Abnormal Uterine Bleeding

What causes abnormal bleeding?  Abnormal bleeding from the uterus (anything not consistent with a regular menstrual cycle for a female) can be caused be a wide variety of things such as medications( contraceptives, blood thinners, steroids, antipsychotics, chemo, dilantin, some antibiotics, others), or benign growths such as polyps, thick uterine lining, fibroids; infections of the uterus; issues of the cervix such as polyps or endometriosis; cancer of the uterus or cervix; sexually transmitted diseases. There are many other causes of abnormal bleeding—it just depends on where the location is in the genital tract.

Age, sexual activity, pregnancy possibilities, ovulation, eating disorder symptoms, and if this is like a normal period are all other factors in determining cause.

For example, causes of abnormal bleeding in women between age 40 and menopause are usually due to growths, either benign or malignant.

For women between teenage and about 20, the causes are broken down based upon whether or not one ovulates or not. If you ovulate and bleed abnormally, the bleeding is usually cyclic only heavy or prolonged.  The cause is usually anatomic or physical such as a polyp, fibroid, endometriosis, cancer, or a foreign body. Hormone levels are normal in this circumstance.

What about bleeding outside of regular menstrual cycle?  Anovulatory means bleeding that occurs outside of ovulation, hence it is unpredictable. It is the most common cause of abnormal uterine bleeding. The cycle of when sex hormones are produced is off so bleeding is irregular (bleeding is a function of hormone interaction). The most common cause of this scenario is too much estrogen causing the lining of the uterus to become too thick, outgrowing its blood supply and eventually dying off. This causes irregular, prolonged and heavy bleeding.

So, what can cause a woman to stop ovulating? There are many possibilities such as: thyroid disorders, polycystic ovary syndrome, liver or kidney disease, endocrine disorders such as Cushing’s disease, eating disorders, intense exercise, stress, pituitary growths, tumors of the pituitary or brain and other things. The most common of these are stress,  polycystic ovary syndrome (PCOS)—comprised of obesity, abnormal hair growth, acne, and irregular periods., and abnormal exercise (too much of a good thing!).

For a teenager, ovulation is not always consistent. So, there may be episodes of no periods interspersed with times of heavy bleeding. This is because the hormonal axis in the body is still maturing. As always, make sure the person is not pregnant!

At the end of the day a biopsy of the lining of the uterus may be needed to help discern the cause of the bleeding. Most importantly, it is the way to rule out cancer.

What is the treatment?  Treatment is diverse from correcting the underlying problem to attempting to regulate the hormones with birth control pills to surgical intervention. As one can see, a health care professional is needed for cases of abnormal bleeding.

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Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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Tic, Tac Twitch

Tics and twitches (medically called dystonia) are involuntary muscle contractions that result in a twisting or repetitive movement or abnormal postures. Examples would be a twisting of the neck or writer’s cramp or repetitive blinking of the eyes. The first time may have been triggered by an activity or event but over time the twitch becomes susceptible to less and less stimuli, even at rest. 

Most tics/twitches occur early in age but some may present older (more than 26 years of age). The abnormal movement can involve a body part such as a finger, or a leg or the trunk or even one side of the body. Some are inherited, some occur at birth (such as from brain injury), and others are acquired later on due to unknown reasons. It is interesting that the earlier the onset, the more likely it will present in the limbs (arms, legs) whereas older presentations occur in the neck, arm or face. 

Examples:

• Common types include: neck—spasms of neck and shoulders
• Blepharospasm—spasms of muscles around the eyes leading to involuntary eye closure and incessant blinking.
• Facial—jaw, tongue, or facial muscles spasm out
• Limbs—movements of the arm or leg
• Voice—a high pitch tremor nasally sound
• Occupational—writer’s cramp; typists; golfers spasm( the yips); and musicians mouth that twists including the jaw or tongue. Usually, when the activity is over so it the twitch. 

      Late onset twitch starts usually in the face, arm, neck. It rarely goes generalized. If so, further workup is definitely suggested.

There is good genetic linkage for early onset twitches and possibly with late onset.  If interested, ask for the DYT1 gene testing. Always have a doctor evaluate the twitch as it may be unusual and need further workup.

The main idea here is that a tic, a twitch or a dystonia is common and does not necessarily mean a seizure disorder. Tics in particular are usually accompanied by a sense of having to perform the tic and are relieved by doing it. A tic as well may be temporarily suppressed. The movements of these are also quite variable in comparison to a seizure. Also, there is a degree of suppression that can be achieved as opposed to a seizure.

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Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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Prostatitis

What is prostatitis?  Prostatitis refers to inflammation of the prostate gland. Note, this is not cancer. It  is a very common condition affecting males over the age of 18. Prostatitis tends to occur in young and middle-aged males. The symptoms, though common are often not readily detected. Symptoms such as pain in the lower abdomen, perineum (area between anus and scrotum), testicles, penis, bladder pain, difficulty passing urine, and sometimes blood in the semen. Note that prostatitis  does not cause impotency. There are two major forms, acute and chronic.

Acute Prostatitis

What  are risk factors?  Acute prostatitis risks include trauma such as bike riding (Training for the STP (Seattle to Portland bike ride)?), horseback riding, dehydration, and sexual abstinence. It can also occur if one has a chronic indwelling catheter. Most of the occasions of acute prostatitis are caused by bacterial infections. 

What are the symptoms? The usual presentation is that of fever, chills, fatigue, pain on urination, pain in abdomen or lower, and cloudy urine. It is to be noted that these are similar symptoms for a bladder infection except for the fact that bladder infections are not common for males. 

How is it diagnosed?  Diagnosis includes the history as well as exam. The prostate typically feels swollen or “boggy”. The blood test called PSA( prostate specific antigen) may or may not be elevated. Treatment includes antibiotics. Anti-inflammatories also help to reduce the swelling. Antibiotics usually require four to six weeks to bring about cure. Rarely is hospitalization required. It is important to get treatment to help reduce the potential complications of chronic prostatitis as well as prostate abscess formation. 

Chronic prostatitis

Chronic prostatitis should be considered in men who have pain on urination and frequency but not the symptoms of acute prostatitis, those who have recurrent urinary tract infections for no obvious cause, and for those who have chronic bacteria in the urine.

What are the symptoms?  The symptoms of chronic prostatitis are more subtle than the acute phase. Patients may have no symptoms at all or may have some pain on urination or frequency, urgency etc. Exam may reveal a large prostate or be completely normal. Exam may also include prostatic massage, but this is not too popular.

What is the cause?  The cause is usually bacterial infection. Obtaining fluid should be attempted as it will greatly help choose the proper antibiotic. The coarse needs to be at least four weeks of antibiotics.

The take home message is this: if you have any of these symptoms, get it checked out, as the condition may lead to a more chronic state that may become recurrent.

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Dr. Frank Marinkovich owns and operates Eastside Family Health Center in Kirkland, WA. Serving Kirkland and the Eastside, Seattle, Bellevue, Renton and the surrounding local communities. Specializing in Primary Care, Automobile Accidents and FAA physicals. Visit them online at Eastside Family Health Center or call them at (425) 899-2525.
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