Search for tag: "stop"

Interviewer: How to handle a bloody nose that doesn't seem to want to stop bleeding. Emergency room Dr. Troy Madsen, what should a person do?

Dr. Madsen: Bloody noses are a very common thing that we see in the emergency department and these can be very messy and, sometimes, really tough to stop. But the thing I tell people, the key is if you're at home, hold pressure on your nose. Don't hold it on the bony part of your nose. Hold it on the soft part of your nose on the outside and hold pressure for 15 minutes. You'll be really tempted after two or three minutes to let up and look, but just keep holding pressure.

If you look after 15 minutes and it's still bleeding, hold pressure for another 15 minutes. Look again, if it's still bleeding, another 15 minutes. So three times total. If it's still bleeding at that point, you may need to come to the emergency department, but 95% of the time, this is going to work. Most times, it's going to keep you out of the ER.

updated: February 22, 2021
originally published: January 25, 2019

You've been so good about your family planning. You've always used birth control, but when can you stop? This is Dr. Kirtly Jones from Obstetrics and Gynecology here at University of Utah Health Care and this is The Scope.

So you've spent all your life planning your children. You had your babies when you wanted them. You didn't have any extra babies. You've really been good at it, but when can you stop? The answer is when you or your partner are using some form of really good birth control so you can stop. If your partner has a vasectomy, well, that's great.

Now, a really good form of birth control was menopause. So let's talk a little bit about your contraceptive method and menopause. First, fertility, we know, declines starting at about 30. We know that women who are trying to get pregnant sometimes struggle in their late 30s and certainly do in their 40s. The difficulty is that a pregnancy in your 40s that's unplanned is a definite problem because women in their 40s who get pregnant, even though they're not very fertile, do have higher risks of complications in pregnancy, like high blood pressure and diabetes.

They're actually more likely, believe it or not, to have twins. And they have more complications in terms of blood loss and a whole lot of other problems just with the pregnancy. And of course, we all worry about the difficulties in chromosomal abnormalities in our babies that increases in women after their 30s. So women are more likely to have complications in pregnancy. They are more likely to have a baby with a chromosomal anomaly like Down syndrome and importantly, they are more likely to miscarry. And by the end of your 40s, you are really likely to miscarry.

However, you don't want to get pregnant even though your chances are low. So when, even if you're being very careful, when is it time to stop? Okay. So let's now talk about menopause. Menopause is defined as when you haven't had a period for a year. Then that last period a year ago is your menopause. Now, you have to be of the right age.

So the average 20-year-old who hasn't had a period for a year is probably not in menopause. She hasn't run out of eggs. She may have another reason for not having her periods. But women in their late 40s and early 50s who haven't had a period for a year are very, very likely to be in menopause. So if you haven't had a period for a year, then you're likely in menopause and you can stop using your contraceptive method.

However, it's difficult to know if you're in menopause based on your periods if you're using a contraceptive method that changes your periods. So let's take, for example, birth control pills. Birth control pills block ovulation but give you hormones that make you have a period every month. So you can be in menopause, have no more eggs, be completely infertile, but because you're taking the pill, you'll have a period every month.

So how do you know, if you're on birth control pills, that you're in menopause? Well, the difficult answer is you have to stop your pills and see what happens. If you stop your pills, and you're about 52, and you don't have a period for six months, then you're in menopause. But what happens if you are 52, and you're still fertile, and you stop your pills, and you get pregnant? Well, the option is, of course, to stop your pills, see what happens, and use a different method, a barrier method, use condoms, use foam. Remember, you're not very likely to get pregnant because you're not very fertile and you're not very likely to stay pregnant because you're likely to miscarry. So that's one option.

The other option is to say, "Well, why don't I just stay on my pills because going through the perimenopause," those years when your periods are totally unpredictable and not very pleasant, "why don't I stay on these nice little periods that I like on the pill until I'm about 54?" We know that at 54, about 90% of women have gotten through menopause. At 50, the average age of menopause, only 50% of women are menopausal. But by 54, about 85 to 95% of women are menopausal. So you just stay on your pills and stop at 50 and you're very likely to be done.

Let's talk about an IUD that has hormones in it. For women who have an IUD with hormones in it, many of those women have very light periods or no periods at all so you may not know that you're in menopause. You may have some hot flushes because your estrogens have gone away. You may use a blood test, which doesn't work very well for women on the pill, but it can work for people with a hormone-containing IUD. You could do a blood test called FSH and if that is really high, then it's likely, not guaranteed, but likely, that you've run out of eggs and you're in menopause.

Or you can just stay on that IUD that has some hormones in it until you're about 54. And many women in their early 50s who have hot flushes may want to take a little estrogen and they have the progestin protection. They protect their uterus lining against abnormalities with that little hormonal IUD. So wait until you're a little older and then take your hormonal IUD out.

If you're taking a shot like Depo-Provera, about 80% of women on Depo-Provera don't have periods so you won't know when you're in menopause. Well, the same kind of strategy goes with Depo-Provera as it does with the hormone-containing IUD. You can just wait till you're a little older or you can stop, use a backup method. You can stop your shots, use a backup method, and wait and see if you start your periods again.

So this is kind of a complicated question. The good news is that for women who stop their method, whatever it might be, at 50, then, in fact, the chances of getting pregnant are very low. How low is low for you, though? If the chances of getting pregnant and having a baby is 50 to 1 in 100, is that a number that you're willing to take a risk for? Not me. For me, that's no, I wouldn't take a 1 in 100 risk of a baby, that with all the complications of a pregnancy at 50 is. So I was much more willing to push my contraception out to 54 and then say, "Now I'm ready to be done."

So it's a personal choice. It's one that you discuss with your partner, with your family, if that's what you want to do, in terms of what their thinking about future childbearing, what kinds of risks are they willing to take if you do get pregnant? But definitely talk with your clinician because there are some options that are really good ones to make this transition with low fertility, but still some fertility, and some good therapy for menopausal symptoms.

So many women actually use a low-dose birth control pill to help them with their menopause symptoms. So that's the difficult answer for a difficult question, but I want to say good for you for having been such a good contraceptor all these years. And thanks for joining us on The Scope.

updated: January 28, 2021
originally published: September 29, 2016

Dr. Jones: Wait, can we stop at the next gas station? Yes, I know we stopped at the last one but this is your bladder speaking and maybe it's time to get some help. This is Dr. Kirtly Jones from Obstetrics and Gynecology at University of Utah Health Care and this is your bladder on The Scope.

Announcer: Covering all aspects of woman's health, this is The Seven Domains of Woman's Health with Dr. Kirtly Jones on The Scope.

Dr. Jones: Urinary incontinence is common in women, as many as 30% of women have incontinence for one reason or another. Babies moved your bladder around or you have an overactive bladder. Incontinence pads are a billion dollar business. But if your primary care provider can't help or you have more complicated medical issues maybe you need to see a urologist.

Today in The Scope Radio studio we'll be talking to Dr. Sara Lenherr. Dr. Lenherr is a urologist at the University of Utah and she's going to help us understand some of the more complicated reasons for bladder problems. She has a special interest in neurology, let's talk about how our brain and our bladder communicate.

Dr. Lenherr: The brain and the bladder have a really important communication process that needs to occur and basically the bladder is designed to store urine as a vessel until your brain tells it that it's okay to go to the bathroom, like when you're near a bathroom. And then the sphincter is designed to hold urine in place. Again, when you're able to get to the bathroom in time.

Sometimes in some medical conditions and other things that have happened with pelvic surgery or other types of vaginal deliveries with babies, that communication can get disrupted and so we need to pay special attention to that type of communication.

Dr. Jones: I always admired dogs who could put a little here and put a little there and do exactly what they wanted and when. But when that's not working I thought only men went to urologists. You know, for their prostate problems or those guy things. So urology for girls? For women?

Dr. Lenherr: So that is a really common perception and actually women have bladders too and they need to be pee too and urologists are specially trained to take care of the bladders pretty much exclusively and so we're here to help both men and women.

Dr. Jones: Great. So I'm an OBGYN and in our department we see a lot of women with urinary problems and we can fix a lot of them. But we're not very good for those women with complex medical problems. So can you talk a little bit about that?

Dr. Lenherr: So women have many different sorts of disorders that can disrupt the way the bladder works. The common ones are ones that disrupt the signals that go back and forth between the bladder and the brain. And also there are signals that make too much urine, so some women have heart disease which causes their kidneys to actually make urine and shift that around at the wrong time, and so they need to go more frequently and urgently because they're just making more urine.

There are many different types of conditions that affect the way the bladder works and really with an in-depth evaluation with a specialized urologist is really useful in order to figure out do we need to work on the bladder squeezing too much at the wrong time? Or is it a problem with the sphincter being too leaky, causing you to leak when you don't want to?

Dr. Jones: Well I can see that really takes some specialty training and you did a specialty fellowship in this area?

Dr. Lenherr: Yes, so there's a new specialty that came out a couple of years ago called, "Female Pelvic Medicine Reconstructive Urology" and we specialize in basically bladder function and how the bladder and the brain communicate. In order to evaluate how the bladder and the brain communicate frequently we perform what's called, "urodynamic evaluation" where we study the bladder pressures and the sphincter pressures, the urethral pressures, and figure out how they coordinate and communicate with different sensations.

Dr. Jones: Well we're really glad you're here at the University of Utah for all of us who are getting a little older, having a few more medical problems, and don't have the bladder that we want. Voluntary control of the bladder is a beautiful thing, but if it's not working for you, we and Dr. Lenherr can help.

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