Janelle's Journey

“Nobody prepares you for the thief miscarriage is. I feel if I can share my story, it might help somebody else from suffering alone, because they're not alone.”

Janelle took a deep breath, paused, and then apologized.

“I’m sorry if I cry."

And then she began:

It was my first pregnancy, June of 2021. We had our first appointment. I felt great. They said everything looked great. Go ahead, tell the world, we're so excited for you. And then just shy of 12 weeks we miscarried.

And there was no reason for it.

We had no bleeding or anything up until that point. I remember clearly it was a Sunday morning when I first noticed some bleeding, then called on Monday. They got me in as soon as possible. Dr. Swift was in surgery that day when we found out our baby didn't have a heartbeat. While still trying to process the loss of our baby the Dr. gave us all of our options, which is kind of overwhelming. My husband and I went home and I decided on a D&C. That day was a whirlwind as my appointment was at 8:30am and I was at the hospital for the D&C at 1:30pm.

While we were in the pre-op room for the D&C, Dr. Swift came in. You could see the genuine shock and concern on her face. She was as surprised as we were, as a couple weeks prior everything was great. She said she wanted to do some genetic testing on our baby if we were okay with it. She said, ‘I don't understand why this happened. I want to have peace of mind just as much as you do. Would you be okay if we did that?’

I said yes.

And she said, ‘We've got two options: we can either run the genetic testing through the hospital, which will cost you an arm and a leg, or, if you're okay with it, I’ll run back to my office and grab one of our kits and have it sent out this afternoon.’ So she ran from the pre-op room all the way back to the clinic to get a DNA testing kit for me and my husband. I know it's not about money, but, yes, it is about money. Because we were looking at thousands of dollars’ worth of medical bills had she not done that for us. She cared enough to run back all the way to her clinic to get this testing kit and came all the way back.

She didn't have to do that. 

I had the D&C in August of 2021; everything went well. Then at my follow up appointment Dr. Swift shared the results of the genetic testing: there was nothing wrong with our baby. It was perfectly healthy. So they don't know why it happened to us. But it did. Like it does to many. Because of that Dr. Swift wanted to do some other testing, with my permission. She said, ‘I want to eliminate if you have a blood clotting disorder or some underlying condition that we don't normally check for with low risk pregnancy.’

There's wasn't really a reason to expect a miscarriage to happen. I wasn't high risk. I had no underlying conditions. I was 29 at the time; I was a fit, healthy person, so it left my husband and me heartbroken and dumbfounded. But Dr. Swift had a game plan. ‘Here’s what we're going to do for when you get pregnant the next time, just to make sure that we've ruled out everything that we can control on our end.’

She didn't have to do that, but she cares so much for her patients.

I know people whose doctors dismissed them with a 'Yep, you had a miscarriage; happens to one in four,’ and then they expect their patients to just go about their day. Swift isn't like that; she wanted to make sure that we covered all of our bases so that my husband and I could have our family.

My miscarriage left this empty, hollow person for a long time. And to this day I still think about when we found out our first baby would have been a girl. Who would she be today? Would she look like me or would she look like her daddy? Would she have my personality? Or his? Also, a dear friend who's a photographer created a beautiful photo shoot to tell my stepson that he was going to be a big brother. We had all this excitement bursting within us, so we told the world and right after we told the world we lost her. And then we had to tell my stepson he wasn’t going to be a big brother anymore because for reasons unknown to us God needed our baby . . . 

*******

After trying for almost a whole year and not succeeding, we finally got pregnant again. As soon as they found out I was pregnant, Women’s Care was like, ‘We want you to come in. We want to monitor your levels, make sure everything is progressing the way that it needs to.’ They were with me every step of the way. If I had any questions, I never hesitated to call because Dr. Swift and her team never treated me like I was a burden. It was always, ‘We've got room for you. Let’s get you in and get you taken care of.’

I was induced two weeks early because I experienced a heavier amount of bleeding than I should have. I had my 38 week check up on December 28, 2022. I also was exhausted and very fatigued. I had to drag myself to do every little thing. Something was not right. And then the bleeding got worse. I was in the following day, December 29, to monitor for contractions. Still bleeding. 

Swift said we were going to get the baby out now.

The induction process went really smooth and I progressed nicely. Labor started at around 2:00pm. The whole time I was in labor Dr. Swift came in and checked on me. Our daughter was born at 7:43pm. She was full of life right from the start and has continued to develop that little personality (she’s 15 months old this week).

Her name is Wilomena. I call her Mena. My stepson calls her Wilo. My husband calls her Lolo. She loves our pets and her brother is the light of her life.

And she is the light of ours.

*******

I’m currently pregnant now with our second child. We’ve been quiet about it just like with Wilomena, but I think sharing my experience at this time is important. I can tell you every single day of my life, even with my daughter and now with this pregnancy, miscarriage just sits there in the back of your mind and robs a lot of joy and happiness that you should be feeling. Because there's always that what if.

What if I lose this one too?

The beginning part of my pregnancy hasn't been easy. I had bleeding once again and those very same thoughts were present. But we’ve had a few extra appointments and ultrasounds. We’re at 15 weeks now and the baby is healthy and developing appropriately. As I said, nobody prepares you for the thief miscarriage is. I’d like to say I’m fully healed, but part of that grief is always in your heart.

If sharing my story can help one person not suffer in silence, I think that would be wonderful.

Protecting Yourself from STIs

With the spread of sexually transmitted infections (STIs) on the rise, we want to make sure every person in our Circle of Care has the information they need to live a safe and healthy life. April is STI Awareness Month, so we're breaking down the most effective ways to prevent contracting an STI and the symptoms that require a prompt visit to your OB/GYN.

What are STIs?
Sexually transmitted infections (STIs) are infections or viruses spread from person to person by intimate physical contact or through sexual intercourse. Common STIs include chlamydia, gonorrhea, HPV, genital herpes, and syphilis.

Aside from colds and the flu, STIs are the most common contagious (easily spread) infections in the United States. The American College of Obstetricians and Gynecologists reports that there are millions of new cases each year, so it's important to know the facts when it comes to protecting your body.

How Can I Protect Myself?
The good news is, that there are a lot of different ways you can protect yourself. You can reduce your risk of contracting an STI by:

• Limiting your number of sexual partners. 
• Using protection (such as condoms) every time you have vaginal, oral, or anal sex. 
• Making sure you are up to date on all of your immunizations. Vaccinations are available for hepatitis B as well as some forms of HPV.

Regular screening is also key to catching an STI early if you do contract an infection.

"It's recommended that sexually active women between the ages of 15 and 25 have at least annual gonorrhea and chlamydia screening," says Dr. Valary Gass of Women's Care of Wisconsin.

There are some STIs that can be cured but could cause long term problems like pain and infertility, so early detection is important.

"Additional screening can be offered for HIV, syphilis, and hepatitis B or C," Dr. Gass says.

What are the Most Common Symptoms of an STI?
Some of the most common STI symptoms to look out for include:

• A burning sensation when urinating
• Sores, bumps, rashes, or blisters in the genital or anal area
• Abnormal discharge 
• Redness or swelling in the genital area
• Pain in the pelvic or abdominal area
• Pain, soreness, irritation, or other discomforts during intercourse
• Bleeding after intercourse
• Recurring yeast infections 

If you believe you are at risk for contracting an STI, it is very important to schedule an appointment with your healthcare provider.

During pregnancy, STIs can also cause harm to the fetus. If you are pregnant and you or your partner have had -- or may have -- an STI, be sure to inform your doctor so you can work out a treatment plan that will decrease the chances of your child getting the infection.

Schedule An Appointment
If you have concerns about STIs or believe you need screening, please talk to your healthcare provider," Dr. Gass says. 

At Women's Care, our providers are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information, and compassionate, caring staff.

To schedule an appointment with one of our providers to discuss STI screening or any other health related topic, please call or text us at 920-729-7105.

 

Meet Gretchen Augustine DO, Women's Care of WI

“Pretty much every visit I have with a patient starts the same way,” said Gretchen Augustine. “I ask them to tell me in their own words, in their own time, why they are here.”

Perhaps that’s why the Women’s Care of Wisconsin OB/GYN develops such a strong connection with them.

“Those first minutes in a first appointment are crucial,” said Augustine. “My patients know their bodies better than anyone else, so I provide them the time, opportunity and space to share what they’ve been through. Details they provide can be very powerful.”

The Michigan native actually started her career in journalism. Her decision to follow a very different path was rooted in being able to connect with people at a deeper level. She returned to school to pursue a degree in osteopathic medicine (Doctor of Osteopathic Medicine, or DO). That means she’s trained exactly as an MD, but with additional training in manipulative medicine.

“An osteopath is trained to view the patient holistically, to take care of the patient’s mind, body and spirit,” Augustine said. “It’s about finding and treating the root causes of issues rather than simply assigning a medicine to fix a problem.”

A staunch advocate for patient empowerment, Augustine insists that the education of those she serves be a top priority in her practice.

“It’s important patients understand the best options available to them,” said Augustine. “And they need to be comfortable with the treatment and have confidence that it is right for them and that it will be successful.”

Fundamental to women’s medicine, said Augustine, is developing relationships.

“We take care of women throughout the spectrum of their lives, and those of us in the field embrace that role,” she said.

Her patients describe Augustine as genuine, kind, astute, supportive, and funny.

“I laugh with my patients a lot, and I think that’s important,” said Augustine. “Most important of all, though, is that my patients feel heard and know that we’ll be working together on a plan to get them to where they want to be.”

Dr. Gretchen Augustine sees patients at Women's Care of Wisconsin locations in Appleton and Shawano. To schedule an appointment with Dr. Augustine, please call or text 920.729.7105.

March is Endometriosis Awareness Month

Are you doubling over in pain during your period? Do you have cramps you just can’t seem to shake throughout the month? For 1 in 10 women, these killer cramps are a symptom of endometriosis. Although endometriosis affects 190 million women worldwide, many go undiagnosed. March is Endometriosis Awareness Month and the perfect time to educate about this painful, chronic disease. Here’s what you need to know to find out if endometriosis might be affecting you.

What is Endometriosis?

"Endometrial cells are what make up the lining of the uterine cavity," Women's Care of Wisconsin's Dr. Therese Yarroch explains. "In women with endometriosis these cells are found outside of the uterus, where they cause inflammation. Sometimes referred to as 'endometrial implants,' they can be found on the ovaries, fallopian tubes, bladder, bowels and anywhere else in the pelvic region. This inflammation can result in pain and significant scarring to the surrounding tissue."

What Causes Endometriosis?

"We do have evidence that there is an increased risk of endometriosis in women with heavy menstrual bleeding and longer or more frequent menstrual cycles," Yarroch says. "Doctors also know that estrogen plays a role and women who have a close female relative with endometriosis are 5-7 times more likely to have it themselves."

Spotting the Symptoms

"Although it’s a common misconception that endometriosis only occurs in women over the age of 20, the truth is that the disease can develop as soon as a girl gets her first period and can span the rest of a woman’s reproductive years," Yarroch says. "The most common symptom of endometriosis is pelvic pain. While this pain usually coincides with menstruation, some women can experience this symptom throughout their entire cycle.”

Other symptoms to look out for include:

• Pain during or after sex
• Severe cramps that do not go away with NSAIDs or that impede the activities of your everyday life
• A heavy menstrual flow
• Periods that last longer than 7 days
• Nausea or vomiting
• Urinary and bowel disorders
• Difficulty getting pregnant

Not every woman will experience all of these symptoms, but approximately 30%-40% of women who have endometriosis will experience issues with fertility.

Getting a Diagnosis

The only way to know for sure if you have endometriosis is through a surgical procedure called laparoscopy. Laparoscopy uses a small telescope that is inserted into the abdomen through a very small incision. It brings light into the abdomen so the doctor can see inside.

Treating the Symptoms

There are a wide range of treatment options for endometriosis and your doctor may suggest a less invasive methods before ordering a biopsy. Some of the most common treatments include:

• The use of NSAIDs, such as ibuprofen (Advil, Motrin) and naproxen (Aleve). NSAIDs can help relieve or lessen the pain caused by endometriosis by stopping the release of prostaglandins, one of the main chemicals responsible for painful periods. While NSAIDs can help manage the pain-related symptoms of endometriosis for some women, it’s not effective in every case.
• Birth control methods such as the pill, the patch and the ring are often helpful to treat the pain associated with endometriosis because they reduce heavy bleeding. This method works best for women who only have severe pain during their period and not during the rest of their cycle.
• Progestins are recommended for women who do not get pain relief from or who cannot take hormonal birth control that contains estrogen (such as smokers). This synthetic form of the natural hormone progesterone is available by prescription as a pill or an injection.
• GnRH therapy uses medicines that work by causing temporary menopause. The treatment actually causes the ovaries to stop producing estrogen, which causes the endometriosis implants to shrink.

For some women, surgery may be the best treatment method. While there isn’t a cure for endometriosis yet, it is possible to remove some of the scar tissue and lesions with surgery.

If you have endometriosis, surgery could be an option if you:

• Have severe pain
• Have tried medications, but still have pain
• Have a growth or mass in the pelvic area that needs to be examined
• Are having trouble getting pregnant and endometriosis might be the cause

"It is important to note that there are other conditions that can cause many of the same symptoms as endometriosis," Yarroch says. "An OB/GYN can help determine if endometriosis is the appropriate diagnosis."

So What Now?

"Endometriosis can have a significant impact on a woman's life. Fortunately, there are treatment options available to manage pain and minimize recurrence," Dr. Yarroch says.

OB Emergency Dept/Hospitalist Program Debuts

Last month, ThedaCare announced the opening of their new Obstetrical Emergency Department (OB-ED) and Hospitalist Program. Providing specialized care to expectant mothers, babies and families, the new program is part of the update to the Theda Clark Peters Family Birth Center through the $100M investment to modernize the Neenah campus. The addition of these hospital-based women’s services can help ThedaCare continue to provide comprehensive, safe care for expectant mothers and babies in Northeast and Central Wisconsin.

The OB-ED, staffed by board-certified and board-eligible specialists, operates around the clock and provides care for pregnant women facing obstetrical challenges.

“Through this program, a trained physician will evaluate every patient, and our goal is that expectant mothers can leave the hospital with peace of mind, focusing on the health and well-being of their family,” said Dr. Eric Eberts, Department Chair of the ThedaCare OB-ED and Hospitalist Program. “Having an OB-ED and Hospitalist Program can redefine the standard of women’s care in the hospital setting to help continue safe patient care.”

The creation of an OB-ED and Hospitalist Program is an important milestone in ThedaCare’s history. For 115 years, ThedaCare has provided care for the people in Northeast and Central Wisconsin, an opportunity made possible more than a century ago when Theda Clark Peters directed a significant portion of her estate to be used to build a hospital in Neenah so that people in the community would have local access to medical care.

Through the program, women who are more than 16 weeks pregnant now bypass the emergency department and go directly to an obstetrical triage area located in the Family Birth Center at ThedaCare Regional Medical Center-Neenah. This program will supplement the care of a woman’s OB provider; her doctor will continue to provide care in the facility. The program ensures a highly specialized doctor to be available to evaluate a woman immediately, without waiting for the patient’s doctor to arrive onsite, or providing a consultation over-the-phone. 

Eberts noted that the program aims to provide support for ThedaCare’s other hospitals, including those in rural communities via telehealth consultations.

“The OB-ED and hospitalist program can help ensure that expectant mothers continue to receive timely, specialized care for themselves and their babies,” Eberts said. 

Learn more via NBC 26’s exclusive report, which includes Dr.Eberts’ special connection to Theda Clark Peters.

Meet Pa Kou Thao, Nurse Practitioner

You don’t question an epiphany. Such a revelatory moment can only be absorbed, followed.

Nonetheless, Pa Kou Thao did question the timing of hers.

“I was a year from graduating with my business degree when I got to be part of my nephew’s birth,” said the newest provider at Women’s Care of Wisconsin. “Two weeks before the semester started and I was like, “Yeah, I don’t think this is what I want to do.”

Thao immediately threw her business classes into a minor, switched to a nursing major, and started fresh.

It was a decision she knew she had to make. She never wavered, although a thought did cross her mind every now and then.

“There were times when I said to myself, ‘I could be getting my master’s right now.”

Thao pursued her calling, earned her nursing degree and became a labor and delivery nurse. Later, she would continue her studies and achieve her certification as a Family Practice Nurse Practitioner with a focus on women’s health.

You wouldn’t know it by looking at her, but she’s 17 years into her healthcare gig. With that kind of experience, no surprise there wasn’t a nanosecond of hesitation when asked about her philosophy of patient care.

“Everybody who walks through the door to see me is like a family member, right?” said Thao. “I'm going to treat you like you are my family, because that's how I would want somebody to treat any family member of mine if the roles were reversed.”

Not that she wouldn’t have had great success in the business world and made her mark there, but Thao relishes the impact she can make as a healthcare provider.

“My work is so fulfilling,” said Thao. “I love being able to develop long lasting relationships with my patients, people who come to see me year after year because we have that bond of trust.”

Thao is a highly positive force—easygoing, personable, empathetic. It’s easy to see why her patients love to see her.

Well, she had a bit of a different spin on that one.

“Almost every patient that comes in is like, ‘I hate these yearly exams!’ And I always tell them nobody enjoys them! But it’s so great they come in—it’s so important to take care of yourself and make sure you're keeping yourself healthy.”

A provider who effortlessly turns a first visit into a fast friendship, Thao loves connecting with her patients and using her expertise to make a difference in their lives.

Clearly the path of someone who followed her heart.

 

Incontinence: More Common Than You Think

Did you know that 50% of women have incontinence at some point in their life? Here’s what you can do to take control.

Incontinence is the loss of urine in an uncontrollable fashion. There are many reasons as to why people have it. Some of them are very easy to treat successfully and are easily cured, and some of them are very challenging to cure. But we can usually get significant improvement with treatment. Incontinence is one of my favorite conditions to see a new patient with; I can often cure them outright and almost always make a big improvement for them with fairly little intervention.

Most people put up with it and hope that it’s going to get better, or put if off until tomorrow, only to realize that several years have passed and it’s only gotten worse.

In generations past, people have looked at the loss of urine as a normal part of aging or normal consequences of childbearing, both of which I think are mistakes. What I would encourage people to think about is the fact that although incontinence is not painful, it’s not normal. People really don’t like to deal with it because it’s embarrassing. But they should realize, it’s very common, and often very easy to treat.

However, correctly treating incontinence means also that you have an understanding of what the true diagnosis is, very much like a headache. There are many different causes for it and the headache itself is usually a symptom of an underlying abnormality of some type, just as incontinence can be caused by many different things. 

Relief for women dealing with bladder control issues typically takes one of three routes:

• It can be as simple as a 10-minute outpatient procedure or a prescription for  medication.
• It may require a combination of therapies to get someone to a much better function.
• Sometimes we need to treat an underlying, undiagnosed urinary tract infection, which should be evaluated further, as it could possibly be a sign of other diseases such as MS or diabetes. 

There are varying levels of incontinence, all of which can be diagnosed and treated to help you return to a normal, active lifestyle.

Spasm and bladder irritability:

• Conditions where a person is urinating frequently and up a lot at night with a sudden sense of urgency (similar to the television commercials you see).
• Tends to be a neurologic, irritational aspect to the bladder.
• There are a handful of different medications that are typically used to treat this.

Stress incontinence:

• People leak a small amount of predictable urine every time they cough, sneeze, lift or jump.
• Will not get better with time.
• Often times this can be treated effectively with proper Kegel exercises, but a lot of times that treatment requires ongoing and continuous exercise by the person, and sometimes even then it won’t hold up over time.
• Should that fail, we can proceed with a small, 15-minute, outpatient procedure that is very successful (such as some type of sling procedure), which in the past was a very big surgery and nowadays really can be done quickly with a very fast return to full function status.

When incontinence affects how you function, what you’re doing, your clothing choices or travel plans, it’s just a shame not to get an evaluation and treatment—because so often, it is actually fairly easy to fix with many different treatment modalities. 

Suffice it to say, there are many treatments for many different causes in the many unique types of patients out there. But I would encourage readers to not for a minute think that this is a normal part of aging and something they simply have to “put up with.”  I would encourage them to seek medical evaluation and intervention, because if you’re thinking about the fact that you’re leaking urine, then it is probably affecting you on a daily basis.

Dr. Eric Eberts is an Obstetrician/Gynecologist at Women’s Care of Wisconsin. Contact Dr. Eberts at 920-729-7105.

The providers at Women’s Care of Wisconsin are devoted to you and your health. That means having the most advanced techniques, up-to-date educational information and a compassionate, caring staff. Our providers offer a well-rounded approach to your OB/GYN care, one that meets both your physical and emotional needs throughout every phase of your life. We call it our Circle of Care. And it begins with you.

Swift Connects with Patient in the Valley

No, not that Swift. A different Swift. But a Swift nonetheless. And there’s a Taylor in it too.

But not a Kelce. There is a reference to pro football, however.

This all started due to a Facebook post, one of those that immediately grabs your interest. It went like this:

With my first baby, I had some doctor changes, due to my previous doctor being injured. I was supposed to meet Swift before my induction date, but our baby had different plans and came a little early. The nurses called Swift when I was in labor and she agreed to come and deliver. I met her for the first time as I was delivering. Swift was sweet, kind, and ready to help me deliver my first baby. Fun fact: my nurse's name was Taylor!!

We had to know more. And Amanda Prodell was kind enough to share her story.

It’s quite the tale . . .

. . . Ready for it?

This was about three years ago. My really good friend is a Swiftie. Yeah, to the point where she wrote Taylor Swift a letter inviting her to her wedding. Never came. But that’s not my story. So, my husband and I struggled with fertility for quite some time, and we were seeing another provider in the Fox Valley area for fertility. In October 2019, we miscarried with our first one. I tried some more fertility treatments, and nothing was working. I just started a job at a different school, so I decided to give my body a break, start in the spring kind of thing. Well, COVID hit in March of 2020, and everything was shut down.

Literally a week after the COVID shutdown we conceived. My body was just able to do what it needed to do. Guess we just needed a little COVID in our lives to get pregnant.

In November of 2020, I had an insurance meeting at work and they said that even though your doctor might be in network, you had to make sure the hospital was in network too. Turned out my doctor had switched to a hospital that wasn’t in network for me, and the out-of-pocket deductible we would have to pay wasn’t going to happen.

I heard from different friends who said I should go to Women’s Care and their place on Ballard was really close to where I work, so I called them and told them my situation and they asked who I’d like to see. I’m pretty easygoing, so I let them choose. They got me set up with a provider that I saw a couple of times until she cut her hand and was taken out of commission. I already had an induction date with her for December 26th, a Saturday. Turns out on call that weekend was Dr. Swift. I never met Dr. Swift and didn’t really know anything about her, but I was game.

I was supposed to meet Swift on the Wednesday before the induction, but my little guy decided to come on that Monday. When the hospital staff asked me who my doctor was, I told them I really didn’t have one but that Swift was supposed to do the induction on the 26th. They gave her a call; she came up at 12:45 on December 21st and that was my first time meeting her. 

Swift was there for probably 45 minutes; she delivered my son, Keegan, then we chit chatted, and then she was gone. She was so great and really came through for me after all the craziness with my whole pregnancy. It just so happened though my delivery my nurse’s name was Taylor (and she was there for me too:)

Women’s Care in general just stepped up to the plate and really made me comfortable with all the changes that were going on.

Then when I got pregnant with my second (we got pregnant naturally), I called Women’s Care again, but by that time Swift had moved to her new location, which I probably could have made work, but coming to Appleton was just a lot easier. Told Women’s Care my situation; again, I was asked who I wanted to see. Honestly, I was really open to anybody who was honest and upfront. And I got Dr. Reed.

So I met with Reed throughout my whole pregnancy, and it was a really good experience. She really cares for her patients. She checked in on me after delivery. I was really happy I got her because it was kind of iffy. I didn't want to be induced at all, even though I had an induction date with one of her co-workers right on the books. But I knew that this little guy was probably going to come earlier than his due date due to my son coming earlier. Reed delivered our second, Tatum, on December 22nd. So they're three years and a day apart.

Oh, the football part. With Keegan, our birthing room was 412. I was like, this is perfect, Brett Favre and Aaron Rodgers. For Tatum, they put us in Room 410. My husband kind of wanted to be in 412 again, but I was thinking Brett Favre and Jordan Love, so we stuck with 410.

 

 

 

 

 

 

Abnormal Uterine Bleeding: Know the Facts

What is a normal menstrual cycle?

The menstrual cycle begins with the first day of bleeding of one period and ends with the first day of the next period. In most women, this cycle lasts about 28 days. Cycles that are shorter or longer by up to 7 days are normal.

What is abnormal uterine bleeding?

Bleeding in any of the following situations:

• Bleeding between periods
• Bleeding after sex
• Bleeding heavier or for more days than normal
• Any bleeding after menopause

Menstrual cycles that are longer than 35 days, or shorter than 21 days, are abnormal. The lack of periods for 3-6 months (amenorrhea) is also abnormal.

When is this common?

Abnormal uterine bleeding can occur at any age; however, at certain times in a woman’s life it is common for periods to be somewhat irregular. They may not occur on schedule in the first few years (around ages 9-16). Cycle length may change as a woman nears menopause (around age 50). It also is normal to skip periods or for bleeding to get lighter or heavier at this time.

What causes abnormal uterine bleeding?

• Pregnancy
• Miscarriage
• Ectopic pregnancy (fertilized egg begins to grow in a place other than inside the uterus, usually in the fallopian tubes)
• Adenomyosis (tissue that normally lines the uterus begins to grow in the muscle wall of the uterus)
• Endometriosis (uterine lining growth outside of the uterus)
• Certain birth control methods such as an IUD or the pill
• Infection of the uterus or cervix
• Fibroids (noncancerous growths that form on the inside, outer surface, or the wall of the uterus)
• Coagulopathy (problems with blood clotting)
• Polyps (growths that develop from membrane tissue)
• Endometrial hyperplasia (the lining of the uterus grows too much and can become precancerous)
• Cancer such as uterine, cervical or vaginal
• Polycystic ovary syndrome
• Abnormal weight (both very low and very high BMI)

How is it diagnosed?

Your health care provider will ask about your personal and family health history as well as 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 your bleeding.

You will have a physical exam. You may also have an ultrasound and blood test done. These tests will count the hormone levels and rule out some diseases of the blood. A pregnancy test may also be done.

How is it tested?

The type of tests completed will be based on your symptoms.

• Ultrasound
• Sonohysterography—fluid is placed in the uterus through a thin tube, while ultrasound images are made of the uterus. We recommend ibuprofen be taken before this exam.
• Hysteroscopy—device inserted into the vagina to view the inside of the uterus. This can be completed in our office or operating room.
• Endometrial biopsy—tissue is taken from the lining of the uterus.
• Dilation & curettage (D&C)—the cervix is dilated and instruments are inserted and used to remove endometrial or uterine tissue. It can sometimes be used as a treatment for prolonged or excessive bleeding that is due to hormonal changes and that is unresponsive to other treatments. This may be done in the office or in the OR with anesthesia. Most women may return to normal activities with a day or two.

Factors to consider

Most women can be treated with medications; others may need surgery. The type of treatment depends on certain factors:

• The cause of the bleeding
• Your age
• Whether you want to have children

Treatment Options

Birth Control Pills

• Often used to treat uterine bleeding that is due to hormonal changes or hormonal irregularities. May be used in women who do not ovulate regularly to establish regular bleeding cycles and prevent excessive growth of the endometrium. In women who do ovulate, they may be used to treat excessive menstrual bleeding. Non-steroidal anti-inflammatory drugs (NSAIDs, i.e. ibuprofen, naproxen) may also be helpful in reducing blood loss and cramping in these women.
• During the menopausal transition, birth control pills or other hormonal therapy may be used to regulate the menstrual cycle and prevent excessive growth of the endometrium. 

Progesterone

• A hormone made by the ovary that is effective in preventing or treating excessive bleeding in women who do not ovulate regularly. A synthetic form of progesterone, called progestin, may be recommended to treat abnormal bleeding. Progestins are usually given as pills and are taken once a day for 10 to 12 days each month or two, or taken continuously (every day). In women taking monthly cyclical progestin therapy, vaginal bleeding may begin before the 7th day of progestin treatment if the uterine lining is overgrown; otherwise, it may not be seen until several days after the last progestin tablet is taken. In some cases, the progestin is given on a regular basis to prevent excessive growth of the uterine lining and heavy menstrual bleeding. If no bleeding is seen after progestin treatment, the possibility of pregnancy or other hormonal imbalances should be explored.
• Progestins may also be given in other ways, such as an injection, implant, or an intrauterine device.

Intrauterine Device

• An intrauterine contraceptive device (IUD) that secretes progestin (ex. Mirena, Liletta, or Skyla) may be recommended for women who have abnormal uterine bleeding. IUDs are T-shaped devices inserted by a healthcare provider through the vagina and cervix into the uterus. IUDs include an attached plastic string that projects through the cervix, enabling the woman to check that the device remains in place.
• Progestin-releasing IUDs decrease menstrual blood loss by more than 50% and decrease pain associated with periods. Some women completely stop having menstrual bleeding as a result of the IUD, which is reversible when the IUD is removed.

Surgery

• Surgery, such as hysteroscopy, may be necessary to remove abnormal uterine structures (ex. fibroids, polyps). Women who have completed childbearing and have heavy menstrual bleeding can consider a surgical procedure such as endometrial ablation. This procedure may be performed in a gynecologist’s office or in an operating room as a same-day surgery, and uses heat, cold, electrical energy, or a laser to destroy the lining of the uterus.
• Hysterectomy may be done when other forms of treatment have failed or they are not an option. Hysterectomy is a major surgery that removes the uterus, that typically requires 3-6 weeks for recovery. Afterwards, a woman no longer has periods and cannot get pregnant.

 

 

Rolling with Life: Michelle's Fertility Journey

Michelle’s story begins like this: “It was a very tough and long journey.”

And ends with, “I don't know how I could have gotten any luckier.”

Really sets you up for the middle, doesn’t it? So here’s Michelle telling her own powerful tale, a roller coaster ride of emotions on the journey to create a family:

“It was a very tough and long journey. I’m on the older end; I turn 40 this year. We got married kind of later in life, in 2017. We really didn't start trying for baby until 2018. And from there we just kind of led the unexplained infertility life. For five years. We literally had to try just about everything, and most of those things we tried had to come out of pocket.

We were taught different ways to try, or you try different meds, or you try an IUI. You’re getting all this hope because your follicles look good, but then your lining doesn’t look good. So you try something else, and then your follicles and your lining look good, but it’s still not happening. Then I developed a cyst on my ovary, so for three months we had to wait for it to go away.

We even got a genetic test done to see if that wasn’t what was causing it. Got a $13,000 bill for a blood draw which, for a week, was another thing we thought might come out of pocket. That’s enough for the whole IVF process! But it got covered, thankfully.

Eventually we tried four rounds of IUI, and we thought we were at the end of our tunnel, but then it was on to IVF. So the nurse helped us with the different types of options for IVF consultations, we got all our paperwork done and were all set up for consults, but then it was a three month wait because so many people are dealing with infertility. In my Wisconsin infertility group alone there are 2.3k people!

It’s such an emotional time.

So for three months, we decided we weren’t going do any meds. We're just gonna roll with life. Two weeks before our first IVF consultation, I just thought I’d check: it was day 28. And the test showed the thinnest, lightest line. We were finally pregnant after five years of spending 1,000’s of dollars and trying all these different things trying to avoid IVF because it's such a cost.

I was overjoyed, but then extra cautious and scared, because I was always thinking, 'Oh my goodness, is this really going work?'

And of course, all kinds of weird things happened. Like he was really small. So by 28 weeks, we had to have appointments two times a week because there was fetal growth restriction. They thought my artery maybe wasn't working very well. So we had to be monitored twice a week. And I had to miss work twice a week to get monitored. And at first I was monitored just by Women's Care, but then I was also monitored by the perinatal clinic right in ThedaCare. So I had two different groups of people monitoring me. Then I got COVID. Then I got preeclampsia. At one point I was in the hospital for three days because they couldn't get my blood pressure back on track. We thought maybe we were having the baby then, but we made it to 37 weeks, which was the goal for his size. Had some trouble with the induction, got him back on track and ended up getting a C-section.

And I saw every doctor from Women’s Care. Vandenberg’s my primary, but I saw Williams. I saw Reed. I saw Brubaker. I saw Yarroch. I saw Augustine. I saw every single one of them. So many appointments, so many people helping. Everything was done well. Everything went well. I can’t be more thankful.

Dr. Vandenberg delivered Jaxon on April 11th. Right now, he just got over RSV plus a cold, but he’s doing well, pretty much on his curve. He's been small. He was at the one percentile for most everything except height. But his weight finally was up to the fifth percentile the last time we checked, so we’re making progress!

Honestly, this is this was our last shot at it. I'll be 40 in September. I don't know how I could have gotten any luckier.”