Uterine GYN Problems -- March 29, 2010 -- Dr. Laura Williams and Dr. Larry Gurley - NewsChannel5.com | Nashville News, Weather & Sports

Uterine GYN Problems -- March 29, 2010 -- Dr. Laura Williams and Dr. Larry Gurley

Uterine GYN Problems
March 29, 2010
Dr. Laura Williams and Dr. Larry Gurley

Dysfunctional Uterine Bleeding - When To Call a Doctor

If you have not been diagnosed with dysfunctional uterine bleeding (DUB), see the topic Abnormal Vaginal Bleeding to determine whether you should see your health professional.

Any significant change in menstrual pattern or amount of bleeding that affects your daily life requires evaluation by a health professional. This includes menstrual bleeding for three or more menstrual cycles that:

• Occurs more frequently than every 21 days or farther apart than 35 days (a normal teen menstrual cycle can last up to 45 days).
• Lasts longer than 7 days.
• Consists of more than 80ml of blood lost or involves passing blood clots and soaking through your usual pads or tampons each hour for 2 or more hours.

Watchful Waiting

Watchful waiting is a wait-and-see approach. If you have been diagnosed with dysfunctional uterine bleeding, you may consider watchful waiting when:

• A careful examination has revealed no underlying physical problem or disease.
• Blood loss is not severe enough to cause anemia.
• You prefer to wait and see if your symptoms get better on their own. If you are a teen, you can expect your cycles to even out with time. If you are nearing the age of menopause, you can expect menstrual cycles to stop eventually.

Talk to your doctor if you have not had a menstrual period for more than 3 months. He or she may give you medicine to start your menstrual period, so your uterine lining doesn't become too thick.

Endometrial ablation

Endometrial ablation is a procedure that uses a lighted viewing instrument (hysteroscope) and other instruments to destroy (ablate) the uterine lining, or endometrium. Endometrial ablation can be done by:

• Laser beam (laser thermal ablation).
• Heat (thermal ablation), using:
• Radiofrequency.
• A balloon filled with saline solution that has been heated to 85C (thermal balloon ablation).
• Normal saline (heated free fluid).
• Electricity, using a resectoscope with a loop or rolling ball electrode.
• Freezing.
• Microwave.

The endometrium heals by scarring, which usually reduces or prevents uterine bleeding.

What To Expect After Surgery

Endometrial ablation is usually done in an outpatient facility or hospital. The procedure may be done using a local or spinal anesthesia, although general anesthesia is sometimes used.

It takes a few days to 2 weeks to recover.

Why It Is Done

Endometrial ablation is used to control heavy, prolonged vaginal bleeding when:

• Bleeding has not responded to other treatments.
• Childbearing is completed.
• You prefer not to have a hysterectomy to control bleeding.
• Other medical problems prevent a hysterectomy.

How Well It Works

Most women will have reduced menstrual flow following endometrial ablation, and up to half will stop having periods.¹

Younger women are less likely than older women to respond to endometrial ablation. After an endometrial ablation, younger women are more likely to continue to have periods and need a repeat procedure.

Young women may be treated with either gonadotropin-releasing hormone analogues (GnRH-As) 1 to 3 months before the procedure. This will decrease their production of estrogen and help thin the lining of the uterus (endometrium).

Risks

Problems that can happen during endometrial ablation include:

• Accidental puncture (perforation) of the uterus.
• Burns (thermal injury) to the uterus or the surface of the bowel.
• Buildup of fluid in the lungs (pulmonary edema).
• Sudden blockage of arterial blood flow within the lung (pulmonary embolism).
• Tearing of the opening of the uterus (cervical laceration).

These problems are uncommon but can be severe.

What To Think About

Regrowth of the endometrium may occur after you have endometrial ablation. This procedure is not recommended if you have a high risk for endometrial cancer.

Do not consider this procedure if you plan to become pregnant in the future.

Although this surgery usually causes sterility by destroying the lining of the uterus, pregnancy may still be possible if a small part of the endometrium is left in place. This can lead to severe pregnancy problems. Birth control of some form is needed if you have not finished menopause.

Endometrial (Uterine) Cancer - Topic Overview

Endometrial cancer affects the lining of the uterus (endometrium). This topic focuses on type I endometrial cancer, which is the most common kind.

What is endometrial cancer?

Endometrial cancer is the growth of abnormal cells in the lining of the uterus. The lining is called the endometrium. Endometrial cancer is also called cancer of the uterus, or uterine cancer.

Endometrial cancer usually occurs in women older than 50. The good news is that it is usually cured when it is found early. And most of the time, the cancer is found in its earliest stage, before it has spread outside the uterus.

What causes endometrial cancer?

The most common cause of endometrial cancer is having too much of the hormone estrogen compared to the hormone progesterone in the body. This hormone imbalance causes the lining of the uterus to get thicker and thicker. If the lining builds up and stays that way, then cancer cells can start to grow.

Women who have this hormone imbalance over time may be more likely to get endometrial cancer after age 50. This hormone imbalance can happen if a woman:

• Is obese. Fat cells make extra estrogen, but the body doesn't make extra progesterone to balance it out.
• Takes estrogen without taking a progestin.
• Has polycystic ovary syndrome, which causes hormone imbalance.
• Starts her period before age 12 or starts menopause after age 55.
• Has never been pregnant or had a full-term pregnancy.
• Has never breast-fed.

What are the symptoms?

The most common symptom of endometrial cancer is unexpected (abnormal) bleeding from the vagina after menopause. (If you are taking hormone therapy, some vaginal bleeding is expected.) About 20 out of 100 women who have abnormal bleeding after menopause have endometrial cancer.¹ That means that 80 out of 100 women with abnormal bleeding after menopause don't have this cancer.

A woman with advanced endometrial cancer may have other symptoms, such as losing weight without trying.

How is endometrial cancer diagnosed?

Endometrial cancer is usually diagnosed with a biopsy. In this test, the doctor removes a small sample of the lining of the uterus to look for cancer cells.

How is it treated?

Endometrial cancer in its early stages can be cured. The main treatment is surgery to remove the uterus plus the cervix, ovaries, and fallopian tubes. The doctor will also remove pelvic and aortic lymph nodes to see if the cancer has spread.

A woman whose cancer has spread may also have:

• Chemotherapy to kill cancer cells.
• Hormone therapy to block cancer growth.
• Radiation therapy to kill cancer cells.

Cervical Cancer : Topic Overview

What is cervical cancer?

Cervical cancer occurs when abnormal cells on the cervix grow out of control. The cervix is the lower part of the uterus that opens into the vagina. Cervical cancer can often be cured when it's found early. It is usually found at a very early stage through a Pap test.

What causes cervical cancer?

Most cervical cancer is caused by a virus called human papillomavirus, or HPV. You can get HPV by having sexual contact with someone who has it. There are many types of the HPV virus. Not all types of HPV cause cervical cancer. Some of them cause genital warts, but other types may not cause any symptoms.

You can have HPV for years and not know it. It stays in your body and can lead to cervical cancer years after you were infected. This is why it is important for you to have regular Pap tests. A Pap test can find changes in cervical cells before they turn into cancer. If you treat these cell changes, you may prevent cervical cancer.

What are the symptoms?

Abnormal cervical cell changes rarely cause symptoms. But you may have symptoms if those cell changes grow into cervical cancer. Symptoms of cervical cancer may include:

• Bleeding from the vagina that is not normal, or a change in your menstrual cycle that you can't explain.
• Bleeding when something comes in contact with your cervix, such as during sex or when you put in a diaphragm.
• Pain during sex.
• Vaginal discharge that is tinged with blood.

How is cervical cancer diagnosed?

As part of your regular pelvic exam, you should have a Pap test. During a Pap test the doctor scrapes a small sample of cells from the surface of the cervix to look for cell changes. If a Pap test shows abnormal cell changes, your doctor may do other tests to look for precancerous or cancer cells on your cervix.

Your doctor may also do a Pap test and take a sample of tissue (biopsy) if you have symptoms of cervical cancer, such as bleeding after sex.

How is it treated?

Cervical cancer that is caught early can usually be cured. If the cancer is caught very early, you still may be able to have children after treatment.

The treatment for most stages of cervical cancer removes the cancer and makes you unable to have children. These treatments include:

• A hysterectomy and removal of pelvic lymph nodes with or without removal of both ovaries and fallopian tubes.
• Radiation therapy.
• Chemotherapy.
• Depending on how much the cancer has grown, you may have one or more treatments. And you may have a combination of treatments.
• It's common to feel scared, sad, or angry after finding out that you have cervical cancer. Talking to others who have had the disease may help you feel better. Ask your doctor about support groups in your area. You can also find people online who will share their experiences with you.

Can cervical cancer be prevented?

• The Pap test is the best way to find cervical cell changes that can lead to cervical cancer. Regular Pap tests almost always show these cell changes before they turn into cancer. It is important to follow up with your doctor after any abnormal Pap test result to treat abnormal cell changes. This may help prevent cervical cancer.
• A vaccine called Gardasil protects against four types of HPV, which together cause most cases of cervical cancer and genital warts. You get three shots over 6 months. The vaccine is recommended for girls 11 to 12 years old. It is also recommended for females 13 to 26 years old who did not get the vaccine when they were younger.

Ovarian Cancer: Topic Overview

What is ovarian cancer?

• Ovarian cancer happens when cells that are not normal grow in one or both of your ovaries. This topic is about epithelial ovarian cancer, the most common type.
• This cancer is often cured when it is caught early. But most of the time, the cancer has already spread by the time it is found.
• It is frightening to hear that you or someone you love may have ovarian cancer. It may help to talk with your doctor or join a support group to deal with your feelings.

What causes ovarian cancer?

• Experts do not know exactly what causes ovarian cancer. But they do know that DNA changes play a role in many cancers.
• Some women are more likely than others to get this rare cancer. Women who are past menopause or who have never been pregnant are more likely to get ovarian cancer.

What are the symptoms?

• In some cases, ovarian cancer may not cause early symptoms. But most women do have symptoms, even in early-stage ovarian cancer. These symptoms include recent, frequent bloating; pain in the belly or pelvis; difficulty eating or feeling full quickly; or urinary problems, such as an urgent need to urinate or urinating more often than usual.
• Other symptoms that women with ovarian cancer may have include fatigue, indigestion, back pain, pain with intercourse, constipation, and changes in their menstrual cycles. But these symptoms are also common in women who don't have ovarian cancer.

How is ovarian cancer diagnosed?

• Sometimes the doctor may feel a lump in or on an ovary during a routine pelvic exam. Often a lump may be seen during an ultrasound. Most lumps are not cancer.
• The only way to know for sure that a woman has ovarian cancer is with biopsies taken during surgery. The doctor makes a cut (incision) in the belly so that he or she can look inside. The doctor will remove bits of any tumors that are found and send them to a lab to confirm that they contain cancer.
• There is a blood test called CA-125 (cancer antigen 125) that is sometimes done to look for cancer in women at high risk. So far, there is not enough proof to show that this test works to find ovarian cancer early in most women. Too much CA-125 in the blood can be caused by many things, such as the menstrual cycle, endometriosis, and uterine fibroids, as well as many types of cancer.

How is it treated?

• Surgery is the main treatment. The doctor will remove any tumors that he or she can see. This usually means taking out one or both ovaries. It may also mean taking out the fallopian tubes and uterus. After surgery, most women have several months of chemotherapy, which means taking drugs that kill cancer cells.

This cancer often comes back after treatment. So you will need regular checkups for the rest of your life. If your cancer does come back, treatment may help you feel better and live longer.

Ovarian cancer is very serious, but many women do survive it. It depends on your age and overall health, how far the cancer has spread, and how much cancer is left behind during surgery.

It may help to talk to other women who are going through the same thing. People who take part in support groups usually feel better, sleep better, and feel more like eating. Your doctor or your local branch of the American Cancer Society can help you find a support group. You can also look on the Internet to find support sites where women with this cancer can talk to each other.

What are your chances of getting ovarian cancer?

This cancer most often affects women who are past menopause. Women are more likely to get ovarian cancer if others in their family have had it. They are more likely to get it if they have had breast cancer.

You may also be more likely to get this cancer if:

• You never had a baby.
• You started your menstrual cycles before age 12 and went through menopause after age 50.
• You are unable to become pregnant.
• You have used hormone replacement therapy for menopause symptoms.