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FAQs

What is the CA 125 cancer detection test?

CA-125 is a blood test used to evaluate ovarian cancer treatment. CA-125 is a protein that is found more in ovarian cancer cells than in other cells. This protein enters the bloodstream and can be measured by a blood test. There are two CA-125 tests: a first and second generation test. The second generation test is now more widely used and is generally more accurate.The test is often used to follow women who have already been diagnosed with ovarian cancer. In these cases, the CA-125 is a very good indicator of whether a patient is responding to treatment, and whether a patient remains in remission after treatment. In general, the CA-125 is not a good test to screen healthy women for ovarian cancer.

Normal Results
The normal values for a CA-125 depend on the lab running the test. In general, levels above 35 U/mL are considered abnormal. Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

What do Abnormal Results Mean?
In a woman with known ovarian cancer, a rise in CA-125 usually means that the disease has progressed or recurred. A decrease in CA-125 usually means the disease is responding to treatment.

In a woman who has NOT already been diagnosed with ovarian cancer, an elevated CA-125 can mean a number of things. While it can indicate that she has ovarian cancer, it can also indicate other types of cancer, as well as several benign diseases such as endometriosis. When used in healthy women, an elevated CA-125 usually does NOT mean ovarian cancer is present. The vast majority of healthy women with an elevated CA-125 do not have ovarian cancer (or any other cancer for that matter). The "false positive" rate for this group of women is high.

Any woman with an abnormal CA-125 test will need further tests, and sometimes invasive surgical procedures, to confirm the result. These additional tests all involve risks and anxiety. Therefore, the CA-125 should not be considered an effective general screening test for ovarian cancer. Studies are underway to determine whether it might be effective when combined with other blood tests or radiologic studies.

Review Date: 6/10/2008 Reviewed By: James R. Mason, MD, Oncologist, Director, Blood and Marrow Transplantation Program and Stem Cell Processing Lab, Scripps Clinic, Torrey Pines, California. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

What is PreEclampsia?

Definition: PreEclampsia is a syndrome unique to the pregnancy state. It occurs typically in the latter stages of pregnancy but has been found earlier than 26 weeks. The syndrome requires elevation of blood pressure and either edema (swelling, typically of the face or hands) and/or protein spillage into the urine. The typical prenatal visit always includes screening for preEclampsia by checking a patient's weight, blood pressure, urinalysis and physical symptoms. It is the constellation of symptoms and signs that occur prior to the onset of seizures or Eclampsia and hence the name Pre-Eclampsia.

Risk Factors for Developing PreEclampsia:

Preeclampsia is most often seen in first-time pregnancies and in pregnant teens and women over 40. Other risk factors include:

  • Pre-pregnancy blood pressure elevation
  • Previous history of preeclampsia
  • A family history of preeclampsia in mother or sisters. Pre pregancy obesity
  • Multiple gestation (twins)
  • History of diabetes, kidney disease, lupus, or rheumatoid arthritis

Physiology:

Women destined to develop preEclampsia tend to have lost the ability for their blood vessels to relax during pregnancy as the body attempts to accommodate a large increase in intravascular volume. In these patients, the unrelaxed (tense) blood vessels translates to higher blood pressure and as blood vessels are found in every part of the body, pre Eclampsia can affect multiple organ systems. Nobody has ever discovered exactly what it is that causes this in some women and not in others.

Degrees of Severity:

We tend to think of preEclampsia as either 'Mild' or 'Severe' and there are several variant forms such as HELLP syndrome and superimposed preEclampsia which seem to be particularly more aggressive forms. Mild preEclampsia is typically a diagnosis given to a patient when the criteria for preEclampsia are met but she has no other symptoms or abnormal organ system tests. The patient's reflexes may be significantly elevated. Severe PreEclampsia is a diagnosis given to that patient as above but in addition has symptoms of:

  • severe headaches unresponsive to medicines
  • disturbance (blurred vision or bright spots)
  • Nausea and Vomiting
  • Severe mid abdominal/mid epigastric pains
  • Severe amounts of protein spillage into the urine
  • abnormal liver enzymes
  • low platelet count
  • A baby that is <10th%ile in body wt.
  • Renal failure or evidence towards such
  • lung or brain swelling (edema)

Treatment

PreEclampsia is only cured by delivery of the baby but the timing and route of delivery will vary from patient to patient and their particular degree of severity and their doctor's assessment of risk to the Mother vs risk to delivery of the baby which may be preterm. Typically, during delivery magnesium sulfate is useful to help prevent worsening of preEclampsia to seizure onset (eclampsia) and blood pressure is typically treated with a variety of antihypertensive agents.

Future Implications of preEclampsia complicating Pregnancy

Having a history of preEclampsia is a risk factor for recurrence of the syndrome. But most patients will recover speedily and completely from their experience and not have it recur in the future. Your doctor will check you during your next pregnancy quite frequently for evidence of chronic hypertension or recurrent preeclampsia.

Bioidentical Hormone Pellet Questions:

What is the difference between taking a pill orally vs other routes?

Oral hormones pass through the liver in the process of metabolism and a result of this liver pass, the liver increases the production of proteins which are involved in blood clot formation. This is why increased risks of stroke and heart attack are reported in women taking oral hormones. The pellets subcutaneous route of delivery directly into the blood stream of active hormone substantially reduces this risk.

What about the estrogen patch? Won't it provide good hormone levels comparable to the pellets? It is easy to wear and I change it weekly.

No. Blood estradiol levels on the patch are not as high nor as consistent and even as they are on the pellets. The other disadvantage of the patch is that it only contains estradiol or estradiol with a synthetic progesterone. The pellets offer a combination of estradiol and testosterone, which are complimentary to one another. Estrogen eliminates the hot flashes, night sweats, insomnia and vaginal dryness. Testosterone increases energy, enthusiasm, and sex drive.

Why do I have to take progesterone with the estrogen replacement pellets?

Traditional hormone replacement requires the prevention of unopposed estrogen stimulation onto the uterine lining as this can cause uterine hyperplasia, and potentially uterine cancer. Progesterone prevents this overgrowth in most cases so that your risk of cancer of the uterus from estrogen exposure is back to the population's standard risk. If a woman has had a hysterectomy, progesterone replacement is not necessary because there is no uterus to protect from the estrogen stimulation.

How often do I need to have the pellets inserted?

Timing of pellet insertions is an individual matter but typically the hormone pellets last 4 months (sometimes 3 months and in other sometimes 6 months). You will sense when your pellet hormone replacement levels are getting low and should call the office to have an evaluation for another dose of the pellets.

What are the side effects of hormone pellets?

Most women feel great on the pellets and have minimal to no side effects. But when side effects are reported, the most commonly reported ones are breast tenderness due to the estrogen stimulation of the breast tissue and mild acne from the testosterone and even rarely hair growth. If these symptoms develop, we reduce the dose of the pellets. Rarely side effects can include facial hair growth, weight gain, or fluid retention.

I have heard that estrogen increases my risk of breast cancer. Is this true?

At this time, we have no evidence that estrogen alone increases a woman's risk of developing breast cancer. The Women's Health Initiative Study done in 2002 showed an elevated risk of breast cancer in women starting the hormone replacement 10 years post onset of menopause and only in those on synthetic (oral equine estrogen + synthetic progesterone) combination hormones (PremPro) if used for over 4 yrs duration. If estrogen does stimulate breast cell growth, it appears that testosterone counteracts that process and may be protective against breast cancer development. We do know that estrogen users who do develop breast cancer appear to have a lower mortality from the disease and it is thought this could be due to earlier detection. Our recommendation is to stick with non-oral bioidentical estrogen when possible and testosterone (for libido) and if progesterone is necessary, use bioidentical instead of synthetic. Any time one uses any medication she must come from the perspective of whether the risks of using the medicine are outweighed by the benefits or are the benefits outweighing the risks. Whether to use HRT a woman must determine these risks for herself with medical professional guidance and use her individual well being and health as a guide to make her decision.

I want protection from bone loss. Will the pellets help with this too?

Yes. Estrogen therapy, especially when combined with testosterone, has been shown to maintain the mineral content and strength of bones after menopause. The consistent level of estrogen achieved by the pellets is especially effective in preventing bone loss. And one must combine this with adequate intake of calcium and vitamin D daily.

Do the pellets leave me at risk for blood clots?

Oral estrogen, because liver metabolism is required, increases the risk of blood clots. Pellets deliver the estradiol directly into the blood stream without passing through liver metabolism and therefore without increasing the clotting factor production by the liver. Because of this route of delivery they do not appear to increase the risk of blood clots, and consequently do not appear to increase the risk of strokes or heart attacks that are thrombotic in nature.

How soon will I feel the effects of the hormone pellets?

Fairly rapidly usually. Within a few days to a week.

My sex drive is low and has been for a long time. Can this help?

It appears that estrogen alone is not effective in increasing sex drive. The addition of testosterone, however, increases not only drive, but sexual enjoyment and orgasmic potential. In fact studies have been done showing this with oral estratestHS and with the bioidentical pellets .Women who are receiving both estrogen and testosterone report more frequent sexual fantasies, desire to initiate sexual interaction, and pleasure associated with sexual activity. Combining bioidentical HRT with treatment of the other modalities of loss of libido (life stresses, physical illness, partner/relationship issues, etc) can help drastically to improve your libido (sex drive).

Since the menopause, I have noticed significant mood alteration. I feel depressed and have easy crying fits and difficulty sleeping. Can HRT help?

Yes, estradiol replacement can significantly help this common symptom of menopause.

I have read that hormones cause heart disease. I have a strong family history of heart disease and I do not want to end up with a heart attack. Should I stay away from hormones?

You may wish to discuss this further with your healthcare provider. If you have a strongl family history of stroke, breast cancer or heart attack you may wish to avoid HRT altogether. However, it is only true in certain circumstances that estrogen can be a problem and in fact if estrogen replacement is started at the onset of menopause it can actually protect against heart disease. Studies have shown that in women who experience removal of their ovaries in their 40s (early onset surgical menopause) and did not receive estrogen replacement, they actually had a much higher incidence of heart disease and neurologic disease in the next 30 years than the general population.

Who should not take hormones?

Your Provider will evaluate your personal and family history at the time of your consultation and determine if you are a candidate for hormone therapy but generally if you have a history of stroke, breast cancer or blood clot formation or heart attack you should probably avoid hormone replacement..

Can I get all of my Gynecologic care at this office, or just my pellets?

All of your Women's Healthcare needs can be addressed at this office and we hope you will take advantage of our extensive menu of expertise! You must have a full evaluation prior to the onset of any medication and pellet placement HRT is no different. A pelvic examination to evaluate the health of your uterus and ovaries and a breast examination as well as a thorough review of your health and desires is necessary to establish your candidacy for hormone replacement therapy and pellet placement. A baseline evaluation of your endometrial lining may be required by ultrasound and possibly an endometrial biopsy as well if any abnormal bleeding patterns exist.

Scott M. Gulinson, MD, FACOG