Thursday, March 25, 2010

What to Do About Heavy Bleeding???

Do you miss work or limit your activities because of your periods?
Do you ever soak through your clothes? (see entry #2- I know I have and even had my male partners tell me I have blood on my clothes. UGH! )
Do you stay close to a bathroom during your periods? (well, I stay close to the bathroom all the time :)
Does bleeding limit your intimate time with your partner? (I wish that was my only excuse)
Do you need to take iron to keep from becoming anemic?

It is not normal to have your menstrual periods control your life!! There's too many contenders for that positon- kids, husband, job- you get my drift. Heavy menstrual bleeding (menorrhagia) is a common problem for women. The worst cases of excessive menstrual bleeding can cause severe anemia and even require blood transfusions.

When you know all your options up front you can make a more informed decision about which is right for you. Here's just a general overview of what I can do to treat your heavy bleeding but we'll have to talk about the specifics for your medical history, age and future plans for childbirth. And certainly, we may need to do some tests first (like an ultrasound) to see which option is best for YOU. Several factors will be important to your decision, including whether or not you plan to have children in the future and whether you want ongoing therapy or a one time treatment.

So here's a list of some options to fix this common problem:

1. Medicines: The simplest treatment is the use of hormones such as birth control pills or progesterone pills. Most bleeding caused by hormone imbalance can be treated with medications. However, many women are unable to use this option due to side effects or other medical problems. Also, some women simply just don't want to take a birth control pills.
Some prescription "cousins" of ibuprofen may decrease heavy flow, but may lengthen the time of bleeding.

2 Progesterone IUD: The Mirena® progesterone IUD (
may decrease bleeding. This IUD was recently FDA approved for the treatment of heavy bleeding. Prior to this FDA approval, physicians were just using it "off-label" for menorrhagia. It can, however, cause irregular bleeding and occasionally have some other side effects of moodiness, acne, and pain .It is a good option for women that want to conceive in the future as you can become pregnant within 1 month of its removal.

3. Endometrial ablation: Endometrial ablation is a quick (about 2 minutes) office procedure, that will usually eliminate or greatly decrease bleeding. After the procedure, over 95% of women will be satisfied with the results. Approximately 60-70% will no longer have any more periods. Another 20-30% will have very light periods only using a pantiliner throughout the period. Approximately 10% will fail the procedure and choose to manage bleeding as they have been doing, use hormones to control bleeding or opt for other surgical treatments.
It is also very important to understand that you should not become pregnant after an ablation.

4.Hysterectomy: This is the only procedure that guarantees permanent elimination of any bleeding. In my opinion, itt usually makes sense to consider less invasive alternatives before having major surgery. A hysterectomy is the removal of the uterus and cervix but not necessarily the removal of the ovaries. When a hysterectomy is the best option for you, I want you to have the LEAST invasive- which means FASTEST recovery- option. So then you can get back what's more important- family, friends and job. Who has 6 weeks to recover from a sugery these days? Laparoscopic hysterectomy ( is the most common way that I choose to remove a patient's uterus and cervix. This surgery usually takes 45-60 minutes to perform and you would stay in the hospital for 10-23 hours.Most patients are back to work in 2 weeks sometimes even sooner.

Hope this overview helps, but come talk to me about your specific situation and we'll talk about what's the best for YOU!

For more reading, here's a reputable website

Saturday, March 20, 2010

Are You Nervous Going to the Gynecologist?

Have you ever gone to your Gyno and then while you were waiting to see her, you realized you forgot to shave your legs? Or forgot to trim things up "down there"? Have you ever gone to the doctor after a workout or at the end of the day when that fresh feeling has left? Or the worst one yet- you were bleeding? What is she going to say about how much weight was gained since last year? OMG! You are wondering.- what is the doctor going to think? Will she assume you're unkempt and unsanitary?

Are you kidding? At least this gynecologist has her own personal hygiene and bodily functions to worry about.

It's not an uncommon morning for me to slug down a few cups of coffee, get ready for work, make breakfast, kiss my kids goodbye about 3 times each, and then before I'm out the door- dash upstairs to brush my teeth and then dribble toothpaste on my outfit. No prob. I'll just wash it off with a washcloth- only to get to the office and realize it didn't quite come out. How unprofessional!

Or then there's the time when I was pregnant and nauseated and had to deliver a baby in the middle of the night. ie empty stomach. After the baby was born, I had to run and vomit in the trash can. I felt so bad. What kind of Obstetrician gets sick at the sight of a placenta and blood? Of course, there's another story I have relating to my vomit and that's when I threw up on myself in the car on the way to work- pregnancy #1 that was.

Its a good thing my patients don't know the real reason why I often wear scrubs to the office. Sure, many times its because I'm doing an in office procedure , but lately its because I've gained a few pounds and most of my clothes don't fit.

I've also been in the office with that white coat on and had one of my male partners, Dr.Silver, to be exact, tell me that I had blood on my lab coat. He just assumed I must have sat in blood after a procedure or something. I just let him go on believing this while I whispered to my nurse what really happened and how she would be a lifesaver and find me a new pair of scrubs and lab coat. I need to get that endometrial ablation myself!!!

I used to have a partner, Dr. Freeman, now retired , who liked to tell a lot of jokes. This is not a good thing to do in the office setting to a woman who has had 3 kids and poor bladder control. Now I've got that problem taken care of- so laughing is now permitted in my office.

So- the moral of my story is: in case you are worried what I am going to think about your unwanted hair, added pounds or menstual blood, rest assured. I've been there, done that. I'm a woman just like you. So don't worry, I'm not thinking about those things, I'm thinking about what I need to do to take care of you and your health.

what makes you wanna do this job?

Many times when I am doing a pap smear or a pelvic exam, a patient will ask me: "What made you ever want to go into this field?" Well, I thought this would be a good way to open up in my first blog. So- here's a few of the reasons why I decided to become a Obstetrician/Gynecologist

1. Bringing babies into the world is absolutely amazing!!!! There is nothing like it in the entire world and in my job, I get to be a part of it. It is such an intimate moment in a family. I love it!!!

2. I love taking care of women. I feel like I can relate- after all, I'm a woman and unfortunately- or fortunately - I've had many of the "female medical problems myself"- such as painful, heavy periods, PMS, infertility, polycystic ovarian syndrome, gestational diabetes, abnormal mammogram and a breast biopsy. More of that stuff later........

3. I enjoy the continuity of care that being an Ob/Gyn affords. It's great to take care of a woman for her yearly exams, then see her through a few pregnancies and watch her and her family develop. I love being there for her as her doctor and the lasting relationships this leads to.

4. I like to do Gyn surgery. And in womens health- it is such an exciting time to be a gyn surgeon. There are so many new surgical instruments and ways to do things to ensure my patients a better outcome and quicker recovery. I really pride myself on staying current in what's going on in the gyn surgery field.

5.Procedures are fun. Not just surgeries, but excising a painful abscess (its kinda satisfying like squeezing a big zit. Gross- I know) LEEPs, IUD insertions, polyp removals, and endometrial biopsies.

6. I love to teach. When I was a college student, I couldn't decide if I should be a high school biology teacher or a doctor. Obviously, you know what I chose. But now I get to do both. Not only do I get to inform women about all the stuff I learn to keep them healthy, but now I have started teaching other doctors. Often I have other doctors watch me do certain procedures or I go to their place and help them with their first cases. I also do speaking engagements for physicians. I am also going to get back to teaching medical students and residents (I used to do this before I had kids)

But the main reason why I just love my job- I feel that I am making a difference in women's lives..... Hopefully, with this blog, I can make an impact in yours too.