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Obstetrics, Gynecology & Reproductive Sciences Archive Questions

Below are Dr. ’s answers to Obstetrics, Gynecology & Reproductive Sciences questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 27.

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Q : 1

Have there been any studies on women's libido while taking curcumin? Mine has plummeted, my hormone levels are fine and the only difference in my life is that I have been taking curcumin for six months.

I am unaware of any studies on curcumin and female libido. There are few, if any good scientific studies, randomized controlled trials, showing clear health benefits from taking curcumin.

Q : 2

I started bio-identical HRT for severe menopausal symptoms but still having periods. Unfortunately I have irregular early bleeding starting usually on 9-nth day of progesterone and prolong bleeding and spotting. Different doses of progesterone did not make any difference. Some sources say it is not enough progesterone but some say it is too much, anyway I have tried between 100 and 400 mg of progesterone, nothing seems to work to have withdrawal bleeding at the end of progesterone faze. I had in the past small fibroids and polyps removed. It looks like I can not tolerate HRT but my life is extremely difficult due to menopause (confirmed by blood tests - very high FSH, low estrogen and progesterone). Any suggestions? thanks for your help

There are a variety of reasons women bleed on hormone therapy. Absorption of hormones may vary depending on the formulation, how it's administered (oral, transdermal(skin absorption) or vaginal). There may be abnormalities of the uterine lining contributing to bleeding. There are also different ways to schedule hormone therapy. A gynecologist who specializes in menopause can be very helpful in sorting out such issues.

Q : 3

I am menopausal with a normal mammogram and Pap smear. Could I be a candidate for HRT?

Hormone therapy is prescribed to treat hot flashes and night sweats that are interfering with a woman's quality of life or to treat symptoms of atrophic vaginal changes that are causing painful intercourse. Each woman needs to review her symptoms and medical history with her healthcare provider to determine if she has any contraindications to taking hormone therapy and determine the best treatment for her individual symptoms.

Q : 4

I am 51 and haven't had a period for one year. Is it possible to still get pregnant?

Guidelines for menopausal women are that after 12 consecutive months without a period, women can stop using contraception.

Q : 5

What is your opinion on testosterone cream? Do you think it is effective? Does it have side effects?

The most common reason women inquire about testosterone cream is decreased libido (sexual desire). Decreased desire is very often due to multiple causes, and these non-hormonal causes need to be explored in detail prior to considering testosterone therapy. Testosterone cream is a compounded medication, because currently there are no FDA approved testosterone formulations for women. Also, no studies exist that evaluate the long term safety of testosterone use in women. A thorough evaluation with an experienced provider who treats sexual dysfunction is appropriate before initiating testosterone therapy.

Q : 6

I recently turned 39 and had my last child 10 years ago. Once my periods resumed after my pregnancy, my cycle was shorter (every 3.5 weeks, lasting 5 days) and very regular. My last few periods have been on time and normal except for my last one, which is now two weeks late and with no signs of starting anytime soon. I am not pregnant and have not been under anymore stress than usual, although I have suffered from a bad allergy flare-up this past month. I do not have hot flashes or night sweats, nor have I experienced spotting. Could the late/skipped period be perimenopause?

Many women will notice changes in their menstrual cycle as they age, including skipping an occasional cycle. These changes are rarely cause for concern, unless accompanied by other symptoms such as hot flashes, breast discharge, or abnormal fatigue, to name a few symptoms.

Q : 7

Do you do prenatal care?

My practice is limited to gynecology only. I have several Women's Health colleagues at the University of Maryland who do prenatal care. The office number to make appointments in that department is (410) 328-6640.

Q : 8

Do you only see women that are near menopausal or in menopause? Do you see younger patients for sexual dysfunction?

My practice sees women at any age with sexual dysfunction. To schedule an appointment, you may call our office (410) 328-6640.

Q : 9

I am scheduled to have a hysterectomy with ovary removal. I am 62 years old and post-menopausal. Do I need to have the ovaries removed? Will I have to take an estrogen supplement if they are removed?

The decision to have ovaries removed at the time of hysterectomy is a very individual one. It involves balancing the risk of developing ovarian cancer in the future if the ovaries are left in against the possible loss of the small amount of testosterone that the ovary is still making. The ovary is essentially not making any estrogen after menopause and women who are not taking estrogen after menopause do not need to start estrogen if they have a hysterectomy and removal of the ovaries. These are questions to discuss with the gynecologist who will be performing the surgery.

Q : 10

I am 39 and think I may be going through menopause. How can I tell?

Menopause is defined as 12 consecutive months without a period. Women may or may not experience hot flashes after menopause. If a women is having regular menstrual cycles, then her symptoms are not due to menopause. Women who have skipped the period for 6 months, should be evaluated by a gynecologist to determine the cause.

Q : 11

I have had a long standing problem with severe pelvic pain. I am unable to walk and my periods are irregular and extremely heavy. I was recently scanned for polycystic ovaries, but was told they looked healthy and normal. Would this scan show endometriosis?

Endometriosis is frequently not diagnosed by ultrasound. When a woman has severe pelvic pain options include further testing, such as a laparoscopy or empirically treating endometriosis with medication.

Q : 12

I have endometriosis and had an full hysterectomy in October 2008. I have tried many hormonal replacements without success. In 2008, I started taking 2mg of Estradiol which worked for a year. Now I am having problems with hot flashes and the pain/discomfort came back where my ovaries were. Do you have any suggestions that may help?

Many women find transdermal estrogen to be very effective for treatment of hot flashes. In women with a history of endometriosis, use of a progestin with estrogen for a few years can be helpful in preventing growth of endometriosis implants. In addition, low dose testosterone may be helpful for hot flashes when estrogen alone is not working.

Q : 13

When the Women's Health Initiative did the major study on hormone therapy, did they ever look at hormones as the cause of migraine headaches? I have been on a low dose of hormones since my mid thirties (I am now 72) as it keeps the migraines at bay. My physician is recommending (well insisting) that I stop taking the Premarin. Any information you may have on this issue would be greatly appreciated.

The Women's Health Initiative has not published any data on migraines and hormone therapy. Many premenopausal women have exacerbations of their migraines related to hormone fluctuations. After menopause, when hormone levels no longer cycle, many women have improvement in migraines. For those women who continue hormone therapy after menopause, a very gradual tapering of the estrogen dose is often successful, without increasing headaches. This can take several months to accomplish.

Q : 14

I have been going through menopause for a year and half, but I don't want to take HRT because of the side effects. Are there any over the counter solutions you can recommend?

Many women who experience hot flashes or night sweats find some benefit from soy isoflavones. Foods that contain soy isoflavones are soybeans, soy milk, tofu, tempeh, and soy yogurt. There are also a variety of formulations available in pill form that are available in most drug stores and health food stores.

Q : 15

Is it possible to get a wart in the genital area without having an STD?

Genital warts are frequently caused by the HPV virus, which is contagious. Over-the-counter medications can cause irritation and may not be effective. A gynecologist should evaluate all genital lesions, especially since not all genital lesions are warts.

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