Frequently Asked Questions
Q: I thought that estrogen caused breast cancer.
A: No, it doesn't plant that seed of breast cancer. Estrogen may be the water that causes that seed to grow in certain women who are predisposed to that.
Q: How long should I take hormone replacement therapy?
A: That is actually a good question. There are two main reasons to consider hormone therapy.
1) Number one is quality of life symptoms. As long as you take the hormone therapy you are going to have those benefits from the quality of life changes. So as long as you want to feel good which I assume would be for as long as you are alive, then I would recommend taking it long term to improve quality of life symptoms.
2) There are long term benefits from hormone therapy if you start on it right when you go through the change of life. Those are decreased risk of heart disease, decreased risk of bone loss, decreased risk of colon cancer, and decreased risk for Alzheimer's. If at any time you stop the hormone therapy then those benefits go away, so it is the same thing as quality of life. I would recommend you stay on it for as long as you are alive.
Q: I was thinking of getting a Mirena IUD for birth control. Is it safe?
A: Yes, absolutely. The Mirena IUD is safe, however I think it is very important that if you are going to have one put in that you see a physician who is well-trained at putting those in, has an ultrasound that can look at the uterus and know the position and any unusual changes in the uterus before placing the IUD. I would recommend seeing somebody who is willing to give you local anesthetic on the cervix to decrease cramping which makes it much easier to put in the IUD. Just also remember the benefits not only are birth control, but the majority of women will have decreased bleeding and will actually stop having their period for the five years that it is in.
Q: I am student and have been missing school because of painful and heavy periods. Is that normal?
A: It is definitely not normal. In my experience ladies who miss school on a regular basis over 95% of those will have endometriosis. So if you are missing school on a regular basis because of pain and heavy periods it is important that you see a gynecologist who specializes in the treatment of endometriosis.
Q: I have fibroids and I am considering hysterectomy. Do I have to have a big incision to have that surgery done?
A: No, not necessarily. It depends on the size of the fibroids and the location. The majority of fibroid uteruses can be removed laparoscopically. The fibroids may be taken out either vaginally or through a small incision in the abdominal wall with a machine that will morcellate or take the uterus out in pieces. Some laparoscopic hysterectomies can be done on an outpatient basis. I recommend that you seek out a gynecologist that does many laparoscopic surgeries and specializes in laparoscopic hysterectomies and has a dedicated team that does those on a regular basis.
Q: I am having symptoms of bladder infection but my urine test is normal. Antibiotics don't seem to work. What are the possible causes?
A: Well, it appears there may be an inflammation on the inside of the bladder. The most likely cause for that is a condition called interstitial cystitis, which is an inflammation of the wall of the bladder. The most frequent symptoms are urinary urgency, urinary frequency, and bladder pain or spasms. It is important to make sure you don't have kidney stones. It is important to see a provider that specializes in the treatment and diagnosis of interstitial cystitis.
Q: I have had only two babies and now I am leaking urine when I cough and exercise. Is that normal for a 30-year-old? Do I have to have surgery?
A: No, you don't necessarily have to have surgery. That type of incontinence is what we call stress urinary incontinence which means leaking when you have coughing, laughing, sneezing, or doing exercises. The success of surgery is about 80-85% with a side effect risk of about 15-25% for causing a new problem with bladder spasms.
There is an exciting new treatment which involves what we call Pfilates which is a type of pelvic floor exercises that use Pilates, and involves doing ten exercises which help strengthen the pelvic floor. The success rate of this exercise program is 80-85% and the only side effect you are going to have is that it is going to tighten your lower abds, tighten your inner thighs and your buttocks. The only requirement for this is a simple workup in the office for which your insurance will cover.
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