What is Abnormal Menstrual Bleeding?

Normally women menstruate once a month for 4 to 7 days and lose less than half a cup of blood. Frequent, prolonged and heavy bleeding results in chronic blood loss causing anaemia.

Heavy menstruation is usually described as flooding, large clots, changing pads frequently and during the night. Two thirds of women do not perceive this as being abnormal and never consult a physician.

The most common cause of abnormal bleeding is hormonal imbalance. This is more prevalent after the age of 40 as the patient approaches menopause. Benign growths within the cavity or the wall of the uterus, bleeding disorders, and chronic kidney and liver ailments can also cause abnormal bleeding. Your doctor should conduct a thorough medical examination to diagnose the cause of your DUB. Following this examination, you may be faced with several options for treatment.

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What are Fibroids?

A fibroid is a benign growth in the uterus, which may cause pelvic pain, increased menstrual bleeding, urinary problems, or increase in abnormal size. Uterine fibroids usually shrink and the problems they cause will usually subside once you reach menopause.

What is Stress Urinary Incontinence?

Stress Urinary Incontinence is the unintentional release of urine during normal everyday activities. If you have SUI, you may lose urine when you:

	Laugh, sneeze, or cough
	Walk or exercise
	Get up from a seated or lying position

You may also go to the bathroom frequently throughout the day in order to avoid accidents.

What is Menopause and Perimenopause?

Menopause is the cessation of menstrual periods. You know you've reached your menopause when you haven't had a menstrual period for one full year. This can happen anytime between the ages of forty and sixty. So the term menopause simply means the end of menstruation. Perimenopause refers to the years surrounding the menopause. At any time during these years, regardless of a women's age, a physician may prescribe treatment. Hormone treatment is generally begun 6 months to 1 year after periods have stopped.

What causes Menopause?

Menopause occurs naturally when the ovaries stop making the hormones estrogen and progesterone, however; if you are still having regular periods and you lose both ovaries at surgery (required to treat a condition), you'll experience an immediate (surgical) menopause, no matter what age you are. There are many reasons for early menopause. Typically many women go through menopause at the same age as their mother did. Smokers often reach menopause two to five years earlier on average than non-smokers. Surviors of cancer treatment may also go through early menopause.

What are the symptoms of Menopause?

Most women do experience changes in their bodies and emotions that can be most stressful if not fully understood.

Here are some common symptoms:

	Although menopause is a completely normal event, the decrease in the production of estrogen can cause changes or symptoms which will vary with each individual. The most common is hot flashes. These are sudden and often intense periods of warmness in the face, neck, and chest. When they happen at night, they are called, "night sweats" and often disturb sleep. Other symptoms may include reduced quality of sleep, vaginal dryness and loss of bladder control.
	Dry vagina, vaginal and urinary infection, and pain with intercourse can be classes as atrophic genitourinary (genital and urinary) sympotoms
	Psychological irritability, mood swings and memory loss.
	Skin and hair changes
	Other symptoms (bloating, headaches, fatigue, joint and muscle pains)

What you can do about Menopause

Hormone Replacement Therapy

HRT replaces the hormones your body has stopped producing itself. HRT is estrogen, progestin and, of lesser importance, androgen replacement. There are two types of HRT therapy: combined therapy which consists of an estrogen/progestin combination, and unopposed therapy which consists only of estrogen. Estrogen-only therapy is primarily for women without a uterus. Fortunately, a wide range of products are available to help you and your health care provider chose the right therapy for you. HRT is an option for all women who do not have health problems or risk factors that prevent its use.

Non-Hormonal and Herbal Therapies

The use of herbal therapies to treat menopausal symptoms is growing rapidly. However, no therapeutic claims have been made for most natural health products and herbal remedies. so they are classified as food or dietary supplements, not as drugs. Also, there is still no routine surveillance by Health Canada for product quality. The products mentioned in this booklet have been studied in clinical trials and there is some evidence about their effectivness or lack of effectivness. Some of these products have provided short-term relief of symptoms.

Self Help Tips

Hot Flashes And Night Sweats

	Drink cool water at the time of a hot flash.
	Dress in layers and peel off during a hot flash.
	Exercise regularly.
	Try deep breathing exercises.
	Reduce or stop caffeine and alcohol

Urogenital And Sexual Symptoms

Evaluate your partnership:

	Are you the only one who experiences a lack of desire?
	Does your partner also experience a lack of sexual desire?
	Could erectile dysfunction or other medical problems be an issue?

	Regular Kegel exercise can improve sexual function.
	Use of vaginal lubricants or moisturizers can help with dryness and discomfort during intercourse.
	Decreasing stress and/or increasing foreplay before intercourse can enhance sexual desire

Sleep Disturbances

	Go to bed and get up at about the same times every day.
	Keep your bedroom dark, cool, and quiet.
	Use your bedroom for sleep and sexual activity only.
	Exercise regularly, but not too late in the evening.
	Try relaxing activities before bed, such as taking a warm bath.
	Avoid alcohol and caffeine use near bedtime.

What is Osteoporosis?

Osteoporosis is a serious disease that can lead to broken bones, constant pain, and spinal deformity. Without proper care, osteoporosis can threaten a women's independence and well-being.

At first you may not even notice that you have osteoporosis. You may not feel any symptoms at all. Over time, however; it produces a harmful level of bone loss, as much as 30-40% of bone tissue. When this happens your bones become so weak that normal day-to-day activities or minor falls can cause the bones to fracture. People with severe bone loss can average about one spinal (vertebral) fracture a year. If this injury is left untreated, many women with osteoporosis will develop a "Dowager's Hump" , and can lose four more inches of height over a lifetime.

Osteoporosis also causes about 15,000 hip fractures a year. More than a third of these patients will require institutional care.

Calcium

Lack of calcium plays a key role in developing osteoporosis. When people don't get enough calcium from the foods they eat, the body meets its needs for the mineral by taking it from the bones. To reduce this problem, most women should consume between 800 and 1500 mg of calcium a day through diet or supplements. A supplement, such as calcium carbonate, containing 500 mg of elemental calcium, combined with a normal diet is usually sufficient for most women to ensure these daily requirements are met. While calcium is very important for preventing osteoporosis, it alone cannot stop or reverse the disease process.

Are You at Risk?

It is very important to find out if you are at risk of developing osteoporosis and to take the steps toward prevention of treatment. The sooner you take control of osteoporosis, the better your chances of a healthy, active future.

Hormonal

Depo-Provera

Depo-Provera is one of the most reliable, reversible contraceptive methods available today. It is a prescription medication that requires an almost painless injection into the upper arm or buttocks by a doctor or other health care provider once every three months. Unlike the "Pill", it does not need to be taken every day. Depo-Provera contains a hormone similar to the body's own natural progesterone that stops the release of a mature egg. Depo-Provera is 99.7% effective, and only needs to be taken four times a year.

Oral Contraceptive (The Pill)

The 'Pill' is a small prescription tablet which it taken once a day, in sequence, until every pill in the package is used up. There are two types of birth control pills; the combination pill and the minipill. The combination pill contains both an estrogen and a progestin, whereas the minipill contains a progestin only. Oral contraceptives contain hormones similar to the body's own natural hormones that stops the release of a mature egg. When used exactly as directed, the Pill has an effectiveness rate greater than 99%, however; typical effectiveness is closer to 97% during the first year of use.

Natural

Fertlity Awareness

Fertility Awareness Methods (two are noted below) are designed to help determine on which days of the menstrual cycle a women is likely to become pregnant.

The Basal Body Temperature Method requires women to take their temperature every morning before getting out of bed. A small rise of less than one degree occurs when the egg is release, which is carefully recorded. Couples must not have sex from the end of the menstrual period until three days after this rise in temperature.

In the Ovulation Method, changes in vaginal secretions during different phases of the menstrual cycle are observed. Following menstruation, vaginal mucus will become increasingly wet and slippery until the time of ovulation when thick, sticky mucus appears. Couples must not have sex for four days after the 'peak' day of the mucus is noticed.

The typical effectiveness rate for these methods is only 80%. This is because many women report losing track of their menstrual pattern, or forget to take their temperature every day.

Sugical

Tubal Sterilization (Female) & Vasectomy (Male)

Female sterilization, often called a tubal ligation or getting "tubes tied", requires a surgical procedure that closes the fallopian tubes between the ovaries and the uterus.

Male sterilization is known as a vasectomy. A vasectomy requires a surgical procedure that closes the small tubes through which sperm are released. With appropriate anesthesia, a small incision is made near the women's navel. The doctor seals the fallopian tubes using an electric current, clip or band. Pregnancy cannot occur because the sperm cannot get tot the egg.

During the male's surgery, the doctor makes one or two very small incisions in the scrotum, while the patient in under local anesthesia. A small section of each tube is removed and the two ends are sealed. Pregnancy cannot occur because there is no sperm being released to fertilize the egg.

Barrier

Diaphragm or Cervical Cap

A Diaphragm is a flexible rubber or plastic barrier that is intended to fit securely over the cervix. Similarly, the cervical cap is a thimble-shaped rubber or plastic dome. For a correct fit, each require a pelvic examination by a health care provider. Both methods block sperm for entering the uterus and fertilizing an egg. The diaphragm can be put in place up to two hours before intercourse and may be left in for about six hours. The cervical cap may be inserted six hours before intercourse, but it may be left in place for up to 48 hours. The cervical cap cannot be used during menstruation. Each time sex occurs, a small amount of spermicidal cream or jelly should be spread inside and along the rim of the devices. The effectiveness rates of the diaphragm or cervical cap ranges from 72% to 94%, depending upon consistent and correct use. Each must be inserted properly every time to be effective.

The Condom

A condom is a latex, rubber or 'lambskin' sheath that fits over the penis. They are available over the counter with or without added spermicide. A condom prevents pregnancy by containing sperm during intercourse, preventing the sperm from entering the uterus and fertilizing an egg. The effectiveness rate of the condom ranges from 88 to 98% depending upon consistent and correct use. Greater protection against pregnancy is possible when a condom is used with a vaginal contraceptive, such as a spermicide, a sponge, diaphragm or cervical cap. Latex condoms can help protect against sexually-transmitted diseases, including HIV, the virus that cause AIDS.

The Female Condom

The female condom is a birth control device that fits inside the vagina. It is made of pre-lubricated polyurethane, and is available over the counter without a prescription. The female condom prevents pregnancy by containing sperm during sex, so that sperm cannot enter the uterus and fertilize an egg. Insertion is similar to inserting a diaphragm. The closed end covers the opening of the cervix and the open end stays outside of the vagina, held in place by an outer ring. The female condom can be inserted up to eight hours prior to intercourse.

The effectives rate of the female condom ranges from 75% to 87%, depending upon consistent and correct use.

The Sponge

The Vaginal Contraceptive Sponge is a small, disposable plastic (polyurethane) foam device measuring approximately five centimeters in diameter. The sponge can be purchased in a drug store without a prescription.

Prior to sex, the sponge is inserted into the vagina over the cervix, and prevents sperm from entering the uterus and fertilizing an egg. Spermicide, which kills sperm or leaves them inactive, is released from the sponge for up to 12 hours while the sponge is in place. The effectiveness rate of the sponge ranges from 72% to 82%.

Spermicide

Vaginal spermicides include creams, jellies, foams and vaginal inserts or suppositories. Vaginal spermicides are sold in drug stores without a prescription. Spermicides contain a small amount of a chemical that kills sperm or makes them inactive. This prevents the sperm from entering the women's uterus and fertilizing an egg. The spermicide is put into the vagina before intercourse.

The effectiveness rate of spermicide ranges from 79% to 97%, depending upon consistent and correct use, and use with another barrier method. The best results are achieved when vaginal spermicides are used with another barrier method, such as a condom, diaphragm or cervical cap.

Other Alternatives

IUD

The intrauterine device (IUD) is a T-shaped plastic device that is inserted into the uterus. The insertion of an IUD is a simple procedure performed in a doctor's office. IUDs have a thread that hangs down from the uterus into the vagina, which enables women to ensure that the device is still in place after each menstrual period. The IUD contains copper and prevents pregnancy by causing a reaction within the uterus, so that a fertilized egg cannot be implanted. The effectiveness rate of the IUD ranges from 97% to 99.2%, depending upon correct insertion and the type of IUD. Some IUDs can be left in place for up to four years, while others must be replaced annually, or when desired.

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Essure

Essure is a new method of permanent birth control that is a lower impact approach that is gentler on your body. The Essure procedure involves placing a small, flexible device called a micro-insert into each of your two fallopian tubes (the tubes where your eggs travel from your ovaries to your uterus.) The micro-inserts are made from materials that have been well-studied and used successfully in heart and other surgeries for many years. Once the micro-inserts are in place, your body tissue grows into the micro-inserts, blocking the fallopian tubes. Blocking the tubes is intended to prevent sperm from fertilizing the egg, thereby preventing pregnancy. Your doctor will be able explain the procedure to you in more detail.

Dr. Roy Jackson, Canadian board certified obstetrician gynecologist and pioneer in endoscopic gynecological procedures is currently a consultant to Conceptus Inc. Conceptus Inc. based in California is developing the Essure procedure. This is a medical procedure designed to provide a non-incisional alternative to tubal ligation, the leading form of birth control worldwide. The Essure procedure is a non-incisional permanent birth control method. In the United States it is predicted that in 2003 surgical tubal ligation and vasectomy which combined will account for more than 1 million procedures in the United States.

What is vaginal atrophy?