Treatment (To Resolve the Problem)

Polyps, because they can occasionally be cancerous or precancerous, I recommended to be removed. Fibroids inside the uterus associated with abnormal uterine bleeding are also recommended to be removed. Removal of many polyps and some fibroids can be achieved with newer techniques and equipment either under local anesthesia or general anesthesia. If no polyps or uterine lining fibroids are found at the time of hysteroscopy, certain hormone or anti- hormone treatments may be recommended. These include oral progesterone type medications, oral contraceptives pills, and the progestin releasing IUD. If medical treatments are not chosen or not helpful, a minor procedure called ENDOMETRIAL ABLATION can be performed in the office setting. During Endometrial Ablation, the uterine lining is treated, causing the lining to shrink. Eight out of ten treatments are successful and lead to normal or little-to-no bleeding in the future. Endometrial ablation is best when heavy bleeding is the main or only concern. The presence of other pelvic masses or pelvic pain may require consideration of a hysterectomy.

THE SOLUTION

Diagnosis (to determine treatment options)

Before a treatment plan can be chosen, the cause of the heavy bleeding must be found. At the Nashville Gynecology Center, hysteroscopy is the preferred technique to find out whether a polyp or internal fibroid is present. This procedure can be done in the Ambulatory Surgery Center within the Nashville Gynecology Center office suite with local anesthesia, or in the outpatient operating rooms of a hospital under general anesthesia. A hysteroscopic examination has advantages over a D&C (dilation and curettage) only, as the hysteroscopic examination allows the uterine lining to be seen rather than blindly sampled. A narrow telescope is used to inspect the lining of the uterus. If a fibroid or polyp is found, the follow-up treatment plan can be arranged.

Heavy or irregular menstrual bleeding is a common problem that often causes loss of well-being and life pleasure. Sometimes women assume that they must “just live with it” or go through a major surgery (hysterectomy) for treatment. Also, many women do not know if their bleeding is actually too heavy to be normal. The following conditions indicate a medical problem:

1. Bleeding causing Anemia
2. Having to re-schedule, miss, or restrict activities or appointments due to bleeding
3. Staining of clothing or sheets
4. Frequently worrying about when the next period will occur
5. A recall diary form is used in our office to determine, with good accuracy, the amount of blood loss woman is actually experiencing during her period.

THE CAUSES

Hormone imbalance can cause the lining of the uterus to be too thick or thin, leading to bleeding problems.

Polyps, which are uterine lining gland growths.

Fibroids are uterine muscle growths. Fibroids may occur on the outside, in the wall, or inside the lining of the uterus.

Both polyps and fibroids of the uterus are usually benign, and are recommend to be removed when found inside the uterus.

FemiLift is breakthrough technology using an Alma CO2 laser to deliver fractionated thermal energy to assist in the vaginal mucosal revitalization. Alma Lasers which manufactures the technology is the worldwide leader of aesthetic and surgical laser technologies.

Who Is A Candidate for FemiLift?

Due to the aging process and childbirth, vaginal tissue can change leading to a variety of uncomfortable symptoms including pain, itching and heaviness. While FemiLift is best known for laser vaginal tightening, it can also be used to improve tissues that restore metabolic trophism and youthful tissue dynamics including self-lubrication capabilities and improve bladder control.

How Does The Procedure Work?

The procedure is performed by inserting a probe in to the vagina with a 360 degree rotation capability. This probe delivers thermal energy while simultaneously being inserted.

How Long Does The Treatment Take?

Each treatment takes approximately 10 minutes. We recommend 3 treatments every 4 weeks for optimal results.

Are There Any Side Effects?

The FemiLift procedure is a virtually painless procedure without surgery, anesthesia, or downtime.

Am I a Candidate for The Procedure?

We recommend that you call us and schedule a consultation with Dr. Gurley to discuss the procedure. He will review your medical history, discuss the procedure with you and determine if you are a candidate.

To learn more about FemiLift, visit their website by clicking here.

Doctors that Other Doctors Choose

The Best Doctors database is based on an exhaustive, peer-review-based evaluation of the medical profession in which we contact about 50,000 doctors who have been identified in our previous surveys as “the best” in their specialties and ask them: “If you or a loved one needed a doctor in your specialty, and you could not treat them yourself, to whom would you refer them?” Even though we use extensive proprietary polling and balloting software on an exhaustive scale, our survey is designed to mimic the informal, peer-to-peer referral process that doctors themselves use to determine the appropriate specialists for individual cases. The difference is that we bring together the insights and experience of tens of thousands of leading specialists and cover over 400 subspecialties of medicine.

Every doctor contacted is given the opportunity both to comment (confidentially) on the other doctors listed in his or her specialty, and to make additional nominations. As new names are added to the pool, each undergoes the same rigorous peer-evaluation process.

The result is a constant refinement of both the voting pool and the nominee pool. Each time a survey is conducted, the list is sifted, refined, and improved, resulting in better representation and more solid consensus. The broadness and depth of the voting pool help eliminate the biases and cronyism that often mar smaller-scale surveys. Finally, in-depth surveying of this type allows Best Doctors to develop detailed profiles of each of the doctors in its database (e.g. hospital affilliations, in-office language skills, special areas of research and/or experience).

Our most recent survey of the medical profession involved more than 1 million individual evaluations. Best Doctors employs a combination of high-technology surveying methods and person-to-person phone interviews which permit more detailed questions regarding a physician’s practice and encourage more open and candid responses.

Doctors who are nominated because of their membership in an informal “referral loop” are subjected to the unbiased votes of scores of doctors not in the loop.

Because all voting is strictly confidential, voters are not subject to the institutional, professional, or community pressures that often influence individual referrals.

We are Completely Independent.

Doctors are not asked for and do not ever pay any fees for inclusion as a Best Doctors Physician. Doctors are not notified of their inclusion until after the survey process is completed.

Every one of the physicians included in The Best Doctors database are certified or subcertified through the American Board of Medical Specialties.

We are very pleased to announce that the Advanced GYN Surgery Center was formally certified by the AAAASF in November of 2004. This certification process included a thorough review of our systems and safeguards. We strive to offer the highest degree of professional services to our clients and will continue to stress quality improvement in every aspect of our center. The Advanced GYN Surgery Center is licensed by the State of Tennessee and is certified by Medicare as a provider of ambulatory surgical services.

The American Association for Accreditation of Ambulatory Surgery Facilities (AAAASF) is a voluntary program of inspection and accreditation in surgery facilities to ensure excellence and quality care to patients.

We are now able to offer our patients in-office testing for bladder function, using a computerized device which measures bladder pressure and other characteristics. This is done using state-of-the-art Lumax equipment and takes only about 20 minutes. The testing does not cause pain, only the sensation of needing to void is noted. After the test has been analyzed, patients return in a week or so to discuss the results and begin a treatment plan.

We have acquired a state-of-the-art Hologic Delphi QDR bone densitometer. This excellent machine allows both screening and tracking in the management of bone loss. Since osteoporosis is a silent disease, women must be aware of the risk factors for this problem, and obtain bone density testing when needed.

Risk Factors for Osteoporosis

The following is a list of RISK FACTORS for Osteoporosis:

Menopause

Family history of Osteoporosis

Cigarette Use

Thin body build

Long-term (over 3 months) use of steroids

Caucasion race

Thyroid problems

Use of Depo-Provera(DMPA), depo-medroxyprogesterone acetate

If you have one or more of these factors, ask your doctor about bone density testing, a painless, quick, and safe procedure.

THE WOMEN’S HEALTH INITIATIVE STUDY AND WHAT IT MEANS TO YOU

WHI followed 16,608 healthy women ages 50-70 who took either combined, continuous estrogen and progestin therapy (HRT), estrogen alone (if they have had a hysterectomy), or a placebo. Progestin is used along with estrogen in persons who have not had a hysterectomy to reduce the risk of cancer of the uterus. The goal of the study was to determine the relationship between HRT and it’s possible benefits for heart disease and hip fracture, as well as its possible risks for breast cancer, endometrial cancer, and blood clots. The trials were stopped when it was concluded that the medical risks for the study groups outweighed the benefits..

1) Specific risks and benefits uncovered by the WHI study are as follows (estrogen plus progestin):

Heart Disease: The risk for heart disease was 29% higher for the group taking combined HRT than for the group on placebo. There were, on the average, 7 more cases per 10,000 women per year in the HRT group. The risk appeared in the first year of HRT use.

Breast Cancer: The risk for invasive breast cancer was 26% higher in the group on HRT. There were, on the average, 8 additional cases of breast cancer per 10,000 women per year, in the HRT group. The increase was apparent after 4 years of HRT use, and the risk appears to be cumulative, increasing over time.

Stroke and Blood Clots: There was a 41% increased risk for stroke for the group on HRT. There were 8 more occurrences of stroke per 10,000 women in the HRT group than in the placebo group. There were 18 more cases per 10,000 women of blood clots in the HRT group than in the placebo group.

Dementia: There were 23 more cases of dementia in women over 65 years of age per 10,000 women in the study.

Specific benefits uncovered by the WHI study are as follows:

Colon Cancer: The risk of colon cancer was reduced by 37% in the HRT group. There were 6 fewer cases per 10,000 women of colon cancer in the HRT group than the placebo group.

Bone Fractures: There was a 24% reduction in total fractures and a 34% reduction in hip fractures in the HRT group. There were 5 fewer cases per 10,000 women of hip fractures in women on HRT when compared to the placebo group.

2) For women using Estrogen only, the findings showed a slight increase in stroke risk. No increase in breast cancer or heart attack was found for this group.

Although the above statistics and numbers are extremely important, the risks for the individual woman (YOU) is equally as significant and not quite as staggering. Since the percentage of women in the WHI study who actually had adverse effects from HRT use was small, the size of the risk for each individual woman on HRT was also small. For example, with breast cancer, while the increased risk for the group on HRT was 26%, an individual woman’s increased risk for breast cancer with HRT use was less that one tenth of one percent a year, according to study authors. This small increase in individual risk appeared to be cumulative over time. The longer a woman stayed on HRT, the more her risk for breast cancer increased, at a higher rate than would normally occur with advancing age.

What does this information mean for YOU as you try to make a decision about HRT? You will have to decide in consultation with your clinician whether the risks uncovered by the WHI are acceptable to you. This means reviewing with your clinician why you want to be on HRT; your personal benefits with HRT use; and your increased risks with HRT use, taking into account your individual and family history for conditions such as heart disease or breast cancer.

If you are taking HRT just to protect against heart disease, it is recommended that you stop. Lifestyle changes can help prevent heart disease—particularly regular exercise, smoking cessation, and weight control. And, for certain women at high risk for heart disease, other medications have been shown to be effective.

If you are taking HRT solely for the prevention of osteoporosis consider stopping it, because there are other medications that can help prevent osteoporosis and fractures that appear to carry lower risks for conditions such as breast cancer or heart disease, such as bisphosphonates or selective estrogen receptor modulators (SERMS). For all women, lifestyle recommendations for healthy bones include a diet high in calcium (postmenopausal women should be taking 1200 to 1500 mg of calcium per day), a multi-vitamin containing Vitamin D, and regular weight-bearing exercise such as walking or jogging.

If you are taking HRT only for the relief of hot flashes and sleep disturbances, genitourinary symptom, or vaginal dryness, your decision becomes more complicated considering the small but real increased risks uncovered by the WHI study. Some lifestyle modifications may help reduce symptoms such as hot flashes. These include; quitting smoking, avoiding or reducing foods or substances that may trigger flashes, such as spicy foods, caffeine and alcohol, lowering stress levels, exercising regularly and wearing loose clothing or dressing in layers to peel off top layers during a hot flash.

How to stop hormones: We recommend tapering by using ½ of your current estrogen patch or pill for 4 weeks and then stopping. If you are using a progestin (Prometrium, progesterone, or provera), continue this until you have stopped the estrogen.

Hormone Alternatives (Prescription Medications are CAPITALLIZED)

Hot Flashes: CLONIDINE 0.1 mg three times a day by prescription only—could rarely cause dizziness. SSRI’s (such as FLUOXITINE) and EFFEXOR are reported to help hot flashes. Black cohosh and traditional Chinese herbal preparations, soy food, or acupuncture are also options.

Vaginal Dryness or Irritation: Small doses of vaginal estrogen such as VAGIFEM will help these symptoms and won’t raise blood estrogen levels

Osteoporosis prevention/treatment: Prevention: EVISTA (an estrogen receptor agent, not a hormone), (bone re-building agents), Calcium 1200mg per day, Vitamin D 400 units per day, walking, may add FOSAMAX or ACTONEL (bone rebuilders) for treatment

Cholesterol or blood lipid elevation: Lipid lowering agents such as LIPITOR

Sleep Disturbance: SONATA or AMBIEN—use 3 times per week; if taken every night may stop working

PMS or Anxiety/Depression: Serotonin activity medications such as FLUOXITINE or EFFEXOR, acupuncture

Muscle Cramps: Quinine: drink ½ cup of tonic water (contains quinine) at bedtime

Traditional Chinese Herbs or Acupuncture are available for many symptoms: Our staff can dvise and offer specific treatments.

If you choose HRT for relief of menopausal symptoms, the American College of Obstetricians and Gynecologists recommends the following: (1) Take HRT for the shortest possible time that works for you, in the smallest effective dose; (2) Have regular consultations with your clinician at least once a year-to review your reasons for taking HRT and to see if you can successfully discontinue HRT use; and (3) Like all women, get regular breast cancer screenings, including annual clinician breast exams and periodic mammograms (which ACOG recommends every one to two years during your forties, and annually thereafter), and have a colon screening test at age 50.