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Getting Answers to your Women's Health Questions

Online Health Chat with Dr. Linda M. Bradley

August 25, 2011


Introduction

Cleveland_Clinic_Host: If you experience heavy periods, there is no reason to suffer in silence. And if you've been told hysterectomy is your only solution, take hope. There are many options available to women today.

The Cleveland Clinic Center for Menstrual Disorders, Fibroids, and Hysteroscopic Services is part of the OB/GYN and Women’s Health Institute, which offers comprehensive and compassionate care to women during all phases of life. The Center uses a streamlined, unified interdisciplinary approach to evaluate your problem and arrive at the best treatment for you.

Menstrual disorders are the No. 1 reason that women seek help from a gynecologist. They are more common than all gynecologic cancers combined, more common than infertility, and more common than uterine prolapse. Each woman experiences 400 to 500 menstrual cycles during her lifetime. They typically begin at age 11 or 12 and end sometime during her 50s. The law of averages dictates that menstrual problems are likely at some point. Excessively long, heavy, or frequent periods can disrupt a woman’s life, interfering with her normal activities, her favorite pastimes, and her sexuality. Blood loss can produce anemia, which leads to fatigue and other problems. Menstrual irregularities are also linked to miscarriage and infertility.

Linda D. Bradley, MD, FACOG, specializes in the evaluation, diagnostic testing, and surgery for uterine fibroids and menstrual disorders. She has been very active in endoscopy for more than 20 years. Her expertise in endometrial ablation technology makes her an innovative leader in the field of hysterectomy alternatives. Female sexual dysfunction, menopause, and contraception are her other areas of interest. She recently was involved in several multicenter clinical trials involving endometrial ablation, uterine fibroid embolization compared to abdominal myomectomy, and hysteroscopic sterilization procedure. She is the principal investigator for two new hysteroscopic procedures currently in development for endometrial ablation and operative hysteroscopic myomectomy and polypectomy. With more than 500 1000 referrals for uterine fibroid embolization (UFE), she maintains an excellent collaborative practice with the interventional radiology department for a UFE fibroid registry database. She has published extensively and presented internationally on this topic.

A gynecologist at Cleveland Clinic for more than 20 years, Dr. Bradley has performed thousands of flexible hysteroscopic office procedures and operative hysteroscopic procedures, including myomectomy, polypectomy, and endometrial ablation. With her extensive medical background and clinical expertise, she can speak to her patients not only as an expert, but also as a woman who understands their concerns.

Cleveland_Clinic_Host: To make an appointment with Dr. Linda Bradley, or any of the specialists in the OB/GYN and Women’s Health Institute at Cleveland Clinic, please call 216.444.4HER (444.4437) or call toll-free at 800.CCF.CARE, extension 46601. Visit us online at my.clevelandclinic.org/ob_gyn.

Cleveland_Clinic_Host: The 8th Annual Universal Sisters "Live Younger Longer!" event is Saturday, October 22, from 7:30 a.m. to 3 p.m. Come and enjoy an intimate, dynamic, in-depth, and uplifting experience for women of color surrounding health and wellness. The keynote speaker will be Susie Q, a national fitness and health expert seen on national television. For more information or to register, call 1.888.410.0904 or visit the website clevelandclinic.org/universalsisters

Cleveland_Clinic_Host: Welcome to our Online Health Chat with Dr. Linda Bradley. We are thrilled to have her here today for this chat. Let’s begin with some of your questions.


Menstruation

canbe: What do changes in a woman's menstrual cycle mean? My cycle has gotten a lot heavier and with more clotting. I also now have cramping. I am 43.

Dr_Linda_Bradley: Any changes in the menstrual cycles that last for more than two to three months should be evaluated by your gynecologist. Causes of bleeding can range from fibroids to endometrial cancer. Most often a benign cause is found. Some women have no etiologies detected; however, medication may be used during the menstrual cycle to decrease menstrual flow. There are several new medications available within the last two years that may dramatically decrease menstrual bleeding and solve your problem without surgical intervention.

forthcoming: Why did my heavy bleeding start again after having a D&C?

Dr_Linda_Bradley: The evaluation of heavy uterine bleeding has evolved. It is important that a component of surgery and evaluation includes hysteroscopy. This test should be coupled with a D&C so that the physician can view the area of menstruation. A D&C alone is not diagnostic or therapeutic. Therefore, if you have already undergone a surgical D&C, I would recommend that you restart another office evaluation with a saline infusion sonogram. This comprehensive visualization will more thoroughly evaluate causes of bleeding. A D&C alone may have missed a focal growth that can contribute to heavy menstrual periods. Please feel free to contact my office to schedule a consultation, and I will determine the next steps. Please bring a copy of any testing you have had done, including surgery and results to the appointment. The appointment number is 216.444.6601.


Menopause

clara: What are the most common signs that you are going into menopause?

Dr_Linda_Bradley: Symptoms of menopause often begin before the last menstrual period. Many women experience no symptoms and others have variable symptoms. Changes in menstrual cycles (skipping periods, more than one period a month, change in menstrual flow, including duration and amount) often occur one to seven years before the periods stop. Additionally, hot flashes, night sweats, vaginal dryness, decreased libido, and change in mood and memory can occur.

It is important to determine whether any of these symptoms impact your quality of life. Specifically, do the symptoms interfere or disturb your daily functioning? If so, I would advise that you see a physician in the Women's Health Institute. Please call 216.444.4HER (444.4437) or call toll-free at 800.CCF.CARE extension 46601. They offer comprehensive, individualized and personal attention to these concerns.

Nubianspirit: Since hitting menopause three years ago, I have no libido. None. I am not on any HRT, just taking one day at a time through the flashes and anxiety attacks. Will my libido ever return; and even though it doesn't bother me that it is gone, do I need medical attention for this?

Dr_Linda_Bradley: It is common that libido decreases with aging. Currently, there are no FDA-approved medications for decreased libido. There are other causes for decreased libido, including an underactive thyroid gland, elevated prolactin levels, depression, alcohol abuse, and an unsatisfactory interpersonal relationship with your sexual partner. All of these issues and more should be discussed with a physician. We are fortunate to have a national leader in sexual health at Cleveland Clinic who provides expert evaluation and treatment options. Dr. Margery Gass (OB/GYN) may be contacted for an appointment by calling 216.444.4HER (216.444.4437). She is excellent!


Intercourse

gatorfrog: I recently had a rectocele repair surgery with mesh. (May 18th). I am having considerable pain with sexual intercourse, and my surgeon has told me that he doesn't believe it is the repair that is causing the pain. I went online and read patient accounts and all indications are that it takes months afterwards for no pain. I would like to know how long it takes for the pain from the repair to last. Thank you!

Dr_Linda_Bradley: Please consider getting a second opinion with a urogynecologist who has experience with pelvic floor dysfunction following pelvic reconstruction surgery and mesh procedures. We have five board certified urogynecologists here at Cleveland Clinic that can provide a second opinion.

While there will be another web chat scheduled about this topic in October, I would suggest that you get a second opinion in the interim.

gretab: I am 42. When having sex, I am now experiencing vaginal dryness. I have never had this problem before. Is there a way to treat this without just using creams during sex?

Dr_Linda_Bradley: You are considered perimenopausal. This means that your estrogen levels are changing. Due to a decline in estrogen, vaginal dryness is common. A physician can prescribe an estrogen tablet, estrogen ring, or estrogen cream, which after 8 to10 weeks improves lubrication. See your doctor for evaluation and treatment options.


Fibroids and Cysts

tina: I am in my 50s and am having very heavy, uncomfortable periods. My doctor told me that my ultrasound showed I have a large uterine fibroid. What is the latest on UAE/UFE versus hysterectomy? Will an abdominal hysterectomy compromise my abdominal muscles long-term?

Dr_Linda_Bradley: There are many options for treating heavy menstrual cycles related to uterine fibroids. The size, number, and location of the fibroid often determine treatment options. Hysterectomy should always be the last option.

Within the last year, Lysteda® (tranexamic acid), which is an oral medication taken only during the menstrual cycle, has been demonstrated by FDA trials to decrease menstrual bleeding by 40 percent to 50 percent. It is a non-hormonal medication that decreases menstrual bleeding from many causes.

If it does not work, UFE (uterine fibroid embolization) may also be considered and is effective in 90 percent of properly evaluated patients. Currently, Cleveland Clinic gynecologists recommend a minimally invasive surgical route (laparoscopic, robotic, or single port) laparoscopic hysterectomy if surgery is ultimately needed. In many cases abdominal hysterectomy can be avoided.

By avoiding an abdominal approach, abdominal muscles, large scars, longer recovery and complications can be minimized. The route of surgery for hysterectomy is evolving to a minimally invasive approach. Find a physician who can offer these options.

alphagirl: What do you recommend for treatment of an ovarian cyst in a 49-year-old menopausal woman? I have pain in my lower back associated with this cyst. My mother had ovarian cancer.

Dr_Linda_Bradley: Ovarian cysts are common during the reproductive years when women have menstrual cycles. They are uncommon in menopause. In fact, generally the ovaries are small, and in 30 percent of cases are not visualized by ultrasound. While the majority of cysts, if found in the menopausal years, are benign (not cancerous), due to your family history, you need more follow-up and evaluation. Characteristics of the cyst that your doctor will evaluate include size and whether the cyst has a complex or simple appearance. Also, the doctor will determine if the cyst is growing rapidly.

Additionally, symptoms of ovarian cancer -- such as bloating, abdominal pain, urinary frequency, nausea and vomiting, and early satiety (feeling full with minimal food intake) -- may occur. In light of your family history, please see your physician for a thorough history and physical examination. Do not delay!


General Questions

donnaj: What effects does birth control have on young women? My daughter is 16 and has just started birth control to help with heavy and erratic periods. She chose to have the depo shots. How long is it safe for her to be on the shots or birth control in general?

Dr_Linda_Bradley: It is great that your daughter is using an effective means to control her menstrual cycles. Depo-Provera shots -- as well as oral contraceptive pills, patches, contraceptive vaginal rings and Implanon -- are safe and effective long-term solutions for menstrual control and pregnancy prevention.

Often, it may take two to five years for adolescents to establish a normal menstrual flow.

I applaud you for seeking medical advice, adhering to the treatment regimen, and having a critical and necessary conversation with your daughter about this personal topic. She certainly has a great mom! Hope this information helps!

bonder: I am 43 and prone to urinary tract infections. What can I do decrease/stop getting them?

Dr_Linda_Bradley: If you have had three or more urinary tract infections within 12 months, you should see an urogynecologist to exclude an anatomic cause of an infection. In the meantime, try to void after intercourse. For personal hygiene, wipe from front to back. Unfortunately, research recently shows that cranberry juice is not effective for UTI's.

Also, try to determine if these infections are always associated with intercourse. If so, most physicians will prescribe a single antibiotic pill to take after intercourse.


Closing

Cleveland_Clinic_Host: I'm sorry to say that our time with Dr. Linda Bradley is now over. Thank you again Dr. Bradley for taking the time to answer our questions today about women's health.

Dr_Linda_Bradley: In closing, thank you for your interest and time. Please exercise, eat healthy and -- despite a busy life -- please find time to smell the roses!


More Information

The 8th Annual Universal Sisters "Live Younger Longer!" event is Saturday, October 22, from 7:30 a.m. to 3 p.m. Come and enjoy an intimate, dynamic, and in-depth, uplifting experience for women of color surround health and wellness. The keynote speaker will be Susie Q, a national fitness and health expert seen on national television. For more information or to register, call 1.888.410.0904 or visit the website www.clevelandclinic.org/universalsisters.

A remote second opinion may also be requested from Cleveland Clinic through the secure eCleveland Clinic MyConsult Web site. To request a remote second opinion, visit www.eclevelandclinic.org/myConsult.

If you need more information, click here to contact us, chat online or call the Center for Consumer Health Information at 216.444.3771 or toll-free at 800.223.2272 ext. 43771 to speak with a Health Educator. We would be happy to help you. Let us know if you want us to let you know about future web chat events!

Some participants have asked about upcoming web chat topics. If you would like to suggest topics, please use our contact link www.clevelandclinic.org/webcontact.

This chat occurred on 8/25/2011

This information is provided by the Cleveland Clinic and is not intended to replace the medical advice of your doctor or health care provider. Please consult your health care provider for advice about a specific medical condition. ©Copyright 1995-2011 The Cleveland Clinic Foundation. All rights reserved.