Testing for Genetic Risks
We have moved into an era of “precision medicine” a term used for basing recommendations and treatment for patients on the basis of genetic risks.
Hereditary cancer risk occurs when an altered gene is passed down from parent to child. In these scenarios, there are usually family members that will have a history of similar types of cancer related to an abnormal gene. A given patient’s cancer risk will determine the options for medical management including greater surveillance well as medication and in some cases surgery.
In the field of gynecology, we are especially concerned regarding hereditary risks for uterine, ovarian, breast and colon cancer as an individual with abnormal genes, may be at risk for all of these conditions.
Following a screening, a patient may be advised to undergo a multi-gene panel. The results of the panel, if positive, should be discussed with a genetic counselor followed by further management by medical providers who will counsel the patient regarding treatment recommendations.
In Office Management of Heavy Bleeding/Periods
Many women experience heavy periods and the associated symptoms such as anemia, fatigue, disruption of their daily routines, restricted activities due to heavy flow, and an overall diminished quality life. It is most important for women experiencing these symptoms to seek evaluation and treatment. As clinical medicine has progressed, we now have many treatment options that do not include hysterectomy, for women with heavy bleeding. The best first step is an evaluation by a trained gynecologist that will include an exam, screening for cervical cancer, ultrasound, and in some patients, a biopsy of the uterine lining to exclude cancer.
Once the patient has been evaluated and the cause of heavy bleeding is diagnosed, treatment options that are appropriate to the cause will be offered. Women may opt for hormonal management and many have opted for a Mirena IUD, a device that emits hormones that prevent a build-up of the uterine lining. Mirena is FDA approved for both contraception and heavy menstrual bleeding. Patients who do not wish to use hormones may be candidates for in-office ablation, a procedure during which the uterine lining is ablated, or burned over 1-2 minutes. There is a very high patient satisfaction rate with this procedure given that 70-80% of the patients will either have no period or a very light period after ablation.
There is a growing awareness for the needs of young women including contraception, prevention of cervical cancer with vaccines, screening for healthy relationships, awareness and screening for sexually transmitted infections, and treatment of painful/heavy periods. The usual age of onset of the period is age 11-12. If the periods do not regulate, i.e., come monthly, with manageable flow, evaluation by a gynecologist is advised. In many cases, regulation of themeless with hormonal contraception will allow a young woman to return to her activities related to academics, sports, hobbies and social life, unhindered by abnormal periods.