San Marcos Women's Health

Abnormal uterine bleeding is classified as any bleeding that occurs between regular menstrual periods. In some cases, abnormal uterine bleeding occurs after intercourse, or in women who are postmenopausal. Heavier-than-normal menstrual bleeding that lasts for more than seven days is considered abnormal uterine bleeding. Causes Of Abnormal Uterine Bleeding Abnormal uterine bleeding has many possible causes. In some cases, birth control methods, including birth control pills or intrauterine devices (IUDs), can cause spotting or heavy periods. Additional causes of abnormal uterine bleeding include the following: Abnormal growths Pregnancy Miscarriage Polycystic ovary syndrome Pelvic inflammatory disease Uterine fibroids Polyps Infection Cervical cancer Uterine cancer Vaginal cancer Abnormal uterine bleeding can also be caused by abnormal hormone levels. Often the result of high estrogen levels that are not balanced by an appropriate level of progesterone, they can prevent an egg from being released, or thicken the uterine lining and cause it to shed irregularly. Chronic medical conditions, such as thyroid disorders and diabetes, can also lead to abnormal uterine bleeding. Diagnosis Of Abnormal Uterine Bleeding Abnormal uterine bleeding is diagnosed through a physical examination and an evaluation of the patient’s medical history, including the frequency and length of menstrual periods. A pregnancy test may also be administered. Additional tests may include the following: Sonohysterography Blood tests Endometrial biopsy Hysteroscopy An ultrasound or MRI scan, which will provide images of the uterus and internal organs, may also be performed. Treatment Of Abnormal Uterine Bleeding Treatment for abnormal uterine bleeding varies, depending on its cause. Treatment methods may include the following: Hormone supplements Antibiotics to treat infection Removal of an IUD Birth control pills to regulate periods Nonsteroidal anti-inflammatory medication Surgery may be necessary to remove growths such as polyps or fibroids that can cause bleeding. Several other types of surgery may be performed to treat abnormal uterine bleeding. Endometrial Ablation Endometrial ablation is a procedure that destroys a layer of the lining of the uterus to stop bleeding. In some cases, it means the cessation of menstruation; in others, it means a reduction in menstrual blood flow to lighter or normal levels. Pregnancy following endometrial ablation is unlikely; a woman who wants to become pregnant should not have the procedure. Hysterectomy In severe cases, if other treatment methods have not been successful, hysterectomy, which removes the entire uterus, may be recommended. Hysterectomy requires a hospital stay, and then an at-home recovery period of 6 to 8 weeks. Abnormal uterine bleeding caused by a miscarriage requires prompt medical attention to prevent serious complications.

Adenomyosis is a condition that occurs when endometrial tissue, which normally lines the uterus, grows into the outer muscular walls of the uterus. This condition differs from endometriosis, in which the tissue grows outside of the uterus. Adenomyosis commonly occurs in women older than 30 who have had at least one full-term pregnancy. Symptoms of adenomyosis can include severe menstrual cramps, and heavy or prolonged menstrual periods. Adenomyosis usually does not occur after menopause. Causes Of Adenomyosis Although the exact cause of adenomyosis is unknown, it is believed to be caused by an invasion of endometrial cells into the uterine wall. Women who have had previous uterine surgery, as well as those who have given birth at least once, may be at a higher risk of developing adenomyosis. Research indicates that its development may be related to the production of estrogen in a woman’s body, because as estrogen production decreases during menopause, adenomyosis eventually goes away. Symptoms Of Adenomyosis Some women with adenomyosis do not experience any symptoms. Others may experience the following: Heavy menstrual bleeding Severe cramps and pelvic pain Pelvic pain during intercourse Bleeding between periods Passing of blood clots during period The uterus can also become enlarged, resulting in tenderness or pressure in the lower abdomen. Diagnosis Of Adenomyosis Adenomyosis is commonly diagnosed after a pelvic examination, and a review of symptoms, medical history and menstrual cycles. Additional diagnostic tests may include the following: Pelvic ultrasound Hysteroscopy MRI scan of the pelvis A biopsy of endometrial tissue may also be taken to rule out any underlying conditions. Adenomyosis can be difficult to diagnose because several other uterine conditions cause similar symptoms. Treatment Of Adenomyosis Treatment for adenomyosis depends on the severity of the condition, and often focuses on relieving symptoms. Anti-inflammatory medication and hormones may be prescribed. If pain is severe and does not respond to treatment, a hysterectomy, which removes the uterus, may be recommended. Most cases of adenomyosis resolve on their own, however, and symptoms dissipate as women go through menopause.

The annual gynecological exam, also known as a gynecological well-visit, is a yearly preventative and diagnostic examination which serves to maintain the wellness of female patients, as well as monitor any ongoing physical and hormonal conditions. This annual visit is an opportunity for doctors to counsel patients about maintaining a healthy lifestyle and minimizing health risks. The annual gynecological exam includes a routine breast and pelvic exam, and may include a screening for sexually transmitted diseases, such as chlamydia or gonorrhea. A Pap test may also be performed depending on the age and sexual history of the patient. The American College of Obstetricians and Gynecologists recommends that women begin annual pelvic exams at the age of 21. During the annual well-visit, a physical examination will be performed to assess the patient’s overall health. The examination may vary based on the patient’s age and sexual history, but most annual gynecological examinations may include the following: Pelvic exam Breast exam Pap smear HPV screening Blood pressure check Height and weight measurement Urine screening Cholesterol screening every 3 to 5 years Complete blood count Thyroid screening Screening for blood in stool In addition, there are several other tests that may be recommended for patients. These may include monthly self examination of the breasts, mammograms, bone density screenings, skin and mole examinations, blood sugar tests and others, based on age, individual medical history, family history, and lifestyle habits.

Breast cancer affects a significant number of women each year. It is the second-most-common cancer, and the second-leading cause of cancer death, among women. Most breast cancers are slow-growing, but there are types that are aggressive, which is why early detection is essential. Regular screenings are the best way to detect breast cancer in its early stages. The most common screenings are mammograms and doctor-performed clinical breast exams. Official recommendations are that, starting at 20 years old, a woman should have a clinical breast exam every three years. At 40 years of age, a woman should have a yearly clinical breast exam. The second recommendation is for a screening mammogram, but there is some dispute about the age at which women should start getting them, and how frequently. One recommendation calls for yearly exams once a woman turns 40 years old; another specifies biannual exams for women between 50 and 74 years old. A woman should check with her doctor to determine her best course of action. It may also be helpful for a woman to examine her breasts once a month, usually about a week after her menstrual period, to identify any changes or abnormalities such as a lump, swelling, irritation or pain. Breast self-exams are not officially recommended as a screening tool for breast cancer because their success in detecting early-stage cancers and increasing the survival rate have not been proven. But, by becoming familiar with the way her breasts normally look and feel, a woman may recognize changes indicating an abnormality.

Colposcopy is a diagnostic procedure used to examine, under magnifcation, certain areas of the body and determine abnormalities. A vulvar colposcopy typically examines lesions on the vulva and is used to identify cancer or genital human papillomavirus, also called HPV. The procedure is done with a colposcope, a microscope that can help identify malignant lesions on the vulva. It is usually performed as a follow-up to an abnormal pap smear. The exam itself is similar to a pap smear in that a speculum is inserted into the vagina so that the cervix is visible. The colposcope is situated so that the physician may view the area in question with a magnification of 10 to 40 times its normal size. If any abnormal cells are noticed, a biopsy of the tissue may be done. A colposcopy is a safe procedure with few complications. Light bleeding or discharge for up to a week after the procedure is normal.

The procedure is done in the hospital to remove advanced pre-cancer cells of the cervix.

Contraception is any method of birth control used to prevent pregnancy. A woman has many birth control options; which are appropriate depend on her age, overall health and lifestyle. Contraception can be permanent or temporary. Some types of contraception are more effective than others, and it is up to each woman to decide which type is right for her. During a woman’s monthly cycle, the ovaries produce an egg that moves through the fallopian tubes into the uterus. When an active sperm reaches and fertilizes the egg, it attaches to the wall of the uterus and begins to develop. There are various methods of contraception that prevent pregnancy, some by changing the process of a woman’s cycle, and some by ensuring that the sperm and egg do not meet. Methods Of Contraception There are two basic types of contraception available. Some are available by prescription only, and others can be purchased over the counter, at a pharmacy. Barrier Methods A barrier method of contraception places a barrier or block between the sperm and the egg, thus preventing pregnancy from occurring. Common barrier methods include: Cervical cap Diaphragm Sponge Condom Condoms and sponges may be purchased over the counter, but diaphragms and cervical caps must be prescribed and fitted by a physician. Spermicide, a substance that kills sperm, can be used in conjunction with all barrier methods except the sponge, which already contains a spermicide. Hormonal Methods Hormonal methods of birth control use hormones to prevent pregnancy. Most methods use estrogen or progestin, or a combination of the two. Both hormones prevent a woman’s body from ovulating or releasing an egg. In addition, progestin causes the mucus within the cervix to thicken, making it difficult for the sperm to reach the egg. Common hormonal methods of birth control include: Birth control pills Injections Vaginal ring Patch Implant IUD Hormonal methods of birth control are prescribed by a physician after a physical examination. The doctor determines which type of hormonal method of contraception is appropriate for each individual. Birth control pills must be taken on a daily basis, or on a schedule determined by the physician. In order for birth control pills to be effective, they must be taken daily or as directed by a doctor. Other types of hormonal methods, such as a vaginal ring, implant or IUD, are surgically implanted into the woman’s cervix or uterus, and release a steady stream of hormones. To be effective, both barrier and hormonal methods of contraception must be used consistently and correctly. Risks Of Contraception In general, hormonal methods of birth control have more risks associated with them than barrier methods. Barrier Methods Although most barrier methods of birth control are safe, they are associated with the following risks: Vaginal or cervical irritation Allergic reaction to spermicides Toxic shock syndrome Urinary tract infection Allergic reaction to latex It is important to note that condoms are the only method of contraception that provide protection against sexually transmitted diseases and HIV. Hormonal Methods Although most methods of hormonal birth control are safe, they are associated with the following risks: Irregular bleeding Heart attack Skin or vaginal irritation Blood clots Headache Weight gain Stroke Women who are older than 35 or who smoke have a much higher risk of heart attack or stroke when using hormonal birth control methods. Hormonal methods of birth control do not provide any protection against the HIV virus or sexually transmitted diseases. It is important to consider all risks inherent in a particular method of birth control before choosing it. Considerations Of Contraception Choosing a method of birth control is a personal decision. It is important for a woman to consider the following before deciding which method of birth control is right for her: Age Personal health issues Risks Hormone levels Frequency Effectiveness Permanence No contraception method is 100 percent effective. Women should consult with their doctors about the different types of oral contraception available, and to get answers to any questions they may have about contraception and family planning.

Cryosurgery, also called cryotherapy or cryoablation, is a procedure in which extreme cold produced by liquid nitrogen is used to destroy abnormal tissue. An alternative to traditional surgery and its drawbacks, cryosurgery is used to treat tumors in the kidney, lung, liver, breast, prostate, cervix and bone, and on the skin. For internal cancers, liquid nitrogen is circulated through a hollow needle, called a cryoprobe, that is inserted through a small incision, and then placed into the cancerous tissue. A CT scan and ultrasound provide guidance for proper placement of the probe. When it is inserted, ice crystals form around the probe, freezing nearby cells. After surgery, the cells thaw and are absorbed by the body. For treatment of skin lesions, liquid nitrogen is either sprayed on the area or applied with a cotton swab. The frozen tissue dissolves and a scab forms. For internal cancers, the procedure may require general anesthesia, and last for a few hours. To ensure complete removal of cancerous tissue, cryosurgery may be combined with chemotherapy or radiation therapy. It may also be used to treat retinoblastoma, a childhood cancer that affects the retina. Cryosurgery usually means patients have less pain, shorter hospital stays and recovery times, and fewer complications than they would with more-invasive traditional surgery. There is uncertainty surrounding cryosurgery’s long-term effectiveness. It may be effective in treating tumors that can be seen using imaging tests, but may miss microscopic cancers.

Dilation and curettage (D&C) is a procedure to scrape and collect endometrium, the tissue inside the uterus. Dilation is the widening of the cervix which allows instruments to pass into the uterus, while curettage is the scraping of the uterine walls. A dilation and curettage procedure is performed for several reasons. They are as follows: Diagnose uterine cancer or other conditions Remove tissue after a miscarriage Treat heavy bleeding Perform a therapeutic or elective abortion Investigate infertility A dilation and curettage is performed under general or local anesthesia. A speculum is inserted into the vagina to hold it open. Medication to numb the opening to the uterus may be applied at this time. A curette is then inserted to gently scrape the tissue.

When her due date approaches, an expectant mother may look for signs that labor may be starting. Certain signs may suggest that labor may be starting soon. It is important for a woman to be aware of the changes that her body is going through as it prepares for labor, and what to expect as the labor process begins. If a woman suspects that she is indeed in labor, she should contact her doctor or midwife immediately. Signs Of Labor As labor approaches, some women may experience a burst of energy and the impulse to clean or get the house ready for the baby. This urge is commonly referred to as “nesting”, although not all women experience it. As the body begins to prepare itself for labor, the baby may “drop” or move into the lower part of the pelvis. The cervix may begin to thin and soften. Vaginal discharge that is clear or slightly bloody may begin a few days before labor begins. Additional signs of labor include: Lower back pain or cramping that does not subside Cervix begins to open or dilate Uterus begins to contract at regular intervals Rupture of membranes (water breaks) It may help to time the contractions to determine whether they are true contractions or Braxton Hicks (false) contractions. True contractions last about 30 to 90 seconds, and become more frequent and intense. Stages Of Labor And Delivery The process of labor and delivery occurs in three stages beginning with the onset of labor. Depending on their preference or birth plan, some women may choose to experience the first phase of labor at home and as it progresses to active labor, they may choose to go to a hospital or medical facility. In a hospital setting, the heart rate and vital statistics of both mother and unborn baby are monitored during the labor process. The health and safety of the mother and unborn baby should always be considered first when planning for labor and delivery. First Stage The first stage of labor occurs in two phases: early labor and active labor. Early labor begins when the baby has moved down into the birth canal and the cervix begins to dilate. Mild contractions occur and a brown or red discharge may indicate that the mucus plug has been shed from the cervical opening. This phase may last from 6 to 12 hours but may occur more rapidly in women who have given birth before. Contractions become more frequent and much more intense during active labor and the cervix continues to dilate. An epidural may be administered for pain. The membranes around the amniotic sac may rupture (water breaks). Active labor may last up to 8 hours. Second Stage The second stage of labor occurs when the cervix has fully dilated and the mother is ready to push the baby out of the birth canal and deliver the baby. When the top of the baby’s head fully appears (crowns), the doctor or midwife will advise the mother to push and will help deliver the baby. If necessary, the doctor may make a small incision to the enlarge the vaginal opening (episiotomy) to help the baby fit through the birth canal. After the baby is delivered, the umbilical cord is cut. Third Stage The third stage of labor is the delivery of the afterbirth (placenta). This stage may last from 5 to 30 minutes. After the baby is delivered, contractions will continue and the mother may experience chills or shakiness. Usually, the woman will push one more time and the placenta is expelled from the uterus. If an episiotomy was performed it is stitched at this time. Labor is over once the placenta has been delivered. Pain medication is a personal choice during labor and many women find they are able to relax more and find relief from the use of medication. Other women may choose to experience labor and delivery without pain medication and use natural methods of pain relief such as a warm shower or bath, music, massage, or the assistance of doula. Childbirth can be a different experience for each woman and the methods used to relieve pain can vary based on the health and safety of the mother and child, as well as the recommendations from her doctor. Complications Of Labor And Delivery In most cases, the labor and delivery process will occur without any complications. In some cases however, a cesarean section (c-section) may be necessary when unexpected problems arise during labor or delivery. During a c-section, a doctor surgically removes the baby through the mother’s abdomen. It takes place in the operating room of a hospital. A c-section may be necessary when: A c-section may also be necessary if the mother has any underlying health problems such as a heart condition, or an HIV or herpes infection. Because of the possibility that a c-section may be necessary, most women with high risk pregnancies are advised to go to a hospital when they are in labo

Endometriosis is a painful medical condition that affects many women. It occurs when the endometrium (the tissue that normally lines the uterus) grows beyond the uterus and into other parts of the pelvic area. Endometriosis most commonly affects the ovaries, fallopian tubes and bowels, and the pelvic region behind the uterus. In rare cases, endometrial tissue can spread beyond the pelvis to other areas of the body. Endometriosis is usually not a serious condition, but it can cause chronic pain and interfere with daily life. During normal menstruation, the endometrial tissue swells and bleeds, and is shed from the uterine lining. When endometrial tissue grows outside the uterine wall, it can swell and form scar tissue, causing pain and discomfort. Endometriosis can develop any time after a woman begins menstruating, but is typically seen in women in their 30s or 40s. Although some women with endometriosis experience little or no discomfort, others suffer from considerable pain and, in some cases, may experience fertility problems. Causes Of Endometriosis While the exact cause of endometriosis is unknown, some research indicates that it may be hereditary. Women who have never had children or who experience longer than normal menstrual cycles may also be more likely to develop endometriosis. Additional causes my include the following: Retrograde menstruation (menstrual blood flows into fallopian tubes and pelvic cavity) Excessive growth of embryonic cells Attachment of endometrial cells to a scar after a surgical incision Endometriosis may also be caused by an immune-system disorder that makes the body unable to detect or destroy endometrial tissue growing outside the uterus. Symptoms Of Endometriosis In most cases, endometriosis is characterized by severe pelvic or lower-back pain, usually occurring during menstruation. Other common symptoms of endometriosis may include the following: Excessive menstrual bleeding Pain during or after sexual intercourse Painful urination or an increase in its frequency Infertility Pelvic cramping or pain that has been worsening Vomiting or nausea Exhaustion Bowel movements may also be affected by endometriosis, and many women suffer from constipation and diarrhea. Diagnosis Of Endometriosis Doctors often first suspect endometriosis based on the patient’s symptoms. Once a medical history has been taken, a pelvic examination is performed. Diagnosis is typically confirmed through screening with an ultrasound, MRI scan or diagnostic laparoscopy, which provide internal views of the abdominal area. Treatment For Endometriosis Depending on a patient’s symptoms, treatment for endometriosis varies. In milder cases of endometriosis, conservative methods are often effective at alleviating symptoms. Conservative methods of treatment include over-the-counter or prescription pain relievers, and birth control pills to regulate hormones. If the condition does not respond to treatment with medication, surgery to remove excess endometrial tissue may be required. Surgery for endometriosis is usually performed through minimally invasive laparoscopy, which can thoroughly remove the endometrial tissue. Severe cases of endometriosis may require hysterectomy, which involves the removal of the uterus and cervix. This may help to eliminate the severe pain caused by endometriosis. However, a hysterectomy is typically considered a last-resort form of treatment, especially for women of childbearing age, because they will no longer be able to bear children. There is currently no cure for endometriosis, and no certain method for its prevention. Some women find it beneficial to attend support groups with other women who suffer from endometriosis. With proper treatment and medical attention, endometriosis can be well managed.

Uterine fibroids, also known as myomas, are tumors that grow in the uterine walls. They are usually benign and can range in size and quantity. The exact cause of uterine fibroids is unknown, but they may be affected by hormones and genetics, as women are more likely to develop fibroids if they have a family member with the condition. Most fibroids do not cause any symptoms and do not require any treatment, however, in some cases they may lead to pregnancy complications. Uterine fibroids are most common in women over the age of 30 and during the reproductive years. Symptoms Of Uterine Fibroids Uterine fibroids are growths or benign masses that can form on the inside or outside of the uterus. In many cases, women do not experience any symptoms from uterine fibroids. If symptoms are present, the most common symptoms may include: Heavy bleeding Feeling of fullness Pelvic pressure Lower back pain Frequent urination If uterine fibroids grow very large they may put pressure on the large bowel, causing painful bowel movements, constipation or hemorrhoids. In some cases, sexual intercourse may also be painful because of large uterine fibroids. Complications Of Uterine Fibroids In rare cases, uterine fibroids may cause cause infertility or pregnancy complications. Uterine fibroids may prevent implantation and growth of an embryo. If the fibroids cause infertility or miscarriage, a doctor may recommend removing the fibroids before attempting another pregnancy. Fibroids present during pregnancy may increase the risk of premature delivery and cesarean section. Diagnosis Of Uterine Fibroids Uterine fibroids are commonly discovered during a pelvic exam. If fibroids are suspected, the doctor may confirm the diagnosis with blood tests and additional imaging tests that may include: Ultrasound Hysterosonography MRI scan Hysterosalpingography Treatment Of Uterine Fibroids In cases where women do not experience any problems or symptoms with uterine fibroids, no treatment may be necessary as doctors may choose to just monitor the condition. Uterine fibroids usually grow slowly and tend to shrink after menopause, when reproductive hormones levels drop. When uterine fibroids cause uncomfortable symptoms, hormonal medications may be prescribed to shrink the fibroids. A common method used to treat uterine fibroids is a procedure called fibroid embolization. Fibroid embolization, is a minimally invasive procedure that blocks blood flow to uterine fibroids, shrinking or destroying the tumors that grow on the uterine walls. There are several other minimally invasive procedures available to treat uterine fibroids without the use of surgery. These procedures may include: Laparoscopic myomectomy Myolysis Endometrial ablation and resection of fibroids In cases where the uterine fibroids have grown very large, more traditional surgical methods such as an abdominal myomectomy or hysterectomy may be performed. A hysterectomy is an option only for women who longer want to have children, as the entire uterus is removed. Except for a hysterectomy, and while rare, there is a possibility that new fibroids may develop after all treatments have been performed.

A hysteroscopy is a procedure, using a tool called a hysteroscope to examine the lining of the uterus and identify, diagnose or treat abnormalities. Reasons For A Hysteroscopy A hysteroscopy may be performed to determine the cause of: Abnormal bleeding Bleeding after menopause Infertility It may also be used to diagnose and remove fibroids or polyps and find and reposition an intrauterine device. Hysteroscopy Procedure A local or general anesthesia may be used to relax the patient and relieve any potential discomfort. The hysteroscope which has a light and camera, is inserted into the vagina and moved through the cervix to the uterus. The hysteroscope projects an image onto a display screen for the doctor to review. If polyps are present, the doctor may use a surgical device to cut and remove them. The doctor may also take a small sample of tissue to examine more closely under a microscope. Patients may experience some cramping or vaginal discharge following the procedure. While a simple and safe procedure, a hysteroscopy is not recommended for everyone. A hysteroscopy should only be performed if recommended specifically by a doctor.

Obstetrical ultrasound is a safe, noninvasive procedure that uses sound waves to create images of the fetus, placenta and amniotic fluid. These images can be viewed in real time on a computer monitor by both patient and doctor. These are the first images parents are able to see of their unborn child. An obstetrical ultrasound is performed several times throughout pregnancy in order to monitor the growth and development of the fetus. During the first trimester, an ultrasound can determine the age of the fetus or screen for any potential birth defects, such as Down syndrome. Later in the pregnancy, regular ultrasound exams will measure the size and position of the fetus, placenta and amniotic fluid to ensure that there will not be any major complications during delivery. Preparing For The Procedure Patients should drink plenty of water before an obstetrical ultrasound. A full bladder usually provides a clearer image of the fetus. It is best to wear loose-fitting, two-piece clothing that allows the lower abdomen to be easily exposed. A transvaginal ultrasound does not require a full bladder or access to the lower abdomen. The Ultrasound Procedure An obstetrical ultrasound can be performed in your doctor’s office during a regular visit. This procedure can be performed either transabdominally or transvaginally. Transabdominal Ultrasound A transabdominal ultrasound involves applying a gel to the lower abdomen and moving a handpiece, or transducer, across the skin. This exam requires a full bladder that should not be emptied until after the procedure is over. Transabdominal ultrasounds take 30 to 60 minutes to complete. Transvaginal Ultrasound A transvaginal ultrasound involves the insertion of a transducer into the vagina and rotating it for a comprehensive view of the fetus and surrounding organs. Patients may experience some mild pressure, similar to that experienced during a regular gynecological exam. There is no special preparation needed for this procedure, and it is usually completed in 15 to 30 minutes. A transvaginal ultrasound provides more detailed images of the uterus and ovaries and is especially useful in the early stages of pregnancy. Results Of An Obstetrical Ultrasound The results of this procedure are visible immediately for the doctor and patient to view. More detailed results are usually available within one to two days, which your doctor will analyze for any additional information. Normal results will show a healthy, growing fetus with a normal heart rate and no visible signs of birth defects. An abnormal ultrasound may indicate a fetus that is too small or underdeveloped for its age, in a breech position or has a birth defect such as absent kidneys or anencephaly. It can also indicate other problems such as an ectopic pregnancy or a lack of fetal heartbeat. If abnormal results occur, your doctor may need to perform additional testing or a procedure to address the abnormality. Risks Of An Obstetrical Ultrasound There are no major risks or complications associated with an obstetrical ultrasound for either the mother or fetus. Ultrasound is one of the most commonly performed diagnostic procedures and has been used for years in fetal monitoring and for many other purposes. There are no needles or ionizing radiation used during this procedure, eliminating the common risks of other diagnostic procedures.

Couples are considered to have infertility problems if they have been unable to conceive after a prolonged period, usually a year, of regular, unprotected sexual intercourse. Infertility may be attributed to the man, the woman, or both partners. When infertility is determined, which occurs about one-third of the time, there are many measures that can be taken to help the couple conceive. Single women who are having trouble becoming pregnant may also seek medical evaluation. Risk Factors For Infertility Women may be at increased risk of infertility if they: Menstruate irregularly or not at all Are older than 40 years of age Have undergone cancer treatments Have had more than one miscarriage Exercise excessively or have an eating disorder Are extremely obese Smoke or drink alcohol to excess Some women may want to be evaluated for infertility because they are already aware of an underlying anatomical anomaly or disease condition preventing conception. Causes Of Infertility Infertility may have a number of causes. Although the cause in a particular case may remain unknown, the following are possible reasons a woman may have trouble conceiving: Ovulation disorders, endometriosis, or pelvic adhesions Certain medications Uterine fibroids Damage to, or blockage of, the fallopian tubes Early menopause (before 40 years of age) Thyroid disorders, celiac disease or diabetes Cancer or cancer treatment Congenital or other disorders of the reproductive tract Fallopian tube blockage is frequently the result of pelvic inflammatory disease, usually caused by a sexually transmitted disease. Diagnosis Of Infertility In order to determine the cause of infertility, the patient may undergo blood tests, urinalysis, and imaging tests to check or monitor: Reproductive hormone levels Ovulation Anatomy of reproductive organs These tests may include an MRI scan, an ultrasound, or a hysterosalpingography. The last is a series of X-rays of the uterus and fallopian tubes using ultrasound guidance and contrast dye. Treatment Of Infertility Treatment for infertility is designed to maximize the fertility potential and allow for successful conception. Depending on the determined cause of infertility, recommendations for increasing fertility may include: Lifestyle changes, such as smoking cessation, alcohol avoidance Prescription of fertility drugs to induce ovulation Surgery to repair blocked or damaged fallopian tubes Surgery to correct uterine problems Administration of prescribed hormones Intrauterine insemination may also be performed to assist with pregnancy. In this procedure, a large number of healthy sperm are implanted directly into the uterus at the time of ovulation. If these infertility treatments are unsuccessful, other options for women with fertility problems include assisted reproductive technology (ART), such as in vitro fertilization, the use of donor eggs or the assistance of a traditional or gestational surrogate. Because ART potentially involves medical, emotional, financial, and legal complications, women or couples considering such intervention are advised to undergo counseling before proceeding.

IUDs are a very popular form of birth control. We stock and are able to place Paragard, Mirena, and Kyleena on the same day if approved by insurance and patient is on appropriate cycle day. By using ultrasound, we are able to achieve a high success rate for proper placement.

Tubal ligation is a surgical procedure that involves blocking, tying or cutting a woman’s fallopian tubes to prevent eggs from traveling into the tubes and being fertilized. It is a permanent form of birth control so you must be sure that you do not want to have more children in the future. Tubal ligation is not 100% effective; pregnancy can occur if the tubes grow back together or create a new passage. This is a rare occurrence and the procedure is effective for most women. Tubal ligation is performed either laparoscopically, with tiny incisions in the abdomen, or through a laparotomy or mini-laparotomy, which is open surgery with a larger incision. A full recovery usually takes about a week, and complications with this procedure are rare. While a tubal ligation is reversible, it does not have a high reversal success rate. It is important to discuss the different birth control options with your partner before undergoing a permanent procedure. Talk to you doctor today if you are considering this procedure.

A myomectomy is a surgical procedure that is performed to remove uterine fibroids,non-cancerous tumors of the uterus. Uterine fibroids may cause troublesome symptoms such as heavy menstrual bleeding and pelvic pain and pressure. Conservative treatments are initially used to treat uterine fibroids, but if they are not effective, surgery may be necessary. In some cases, a hysterectomy may be performed as treatment for uterine fibroids; however after a hysterectomy, a woman will not be able to bear children, due to the removal of the uterus. Therefore, a myomectomy is an effective treatment option for women considering having children in the future. Types Of Myomectomy Procedures Depending on the type or size of the fibroids, the myomectomy procedure can be performed through several different techniques. Abdominal Myomectomy Abdominal myomectomy is performed by making vertical incisions in the abdominal wall to access fibroids that require removal. The procedure is performed under general anesthesia. Full recovery is expected in approximately four to six weeks. Hysteroscopic Myomectomy A hysteroscopic myomectomy uses a tool called a resectoscope. The resectoscope is inserted through the vagina, and releases a liquid to expand the uterus and then shave away the fibroid pieces. The fibroid tissue is then flushed from the uterus. Laparoscopic Or Robotic Myomectomy During a laparoscopic or robotic myomectomy, a laparoscope with a small tube with a camera, is inserted into the pelvis. This tool is used to remove fibroids through small incisions made in the abdomen. Laparoscopic patients are usually released the same day. After any myomectomy procedure, vaginal spotting may occur. Patients may also be advised to avoid physical activities, heavy lifting and sexual intercourse for several weeks after the procedure. Risks Of Myomectomy Although these procedures are generally considered safe, common risks may include: Blood clots Infection Minor blood loss Damage to pelvic structures In rare cases, if bleeding is uncontrollable during the myomectomy procedure, a hysterectomy may be necessary. Considerations Of Myomectomy Most women who undergo a myomectomy procedure experience significant relief of symptoms. While women who undergo myomectomy will still be able to bear children, the procedure may have an effect on fertility due to scarring that can be incurred during surgery. Women who have undergone a myomectomy are also more likely to give birth via cesarean section in the future.

Choosing a method of birth control is an important decision many women must make each day. Implantation devices offer long-term convenience and protection that is appealing to many women. Nexplanon is a birth control implant that is inserted under the skin and releases hormones into the body to prevent pregnancy. While there are several different types of devices available today, Nexplanon® is a discreet, single-rod implantable device that is medically inserted by a doctor. Nexplanon is effective for up to three years and is more than 99% effective in preventing pregnancy. How Nexplanon Works The Nexplanon devices that is inserted under the skin releases hormones that prevent the ovaries from releasing eggs. These hormones also cause the lining and mucous in the cervix to thicken, making it difficult for sperm to reach the uterus and fertilize the egg. This process prevents pregnancy from occurring. Insertion And Removal Of Nexplanon A doctor will implant Nexplanon under the skin on the inside of the upper arm. Insertion is performed quickly through a minor in-office procedure. To remove Nexplanon, a tiny incision is made in the arm and pushing on the other end will pop the rod out. The insertion and removal of Nexplanon requires extreme precision and must be administered by a professional. The implant can be removed at any time, but will remain effective for three years. Risks Of Nexplanon While Nexplanon is a safe and effective form of implantable birth control, there are risks and side effects which may include: Irregular periods Headache Weight gain Acne Skin irritation or pain at the implant site Ovarian Cysts Blood Clots Mood swings Nexplanon does not provide any protection against the HIV virus or sexually transmitted diseases. Women who are older than the age of 35 or who smoke, have a much higher risk of heart attack or stroke when using contraceptives such as Nexplanon, that contain hormones. Choosing the right method of birth control is a personal decision. It is important for patients to consult with their doctors about the different types of birth control available before deciding on using Nexplanon.

We can freeze condyloma, moles and molluscum in the office.

An ovarian cyst is a fluid-filled sac that can form in the ovaries. The ovaries are two small organs that produce eggs and female hormones. The ovaries affect our body’s appearance, menstrual cycle and pregnancy. There are several types of ovarian cysts. The most common form of a cyst is a functional cyst. Functional cysts form during ovulation. Eggs that are produced each month are grown in tiny sacs called follicles. After these sacs release the egg, the sac dissolves turning into corpus luteum, which produces hormones. If the sac does not dissolve, a functional cyst will form from the sac and cause them to grow. Normally the cysts disappear within a few months. They are rarely cancerous but can cause mild symptoms. Other types of cysts can form as a result of disease or from the egg not being released. These may be larger and more painful. While some ovarian cysts don’t cause any symptoms, others may experience the following symptoms: Pressure, swelling or pain in the abdomen Pelvic pain Pain during sex Weight gain Abnormal bleeding Nausea Vomiting Ovarian cysts can usually be diagnosed during a routine pelvic exam. An ultrasound or blood test may also be used to diagnose and determine the size and type of the cyst. Many cysts will go away on their own, so initial treatment may just be to wait and see if the size changes. Surgery to remove the cyst may be performed in those cysts that do not change or cause pain. If you think you have a cyst, schedule a pelvic exam with your doctor.

A pap test is a screening for cervical cancer. It is a standard gynecological procedure that examines your cervix for changes or abnormalities. It can also detect infections and the human papillomavirus (HPV). A pap test is recommended every year for women over the age of 21 and slightly less frequently for women over 30. A pap test collects cells from your cervix. The cells are sent to a laboratory for testing. Regular Pap tests detect problems quickly and rule out mistakes made by false positive and false negative results. We strive to detect cervical cancer as early and as accurately as possible with the use of PapSure®. PapSure is the only in-office direct visual screening exam, approved by the Food and Drug Administration (FDA) for all women. It is a visual exam, performed by your physician, in addition to your Pap Test. PapSure reduces the amount of false results. PapSure uses Speculite®, a bright light technology that illuminates the vagina and helps the doctor visually identify any abnormalities. The cells are examined under a blue light which will cause any irregular cells to appear white. Results are rapid and provide extra confidence to the Pap test results.

Pelvic pain syndrome is a chronic condition that involves persistent pain in the lower-abdominal and pelvic regions. Pelvic pain syndrome may be diagnosed when pelvic pain is chronic, and has been present for more than 6 months. It can affect women both physically and emotionally, leading to sleep disturbances, anxiety, depression and sexual dysfunction. Pelvic pain can be a symptom of an underlying condition, or its cause may remain unknown. Living with pelvic pain syndrome is often difficult, and many women spend years trying to determine its cause. Causes Of Pelvic Pain Syndrome In many cases, the exact cause of pelvic pain syndrome is unknown. In others, symptoms are linked to other health issues that contribute to pain in the pelvic region. Possible causes of pelvic pain syndrome include the following: Endometriosis Hormonal changes Irritable bowel syndrome Scarring after abdominal surgery Interstitial cystitis Pelvic inflammatory disease Uterine fibroids Pelvic pain syndrome can also occur in women with a history of vulvodynia (chronic vaginal pain and infection). Symptoms Of Pelvic Pain Syndrome Patients with pelvic pain syndrome often experience the following: Constant or intermittent pelvic pain Severe cramping Muscle tenderness Pressure within the pelvic region Pain during intercourse Painful menstrual periods Fatigue Backache Pain during bowel movements or urination Pain when sitting for long periods of time Pain in the pelvic muscles can lead to various problems and complications that primarily affect the bladder and the bowels. In some cases, pain spreads to the back and legs. Diagnosis Of Pelvic Pain Syndrome Pelvic pain syndrome is diagnosed through a physical examination, and a review of symptoms and the patient’s medical history. During the exam, the pelvis is checked for signs of infection or abnormal growths. Additional diagnostic tests may include the following: Laparoscopy Ultrasound Colonoscopy Cystoscopy CT scan Tissue samples of the cervix or vagina may be taken to test for any signs of infection or sexually transmitted disease. Treatment Of Pelvic Pain Syndrome Treatment of pelvic pain syndrome varies depending on its underlying cause. If an infection is the cause, antibiotics may be prescribed. If an underlying cause cannot be identified, treatment focuses on managing painful symptoms. Treatment can include the following: Pain medication Hormones Neurostimulation Antidepressants For some people, physical therapy that helps to develop healthier and stronger muscles can relieve symptoms. In severe cases, surgery may be recommended to treat underlying causes, such as endometriosis, or to remove scar tissue.

Low Risk Pregnancy Most women fall into this category. Our goal is to assist the mom in managing her pregnancy as she likes. High Risk Pregnancy We manage all high risk conditions. Common conditions include diabetes, hypertension, advanced maternal age, twins, lupus, multiple miscarriages, molar pregnancy, previous cesarean section, previous stillbirth, previous adverse outcome

A sexually transmitted disease, or STD, is a disease or infection that is spread from one person to another through sexual contact. Most STDs are caused by bacteria, parasites or viruses, that are transmitted through contact with the genitals, skin, mouth, rectum, or bodily fluids. STDs can cause problems ranging from mild irritation to severe pain. Left untreated, some STDs can cause illness, cancer, infertility or harm to a fetus during pregnancy Risk Factors For STDS STDs may be caused by a bacterial or viral infection that is spread through sexual contact. Individuals who may be more at risk for contacting an STD may include those who: Engage in unprotected sex Have multiple sexual partners Are already infected with an STD Abuse drugs or alcohol Share needles for drug use or tattoos In many cases, sexually transmitted diseases have no symptoms, especially in women, so a person may not even know if they have been infected. Periodic testing is recommended for anyone who may be at risk for an STD, including those who have multiple sexual partners, even if they are having protected sex. Types Of STD Testing STD testing is not part of a standard physical exam or gynecological checkup, so unless an STD infection is suspected by a physician, testing must be specifically requested. The method of testing may vary depending upon the type of STD and it may include the following methods: Blood test Urine test Swab sample from the genitals Tissue sample There are also several at-home test kits available for certain STDs. These tests usually involve the individual collecting a urine sample or a genital swab at home and sending it to a laboratory for analysis. Results are usually received within a few days. In some cases, because the sample is taken at home and not in a completely sterile environment, results of these test may not always be reliable. Positive test results from at-home STD tests, should always be confirmed by a doctor. If an individual tests positive for an STD, a treatment plan should be discussed with and developed by a doctor. Fortunately, there are many effective treatments available for most STDS and although many STDs cannot be cured, there is medication available to treat and manage symptoms. Patients infected with a sexually transmitted disease should inform any sex partners of the infection to make sure they are tested and treated. This reduces the risk of re-infection and spreading the disease to a partner. STDs are serious infections that can cause lifelong or recurring symptoms and side effects. It is important for individuals to practice safe sex and get tested often.