Wednesday , 26 November 2014
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ADVICE from the GYNO — Randye Karmin, MD, FACOG

I’ve heard rumors that radiation in mammograms can increase my risk of breast cancer. Is this true? Can I get a thermography instead?

There is a lot of confusion about mammogram screening and the risks versus the benefits at various ages. The absolute truth is that breast cancer is still on the rise and women are being diagnosed younger and younger. The good news is that deaths from breast cancer are decreasing and this is in large part due to early detection afforded by routine mammogram screening. In spite of varying reports by the US Preventative Task Force, The American College of Ob/Gyn still recommends screening mammograms every one to two years for women between 40 and 50, and every year thereafter. Digital mammography uses a technology that is far improved from traditional film mammograms, allowing better visualization with less radiation exposure, and typically less compression to achieve the same image quality. While cumulative radiation exposure may increase one’s risk for cancer, the amount of radiation from digital mammography used according to current guidelines is not felt to be of significant enough risk compared with the overwhelming benefits of early diagnosis.

Thermography is considered experimental by the FDAas there is not enough evidence to suggest that it is as effective as mammogram for identifying breast cancers. That being said, thermography is being investigated as an adjunct to possibly better evaluate whether patients with an “abnormal” mammogram should proceed with biopsy. However, since it is still under investigation, most insurance companies will not cover the procedure. Breast ultrasound, on the other hand, has been shown to improve detection of breast cancer when used in conjunction with mammogram for women with dense breasts. Ask your gynecologist if this would be appropriate for you.

I’m 40 years old and I don’t have any hot flashes, but my periods have gotten so heavy and are coming more often than they used to. Am I going through menopause already? It’s unlikely that you are going through menopause. As women get older, their ovarian function changes and therefore, so does their cycle. This can result in dramatic changes in your periods similar to what you are describing. For most women, this is normal and can be managed with either a low dose birth control pill or a progesterone containing IUD. For women who don’t want any type of hormonal treatment, there is a minimally invasive office procedure called endometrial ablation, which can significantly reduce or eliminate your periods for good. While most of the time a change in your bleeding pattern is normal, you should make an appointment with the Gynecologist if your period comes less than 21 days apart or lasts for more than 7 days. This may be a sign of a polyp, fibroid, or other uterine abnormality and should be evaluated by a pelvic ultrasound and possibly a uterine biopsy, both of which can be performed in the doctor’s office with minimal discomfort.

My husband and I are done having children, but I can’t get him to wear a condom and he refuses to have a vasectomy. I hate the side effects of birth control pills. What are my options?

After carrying their children and going through labor, one would think a little snip wouldn’t send our hubbies running for the hills. But many men refuse to bite the bullet. Fortunately for women, there are good, non-hormonal, long-term and even permanent birth control options. Today’s IUDs are not like the devices from the 70’s that got a lot of bad press because of poor design. The copper IUD is a hormone-free device that is inserted into the uterus in the doctor’s office and can last for up to 10 years. Should you change your mind about having more children, it can be removed easily so you can conceive again. If you are 100% sure you have completed childbearing, Essure permanent birth control is a minor procedure performed in the office which uses a tiny coil to block each of your tubes. The coils are inserted vaginally with no surgical scars and you return to your normal activities almost immediately.

Dr. Randye Karmin is a Board Certified Ob/Gyn in Private Practice in Miami, Florida. Call 305-670-0010 for an appointment or book online at www.miamiwomencare.com

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