Is It PMS or PMDD? How to Tell the Difference

Is It PMS or PMDD? How to Tell the Difference

Almost every woman has experienced it: that stretch of days before your period when the world just feels harder. You're more irritable, more tired, maybe bloated or achey. You might cry at a commercial you've seen a hundred times.

For most women, this is PMS — premenstrual syndrome — and while it's genuinely unpleasant, it's manageable. But for some women, the symptoms are so severe they can't function normally. That's a different condition entirely, and it has a name: PMDD.

What Is PMS?

Premenstrual syndrome describes a collection of physical and emotional symptoms that occur in the one to two weeks before menstruation. Symptoms typically ease within a day or two of your period starting.

Common PMS symptoms include:

  • Bloating and water retention
  • Breast tenderness
  • Headaches
  • Mood swings or irritability
  • Fatigue
  • Food cravings
  • Mild anxiety or sadness

 

PMS is extremely common — estimates suggest up to 75% of menstruating women experience some form of it. While the symptoms are real and can be bothersome, they generally don't prevent you from carrying out your day-to-day activities.

What Is PMDD?

Premenstrual dysphoric disorder (PMDD) is a severe form of PMS that primarily affects mood. The physical symptoms can overlap with PMS, but the defining feature of PMDD is the degree to which emotional symptoms interfere with daily life.

PMDD symptoms can include:

  • Severe depression or hopelessness
  • Intense anxiety or tension
  • Extreme mood swings
  • Feeling overwhelmed or out of control
  • Difficulty concentrating
  • Significant irritability or anger that affects relationships
  • Low energy or fatigue so severe it's hard to function

 

PMDD affects approximately 3–8% of menstruating women. Unlike PMS, PMDD-level symptoms are disabling, not just uncomfortable. If you've ever had to cancel plans, call out of work, or feel like a different person in the two weeks before your period — that's worth taking seriously.

 

“The whole staff was very sweet, kind and very professional. I did not have to wait long to be seen by Dr. Fraley. I'm usually very nervous about going to doctors appointments, especially OB/GYN, but Dr. Fraley and her assistant made me feel very comfortable and relaxed. Dr. Fraley took her time explaining the different options available for me. I appreciate the gentle, kind, and special treatment that I received from Dr. Fraley. I would certainly recommend your practice to my friends.”

— Cary OB/GYN Patient Testimonial 

 

How to Tell the Difference

The line between PMS and PMDD isn't always obvious, especially when you're in the middle of it. The most useful distinction is severity and impact. Ask yourself:

  • Do my symptoms significantly affect my ability to work, parent, or maintain relationships?
  • Do I feel like a different person — emotionally — in the two weeks before my period?
  • Do my symptoms resolve completely after my period starts?

 

If you're answering yes to all three, especially the first two, a conversation with your OB/GYN is warranted. Tracking your symptoms — including their timing and severity — over two or three cycles is one of the most helpful things you can do before that appointment.

What Can Help?

Both PMS and PMDD are treatable. Your care plan will depend on the severity of your symptoms and your overall health history.

For PMS, lifestyle adjustments often make a real difference: regular aerobic exercise, reducing salt and caffeine in the week before your period, and prioritizing sleep. Some women also benefit from supplements like calcium or magnesium, though you should talk with your provider before starting anything new.

For PMDD, treatment typically involves a combination of approaches — which may include antidepressants (especially SSRIs), hormonal therapy, or in some cases, hormonal contraceptives. Our team can help you figure out what's right for your body and your life.

 

“I appreciate how Dr. Wyckoff clearly explains what is going on and what needs to be done. She presents all available treatment options and thoroughly discusses the benefits, risks, and implications of each one. She provides as much information as you want upfront and also shares her professional recommendation on the option she believes is best. Throughout the process, she makes you feel informed, involved, and empowered to be an active participant in your own treatment plan.”

— Cary OB/GYN Patient Testimonial 

 

You Don't Have to Just Push Through It

One of the most common things women say when they finally talk to a provider about PMDD is that they thought it was normal. They assumed everyone felt this way. They didn't want to seem dramatic.

You are not dramatic. If your cycle is affecting your mental health, your relationships, or your ability to function, that is a medical issue — and there are real solutions.

The Cary OB/GYN team offers comprehensive care for hormonal health, abnormal bleeding, and preventive screenings that can help us get a full picture of what's going on. Visit our services page or schedule an appointment to start the conversation.

 

Do Fibroids Always Need Treatment? What Your Doctor Wants You to Know

Do Fibroids Always Need Treatment? What Your Doctor Wants You to Know

You find out you have fibroids. Maybe your doctor mentioned it at your last visit, or maybe it came up during a routine ultrasound. Either way, the word can feel alarming and your first question is probably: Do I actually need to do something about this? The short answer is: not always. Here's what you really need to know.

First, What Are Uterine Fibroids?

Fibroids (also called uterine myomas or leiomyomas) are non-cancerous growths that develop in or around the uterus. They're actually incredibly common: research suggests that up to 80% of women will develop fibroids by age 50. The size can vary wildly, from a tiny seedling to, in some cases, a mass large enough to distort the shape of the uterus.

Here's the thing that often surprises patients: most fibroids never cause any problems at all. Many women have them and never know it.

When Fibroids Don't Need Treatment

If your fibroids are small, not growing, and not causing any symptoms, a "watch and wait" approach is completely reasonable. Your provider will likely monitor them over time with imaging, but there's no medical necessity to treat fibroids that aren't disrupting your life.

This is an especially common approach for women who are nearing menopause, since fibroids tend to shrink naturally as estrogen levels decline.

When Treatment May Be the Right Call

Not every fibroid stays quiet. Some grow quickly or land in a spot that puts pressure on surrounding organs. Treatment is worth discussing if you're experiencing:

  • Heavy or prolonged periods: soaking through a pad or tampon in an hour or less counts as heavy. Our team can help you understand what's normal and what isn't through our Abnormal Bleeding services
  • Pelvic pain or pressure: ongoing discomfort in your lower abdomen or back may be fibroid-related. Learn more about our Pelvic Pain services
  • Bladder or bowel changes: fibroids pressing on the bladder can cause frequent urination or difficulty emptying completely
  • Fertility challenges: fibroids in certain locations can interfere with implantation or pregnancy
  • Significant anemia from blood loss

 

What Are Your Treatment Options?

Treatment isn't one-size-fits-all, and your options depend on your symptoms, the size and location of your fibroids, and whether you're planning future pregnancies.

Medication: Hormonal therapies can help manage heavy bleeding and temporarily shrink fibroids. They're not a permanent fix, but they can buy time or help you prepare for a procedure.

Minimally invasive procedures: Several office-based and surgical options can remove or destroy fibroids while preserving your uterus. The team at Cary OB/GYN specializes in minimally invasive surgery that gets you back on your feet faster.

Hysterectomy: For women with severe symptoms who are done with childbearing, a hysterectomy is a permanent solution. It's major surgery, but for the right patient, it can be truly life-changing.

 

“Kind staff and doctor, good listener. She takes time with you.”

— Cary OB/GYN Patient Testimonial 

 

What Your Doctor Wants You to Know

Your OB/GYN is not trying to push you toward treatment you don't need. A fibroid diagnosis is not an automatic surgery referral. What your doctor wants most is for you to feel informed: to understand your options, know what symptoms to watch for, and feel confident asking questions.

Don't downplay symptoms because you think heavy periods or pelvic pressure are "just the way it is." They might be. But they also might point to something treatable that could genuinely improve your quality of life.

 

“She was amazing! I'm so pleased to have her as my new provider.”

— Cary OB/GYN Patient Testimonial 

 

Ready to Talk Through Your Options?

Whether you were just diagnosed or you've been living with fibroids for years, the team at Cary OB/GYN is here to help you figure out what, if anything, needs to happen next. Visit our Services page to learn more, or schedule an appointment at our Cary or Morrisville office today.

Summer Health Tips: Staying on Top of Your Annual Well-Woman Exam

Summer Health Tips: Staying on Top of Your Annual Well-Woman Exam

Summer has a way of filling up fast. Between kids out of school, vacations, and longer evenings that seem designed for everything except health appointments, it's easy to let your annual well-woman exam drift toward fall  and then toward the end of the year and then, somehow, into next year.

We get it. But we also know this: the women who feel most in control of their health are the ones who make that appointment a non-negotiable, not something they fit in when everything else settles down. And honestly? Summer is actually a great window to get it done.

What Happens at a Well-Woman Exam?

A well-woman exam is more than a Pap smear. It's an annual check-in on your whole gynecologic and reproductive health: a chance to catch things early, ask questions that have been on your mind, and make sure you're heading into the second half of the year feeling informed and looked after.

Depending on your age and health history, your visit at Cary OB/GYN may include a pelvic exam, a Pap smear (if you're due for one), a breast exam, and a review of your blood pressure, weight, and general health. It's also a natural moment to revisit your contraception or family planning needs: because life changes, and your birth control should keep up.

“For the first time since I gave birth to my 3 year old I felt like my provider actually listened to me and treated all of my concerns like they were concerns. Other providers have made me feel like my concerns were nothing or not important.”
—Cary OB/GYN Patient Review

A Perk Worth Knowing: In-Office 3D Mammography

One of the things our patients appreciate most is that at Cary OB/GYN, you can get your annual mammogram without scheduling a separate appointment at a separate imaging center. We offer 3D mammography right in our office, often on the same day as your well-woman exam.

3D mammography creates layered, detailed images of breast tissue that can detect abnormalities more accurately than traditional 2D screening, especially for women with dense breast tissue. If you're due for a mammogram, ask about scheduling it alongside your exam. One trip. One day. Done.

A Few Summer Health Tips

The season itself brings some health considerations worth keeping on your radar:

Hydration and your urinary tract

Warmer weather, more outdoor activity, and let's be honest, more alcohol and caffeine on vacation can all increase your risk for urinary tract infections. Staying well hydrated is one of the simplest things you can do for urinary tract health. If you're prone to UTIs, talk to your provider at your well-woman visit about strategies for prevention.

STI screening: more relevant than you might think

Summer travel, new relationships, and changing circumstances make this a good time to think about STI testing if you haven't been tested recently. Routine screening is part of responsible health care: confidential, quick, and easy to include in your annual visit.

“The facility was clean. All personnel dealt with were accommodating. Dr. Rodrigo was very knowledgeable and helpful.”
— Cary OB/GYN Patient Review 

Heat and hormonal symptoms

If you're in perimenopause or menopause, summer heat can amplify hot flashes and night sweats in ways that make the season genuinely miserable. Don't white-knuckle through it. There are effective options  from hormone therapy to non-hormonal approaches that can make a meaningful difference in your quality of life. Our menopause care team is here to help you find what works for your body.

Abnormal bleeding: don't file it away until fall

If you've been noticing heavier periods, bleeding between cycles, or anything that feels off, please don't put it on the mental back-burner until the fall. Abnormal uterine bleeding is worth evaluating promptly, it can signal conditions like fibroids or hormonal imbalances that are very treatable when caught early.

The Insurance Angle

If your health insurance plan runs on a calendar year and you've already met your deductible, summer is a financially smart time to come in — preventive screenings and diagnostic follow-ups cost you less when your deductible is already satisfied. Don't let those benefits go unused.

Make This the Summer You Prioritize Yourself

We know your schedule is full. But an annual well-woman exam is one of those appointments that pays dividends far beyond the hour it takes. Our team at Cary OB/GYN is welcoming new and established patients at both our Cary and Morrisville locations, and we'd love to see you this summer.

Call us at (919) 467-5941 or book your appointment online:  your future self will thank you.

Managing Chronic Pelvic Pain — When to Seek Help

Managing Chronic Pelvic Pain — When to Seek Help

Chronic pelvic pain is one of the most common reasons women visit a gynecologist and one of the most undertreated. Women often describe living with pelvic pain for months or years before seeking care, sometimes because they assumed the discomfort was just part of being a woman, or because a previous provider dismissed their concerns. Neither of those things should be true.

At Cary OB/GYN, we want to be direct: pelvic pain that persists, interferes with your life, or simply doesn't feel right deserves a thorough evaluation. You should not have to manage it alone, push through it indefinitely, or accept that nothing can be done. There are answers  and there are effective treatments.

What Counts as Chronic Pelvic Pain?

Chronic pelvic pain is generally defined as pain in the lower abdomen or pelvis lasting six months or longer. But that definition shouldn't be a reason to wait six months before calling your doctor. If your pain is recurring, worsening, or affecting your quality of life, that's worth addressing now; not six months from now.

The pain might be constant or come and go. It might be tied to your menstrual cycle or completely unpredictable. It might feel like a dull ache, sharp cramps, pressure, or burning. All of these presentations matter and all of them deserve attention. Our pelvic pain team is experienced in working through the complexity.

“The front office workers were very welcoming and the nurse is always so nice and inviting. A lot of the women in my family see Dr. Piper. She is absolutely professional, always taking time with her patients and she is very knowledgeable of her job about everything. If you need help with menopause she is the 'it doctor'.”
— Cary OB/GYN Patient Review 

What Could Be Causing It?

Pelvic pain rarely has a single, simple cause. It can originate from gynecologic, urologic, gastrointestinal, or musculoskeletal sources and often involves more than one. Common contributors include:

  • Endometriosis — where tissue similar to the uterine lining grows outside the uterus, causing inflammation and pain that often worsens around menstruation
  • Uterine fibroids — noncancerous growths that can cause heaviness, cramping, and pressure
  • Ovarian cysts — which may cause intermittent or sudden pain depending on size and behavior
  • Pelvic inflammatory disease (PID) — infection of the reproductive organs, often resulting from an untreated STI
  • Pelvic floor dysfunction — tightness, weakness, or coordination problems in the pelvic floor muscles
  • Interstitial cystitis — a chronic bladder condition causing persistent pelvic pressure and urinary urgency
  • Irritable bowel syndrome (IBS) or other gastrointestinal conditions

In some cases, chronic pelvic pain is connected to past trauma or a sensitized nervous system, which requires a compassionate, whole-person approach to care. Whatever the underlying cause, a correct diagnosis is the foundation of effective treatment.

When Should You Call Us?

There's no need to wait until you're debilitated. You should schedule an evaluation if your pelvic pain:

  • Has lasted more than a few days and isn't explained by a known cause like menstruation
  • Is getting worse over time, not better
  • Makes it hard to work, exercise, sleep, or go about daily life
  • Occurs during or after sex
  • Is accompanied by abnormal bleeding: between periods, after sex, or unusually heavy
  • Hasn't responded to over-the-counter pain relievers

If you experience sudden, severe pelvic pain, seek care immediately. This can sometimes signal an urgent condition like ovarian torsion or ectopic pregnancy.

“The provider that I saw, Jessica Ramirez-Trower, CNM, MSN, was incredible. She made sure I am comfortable with the exam and the procedure, she explained everything really well and answered all my questions. She also made sure that I understood my treatment options and she also educated me on proper breast exams. I will highly recommend her to my friends and family. The staff at the registration also was very kind.”
— Cary OB/GYN Patient Review 

How We Diagnose the Cause

Getting to the root of chronic pelvic pain often requires more than a single test. At Cary OB/GYN, your evaluation is comprehensive and paced to what your symptoms suggest. We typically begin with a detailed health history and pelvic exam, and move from there into in-office ultrasound imaging, lab work, or STI testing as indicated.

When imaging or medication trials suggest something more structural, such as endometriosis or fibroids, a laparoscopy may be the next step. Laparoscopy is a minimally invasive surgical procedure that allows us to both diagnose and, in many cases, treat the underlying cause at the same time.

 

Treatment: More Options Than You May Realize

Once we understand what's driving your pain, we build a treatment plan around your specific situation. This might include hormonal therapies, such as birth control pills, hormonal IUDs, or other medications to manage conditions like endometriosis or abnormal uterine bleeding associated with fibroids.

For patients whose pain has a structural cause that doesn't respond to medical management, minimally invasive surgery is often highly effective. Our surgeons specialize in laparoscopic and hysteroscopic techniques that achieve real results with less recovery time than traditional surgery.

Pelvic floor physical therapy is another powerful tool, particularly when muscle tension or pelvic floor dysfunction is contributing to the pain. If a PT referral is appropriate for your situation, our on-site pelvic health specialist, Kaitlyn Bachman, DPT, can work with you directly.

You Deserve to Be Heard

Chronic pain is invisible to the people around you, but it is absolutely real and it affects every part of your life. If you've felt dismissed before, or if you've been managing this on your own, we want you to know that you will be listened to here.

Our team is ready to help you find answers. Call us at (919) 467-5941 or schedule online at our Cary or Morrisville location.

Scoliosis and Pelvic Health: What Women Need to Know

Scoliosis and Pelvic Health: What Women Need to Know

June is Scoliosis Awareness Month, and while most conversations about scoliosis focus on back pain and posture, there's a connection that often goes unspoken: the impact scoliosis can have on pelvic health. For women especially, understanding this relationship can make a meaningful difference in how you approach everything from annual gynecologic exams to pregnancy care to managing chronic discomfort.

At Cary OB/GYN, we see the whole patient: not just one system in isolation. The spine, pelvis, and reproductive structures are deeply interconnected, and when one is affected, the others often feel it too.

The Spine-Pelvis Connection

Scoliosis is an abnormal lateral curvature of the spine that affects an estimated 2–3% of the population. Females are significantly more likely than males to develop curves that progress and require treatment, which means this is very much a women's health issue.

When the spine curves, the pelvis compensates;  it may tilt, rotate, or shift to maintain balance. Over time, this asymmetry places uneven stress on the pelvic floor muscles, ligaments, and surrounding structures. The result can include:

  • Tension or tightness in pelvic floor muscles
  • Hip imbalance and altered gait
  • Increased menstrual cramping or pelvic pain
  • Changes in bladder or bowel habits
  • Discomfort during sexual intercourse

If you've been experiencing any of these symptoms and have a known scoliosis diagnosis, it's worth bringing both pieces of information to your next gynecologic visit. Our pelvic pain specialists are trained to evaluate the full picture.

“Everyone is always so friendly and welcoming. I also hardly ever am waiting past my appointment time.”
— Cary OB/GYN Patient Review 

Gynecologic Exams and Procedures With Scoliosis

For women with moderate to severe scoliosis, routine pelvic exams and in-office procedures can sometimes feel more uncomfortable due to spinal and pelvic asymmetry. If you've avoided or postponed care because you're unsure how your anatomy will affect things, please don't let that be the barrier.

Let your provider know about your diagnosis before your appointment. We can modify positioning, take extra time, and talk through each step so you feel informed and in control. Small adjustments can make a significant difference in your experience.

Scoliosis and Pregnancy

Women with scoliosis frequently ask whether the condition will affect their ability to conceive, carry a pregnancy, or deliver safely. In most cases, the answer is reassuring: scoliosis itself does not prevent pregnancy. That said, there are a few important considerations.

Pelvic asymmetry can sometimes influence fetal positioning late in pregnancy or the progress of labor. Women who have had spinal fusion surgery with hardware may also have limitations around epidural placement; something worth discussing with your OB and your anesthesiologist early in your pregnancy, not the day of delivery.

Our team is experienced in supporting patients with complex musculoskeletal histories throughout pregnancy and prenatal care. The earlier we know about your full health picture, the better we can plan your care together.

“The entirety of the office staff were so sweet and accommodating. I felt supported in my care and every concern was met with practical advice and active listening.”
— Cary OB/GYN Patient Review 

The Role of Pelvic Floor Physical Therapy

One of the most effective and often overlooked interventions for women with scoliosis-related pelvic health issues is pelvic floor physical therapy. A pelvic floor PT can assess how your spinal alignment is affecting muscle tension and movement patterns, and develop a targeted plan to address dysfunction.

At Cary OB/GYN, we have Kaitlyn Bachman, DPT, a Doctor of Physical Therapy specializing in pelvic health, on our care team. If scoliosis is contributing to pelvic floor tightness, pain with intercourse, bladder urgency, or other symptoms, Kaitlyn can provide the specialized support you need: right here in our practice.

Practical Tips for Women With Scoliosis

  • Always mention your scoliosis diagnosis and any spinal hardware to your gynecologist before procedures
  • Ask about positioning modifications if exams or procedures have been uncomfortable in the past
  • Discuss your scoliosis with your OB team as early as possible if you are pregnant or planning to become pregnant
  • Ask for a pelvic floor PT referral if you're experiencing any pelvic floor symptoms
  • Don't dismiss pelvic symptoms as unrelated: your body's systems communicate with each other

We See the Whole You

This Scoliosis Awareness Month, we want women living with this condition to know that your spinal health and your pelvic health are both part of the care you deserve. If you've been managing symptoms quietly or haven't found a provider who connects the dots, we'd love to be that team for you.

Reach out to us at (919) 467-5941 or visit caryobgyn.com to schedule an appointment at our Cary or Morrisville location.

Pain Relief for Gynecologic Procedures: What Are Your Options?

Pain Relief for Gynecologic Procedures: What Are Your Options?

If you've ever felt anxious about an upcoming gynecologic procedure,  wondering how much it will hurt or whether your concerns will be taken seriously: you're not alone. At Cary OB/GYN, one of the most common things we hear from patients is that they weren't sure what to expect, or that they wished they'd known their options for managing discomfort beforehand. That's exactly why we want to talk about it openly.

Whether you're coming in for something routine like an IUD placement or Nexplanon insertion, or preparing for a more involved procedure like a laparoscopy or minimally invasive surgery, knowing your pain relief options ahead of time can make a real difference in how you experience your care.

Start With a Conversation

Before any procedure, the most important step is an honest conversation with your provider. Pain tolerance and anatomy vary widely from patient to patient, and what causes mild discomfort for one woman may feel more significant for another; especially if you have conditions like endometriosis, pelvic pain, or cervical stenosis that can make uterine procedures more uncomfortable.

Tell your provider if you're anxious, if you've had a painful experience before, or if you have any underlying conditions that affect your pelvic health. Our team will adjust the approach accordingly; this is not a one-size-fits-all situation.

“Dr. Wyckoff is very patient and very proficient in looking at the whole person. She does not make you feel stupid for expressing concerns. She takes them very seriously.”
— Cary OB/GYN Patient Review 

Over-the-Counter Options: Simple and Effective

For many in-office procedures: IUD insertions, endometrial biopsies, LEEP, colposcopies, taking an anti-inflammatory like ibuprofen about an hour before your appointment can meaningfully reduce cramping and discomfort afterward. It won't eliminate all sensation, but it can take the edge off and support a smoother recovery.

Your provider will give you specific instructions based on your health history. Some patients aren't good candidates for NSAIDs due to gastrointestinal or blood-thinning concerns, so always confirm with your care team before taking anything.

Local Anesthesia: Numbing Where It Counts

For procedures involving the cervix or uterus, local anesthesia is often an option. A paracervical block, an injection of numbing medication near the cervix, can significantly reduce pain during procedures like IUD placement or endometrial biopsy. Topical lidocaine gel applied to the cervix beforehand is another tool that helps reduce initial discomfort.

These options aren't always offered automatically, so if you're concerned about pain, ask specifically whether a paracervical block or topical numbing agent would be appropriate for your procedure. Advocating for your own comfort is not only acceptable; it's encouraged.

“Dr. Piper was very nice, made me feel comfortable.”
— Cary OB/GYN Patient Review 

Sedation and Anesthesia for Surgical Procedures

When a procedure moves to the operating room such as a hysteroscopy, laparoscopy, or hysterectomy, sedation or general anesthesia ensures you are comfortable and free from pain throughout. Our surgical team coordinates all aspects of your anesthetic care and will discuss what to expect in advance.

One advantage of minimally invasive surgical techniques, which our providers specialize in, is that they also tend to mean less post-operative pain and a shorter recovery period compared to traditional open surgery. 

After the Procedure: Recovery Pain Management

Post-procedure discomfort is normal, and your care team will send you home with clear instructions. For most in-office procedures, continued ibuprofen or acetaminophen along with a heating pad applied to the lower abdomen is the primary approach. For surgical procedures, a prescription pain medication may be appropriate for the first day or two.

If your pain isn't well-controlled after returning home, or if you develop fever, heavy bleeding, or unusual discharge, don't wait, call our office. We're here during and after your visit.

You Deserve Comfortable Care

Pain management in gynecologic care has historically been underprioritized, and we know that. At Cary OB/GYN, we are actively working to change that experience for our patients. No procedure should feel like something to simply endure, and no concern about pain should go unaddressed.

If you have an upcoming procedure or are experiencing pelvic pain that needs evaluation, we'd love to partner with you in your care. Call us at (919) 467-5941 or request an appointment online.