Commonly patients present with irregularities in their menstrual period, irritability or mood swings, bloating, fluid retention or weight gain, hot flashes, or decreased libido…wondering if their ‘hormones are out of balance’? Unfortunately, there’s not always an easy answer to that question, but as Gynecologists, it does cause us to consider two common ‘hormonal’ conditions that could explain such symptoms: Polycystic Ovarian Syndrome, and the Perimenopause.
Polycystic Ovarian Syndrome is characterized by menstrual irregularities (chronic anovulation) and signs of androgen excess (hair growth, acne), and is the most common ‘hormonal abnormality’ affecting reproductive aged women. Nearly 1 in 15 women are affected, half of those women being overweight or obese. Many women with PCOS have had a long history of irregular menstrual periods, dating as far back as they can remember. The irregularities can vary between skipped periods to frequent periods, flow may be light to heavy, and short or prolonged in duration. Some women describe light cramping/a sensation of pelvic ‘fullness’ or bloating (like their period is ‘about to start’), in the months of skipped periods. Others describe a feeling of emotional ‘tension’, while in wait for that unknown date when their period will start. Though the cause of PCOS is unknown, genetic inheritance may play a role.
In discussing the concerns of Menopausal Hormone Therapy (MHT) with patients in the office, it’s evident that ‘the fear’ of developing breast cancer from hormone use, by far outweighs the benefits of use, for many women. With breast cancer being the number one cancer diagnosed among US women, and the second leading cause of cancer-related deaths (second to lung cancer,) those concerns are certainly understandable.
Though concern for an association of breast cancer from hormone use have perplexed patients and the medical community for many years, in the last 10 years, that level of concern has escalated to nearly a level of fear. Despite some public perception of hormones as the cause of breast cancer, the medical evidence does not support hormones as a cause for breast cancer. Unlike the causal link between smoking and most cases of lung cancer, a causal link between hormone use and breast cancer has not been established. In fact, the cause of breast cancer is still unknown.
Heavy menstrual flow is a common occurrence affecting 10-35% of women, and a common reason for visits to the gynecologist. Though the causes for heavy menstrual periods (menorrhagia) vary, the Novasure endometrial ablation procedure is an excellent treatment option for many women, when child-bearing is completed.
As an Ob/Gyn physician with greater than 10 years of experience performing the Novasure procedure (and with hundreds of satisfied patients having selected the procedure), I thought it may be helpful to discuss common questions from patients considering the procedure as their treatment of choice. Here are my answers to 5 common patient questions regarding the Novasure procedure:
1. How is the procedure performed?/What can I expect from my menstrual flow after the procedure…lighter periods or no period?
The procedure is considered minimally invasive, performed through the vaginal aspect without surgical incisions. The Novasure wand (containing a triangular mesh) is inserted within the uterus, where a short (less than 2 minute) cauterization of the uterine lining occurs. The procedure may be performed in an outpatient surgical setting (with anesthesia) or possibly in your doctor’s office. You should expect to be back to normal activities within a day or so.
Several research studies on the results of the Novasure procedure note over 90-95% patient satisfaction with the procedure. Expected results range from notably lighter menstrual periods (for most patients)…to skipped/or absent menstrual flows (up to 40% of patients.) It’s not possible to predict for patient’s what result they will get, but when questioned overall, most patients are (very) satisfied with the results achieved.
Confused about Menopausal Hormone Replacement Therapy? Let's discuss the differences in FDA-Approved versus Bio-Identical Hormones...
I often use analogies when explaining concepts with patients in the office. Though the issue of Menopause/Hormone Replacement Therapy (HRT) is a complex one, with many different considerations…We have to start somewhere in grasping the array of options. Here’s my bit. In my analogy we’ll start with 3 options:
1) FDA-approved HRT,
2) Bio-Identical HRT
3) Herbal options.
One of the main differences in FDA HRT and Bio-Identical HRT is their derivation. FDA/HRT may come from plant or animal sources, whereas the Bio/HRT and herbal options come from plant sources only. I explain to patients, you can take certain plants (mostly soy containing yams) and “squeeze out’’ products EQUAL to “human hormones” (there are both FDA-approved HRTs and Bio-identical/HRT options.) Certain other plants have “plant hormone” with similar qualities, but not equal to human hormone (isoflavones like soy, Siberian rhubarb.)