Frequently Asked Questions
Q: What is endometrial ablation?
A: Endometrial ablation (EA) is a minimally invasive surgical procedure
for the treatment of menorrhagia, or heavy menses. A variety of
devices exist, but the basic principle of treatment is the same
which is to ablate or cauterize the lining of the uterus to reduce
the quantity of bleeding each month. The procedure is performed
on an out patient basis. EA is not to be used as a form of contraception
and is only indicated in women who have completed child bearing.
A thorough pre-operative evaluation is essential and should be performed
by a gynecologist familiar with this technique. Please call my office
to schedule an appointment if you would like to discuss this procedure
in more detail. 802.861.0200.
Q: I am 47 years old. I started having hot flashes at night
but I still get my period every month. When will I go through menopause?
A: The length of time it takes to become menopausal (one year without
a period) varies from woman to woman. A woman’s body may begin
to go through subtle hormonal changes as early as age 35. The average
age of menopause is between the ages of 50 and 51. What happens
between start and finish is unique to each woman and difficult to
predict. Some women stop menstruating abruptly with or without the
onset of hot flashes. Others skip their periods on and off for 2
to 5 years with associated and sometimes frequent hot flashes. Skipped
periods are normal although it is still possible to conceive during
this time and pregnancy should be considered if contraception is
inadequate. Additional symptoms some women experience are fatigue,
decreased ability to concentrate, and reduced libido.. Frequent
menses more than every 21-28 days may not be normal and should be
evaluated by a health care provider familiar with menopausal issues.
Q: My daughter is 18 years old. When should she see a gynecologist?
A: The American College of Obstetricians and Gynecologists recommends
a first visit with a gynecologist between the ages of 13-15. The
decision to perform a pelvic exam is determined by the adolescent’s
needs. Many adolescent girls and their parents are not aware of
the difference between a Pap test (cervical cancer screening) and
a pelvic exam. The American Cancer Society recommends a first Pap
test three years after the onset of intercourse or no later than
21 years of age. The need for contraception, sexually transmitted
disease screening and counseling may arise before this time. It
may be necessary to perform a pelvic exam for these reasons prior
to needing a Pap test.
Q: What should I do to prepare for a pregnancy?
A: Preconception care is an important part of having a healthy pregnancy
and baby. Some steps women can take to ensure a good outcome are:
(1) Update your immunizations. (2)Avoid alcohol and tobacco.(3)
Do not take medications unless absolutely necessary and check with
your physician regarding a medication’s risk category during
pregnancy before taking it. (4)Begin taking folic acid to reduce
the risk of neural tube defects. (5)Avoid exposure to occupational
and environmental hazards. (6)Eat a healthy and well balanced diet.
Notify your physician as soon as you think you are pregnant.
Q: My family doctor told me I have uterine fibroids. Should
I be concerned?
A: Uterine fibroids are common. Seven out of ten women ages 30-50
may have one or more fibroid. Fibroids are made of muscular and
fibrous tissue and are rarely malignant. Newly found fibroids should
be evaluated with an ultrasound and rechecked in 3-6 months to determine
if they are enlarging. If the fibroid is stable in size and is not
causing symptoms, no treatment may be necessary. If the fibroid
is causing symptoms like pain, heavy periods, infertility or miscarriages,
it may need to be treated. Options for treatments include contraceptives,
anti-hormone medication to shrink fibroids, myomectomy to remove
the fibroid(s), uterine artery embolization to block the blood flow
to the fibroid(s), hysterectomy to remove the uterus and fibroid(s),
and magnetic resonance-focused ultrasound to destroy the fibroid(s).
Treatment decisions are based on the size, location, and number
of fibroids as well as symptoms. Please contact my office for an
appointment if you have questions regarding fibroids and their treatment.
Q: I am 55 years old and my doctor told me I should take
calcium supplements. Is this necessary and which supplement should
A: When the diet does not contain enough calcium, it is taken from
the bones. Most people require a supplement to reach the recommended
daily intake of 1200-1500 mg per day. A brand name supplement with
the USP symbol on the label is a good choice. Calcium carbonate
and calcium citrate are popular supplements. Calcium carbonate is
absorbed best when taken with food. Calcium citrate can be taken
at any time. Calcium is absorbed efficiently in doses of 500 mg
or less. Chewable supplements and liquid calcium dissolve well and
are absorbed quickly. Vitamin D (400IU) is necessary for the absorption
of calcium and should be taken either in a multivitamin or as part
of the calcium supplement. Avoid calcium from unrefined oyster shell,
bone meal or dolomite without the USP as these may have high levels
of toxic metals.
Q: Who should get the vaccine to prevent
cervical cancer? How does it work?
A: A vaccine to prevent infection with a virus linked to cervical
cancer is now available. The Gardasil vaccine has been shown in
clinical trials to be nearly 100% effective in preventing infection
with four types of human papillomavirus (HPV), specifically numbers
6, 11, 16, and 18. HPV 16 and 18 are responsible for 70% of all
cases of cervical cancer while HPV 6 and 11 cause 90% of all genital
warts. The primary target of this vaccine is females ages 9-26 before
natural exposure to HPV occurs through sexual activity. Women already
sexually active but not yet infected with HPV are candidates for
the vaccine as well. No serious side effects from receiving the
vaccine have been seen. The vaccine will not change current cervical
cancer screening guidelines (PAP tests). Please call my office for
an appointment to receive additional information regarding this
vaccine or to schedule an appointment to receive it. 802.861.0200.
Q: I am 42 years old and recently my doctor suggested that
I start a low dose birth control pill to help regulate my periods.
Is this safe?
A: Yes. Women over 35 years of age who are nonsmokers and do not
have a history of high blood pressure or blood clots may take a
low dose birth control pill until menopause. As a matter of fact,
there are many non contraceptive uses and benefits from using hormonal
contraception in women in your age group.
Starting at age 35 and lasting until menopause, women experience
subtle hormonal changes. These changes may lead to irregular cycles,
heavier cycles, increases in pre menstrual symptoms (PMS), hot flashes
and sleep disturbances. Hormonal contraceptives, in the form of
pills, patches and vaginal rings, suppress ovulation and therefore
monthly fluctuations in hormonal levels. Stimulation of the lining
of the uterus is reduced and therefore monthly flow may significantly
decrease. Since the hormonal contraceptive is controlling the onset
of menses, cycles usually become more predictable and regular. Of
course it is important to rule out other causes of irregular and
heavy periods prior to initiating hormonal contraception. This evaluation
can usually be accomplished in one to two visits with your gynecologist.
Suppression of ovulation eliminates the cyclic production of hormones
which frequently contributes to symptoms of PMS. A steady dose of
estrogen on a daily basis may considerably reduce hot flashes that
frequently disturb sleep patterns, particularly around the time
There are many other non contraceptive health benefits from the
use of hormonal contraception at any point in a woman’s life.
Use of oral contraceptives after the age of 40 has shown to have
a positive influence on the maintenance of bone density during the
perimenopause. Also, women who use oral contraceptives in their
forties have been found to have a reduction in postmenopausal hip
fractures. In addition, use of oral contraceptives for at least
12 months in women of reproductive age reduces the risk of hospitalization
for pelvic inflammatory disease.
Many women are concerned about hormonal contraceptive use and the
increased risk of cancer, breast cancer in particular. Many large
studies have consistently shown that the risk of breast cancer in
women who have ever used currently available low dose oral contraceptives
is not increased. Numerous studies have also found that use of any
type of oral contraceptive (both low and high dose) reduces the
risk of epithelial ovarian cancer by as much as 40% compared to
non users. Each year of use reduces the risk by 10-12 % in both
women who have had children and those who have not. The protective
effect persists for 20 years. Substantial evidence also supports
the fact that use of oral contraceptives for as little as one year
reduces the risk of endometrial cancer by 40% and that this protective
effect lasts for 20 years as well. The long term risk reduction
of both ovarian and endometrial cancer will be beneficial to women
who have used oral contraception during their reproductive years
when they are in their 60s when incidences of cancer are highest.
In addition, studies have shown that women who have used oral contraceptives
have an 18% reduction in the risk of colon and rectal cancer compared
to women who never used oral contraceptives.
In summary, the use of hormonal contraception in one’s forties,
or at any time in a woman’s life, seems to be a safe choice
while providing many non contraceptive health benefits. The regulation
of menstrual cycles, reduction of PMS, elimination hot flashes in
the perimenopause, and reduced risk of ovarian, endometrial, and
colorectal cancer are among the significant benefits many women
receive from hormonal contraception use.
Q: There are many different alternative medications available
for the treatment of menopause… are they safe and what is
A: Alternative therapy choices for the treatment of menopausal symptoms
are many. Both major grocery stores as well as health oriented stores
offer numerous over-the-counter options. Black cohosh has been used
for centuries for the relief of menopausal symptoms and is probably
one of the most widely studied supplements. It has been demonstrated
to be safe and effective. Other products containing ginseng, red
clover, dong quai, St. John’s wort, chasteberry, and ginkgo
are commonly recommended for the treatment of menopause. These supplements
are less thoroughly researched and may interact with medications
and/or have dangerous side effects. It is important for all women
to discuss alternative therapies with their healthcare provider
prior to taking any available preparations.
Q: I am 36 years old and I have a family history of breast
cancer. Is it safe for me to take birth control pills?
A: Yes. Large U.S. based studies have shown that
the use of current low-dose oral contraceptives in healthy, nonsmoking
women over 35 is safe. Many women choose to use oral contraceptives
into their 40s and early 50s. Studies have shown that the use of
oral contraceptives after the age of 40 has a positive influence
on the maintenance of bone density during the perimenopause. The
reduction of vasomotor symptoms (hot flashes) in the perimenopause
is another positive effect of oral contraceptive use. Also, the
reduced risk of ovarian and endometrial cancer in women who use
oral contraceptives is an additional benefit.
The Women’s CARE study conducted by the National Institutes
of Health (NIH) found no increased risk of breast cancer in women
who use current low-dose birth control pills, including women who
have a family history of breast cancer. Other studies have shown
that there is no increased risk of breast cancer in women who have
benign breast disease and use hormonal contraception. A history
of either benign breast disease or a family history of breast cancer
is not considered a contraindication to using current low-dose birth
control pill use.
In summary, current low-dose oral contraceptives are safe to use
in healthy, nonsmoking women over 35 who have a family history of
breast cancer. In addition, there are other benefits from using
birth control pills including maintaining healthy bones, reducing
hot flashes, and reducing the risk of ovarian and endometrial cancer.
Q: I feel like a different person the week before my menses.
Is this normal and is there anything I can take to help with my
A: Almost every woman experiences some pre-menstrual symptoms during
the 400-500 cycles she has during her life. These symptoms are usually
a combination of mood disorders and physical complaints. About 60%
of all women in the United States find these symptoms bothersome
however not all of these women have premenstrual syndrome (PMS)
or premenstrual dysphoric disorder (PMDD), a more severe form of
The relationship of symptoms of PMS and PMDD to the menstrual cycle
defines both syndromes. Symptoms intensify between mid-cycle and
onset of menses. Typical affective symptoms observed with PMS include
angry outbursts, irritability, anxiety, confusion, poor concentration,
sleep disturbances, social withdrawal, and depression. Common physical
complaints include abdominal bloating, headache, breast tenderness,
change in appetite, weight gain and swelling of the hands and feet.
Symptoms are bothersome but not debilitating and at least one of
them must be present and intensify during the two weeks prior to
PMDD is diagnosed when the symptoms of PMS are more disabling and
severe. Symptoms usually interfere with daily activities at school,
work or home. Five of the following eleven symptoms must be present
with one of them being the first four listed: anger, anxiety, depressed
mood, moodiness, appetite changes/cravings, decreased interest in
usual activities, difficulty concentrating, insomnia, extreme fatigue,
feeling overwhelmed, and all of the physical symptoms listed above.
It is important to determine the diagnosis as precisely as possible.
A thorough history and physical exam is important as is a prospective
symptom diary for two menstrual cycles. Underlying medical and psychological
disorders must also be ruled out before the diagnosis of either
PMS or PMDD is made.
Treatment options have increased over the past 10-15 years. Therapy
for PMS and PMDD can be divided into nonpharmacologic and pharmacologic.
Changes in lifestyle and patient education are the cornerstones
of the nonpharmacologic therapy. When women anticipate their symptoms
based on their menstrual calendar, they can prepare for and better
cope with mood alterations and physical complaints. An example of
a lifestyle change is to plan ahead and defer situations that may
trigger or intensify one’s symptoms to a different time during
the menstrual cycle, for example an important meeting at work or
a social event at home.
Women with severe PMS or PMDD usually require pharmacologic intervention.
Some studies suggest that oral contraceptives may help with symptoms.
Selective serotonin reuptake inhibitors (SSRIs), such as fluoxetine,
have been approved by the US FDA for treatment of severe affective
symptoms such as depression, irritability and anxiety. Nonsteroidal
anti-inflammatory drugs like ibuprofen are used to treat physical
symptoms. Diuretics are sometimes used to treat severe fluid retention.
If a woman feels like her symptoms during the two week period before
her menses interfere with her well-being, she should seek evaluation
from a healthcare provider familiar with the diagnosis and treatment
of PMS and PMDD. There are many treatment options available that
should be discussed and offered to women with PMS and PMDD. Initiating
either nonpharmacologic or pharmacologic therapy may help women
who suffer from PMS and PMDD and significantly improve the quality
of their life.
Q: What are bioidentical hormones and are they safe?
A: Bioidentical hormones are plant-derived hormones that are prepared
by a compounding pharmacist. Compounded hormones have the same risk
and safety issues as hormone therapy products approved by the FDA.
Sometimes salivary testing of hormone levels is recommended to help
individualize dosing, however, hormone therapy actually does not
belong to a class of drugs which requires such testing. There is
no scientific evidence to support increased benefit or safety with
use of bioidentical hormones although many women experience significant
relief from menopausal symptoms with bioidentical hormone therapy.
Any decision to use hormonal therapy should be discussed with your
health care provider.
Q: I am 22 years old. I frequently forget to take my birth
control pills and I am worried that I might get pregnant. My doctor
suggested an IUD (intrauterine device) as a possible contraceptive
choice. I have never been pregnant. Is this safe?
A: Yes. IUDs are a safe and highly effective form of contraception.
Many women do not realize that they are candidates for an IUD. In
2005 the FDA expanded the guidelines for women who can use an IUD
for contraception. IUD use in the United States is very low, less
than 2% when last surveyed in 2004. Unfortunately, misconceptions
by both patients and physicians contribute to the low rate of use
in the United States.
There are two types of IUDs available in the United States, the
Copper IUD and the levonorgestrel intrauterine system (LNG-IUS).
Both IUDs have a long history of safety and efficacy. Both IUDs
work by creating an environment within the uterus that is unfavorable
for conception. The Copper IUD contains a small amount of copper
that results in conditions unacceptable for conception and implantation.
It may be left in place for 10 years. The LNG-IUS releases a small
amount of levonorgestrel on a daily basis. This is a progestin commonly
used in oral birth control pills. Not only is pregnancy prevented,
menses may become light and other symptoms, like painful periods,
may be improved. The LNG-IUS is effective for up to five years after
Many women are candidates for the IUD. Women who have never been
pregnant as well as women who have had children can use an IUD for
contraception. Having just one partner is not a requirement. Mild
Pap smear abnormalities can be followed and managed with the IUD
in place. Women with diabetes, HIV, and leukemia can use the IUD
for effective and safe contraception. The IUD is also an option
for emergency contraception. It is 99% effective up to seven days
after unprotected intercourse and immediately provides long term
contraception. The IUD can even be inserted immediately post partum!
The IUD is an ideal form of reversible contraception for women who
wish to delay child bearing. Although the length of effectiveness
ranges from 5-10 years, a woman can easily have the device removed
should she change her mind about wanting to become pregnant. The
IUD is inserted by a trained healthcare professional in an office
setting. The procedure does not require anesthesia and takes about
15 minutes. Removal is also performed in an office setting.
The IUD is a safe and effective form of contraception. It is a first-line
option for the majority of women in their reproductive years. The
IUD provides a convenient form of long-term reversible contraception.
The LNG-IUS also offers some non contraceptive benefits. Furthermore,
increased use of the IUD by both patients and clinicians could significantly
impact the rising unintended pregnancy rate in the United States.