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Exercises after Breast Cancer SurgeryLEARN MORE
Many women with breast cancer have some kind of surgery, even though other kinds of treatment are done, too. You may have had a:
• Breast biopsy
• Lymph node biopsy or removal
• Breast conservation surgery (lumpectomy)
• Breast reconstruction
Any of these can affect how well you can move your shoulder and arm, take a deep breath, or do your daily activities, like dressing, bathing, and combing your hair. Pain and stiffness can cause weakness and limit movement of your arm and shoulder.
Exercises Can Help Restore Movement
No matter what type of surgery you have, it’s important to do exercises afterward to get the arm and shoulder moving again. Exercises help to decrease side effects of your surgery and help you get back to your usual activities.
If you’ve had radiation therapy after surgery, exercises are even more important to help keep your arm and shoulder flexible. Radiation may affect your arm and shoulder long after treatment is finished. Because of this, it’s important to develop a regular habit of doing exercises to maintain arm and shoulder mobility after radiation treatments for breast cancer.
It’s very important to talk with your doctor before starting any exercises so that you can decide on a program that’s right for you. Your doctor might suggest you see a physical therapist or occupational therapist, or a cancer exercise specialist certified by the American College of Sports Medicine. These health professionals are specially trained to design an exercise program just for you. You might need this kind of help if you do not have full use of your arm within 3 to 4 weeks of surgery.
Some exercises should not be done until drains and sutures (stitches) are removed. But some exercises can be done soon after surgery. The exercises that increase your shoulder and arm motion can usually be started in a few days. Exercises to help make your arm stronger are added later.
The Week after Surgery
The tips and exercises listed below should be done for the first 3 to 7 days after surgery. Do not do them until you get the OK from your doctor.
• Use your affected arm (on the side where your surgery was) as you normally would when you comb your hair, bathe, get dressed, and eat
• Lie down and raise your affected arm above the level of your heart for 45 minutes. Do this 2 or 3 times a day. Put your arm on pillows so that your hand is higher than your wrist and your elbow is a little higher than your shoulder. This will help decrease the swelling that may happen after surgery
• Exercise your affected arm while it’s raised above the level of your heart by opening and closing your hand 15 to 25 times. Next, bend and straighten your elbow. Repeat this 3 to 4 times a day. This exercise helps reduce swelling by pumping lymph fluid out of your arm
• Practice deep breathing exercises (using your diaphragm) at least 6 times a day. Lie down on your back and take a slow, deep breath. Breathe in as much air as you can while trying to expand your chest and abdomen (push your belly button away from your spine). Relax and breathe out. Repeat this 4 or 5 times. This exercise will help maintain normal movement of your chest, making it easier for your lungs to work. Do deep breathing exercises often
• Do not sleep on your affected arm or lie on that side
General Guidelines for These Exercises
The exercises described here can be done as soon as your doctor says it's OK. They’re usually started a week or more after surgery. Be sure to talk to your doctor before trying any of them. Here are some things to keep in mind after breast surgery:
• You will feel some tightness in your chest and armpit after surgery. This is normal, and the tightness will decrease as you do your exercises
• Many women have burning, tingling, numbness, or soreness on the back of the armand/or on the chest wall. This is because the surgery can irritate some of your nerves. These feelings might increase a few weeks after surgery. But keep doing your exercises unless you notice unusual swelling or tenderness. (If this happens, let your doctor know about it right away.) Sometimes rubbing or stroking the area with your hand or a soft cloth can help make the area less sensitive
• It may be helpful to do the exercises after a warm shower when muscles are warm and relaxed
• Wear comfortable, loose clothing when doing the exercises
• Do the exercises slowly until you feel a gentle stretch. Hold each stretch at the end of the motion and slowly count to 5. It’s normal to feel some pulling as you stretch the skin and muscles that have been shortened because of the surgery. Do not bounce or make any jerky movements when doing any of the exercises. You should not feel pain as you do them, only gentle stretching
• Do each exercise 5 to 7 times. Try to do each exercise correctly. If you have trouble with the exercises, talk to your doctor. You may need to be referred to a physical or occupational therapist
• Do the exercises twice a day until you get back your normal flexibility
• Be sure to take deep breaths, in and out, as you do each exercise
• The exercises are set up so that you start them lying down, move to sitting, and finish them standing up
Here are some of the more common exercises that women do after breast surgery. Talk to your doctor or therapist about which of these are right for you and when you should start doing them. Do not start any of these exercises without talking to your doctor first.
This exercise helps increase your ability to move your shoulders forward. You will need a broom handle, yardstick, or other stick-like object to use as the wand in this exercise. Do these exercises on a bed or the floor. Lie on your back with your knees bent and your feet flat.
• Hold the wand across your belly in both hands with your palms facing up
• Lift the wand up over your head as far as you can. Use your unaffected arm to help lift the wand until you feel a stretch in your affected arm
• Hold for 5 seconds
• Lower arms and repeat 5 to 7 times
This exercise helps increase the movement in the front of your chest and shoulder. It may take many weeks of regular exercise before your elbows will get close to the bed or floor. Do these exercises on a bed or the floor. Lie on your back with your knees bent and your feet flat.
• Clasp your hands behind your neck with your elbows pointing toward the ceiling
• Move your elbows apart and down toward the bed or floor
• Repeat 5 to 7 times
Shoulder Blade Stretch
This exercise helps increase your shoulder blade movement.
• Sit in a chair very close to a table with your back against the back of the chair
• Place the unaffected arm on the table with your elbow bent and palm down. Do not move this arm during the exercise
• Place the affected arm on the table, palm down, with your elbow straight
• Without moving your trunk, slide the affected arm forward, toward the opposite side of the table. You should feel your shoulder blade move as you do this
• Relax your arm and repeat 5 to 7 times
Shoulder Blade Squeeze
This exercise also helps increase shoulder blade movement.
• Sit in a chair in front of a mirror. Face straight ahead. Do not rest against the back of the chair
• Your arms should be at your sides with your elbows bent
• Squeeze your shoulder blades together, bringing your elbows behind you. Keep your shoulders level as you do this. Do not lift your shoulders up toward your ears
• Return to the starting position and repeat 5 to 7 times
This exercise helps increase movement of your trunk and body.
• Sit in a chair and clasp your hands together in front of you. Lift your arms slowly over your head, straightening your arms
• When your arms are over your head, bend your trunk to the right keeping your arms overhead
• Return to the starting position and bend to the left
• Repeat 5 to 7 times
Chest Wall Stretch
This exercise helps stretch your chest.
• Stand facing a corner with your toes about 8 to 10 inches from the corner
• Bend your elbows and put your forearms on the wall, one on each side of the corner. Your elbows should be as close to shoulder height as possible
• Keep your arms and feet in place and move your chest toward the corner. You will feel a stretch across your chest and shoulders
• Return to the starting position and repeat 5 to 7 times
• The picture shows stretching both sides at the same time, but you may find it more comfortable to stretch one arm at a time
• Be sure you keep your shoulders dropped far away from your ears as you do this stretch
This exercise helps increase your mobility in your shoulder.
• Stand facing the wall with your toes about 8 to 10 inches from the wall
• Put your hands on the wall. Use your fingers to "climb the wall," reaching as high as you can until you feel a stretch
• Return to the starting position and repeat 5 to 7 times
• The picture shows both arms going up at the same time, but you might find it easier to raise one arm at a time
• Be sure you keep your shoulders dropped far away from your ears as you raise your arms
Things to Keep in Mind after Breast Surgery
Start exercising slowly and increase as you are able. Stop exercising and talk to your doctor right away if you:
• Get weaker, start losing your balance, or start falling
• Have pain that gets worse
• Have new heaviness, aching, tightness, or other strange sensations in your arm
• Have unusual swelling or swelling gets worse
• Have headaches, dizziness, blurred vision, new numbness, or tingling in your arms or chest
It’s important to exercise to keep your muscles working as well as possible, but it’s also important to be safe. Talk with your doctor about the right kind of exercises for your condition, and then set goals for increasing your level of physical activity.
Other Kinds of Exercise
Exercise to help improve aerobic (heart-lung) capacity is also important for women who have had breast cancer. There’s evidence that fitness and weight loss may even help lower the risk that some types of cancer will come back after treatment. Ask your doctor about fitness exercises during and after breast cancer treatment.
Other exercises are designed to help reduce your risk of lymphedema, or swelling in the arm on the side where you had surgery. The exercises shown here are mainly designed to help regain range of motion (flexibility) of the arm and shoulder. Ask your doctor about your lymphedema risk and if you should use exercises to help reduce that risk.
Strengthening exercises are now recommended as part of regular exercise programs to improve health. These are not started until 4 to 6 weeks after surgery, and must be tailored to your general health, medical condition, and fitness. Strength building starts by using small hand weights, and is increased slowly over time. Again, this is addressed with your doctor or physical therapist. It’s probably to start a strengthening program in a supervised setting with a cancer exercise trainer or physical therapist to be sure you’re doing the exercises properly.
This information was developed with assistance from the Oncology Section of the American Physical Therapy Association.
Breast Cancer Screening GuidelineLEARN MORE
The goal of screening tests for breast cancer is to find it before it causes symptoms (like a lump that can be felt). Screening refers to tests and exams used to find a disease in people who don’t have any symptoms. Early detection means finding and diagnosing a disease earlier than if you’d waited for symptoms to start.
Breast cancers found during screening exams are more likely to be smaller and still confined to the breast. The size of a breast cancer and how far it has spread are some of the most important factors in predicting the prognosis (outlook) of a woman with this disease.
An active breast care health plan includes:
• Increasing self-awareness on breast health, i.e., if you notice any breast changes, please communicate with your doctor and follow medical suggestions for examinations and follow up visits
• Mammograms; a mammogram has been proved to decrease mortality between the age from 40 to 74, especially among the age of 50 and older. Get mammograms every year starting from 40 years old to 75 years old in order to get early treatment and increase survivor
If you want to know about breast self-exam and whether you need early screening and prevention, you can consult with your doctor.
We have consolidated current international standards on screening guide for average risk and high risk.
Guidelines for Women at Average Risk for Breast Cancer
These guidelines are for women at average risk for breast cancer. For screening purposes, a woman is considered to be at average risk if she doesn’t have a personal history of breast cancer, a strong family history of breast cancer, or a genetic mutation known to increase risk of breast cancer (such as in a BRCA gene), and has not had chest radiation therapy before the age of 30.
• Women between 40 and 44 have the option to start screening with a mammogram every year
• Women 45 to 54 should get mammograms every year
• Women 55 and older can switch to a mammogram every other year, or they can choose to continue yearly mammograms. Screening should continue as long as a woman is in good health and is expected to live 10 more years or longer
All women should understand what to expect when getting a mammogram for breast cancer screening – what the test can and cannot do.
Guideline for High Risk Women for Breast Cancer
Women who are at high risk for breast cancer based on certain factors, i.e., family history, or having had a biopsy and its result was high risk, or mammogram result showed should have mammogram earlier and also get breast color ultrasound, and even breast MRI. These women should get an MRI typically starting at age 30. This includes women who:
• Have a lifetime risk of breast cancer of about 20% to 25% or greater, according to risk assessment tools that are based mainly on family history
• Have a known BRCA1 or BRCA2 gene mutation (based on having had genetic testing)
• Have a first-degree relative (parent, brother, sister, or child) with a BRCA1 or BRCA2 gene mutation, and have not had genetic testing themselves
• Have radiation therapy to the chest when they were between the ages of 10 and 30 years
• Have Li-Fraumeni syndrome, Cowden syndrome, or Bannayan-Riley-Ruvalcaba syndrome, or have first-degree relatives with one of these syndromes
Pulmonary Function TestsLEARN MORE
You have been diagnosed with blepharitis, which is an inflammatory condition of the eyelids. You may notice some or all of the following:
● Eyelids become crusty, irritated and red due to a build-up of oil and debris on the eyelids and eyelashes
● Burning, irritation, soreness and itching of the eyelids
● Foreign body sensation (you feel like there is something in your eye)
● Scales close to the root of the eyelash
Blepharitis is a chronic (long-term) recurring condition and so the most important part of treating and managing it is to keep your eyelids clean. Occasionally it is due to an infection, if so you may also have to take medication prescribed by your healthcare professional to be used throughout the prescribed treatment.
Although blepharitis is not life threatening, if not treated it will not improve, and your symptoms will remain and possibly worsen. Blepharitis is one of the most common reasons for cancelling elective (planned) eye surgery.
There are two easy methods for proper eyelid hygiene which will help manage your blepharitis.
1. Apply Heat & Massage
● Wash your hands before and after cleaning
● Apply a warm compress to your closed eyes at 35-40°C for 10 minutes, which will soften the debris and oils. Then massage your eyelids, which will help reduce your symptoms
● You can use a clean facecloth soaked in hot water or alternatively there are a number of heat masks specifically for the eye
● Wash your hands before and after cleaning
● Commercially available lid scrubs are usually pre-soaked in a cleansing solution and are ready to use
● You may alternatively have been advised to use "at-home" remedies such as diluted baby shampoo or baking powder. Due to the steps involved, many patients find these remedies inconvenient in day to day life, which can also be irritating to your eyelids
● When using lid scrubs, close your eyes and gently scrub your eyelid using side-to-side strokes for approximately 30 seconds. Repeat this for your other eyelid
● Lid scrubs may require you to rinse your eyelids after applying, please follow the manufacturer's instructions. There are many lid scrubs available, which your healthcare professional may be happy to recommend
As blepharitis is a long term condition, it is important that you continue this routine for as long as you have been told by your healthcare professional, in many cases this may be forever. While short term treatments will reduce the symptoms, the likelihood is that they will return once you stop performing regular eyelid hygiene.
● Remove any eye make-up before going to bed. The lid scrub pads mentioned are an excellent way of doing this while also keeping your eyelids clean
● Don't share your eye make-up or lotions with anyone else
● Don't share your facecloths or towels with anyone else
● Blepharitis is often associated with Dry Eye. Artificial tears will help to relieve these symptoms
Other Times When Hygiene is Important
If your healthcare professional has discussed the importance of eyelid hygiene with you, it may be because you have one of the following:
● Meibomian gland dysfunction (MGD)
● Stye (infection of a gland in the eyelid)
● Marginal keratitis (inflammation of the eye itself; often secondary to bacterial infection or blepharitis)
● Ocular rosacea (redness of the eyelids)
● Conjunctivitis (inflammation of the outer surface of the eye and inner surface of the eyelid－commonly caused by infection or an allergy)
If so, you should perform daily eyelid cleaning as detailed above for as long as your healthcare professional has advised.
How to Put in Your Eye DropsLEARN MORE
Your nursing staff created this information to show you a way to put in eye drops. By following these directions, you will keep this medication clean and prevent eye infections.
Uterine FibroidsLEARN MORE
What are uterine fibroids?
Uterine fibroids are benign (not cancer) growths that develop from the muscle tissue of the uterus. They also are called leiomyomas or myomas. The size, shape, and location of fibroids can vary greatly. They may be present within the uterine cavity, within the muscular wall of the uterus, on the outer surface of the uterus, or attached to the outside of the uterus by a stem-like structure. A woman may have only one fibroid or many of varying sizes. A fibroid may remain very small for a long time and suddenly grow rapidly, or grow slowly over a number of years.
What are symptoms of fibroids?
• Changes in menstruation
○ Longer, more frequent, or heavy menstrual periods
○ Menstrual pain (cramps)
○ Vaginal bleeding at times other than menstruation
○ Anemia (from blood loss)
○ In the abdomen or lower back (often dull, heavy and aching, but may be sharp)
○ During sex
○ Difficulty urinating or frequent urination
○ Constipation, rectal pain, or difficult bowel movements
○ Abdominal cramps or bloating
• Enlarged uterus and abdomen
• Fibroids also may cause no symptoms at all
When is treatment necessary for fibroids?
• Heavy or painful menstrual periods that cause anemia or that disrupt a woman’s normal activities
• Bleeding between periods
• Uncertainty whether the growth is a fibroid or another type of tumor, such as an ovarian tumor
• Rapid increase in growth of the fibroid
• Pelvic pain
Can medication be used to treat fibroids?
• Birth control pills and other types of hormonal birth control methods: These drugs often are used to control heavy bleeding and painful periods
• Gonadotropin-releasing hormone (GnRH) agonists: These drugs stop the menstrual cycle and can shrink fibroids. They sometimes are used before surgery to reduce the risk of bleeding. They can also be used to bridge a woman to menopause when fibroids will then naturally shrink. Because GnRH agonists have many side effects, they are used only for short periods (less than 6 months). After a woman stops taking a GnRH agonist, her fibroids usually return to their previous size
• Progestin-releasing intrauterine device: This option is for women with fibroids that do not distort the inside of the uterus. It reduces heavy and painful bleeding but does not treat the fibroids themselves
• Tranexamic Acid:This medication helps our blood clotting mechanism and will reduce the amount of bleeding when bleeding occurs. It does not treat the fibroids, just the bleeding caused by the fibroids
• Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as ibuprofen can minimize the pain and some of the bleeding caused by fibroids
What types of surgery may be done to treat fibroids?
• Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have children. Fibroids do not regrow after surgery, but new fibroids may develop. If they do, more surgery may be needed
• Hysterectomy is the removal of the uterus. The ovaries may or may not be removed. Hysterectomy is done when other treatments have not worked or are not possible or the fibroids are very large. A woman is no longer able to have children after having a hysterectomy
Are there other treatments besides medication and surgery?
• Endometrial ablation
• Uterine artery embolization
• Magnetic resonance imaging-guided ultrasound surgery
Bleeding During and After MenopauseLEARN MORE
What are menopause and perimenopause?
• The absence of menstrual periods for 1 year
• The average age of menopause is 51 years, but the normal range is 45 years to 55 years
• The years leading up to this point are called perimenopause, it means “around menopause”
• This phase can last for up to 10 years. During perimenopause, shifts in hormone levels can affect ovulation and cause changes in the menstrual cycle
What are some of the common changes that occur in the menstrual cycle during perimenopause?
• Irregular bleeding or spotting
• Longer and heavier periods alternate with shorter and lighter periods
• The number of days between periods may increase or decrease
• You may begin to skip periods
How can I tell if bleeding is abnormal?
• Very heavy bleeding
• Bleeding that lasts longer than normal
• Bleeding that occurs more often than every 3 weeks
• Bleeding that occurs after sex or between periods
What are some of the common causes of abnormal bleeding?
Polyps - Polyps are usually noncancerous growths of tissue that grow on the inside of the uterus. They may cause irregular or heavy bleeding. Polyps also can grow on the cervix or inside the cervical canal. These polyps may cause bleeding after sex.
Endometrial atrophy - After menopause, the endometrium may become too thin as a result of low estrogen levels causing abnormal bleeding.
Endometrial hyperplasia - The lining of the uterus thickens which can cause irregular or heavy bleeding. It is most often caused by excess estrogen without enough progesterone. In some cases, the cells of the lining become abnormal, called atypical hyperplasia which can lead to cancer of the uterus. When endometrial hyperplasia is diagnosed and treated early, endometrial cancer often can be prevented. Bleeding is the most common sign of endometrial cancer in women after menopause.
How is abnormal bleeding evaluated?
• Endometrial biopsy
• Transvaginal ultrasound
• Dilation and curettage
What treatment is available for abnormal bleeding?
• Surgical removal of polyps
• Endometrial atrophy can be treated with medications
• Thickened areas of the endometrium may be removed by using hysteroscopy or D & C
• Endometrial cancer is treated usually surgery, typically with hysterectomy
What is endometriosis?
Endometriosis is a condition in which the type of tissue that forms the lining of the uterus (the endometrium) is found outside the uterus.
How common is endometriosis?
Endometriosis occurs in about one in ten women of reproductive age. It is most often diagnosed in women in their 30s and 40s.
Where does endometriosis most often occur?
• Fallopian tubes
• Outer surfaces of the uterus, bladder, ureters, intestines and rectum
• Cul-de-sac (the space behind the uterus)
How does endometriosis cause problems?
Endometriosis implants respond to changes in estrogen, a female hormone. The implants may grow and bleed like the uterine lining does during the menstrual cycle. Surrounding tissue can become irritated, inflamed, and swollen. The breakdown and bleeding of this tissue each month also can cause scar tissue, called adhesions, to form. Sometimes adhesions can cause organs to stick together. The bleeding, inflammation, and scarring can cause pain, especially before and during menstruation.
What is the link between infertility and endometriosis?
Almost 40% of women with infertility have endometriosis. Inflammation from endometriosis may damage the sperm or egg or interfere with their movement through the fallopian tubes and uterus. In severe cases of endometriosis, the fallopian tubes may be blocked by adhesions or scar tissue.
What are the symptoms of endometriosis?
The most common symptom is chronic (long-term) pelvic pain, especially just before and during the menstrual period. Pain also may occur during sex. If endometriosis is present on the bowel, pain during bowel movements can occur. If it affects the bladder, pain may be felt during urination. Heavy menstrual bleeding is another symptom of endometriosis. Many women with endometriosis have no symptoms.
How is endometriosis diagnosed?
• History and physical exam
How is endometriosis treated?
Treatment for endometriosis depends on the extent of the disease, your symptoms, and whether you want to have children. Endometriosis may be treated with medication, surgery, or both. When pain is the primary problem, medication usually is tried first.
What medications are used to treat endometriosis?
• Pain relievers, such as non-steroidal anti-inflammatory drugs
• Hormonal medications, including birth control pills, progestin-only medications, and gonadotropin-releasing hormone agonists. Hormonal medications help slow the growth of the endometrial tissue and may keep new adhesions from forming. These drugs do not remove endometriosis tissue that is already present
How can surgery treat endometriosis?
Surgery can be done to relieve pain and improve fertility. During surgery, endometriosis implants can be removed.
Does surgery cure endometriosis?
After surgery, most women have relief from pain. However, about 40-80% of women have pain again within 2 years of surgery. The more severe the disease, the more likely it is to return. Taking birth control pills or other medications after having surgery may help extend the pain-free period.
What if I still have severe pain that does not go away even after I have had treatment?
If pain is severe and does not go away after treatment, a hysterectomy may be a “last resort”option. Endometriosis is less likely to come back if your ovaries also are removed. If you keep your ovaries, endometriosis is less likely to come back if endometriosis implants are removed at the same time you have the hysterectomy.
Cervical Cancer ScreeningLEARN MORE
What is cervical cancer?
1. Cancer which occurs when the cells of the cervix grow abnormally
2. Usually caused by the human papilloma virus (HPV)
3. Common in women worldwide
What are the symptoms of cervical cancer?
There are usually no symptoms during early stages. At later stages of cervical cancer, there can be pelvic pain and vaginal bleeding.
Who is at risk for cervical cancer?
• Use oral contraceptives
• Are sexually active
• Have persistent HPV infection or are at risk of being infected with HPV. This includes those with:
○ Early sexual onset
○ Multiple sexual partners
○ A high-risk sexual partner (e.g. a partner with multiple sexual partners or an HPV infection)
○ A history of sexually transmitted infections (e.g. Chlamydia trachomatis, genital herpes)
○ A history of vaginal or vulvar cancer
○ A suppressed immune system
Are there any tests for early detection of cervical cancer?
Yes, the following are cervical cancer screening tests that detect cervical cancer in its early stages:
• Pap smear
• Human papilloma virus (HPV) test
How is a Pap smear and an HPV test done?
These tests can be done during a pelvic examination in the clinic. They take about 10 to 15 minutes.
During the pelvic examination, your doctor will insert a speculum into your vagina to examine your cervix. This may cause mild discomfort but should not cause any pain.
Your doctor will then perform the Pap smear by using a small brush or spatula to gently scrape some cells from the cervix. These cells are then sent to the laboratory to look for abnormal changes. An HPV test can be done along with a Pap smear or as a separate test.
How often do I need a Pap smear and HPV test done?
• Pap smear every 3 years
• HPV test not routinely needed. It may be done if the Pap smear results are abnormal
• Pap smear every 3 years or combined Pap smear and HPV test every 5 years
Aged above 65:
• May no longer need Pap smears done; talk to your doctor to determine your needs
More frequent testing may be required if:
• Your Pap smear or HPV test results are abnormal
• You have human immunodeficiency virus (HIV)
• You have other conditions that suppress your immunity
Talk with your doctor to have a personalized plan made.
Do I still need to do Pap smear and HPV test if I have had a hysterectomy?
This depends on:
• Why your hysterectomy was needed
• Whether your cervix was removed
• Whether you have a history of moderate or severe dysplasia
Do I still need a Pap smear and HPV test if I have had an HPV vaccine?
Yes. You will still require a regular Pap smear and an HPV test. The Pap smear helps to determine presence of abnormal cervical cells. With or without HPV vaccination, this test should be regularly done for early detection and treatment.
The HPV test is also necessary because the HPV vaccine does not protect against all forms of HPV.
I am a transgender person. Should I be tested?
Everyone who has a cervix should get checked on a regular basis. Testosterone therapy may affect test results. Let your doctor know if you are on testosterone therapy.
Abnormal Uterine BleedingLEARN MORE
What is a normal menstrual cycle？
The normal length of the menstrual cycle is typically between 24 days and 38 days. A normal menstrual period generally lasts up to 8 days.
When is bleeding abnormal？
• Bleeding or spotting between periods
• Bleeding or spotting after sex
• Heavy bleeding during your period
• Menstrual cycles that are longer than 38 days or shorter than 24 days
• “Irregular” periods in which cycle length varies by more than 7-9 days
• Bleeding after menopause
At what ages is abnormal bleeding more common？
Abnormal bleeding can occur at any age. However, at certain times in a woman’s life it is common for periods to be somewhat irregular. Periods may not occur regularly when a girl first starts having them (around age 9-14 years). During perimenopause (beginning in the mid-40s), the number of days between periods may change. It also is normal to skip periods or for bleeding to get lighter or heavier during perimenopause.
What causes abnormal bleeding？
• Irregular ovulation
• Fibroids and polyps
• Bleeding disorders
• Miscarriage and ectopic pregnancy
• Intrauterine device (IUD)or birth control pills
• Endometriosis and pelvic inflammatory disease
How is abnormal bleeding evaluated?
Your ob-gyn will ask about your health history and your menstrual cycle. It may be helpful to keep track of your menstrual cycle before your visit. Note the dates, length and type (light, medium, heavy or spotting) of bleeding on a calendar.
You will have a physical exam. You also may have blood tests. These tests check your blood count and hormone levels and rule out some diseases of the blood. You also may have a pregnancy test and tests for sexually transmitted infections (STIs).
What other tests may be needed to evaluate abnormal bleeding？
• Endometrial biopsy
What medications are used to help control abnormal bleeding？
• Hormonal birth control methods - birth control pills, the skin patch, and the vaginal ring contain hormones. These hormones can lighten menstrual flow. They also help make periods more regular
• Tranexamic acid and nonsteroidal anti-inflammatory drugs
• If you have an infection, you may be given an antibiotic
What types of surgery are used to help control abnormal bleeding？
• Endometrial ablation destroys the lining of the uterus. Pregnancy is not likely after ablation, but it can happen. If it does, the risk of serious complications, including life-threatening bleeding, is greatly increased. If you have this procedure, you will need to use birth control until you reach menopause
• Uterine artery embolization is a procedure used to treat fibroids. This procedure blocks the blood vessels to the uterus, which in turn stops the blood flow that fibroids need to grow
• Another treatment, myomectomy, removes the fibroids but not the uterus
• Hysterectomy, the surgical removal of the uterus, is used to treat some conditions or when other treatments have failed