With the development of modern technologies and the Internet, trust in doctors is gradually fading away. Any patient today can independently study the diagnosis and think about the appropriateness of the prescribed treatment. The patient is not always right in such a situation, however, there are more cases when diagnoses are made that have nothing to do with the truth. It is especially strange to receive meaningless appointments from a gynecologist.
This material contains situations in the gynecologist’s office that should alert you. So…
Gynecologist-endocrinologist in Moscow | Gynecologist-endocrinologist
1. YOU ARE GIVEN A REFERENCE TO NUMEROUS ANALYSIS TO FIND A CONTRACEPTION
If a woman is generally healthy and she needs to choose a drug for contraception, then a gynecological examination, ultrasound and the exclusion of contraindications are enough. Hormonal tests in a healthy woman do not indicate which drug to choose. If there are no contraindications, it is specified which type of contraception is preferable: pills, plaster, ring or Mirena system. Objectively speaking, you can start with any modern monophasic drug, either a ring or a patch, because you can only assess how well the remedy suits you during the first cycles of administration. The normal adaptation period is considered to be two months. During this period, unpleasant sensations may occur: the chest hurts, spotting bloody discharge appears, weight and mood change, libido decreases. As a rule, if the drug is suitable, the side effects disappear quickly. If they persist, then the drug should be changed. If a woman has concomitant gynecological diseases, then initially you can choose a drug that has a more pronounced therapeutic effect.
2. YOU ARE STRONGLY RECOMMENDED TO TREAT UREAPLASMA AND MYKOPLASMA
In the overwhelming majority of cases, the diagnosis and treatment of ureaplasmas and mycoplasmas are not needed: these microorganisms can normally exist in the genital tract of men and women without causing any diseases. They can be detected in perfectly healthy people in the absence of disease. At the same time, depending on the state of the protective systems of the vagina, ureaplasmas can disappear, or persist for a long time, or, after disappearance, appear again – from the sexual partner. It is worth treating ureaplasma only if there are clinical signs of the disease in at least one partner (most often this is frequent painful urination).
Often, patients are advised to treat ureaplasma before a planned pregnancy. In fact, this is impractical, since the risk of developing complications associated with it is extremely low, and the treatment is quite aggressive. During pregnancy, treatment is also very doubtful, since a positive effect has not been proven.
3. YOU HAVE HPV VIRUS AND SAY THAT IT IS NECESSARY TO TREAT URGENTLY, BECAUSE IT CAUSES CERVICAL CANCER.
There is no need to carry out drug treatment of the human papillomavirus – today there is not a single drug that effectively affects this virus. It is impossible to cure it. The immune system can suppress viral replication, but no drug, no matter what the manufacturer claims, can help the immune system suppress HPV.
Quite aggressive treatment is often prescribed, a biopsy is performed, but the patient is not explained what is really happening and what is the prognosis of the disease. The main thing is that the doctor does not adhere to a clear algorithm that has existed in the world for a long time. So, if using the PCR method (polymerase chain reaction) you have identified the presence of HPV of high oncogenic risk, do not panic. There is nothing serious about this find. This is just a reason to undergo an appropriate examination. There is a chance that you will develop cervical cancer, but it is very small. And, if you regularly visit a gynecologist, the disease can be detected at the earliest (precancerous) stages and completely cured.
It is often advised to remove condylomas on the genitals or the mucous membrane of the cervix – their appearance is caused by the same HPV (condylomas and papillomas are two names for the same formation, just in different languages: warts – Greek; papillomas – Latin). Small condylomas of the vulva and vagina do not need to be removed if they do not create aesthetic or physical discomfort for you, and only a doctor indicates their presence – they are safe and usually go away on their own within 1.5-3 years from the moment of appearance.
4. YOU ARE DIAGNOSED WITH CERVICAL EROSION AND TELLED THAT IT SHOULD BE BURNED
Let’s start with the fact that the term “cervical erosion” is outdated, and now it can be considered colloquial. The correct name is ectopia of the cervix. This is a fairly common condition and, in general, completely safe, it should be treated only in two cases: if spotting appears after intercourse; if a woman has an excess amount of usual odorless discharge.
In the vast majority of cases, erosion will “heal” on its own. However, it must be remembered that its presence is a reason for a regular examination by a gynecologist, colposcopy and cytological examination. You should not agree to the proposal to “burn it” at all costs because the doctor says: “This must be done.” If the tests show that this is a simple ectopia and there are no 5 questions of atypical cells, just come for a second examination in a year (of course, if there is no reason to show up earlier).
5. YOU ARE GIVEN THE DIAGNOSIS OF “GARDNERELLEZ”
There is no such diagnosis. There is a disease “bacterial vaginosis”, in which the number of several types of opportunistic microorganisms increases, including gardnerella. Isolated detection of gardnerella by PCR does not indicate the presence of the disease. The most common misconception: if gardnerella is detected by PCR, then this means that there is a disease “bacterial vaginosis”, or they often say “gardnerella”. This is wrong: gardnerella can normally be present in the vagina without causing any disease.
In addition, gardnerella is far from the only microorganism, the amount of which is increased in this disease. For the diagnosis of bacterial vaginosis, there are special criteria – Amsel criteria and Nugent scores.
6. YOU HAVE CANDIDA MUSHROOMS AND SAY THAT IT IS A DAIRY
Mushrooms normally live in the vagina, so their detection in the absence of clinical manifestations of the disease is not an indication for treatment. The main symptoms of thrush are profuse or moderate cheesy discharge, redness, swelling, rashes on the skin and mucous membranes of the vulva and vagina, itching, burning, which intensifies during sleep, after showering and intercourse. If you have frequent relapses of thrush, additional examinations should be done to exclude endocrine and other diseases that may contribute to frequent exacerbations.
7. THE DOCTOR INSASTS THAT SMALL ENDOMETRIOID OVARIAN CYSTES SHOULD BE REMOVED
Not all endometrioid ovarian cysts require mandatory surgical treatment: for small cysts (up to 2 cm), dynamic observation is permissible. Pregnancy on their background is also acceptable and safe.
8. YOU ARE PRESCRIBED AT THE SAME TIME OF 10-15 DRUGS
Remember: for the successful treatment of gynecological diseases, immunomodulators, interferons, vitamins, dietary supplements, hepatoprotectors, as well as means for restoring the intestinal and vaginal flora are not needed. In medicine, there is the concept of “polypharmacy” – the simultaneous unjustified prescription of many medicines and medical procedures to the patient.
It is known that the interaction of various drugs occurs in the human body. At the moment, it is possible to predict the interaction of two, maximum of three agents simultaneously present in the body. If there are more of them, the effect is unpredictable. Any doctor knows this, but quite often you can find treatment regimens in which 15–20 or even 30 drugs are used. This approach is completely wrong and not justified. Most often, such treatment regimens are prescribed for infections and inflammation.
The list of recommendations may include antibiotics, local antibacterial drugs, immunomodulators, enzymes, vitamins, hepatoprotectors, bio-additives … The expediency of prescribing most of these funds is absent. For example, antibiotics are the basis for treating genital infections and inflammation. In modern medicine, broad-spectrum antibiotics are mainly used; they act on a very large number of various microorganisms. For most infections and inflammations, just one antibiotic is sufficient, maximum two. You should not save on yourself, so my personal opinion is that it is better to use an antibiotic of the highest quality, since a cheaper option may not completely destroy pathogenic microorganisms, and because of this, the process will become chronic.
Some doctors already collect treatment regimens that patients bring them (often from paid clinics). Studying these schemes, you involuntarily ask yourself: what was the goal of the doctor, prescribing, say, 16 drugs for the treatment of bacterial vaginosis or trichomoniasis, which in 90% of women are treated with just one drug?
If you are faced with a similar pattern, you can ask your doctor the following questions:
- Why did the doctor decide that you have lowered immunity and have a lack of vitamins (after all, you eat normally)?
- Why drugs without enzymes (enzymes) will treat infections poorly or not reach the inflammation focus (after all, all drugs were tested for effectiveness without the use of enzymes and they were effective)?
- Why do you need to take several of the same antibiotics if you have not yet taken one (because it must be effective)?
- You have never complained of liver problems, and everything was fine when you took drugs before. Why are you prescribed drugs that protect the liver, if the need to take them is not mentioned in the antibiotic summary?
9. YOU ARE CONVINCED TO REMOVE UTERINE MYOMA
Uterine fibroids – for many women, this diagnosis sounds like a bolt from the blue, and it often happens that a misconception about the disease condemns the patient to difficult experiences and unjustified surgical interventions.
- About 80% of all operations in gynecology are performed for uterine fibroids, 90% of them are removal of the uterus.
- Every third woman after 55 years has had her uterus removed due to the diagnosis of uterine fibroids.
- The average age at which the uterus is removed due to fibroids is 42 years.
There are several reasons: conservatism of doctors, lack of knowledge about new methods of treating uterine fibroids and technical possibilities for conducting modern therapy, subjective distrust of all new methods of treatment, etc. out of employment.
Quite often, fibroids can be treated without removing the uterus itself: there is an effective non-surgical method – embolization of the uterine arteries. In menopause, uterine fibroids are not treated. This does not apply to those cases when it suddenly begins to grow.
When should the uterus be removed for fibroids? Only in very advanced cases, when the size of the uterus is very large and it is so “stuffed” with nodes that it is impossible to find healthy tissue.
It’s a shame that many women start the disease themselves. They see that their belly is growing, but they do not visit the gynecologist for 10 years (and some even more) and come when their disease reaches a stage at which organ-preserving treatment is impossible. Some women avoid going to the doctor, because they are offered to remove the uterus from the very beginning without telling about the alternatives available.
10. YOU HAVE NO COMPLAINTS, BUT YOU ARE TOLD THAT YOU NEED TO TREAT ADENOMIOSIS
You come for a routine examination, an ultrasound scan is done and you are diagnosed with adenomyosis, despite the fact that you have no characteristic symptoms (profuse, painful and prolonged menstruation with clots and pain during intercourse). In such a situation, the doctor is obliged to describe the changes that he saw, but this does not mean that you urgently need to be treated. Adenomyosis is a very common condition in which the endometrium invades the muscular wall of the uterus, causing the muscle fibers to thicken. Adenomyosis may not manifest itself in any way all life and independently regress after menopause. For most women, it does not require treatment – only preventive measures.
5 questions to the gynecologist
Patients often ask questions about the treatment of ureaplasma and mycoplasma at the reception, but not every doctor answers them with an open mind.
WHY ARE UREAPLASMA / MYKOPLASMA THAT DETERMINED OR NOT?
This is a transient flora, and it can disappear and reappear on its own, coming from a sexual partner.
WHY DO I HAVE THESE BACTERIA, AND THE PARTNER DOESN’T?
Because in men, ureaplasma in most cases does not exist for long.
I HAVE FOUND UREAPLASMA / MYKOPLASMA, BUT WHY DOES I NOT BREAK THEN?
This microorganism causes disease only under certain conditions, and until then it is safe.
DO I NEED TO TREAT THESE INFECTIONS?
It is necessary if at least one of the partners has clinical manifestations of the disease.
DO I NEED TO BE TREATED DURING PREGNANCY?
There is no proven improvement in the forecast. In the overwhelming majority of cases, the presence of ureaplasma in pregnant women does not lead to a violation of pregnancy and diseases in the fetus.