Menopause & Beyond

Menopause begins with the perimenopausal period, which encompasses the time before, during, and after a woman’s last period.

Menopausal symptoms and their severity vary from patient to patient. However, it is common at this time to discuss issues such as irregular bleeding, hot flashes, vaginal dryness, skin changes, mood changes, and hormone replacement therapy. During visits we also perform routine exams and tests and address common medical problems and any specific gynecological conditions the patient may be experiencing (irregular bleeding, incontinence, pelvic organ prolapse). We are open to many types of treatments, and try to use clinically proven data to suggest the right treatment for each patient.

We encourage my patients to have a good relationship with a primary care physician and try to emphasize to them that their biggest concern should be their overall health. This should focus on diet, exercise, smoking cessation, and appropriate management of problems such as heart disease, hypertension, cholesterol, and diabetes. We also encourage patients to continue performing self-breast exams, having mammograms, and being screened for colon cancer and bone density.

Hormone Replacement Therapy

We think there are a lot of misconceptions regarding hormone replacement therapy (HRT), and I spend a lot of time helping patients become comfortable about their decision to use or not to use HRT. For those who want HRT, there are many different formulations from which to choose depending on their predominant symptoms. There are also treatment options other than HRT to consider.

Irregular Bleeding

Irregular bleeding is common as women approach menopause. Sometimes it is related to hormone levels affected by inconsistent ovulation, enlarging fibroids, or endometrial hyperplasia and cancer. Diagnosis usually includes blood work, ultrasound, and endometrial biopsy. Treatment ranges from observation or hormonal treatment to endometrial ablation or hysterectomy. When observation and hormonal therapy fail to achieve the desired results, both endometrial ablation and less invasive types of hysterectomy can be good options. We offer patients different types of hysterectomy, including vaginal and laparoscopic hysterectomy when appropriate.

Incontinence

At any point in this stage of a woman's life, incontinence may become an issue which affects everyday life. There are different types of  incontinence. We have the equipment (urodynamic testing) to diagnose them in the office. Some forms are more treatable with medications, and others with surgery. The newer minimally invasive sling procedures (TVT/TVT-O) have excellent results, and are procedures that we perform.

Pelvic Organ Prolapse

Pelvic organ prolapse can be a very difficult condition for some women. This term includes uterine or vaginal prolapse, cystocele, and rectocele. Treatment usually starts conservatively in the form of pelvic floor exercises. Some women may elect to try a pessary, a small plastic device inserted into the vagina that can minimize symptoms. If surgery is necessary, we perform a new technique called ProLift that involves a permanent mesh that is inserted underneath the lining of the vagina.