Gynecology Problems

  • How safe are hormones in menopause? (English)
  • What alternatives to hormones exist for the treatment of menopausal symptoms? (English)
  • When and why do I need a mammogram? (English)
  • What is HPV? (English)
  • I’m 45 and have irregular/heavy bleeding but I don’t want to have a hysterectomy. What are my options?(English)
  • How to Prevent Sexually Transmitted Diseases (English) (Spanish)
  • Pelvic Support Problems (English) (Spanish)
  • Endometriosis (English) (Spanish)
  • When Sex is Painful (English) (Spanish)
  • Detecting and Treating Breast Problems (English) (Spanish)
  • Vaginitis (English) (Spanish)
  • Dysmenorrhea (English) (Spanish)
  • Urinary Tract Infections (English) (Spanish)
  • Genital Herpes (English) (Spanish)
  • Premenstrual Syndrome (English) (Spanish)
  • Gonorrhea, Chlamydia, and Syphilis (English) (Spanish)
  • Human Papillomavirus (HPV) Infection (English) (Spanish)
  • Uterine Fibroids (English) (Spanish)
  • Ovarian Cysts (English) (Spanish)
  • Pelvic Inflammatory Disease (English) (Spanish)
  • Preparing for Surgery (English) (Spanish)
  • Urinary Incontinence (English) (Spanish)
  • HIV and Women (English) (Spanish)
  • Disorders of the Vulva (English) (Spanish)
  • Abnormal Uterine Bleeding (English) (Spanish)
  • Cancer of the Ovary (English) (Spanish)
  • Cancer of the Uterus (English) (Spanish)
  • Chronic Pelvic Pain (English) (Spanish)
  • Polycystic Ovary Syndrome (English) (Spanish)
  • Vulvodynia (English) (Spanish)
  • Evaluating Infertility (English) (Spanish)
  • Treating Infertility (English) (Spanish)
  • Endometrial Hyperplasia (English) (Spanish)
  • Understanding Abnormal Pap Test Results (English) (Spanish)
  • Perimenopausal Bleeding and Bleeding After Menopause (English) (Spanish)
  • Cancer of the Cervix (English) (Spanish)
  • Human Papillomavirus Vaccines (English) (Spanish)

How safe are hormones in menopause?
The most recent large study, The Women’s Health Initiative, documented an increased risk of heart attack, stroke, blood clots, breast cancer, and most recently, Alzheimer’s Disease associated with the use of hormone replacement therapy. However, as the data was more closely analyzed and separated by age groups, these risks were not bestowed on women who initiated therapy at the onset of menopause. Thus, hormones still play a vital role in the transition through a women’s most symptomatic years of menopausal life. The goal is to treat patients with the lowest dose for the shortest amount of time so as to obtain the benefits (less mood swings, less hot flashes, more sleep, less risk of osteoporosis and colon cancer) without incurring the risks.

What alternatives to hormones exist for the treatment of menopausal symptoms?
Non-hormonal forms of treatment that have shown varying results include herbal remedies such as soy products and black cohosh. A prescribed medication that usually functions as an antidepressant has been shown to reduce the number of daily hot flashes experienced and improve the response to them.

When and why do I need a mammogram?
Annual screening mammography is currently recommended to begin at the age of 40. Tests can be ordered sooner if warranted by a patient’s symptoms or family history. A woman with a positive family history of premenopausal breast cancer would be encouraged to begin screening 10 years prior to that family member’s diagnosis. Mammograms are still the mainstay of screening as they detect 90% of all breast cancers. As they miss 10% of all breast cancers, it is still important to perform monthly self-breast exams after each cycle. Other screening modalities, such as MRI, may be employed in high risk patients.

What is HPV?
HPV is a virus known as Human PapillomaVirus spread through sexual contact and is responsible for abnormal pap smears and 99.7% of cervical cancers. There are more than 100 different types with approx. 30 types responsible for infection in the genital tract. Low-risk types cause genital warts and high-risk types cause abnormal pap smears. 90% of the time, your body naturally rids itself of the virus much the same way its does with many other viruses. About 10% of the time, the virus persists and continues to cause abnormal pap smears that can progress to cancer over time. Usually, definitive therapy can be carried out before cancer ensues. For that reason, appropriate follow-up is of utmost importance.

I’m 45 and have irregular/heavy bleeding but I don’t want to have a hysterectomy. What are my options?
The time period when a woman naturally experiences changes in her cycle prior to menopause is referred to as PERIMENOPAUSE or “around the time of” menopause. The changes in circulating hormone levels are thought to result from the decrease in ovarian function. When irregular bleeding occurs in this age group however, care must be taken to insure no significant intrauterine pathology, namely cancer, exists. This can usually be determined through a patient’s history in addition to diagnostic tests such as endometrial biopsy and ultrasound. If no obvious pathology is identified, medical management of irregular bleeding can usually be attempted. Often times, benign conditions such as UTERINE FIBROIDS or EDOMETRIAL POLYPS may be less responsive to medical management and require surgical excision. Although hysterectomy may be an option, other less invasive approaches, such as ENDOMETRIAL ABLATION are available which provide long-term results.

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