August 29, 2008
Cleveland_Clinic_Host: Linda Bradley, MD is an internationally recognized gynecologic surgeon known for her expertise in diagnostic and operative hysteroscopy, endometrial ablation, alternatives to hysterectomy, Hysteroscopic sterilization and the evaluation of abnormal uterine bleeding.
She is a gynecologist at the Cleveland Clinic Foundation in Cleveland, Ohio and is Vice Chair of Obstetrics, Gynecology, and Women’s Health Institute as well as the Director of The Fibroid and Menstrual Disorders Center and Director of Hysteroscopic Services. She was recently elected to the Board of Governors at the Cleveland Clinic Foundation, 2006-2010.
Dr. Bradley is certified by the American Board of Obstetrics and Gynecology. Additionally she is certified in advanced laparoscopy and hysteroscopy.
Dr. Bradley specializes in the evaluation, diagnostic testing, and surgery for uterine fibroids and menstrual disorders. She has been very active in endoscopy for over 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 over 500 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 the Cleveland Clinic for over 17 years, she has performed over 9,000 office flexible hysteroscopic procedures and over 2,000 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.
She has served on the Board of Trustees for the American Association of Gynecologic Laparoscopy (1997-1999) and currently serves as an Editorial Advisory Board member for the Journal of American Association of Gynecologic Laparoscopists. She is Chair of the OB/GYN section of the National Medical Association, 2006-2008. She is also on numerous advisory boards.
Dr. Bradley has been an invited lecturer at more than 300 local, national and international symposia conferences, and meetings as an honored guest speaker. She has actively participated in AAGL as a speaker, instructor, journal reviewer, and as a member of the video review committee. Additionally, she has performed live telesurgery for many programs.
She has published numerous journal articles, book chapters, and continuing medical education films. Her films cover topics such as saline infusion sonography, flexible hysteroscopy, operative hysteroscopy, endometrial ablation, abdominal myomectomy, and laparoscopic hysterectomy. Most recently, she was editor and contributor to: Hysteroscopy: Office Evaluation and Management of the Uterine Cavity, published by Elsevier in June 2008.
Recognized by the media as an expert in her field, Dr. Bradley has been interviewed extensively about women’s health issues in publications such as First for Women, McCall’s, Ladies Home Journal, Heart and Soul, O Magazine (Oprah Winfrey), Essence, Prevention Magazine, and Cosmopolitan.
She has been named as the Cleveland Clinic Foundation Bruce Hubbard Stewart Fellow, which honors physicians with compassion and clinical care. She also received the APGO award, which honors physicians for resident and fellow teaching. Named by graduating residents, in 1987, 1988, 2001, 2003, and 2004 as “Faculty of the Year”, she is admired and respected for her clinical teaching, surgical expertise, and compassionate bedside manner. She has received “Top Doctors of America” award annually from 2002-2008. Linda is proud to be a member of the Department of Obstetrics and Gynecology department at the Cleveland Clinic Foundation, Cleveland, Ohio which was ranked 7th in the country by US News and World Report 2007, and number one in Ohio.
Dr. Bradley is committed to educating women around the world about their bodies, their health concerns, and most importantly, their options.
Dr. Bradley earned a Bachelor’s degree in Biopsychology from Vassar College before attending the University of Cincinnati College of Medicine for her M.D. She completed her residency training at Case Western Reserve University in Cleveland, Ohio. She has completed an executive program in practice management from the Weatherhead School of Business, Case Western Reserve University in Cleveland, Ohio.
A Cleveland native, she lives with her two children and husband in Shaker Heights, Ohio.
Cleveland_Clinic_Host: Welcome everyone, and thank you Dr. Bradley, for being with us to discuss women's health issues. We look forward to an interesting chat today. Let's begin with one of the questions.
Speaker_-_Dr__Bradley: Thank you for having me. I am excited to talk and answer questions today.
suzieq216: I go regularly, every year, for my pap test and everything is fine. My doctor suggested that I have a sonogram, a procedure that inserts into you a camera to check your ovaries. He said it might show something that doesn't show up in a regular pap. Is that something you would recommend to have done when no problems are evident?
Speaker_-_Dr__Bradley: I would recommend that you follow the instructions for an ultrasound as requested by your physician. The ultrasound can check for the size of the uterus and the presence of fibroids or ovarian cysts.
Ultrasound is not a routine test at a check-up. It is usually requested if the physician is concerned about a mass in the pelvis or to evaluate pain in the abdomen.
The PAP test only screens for precancerous tissues and cancer of the cervix.
These are two completely different tests that assess the health of the female pelvic organs.
alexis: At what age can you stop getting PAP tests?
Speaker_-_Dr__Bradley: Women should begin PAP tests within 3 years of sexual activity. If someone is not sexually active, PAP tests should begin by age 21. The current recommendation for interval screening is an annual PAP test for 3 years. If negative, the test is done every 3 years. The cause of cervical cancer is due to the HPV virus.
In addition to the PAP test, physicians are also checking for the presence of the HPV virus. Therefore, when the PAP and HPV tests are negative ("double negative PAP smear") the every 3 year interval is advisable.
If a woman has the presence of HPV, the annual PAP tests are advised. If you have had a hysterectomy and removal of your cervix for a non- cervical reason, then you do not need to have a PAP test again.
Currently we stop screening at age 65 if all the PAP tests have been normal. However, if you are over 65 and began with a new sexual partner or resumed sexual activity, I would recommend continuation of screening as described above.
mechuda53: How can I know if the menstruation pain is because I have tumors or ovarian (cysts)??
Speaker_-_Dr__Bradley: Most women have menstrual pain (cramps) with menstrual cycles. If the pain is not easily relieved with other the counter (OTC) meds like Aleve, Motrin or Tylenol ... or if you are unable to participate in work, travel, hobbies, sports... then you should see your physician.
There are many reasons for more significant menstrual pain such as fibroids, endometriosis or ovarian cysts. A physical examination and ultrasound might be required to determine the cause of the menstrual pain.
mechuda53: My daughter is 18 and she has strong pain every month. The doctor had said she probably has some (cysts) in her ovaries. Can this be true if she is very young?
Speaker_-_Dr__Bradley: Yes. Beginning with the onset of menstruation until menopause, ovarian cysts are made monthly. This is normal. Cysts are usually not cancerous and are small. When they enlarge more than 5 centimeters doctors may advise birth control pills and a repeat transvaginal ultrasound to determine if the cyst resolves.
Although normal, many women do make cysts. Frequently, physicians will recommend low dose birth control pills (BCP's) to suppress the formation of cysts. Luckily, 90% of women who take BCP's will favorably respond and have decreased pain.
Often a combination of BCP's and OTC products (Aleve, Motrin, and Tylenol) will relieve the menstrual cramps or pain.
kels1780: Is it normal to experience rectal pain during your menstrual cycle? This is the only time the pain occurs, and is sharp shooting pain and usually never lasts longer than 10 seconds... it's also more frequent when I need to release bowels.
Speaker_-_Dr__Bradley: Rectal pain may be normal however endometriosis can also be the cause of rectal pain during menses.
See your physician for a physical examination, including a rectal exam would be important. The physician will be checking for rectal nodules, tenderness and rectal masses. An ultrasound may also be ordered to determine the presence of masses.
jhjohn02: I am a 36 year old woman. Due to ovarian cysts, fibroid tumors, excessive bleeding, pain, and troubled pregnancies, I had a hysterectomy back in 2001. This past weekend, after sex, I experienced pain in the lower abdomen, followed by a dark brown vaginal discharge. I know this is usually the body cleansing itself of dead blood, but with me having had a hysterectomy, what could this have been? It has cleared up now, but do I still need to go see a doctor?
Speaker_-_Dr__Bradley: It is not normal to have vaginal bleeding after a hysterectomy. Sometimes bleeding may be due to endometriosis that can still occur after a hysterectomy because you still have your ovaries.
I would advise that you see your gynecologist for a physical examination to determine if there are any vaginal infections, or scar tissue or an ovarian cyst. It is likely that a more comprehensive evaluation with a transvaginal ultrasound will be needed.
jjacksonwriter: When does menopause typically begin and how do you know you are in menopause?
Speaker_-_Dr__Bradley: The definition of menopause is the absence of menstruation for 12 consecutive months. The average is 51 years; however by age 51 only 80% of women have stopped their periods. By age 55, 95% of women have stopped their periods. By age 58, 100% of women should stop menses.
Please note that 1% of women at age 40 have stopped their periods and 10% by age 45. Our bodies are not like a light bulb. Menopause does not 'just happen.' But a 'gradual change' will occur. This time is termed Perimenopause.
Premenopausal changes (hot flashes, night sweats, vaginal dryness, and menstrual irregularities) do occur 7-10 years before menstruation completely stops.
bchisholm: Hi Dr. Bradley, I will be 49 this month and still have regular menstrual cycle. When will I know I have started menopause?
Speaker_-_Dr__Bradley: We answered a similar question at the beginning of the chat. If you are unable to view the answer, click on the transcript button and it will take you back to the beginning.
costalot: Vaginal estrogen did not help painful vaginal dryness. HRT helps, but I have been on it for 10 years. Are there any other choices?
Speaker_-_Dr__Bradley: There are three ways to take vaginal estrogen (vaginal creams, vaginal rings or vaginal tablets.) I would recommend switching from whatever product you are currently using to another product.
Sometimes it is trial and error to determine which product will work best for you. In addition, an OTC (Over-the-Counter) vaginal moisturizer (without estrogen) will help to hydrate the vaginal tissue in combination with a vaginal estrogen product may improve symptoms.
However, please note that up to 30% of women will still require a systemic (oral or patch) estrogen to improve symptoms. Unfortunately, for some women topical products will not be enough.
Some OTC products include Replens, Astroglide, Lubrin or WET.
jhjohn02: After having a hysterectomy in 2001, I sometimes experience the same symptoms as before (abdominal pain, swelling, nausea). If the hysterectomy was done to eliminate the possibility of getting cysts and tumors again, what could be happening to me? Can they actually come back after a hysterectomy?
Speaker_-_Dr__Bradley: A hysterectomy only removes the uterus and cervix. This is called a partial hysterectomy.
Your ovaries are left intact and still function. Therefore, some women after a hysterectomy will still have PMS-like physical and emotional symptoms such as bloating, abdominal pain, swelling, nausea and mood swings.
Luckily, there are medicines for PMS. See your physician.
The reason for not removing the ovaries is that they serve a vital function. The ovaries make estrogen. Currently most gynecologists do not remove the ovaries until age 55 if a hysterectomy is needed. Premature removal of the ovaries often causes lower estrogen levels leading to hot flashes, night sweats, decreased libido, increased risk of osteoporosis and other menopause related symptoms.
Menopause and Fibromyalgia
mechuda53: Is Fibromyalgia part of the menopause symptoms??
Speaker_-_Dr__Bradley: Some patients during menopause will experience muscle aches and joint stiffness. Fibromyalgia has many additional symptoms that are unrelated to menopause.
Only your physician can differentiate between menopause and Fibromyalgia related symptoms.
jhjohn02: At times, bumps arise on my private areas (vagina, butt, between legs). They are like abscesses. They are filled with pus and blood, and are very painful. They are large in circumference, and don't get any better until they are drained. What are these bumps called, why are they present, and what can be done about them?
Speaker_-_Dr__Bradley: The 'private areas' have oil glands and hair follicles. Believe it or not, these areas can develop acne. Very often, these small abscesses are due to inflamed hair follicles or oil glands.
This could also be seen in the underarm area and beneath the breast. It can also be seen in men who have beards. This is called folliculitis. In general a dermatologist can evaluate the skin area. They might advise antibiotics or ointments to the affected area. Other treatments may also be needed. This is an easy problem for dermatologists to fix.
CAG117: Two years ago I had a breast reduction (Size Double I to B). They had to remove my nipples and put them back on. During the healing process, they were black and it was unsure if they would take. After about 3 weeks they were turning pink. Now, I am getting a smelly discharge from them. Is this normal, or does it indicate a problem?
Speaker_-_Dr__Bradley: Any discharge from the breast related or even unrelated to surgical procedures should always be evaluated. Is it normal? There are very few reasons for having a discharge i.e. recent breast feeding or recent surgery less than six months. It is recommended to see your doctor for an examination and additional testing.
newtonm: One week after a spinal, I experienced slight incontinence with coughing. If nerve was injured or affected, what can be done? Years later, I now have frequent urinary leakage beginning.
Speaker_-_Dr__Bradley: This is most likely a coincidence, but is unrelated. There are many causes of frequent urination including diabetes, urinary tract infection (UTI), too much caffeine or water.
A very common cause of urinary frequency is due to an overactive bladder. There are tests (urodynamics) that can be ordered by your gynecologist. These tests are very easy and help determine the cause of frequent urination. Additionally, daily medication may also decrease urinary frequency and urgency.
candygirl5: I have been getting the Depo Provera shots for two years now, and will not be getting another one as my husband and I are going to try to have a baby. How long does it take for the Depo to get out of my system? How long before I could conceivably become pregnant?
Speaker_-_Dr__Bradley: Depo Provera is an excellent method of birth control. Usually, the method will be effective for 12-16 weeks. However, it is not uncommon have the effects on the menstrual cycle for 6 -18 months following the last injection.
If you are planning for pregnancy soon, I would recommend that you stop the Depo Provera shots soon.
Cleveland_Clinic_Host: We are ready to close the chat for today. A large number of questions were received and we apologize if we did not get to your question. If you have additional questions that were not answered, please go to www.clevelandclinic.org/health/livepersonchat to chat online with a health educator.
Speaker_-_Dr__Bradley: I am happy to have been involved with this session.
To answer more questions and schedule appointments you may contact our Cleveland Clinics Women’s Health 4-HER line (216.444.4HER) This line is answered by a registered nurse who is able to answer many of your questions or refer you for an appointment.
You can make appointments at our Main Campus facility. You can also enjoy the expertise of Cleveland Clinic physicians at any of our 8 community hospitals or 13 Family Health Centers.
Again, thank you for having me.
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