Hormonal Disorders in Women

Hormonal Disorders

Many women live with symptoms everyday that are a sign of a hormonal imbalance.

These symptoms can include fatigue, depression, allergies, endometriosis, PMS, period disturbances and hair loss. The symptoms may be caused by many reasons, but the basic reason is there is an incorrect relationship between progesterone and estrogen levels in the body.

The number of female hormones produced can vary month to month. The production of the hormones is dependent on factors such as nutrition, weight, exercise, stress, ovulation and polycystic ovary syndrome. Hormonal imbalance can be caused by contraceptive pills, hormone replacement therapy, lifestyle-related factors, and external factors (such as pollution or incorrect administration of medication).

Moore for Women Health and Wellness Chicago OBGYN can help you assess your hormonal health and determine what type of hormonal imbalance you are experiencing (estrogen, progesterone or androgen imbalance). From there, we will work with you to find the right treatment for your condition. Many times, hormonal imbalance treatment is much simpler than many women have imagined.

Zika Virus: Everything Pregnant Women Should Know

If you’re pregnant—or trying to conceive—the Zika virus is probably a top-of-mind concern right now, and with good reason: This mosquito-borne virus is dominating headlines with its scary multi-country advance and potentially devastating consequences for pregnant women and their babies.

Zika surfaced just over a year ago in South America, and Brazil has been disproportionately affected, with thousands of babies suffering severe birth defects, including brain damage, in utero when their mothers contracted the virus. But it has now spread to more than three dozen countries and territories in the Americas, and has recently landed in the United States (although it’s important to note that these U.S. cases were brought by returning travelers from affected regions). According to the Centers for Disease Control and Prevention (CDC), 168 pregnant women in the US and the District of Columbia have been diagnosed with Zika and another 142 have been identified in the US territories, which includes the US Virgin Islands and Puerto Rico.

Per the CDC, mosquitoes in the continental United States or Hawaii have not spread Zika. However, lab tests have confirmed Zika virus in travelers returning to the United States. These travelers have gotten the virus from mosquito bites and some non-travelers got Zika through sex with a traveler. Cases of local transmission have been confirmed in three US territories: Puerto Rico, the US Virgin Islands, and American Samoa.

The virus is likely to spread further, according to the World Health Organization (WHO), because the mosquito that transmits Zika is in all but two countries of the Americas, and the people in these regions lack immunity to the virus.

If you’re expecting (and frankly, even if you’re not), it’s crucial to arm yourself with information and up-to-date advice. This is what you need to know:

What is Zika virus?

The Zika virus is an insect-borne illness that can be primarily transmitted by infected Aedes mosquitoes, the same kind that carry dengue and yellow fever. The name comes from the Zika Forest in Uganda where monkeys with the virus were first found in 1947.

Why is it dangerous?

For the relatively few people who show signs of a Zika infection, the illness is often very mild. But in pregnant woman, the effects can be devastating, and can include pregnancy loss or a baby born with an abnormally small head and brain—a condition known as microcephaly, says Edward R.B. McCabe, M.D., Ph.D., Senior Vice President and Chief Medical Officer of the March of Dimes. Microcephaly may be associated with developmental delays, mental retardation, and seizures, and in some cases can be fatal.

Until recently, Zika virus had only been associated with significant risk to the fetus—it wasn’t established that the effects were actually caused by it. But now the news has changed and health officials can report a direct link between Zika and microcephaly. Still, there are many unknowns—including how likely it is that an infection in a pregnant woman will be passed on to her fetus; whether some fetuses are infected but don’t develop microcephaly; how often pregnancy loss may occur in expecting women with Zika virus; and whether pregnancy makes women more susceptible to the virus, says MarjorieTreadwell, M.D., director of the Fetal Diagnostic Center at the University of Michigan and a maternal and fetal medicine expert.

To date, there have been no infants born with microcephaly and other poor outcomes linked to locally acquired Zika virus infection during pregnancy in the continental United States. One infant with microcephaly linked to travel-associated Zika virus infection during pregnancy has been reported in Hawaii as well as one with microcephaly born in a hospital in New Jersey to a woman who had previously tested positive for Zika virus infection and had traveled to Central America during pregnancy.

While the Zika virus remains in the blood of an infected person for a few days to a week, according to the CDC, there’s no current evidence to suggest that it poses a risk of birth defects in future pregnancies. And Zika won’t cause infections in a baby that’s conceived after the virus has left the bloodstream.

Ethical Obligations and Genetic Screening

ACOG’s recent practice advisory on the use of cell-free DNA screening raises a practical ethical question for busy Ob/Gyn practitioners: How do we adequately counsel our patients before and after these tests in the current practice environment that allocates so little time to a follow-up obstetrics visit?

These tests are difficult to explain to patients and even more difficult to interpret. Practices who employ a genetic counselor obviously have a simple solution to this dilemma, but genetic counselors are in short supply, and few physicians in private practice have one available for consultation.

While this might appear to be more a practice management and communication issue than an ethical one, when we fail to properly educate and counsel our patients, and they make decisions based upon inadequate or inaccurate information, we actually failed to respect their autonomy. Our duty to patient autonomy includes providing them with the information necessary to make good choices predicated in their values. This requires us, in turn, to both give adequate information and to describe all the appropriate choices in a non-directive manner. It is simply ludicrous to believe we can do this in a 10-minute visit sandwiched between the other responsibilities of the follow-up appointment.

Time constraints are only one of the ethical challenges posed by these new genetic technologies. Equally important—and concerning—is our own need to remain abreast of these tests and what they can and cannot do. While Sequenom boasts sensitivity and specificity over 99% for the detection of Down syndrome, it is important to remember that positive predictive value is actually much lower than this in a low-risk patient. Scientists and consumer groups have criticized the companies that perform these tests for failing to emphasize that despite higher sensitivity and specificity than previous screening tests, the cell-free DNA test still is not diagnostic.

Few of us remember statistics well enough to explain this clearly and accurately to a patient, and this explanation is crucial to ensuring that patients only terminate desired pregnancies when the fetus actually has the abnormality suggested by the screening test. One report cites a follow-up study to abnormal results that found 6% of patients were obtaining an abortion without confirming the results of the screening test.

I admit when I first saw the impressive accuracy of cell-free DNA screening I thought the amniocentesis had found its replacement, but when you do the math, you see this is not the case. As that previous report describes, in a low-risk population, a positive test result is only correct 50% of the time. Couples are aborting desired pregnancies with normal fetuses because their physicians have not properly counseled them. This is truly tragic. If we do not have the time to educate ourselves about these advancing technologies, then we must find a consultant who can do this counseling for us. Obviously, if we do not understand the science and statistics behind these tests, we cannot possibly guide our patients appropriately.

When training ethics consultants at our institution, I often belabor the point that they must understand the medicine in order to understand the ethics of a particular medical question. The corollary to this, and it is relevant to genetic testing in our obstetrical patients, is that we must understand the medicine in order to appropriately counsel our patients. Failing to counsel our patients properly is a breach of our duty to the patient. We must know the science to be ethical physicians. We must also find the time, or find someone who has the time. These twin responsibilities are crucial and admittedly difficult, but we owe it to our patients to provide them with the information and time to make these vital, life-altering choices.