissed.  She was extremely fatigued – but what new mother isn’t tired? She had memory and cognition problems, and couldn’t get her brain to think clearly – Mommy Brain, right? She felt some numbness and weakness in her legs, which affected her balanced and was investigated as a pinched nerve. She developed a tremor in her left hand.

Not until the fall of 2018, when her balance issues were causing multiple falls and her speech pattern was severely affected, did she finally receive a label for her troubles: multiple sclerosis.

MS is an immune disorder that attacks the central nervous system, comprised of the brain, spinal cord, and optic nerve. The disease targets the protective covering of the nerves, called the myelin sheath (kind of like insulation around an electric wire), causing inflammation and damage. Myelin is necessary for the transmission of messages from your brain to your nerves. If damage to myelin is slight, nerve impulses travel with minor interruptions; however, major damage can cause nerve impulses to be completely disrupted, and the nerve fibres themselves can be damaged. The extent and location of the damage affects the type and severity of MS symptoms.

MS has been called “the snowflake disease”, because the symptoms of MS can vary greatly among individuals, and present themselves in short bursts or long exacerbations. The most common symptoms include troubles with balance, memory, fatigue, numbness or tingling in extremities, and pain. It is three times more common in women than men, and nearly 100,000 Canadians are living with the chronic condition.

It is typically diagnosed after the patient complains to their primary care physician of the most frequent MS symptoms: tremor, numbness, troubles with cognition, balance, or urinary incontinence.  The patient is referred to a neurologist, and receives a magnetic resonance imaging (MRI) scan of the brain, which reveals tell-tale lesions on the brain from the inflammation and breakdown of myelin caused by the disease.

The disease seems to afflict younger adults, striking women during their prime of life – the average age at which people are diagnosed is 32.  At a time when many are reaching new heights in their careers, taking long-awaited trips to far-off destinations, or settling into first homes and starting their families, women newly diagnosed with MS report a wide range of feelings.

They can feel angry, anxious or tearful. They can also feel relieved, like Blair did, especially if they’ve spent years experiencing symptoms and trying to find a name for their affliction. They may feel shocked; some people have symptoms that start very suddenly, and they’re diagnosed within days. They may feel disbelief, like it’s unreal or happening to someone else.

Whatever a person might feel, it’s okay. There’s no correct way to react to the news of diagnosis – it is a lot to take in.  Courtney Fraser, 35, was diagnosed with MS at the age of 32 after living with tell-tale symptoms of the disease for years. “There was a sense of relief that I finally knew what wrong with me and at least I could start to manage the disease,” Fraser says. “However, there was a lot of fear and ‘what-ifs’”.

Fraser also discovered a newfound resolve: to try and do whatever is within her control to alleviate symptoms and slow the progression of the disease.  There is a lot of evidence that diet and exercise can have a positive effect on MS symptoms, and this Halifax woman took that advice to heart.

Fraser is now a personal trainer with Goodlife Fitness and is also a competitive bodybuilder. “After my initial panic, I just I woke up one day and decided to start doing everything I said I’d love to do,” says Fraser. “The reality that anything could happen to me any day made me realize I had better start doing these things before it was too late.”

Canada has one of the highest rates of MS in the world, and one explanation for this might be that we live in the great white north with our long, dark winters. Studies have shown that getting an adequate amount of Vitamin D can be linked to a decrease in risk of getting a number of diseases, including MS.

Most drug and complementary therapies are designed to slow the progression of the disease, and to alleviate some of the symptoms that pose day-to-day obstacles for those with the disease, such as tremor.

More radical treatments may be on the way.  In a 2016 study published in the Lancet, Dalhousie University neurologist Dr. Jock Murray conducted a 13-year study of 24 patients with MS.  In an interview with CBC, he explained the premise of the study by posing the following question: “If MS is caused by the immune system reacting against the brain, what if you gave them a new immune system?”

In simple terms, scientists took bone marrow out of the patient, gave them intensive chemotherapy, and then injected those bone marrow stem cells into the bloodstream.  The results were stunning: Doctors found the disease stopped and the brain repaired the damage, Murray said.

Although the results were promising and exciting, the study was not without its risks: one patient died from complications related to the aggressive chemotherapy and stem-cell transplant.

Despite their diagnosis, many with MS continue to thrive. Fraser has learned to become an advocate for her own health. “I’m stronger and healthier now than before my diagnosis,” says Fraser. “While I can’t control my MS, I can control other aspects of my health and focus on preventative health care, like diet and exercise. I use them as tools to empower myself and manage my symptoms.”

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It’s Time to Listen

Welcome! Thank you for finding your way to our blog. Come sit down, grab some tea, get comfy. There is a lot we need to discuss.

Today, the I Hear You web series began filming in Halifax, Nova Scotia.  This medical drama is a film project by creator Amy Trefry, and it started in the way that most good ideas do – over a friendly cup of coffee in someone’s kitchen.  In the ensuing discussion, two friends shared their struggles with their respective health issues, and their feelings of frustration and hopelessness as they were confronted by a medical system that was dismissive and unhelpful.

These kinds of stories are, sadly, plentiful. Most people have a story about being dismissed by their health care provider – but women, especially so. The show’s creators conducted hundreds of interviews with women and femmes, and found they were facing a growing tide of voices seeking to be heard and acknowledged.

This blog is intended to create a safe space to break open those taboos about women’s sexual health, and start shining a light on some serious issues that need to be acknowledged and addressed. We’ll present some evidence-based information on women’s health and some statistics, sure.  But there are stories in them thar’ numbers.

Here, you’ll read about women and femmes and their lived experiences with sexual health issues. You’ll discover how the medical system’s response is creating barriers to safe, prompt, inclusive, accessible care. Every couple of weeks, you’ll read about topics that branch from the seeds planted in the episodes of the show:

A child-free person who has all but given up asking the medical professionals to grant their desire for a tubal ligation.

A woman whose diagnosis of multiple sclerosis didn’t become the defining feature of her life, or stop her from achieving her goals.

How medical professionals can help women and femmes who are survivors of sexual assault, and how best to navigate the minefield of a routine pelvic exam.

We all have stories, or have heard stories, like these. We want to tell these stories, and we want to hear your stories. Our goal is to create a safe space, to provoke discussion and start having these important conversations. It’s time for all of us to listen – really listen – to the lived experiences of women who are vulnerable and seeking help.   

People start to heal, once they feel heard.