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Frequently Asked Questions

What contraceptive options are available through your office?

AWS offers comprehensive counseling on the contraceptive options available, including discussions ranging from birth control pills, patches, rings to the longer-acting, reversible contraceptives like the nexplanon implant and intrauterine devices (IUD). We also offer permanent sterilization procedures through minimally-invasive surgery once reproductive potential is no longer desired.

What infertility services are available at AWS?

We provide full infertility evaluation to help with diagnosis and some initial treatment for common causes of infertility. We also refer to and work very closely with the local area infertility specialists if initial treatments are unsuccessful.

What can be done to help with my heavy menstrual bleeding?

Historically, women were left with very few options to treat heavy bleeding. Hysterectomies were performed much more routinely to try and remedy this. Today, there are many evolving treatment options available that don’t require hysterectomy. At AWS, we offer treatment options including targeted hormonal therapy, progesterone-containing IUDs, minimally-invasive surgery with hysteroscopy and uterine ablation.  Minimally-invasive surgical approaches to remove fibroids and perform hysterectomy can be offered when appropriate. Learn more about heavy menstrual bleeding at ACOG. (Source: ACOG)

I have diagnosed with PCOS in the past, what treatments are available to me?

Although the cause of PCOS is not known, it appears that PCOS may be related to many different factors working together. These factors include insulin resistance, increased levels of hormones called androgens, and an irregular menstrual cycle. A variety of treatments are available to address the problems of PCOS. Treatment is tailored to each woman according to symptoms, other health problems, and whether pregnancy is desired. Learn more about PCOS at ACOG. (Source: ACOG)

I‘ve been told some women don’t require pap smears yearly. Does this mean that I don’t need to be seen once a year for an annual?

We believe that a yearly exam is a valuable tool to maintain your best health. An annual exam, however, does not necessarily have to include a pap smear.

Although yearly pap smears have been recommended for years, the newer technologies used to perform pap smears have afforded the ability to test for high risks strains of human papillomavirus (HPV). These high-risk strains can increase the chances of developing abnormal or precancerous changes of cervical cells. Based on the information that has been gained on newer large studies, the American College of Obstetrics and Gynecologist (ACOG) has recommended that yearly pap smears may not be necessary for all patients, and may be indicated only for patients that are at higher risk for development of abnormal cells. In our pursuit of best practices following evidence-based medicine, we can help you decide if you would benefit from a yearly pap smear, or whether just a yearly physical would be helpful. We do recommend low-risk patients have a pap smear at least once every three years.

Do you recommend I have testing for sexually transmissible infections (STI/STDs)?

As part of comprehensive gynecological care, we do offer STI testing to all of our patients. Your provider can help direct you through an assessment and offer treatment as necessary.

What are ovarian cysts?

An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms in or on an ovary. Ovarian cysts are very common. They can occur during the childbearing years or after menopause. Most ovarian cysts are benign (not cancer) and go away on their own without treatment. Rarely, a cyst may be malignant (cancer). In most cases, cysts do not cause symptoms. Many are found during a routine pelvic exam or imaging test done for another reason. Some cysts may cause a dull or sharp ache in the abdomen and pain during certain activities. Larger cysts may cause twisting of the ovary. This twisting usually causes pain on one side that comes and goes or can start suddenly. Cysts that bleed or burst also may cause sudden, severe pain.

There are several treatment options for cysts. Choosing an option depends on the type of cyst and other factors. Treatment options include watchful waiting and, if the cyst is large or causing symptoms, surgery. Learn more about ovarian cysts at ACOG. (Source: ACOG)

What is endometriosis and how is it treated?

Endometriosis is a condition in which the type of tissue that forms the lining of the uterus (the endometrium) is found outside the uterus. Endometriosis occurs in about one in ten women of reproductive age. It is most often diagnosed in women in their 30s and 40s.

Endometriosis implants respond to changes in estrogen, a female hormone. The implants may grow and bleed like the uterine lining does during the menstrual cycle. Surrounding tissue can become irritated, inflamed, and swollen. The breakdown and bleeding of this tissue each month also can cause scar tissue, called adhesions, to form. Sometimes adhesions can cause organs to stick together. The bleeding, inflammation, and scarring can cause pain, especially before and during menstruation.

Treatment for endometriosis depends on the extent of the disease, your symptoms, and whether you want to have children. Endometriosis may be treated with medication, surgery, or both. When pain is the primary problem, medication usually is tried first. Learn more about endometriosis at ACOG. (Source: ACOG)

What are uterine fibroids?

Uterine fibroids are benign (not cancer) growths that develop from the muscle tissue of the uterus. They also are called leiomyomas or myomas. The size, shape, and location of fibroids can vary greatly. Fibroids may have the following symptoms:

  • Changes in menstruation
    • Longer, more frequent, or heavy menstrual periods
    • Menstrual pain (cramps)
    • Vaginal bleeding at times other than menstruation
    • Anemia (from blood loss)
  • Pain
    • In the abdomen or lower back (often dull, heavy and aching, but may be sharp)
    • During sex
  • Pressure
    • Difficulty urinating or frequent urination
    • Constipation, rectal pain, or difficult bowel movements
    • Abdominal cramps
  • Enlarged uterus and abdomen
  • Miscarriages
  • Infertility

Fibroids also may cause no symptoms at all. Fibroids may be found during a routine pelvic exam or during tests for other problems.

The first signs of fibroids may be detected during a routine pelvic exam. A number of tests may show more information about fibroids. Most commonly ultrasonography uses sound waves to create a picture of the uterus and other pelvic organs.

The treatment options for fibroids include medical therapy, minimally invasive surgical therapy, as well as internventional radiologic procedures. At AWS, we can help you discover the best treatment plan for your particular situation. Learn more about fibroids at ACOG. (Source: ACOG)

I have been told that I have an abnormal pap smear and need a colposcopy. What is that?

Colposcopy is a way of looking at the cervix through a special magnifying device called a colposcope. It shines a light into the vagina and onto the cervix. A colposcope can greatly enlarge the normal view. This exam allows the health care provider to find problems that cannot be seen by the eye alone.

Colposcopy is done when results of cervical cancer screening tests show abnormal changes in the cells of the cervix. Colposcopy provides more information about the abnormal cells. The procedure is best done when a woman is not having her menstrual period. This gives the health care provider a better view of the cervix. For at least 24 hours before the test, you should not

  • douche
  • use tampons
  • use vaginal medications
  • have sex

As with a pelvic exam, you will lie on your back with your feet raised and placed on foot rests for support. A speculum will be used to hold apart the vaginal walls so that the inside of the vagina and the cervix can be seen. The colposcope is placed just outside the opening of your vagina. A mild solution will be applied to your cervix and vagina with a cotton swab or cotton ball. This liquid makes abnormal areas on the cervix easier to see. Learn more about colposcopy at ACOG. (Source: ACOG)

What surgical services are available at AWS?

We offer a full line of minimally invasive, hysteroscopic, laparoscopic, and robotic as well as traditional abdominal surgical procedures that treat many different problems including abnormal cervical cells, pelvic pain, ovarian cyst, irregular bleeding, and uterine fibroids.

These procedures include:

  • LEEP (loop electrosurgical excision procedure)
  • Endometrial ablation
  • Hysteroscopy
  • Laparoscopy
  • Myomectomy
  • Hysterectomy
What can I do if sex is painful for me?

Pain during intercourse is very common—nearly 3 out of 4 women have pain during intercourse at some time during their lives. For some women, the pain is only a temporary problem; for others, it is a long-term problem.

Pain during sex may be a sign of a gynecologic problem, such as ovarian cysts or endometriosis. Pain during sex also may be caused by problems with sexual response, such as a lack of desire (the feeling of wanting to have sex) or a lack of arousal (the physical and emotional changes that occur in the body as a result of sexual stimulation).

If you have frequent or severe pain during sex, you should see an obstetrician–gynecologist or other health care professional. It is important to rule out gynecologic conditions that may be causing your pain. Your OB-GYN or other health care professional also can help you address problems with sexual response. Learn more about pain with sex at ACOG. (Source: ACOG)

What can cause a vaginal discharge?

A change in the balance of the yeast and bacteria that normally live in the vagina can result in vaginitis. This causes the lining of the vagina to become inflamed. Factors that can change the normal balance of the vagina include the following:

  • Use of antibiotics
  • Changes in hormone levels due to pregnancy, breastfeeding, or menopause
  • Douching
  • Spermicides
  • Sexual intercourse
  • Infection

Learn more about vaginitis at ACOG. (Source: ACOG)

I am transferring from another practice. What information do I need?

If you are transferring your established obstetrical care to Atlanta Women’s Specialists, we need you to have your records sent to us prior to being accepted as a transfer patient. Once your records are reviewed, you will be contacted about the nextsteps prior to your first visit. Our insurance department must verify your benefits before your first visit.

I am pregnant. How soon should I come in for an appointment?

If you have a positive pregnancy test result at home, call Atlanta Women’s Specialists to schedule an appointment for your obstetrical assessment. If you are not yet taking prenatal vitamins, call for a prescription or you can use a reputable over-the-counter prenatal vitamin containing iron and folic acid.

We encourage you to sign up for our office patient portal platform known as “Follow My Health.” Our website has several links to this helpful tool. The program allows you access to your medical information so that you can easily make an appointment, ask a question, and review your own lab results. If a lab result is abnormal, we will contact you.

There are some basic recommendations that you should follow once you become pregnant and leading up to your first OB appointment:

  1. Avoid smoking, alcohol, and recreational drugs: All of these activities increase the risk of miscarriage, bleeding, delivering smaller babies, premature babies, babies with developmental delays, and other serious complications. Also avoid second-hand smoke.
  2. Limit caffeine: Moderate caffeine consumption (less than 200mg per day) is not shown to be a major contributing factor in miscarriage or preterm birth. The relationship of caffeine to growth restriction remains undetermined.
  3. Artificial sweetener safety: Avoid substitute sweeteners similar to saccharine (the pink package). It does cross the placenta and there is not enough data collected on its safety. You can use Equal or Splenda in limited quantities, however recent data suggests artificial sweeteners may be associated with glucose intolerance.
  4. Avoid NSAIDS: NSAIDS are a group of pain and anti-inflammatory medications that can be purchased over the counter. This includes Motrin, Advil, Ibuprofen, Aleve, and aspirin. There are certain conditions in which a daily baby aspirin is recommended. Tylenol as directed is safe to take in pregnancy.
Can I see just one physician for my prenatal visits? Will he/she be there for my delivery?

It is very important that you feel comfortable with your obstetrical care and providers. The physicians at AWS are a close and collaborative obstetrical group who practice respectful and evidence-based medicine. When you go into labor, the physician on call will attend your birth. During prenatal visits, you may choose to see one or as many different providers as you like. We encourage you to see more than one of the physicians to get to know everyone in the practice.

Where will I deliver my baby?

The core staff of physicians at Atlanta Women’s Specialists who you will see during your prenatal visits deliver at the Northside Hospital Atlanta campus. However, we employ a group of staff physicians that deliver at the Northside Cherokee and Forsyth locations. You will discuss these options at your visit.

What happens at each prenatal visit?

We calculate the age of your pregnancy from the 1st day of your last normal and reliable period. The average pregnancy lasts for 40 weeks. We will use your last period to calculate your estimated delivery date. However, if this due date does not match with the due date generated by your earliest ultrasound within so many days, your due date will be changed to reflect the ultrasound due date. Depending on your gestational age you may have a physical done which could include a pelvic exam. Each visit you will be expected to leave a urine sample so always come with a full bladder. At various times you will have blood work drawn so always try to be well hydrated before your visits. After 10 weeks we regularly listen to the fetal heart beat with a device known as a Doppler. Routine ultrasounds are done in the first trimester to confirm your due date and the pregnancy viability and again at 19-20 weeks of pregnancy to evaluate the fetal anatomy. Additional ultrasounds are performed when medically indicated.

How do I manage (avoid) heartburn?

Heartburn is very common and cannot always be avoided. Staying away from highly seasoned foods does help. Eating smaller, more frequent meals and not going to bed immediately after eating may also help. Medications such as Tums, Zantac or Pepcid are fine to take during pregnancy.

How do I manage (avoid) morning sickness?

There is nothing that you can do to completely prevent morning sickness, but keeping food in your stomach by eating small frequent meals does help. You may find that if you eat and drink at the same time, your nausea will be worse so first eat and then drink. Don’t drink large amounts at one time; drink frequent small amounts instead. Avoid spicy highly seasoned foods. Carbohydrates seem to work best in the prevention of nausea. There are safe medications that can be prescribed for nausea and vomiting. For most women nausea subsides by 12-14 weeks of gestation.

Is sex safe during pregnancy?

Sex is safe in pregnancy unless you have developed a problem with your pregnancy that requires abstinence. It is common to have spotting sometimes after sex but this should be very light and will go away with in a day or so.

What nutritional advice should I follow?

All meats should be well cooked. All raw fruits and vegetables should be washed well. Deli meats need to be reheated in a microwave or grilled before eating. Soft cheeses need to be made of pasteurized milk. Fish is safe but you should avoid those that are high in mercury such as Swordfish, Shark, Tilefish or King Mackerel.

What seafood is safe to eat during pregnancy?

Fish and shellfish can be an important part of a balanced diet. It is a good source of high quality protein and other nutrients and is low in fat. The FDA and EPA are advising pregnant women and nursing mothers to eat the types and amounts of fish and shellfish that are safe to prevent harm to the development of their baby or young child. Methyl mercury exposure in the womb is caused by a mother’s consumption of fish and shellfish that contain methyl mercury. This can adversely affect a baby’s growing brain and nervous system. If you follow the advice given by both the FDA and EPA you will gain the positive benefits of eating fish but avoid any developmental problems from mercury in fish. To protect your baby follow these 3 rules

 

  1. Do not eat Orange Roughy, Shark, Swordfish, King Mackerel, or Tilefish.
  2. Levels of mercury in other fish can vary. You can safely eat up to 12 ounces (2 to 3 meals) of other purchased fish and shellfish a week.
  3. Check local advisories about the safety of fish caught by family and friends in your local rivers and streams. Some local lakes and streams may be contaminated and fish from these areas should be avoided.

For additional information on the recommendations on fish and shellfish in your diet, you can go to the web site http://www.epa.gov/fish

What other situations/environments should I avoid?

If you have cats and have no one who can change the cat litter, then you must wear gloves to prevent any feces from touching the skin. Cat feces carries a bacteria called toxoplasmosis that can be dangerous to the pregnancy should you contract this bacteria. If you garden, wear gloves to prevent contact with the soil because the soil can also contain certain bacteria. Wash all raw fruits and vegetables well before eating them.

Avoid Hot tubs and saunas: If you are sweating, it’s too hot for the baby.

Avoid Herbs. Please do not use herbal preparations without first making sure they are allowed. Some herbal preparations can be very harmful and have even been known to cause a miscarriage.

You may have peppermint, ginger, and chamomile tea.

How do I exercise safely?

Low impact aerobics are safe to do. No free weights over 20 pounds. Water aerobics are very good and are offered in many locations. Pregnancy yoga is a good muscle exercise. Walking is one of the best types of exercise. If you play tennis, we recommend doubles. Never get over heated or so winded that you cannot talk. Remember to keep hydrated and avoid getting overheated by coming in and out of the sun more often. Wear heavy sunscreen, especially on your face.

When should I sign up for prenatal classes?

You should sign up for the classes and the tour of Northside Hospital at 20 weeks gestation. You should begin the classes at 7 months gestation. Try to get the hospital tour before you reach 8 months gestation.

How do I contact the on-call doctor after hours?

If you have a problem after office hours you can reach our on-call physician by calling the office phone number: 404 252-5196. An attendant will take down all of your information and page the physician on call. The physician will call you directly at the number you provide. Remember to keep your phone line open so the MD can reach you.

For what symptoms should I call you immediately?

You should call the office for vaginal bleeding if it appears similar to a period. It is pretty common to spot, especially if you had a pap smear or a pelvic exam in the past 72 hours. Spotting is also common after intercourse.

Call us promptly with any of these symptoms: a fever over 100. 4 F, persistent headaches, persistent swelling, constant abdominal pain, nausea and vomiting-especially if you cannot keep down food or liquids. Also, call if your baby is not moving normally.

What age should I feel the baby moving?

First-time moms may not recognize fetal movement until at least 20-24 weeks. Mom’s who have had other babies may recognize movement a few weeks sooner. At this early gestational age, you will not feel all of the movements.

What does high-risk pregnancy mean?

High risk pregnancy means that you have a medical condition prior to pregnancy that requires additional testing or a condition of the baby or the mother that develops during the pregnancy that requires additional testing. Your age at delivery may also make your pregnancy high-risk.

When should I plan to shop for maternity clothes?

Most pregnant women need to start wearing maternity clothes by 16-20 weeks.

When is a good time to start preparing the nursery?

A good time to begin preparing the nursery is beginning at about 7 months. Get on the registry at baby stores so friends can see what you need. You should have your car seat and know how to install it by 35 weeks gestation.

What restrictions on work-related (or housework-related) activities do you recommend?

Maintaining an active and productive lifestyle helps to make the time pass faster. Women who work can continue to do so up until the date of their delivery as long as the pregnancy is uncomplicated. Jobs that are more strenuous might have restrictions such as no lifting greater than 26 pounds. However the lifting restriction may be less depending on the repetitiveness of the activity and the motion required. If using cleaning chemicals, wear gloves and make sure the area is well ventilated. Refer to the CDC website regarding toxic chemicals that can place your pregnancy at risk. www.cdc.gov/niosh/topics/repro/specificexposures.html

If doing yard work, wear gloves. Keep hydrated. It is important that you have the opportunity at work to go to the bathroom often and to have snacks at least mid-morning and mid-afternoon.

Are vaccines in pregnancy safe?

Many vaccines are safe to get in pregnancy. Indeed there are vaccines that are recommended to be done in each pregnancy. There is no evidence of adverse fetal effects from vaccinating pregnant women with inactivated vaccines. Influenza vaccination in pregnancy is important because contracting this infection in pregnancy can lead to a greater risk of maternal and/or fetal morbidity and mortality. All pregnant women should receive the tetanus toxoid, diphtheria toxoid, and pertussis vaccine (Tdap) within the 27-36 week of gestation timeframe to provide the fetus antibodies the newborn will need to fight a potential infection from these viruses. There are vaccines you should not get while pregnant or within three months of conception. The varicella and measles-mumps-rubella vaccines should be avoided during this time. For more information on travel vaccines during pregnancy, see https://wwwnc.cdc.gov/travel/

Is a VBAC safe?

In short, the answer is: It depends. If you are considering a Vaginal Birth After a C/Section (VBAC) please talk to one of our providers as early as possible regarding our approach to VBAC deliveries.

What is the importance of prenatal genetic testing and prenatal genetic screening?

All pregnant women should be offered prenatal assessment for chromosomal disorders by screening or diagnostic testing regardless of maternal age or other risk factors. Prenatal genetic tests are intended to screen or diagnose genetic chromosomal disorders present in the fetus. All pregnancies are susceptible to spontaneous genetic chromosomal disorders no matter how healthy the mother may be. Screening tests are reserved for low risk women under the age of 35. Screening tests are designed to give you the likelihood of there being a problem with the fetus. A diagnostic test is a more invasive procedure however it provides a more definitive answer regarding the presence of a fetal chromosomal abnormality. There are 2 first trimester and 1 second trimester screening tools available to estimate the risk of trisomy 13, trisomy 18 or trisomy 21 (Down Syndrome) affecting your fetus. The cell free DNA (cfDNA) screen or the First Screen-Nuchal Translucency are these first trimester screens. The AFP 4 is an alternative test offered in the second trimester. Diagnostic procedures are offered to women at risk for a chromosomal pregnancy complication. The CVS is offered in the first trimester and the amniocentesis is done in the second trimester. Your provider can review with you what option if any is right for you.

Prenatal genetic screening is mere blood work designed to assess if a non-pregnant patient or an expectant mother is at increased risk of having a fetus affected by a genetic disorder. For example we routinely screen for sickle cell anemia. In addition you can choose to be screened for disorders like cystic fibrosis, muscular dystrophy and many more inheritable disorders. Certain ethnic backgrounds are at an increased risk to carry genes related to genetic disorders.

What is Group B Strep (GBS)?

GBS is a bacteria found in the vagina or urinary tract. At 35 to 36 weeks of pregnancy you will be tested to see if the bacteria is present. If so IV antibiotics are administered during labor to reduce the risk of a GBS infection in the newborn. Sometimes your initial urine culture will indicate the GBS bacteria is present. In that case you will be treated with oral antibiotics at the time the urine results are noted and again during labor.

What should I know as I travel while pregnant?

Travel in pregnancy can be safe and enjoyable as long as you follow a few simple guidelines and you do not have pregnancy complications that could be worsened by travelling. The best time to travel is mid pregnancy (14-28 weeks of pregnancy). Most airlines allow travel until the 36 week of pregnancy. However some International airlines restrict travel as early as 28 weeks. Always check with your carrier. Try not to drive more than 6 hours a day. You should wear a seat belt while driving or riding in a car. Make sure if you cruise you avoid destinations where the food or water may not be safe. Some smaller cruise lines might not employ medical staff so avoid this potential. If you are planning a trip out of the country discuss it with your provider and travel agent first. Allow plenty of time to get any shots you may need. No matter how you travel wear loose, comfortable clothing, drink plenty of water and walk frequently to avoid blood clot formation in the legs or lungs.

Beware of places which may be a source of the Zika infection. The Zika virus is a mosquito-borne virus, however it can be transmitted in humans by other means. It has been associated with severe neurological outcomes in exposed fetuses. Travel to locations where ongoing Zika viral outbreaks are reported should be avoided if you are pregnant or you and your partner are thinking about pregnancy. For more information before traveling refer to:

http://www.cdc.gov/zika/

Please discuss your travel plans with your provider before purchasing your trip to avoid non-refundable payments. Bringing a copy of your prenatal records in case of an emergency is advised. Remember to pack your medications in carry-on luggage.

The Menopause Years

Menopause is the time in your life when you naturally stop having menstrual periods. Menopause happens when the ovaries stop making estrogen. Estrogen is a hormone that helps control the menstrual cycle. Menopause marks the end of the reproductive years. The average age that women go through menopause is 51 years.

The years leading up to menopause are called perimenopause. Beginning in your 30s and 40s, the amount of estrogen produced by the ovaries begins to fluctuate. A common sign of perimenopause is a change in your menstrual cycle. Cycles may become longer than usual for you or become shorter. You may begin to skip periods. The amount of flow may become lighter or heavier. Although changes in menstrual bleeding are normal during perimenopause, you still should report them to your health care provider. Abnormal bleeding may be a sign of a problem.

Some women do not have any symptoms of perimenopause or have only a few mild symptoms. Others have many symptoms that can be severe. Common signs and symptoms include the following:

  • Hot flashes—A hot flash is a sudden feeling of heat that rushes to the upper body and face. A hot flash may last from a few seconds to several minutes or longer. Some women have hot flashes a few times a month. Others have them several times a day. Hot flashes that happen at night (night sweats) may wake you up and cause you to feel tired and sluggish during the day.
  • Sleep problems—You may have insomnia (trouble falling asleep), or you may wake up long before your usual time. Night sweats may disrupt your sleep.
  • Vaginal and urinary tract changes—As estrogen levels decrease, the lining of the vagina may become thinner, dryer, and less elastic. Vaginal dryness may cause pain during sex. Vaginal infections also may occur more often. The urethra can become dry, inflamed, or irritated. This can cause more frequent urination and increase the risk of urinary tract infections.

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Perimenopausal Bleeding and Bleeding After Menopause

Menopause is defined as the absence of menstrual periods for 1 year. The average age of menopause is 51 years, but the normal range is 45 years to 55 years.

The years leading up to this point are called perimenopause. This term means “around menopause.” This phase can last for up to 10 years. During perimenopause, shifts in hormone levels can affect ovulation and cause changes in the menstrual cycle.

During a normal menstrual cycle, the levels of the hormones estrogen and progesterone increase and decrease in a regular pattern. Ovulation occurs in the middle of the cycle, and menstruation occurs about 2 weeks later. During perimenopause, hormone levels may not follow this regular pattern. As a result, you may have irregular bleeding or spotting. Some months, your period may be longer and heavier. Other months, it may be shorter and lighter. The number of days between periods may increase or decrease. You may begin to skip periods.

Any bleeding after menopause is abnormal and should be reported to your health care provider. Although the menstrual period may become irregular during perimenopause, you should be alert for abnormal bleeding, which can signal a problem not related to perimenopause. A good rule to follow is to tell your health care provider if you notice any of the following changes in your monthly cycle:

  • Very heavy bleeding
  • Bleeding that lasts longer than normal
  • Bleeding that occurs more often than every 3 weeks
  • Bleeding that occurs after sex or between periods

Treatment for abnormal perimenopausal bleeding or bleeding after menopause depends on its cause. If there are growths (such as polyps) that are causing the bleeding, surgery may be needed to remove them. Endometrial atrophy can be treated with medications. Endometrial hyperplasia can be treated with progestin therapy, which causes the endometrium to shed. Thickened areas of the endometrium may be removed using hysteroscopy or D&C.

Women with endometrial hyperplasia are at increased risk of endometrial cancer. They need regular endometrial biopsies to make sure that the hyperplasia has been treated and does not return.

Endometrial cancer is treated with surgery (usually hysterectomy with removal of nearby lymph nodes) in most cases. Discuss your options with your health care provider.

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