RENEU WOMEN`S HEALTH & MEDISPA

Newsletter for August 2009 

FINDING YOUR WAY THROUGH  PERIMENOPAUSAL ISSUES

Heavy periods...lighter periods…periods that are more frequent or less frequent… passing large clots with your period…noticing changes cramping.  Perimenopause is the time when women begin experiencing symptoms like these as they transition into menopause.

There is no test to tell us when menopause will happen, but the average age is 51 years.  Half of women are done with their mences before this age and most are done by 55 years of age, although it may several more years for some women.

Most of the time, these changes are related to less efficient ovulation or lack of ovulation. This leads to a lack of orderly hormonal effects on the uterine lining called the endometrium, which results in changes in bleeding patterns. The main worry with these symptoms is the possibility of a precancerous or cancerous condition or some other medical problem.

A gynecological evaluation usually starts with a complete history and physical.  A pap smear is taken. The pelvic exam is done to see if the uterus or ovaries are enlarged.  Blood work can be done to rule out anemia, thyroid issues, diabetes, or other hormonal problems by drawing hemoglobin, blood sugar, TSH, prolactin and, if necessary, conducting a pregnancy test.  An ultrasound of the pelvis can be done to evaluate for the presence of fibroids or an ovarian mass and to measure endometrial thickness to determine if there is a need to evaluate it for abnormal changes.  An endometrial biopsy may be done to rule out this possibility.  In the past, a D&C was usually done but nowadays we can do this evaluation comfortably in the office.

If anemia is diagnosed, iron is often prescribed.  If a thyroid disorder is diagnosed, the physician will develop an appropriate treatment plan. If the patient’s prolactin level is elevated, medication is prescribed to lower the level and an MRI of the pituitary may be done.  If blood sugar is elevated, the patient may need to begin diabetes treatment.  If an ovarian mass is diagnosed on ultrasound, it characteristics will be assessed including the presence or absence of solid or cystic components.  A tumor marker called a CA125 can be done.  If ovarian, endometrial or cervical cancer is suspected, surgery may be recommended. If fibroids or endometrial polyps are seen on ultrasound, the physician will evaluate their size.  Most small fibroids are not the cause of bleeding issues unless they impinge on the endometrial surface and even larger fibroids may not lead to bleeding changes.  Very rarely are fibroids cancerous.

Treatment of a medical condition may help stabilize periods.  If periods do not settle down with treatment, other options can be discussed and implemented. These include hormonal treatments, the use of nonsteroidal anti-inflammatory drugs, endometrial ablation, myomectomy, resectoscopic removal of fibroids or polyps, uterine artery embolization and in rare instances, hysterectomy.

Hormonal treatments include the oral contraceptive pill, the progesterone only pill, progesterone releasing intrauterine device, DepoProvera injection, and progesterone supplementation in the second half of the cycle.  A women’s health history needs to be evaluated to see if she is a candidate for these hormonal treatments. The nice thing about the progesterone releasing IUD is that the hormone is released locally, which allows some women to use hormonal treatments who may not otherwise qualify medically to use these. Nonsteroidal anti-inflammatory drugs such as ibuprofen and naprosyn can also be taken to slow the menstrual flow for some women. If these treatments fail or if a woman’s medical history precludes her from using these drugs, then surgical options can be considered. The endometrial ablation is a procedure that cauterizes the uterine lining so it cannot respond to hormonal influence and thus thicken and bleed. Intrauterine resectoscopic removal of fibroids and polyps can be done in the operating room.  Laparoscopic removal of fibroids is also an option.  An interventional radiologist can also perform a uterine artery embolization which involves the injection of tiny pellets into the area of the fibroid that cuts off blood flow to the fibroid and leads it to shrink.  If these treatments cannot be used, or they are unsuccessful, the last resort is a hysterectomy.

Please let us know if you have any of these issues so we can guide you on an appropriate course of treatments. We believe in developing a lifelong relationship with our patients.

Article written by Dr. Suzanne Schmidt, MD August 2009

RENEU WOMEN`S HEALTH &MEDISPA

262-560-1920

www.reneuhealth.com