Username:

Password:



Q.
After a hysterectomy, hot flashes and night sweats have become a problem. I cannot take hormones because of a history of breast cancer. I’m currently taking tamoxifen. What can be done to relieve the hot flashes?
A.
Tamoxifen, an anti-estrogen drug given for 5 years after cancer treatment, exaggerates hot flashes and night sweats. They will get better once tamoxifen treatment ends. Lifestyle changes that will increase your comfort are: cooling the air temperature in the room, selecting layered clothing, eating cool/cold food and drink, decreasing caffeine intake, and avoiding hot or spicy food. Exercising, maintaining an ideal body weight, quitting smoking, and decreasing alcohol intake can also help. Simple relaxation techniques--slow, controlled paced breathing will reduce hot flashes by 50%. Other stress management techniques that are beneficial are tai chi, yoga, and meditation. Several non-hormonal drug therapies are available. Effexor reduces hot flashes by a significant percentage, but some patients experience uncomfortable side effect. Blood pressure can also rise. SSRI’s like Paxil, Prozac, and others reduce hot flashes; however they can lower the efficacy of the Tamoxifen. Gabapentin reduces hot flashes by about 50%, but again has side effects. Herbal remedies like Estrovert and Remifemin can help for short periods. Black cohash in large doses can cause liver toxicity. Soy, isoflavones, and red clover are not very helpful, and larger doses can have an estrogen effect on breast tissue. It is better to avoid these supplements in your case.


Q.
Is a pap smear still needed after a full hysterectomy?
A.
Post-hysterectomy patients with prior normal pap smears are at low risk for genital cancers; their pap may even be omitted during their check up. The doctor’s advice of whether to continue pap smears will be based on factors such as the woman’s age, medical and family history, and risk factors. Those with pre-cancer and cancers should continue with pap smears after a hysterectomy. Patients with risk factors such a HPV infection, multiple partners, partners with HPV, HIV, or organ transplant need to continue having pap smears, as do smokers. In women who have not had a hysterectomy, screening pap smears may be stopped after the age of 70 if the patient has had 3 negative smears in 10 years. However, and this is important, yearly pelvic exams should still be continued. Advances in pap smears enable liquid-based cell cytology to test for sexually transmitted diseases like G.C., Chlamydia, HPV, and Herpes.


Q.
What is polycystic ovary syndrome?
A.
Polycystic ovary syndrome was first described in 1935. It is an altered function involving the brain center’s hypothalmus pituitary adrenal ovarian axis. A patient with P.C.O.S. has enlarged ovaries, thick capsules with an “oyster-like” smooth pearly white surface. Beneath this is the excess stroma with multiples and multiples of follicle cysts, “arranged like a necklace.” These cysts are in various stages of development. The patient’s ovaries are actively producing an abundance of androgen hormones. Commonly, P.C.O.S. causes a prolonged interval between menstrual periods and no periods. The cause of P.C.O.S. is uncertain, most agree that P.C.O.S. results from over production of male hormones (androgens). Others feel that it is caused by constant hormone secretion from the pituitary which stimulated excess androgens in the ovaries. Still others feel it occurs from overactive insulin in the body. The anovulation and high androgens lead also to infertility, acne, and virulization - increase in body and facial hair, obesity, and diabetes. The estrogen effect on the endometrium causes overactivity in cells, resulting in hyperplasia or even cancer of the uterus. P.C.O.S. is diagnosed by ultrasound and blood tests. Andorgen excess can be treated by the use of birth control pills, gonadotrophins and clomid for ovulation induction, prednisone and metformin. Surgery is indicated only in rare cases.


Q.
I had my lining of my uterus removed to stop heavy periods. Will I need to have a hysterectomy some day down the road?
A.
Heavy periods affect 10 million women in the U.S. and is one of the most common complaints women have. Fatigue, anemia, restricted activity, and work absences can result. Heavy periods also impact the woman’s sexual relationship. Although hormone therapy, a medicated IUD, a D&C, or a hysterectomy were the only options in the past, there is a simple, quick procedure that now has become very popular. Done either in the office or as an outpatient, the ablation removes or destroys the lining of the uterus, and it avoids a hysterectomy. Some patients experience cramping or low abdominal pain afterwards, but an ablation is much less invasive than surgery. A uterine ablation is indicated for women who have completed their childbearing or don’t wish to have children, and it has a high success rate. Patients are very satisfied after the procedure as they have a normal period, scant period, or sometimes no period. 90% of women said they were happy with the result, and 97% would recommend it to a friend. In a study which followed women for 3 years after a uterine ablation, a hysterectomy was necessary with only 2.8% of patients. After 5 years, 75% of patients are still free of heavy periods.


Q.
I have been advised to have a total hysterectomy but the doctor wants me to stop taking my birth control pills at least 2 months prior to operation. Is this correct? Another doctor was willing to operate the next day after consultation and never mentioned this. What should I do? I would like to have it done sooner than later due to work.
A.
If you are an ideal patient-young (aged 15-45), in perfect health, taking low dose birth control pills with no personal or family history of vascular disease, and if you are a non-smoker or have quit smoking, you may not have to wait before having the surgery. However, if you are a high risk patient, taking high dose birth control pills, and older, or have a personal or family history of vascular disease, hypertension, diabetes, high cholesterol, etc., it would be safer to stop the birth control pills 1-2 months before surgery. Other forms of contraception should be used in the meantime. Stopping the pill helps to lower the risk of phlebitis (blood clots) in the leg, thrombophlebitis in the pelvis, and even thromboembolism in the lungs and other sites. The reason behind hysterectomy and immobility post operatively, is that pelvic surgery by itself increases the chance of phlebitis, thrombophlebitis and embolism. When birth control pills are added these conditions are exaggerated by 3-6 fold.


Q.
Is it necessary to have a Cervical Pap Smear done if the patient has had a total hysterectomy?
A.
Cervical cancer is a significant cause of cancer deaths worldwide. In the U.S. 10,000 cases occur annually with over 4100 deaths. Dramatic decreases in incidence and mortality for cervical cancer in the U.S. is because of pap smear testing. HPV infections is present in 99% of cases seen in cervical, anal, vulva and skin cancer greater than 200 types. 70% of cervical cancer is associated with HPV 16 and HPV 18. Most women with HPV infection do not develop invasive cancer. HPV vaccine works by blocking HPV infection and is recommended in all women age 9 to 26 years of age. Cervical cancer screening remains an important prevention component in vaccinated and unvaccinated women. Women who have had a hysterectomy for benign conditions like bleeding, fibroids, prolapse, infections, etc in whom the cervix has been removed and have had normal pap smears in the past need not have a pap smear; however, they do need yearly exams.


Q.
I am 27 years old. I usually have pre-bleeding before periods for a week and then get my regular period of 3 days. This was our first month of TTC and I had small spotting for 14 days before period. I checked and the doctors found the uterus lining thickened 13.6 mm and said I was PCOS. Can I get pregnant? What are my chances?
A.
You are young with regular periods every month and have pre-menstrual bleeding, which is not too bad as it can be corrected. Your doctor said that you have PCOS, Polycystic Ovarian Syndrome, a condition that is associated with infrequent ovulation, excess androgens (male hormones) and increased body weight, etc. Your doctor would perform a blood hormone test, as well as an ultrasound and would treat the condition first. It is also important for you to take care of your diet, weight (if it is high) and lower your stress level. Sleep well and if you are a smoker, quit. Take Prenatal Vitamins while you are being worked up. Your doctor will do the usual physical exam and needs to rule out infection, give you an ovulation kit, obtain your partner’s semen for analysis, then he/she will correct the irregular bleeding with just Progesterone or Birth Control Pills. Use Clomid after your menstrual cycle is in order and even add Metformin if you need help to achieve ovulation and pregnancy. Clomid may induce multiple ovulation and you could end up with twin pregnancy.


This general Information is not intended to provide individual advice. Please make an appointment with a physician to discuss you particular situation and needs.
 

columnists & blogs