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Medical News Today: Adnexal mass: What to know

Adnexal masses are lumps that occur in the adnexa of the uterus, which includes the uterus, ovaries, and fallopian tubes. They have several possible causes, which can be gynecological or nongynecological.

An adnexal mass could be:

A family doctor can usually manage benign masses. However, prepubescent and postmenopausal individuals will need to see a gynecologist or oncologist.

Malignant adnexal masses require treatment from a specialist.

In this article, we discuss the characteristics of adnexal masses. We also review how doctors diagnose and treat adnexal them.

Symptoms

a woman experiencing abdominal pain due to a Adnexal massShare on Pinterest
A person with an adnexal mass may experience lower abdominal pain.

People report different symptoms, depending on the cause of the adnexal mass.

People with an adnexal mass may report:

  • severe lower abdominal or pelvic pain that is usually on one side
  • abnormal bleeding from the uterus
  • pain during sexual intercourse
  • worsening pain during a period
  • painful periods
  • abnormally heavy bleeding during periods
  • abdominal symptoms, including a feeling of fullness, bloating, constipation, difficulty eating, increased abdominal size, indigestion, nausea, and vomiting
  • urinary urgency, frequency, or incontinence
  • weight loss
  • lack of energy
  • fatigue
  • fever
  • vaginal discharge

Different causes of adnexal masses may have similar symptoms, so doctors usually conduct further investigations to determine the exact cause.

Once the doctor has worked out the cause of the adnexal mass, they can recommend treatment and management.

Causes

Adnexal masses include a variety of different conditions that range in severity from benign growths to malignant tumors.

The cause of adnexal masses could be gynecological or nongynecological.

Some of the causes of adnexal masses include:

  • Ectopic pregnancy: A pregnancy where the fertilized egg implants somewhere outside the uterus.
  • Endometrioma: A benign cyst on the ovary that contains thick, old blood that appears brown.
  • Leiomyoma: A benign gynecological tumor, also known as a fibroid.
  • Ovarian cancer: These tumors of the ovary may be ovarian epithelial cancers that begin in the cells on the surface of the ovary or malignant germ cell cancers that begin in the eggs.
  • Pelvic inflammatory disease: Inflammation of the upper genital tract, which includes the uterus, fallopian tubes, and ovaries. It occurs due to an infection.
  • Tubo-ovarian abscess: An infectious adnexal mass that forms because of pelvic inflammatory disease.
  • Ovarian torsion: A gynecological emergency involving a complete or partial rotation of the tissue that supports the ovary, which cuts off blood flow to the ovary.

Diagnosis

A doctor may diagnose an adnexal mass by:

  • taking a complete medical history
  • asking questions about symptoms
  • conducting a physical examination
  • obtaining blood samples

Most of the time, people will need a transvaginal ultrasound to allow doctors to evaluate the characteristics of an adnexal mass.

Females who have had a positive pregnancy test result and report abdominal or pelvic pain and vaginal bleeding might have an ectopic pregnancy. An ovarian torsion causes sudden, severe pain with nausea and vomiting. Immediate medical attention is necessary to treat both an ectopic pregnancy and ovarian torsion.

People with pelvic inflammatory disease or a tubo-ovarian abscess may experience gradual pelvic pain with nausea and vaginal bleeding.

Early ovarian cancer may sometimes present with nonspecific symptoms. Sometimes, doctors may only detect cancer when the tumor has become malignant.

Malignant tumors may have one or several of the following characteristics:

  • a solid component of the tumor
  • parts of the tumor have thick divisions larger than 2–3 centimeters separating them
  • they are present on both sides of the reproductive tract
  • the presence of fluid filled lumps

Treatment

A doctor will choose the most appropriate treatment depending on the cause of the adnexal mass. Women with an ectopic pregnancy will have to end their pregnancy. A doctor may choose one of the following procedures:

  • the administration of a single or two-dose intramuscular methotrexate
  • laparoscopic surgery
  • a salpingostomy or salpingectomy, which are surgical procedures involving the fallopian tubes

Doctors have not yet determined the optimal management of an endometrioma, according to a study that featured in Obstetrical & Gynecological Survey.

Currently, the possible treatments for an endometrioma include:

  • watchful waiting
  • medical therapy
  • surgical intervention
  • inducing ovulation and using assisted reproductive technology in females with infertility

People with pelvic inflammatory disease will require courses of intravenous antibiotics, which may include:

  • cefotetan (Cefotan)
  • cefoxitin (Mefoxin)
  • clindamycin (Cleocin)

Some people can receive treatment outside of the hospital setting with oral doxycycline (Vibramycin) and intramuscular ceftriaxone (Rocephin) or another third generation cephalosporin antibiotic. In some cases, doctors will need to add oral metronidazole (Flagyl).

In the past, tubo-ovarian abscesses required surgical removal of the uterus, ovaries, and fallopian tubes. However, doctors can now prescribe broad-spectrum antibiotics. A person with a ruptured tubo-ovarian abscess may still require surgery.

Ovarian torsion is a gynecological emergency. The only treatment is surgery to prevent severe damage to the ovaries and fallopian tubes.

People with leiomyomas or fibroids may receive hormonal treatments or nonsteroidal anti-inflammatory drugs to control the symptoms. Once a person stops taking medication, the symptoms may return, and the fibroids may continue to grow. Surgery is the most successful treatment for fibroids.

The treatment options for ovarian cancer include surgery, chemotherapy, and targeted therapy. Oncologists will consider the following factors before recommending a treatment plan:

  • the type of ovarian cancer and how much cancer is present
  • the stage and grade of the cancer
  • whether the person has a buildup of fluid in the abdomen causing swelling
  • whether surgery can remove the whole tumor
  • genetic changes
  • the person's age and general health status
  • whether it is a new diagnosis, or if cancer has come back

Risk factors

Risk factors depend on the cause of the adnexal mass. Females with ovarian masses have an increased risk of developing ovarian torsion. More than 80% of females with ovarian torsion have masses of 5 cm or larger.

Doctors diagnose fibroids in about 70% of white females and more than 80% of black females by the age of 50 years. Other factors may increase a person's risk of developing fibroids, such as:

  • starting periods early in life
  • using oral contraceptives before 16 years of age
  • an increase in body mass index (BMI)

Ovarian cancer can run in families. People with a family history of ovarian cancer may have an increased risk of developing ovarian cancer. Other risk factors include:

The likelihood of developing cancer also tends to increase with age.

Summary

Adnexal masses are lumps that doctors may find in the adnexal of the uterus, which is the part of the body that houses the uterus, ovaries, and fallopian tubes. Not all masses are cancerous, and they do not all require treatment.

Different types of adnexal mass can share many of the same symptoms. As a result, doctors need to collect a full medical history and data from physical examinations, blood tests, and medical imaging, including transvaginal ultrasounds.

Doctors need to pinpoint the location and cause of an adnexal mass to determine the appropriate management and treatment.

Original Article

Medical News Today: Can diet improve a person’s vaginal health?

Certain foods and drinks contain compounds that may improve vaginal health and symptoms of vaginal conditions. These include probiotics, prebiotics, and fermented food and beverages.

The vagina uses natural secretions, immune defenses, and "good" bacteria to keep itself healthy. Eating a healthful, balanced diet might also further prevent infections and improve vaginal conditions.

This article discusses what little research there is into the effects of diet on vaginal health, looks at dietary choices for common vaginal conditions, and identifies other ways to improve vaginal health.

People should speak to a doctor before using diet to address any health concerns.

Balancing pH levels

The vagina is a moderately acidic environment with a pH of around 4.5. This acidity helps healthful bacteria to grow and prevents harmful microbes from developing.

Some good bacteria, such as probiotics, may help balance vaginal acidity levels.

Probiotics

a woman eating yoghurt as it is a good food for vaginal healthShare on Pinterest
The probiotics in yogurt may help balance vaginal acidity levels.

Lactobacillus species bacteria is the most dominant type of "good" bacteria found in a healthy vagina.

Research has suggested that Lactobacillus could benefit vaginal health in the following ways:

  • regulating the microflora in the vagina
  • improving the vagina's acidity levels
  • stopping harmful microbes from attaching to the vaginal tissues
  • working with the body's immune system

A 2016 study indicated that using vaginal Lactobacillus supplements after taking antibiotics hindered bacteria growth in people with bacterial vaginosis (BV), and significantly reduced vaginal pH.

A 2015 review study found "no significant evidence" that probiotics were more beneficial than using a placebo or no treatment. However, the authors noted that due to a lack of evidence, "a benefit cannot be ruled out."

Probiotic supplements are available, but some nutritionists recommend getting them from fermented foods and drinks, such as:

  • yogurt and kefir
  • kimchi and sauerkraut
  • pickles
  • tempeh
  • kombucha

Prebiotics

Prebiotic compounds may also help stabilize vaginal pH by promoting the growth of healthy bacterial populations. Foods rich in prebiotics include:

  • leeks and onions
  • asparagus and Jerusalem artichoke
  • garlic
  • whole wheat products
  • oats
  • soybeans
  • bananas

It is important to note that prebiotics can worsen bowel conditions, such as irritable bowel syndrome (IBS).

Preventing UTIs

Urinary tract infections (UTIs) occur when bacteria enter parts of the urethra, bladder, or kidneys, causing symptoms such as burning or pain during urination and bad smelling or cloudy urine. According to the Urology Care Foundation, about 60% of women will experience a UTI at some point.

Drinking lots of fluids might help prevent a UTI.

Cranberry juice

According to the Urology Care Foundation, drinking cranberry juice or taking cranberry tablets may prevent UTIs from developing.

Research supports this idea — in a 2016 study, researchers found that drinking 8 ounces (oz), or 240 milliliters (ml) of a 27% cranberry juice drink each day for 24 weeks lowered the rate of UTIs in adult women who had recently had a UTI.

Cranberries are rich in antibacterial compounds that kill bacteria. These include antioxidants and organic acids, such as:

  • proanthocyanidins and anthocyanins
  • organic and phenolic acids
  • vitamin C
  • flavanols and flavonols

Research into diet and UTIs has mainly focused on cranberries, but many fruits, especially citrus fruits and berries, are also rich in antioxidants and may have similar effects.

Read about other home remedies for UTIs here.

Reducing candida infections

Candida infections, or yeast infections, are the second most common cause of vaginitis, or vaginal inflammation.

There is no scientific proof that any foods can reduce candida infections. However, some foods contain ingredients that the fungus uses to grow. These ingredients include refined sugar, preservatives, yeasts, fungi, allergens, and trace antibiotics. People may benefit from avoiding these foods.

Researchers are studying the possible benefits of natural remedies with antifungal, anti-inflammatory, or antioxidant properties for candida infection, including tea tree oil, coconut oil, and garlic.

Read more about home remedies for yeast infections here.

Other ways to improve vaginal health

Regularly eating a healthful, balanced diet that contains fermented products with probiotics and prebiotics can improve vaginal health.

Following some of these lifestyle habits might also help:

  • cleaning the genital region with mild, unscented soap before rinsing well and patting dry daily or as needed during menstruation
  • wiping from front to back
  • using antibiotics appropriately and only when necessary
  • reducing sweat around the vagina
  • exercising regularly
  • maintaining a healthy weight
  • staying hydrating
  • reducing stress
  • wearing loose-fitting cotton underwear

Avoiding or limiting things that can imbalance the body's systems or irritate the vagina can help, such as:

  • douching
  • holding in urine or rushing urination
  • personal care products with dyes, flavors, or fragrances
  • spermicidal foam or diaphragms
  • tight pants or underwear
  • smoking
  • prolonged exposure to moisture
  • alcohol
  • processed or heavily refined foods
  • foods or drinks with artificial hormones

Summary

Many nutrients contribute to vaginal health. Eating a healthful, nutrient-rich diet can improve all body systems.

Certain nutrients, antioxidants, and probiotics may have particular benefits for vaginal health. However, researchers need to do more studies to work out which nutrients help boost vaginal health and prevent vaginal infections.

Original Article

Medical News Today: Depression during period: Everything you need to know

Feeling depressed before and during a menstrual period is common. Experts believe that these emotional changes occur as a result of fluctuating hormone levels.

Most people who menstruate will experience some symptoms of premenstrual syndrome (PMS), including moodiness and headaches.

However, some individuals can develop more severe symptoms, such as depression and anger. Hormones can also cause people to feel nauseated during their period.

Severe PMS symptoms may indicate another condition, which is called premenstrual dysphoric disorder (PMDD). Additionally, existing mental health conditions may temporarily worsen during a menstrual period.

In this article, we explore why some people feel depressed during a period. We also list home remedies and treatment options.

Why hormones affect mood

a woman looking sad because she has depression on her period Share on Pinterest
Low levels of serotonin and dopamine can cause sadness and anxiety.

Hormonal changes during the second half of the menstrual cycle, called the luteal phase, may cause a low mood and irritability in some people.

After ovulation, which occurs midcycle, the levels of the female sex hormones estrogen and progesterone begin to fall.

Rising and falling levels of these hormones can affect brain chemicals called neurotransmitters.

Examples of these neurotransmitters are serotonin and dopamine, which are both chemicals that influence mood, sleep, and motivation.

Low levels of serotonin and dopamine can cause:

  • sadness
  • anxiety
  • irritability
  • sleep problems
  • food cravings

All of these are common symptoms of PMS and PMDD.

When the levels of estrogen and progesterone begin to rise again a few days after the onset of a period, these symptoms often go away.

Despite the connection between neurotransmitters and sex hormones, it is still unclear why some people develop PMS or PMDD when others do not.

Research indicates that the levels of progesterone and estrogen are similar between people who develop a premenstrual disorder and those who do not.

Therefore, experts speculate that genetic differences may make some people more sensitive than others to changing hormone levels and the influence of these hormones on the brain.

Menstrual-related mood disorders

PMS and PMDD are types of menstrual-related mood disorders. A period can also cause an existing mental health condition to worsen temporarily.

PMS

PMS causes both physical and emotional symptoms. These symptoms can begin at any stage between the end of ovulation and the beginning of the menstrual period.

Experts estimate that up to 75% of menstruating women experience some form of PMS.

The symptoms of PMS can vary greatly. Some people may have very mild symptoms, while those that others experience are debilitating.

PMS can cause:

  • aches and pains
  • acne
  • anxiety
  • bloating
  • bouts of crying
  • breast tenderness
  • changes in appetite
  • constipation or diarrhea
  • depressed mood
  • fatigue
  • headaches
  • irritability and anger
  • lack of concentration
  • sleep difficulties

PMDD

PMDD is a more severe form of PMS. PMDD may affect 3–8% of people with menstrual cycles.

The symptoms are so severe that they affect the person's daily activities and, sometimes, their relationships with others.

Symptoms of PMDD include:

  • severe depression, anxiety, and irritability
  • panic attacks
  • severe mood swings
  • frequent episodes of crying
  • loss of interest in activities and other people

Suicidal ideation or attempts are a possible symptom of PMDD. According to the International Association for Premenstrual Disorders (IAPMD), an estimated 15% of women with PMDD will attempt suicide in their lifetime. Transgender people have an even higher risk.

Suicide prevention

  • If you know someone at immediate risk of self-harm, suicide, or hurting another person:
  • Call 911 or the local emergency number.
  • Stay with the person until professional help arrives.
  • Remove any weapons, medications, or other potentially harmful objects.
  • Listen to the person without judgment.
  • If you or someone you know is having thoughts of suicide, a prevention hotline can help. The National Suicide Prevention Lifeline is available 24 hours a day at 1-800-273-8255.

PMDD also shares many symptoms with PMS, including:

  • aches and pains
  • acne
  • bloating
  • breast tenderness
  • constipation or diarrhea
  • fatigue
  • food cravings
  • headaches
  • lack of concentration
  • sleep difficulties

Premenstrual exacerbation

Hormonal changes before a period can make the symptoms of an existing mental health condition worse. This effect is known as premenstrual exacerbation.

Common disorders that may co-occur with PMS include:

  • bipolar disorder
  • depression
  • persistent depressive disorder (dysthymic disorder)
  • generalized anxiety disorder
  • panic disorder

Research suggests that depression tends to be more prevalent among those with PMS than in those without this condition.

What to do

Individuals who experience depression during their period should speak to their doctor.

Various treatments are available for depression, PMS, and PMDD. The options range from home remedies to medication.

It can be useful to track symptoms before and during a menstrual period to help a doctor confirm a diagnosis and create a treatment plan.

People can keep a journal of their moods and their cycle, or they can use a period tracking app.

Learn about 10 of the best period tracking apps in this article.

Home remedies

Dietary and lifestyle changes may help in cases of mild PMS.

In more severe cases, or for PMDD, home remedies alone are unlikely to make a significant difference. However, they may help when individuals combine them with other treatments.

Potentially remedies include:

  • eating a balanced diet and limiting the intake of sugar, fat, salt, refined carbohydrates, and alcohol
  • exercising regularly
  • getting enough sleep and keeping a regular sleep schedule
  • reducing stress by eliminating sources of stress where possible and practicing yoga and mindfulness

Supplements may also help. Research suggests that a calcium supplement may reduce PMS-related symptoms, including depression, fatigue, and appetite changes.

It is important to speak to a doctor before taking supplements to treat PMS or any other condition.

Medication

A doctor may suggest using hormonal birth control to manage PMS symptoms. Sometimes, they may prescribe an antidepressant. Finding the right treatment can require a trial-and-error approach.

Hormonal birth control options include the pill or the patch. These may alleviate depression and other emotional and physical symptoms. In some cases, however, birth control can make depression worse.

Selective serotonin reuptake inhibitors (SSRIs) are the first-line treatment for PMDD.

People may take SSRIs throughout their menstrual cycle or during the luteal phase only. They may also be helpful for more severe cases of PMS.

Research indicates that 60–70% of women with PMDD respond to SSRIs. This rate of effectiveness is similar to that in those with major depression.

If SSRIs do not work, or if they cause undesirable side effects, a doctor may prescribe another type of antidepressant.

When to see a doctor

Individuals who experience depression regularly before or during their period may wish to speak to a doctor. Treatment is available for people with PMS, PMDD, or co-occurring mental health conditions.

If someone is at immediate risk of suicide or serious self-harm, seek emergency help by calling 911 or the local emergency number.

Anyone with suicidal thoughts can access help from the National Suicide Prevention Lifeline at 1-800-273-8255.

Summary

Experiencing low mood, anxiety, or irritability during a period is common. These symptoms should resolve a few days after the onset of the menstrual period. In mild cases, lifestyle and dietary changes may be beneficial.

If these mood changes occur regularly, persist all month, or have a significant effect on a person's life or relationships, they may require other treatment.

Many people can get relief from PMS or PMDD with appropriate treatment.

More support and information are available through the IAPMD.

Original Article