American Medical Association Family Medical Guide - American Medical Association [568]
If these measures do not limit the bleeding after a few months, your doctor may evaluate your pelvic organs using an ultrasound scan called a sonohysterogram. Even if no abnormality is found, the doctor may consider doing a hysteroscopy (see below) to examine the inside of your uterus. If a problem is found, the doctor will perform a procedure called endometrial ablation. In endometrial ablation, the doctor removes all or most of the lining of the uterus (endometrium) using a controlled delivery of heat from a balloonlike device inserted through the hysteroscope into the cavity of the uterus. Because endometrial ablation destroys the lining of the uterus, a woman’s fertility is affected. The procedure is performed mainly on women who want to avoid the major surgery of a hysterectomy. In some circumstances, however, a hysterectomy is the best treatment.
Hysteroscopy
To diagnose some gynecologic conditions, such as heavy or prolonged periods or bleeding between periods, a doctor needs to examine the inside of the uterus. In a procedure called hysteroscopy, the doctor can view the uterus directly to diagnose, evaluate, and treat disorders such as uterine fibroids, endometrial polyps, hyperplasia (thickening of the lining of the uterus), or benign or malignant tumors. Hysteroscopy can be performed in a hospital outpatient clinic or in a doctor’s office using local anesthetic with sedation.
Hysteroscopy
During a hysteroscopy, the doctor inserts a flexible, lighted viewing instrument called a hysteroscope through the vagina into the uterus. He or she introduces a small amount of liquid or gas through the hysteroscope to expand the uterus. The doctor can also pass medical instruments through the hysteroscope to remove growths from the uterus or to perform procedures such as biopsies.
Premenstrual Syndrome
The combination of physical and emotional changes that sometimes occur in the week or so before your period is called premenstrual syndrome (PMS). Doctors believe that PMS results from hormonal fluctuations during the menstrual cycle. A number of other factors may also contribute—such as changes in the levels of a chemical messenger in the brain called serotonin (which helps regulate mood), stress, inadequate levels of some vitamins and minerals, eating salty or caffeine-containing foods, or drinking excessive amounts of alcohol.
Up to 75 percent of women who menstruate experience some uncomfortable premenstrual symptoms, and 30 to 40 percent have symptoms serious enough to disrupt their daily activities. PMS occurs most commonly in a woman’s 20s or 30s and in the years preceding menopause; for each woman, the symptoms tend to follow a predictable pattern.
Symptoms
Common symptoms of PMS include mood swings, tender and swollen breasts, weight gain from fluid retention, a bloated abdomen, fatigue, food cravings, headaches, difficulty concentrating, irritability, anxiety, and depression in the days before a period. Some women also experience joint and muscle pain or nausea and vomiting. Most women have only some of these symptoms.
Diagnosis
Talk to your doctor if symptoms of PMS are affecting your normal routine and if lifestyle changes have brought no relief. No specific tests are available to diagnose PMS with certainty, but your doctor will be able to make a diagnosis based on your description of your symptoms and on their pattern. He or she may suggest that you keep track of your symptoms on a calendar every month to help you recognize the pattern.
Treatment
You may need to try different treatments for your PMS to find the ones that are most effective. Some women find that their symptoms are relieved by over-the-counter pain relievers such as ibuprofen or naproxen. The