Tampa Obstetrics, Fertility & Gynecology

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Adam S. Levine, M.D. recently finished his fellowship in reproductive endocrinology and infertility within the department of gynecology and obstetrics at the Johns Hopkins University School of Medicine. His areas of expertise include reproductive endocrinology, infertility, assisted reproductive technology, reproductive surgery, pediatric and adolescent gynecology, and menopause.

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Q:    Are there any medications that can be taken for excess body hair when all other methods have failed? I have heard that a certain combination of medicines can be taken -- possibly birth control pills and some kind of estrogen pill. Is this true? If not, can anything be done medically to correct this problem? A:    Excessive growth of body hair is technically called hirsutism. Hirsutism is a difficult condition to diagnose because hair growth varies by several factors including ethnic origin. Hirsutism may be caused by several different abnormalities, including hormonal imbalances or medication use. In some cases, it may not be possible to determine the actual cause of hirsutism.
    Before beginning treatment, it is important to have hirsutism evaluated by either a reproductive endocrinologist or a gynecologist. This is necessary because serious hormonal imbalances should be excluded. Medical treatment is possible with several different medications. Oral contraceptives contain estrogen which may help to decrease hair thickness and growth. Anti-androgens (androgens are male hormones like testosterone) are medications which also decrease hair growth. Many physicians will begin treatment with a combination of medications to maximize treatment.
    Cosmetic treatment may also be helpful in some cases. Professional electrolysis has been shown to be effective, but home electrolysis methods have not. Unfortunately there are no instant cures. It is important to keep in mind that treatment may take several weeks before there is a noticeable change.

Q:    Is there any way to prevent severe headaches that occur monthly with the menstrual cycle? A:    Yes. Headaches are common in the general population. However, individuals experiencing a new-onset or severe headache should seek prompt medical attention. In reproductive age women, menstrual headaches are defined as any kind of headache that occurs in association with their menstrual cycle. These headaches may include stress or tension headaches, migraine headaches with or without an aura, or cluster headaches. Generally, menstrual headaches begin either prior to or during the menstrual flow. As with most types of headache, menstrual headaches may be treated when they occur or they may be prevented.
    Important considerations before undertaking long-term treatment to prevent menstrual headaches are how debilitating the headaches are, whether the headaches occur each month, and whether or not the headache responds to treatment after it has begun. There are several different theories regarding the cause and ultimately the prevention of menstrual headaches. One theory is that suppressing the changes in the hormonal environment that naturally occur during the monthly cycle could either lessen the severity or prevent menstrual headaches. One way to suppress the menstrual cycle is to use monophasic oral contraceptives on a continuous basis, i.e., always taking active pills with no pill-free interval between the packages. Monophasic oral contraceptives deliver the same amount of hormone every day that an active pill is taken. Other methods to prevent menstrual cycle hormone fluctuations include treatment with other hormonal compounds such as estrogen or progesterone.
    Should preventative measures not prove adequate, many of these menstrual headaches may be treated with non-prescription mild analgesics such as acetaminophen, aspirin, or ibuprofen. Headaches that are resistant to these initial treatments may respond to other prescription strength medications under the care of your physician. Some individuals are successful preventing or treating menstrual headaches with various prescription medications, including anti-hypertensive medications such as beta-blockers or calcium channel blockers, antidepressants, or serotonin antagonists. Many patients have also reported success treating and preventing menstrual headaches by utilizing biofeedback, relaxation training or stress management training.

Q:      I would like to know which medications are used for panic attacks? I have a panic disorder that surfaced 6 months ago after 6 years in remission. I have had counseling in the past, and there is also a history of this in my family. My doctor gave me imipramine 50 mg at night but I still have occasional attacks that seem to be worse around my period. Is there a connection? A:    Panic attacks are time-limited, recurrent episodes of intense anxiety or fear. They are sometimes accompanied by discomfort or pain and occur without warning. These attacks may be elicited by specific emotional or physical stresses. There is also evidence that individuals can learn to respond to certain situations or conditions with a panic attack. These attacks are more common in women than in men. Individuals with a first-degree relative (parent, sibling) who suffers from panic attacks are 10 times more likely to experience panic attacks than those without a family history.
    Whether the menstrual cycle directly affects women with panic attacks is controversial. There is some evidence that rising (or elevated) levels of estrogen can induce a panic attack. This supports the idea that the fluctuations of estrogen occurring during the normal course of the menstrual cycle can provoke a panic attack. There is also evidence that women with premenstrual syndrome have a measurable increase in overall anxiety during week preceding their menses. This anxiety may either directly provoke a panic attack or be interpreted as an actual panic attack.
    Most women with panic disorders will improve with counseling and some form of pharmacotherapy. Antidepressant medications (such as imipramine) are frequently used to reduce the frequency and intensity of these attacks. Importantly, many of these medications require several weeks before an effect is noticed. Individuals with panic attacks should also avoid caffeine and other stimulants, alcohol, or other substances that are associated with intoxication or withdrawal. Women with panic attacks who demonstrate a clear association between their menstrual phase and the occurrence of panic attacks may theoretically benefit from hormonal therapy (such as oral contraceptives).

©1999 Tampa Obstetrics, P.A. All rights reserved. All information is intended for your general knowledge only and is not a substitute for medical advice or treatment for specific medical conditions. You should seek prompt medical care for any specific health issues and consult your physician before starting a new fitness regimen.

Q: Are there any medications that can be taken for excess body hair when all other methods have failed? I have heard that a certain combination of medicines can be taken -- possibly birth control pills and some kind of estrogen pill. Is this true? If not, can anything be done medically to correct this problem?	A: Excessive growth of body hair is technically called hirsutism. Hirsutism is a difficult condition to diagnose because hair growth varies by several factors including ethnic origin. Hirsutism may be caused by several different abnormalities, including hormonal imbalances or medication use. In some cases, it may not be possible to determine the actual cause of hirsutism. Before beginning treatment, it is important to have hirsutism evaluated by either a reproductive endocrinologist or a gynecologist. This is necessary because serious hormonal imbalances should be excluded. Medical treatment is possible with several different medications. Oral contraceptives contain estrogen which may help to decrease hair thickness and growth. Anti-androgens (androgens are male hormones like testosterone) are medications which also decrease hair growth. Many physicians will begin treatment with a combination of medications to maximize treatment. Cosmetic treatment may also be helpful in some cases. Professional electrolysis has been shown to be effective, but home electrolysis methods have not. Unfortunately there are no instant cures. It is important to keep in mind that treatment may take several weeks before there is a noticeable change.
Q: Is there any way to prevent severe headaches that occur monthly with the menstrual cycle?	A: Yes. Headaches are common in the general population. However, individuals experiencing a new-onset or severe headache should seek prompt medical attention. In reproductive age women, menstrual headaches are defined as any kind of headache that occurs in association with their menstrual cycle. These headaches may include stress or tension headaches, migraine headaches with or without an aura, or cluster headaches. Generally, menstrual headaches begin either prior to or during the menstrual flow. As with most types of headache, menstrual headaches may be treated when they occur or they may be prevented. Important considerations before undertaking long-term treatment to prevent menstrual headaches are how debilitating the headaches are, whether the headaches occur each month, and whether or not the headache responds to treatment after it has begun. There are several different theories regarding the cause and ultimately the prevention of menstrual headaches. One theory is that suppressing the changes in the hormonal environment that naturally occur during the monthly cycle could either lessen the severity or prevent menstrual headaches. One way to suppress the menstrual cycle is to use monophasic oral contraceptives on a continuous basis, i.e., always taking active pills with no pill-free interval between the packages. Monophasic oral contraceptives deliver the same amount of hormone every day that an active pill is taken. Other methods to prevent menstrual cycle hormone fluctuations include treatment with other hormonal compounds such as estrogen or progesterone. Should preventative measures not prove adequate, many of these menstrual headaches may be treated with non-prescription mild analgesics such as acetaminophen, aspirin, or ibuprofen. Headaches that are resistant to these initial treatments may respond to other prescription strength medications under the care of your physician. Some individuals are successful preventing or treating menstrual headaches with various prescription medications, including anti-hypertensive medications such as beta-blockers or calcium channel blockers, antidepressants, or serotonin antagonists. Many patients have also reported success treating and preventing menstrual headaches by utilizing biofeedback, relaxation training or stress management training.
Q: I would like to know which medications are used for panic attacks? I have a panic disorder that surfaced 6 months ago after 6 years in remission. I have had counseling in the past, and there is also a history of this in my family. My doctor gave me imipramine 50 mg at night but I still have occasional attacks that seem to be worse around my period. Is there a connection?	A: Panic attacks are time-limited, recurrent episodes of intense anxiety or fear. They are sometimes accompanied by discomfort or pain and occur without warning. These attacks may be elicited by specific emotional or physical stresses. There is also evidence that individuals can learn to respond to certain situations or conditions with a panic attack. These attacks are more common in women than in men. Individuals with a first-degree relative (parent, sibling) who suffers from panic attacks are 10 times more likely to experience panic attacks than those without a family history. Whether the menstrual cycle directly affects women with panic attacks is controversial. There is some evidence that rising (or elevated) levels of estrogen can induce a panic attack. This supports the idea that the fluctuations of estrogen occurring during the normal course of the menstrual cycle can provoke a panic attack. There is also evidence that women with premenstrual syndrome have a measurable increase in overall anxiety during week preceding their menses. This anxiety may either directly provoke a panic attack or be interpreted as an actual panic attack. Most women with panic disorders will improve with counseling and some form of pharmacotherapy. Antidepressant medications (such as imipramine) are frequently used to reduce the frequency and intensity of these attacks. Importantly, many of these medications require several weeks before an effect is noticed. Individuals with panic attacks should also avoid caffeine and other stimulants, alcohol, or other substances that are associated with intoxication or withdrawal. Women with panic attacks who demonstrate a clear association between their menstrual phase and the occurrence of panic attacks may theoretically benefit from hormonal therapy (such as oral contraceptives).