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Dr. Bob is Robert Hsiung, MD,
bob@dr-bob.orgShown: posts 1 to 10 of 10. This is the beginning of the thread.
Posted by Dinah on April 24, 2008, at 10:39:43
You saved me a real scare with the warnings about excessive bleeding.
And you're right. If I had experienced it I would have known.
Why aren't these pieces of information more widely disseminated? You get all the sitcoms about hot flashes, but nothing about the rest of it. My mom had a hysterectomy before she got to menopause, so really I had no one to tell me these things.
Posted by MidnightBlue on April 24, 2008, at 11:36:03
In reply to Thanks to those who helped me with menopause, posted by Dinah on April 24, 2008, at 10:39:43
You doing okay Dinah? You have been sort of quiet.
MB
Posted by Dinah on April 24, 2008, at 12:21:07
In reply to Re: Thanks to those who helped me with menopause » Dinah, posted by MidnightBlue on April 24, 2008, at 11:36:03
I'm in a bit of trouble at work, complete with closed door dressdown from a usually easygoing boss. So I'm reordering my priorities a bit. I may hate my job, but I'd still like control over how and when I leave it.
My diabetes has been affected by the stress as well, and I'm trying to be a bit more healthy and stay calm until it settles down. But I think I don't really want to think about that.
Did you have the excessive bleeding? If so, I have a probably too much information question. How on earth does one leave the house while it's going on? I meant to go to the office today, but I've had to change clothes a couple of times. Am I housebound until it ends?
I skipped two periods completely, and started this one twelve weeks to the day from the last one. I have stuff to do and really can't afford to stay home.
Posted by Phillipa on April 24, 2008, at 13:17:11
In reply to Re: Thanks to those who helped me with menopause » MidnightBlue, posted by Dinah on April 24, 2008, at 12:21:07
Dinah there is an office proceedure that can be done something abberlation? Stops the bleeding forever. Maybe someone knows the correct spelling? I had opposite less flow and closer together must be horrible. Love Phillipa
Posted by Phillipa on April 24, 2008, at 13:23:20
In reply to Re: Thanks to those who helped me with menopause » Dinah, posted by Phillipa on April 24, 2008, at 13:17:11
Read down the page the third option is what I know of just read it destroys the lining of the uterus. Love Phillipa
What is menopause?
Menopause is the time in a woman's life when the ovaries stop producing estrogen. Menopause is usually recognized by the cessation of menstrual periods. Other symptoms of menopause include flashes, mood changes, difficulty sleeping, and vaginal dryness. If a woman is not menstruating because she has had a hysterectomy or endometrial ablation, other symptoms of menopause often alert her that menopause is starting.
When does menopause start?
The average age of the onset of menopause is 51 years, and it is most commonly occurs from age 47 to 53. Perimenopause is the period immediately before and after the onset of menopause, and averages 4 years.
How is menopause diagnosed?
A simple blood test measuring follicle stimulating hormone (FSH) is usually all that is needed to diagnose menopause.
What happens to periods during menopause?
Although some women may abruptly stop having menstrual periods, many women will notice that their periods space out for months to years before bleeding stops permanently. Although pregnancy is unlikely in this age group, it is essential to do a pregnancy test to be absolutely sure.
Why is bleeding irregular in perimenopause?
Regular periods are the result of a precise hormone balance causing regular ovulation. In perimenopause changes in hormone levels interfere with ovulation. If ovulation does not occur, the ovary will continue making estrogen, causing the endometrium to keep thickening. This often leads to a late menstrual period followed by irregular bleeding and spotting. This can also result in endometrial polyps, a greater thickening called "hyperplasia," or in extreme long-standing cases, cancer of the lining of the uterus.
How do I know if my bleeding is abnormal?It is not unusual to have irregular bleeding for up to 6 months before menstrual periods stop completely. Unless the bleeding is excessive, or a woman it at high risk for uterine cancer, this is generally not of concern.
I tell my patients to notify me if they have:
Bleeding that requires the use of a pad every hour
for over 24 hours
Bleeding that lasts more than 2 weeks
Any bleeding after bleeding has be absent for
over 6 months. (An exception is women who just has
started estrogen replacement therapy.)How is abnormal uterine bleeding in menopause or perimenopause evaluated?
Traditionally, an endometrial biopsy, or sampling of the lining of the uterus is done. This is a simple office procedure to rule out cancer or pre-cancer. It is not accurate for diagnosing polyps or fibroids. Vaginal probe ultrasound is a quick and painless screening exam and has frequently made endometrial biopsy unnecessary. It is also possible to look directly into the uterus using a thin telescope called a hysteroscope. Hysteroscopy is usually a simple office procedure that gives far more information than endometrial biopsy alone. Click here to learn more about hysteroscopy. While D&C (dilation and curettage) may be used in an emergency to stop extremely heavy bleeding, I feel that as a diagnostic tool it is obsolete and should be replaced by hysteroscopy with endometrial sampling.
How is abnormal uterine bleeding in menopause or perimenopause treated?
As in all women, the cause of the abnormal bleeding first needs to be determined. If the bleeding is caused by lack of ovulation, cycling with progesterone will usually control the problem.
For some women, surgery is the another alternative. Many women think that hysterectomy is the only choice left, but many alternatives to hysterectomy are available. Before deciding on any surgical treatment, it is important to understand what alternatives to hysterectomy are available.
The large number of surgical possibilities may at first seem confusing. Many have fancy names and may be promoted as being the latest and the greatest. It is easier to understand these surgical procedures when you realize that all of them fall into one or more of the following categories:
Removing the uterus (hysterectomy)
Removing fibroids through an incision in the
abdomen or through a laparoscope
(myomectomy)
Removing fibroids or polyps through the cervix
using a resectoscope
Removing or destroying the lining of the uterus
(endometrial ablation)Most polyps can be removed with the resectoscope. If I do this, I will usually suggest doing an endometrial ablation at the same time to decrease the risk that polyps will regrow. Endometrial ablation in a menopausal woman takes quite a bit of skill, as the walls of the uterus are thin, but in skilled hands the procedure is often an excellent alternative for bleeding that would otherwise require hysterectomy.
Posted by Phillipa on April 24, 2008, at 13:28:25
In reply to Re: Thanks to those who helped me with menopause, posted by Phillipa on April 24, 2008, at 13:23:20
Here it is and the lady I know that had it done said it was nothing and done in docs office. Love Phillipa and no complications. No not put out either.
A common problem
Every year about 650,000 American women have hysterectomies. This operation involves surgical removal of the uterus. Many of the women who have this operation do so because of heavy or prolonged periods.An alternative
Endometrial ablation offers an effective alternative to hysterectomy for patients suffering from heavy or prolonged bleeding during their period. It is often chosen when other medical treatments have failed or are otherwise undesirable. This procedure involves the removal of the lining of the uterus, which is the source of the bleeding.According to recent studies, most women feel that endometrial ablation relieves the problem with their period. Up to 90% of women who have this procedure are satisfied with the results. After the procedure, the women who were satisfied with it reported lighter periods or normal periods. Some women said that their periods stopped completely after endometrial ablation.
Tests
Your physician will take your medical history and perform a physical exam to see if endometrial ablation is right for you.Other tests could include some blood tests, uterine lining sampling (biopsy), and hysteroscopy and/or ultrasonography. These procedures are usually done in your physician's office and are quick and relatively painless.
Drugs
For 1 to 2 months before the procedure you may have to take medication, possibly injections, to decrease the thickness of the endometrium (uterine lining). A GnRH analog may be used for this purpose. Thinning the uterine lining exposes the lower (basal) layer of endometrial cells; this is the tissue your physician will remove with electrosurgery. The day prior to surgery, your physician may choose to place a laminaria to gradually dilate your cervix the night before your surgery.What to expect
Endometrial ablation is an outpatient surgical procedure; this means that you will enter the hospital, have surgery, and usually go home the same day.The entire procedure usually takes only 15 to 45 minutes. You will then be taken to the recovery room for rest and observation, and will be allowed to go home when you have fully recovered from the anesthesia. It usually takes an hour or two to recover from anesthesia.
The procedure
Endometrial ablation is performed during a procedure called operative hysteroscopy. A narrow viewing tube is inserted through the vagina and the cervix into the uterus. A tiny camera attached to the viewing tube (hysteroscope) allows the uterine cavity to be shown on a TV monitor during surgery. Your uterus is filled with a harmless liquid to make the procedure easier. The lining of the uterus is then burned away or vaporized, using a heat generating tool inserted through the viewing tube.Your physician may decide to perform a laparoscopy at the same time to rule out other conditions that could require further therapy.
Afterwards
Your doctor may advise you to:
-Avoid strenuous activity for a period of time, usually 24 hours following the procedure.
-Refrain from sexual intercourse for a specified period, usually 2 weeks or until the discharge stops.
-Schedule an appointment for about a week after your surgery.
In addition, you may experience some of the following:-Frequent urination during the first 24 hours; this is normal.
-A small amount of bloody, watery discharge for up to 6 weeks following the procedure. It is impossible to evaluate the effectiveness of your surgery until at least three months postoperatively.
-Some cramping, for which your doctor may prescribe or recommend pain medication. Many over-the-counter medications such as Motrin, Aleve, Advil or Nuprin.
-The anesthesia may cause mild nausea and vomiting.
Rarely, more serious problems such as cardiac arrest (heart stoppage) and pulmonary arrest (no breathing) have been caused by general anesthesia.Rarely, the viewing tube can puncture the uterus and injure the bowel. This seldom happens, but if it does your physician will generally stop the procedure and postpone it until the puncture heals by itself. Another possible risk is fluid overload. If your body absorbs too much of the liquid used to fill up your uterus during the operation, the procedure will be discontinued.
It is unlikely that the operating tool will puncture the thick uterine wall, but this is a potential risk.
The bowel could also be damaged by heat from this tool. Infections developing from either of these rare complications could require additional surgery.
Can I still get pregnant?
Probably not. Most women cannot have children after this procedure. Because there is still a slight possibility of pregnancy, however, you should continue to use contraception until you have entered menopause.
Endometrial ablation is a safe, effective alternative to hysterectomy. You may also wish to learn more about another alternative, laparoscopic assisted vaginal hysterectomy.
Some Medical Terms
Endometrial Ablation Removing the lining of the womb. Removing the uterine lining will decrease your menstrual flow or even stop it completely.
Endometrium (Uterine Lining) The cells that line the womb. This tissue sheds in response to the hormonal changes of your monthly period.
Electrosurgery Instead of a scalpel, a heat-generating electrical device is used to burn-away, remove or vaporize tissue in this type of procedure.
GnRH Analog This type of drug acts like a natural hormone your body produces. It produces hormonal changes which decrease the thickness of the endometrium.
Hysterectomy The surgical removal of the uterus.
Hysteroscopy A procedure used to see inside the womb, using a viewing tube inserted into the vagina.
Laminaria A laminaria is a small rod-shaped pieced of dried seaweed, that when placed in your cervix provides for more gentle dilation of your cervix minimizing the risk of cervical tears.
Laparoscopic Assisted Vaginal Hysterectomy (LAVH) A simpler form of hysterectomy (LAVH) used the laparoscope to avoid a large abdominal incision.
Laparoscopy In this procedure, the physician inserts a viewing tube through the skin to see inside the body. Other tubes can be pushed through the skin to introduce probes or instruments; in this way a number of surgical procedures can be performed without a large surgical incision.
Ultrasonography A procedure used to "see" inside the body, using high-pitched sound waves. This is a little like radar or sonar.
Uterus The womb.
Uterine Lining Sampling (Biopsy) In this procedure, a small piece of tissue is removed from the lining of the womb and analyzed in the lab.
Posted by Dinah on April 24, 2008, at 13:30:57
In reply to Re: Thanks to those who helped me with menopause, posted by Phillipa on April 24, 2008, at 13:23:20
Thanks, Phillipa.
It seems from those criteria that my experience is within the "norm". But it has the potential to interfere with life. I was afraid to go to work today, even though I'm in trouble there.
I'm also feeling a bit weak and lightheaded, even though I *know* that's all in my head. :) The same thing happened in my teen years, although I was also mildly anemic in my teen years. Of course in my teen years I was also skinny skinny skinny with the very low blood pressure of an athlete (although I was no athlete). So in my teen years it probably wasn't *all* in my head. It is now, though.
Posted by MidnightBlue on April 24, 2008, at 19:16:59
In reply to Re: Thanks to those who helped me with menopause » MidnightBlue, posted by Dinah on April 24, 2008, at 12:21:07
Dinah,
Are you on any kind of hormones? Birth conrol pills, etc? Often I would bleed three weeks out of four. Not heavy but constant. Other times I would just flood. The reason this period is so heavy is because you didn't have one for three months.
You might want to consider going on a low dose bc pill if you respond to them okay. What happened is the lining of your uterus built up too much and then you finally had enough of a hormone surge to release it.
Take extra clothes and change tampons/pads hourly. Use both! Drink plenty of water and be sure to eat iron rich foods. You'll be okay.
MB
Posted by Dinah on April 24, 2008, at 20:47:25
In reply to Re: Thanks to those who helped me with menopause » Dinah, posted by MidnightBlue on April 24, 2008, at 19:16:59
Boy, being female is not for the weak. :(
It's the embarrassment factor that is bothering me. I'm familiar enough with myself to realize that the physical stuff is the same sort of hypochondria that I usually get when anxious. But the embarrassment...
If I didn't already have social anxiety, this would do it.
I guess I ought to call my gynecologist about the possibility of hormones. I don't need a greater push to be a hermit. It already comes naturally to me.
Posted by Happyflower on May 3, 2008, at 13:32:12
In reply to Re: Thanks to those who helped me with menopause » MidnightBlue, posted by Dinah on April 24, 2008, at 20:47:25
Hi Dinah,
I am going through this too. I use a tampon and an overnight pad with wings. It helps protect your clothes more, but you still need to change maybe every 1/2 hour. It is a pain, I try not to do anything those 2 days, but that is hard to do if you are working.
This is the end of the thread.
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