The opportunities for treatment of menstrual disorders have also expanded. There are now a number of options to control heavy menstrual bleeding, that in the past limited a woman’s ability to do what she wanted to do and live the life she wanted to live. Treatments available include hormonal contraceptive medications to regulate, or in some cases eliminate menstrual periods, a hormonal injection that can markedly reduce and in some cases eliminate menstrual bleeding, IUD’s containing a progestin hormone that can reduce period bleeding by as much as 90% after one year of use, and endometrial ablation (a minor surgical procedure that destroys much of the uterine lining, thereby reducing menstrual bleeding). There is also a newer medication that reduces the body’s ability to break down blood clots, thereby reducing menstrual bleeding, sometimes by as much as half. If heavy bleeding is caused by uterine fibroids, they can sometimes be removed from the inside of the uterus with a type of D&C procedure. Uterine artery embolization is a procedure done by an interventional radiologist (a doctor who specializes in imaging procedures) in which the blood supply to the fibroids is markedly reduced. The fibroids then degenerate over a period of a few weeks. Condoleezza Rice, the secretary of state under President George W. Bush, had this procedure to treat her fibroids and talked to the media about it.

Surgical procedures are being done with smaller incisions, and sometimes no incisions. Laparoscopic procedures now allow women who in the past would have had to have a big abdominal incision, to have the uterus removed vaginally. Hysteroscopy procedures allow us to see inside the uterus and remove polyps, fibroids and other abnormalities, under direct vision. Female sterilization procedures have become less invasive and in some cases are done in the office setting under local anesthesia.

Ultrasound, always an integral tool in the practice of gynecology, becomes ever more important. Machines are constantly improving, with more precise resolution of the image for more accurate diagnosis. Doppler studies, which evaluate blood flow in both gynecologic and obstetric studies, are a feature of modern ultrasound machines. Saline infusion sonography (SIS) allows us to accurately image the contour, as well as the thickness of the uterine lining. We are able to know, before a D&C and hysteroscopy procedure, what we can expect to find.

With large numbers of women entering the menopausal transition, and in some cases experiencing life-altering menopausal symptoms, treatment of these symptoms and menopause-associated conditions has become an important part of gynecologic practice. We now have many hormonal as well as non-hormonal options to treat these women. Women entering the menopause today benefit from the information gained from studies and practice over the past twenty years that have focused on menopause. We now have the knowledge to be able to tell a woman more precisely what the actual benefits and risks are of various treatment options.