Women's Health

Discussion About Gynecological Care

Dr. Wen Shen was online Tuesday, June 6, at noon ET to field your questions and comments related to women's health issues.

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Shen received her bachelor's degree from the Johns Hopkins University. Her medical degree and masters in public health are from Tulane University School of Medicine. Shen completed her internship and residency requirements at the Johns Hopkins Hospital. She returned to Johns Hopkins after 18 years of general practice in obstetrics and gynecology in the Baltimore/Washington, D.C. area.

Shen's areas of interest are in all aspects of gynecological care and gynecological surgery, including laparoscopy and pelviscopy procedures. Her primary interest is in the area of menopausal issues.

The transcript follows.

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Dr. Wen Shen: Hello, and welcome to this discussion. I am very pleased to be invited to this session. Please remember that you should always check with your personal physician prior to starting any treatment programs.

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Montross, Va.: I will be 51 in July - post menopausal and morbidly obese. Besides losing weight, what other health tips can you give me? Thank you.

Dr. Wen Shen: Hello, and welcome to this discussion. Please remember to always check with your personal physician regarding your specific issues.

Post menopause is associated with many health issues, in addition to problems specifically related to the decrease in estrogen levels. You should see your physician for routine check ups and obtain routine blood testing.

Gynecologically, obesity is a factor for endometrial cancer, and if you have had any post menopausal vaginal bleeding, you should consult your gynecologist for an endometrial biopsy and/or transvaginal ultrasound for endometrial thickness. You should also have routine yearly mammograms. It is also advised for women to have a colonoscopy at 50, and a Bone Mineral Density radiological exam if you are at risk for osteoporosis.

It is important for you to start on an exercise program, slowly at first, to help you lose weight and improve your heart and vascular systems as well as other benefits.

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Ashburn, Va.: I'm getting ready to have a laproscopic hysterectomy at age 42. I have a very large fibroid and they are going to take uterus and cervix also. What changes should I expect in how I feel (hormonal) and how will my body change or feel? What other things will I feel as I get older and go through menopause totally? Thanks for your time.

Dr. Wen Shen: If you are having a total hysterectomy, without removing your ovaries, then you should not experience any hormonal changes in the immediate post-operative time period. But studies have shown that women who have had hysterectomies, do have earlier onset of menopause. The average age of menopause in the USA is 51 years old, for women who have had hysterectomies, it is 48-49 years old.

If you have a very large fibroid, you will probably feel relief from the pressure and symptoms that the fibroid has been causing. Most patients say they feel much better once they have recovered from their surgeries.

If you should have severe menopausal symptoms, when the time comes, you can ask your doctor for options, from life-style changes to prescription hormonal therapies. Once you are in menopause, your symptoms will not be different from those women who did not have a hysterectomy.

Studies have shown that women who undergo surgical menopause (if your doctor needs to remove your ovaries during the surgery), you might experience fairly significant menopause symptoms soon after the surgery, and might need a short course of estrogen therapy to help your quality of life.

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Washington, D.C.: I'm sure you've seen the onslaught of HPV/ Cervical Cancer commercials lately - any thoughts? I was originally told about HPV when I have an abnormal pap come back years ago - it was explained as being an STD...though incredibly easy to contract etc... I am happy to see that the commercials are not mentioning that fact, because I think it would make many women feel negatively about asking for the test. I'm just curious as to your thoughts on this subject.

Dr. Wen Shen: Great question.

HPV infection has many social issues involved, not the least of which is how young should we recommend the vaccines be given to girls.

HPV is a sexually transmitted viral infection, which can cause cervical cancer if you have the high risk strains, and if your immune system does not clear it. This is one of the reasons why using condoms is so important. The ads do not focus on the STD aspect, but your doctor is right to discuss the issue with you, since prevention is a very important aspect of HPV, if you ever had HPV or not. Studies have shown that by using condoms 100% of the time, can significantly decrease your chances of having repeat abnormal Pap smears, and progression to more severe forms of dysplasia, or cancer of the cervix.

Many of the patients in my practice come in asking for the test after seeing the ads.

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Reston, Va.: I've been told to have a vaginal sonogram done now that I'm a breast cancer survivor and at greater risk for ovarian cancer. How often do you recommend this be done?

Dr. Wen Shen: Certain breast cancers do carry an increased risk for ovarian, endometrial and GI cancers. These are usually familial ones, for which there are certain specific gene testing.

There are many different schools of thought on prophylactic testing. Since many women with breast cancer are perimenopausal, and benign ovarian cysts are very common in this age group, it might lead to unnecessary anxiety/additional testing/surgery.

However, most doctors would agree that it is not unreasonable to obtain an ultrasound once a year, and your routine pelvic exam 6 months after that.

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Alexandria, Va.: Any recommendations for eliminating hot flashes during the night?

Dr. Wen Shen: This is one of the most troubling issues with menopausal women.

Here's a list:

1.dress lightly

2.keep a fan set on low, over you

3.if you are totally tortured and are not getting any sleep, you might need hormone therapy

4. you could try Remifem (black cohosh) for short term (less than 6 months), this is the one alternative medicine that has been widely studied and relatively safe, although not always shown to be effective. Be very careful not to use other "herbals" or "all natural" because they may not be quality controlled and can have toxins or serious side effects.

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Arlington, Va.: So it possible to have the HPV virus and not have any symptoms?

Dr. Wen Shen: Unfortunately yes. Only detected on Pap smears.

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Kensington, Md.: As someone who has suffered from a whole spectrum of problems relating to my period since I was 14, the thought of only having just a few periods a year is oh-so-fabulous!

My question is: How come it seems so hard to pin down what is "wrong" with a woman sometimes? So many things in our bodies - at least in my body - seem to overlap (thyroid, sugar/insulin resistance/hypoglycemia, PMS, depression, irregularity, etc.) yet trying to nail down what is wrong is an achingly slow process and seems like no two doctors think along the same lines about how to tackle such a thing.

Dr. Wen Shen: To answer your question would take more time than I have here, but you are certainly not the only woman so afflicted.

We do not know all the interactions between the immune system and the hormonal system, in fact we know little. But there are definite connections, and many women find the onset of puberty and menses is the beginning of other medical issues. As studies have shown, lupus, thyroid disease, fibromyalgias, etc..., are all more common in women than men.

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Washington, D.C.: Why would a 37-year-old menstruating woman have hot flashes during the night? I often wake-up in a drench of sweat. Thanks.

Dr. Wen Shen: It is not unusual for women to have hot flashes start years before menopause. Although if you are having only hot flashes at night, you should consult your physician, and be evaluated for other possible causes of night sweats, such as thyroid, infections...

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Clifton, Va.: Recently my daughter had her right fallopian tube removed due to an ectopic pregnancy. She is married and 28 years old. What actually causes the egg not to descend in time before the sperm gets to it? Also does a history of PID come into play when it comes to trying to get pregnant and ectopic pregnancies? What are her chances of having another ectopic pregnancy? Thank you so much for your time and comments

Dr. Wen Shen: Anything that affects the motility of the egg through the Fallopian tube can result in an ectopic pregnancy.

Endometriosis can cause scarring which blocks the egg from passing, or it can affect the motility of the Fallopian tube from transporting the egg.

PID (pelvic inflammatory disease), or STD's (Chlamydia is a frequent offender) can also cause the scarring within the tubes.

Her chances of having a repeat ectopic is increased.

She should get at least a hysterosalpingogram (HSG) to make sure her other tube is open before she tries again. She should talk to her doctor, there are other tests which might be helpful depending on your daughter's medical history.

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Reston, Va.: Dr. Shen --

I am 31 years old and married for a bit over a year. After 10+ years, I went off birth control pills last August. We prevented pregnancy until December, since which time we have been actively trying. In March, my CNRP recommended I get an ultrasound and see a GYN after discovering what she thought were fibroids. After my sonogram, the GYN did indeed indicate that I have fibroids outside my uterus and a simple ovarian cyst. She instructed me to schedule another ultrasound for 2 months later, and another appointment with the GYN after that.

Can you tell me about the treatments for fibroids in child bearing women, and maybe give me some information about successful pregnancies in women who have similar issues?

Thank you.

Dr. Wen Shen: Depending on the location of your fibroids, they could have little or no impact on your fertility. Especially the "outside ones", if they are not blocking the Fallopian tubes, they should pose minimal problems. About 1 out of 4 women have fibroids in the USA and most have perfectly normal fertility. The ones that are located within the cavity of the uterus tend to be more problematic, and might need treatment.

The presence of ovarian cyst is also common during certain phase of a woman's menstrual cycle. If it persist on follow up sono, then you might need to have some hormone levels done during certain times of your cycle to further evaluate the situation. Most cysts resolve on their own by the time a follow-up sonogram is obtained.

Good luck!

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Dr. Wen Shen: Thanks for all the great questions!

The most important thing is to have a good dialogue with your physician.

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