By: Catherine Yeh for Uterus1
Angela L. Cope, M.D. is a gynecologist at Present Women’s Integrated Healthcare, P.A. in Grapevine, Texas. She received her Doctor of Medicine from Texas Tech University School of Medicine in 1990 and became a board certified gynecologist in November of 1996. She is a member of the American College of Obstetrics and Gynecology, the American Medical Association and the Texas Medical Association. Dr. Cope treats women of all ages and specializes in treating abnormal bleeding. Currently, she resides in Southlake, Texas with her husband and three kids. In her free time, she enjoys camping, watching her children play softball, and taking family trips.
Uterus1: What excites you in this field?
Dr. Cope: The ability to care for women and make sure they are getting appropriate care at all stages of their life.
Uterus1: Do you see a specific age group?
Dr. Cope: It’s a wide range of ages – anywhere from 16-17, to patients in their 70s or 80s.
Uterus1: How did you become interested in your field?
Dr. Cope: When we go to medical school we rotate through different fields of medicine, and when we did OB/GYN, I absolutely fell in love with the ability to interact with patients and talk about their families, help them with their families, and the ability to care for the patient through all stages of her life.
Uterus1: What do you think is the most common thing people are unaware of when it comes to OBGYN?
Dr. Cope: Well, most people don’t realize that the uterus’s only job throughout our reproductive years is to carry a pregnancy – that’s it’s entire job. The reason we see a lot of patients is because they have problems with bleeding, and the uterus’ response to any hormonal changes – whether it be good or bad changes – is to bleed. It’s the only thing the uterus knows to do. I think a lot of people don’t realize that oftentimes, the uterus does not produce any hormones itself. It is simply responding to hormone patterns it receives from the ovary, and it’s response is to bleed.
Uterus1: What is the most common question that you get asked in your office?
Dr. Cope: Usually it is questions about how to stop the bleeding or make the bleeding go away – or questions about pelvic pain. They just want the bleeding to be gone because it’s very disruptive to their lifestyle.
Uterus1: What are your recommendations for women?
Dr. Cope: It depends on the stage of life they are in. If they are young and still want to have children, we often talk about hormonal manipulation, usually in the form of birth control pills. Once people are done having children, we have more options for them and most of the time I find they are not interested in taking birth control pills. One of the most common things we’re doing right now is in-office endometrial ablation, which has been really nice for women. It’s really freed them up to have a procedure that will control their bleeding and that can be performed in the office with really no downtime and very little risk. It used to be that one of our only options was major surgery in the form of a hysterectomy.
Uterus1: I read that this procedure (endometrial ablation) is safe and less invasive. The only downside is not being able to have children afterward. So is it possible to perform this on young women?
Dr. Cope: It’s possible to perform ablation on any uterus – even on women in their early 20s, but we don’t usually ever see that. The youngest I’ve done in my office is 35 years old. That’s because it is absolutely imperative that you make sure you are done with childbearing. They absolutely cannot become pregnant once they have ablation done. It’s very important for the patient to understand that, and therefore we just don’t do that in young women.
Uterus1:Are there fewer side effects than with other procedures?
Dr. Cope: Yes. There is very little to no risk involved, and very few side effects. Really the only thing that we see and warn patients about is a discharge from the ablation for about 10 to 14 days. And that’s really the only side effect. They might have cramping for the first 24 hours after the procedure, but that’s usually mild and can be controlled with medication we prescribe.
Uterus1: What are other treatment options for heavy bleeding?
Dr. Cope: The first one would be birth control pills. We can also do Lupron, which is a medication typically used for endometriosis. It will shut down bleeding as well. It actually induces a menopausal state in women, but you get the side effects with it – hot flashes, insomnia, etc. – so typically we save this as a last resort. There is endometrial ablation, and then hysterectomy is the ultimate treatment for uncontrolled bleeding.
Uterus1: You gave a presentation on CA125 at one time. Can you please explain CA125?
Dr. Cope: CA125 is a marker in the blood stream that can help identify ovarian cancer. I think there’s a misconception in the general public that it is a screening test. I often get asked by patients if they can have the blood test for ovarian cancer when they come in for their routine screening. It’s very important for women to understand that CA125 is not a screening test. It is not just for anybody that walks through the door, and the reason is because it can be positive and suggest a disease other than ovarian cancer. It can be positive for people who have fibroids, liver disease, or heart disease. It was initially designed for women that we knew had ovarian cancer. For example, if I knew this woman had ovarian cancer, we draw her CA125, we get a number back, she has her chemo therapy…does her CA125 come down? If it does then it shows a good response to the therapy. It’s a great marker, but we need to make a more specific marker just for general screening. We don’t have that yet and researchers are desperately trying to find that.
Uterus1: What is the most important thing you want people to know about in-office HTA?
Dr. Cope: It can be done in the office. It’s really convenient for the patient. I think it has revolutionized women’s health care in that we have a fairly non-invasive procedure with very little risk that can change the way women bleed. I think they need to understand it is not perfect. We have success rates: about 50 percent of women who have the ablation will never bleed again. About another 30 percent of women will still have periods, but they’re much lighter. The last 20 percent of women we don’t see a good response, and they continue to bleed as heavily as they always did. And typically that’s the group of women we talk to about a hysterectomy. I don’t want patients to get the idea that this is a cure-all and you’ll never bleed again, because that would be misleading. But for 80 percent of women we get really good results!
Uterus1: What are the most exciting things you have seen or been able to practice most recently?
Dr. Cope: There have been three advances in healthcare that have really excited me. One is ablation. Number two is cord blood regeneration with stem cells – it is just a passion of mine. We are seeing childrens’ lives be saved and just changed forever. I met a family the other day whose son was cured of sickle cell disease that was going to kill him. They saved his little brother’s cord blood and that cord blood happened to be a match and saved his life. Just incredible – so I am doing a lot of education on cord blood right now. Another thing in office that’s really cool is Essure, a form of sterilization. We don’t have to take women to the operating room anymore. We can do that in the office with very little risk involved.
Uterus1: Finally, what is the most rewarding part of your job?
Dr. Cope: To see beginning of families grow. I’ve been in private practice for almost 14 years now and I have patients that I have taken care of since they were adolescents. I’ve been with them and they’ve had their families. And it is just an amazing thing to get to grow with people and watch their families all the way through life. It’s a lot of fun!