Woodlands OBGYN Associates

Congratulations on Your Pregnancy! At the first sign of pregnancy, it’s important that you begin a routinely scheduled prenatal care plan for your child. This allows the optimum knowledge base for you as a mom-to-be, as well as provides for the opportunity to spot any nutritional deficiencies or issues such as gestational diabetes, which could adversely affect you or your baby’s health. At Woodlands OBGYN Associates, we understand the importance of this level of care, so we’re committed to developing a prenatal care plan designed specifically with you and your baby in mind. Giving Your Baby a Healthy Head Start At the first sign of pregnancy, it’s important that you begin a routinely scheduled prenatal care plan for your child. This allows the optimum knowledge base for you as a mom-to-be, as well as provides for the opportunity to spot any nutritional deficiencies or issues such as gestational diabetes, which could adversely affect you or your baby’s health. At Woodlands OBGYN Associates, we understand the importance of this level of care, so we’re committed to developing a prenatal care plan designed specifically with you and your baby in mind. Developing an Individualized Prenatal Care Plan Together, we will work to develop a carefully constructed individualized prenatal care plan to address all of the aspects of OB care, but which are tailored to your specific medical needs. We will start by implementing standard care practices such as regularly scheduled visits. From there, we will adjust the frequency of your visits based on how your baby is progressing, and the results of any diagnostic testing that may be completed. How often will I be seen during my pregnancy? For women who are not experiencing any medical issues during pregnancy, prenatal visits are scheduled every four weeks until 32 weeks gestation, then every two weeks from 32-36 weeks gestation and then once weekly until you deliver. If you experience any complications or illness during pregnancy, or are having twins, you should expect to be seen more frequently. Your doctor will visit with you about your individualized prenatal care plan and will instruct you about the proper dosage and daily ingestion of prenatal vitamins, issues related to diet and weight gain and many other topics throughout your pregnancy. What routine tests will be performed? At your first visit, your general health is assessed in a number of ways. First, a blood test will be done to verify that you are, indeed, pregnant. Upon confirmation of pregnancy, we will identify your blood type and Rh factor. We will also look at your red blood cell count to check for anemia (a low red blood cell count is an indicator for anemia). We will check for rubella to check for exposure to German Measles and we will perform tests for syphilis, hepatitis B, and HIV. Second, we may also perform a pap smear test and test for gonorrhea and chlamydia at this time. Other tests may be performed at this time as well, based on your medical, obstetrical, or family history. Between weeks 24 and 28 of your pregnancy, your blood count test for anemia will be performed again and you will be screened for gestational diabetes with a one-hour glucola test. If results from your Rh factor come back as negative, then you will receive a shot of Rhogam at 28 weeks so that your blood type does not “fight” with your baby’s blood type during pregnancy and delivery. Your doctor can explain more to you about Rh factor and the use of Rhogam during a scheduled in-office visit. At 32 weeks, you will be rescreened for HIV. In addition, as part of your Individual Prenatal Care Plan, when you are 36 weeks along in your pregnancy, we do a vaginal culture to look for Group B Strep. Group B Strep is a bacteria that many women carry in the vagina. It is usually asymptomatic and does not cause any problems, but has the potential to cause an infection in babies during vaginal delivery. If this test returns positive results, you will be treated with IV antibiotics during labor. Will I have routine ultrasounds? Yes, you will have routine ultrasounds during your pregnancy. We understand how exciting it is to see your baby on ultrasound and to share this wonderful experience your family. Unfortunately, insurance companies often have limited coverage as to the number of ultrasounds we can perform. Ultrasounds beyond the number your policy allows can be performed and paid for directly, should you desire additional ultrasounds during your pregnancy. Visit our Ultrasound page to learn more about routine and optional ultrasounds that are available to you. You are an individual and your pregnancy is unique. Your Individualized Prenatal Care Plan reflects how much we believe this to be true. You are an individual and each pregnancy is unique; therefore, your Individualized Prenatal Care Plan reflects how much we, at Woodlands OGBYN Associates, believe this to be true!

At Woodlands OBGYN Associates, We Deliver! We are excited that all our patients will deliver at Houston Methodist The Woodlands. This is an outstanding facility that provides exceptional nursing, anesthesia and neonatal care for you and your infant. We consider it an extension of our office and of the obstetrical services we provide. The phone number for labor and delivery at Houston Methodist The Woodlands is 936-270-2796. If you need to speak with us at any time, please call our office at 281-364-9898. If you call during office hours, please ask to speak directly to a nurse, or you can leave a message and we will get back to you as soon as possible. Who will delivery my baby? We recognize what a special time the birth of your baby is, and we feel privileged to share this experience with you. If we should not be available when you are in labor due to illness, vacation, family emergencies or other commitments, one of our associates will be there for you. All the physicians who may attend your delivery are superbly trained and are board-certified. In addition, they provide a warm, caring and compassionate approach to childbirth and we are confident that you will receive the highest quality of care. Do I have to register at the hospital? YES — you can register any time after 20 weeks of pregnancy. Please go to: houstonmethodist.org/childbirth and you will be prompted to register for delivery. At some point, after you complete the online registration, you will need to go to Methodist and sign forms to complete your registration process. Are there any “getting ready for childbirth classes” I should take? There are a number of classes designed to instruct you on what to expect during labor and delivery. Many are offered through the hospital and include classes about pregnancy, delivery techniques, cesarean delivery, fitness and well-being during pregnancy, breastfeeding, CPR and first aid, and baby care. Detailed information about these classes are available online at the hospital website. These classes are optional and it is not required that you take any classes prior to childbirth. When should I go to the hospital? If you are 36 weeks or more in your pregnancy, you should go to the hospital if: You are experiencing regular contractions that occur every 5 minutes, the contractions are accompanied by pain, they last 60 or more seconds and they have been going on for at least one hour. You think you are leaking amniotic fluid. Most women experience what they describe to be a large gush of fluid. If you experience this, even if you are not experiencing contractions, you should go to the hospital. You have bleeding similar to your menses. Spotting or brown discharge may be considered normal. You are not feeling the baby move as normally. You are experiencing anything that is concerning to you and it is not resolving. If you are not yet 36 weeks along in pregnancy, you should go to the hospital if: You have six or more contractions in an hour that are not alleviated when you rest and hydrate. You have bleeding of any kind. You think you are leaking amniotic fluid. You are experiencing anything that is concerning to you and is not resolving. If you are bleeding, contracting, or believe you are in labor, please go directly to labor and delivery at the hospital. You do not need to call us. The hospital will contact us after you have been evaluated. We understand that as expectant parents you need OPTIONS; and at Woodlands OBGYN Associates, that’s just what you’ll get when considering all that you need to stay informed and on top of your pregnancy and childbirth experience. Optional Tests There are optional tests that you may wish to consider as part of the OB services we provide. You can access brief descriptions of these tests via clicking our Genetic Testing and Ultrasound pages to get the answers you need. Need to Schedule Optional Testing? CALL US! 281-364-9898 Are there any “getting ready for childbirth classes” I should take? There are many childbirth classes designed to instruct you on what to expect during labor and delivery. Many are offered through the hospital and include classes about pregnancy, delivery techniques, cesarean delivery, fitness and well-being during pregnancy, breastfeeding, CPR and first aid, and baby care. Detailed information about these classes are available online at the Woodlands Methodist Hospital website. These classes are optional, and it’s not required that you take any classes prior to childbirth.

What is Ultrasound? Diagnostic ultrasound, also referred to as sonography, is an imaging technique that uses high-frequency sound waves that are emitted and then bounce back from internal structures to produce images of those structures within the body. Often used during pregnancy, diagnostic ultrasound is used to measure the development of the fetus within the womb, as well as to determine if there may be any abnormalities occurring during pregnancy and fetal development. Routine Ultrasounds There are several ultrasounds that are considered “routine” during pregnancy. Additionally, other ultrasounds are considered “optional.” At Woodlands OBGYN Associates, we routinely perform the first ultrasound in the first trimester to confirm pregnancy viability and to more accurately determine how far along the pregnancy has progressed. In addition, we routinely perform an ultrasound at 19-20 weeks for a detailed survey of the anatomy of your baby. In normal low-risk pregnancies, these are the only two ultrasounds that are performed. In high-risk pregnancies, there may be indication for additional ultrasounds to be performed in order to monitor the pregnancy more closely. Additional Ultrasounds A third trimester ultrasound is generally recommended to be performed at 32-36 weeks to look at the anatomy of the baby, the amniotic fluid, the placenta, position of the baby and the baby’s growth. Unfortunately, insurance companies do not generally feel that this screening ultrasound is justified or “medically necessary” in women with a normal, uncomplicated, low-risk pregnancy. If you choose to undergo this ultrasound, there is usually an associated cost, as it is not at all covered by insurance. A “gender check” ultrasound can be performed at around 15 weeks gestation to determine the sex of your baby. The cost for this ultrasound is not covered by medical insurance. ‘To KNOW or NOT to KNOW?’ That is the question! For many excited parents, learning the sex of their baby is important to family planning, while others prefer that element of surprise with each birth! Regardless of your preference, an ultrasound test can help. A “gender check” ultrasound can be performed at around 15 weeks gestation to determine the sex of your baby. The cost for this ultrasound is not covered by medical insurance. To Schedule Your Ultrasound CALL 281-364-9898

Getting You & Baby Better Sometimes Moms-to-be have to scream for help when they’re sick and unsure of what to do. At Woodlands OBGYN Assoc., we’re here to help you feel better and get back to enjoying pregnancy. Though illness during pregnancy is common, it can still cause stress and discomfort. Connect with us regularly, as our physicians will want to take everything into consideration before prescribing certain medications. Basic Treatments for Common Ailments First Things First You must avoid taking any herbal supplements or other over-the-counter medications without speaking with your doctor first. If your symptoms persist, worsen, or you develop a fever of 101.4 or higher, please contact us immediately. The following are a list of general treatments and safe over-the-counter medications for certain problems or illnesses during pregnancy: Constipation Increase intake of fiber by including all-bran cereals, beans, fruits, raisins and prunes in your daily diet. You may also supplement your fiber intake by taking the prescribed dosage of Metamucil or Konsyl. You may also try Milk of Magnesia, Surfak, or Colace and you may use a Dul-co-lax suppository or an enema. In addition, please up your water intake. Avoid coffee, tea and soda. To get a better understanding if you are taking in enough water, when you urinate, check the color of your urine. Anything other than a clear color indicates that you are not drinking enough fluids. Diarrhea Start with clear liquids like 7-up, Sprite, Ginger Ale or Gatorade and then advance to bananas, rice, applesauce, and toast. You may also take Imodium AD – start with ½ the suggested dose on the label. Once the diarrhea has stopped, resume a bland diet and avoid all dairy products for 2-3 days. Diabetes and Gestational Diabetes Diabetes is now considered an epidemic in the United States. Most people are aware of some facts regarding diabetes; however, there are many aspects, causes and consequences related to diabetes for which the majority of people are not aware. If your blood results show an indication for diabetes, your physician will consult with you and may refer you to an endocrinologist for further testing and confirmation and appropriate long-term treatment. Gestational Diabetes is just as it sounds: diabetes that occurs only during pregnancy. That being said, you should be monitored closely for diabetes after delivery, as a small percentage of women do develop Type 2 diabetes (adult-onset). Flu Shots The Centers for Disease Control recommends all pregnant women receive the flu shot. We recommend you receive the flu shot after the first 12 weeks of pregnancy. Your primary care physician or local pharmacy can administer the flu shot. We do not administer this vaccine with our office. Headaches Tylenol (regular or extra strength) is fine to take. Do not take Advil, Motrin, Aleve, or any other Ibuprofen based product, or aspirin, as they can cause spontaneous bleeding and thinning of the blood. Head Cold/Sinus/Cough Tylenol Cold + Sinus, Sudafed, Benadryl, Drixoral, Robitussin, or Triaminic may be taken. Be sure to match symptoms on label with the symptoms you are experiencing. Do not take more than the recommended dosage. Hemorrhoids Try Tucks Pads, Anusol, or Preparation H Ointment or Suppositories. Be sure to drink plenty of liquids in order to help soften the stool. Indigestion or Gas Tums or Simethicone are fine, but do not take Pepto-Bismol. Leg Cramps Sometimes leg cramps may be due to a lack of calcium or potassium. You may take 600mg x twice daily of calcium citrate and eat one or two bananas daily until cramping resolves. Minor Sore Throat Use Chloraseptic spray, throat lozenges, or gargle with warm salt water to help relieve symptoms of a sore throat. If your sore throat is accompanied by a fever of 101.4 or higher, please call us immediately. Minor Swelling Reduce salt intake and elevate your feet as often as possible. Again, be sure you are taking in additional fluids, as more fluid intake pushes the excess fluids out. Morning Sickness or Nausea While not exactly a true “illness,” nausea during pregnancy can certainly be difficult to deal with and can make day-to-day life difficult. The good news is that most women’s morning sickness or nausea will resolve by the second trimester, so be hopeful. To treat morning sickness/nausea, start by taking 50mg x 3 times daily of vitamin B6; ginger root (1 gram a day), or drink some ginger tea. Discontinue your prenatal vitamin until nausea resolves and eat small, frequent meals. If this does not help, you may try Emetrol – be sure to follow directions on the label for dosing. Have More Questions? CALL 281-364-9898

Get In the KNOW At Woodlands OBGYN Associates, our goal is always… ‘Healthy Mom, Healthy Baby’. We recommend childbirth and childcare classes to help fill in the gaps pertaining to subject matters that may be exceedingly interesting to you — especially as first-time parents. The wide range of events surrounding labor and deliver are discussed, as well as labor and delivery itself, and what to expect during normal (vaginal) or Cesarean deliveries. Where To Go & What To Do We deliver all of our patients at Houston Methodist the Woodlands-The Woodlands, TX. This amazing facility offers resources to families in the Prenatal and Family Education Department and The Motherhood Center offers a wide range of classes, including private education if a group environment is not quite your liking. Many of the classes are offered right at Houston Methodist the Woodlands Hospital, as well as a few affiliated healthcare centers and clinics within the community. It’s best to contact the hospital for detailed information about availability and the registration process. Contact us at 281-364-9898, freely visit the Methodist Hospital website for more information, or call 936-270-2000. Though childbirth classes are not mandatory, it can be to your family’s advantage to participate. One of the most important aspects of the childbirth class is the education expected parents can receive regarding breathing and relaxation techniques during labor and natural childbirth. Classes are always taught by various professional licensed obstetric specialists, childbirth consultants, and nurse practitioners. Another important benefit to participating in a childbirth class is receiving a birthing plan, which is discussed in class and sometimes during hospital tours. Birthing plans provide a clear understanding of the directives you wish to provide to your caregivers during your stay. The tour may also be an ideal time to ask about hospital policies, as you are being shown the labor and delivery areas. The most informative birthing plan is simple, fact based, discussed with your Obstetrician, and taken with you to the hospital when it is time. The value of a birthing plan is that when you are busy being in labor, the decisions have mostly all been made in advance. It is extremely difficult to assimilate new information and make decisions during labor as you might imagine! View All Houston Methodist Childbirth Services We know! You’re super excited, nervous, and curious all at the same time! There’s much to learn, much to think about, and much to do. Take one thing at a time, and know that Woodlands OBGYN Associates is here for you. Learn about preparing for childbirth, then give us a call if you need to schedule your next appointment or exam. Stay Connected! 281-364-9898

Genetic testing is performed during pregnancy to determine if any birth defects, syndromes, or chromosomal disorders may be present within the unborn fetus. As there are several testing options that can be offered during pregnancy, these tests are optional, yet provide information about a woman’s risk of having a baby with certain birth defects. As a result, making informed decisions and sharing concerns with your doctor and family members can occur. Helping You Explore Your Options Testing may be right for some and not right for others, based on many factors. These factors include one’s risk of having an affected baby, one’s personal plans and needs, as well as personal spiritual and religious beliefs. We will discuss specific tests with you during your prenatal visits, but the decision to be tested or not is a personal decision between you and your partner. Many couples choose not to be tested for birth defects, and of course, we always honor the personal decisions of our patients in this regard. In addition to the tests discussed below, there may be additional elective tests that we discuss with you based on your personal and medical history, family history, or ethnic background. The following discussion is not meant to be comprehensive, however, it provides an overview of some of the standard elective tests offered to all pregnant women under the care of Woodlands OBGYN Associates: Chromosomal Disorders Chromosomal disorders may be caused by a missing, damaged, or extra chromosomes. In normal human development, there are 23 pairs of chromosomes, allowing for a total of 46 chromosomes. Sometimes, during the early stages of fetal development, something goes awry during cell division. This usually occurs during the cell division and replication phase known as “mitosis”: mitosis – part of the reproductive cell cycle process by which chromosomes in a cell nucleus are separated into two identical sets of chromosomes, each in its own nucleus. Most children with chromosomal disorders will have physical defects, and some also incur mental defects. Two examples of more common chromosomal disorders are: Down Syndrome – This syndrome results from an extra copy of the chromosome 21, in which mental retardation, abnormal facial features and medical problems such as heart defects occur. Children with Trisomy 21 (Down Syndrome) will have developmental and intellectual delays. Trisomy 18 – Also known as Edwards Syndrome, this disorder results from an extra copy of the chromosome 18, and results in serious consequences for mental and physical development. When carried to term, fifty percent (50%) of infants will be stillborn, with mortality occurring more frequently in boys than in girls. Statistically, most infants die within the first year of life; however, a small number of adults – usually girls – are living well into their 20s and 30s, but with profound mental and medical delays which do not allow them to live independent lives. The risk of having a child with a chromosomal defect increases as a woman ages. The chart below expresses the statistics as such, taking the mother’s age into consideration: Age Down Syndrome Any Chromosomal Disorder 20 1/1,667 1/526 25 1/1,250 1/476 30 1/952 1/385 35 1/378 1/192 40 1/106 1/66 The purpose of testing is to determine if you are at an increased risk of having a baby with chromosomal abnormalities. The decision to test is optional and completely your decision. Cystic Fibrosis Carrier Screening Cystic Fibrosis (CF) is the most common inherited disease of children and young adults. It primarily involves the respiratory, digestive and reproductive systems. Some people are mildly affected and may live into their 30s, but individuals with severe disease state may die in childhood. CF does not affect intelligence.

According to the Department of Health and Human Services, approximately ten to 15 percent (10-15%) of couples in the U.S. are dealing with infertility, meaning they have not conceived after at least one year of regular, unprotected sex. Studies indicate that slightly over half of all cases of infertility are a result of female conditions, while the rest are caused by either sperm disorders or unidentified factors. Finding the Factors Factors that contribute to infertility include: age, smoking, excessive alcohol use, obesity, eating disorders, over exercising, sexually transmitted infections, chemical exposure, and mental stress. Other causes of infertility include ovulation disorders, polycystic ovarian syndrome (PCOS), thyroid dysfunction, uterine fibroids, endometriosis, blocked Fallopian tubes, chronic illnesses, and even medications. Male causes of infertility are due to low or poor quality of sperm. Seeking Consultation A formal evaluation of infertility is started by reviewing your history and performing an exam. Various diagnostic tests, including blood tests, ultrasound, and semen analysis may be ordered. Additional testing may include a hysterosalpingography (to check for blocked tubes) laparoscopy (to treat endometriosis and fibroids), or genetic testing to see if there may be a genetic element in play that is preventing pregnancy from occurring. Treatment will be based on the findings of these test results. If you’ve been struggling with getting pregnant, it’s time to talk with your doctor. Please call the office directly for an appointment at 281-364-9898.

Diabetes During Pregnancy Gestational Diabetes is diabetes that some expected Moms develop during pregnancy. In fact, two to ten percent (2-10%) of pregnant women may be diagnosed with diabetes during pregnancy. The term “gestational diabetes” simply means that diagnosis occurs while pregnant. Yet, all hope isn’t lost. This condition can be managed with the help of Woodlands OBGYN Associates. Hope & Help is Always Readily Available There are many resources available if you are diagnosed with diabetes. Although it is likely that your diabetes will go away after pregnancy, (if diagnosed during pregnancy) for now, you must treat yourself as someone who has diabetes. For expected moms diagnosed with gestational diabetes, they can expect to receive additional prenatal care services, and make more visits to the office to ensure they are being properly monitored and are able to manage the condition well. As with all moms of Woodlands OBGYN Associates, they will receive an individualized prenatal care plan based on their specific needs during pregnancy. Learn the Risk Factors High Blood Pressure & Preeclampsia — Diabetes is more likely to influence blood pressure and can cause a condition called preeclampsia in the mother during pregnancy. Preeclampsia is a potentially dangerous complication which is characterized by high blood pressure, which can make pregnancy difficult and can prove to be serious for both mother and child. Large Babies — Another issue we take into consideration as physicians is that patients with diabetes tend to have larger babies than patients who don’t. An infant that is considered “too large” for their gestational age requires similar monitoring as that of a premature infant. Elevated Blood Sugar Levels & Body Temperature — In addition, close monitoring of both mother and child is required to insure the health and well-being of both. Both mother and child have more difficulty maintaining their blood sugar levels and body temperature than the average newborn does. Of course, this brings cause for concern. Following Medical Recommendations = Good Management You can improve your chances of delivering a healthy baby by: Following the advice of your Woodlands OBGYN Associate physician. Seeing any of the specialists we recommend. Eating a healthy diet. Exercising as instructed. We will ask you about your exercise and activity levels, and about your diet during office visits. We will also be monitoring the size and growth rate of your unborn baby more closely than low-risk pregnancies, and we’ll be checking your urine for sugars and proteins, which provide us specific insights as to how you are doing. If sugars or proteins are present in your urine, this is an indication that excessive sugars are in your bloodstream and we must immediately address this so as to mitigate any harm to you or your developing child. While managing diabetes during pregnancy can be complicated, the doctors of Woodlands OBGYN Associates are experienced and well-able to manage your prenatal care, including gestational diabetes. Connect with us for more information, and a consultation!

Experience Well-Woman Visits w/Woodlands OBGYN Obstetrician/Gynecologists have a tradition of providing preventative care to women. An annual well-woman visit provides an excellent opportunity to counsel patients about maintaining a healthy lifestyle and minimizing health risks. Your well-woman visit is the foundation of your gynecologic care. Learn to Be Well at Every Stage As you change, your needs and concerns will also change. Your yearly appointment is about more than just doing a pap smear. It is an opportunity to discuss your overall health, birth control concerns or options, hormones, gynecologic problems, or a future pregnancy. Appropriate screening tests such as pap smear, mammogram, ultrasound, and blood tests will be recommended as needed. Your first OB/GYN well-woman visit should be around the age of 18 years, or sooner if you have a gynecologic problem or you begin sexual activity. Well-Woman Exam Preparations There are several things you can do to help prepare for your well-woman visit each year with Woodlands OBGYN Associates. Here are a few: For two days prior to your appointment, do not have intercourse or insert anything into your vagina. Write down your questions ahead of time. Be prepared to discuss your medical history, and bring previous medical records for any ongoing concerns/problems you may have. Bring a list of your current medications, including vitamins and supplements. Be sure to note the first calendar day that your last period started. Staying Connected Test results are available within two weeks of your appointment. By creating a secure account through our patient portal, you can easily update your information, fill out forms, request appointments, ask billing questions, ask medical questions, and even request to receive test results by a secure HIPPA-compliant email. Setting up an account is easy and gives you access to our office at any time. Log in or register here. Ready for Your Next Well-Woman Visit? CALL 281-364-9898

Having Symptoms of Abnormal Bleeding? Normal cycles vary over one’s lifetime and between one woman and the next. A regular menstrual cycle occurs every 28 days. While shedding of the uterine lining averages five to seven days in length (5-7 days). For women who experience bleeding more often, or whose menstrual flow lasts longer than this, we consider this to be abnormal bleeding. Learn the Signs & When to Seek Help Bleeding may become lighter, heavier, shorter, longer, absent or more frequent. Variations which continue could be reason for concern. For instance, bleeding after intercourse or between periods would be considered abnormal bleeding and should be discussed with your Woodlands OBGYN Associates’ doctor. The following symptoms are indications to our physicians that there may be a health problem. In these instances, scheduling an immediate appointment is the best recommendation: Absence of menstrual cycles Bleeding prior to menopause or spotting Bleeding after intercourse Bleeding after menopause A change in your normal cycle It will be important for you to share specific dates and instances of abnormal bleeding. Therefore, please bring this information with you to your appointment. Your doctor will begin to identify patterns, potential causes, and appropriate treatments for you. Common causes of abnormal bleeding that your doctor will be assessing include: Hormone imbalances Problems with birth control Pregnancy Infection or other problems of the uterus or cervix Uterine polyps or fibroids Endometriosis Problems with blood clotting To identify problems and appropriate treatment options, diagnostic tests may be needed. We will work with you to provide the best treatment possible, and to educate you throughout the process. Depending on the issue, diagnostic tests or procedures may include blood tests, pelvic ultrasounds, an endometrial biopsy, hysteroscopy, D&C, or laparoscopy. Treatment Options In-office treatments for abnormal bleeding are available. Novasure® and HTA ablation can both be performed in the office with minimal down time. Should the need arise for more invasive surgical treatment, you can rest assured that you are in good hands with Woodlands OBGYN Associates. Some of the surgeries we perform are: Hysteroscopy (to remove polyps or fibroids) D&C (dilation and curettage) Endometrial Ablation Myomectomy (removal of fibroids) Hysterectomy da Vinci® Minimally Invasive Robotic Hysterectomy Don’t Suffer in Silence. Schedule Your Appointment! CALL 281-364-9898 We’re Here for You When otherwise healthy women suddenly begin to experience abnormal, very heavy, or infrequent bleeding, this can be scary and extremely uncomfortable. Bleeding is meant to be cyclic and predictable over time; yet for some, changes can indicate health issues and cause for concern. For additional information on abnormal bleeding, causes and symptoms, browse our Surgical Services pages, they provide details on surgical treatment options. You may also wish to visit the American College of Obstetrics and Gynecology website, as well as other trustworthy educational websites listed on our obstetrics and gynecology links and topics of interest page. For Immediate Assistance – CALL 281-364-9898

Going Through the Change with You Menopause is the time in a woman’s life where menstruation ends. During that time, and the variable years leading up to menopause – known as perimenopause – hormones inconsistently fluctuate, and many refer to this period as “Going through the Change”. For some, dealing with certain symptoms like mood swings, hot flashes, weight gain, low sex drive, and many others can be challenging. However, Woodlands OBGYN is here to help you through, with valuable information and treatment options. The Great Hormone Balancing Act Long before a woman reaches menopause, she can experience hormone dysfunction and imbalance, causing a multitude of symptoms. Symptoms range from lack of energy, insomnia, weight gain, low libido, night sweats, forgetfulness, and emotional problems. Perhaps, the most challenging times are the perimenopause years that lead up to menopause, as the changes and constant physiological uncertainties can be overwhelming for some. We offer treatment options that can help ease the most severe symptoms. Hormone Testing helps us determine your hormone status so we can treat your symptoms. We use both compounded and traditional hormones. Should I Take Hormones? See if they’re an option for you! Menopause & Perimenopause Facts The average age for menopause is 51 years of age. Most often, periods do not just stop and then menopause is considered as having begun. To the contrary, during the nine to 10 years preceding the cessation of menstrual flow, the perimenopause years, the average woman will have lengthened or shortened cycles, hot flashes, sleep issues, and occasional vaginal dryness. These are all symptoms associated with a woman “going through the change” of life. What’s most important to understand about menopause is that every woman will experience symptoms differently, with variables in severity and duration. For each woman, the changes vary to certain degrees; yet, there are many common issues that they will face during those years, and many symptoms can be treated. You Have Options At Woodlands OBGYN, we understand that symptoms of menopause and perimenopause can make life difficult; however, treatment options to help relieve symptoms are available and should be discussed with your doctor. Since not every woman’s experience is the same, not every treatment option is the same. Our trusted physicians take the time to help you determine which options are best for your situation. When hormones are needed, our hormone pellet therapy treatment has proven to be quite effective, yielding steady results from an easy-to-follow plan. Traditional and compounded therapies are also effective. For women who are experiencing vaginal dryness and painful sexual intimacy, the MonaLisa Touch® treatment procedure offers a minimally invasive and hormone-free option! To Explore Your Options CALL 281-364-9898

Making an Informed Decision At Woodlands OBGYN Associates, we can help you make an informed decision about birth control. Birth control is used to prevent unwanted pregnancy. Many forms of birth control are available today. There are non-permanent and permanent methods available, and you should discuss what methods best meet your family planning needs. Learn About Your Birth Control Options If you’re not sure when you’ll be ready to have your first child, or if you are not ready to add to your existing family, a non-permanent method such as daily birth control pills, or a Mirena® IUD, would be excellent options for you to discuss with your doctor. On the other hand, if you are certain that do not wish to have any more children and are looking for a permanent, non-reversible option, a tubal ligation procedure could be an option for you as well. Either way, a candid discussion with your Woodlands OBGYN physician will help guide you to the answer that is right for you, providing you with peace of mind. Non-Permanent Birth Control For couples who have not yet started their families, or who may be unsure about whether they wish to add to their existing family, non-permanent birth control should be considered in order to prevent pregnancy. Some of these options include methods. -Birth Control Pills – Also known as Oral Contraceptive Pills (OCPs), OCPs are taken by mouth daily and rely on hormones to prevent ovulation in order to prevent pregnancy. -NUVA Ring® – This flexible plastic ring is inserted into the vagina and worn 24/7 for the first three weeks of a woman’s menstrual cycle; this method relies on the release of hormones to prevent ovulation, thus reducing the chances of fertilization and pregnancy. Many women appreciate not having to remember to take daily pills with this method. -Intrauterine Device (IUD) – An IUD is a small device, often “Y” shaped. Some contain copper or levonorgestrel to prevent ovulation. -Mirena® IUD (contains progesterone) – A specific type of IUD that is one of the most effective, is made of plastic, and releases hormones to prevent pregnancy. This IUD is effective immediately upon placement in the uterus and remains effective for five years. -Paragard – An IUD made with copper. -Nexplanon – A sub-dermal contraceptive implant. -Diaphragm -Condoms I’d Like to Discuss My Birth Control Options! CALL 281-364-9898

Pelvic Prolapse: A Common Cause of Pelvic Pain & Discomfort Pelvic Prolapse is caused by weakness of the pelvic tissue that then allows the organs to push downward into the vagina. This protrusion causes a feeling of pressure in the vagina, lower pelvis and lower back. Depending on what is prolapsing (bladder, rectum, uterus, or intestines) symptoms can be mild or severe. Gaining an Understanding The most common cause of prolapse is childbirth. During childbirth, the pelvic muscles can get weak or stretched. If they don’t recover, they can’t support your pelvic organs. Other factors that can contribute to prolapse are obesity, chronic coughing, constipation, heavy lifting, smoking, and poor nutrition. Pelvic prolapse can result in loss of urine, frequent urination, chronic constipation, back pain, and pain with intercourse. As it worsens, symptoms increase, and the bladder, cervix, or uterus may be seen coming out of the vagina. Prolapse can also occur after a hysterectomy. prolapse entrocele uterine prolapse rectal prolapse rectocele vaginal vault prolapse bladder prolapse Treating Pelvic Prolapse Conservative treatments include Keegle exercises to strengthen the muscles of the pelvis that will then better support the organs. Keegle muscles are the muscles used to stop the urine flow when urinating. With mild prolapse muscle tone may increase and prevent worsening of symptoms. Additional measures such as limiting lifting, weight loss, and eliminating smoking may help. Treatment Devices: InTone is a device invented to stimulate the Keegle muscles to contract with small electrical impulses. It is FDA approved and highly effective in restoring the muscle tone to all the pelvic muscles. Our office is fully trained and certified in the use of InTone and Apex devices to help treat the symptoms of pelvic organ prolapse. See our InTone & InControl Medical page for additional information. Emsella: Emsella is a non-invasive and revolutionary procedure that helps to strengthen the pelvic floor muscles. The Emsella treatment is delivered by relaxing in an ergonomic chair completely clothed, where electromagnetic technology penetrates the highly targeted tissue in the pelvic floor and stimulates the muscles. This strengthens the muscles and restores the support of the pelvic floor. See our Emsella page for additional information. Surgical Options: For more severe cases, surgery remains a proven and effective treatment option. The type of surgery is determined by the amount and type of prolapse and the symptoms one is experiencing. Procedures are available that do not require a hysterectomy or the use of mesh. Pelvic Reconstructive Surgery is an option for treating severe pelvic prolapse. However, surgical decisions are complex and best made after an examination and discussion with your Woodlands OBGYN physician. We are trained in all the latest procedures using the vaginal, laparoscopic, and robotic techniques. Call our office to assess your needs CALL 281-364-9898

Uterine Fibroids Are Common Fibroids are generally non-cancerous or benign growths that occur on or in the uterus. According to the National Uterine Fibroids Foundation (NUFF), nearly 80% of women in their childbearing years have uterine fibroids to some degree and will have developed fibroids by age 50. Most women have no symptoms or related complications, while 1 in 4 will experience severe symptoms, such as prolonged menstrual cycles and heavy bleeding, which will require treatment. Understanding Symptoms & Causes Uterine fibroids are different and can vary for every woman. For example, they can range in size, from being as tiny as a seedling, to as large as a grapefruit that enlarges and distorts the shape of the uterus. Some women have one or a few fibroids, while others can have multiple. Even the location of the fibroids varies in and/or around the uterus. The good news is that fibroids tend to shrink during menopause. Know the Symptoms As mentioned above, most women don’t know they have fibroids until a physician detects them during a pelvic ultrasound or examination, or if a woman begins to experience related symptoms and possible complications. Common symptoms include and are not limited to: Pelvic pain and pressure Heavy menstrual bleeding Severe cramping Prolonged menstrual periods – over 7 days Lower back and leg pain Frequent urination Difficulty emptying the bladder Constipation If you begin to experience unusual symptoms associated with pelvic pain, menstruation, or difficulty using the restroom, it’s best to contact a Woodlands OBGYN Associate physician for an evaluation. What Are the Causes? Though there is no known cause or causes for uterine fibroids in women, research and clinical experience have found a few common factors associated with having fibroids. Need an Appointment? CALL 281-364-9898 Treatment Options Are Available If you learn that you have fibroids, but are not having any problems, the option for no treatment is an acceptable option! However, for those who are experiencing uterine fibroid symptoms with complications, the following options are available at Woodlands OBGYN: Birth control pills or progesterone hormone therapy to control bleeding. Myomectomy — the surgical removal of the fibroids without removing the uterus. Fibroids are removed thru an incision via laparoscopy, using the da Vinci robot, or thru the cervix via hysteroscopy. (Please note: Myomectomy depends on the size and location of the fibroids, which may make it an option.) Hysterectomy — the surgical removal of the uterus and the fibroids; usually this can be done using less invasive types of surgery, like da Vinci Robotic Surgery. Connect with Woodlands OBGYN Associates CALL 281-364-9898

What is Endometriosis? The American Congress of Obstetricians and Gynecologists defines endometriosis as a condition in which the type of tissue normally found on the inside lining of the uterus (the endometrium) is found outside the uterus. Endometriosis can affect a woman from the time of her first period to menopause. Sometimes, the disease can even last after menopause. At Woodlands OBGYN, our goal is to keep patients informed about endometriosis in efforts to help them maintain overall health and well-being. Addressing Your Concerns Endometriosis most commonly involves the uterus, ovaries, the small bowel, and the tissue lining the pelvis. Endometrial tissue acts just like the normal uterine lining in that it thickens, breaks down, and sheds or bleeds with each menstrual cycle. However, because the displaced tissue has no way to exit the pelvic cavity, it becomes trapped and can cause pain, scar tissue, and adhesions. As a result, fertility problems may arise. Effective treatments are available. What are the symptoms of endometriosis? The primary symptom of endometriosis is pain, mostly in the lower abdomen, lower back, and pelvic area. Pain associated with endometriosis is usually in tandem with a woman’s monthly menstrual cycle, but in more severe cases, can occur more frequently. The amount of pain a woman feels is not linked to how much endometriosis she has. Some women have no pain even though their disease affects large areas, or there is scarring. Some women, on the other hand, have severe pain even though they have only a few small areas of endometriosis. General symptoms of endometriosis can include, but are not limited to: Painful (or disabling) menstrual cramps; pain may worsen over time Chronic pelvic pain (includes lower back pain and pelvic pain) Pain during or after sex Intestinal pain Painful bowel movements or painful urination Heavy menstrual periods Spotting or bleeding between periods Infertility Gastrointestinal symptoms that are like those of a bowel disorder Fatigue How do I know if I have endometriosis? If you think you might have endometriosis, talk with your Woodlands OBGYN physician. There are a number of tests we can perform to determine if you have endometriosis. The only way to know for sure if you have endometriosis is to have a laparoscopy. This is a surgical procedure performed under general anesthesia in which a camera is used to see inside your abdomen. Your surgeon can then check your organs to see if any growths or tissue from endometriosis exists. This procedure will show the location, extent, and size of the growths and begin treatment by removing endometriosis. What causes endometriosis? No one knows for sure what causes this disease. One theory is that during menstruation some of the menstrual tissue backs up through the fallopian tubes into the abdomen, where it implants and grows. Another theory suggests that endometriosis may be genetic or run in families. What is the treatment for endometriosis? There is no cure for endometriosis, but there are many treatments, each of which has pros and cons. It is important to build a good relationship with your doctor, so you can decide what option is best for you. Need an Appointment? CALL 281-364-9898

Urinary incontinence is the uncontrolled leakage of urine from the bladder. There are three types of incontinence: Stress incontinence is the uncontrolled leaking of urine that occurs when coughing, sneezing, laughing, lifting, or when performing any other type of straining motion. Urge incontinence is due to a bladder that is overactive and causes the frequent need to urinate and loss of urine due to a sudden urge. Mixed incontinence is a combination of both. What You Should Know About Urinary Incontinence What Causes Bladder Leakage? Urine loss can occur at any age under challenging conditions; however, frequent urine loss with normal activities occurs due to a change in anatomy. Physicians refer to this as a “fallen bladder,” which can occur due to child birth or constant straining or lifting. Hormone changes may also weaken the bladder and support of the urethra. Kegel exercises can be done to gradually increase the strength of the support muscles. However, for most patients, Kegel exercises have a limited benefit if done without guidance. Surgical procedures to support the urethra are done on an outpatient basis with minimal discomfort and recovery. Current surgical procedures for bladder leakage are very different from procedures performed even 10 years ago. Common Causes Vaginal child birth Heavy lifting or straining Smoking Weight gain Chronic coughing Constipation What is Urge Incontinence? Urge incontinence occurs when the bladder fails to relax to allow more urine to fill, and this stimulates the need to urinate. Patients with this disorder may urinate every 15-20 minutes. Treatment requires medication and bladder training drills. It is important to rule out irritation from foods, medications, or bladder stones. Gain Control Over Bladder Leaks There are treatment options for urinary incontinence. As such, those who are experiencing leaks no longer have to suffer or remain embarrassed about their condition. Certain treatment options may simply require natural and personal changes at home, while others will call for professional medical care. The following treatment options for urinary incontinence are available at Woodlands OBGYN: Lifestyle changes and Diet changes, including decreasing fluids and caffeine intake. Weight loss will also help. Kegel exercises Medications are used mainly for the treatment of urge incontinence. Intone– a non-surgical home treatment device for incontinence O-Shot MonaLisa Emsella Surgical treatment options can be used to correct stress incontinence, depending on the severity and other symptoms. Individualized Plans – After out office provides a complete evaluation of problems with urinary incontinence, we then help you determine which treatment option is best for your situation. Though we offer the full range of incontinence treatments, options are always tailored to the wishes and needs of each patient. If you are experiencing frequent urination or leakage of any kind, discuss it with your Woodlands OBGYN Associates doctor. We can help! Raj K. Syal, M.D., F.A.C.O.G. Connect w/Woodlands OBGYN Associates CALL 281-364-9898

Bio-Identical HRT as an Option Bio-identical hormone replacement therapy (BHRT) can balance hormone levels that become upset or deficient through lifestyle habits and aging. Unlike conventional hormone replacement therapy, BHRT is derived from plant sources and structured to resemble hormones produced by the body. Since the bio-identical hormones are recognized by the body, they are effectively and efficiently used. Feel Balanced Again! BHRT replenishes the body with the healthy hormone levels your body needs to function optimally. Forms of hormone replacement therapy include progesterone, estrogen, and testosterone. Blood tests are taken to determine hormone levels. If there is a deficiency or imbalance, BHRT is recommended to safely balance hormone levels. Restoring hormone balance can provide greater protection from chronic diseases and alleviate menopausal symptoms. Saliva testing of hormone levels is also offered. Insurance coverage of saliva testing is limited. However, we usually use serum hormone levels to optimize your health and limit negative effects. Bio-identical hormones are safe and effective in relieving the symptoms caused by declining hormone levels. Preparations of estrogen, progesterone, and testosterone can be made in creams, capsules, absorption troches, or pellets, as needed to optimize your health. Their use is not limited to the relief of menopausal symptoms. Benefits of BHRT Hormone replacement therapy supplementation can be used to relieve symptoms of: PMS Painful periods Heavy bleeding Heavy menstrual cramps Migraines Low sex drive Trouble sleeping Many other symptoms at any age! Schedule an appointment to discuss your hormone concerns and possible options! Contact Woodlands OBGYN Associates CALL 281-364-9898

Get Informed | Get Help Obstetrician/Gynecologists have a tradition of providing preventative care to women. An annual well-woman visit provides an excellent opportunity to counsel patients about maintaining a healthy lifestyle and minimizing health risks. Your well-woman visit is the foundation of your gynecologic care. Get Informed | Get Help Sexually transmitted diseases (STDs) are an unfortunate part of life. STDs are on the rise again as the fear of HIV has declined. Many sexually transmitted diseases such as chlamydia, HPV, hepatitis, or HIV can cause no symptoms, and are found only by screening. All discussions are confidential. Discuss any concerns you may have with your Woodlands OBGYN Associate physician by calling to schedule an appointment. Get Informed | Get Help CALL 281-364-9898

Diminish Fat & Sculpt Your Body! Sometimes, even after putting forth our best efforts to exercise regularly and eat well, we still find ourselves flustered by certain areas of our body where excess fat and loose skin remain; and it doesn’t seem to want to go away. The new innovative truSculpt® 3D treatment system is designed to safely diminish problem areas to provide permanent fat reduction and skin tightening in the treated areas. Learn more about how to obtain the figure you’ve always wanted; call Woodlands OBGYN Associates, your truSculpt® 3D treatment providers. How Does truSculpt® 3D Work? truSculpt® 3D is an innovative noninvasive treatment device engineered by Cutera, Inc. The technology uses radio frequency energy to heat the deeper tissue without excessive heat to the skin. This heating of the fat cells causes cell injury and eventual death of the fat cells. After cell destruction, the debris will be absorbed and eliminated. This process will continue for up to 12 weeks after treatment resulting in continued improvement in body contour and skin tightening. truSculpt 3D is FDA approved and proven effective in contouring and sculpting the body. Studies show that patients who have had the truSculpt® 3D treatment, have experienced up to a 20% reduction in body fat on average, after just one treatment.

In case you haven’t heard, the MonaLisa Touch® is a FDA-approved and innovative procedure designed to help alleviate the concerns of women experiencing vaginal discomfort and/or painful sex due to feminine dryness. In fact, issues of vaginal health are commonly seen in menopausal women, breast cancer survivors, and women who have had a hysterectomy. Nearly half of all US menopausal women, and over 2.8 million breast cancer survivors, suffer from changes to their vaginal health*. Resulting problems, such as dryness and vaginal discomfort, can impact sexual activity and well-being. * National Institutes of Health 2011 It’s Okay to Talk About It. If you’re experiencing vaginal discomfort for any reason, have persistent feminine dryness, and if intimacy is painful, we encourage you to have a confidential conversation with the experienced and trusted physicians of the Woodlands OBGYN Associates. It’s the best way to learn more and find out if MonaLisa is right for you. Why the MonaLisa Touch® is so Remarkable The MonaLisa Touch® uses laser energy to revitalize the cells of the vagina and vaginal walls by stimulating collagen and vascular growth. This results in improved moisture, flexibility, and thicker tissue. Revitalization results in less burning, cracking and dryness during daily activities and intercourse. This treatment is safe and well-suited for all symptomatic women at any age. For women who cannot, or choose not to, take hormones, this is an ideal non-hormonal treatment for vaginal discomfort. Woodlands OBGYN Associates was the first OBGYN practice in The Woodlands, TX to provide this remarkable procedure. It only takes three short sessions with six-week intervals. The procedure is performed in our office in less than 10 minutes. It is virtually painless, and no anesthesia or painkillers are required. Treatment of vaginal discomforts depends on the underlying cause. There is no need to feel uncomfortable about discussing this condition. We have staff to answer your questions and help you determine if the MonaLisa Touch® is right for you. If you’re ready to feel comfortable and revitalized again, give us a call to make an appointment or to obtain more information.

Making Sex Fun Again The O-Shot® is a revolutionary approach to helping women improve sexual relations and issues related to urinary incontinence. The results of this safe, highly effective, and non-surgical 20-minute procedure are dramatic and long lasting. *Women have reported significant improvement in stimulation, sensitivity, arousal, and sex drive. Problems related to leaky bladders often resolve. You Can Still Enjoy Intimacy Although each woman’s *experience varies, O-Shot® benefits may include: Increased arousal from clitoral stimulation Rejuvenated, smoother skin of the vulva (lips of the vagina) A tighter introitus (vaginal opening) Pinker color of the vulva tissue Stronger, and more frequent orgasm Increased libido and sexual desire Decrease in pain for those with dyspareunia (pain during sexual intercourse) An increase in natural lubrication Improved symptoms of urinary incontinence Decreased inflammation in the condition lichen sclerosus Who Can Benefit From the O-Shot®? If you are a woman who suffers from sexual issues such as low sex drive, difficulty achieving an orgasm, and urinary incontinence, you understand how frustrating these issues can be concerning intimacy. Most women are embarrassed or nervous to speak with their primary physician or gynecologist about these issues, and many doctors have little to say on these important matters. In fact, up until very recently, there were limited resources available to help women deal with these concerns aside from physicians suggesting psychotherapy or prescribing hormones. Now there is a new treatment called the Orgasm Shot®, or O-Shot®, that not only offers hope for these conditions, but can also be administered during a simple in-office procedure. How Does This Procedure Work? First, a small amount of blood is drawn from your arm. Using a centrifuge, one of our doctors will isolate platelets from that blood (platelet rich plasma, or PRP), all within about 15 minutes in the office. The platelets are then “activated” to release multiple growth factors that are normally used to heal injured tissue. These growth factors work to stimulate collagen and new blood flow. For patient comfort, numbing cream is applied around the vaginal area, then the doctor utilizes a small needle to gently and carefully place precise amounts of PRP into the vaginal area. Patients report that they feel minimal to no pain during this procedure. Am I a Good Candidate for the O-Shot®? If you are concerned about your sexual health, and would like to experience increased sexual pleasure and a higher quality of life, then you are a good candidate for the O-Shot®. Many women benefit from the O-Shot® procedure. As their own body’s natural growth factors work to enhance and rejuvenate sexual responsiveness and sensitivity. Symptoms continue to improve over the first 12 weeks. Recovering From the O-Shot® Normally, your O-Shot® involves minimal to no pain, and you can get right back to your normal daily activities after undergoing the procedure. With no downtime, and no recovery time, your quality of life and sexual health are recovered and enhanced. Full results are noticed in 2-3 months. Is the O-Shot Procedure Safe? There have been NO reports of serious side effects from PRP prepared with a FDA (Federal Drug Administration) approved kit. The first O- Shot® was given in 2011 and it continues to be utilized. This procedure enhances the sexual lives of women who seek to heighten their sexual experience or relieve the embarrassment of urinary leakage. Schedule Your Appointment: 281-364-9898 Already a Patient? Click the Patient Portal to Get Started! Still need More? PRICING O-Shot® for WOMEN $1,300 *Additional O-shots, if desired within the first six months of the initial shot will be at the reduced rate of $1,100 To further explore your options, schedule a consult at Woodlands OBGYN Associates @ 281-364-9898

The Priapus Shot for Guys The Priapus Shot® (or P-Shot®) for men is a clinical treatment that provides a specific way of using your own blood-derived growth factors to rejuvenate the penis. It is a breakthrough, clinically-proven, safe, and effective procedure that helps male sexual wellness — without surgery, or the use of medications. Dr. Syal is specially trained and the only physician in our practice that offers this service. Rejuvenate Sexual Wellness – Revitalize Performance! Although each man’s experience *varies, benefits of the P-Shot® include: Enhanced sensation and pleasure Stronger Erection Increased size of penis Increased circulation within the penis for a healthier organ Additional therapies like Viagra® or Cialis® work better Zero allergic reactions (using your own body’s fluids) No lumpiness Minimal to no discomfort Understanding the P-Shot® Procedure A numbing lidocaine cream is applied to the penis. A small amount of blood is drawn from the arm. Using a centrifuge, Dr. Syal will then isolate platelets from that blood (platelet rich plasma, or PRP), all within about 15 minutes in the office. The platelets are then “activated” to release a minimum of eight growth factors that would normally be used to rebuild injured tissue. These growth factors work to stimulate increased collagen and blood flow in the penis. The liquid plasma is transferred into a syringe and injected into the penis– using a tiny needle and a method that distributes the growth factors in the proper way. Getting Guys Results @ Woodlands OBGYN Associates The results of this safe, non-surgical 20-minute procedure are dramatic and long lasting. However, it is important to note that not every man will necessarily achieve similar results or satisfaction with the Priapus Shot. Yet, it has been shown that the increase in the length, girth and sensitivity of the penis, as well as treatment results for most men are quite impressive. About 80% of men improve after the first P-Shot® treatment. Approximately 90% are very impressed after their second procedure. It typically takes about 12 weeks to experience the full effect. Some men may request a series of two or three P-Shots, spaced 8 to 12 weeks apart, to reach their desired potential. Further Improvement is noticed with each additional treatment. Ready to get started? Book an appointment with Dr. Raj Syal Every Guy Needs to Know… There are a few things that may cause the P-Shot® to be less effective, or require additional treatments. Since the experienced physicians of Woodlands OBGYN Associates are concerned about you getting the desired results, please be aware that the following issues may decrease the expected results: Smoking Lack of exercise Vascular disease We understand that for some men, challenges with intimacy and sexual performance can be hard to handle and discuss. However, you can be proactive and take the 1st step by consulting with Dr. Syal to see if the P-Shot is right for you. To help with your decision, Woodlands OBGYN Associates is offering… PRICING P-Shot® for MEN $1,500 (includes one shockwave therapy session) *Additional P-Shot treatments, if desired within the first 6 months after the initial shot will be at the reduced amount of – $1,300 (includes one shockwave therapy session) Additional shockwave therapy sessions, if desired are $300.00 per session. Additional Treatment Options The following treatment options for men’s sexual wellness are available at Woodlands OBGYN: Hormone Therapy Extracorporeal Shockwave Therapy

Men’s Health We provide a variety of services for men’s sexual health. As men age and their testosterone declines sexual performance and satisfaction for both the man and his partner can decline. Hormone Therapy Feeling tired? Can’t sleep? Trouble focusing? Just not feeling the same? Have you had your testosterone tested? There are the symptoms of declining testosterone. This decline is now termed andropause – similar to menopause in women. Andropause not only makes us feel bad, it also increases our risk of heart disease, prostate cancer, diabetes and obesity. Not all men need testosterone. Lifestyle changes, exercise, supplements and medication can be used to enhance the body’s natural production of testosterone. When necessary- if conservative treatments fail-testosterone therapy with bio identical pellets are offered. This is a highly effective treatment that lasts 4-6 months. Compared to injections, creams and gels, pellet therapy is more effective with less side effects. Erectile Dysfunction (ED) ED is the loss of ability to achieve a satisfactory erection. Even with a normal testosterone level ED can occur. Most ED is due to underlying vascular problems. Medications such as Viagra work to help dilate blood vessels and increase blood flow in the penis. The Priapus Shot improves blood flow in the penis by stimulating the growth of new blood vessels and nerves. Erectile Dysfunction Shock Wave Therapy (EDSWT) EDSWT uses acoustic shock therapy focusing on blood vessels to promote the growth of new vessels resulting in improved blood flow to the penis. Some will improve to the point of not needing medications for ED. Others may still need medications, but will have better erections. We recommend 6 treatments – once a week or 2 times a week – Both protocols are effective. Each treatment lasts about 20 minutes and costs $300.00. Most will notice improvement after the third treatment. Additional Treatment Options The following additional treatment options for men’s sexual wellness are available at Woodlands OBGYN: P-Shot Extracorporeal Shockwave Therapy

The Impact of Sexual Dysfunction Many women experience problems with sexual function at some point in their life. A survey conducted by the Journal of American Medical Association in 1999 indicated that sexual dysfunction affects approximately 43% of women in the U.S. Female sexual dysfunction can occur at all stages of life, and it may be ongoing, or happen only once in a while. In any case, and with whatever amount of frequency, the impact it can have on one’s life is a crucial factor to give adequate attention to and to address. Types of Dysfunction & Factors Sexual response involves a complex interaction of physiology, emotions, experiences, beliefs, lifestyle and relationships. Disruption of any of these components can affect sexual drive, arousal or satisfaction. Types of sexual dysfunction include: Low sexual desire – You have diminished libido, or low sex drive. Sexual arousal disorder – Your desire for sex might be intact, but you have difficulty, or are unable to become aroused, and/or maintain arousal during sexual activity. Orgasmic disorder – You have persistent or recurrent difficulty in achieving orgasm after sufficient sexual arousal and ongoing stimulation. Sexual pain disorder – You have pain associated with sexual stimulation or vaginal contact. Many factors can contribute to sexual dysfunction: Hormone dysfunction (low estrogen or testosterone) Vaginal Pain (scarring, lack of hormones, problems with pelvic prolapse) Urinary incontinence (can cause embarrassment, avoidance) Anxiety, depression, stress, distractions, relationship problems Substance abuse (alcohol, tobacco, marijuana) Illness (diabetes, hypertension, cancer) Negative body perception Medications (birth control pills, anti-depressants, blood pressure medication) Excessive exercise Treatment Options for Sexual Dysfunction At Woodlands OBGYN Associates, we understand that the best treatment options for female sexual dysfunction will depend on the underlying cause. Most women are uncomfortable discussing this subject, but as experienced gynecologists, we specialize in treating the various causes of sexual dysfunction. Concerning sexual dysfunction, the primary treatment options offered at Woodlands OBGYN Associates include: Hormone Therapy MonaLisa Touch® procedure The O-Shot® for Women The P-Shot® for Men Incontinence Devices Surgical options like Vaginal Reconstructive Surgery, etc. Should be discussed with your Woodlands OBGYN physician. An open discussion with your physician can enlighten you to the many treatments available to you. If the sexual dysfunction is related to your hormone levels, some quick tests in our office can help determine if hormone pellet therapy or HRT might be right for you. Furthermore, women who cannot, or do not wish to take hormones, but still experience vaginal dryness and pain during or after intimacy, the MonaLisa Touch® safe and effective treatment procedure is also a viable option. Learn more about YOUR options and start enjoying intimacy again! Take the 1st Step… CALL 281-364-9898

Urinary incontinence is the uncontrolled leakage of urine from the bladder. There are three types of incontinence: Stress incontinence is the uncontrolled leaking of urine that occurs when coughing, sneezing, laughing, lifting, or when performing any other type of straining motion. Urge incontinence is due to a bladder that is overactive and causes the frequent need to urinate and loss of urine due to a sudden urge. Mixed incontinence is a combination of both. What You Should Know About Urinary Incontinence What Causes Bladder Leakage? Urine loss can occur at any age under challenging conditions; however, frequent urine loss with normal activities occurs due to a change in anatomy. Physicians refer to this as a “fallen bladder,” which can occur due to child birth or constant straining or lifting. Hormone changes may also weaken the bladder and support of the urethra. Kegel exercises can be done to gradually increase the strength of the support muscles. However, for most patients, Kegel exercises have a limited benefit if done without guidance. Surgical procedures to support the urethra are done on an outpatient basis with minimal discomfort and recovery. Current surgical procedures for bladder leakage are very different from procedures performed even 10 years ago. Common Causes Vaginal child birth Heavy lifting or straining Smoking Weight gain Chronic coughing Constipation What is Urge Incontinence? Urge incontinence occurs when the bladder fails to relax to allow more urine to fill, and this stimulates the need to urinate. Patients with this disorder may urinate every 15-20 minutes. Treatment requires medication and bladder training drills. It is important to rule out irritation from foods, medications, or bladder stones. Gain Control Over Bladder Leaks There are treatment options for urinary incontinence. As such, those who are experiencing leaks no longer have to suffer or remain embarrassed about their condition. Certain treatment options may simply require natural and personal changes at home, while others will call for professional medical care. The following treatment options for urinary incontinence are available at Woodlands OBGYN: Lifestyle changes and Diet changes, including decreasing fluids and caffeine intake. Weight loss will also help. Kegel exercises Medications are used mainly for the treatment of urge incontinence. Intone– a non-surgical home treatment device for incontinence O-Shot MonaLisa Emsella Surgical treatment options can be used to correct stress incontinence, depending on the severity and other symptoms. Individualized Plans – After out office provides a complete evaluation of problems with urinary incontinence, we then help you determine which treatment option is best for your situation. Though we offer the full range of incontinence treatments, options are always tailored to the wishes and needs of each patient. If you are experiencing frequent urination or leakage of any kind, discuss it with your Woodlands OBGYN Associates doctor. We can help! Raj K. Syal, M.D., F.A.C.O.G. Connect w/Woodlands OBGYN Associates CALL 281-364-9898

Physician Supervised Clinical Weight Loss: A Viable Solution! Many patients desiring weight loss have experienced the frustration of their efforts. Weight loss is a component of overall health. Excessive weight increases the risk of heart disease, diabetes, hypertension and hormone dysfunction. The foundation of our weight loss program is common sense, education, optimizing hormones and use of medication as needed. At your initial evaluation extensive testing for hormone dysfunction (including thyroid) diabetes and pre-diabetes. Any deficiencies will be addressed. The key to weight loss is to eat less, eat smarter, move more and monitor your progress. To help you succeed I may prescribe a low dose appetite suppressant combined with low dose naltrexone (LDN). Naltrexone is medication used to treat narcotic overdose. In a low dose, naltrexone reduces cravings for food. LDN can also reduce insulin resistance and improve thyroid function. Sleep may also improve with LDN resulting in improved growth hormone, and hormone balances. LDN is not a miracle drug for weight loss. However, it is a useful tool in addition to others than can help you reach your goal.

Renew | Refresh | Rejuvenate At Woodlands OBGYN, we’re offering SmartSkin™ CO2 Laser Skin Renewal – one of most advanced option for aesthetic treatments. The SmartSkin™ CO2 Laser Skin Renewal system changes appearance because it affects the skin below the surface. The result is skin resurfacing and collagen rejuvenation, resulting in tighter and smoother skin. Fighting Signs of Aging Skin the SMART Way SmartSkin™ CO2 Laser Skin Renewal is new and approved technology which means that our patients are getting better and more focused treatment than ever before. In the medical field, new is almost always better when it comes to innovation. SmartSkin™ CO2 Laser Skin Renewal treatments minimize treatment time with visible results seen in the first visit for most patients. Recovery time for these aesthetic procedures are only a few days rather than weeks when compared to a traditional face lift. There is no bruising, no incision line, and no sutures to worry about. The risks of surgery are gone as are the risks of anesthesia. Areas treated include face, neck, chest, and hands. The SmartSkin™ CO2 Laser Skin Renewal system works by using light energy, focused, strengthened and naturally narrow, to stimulate tissue below skin level to produce more collagen. The full effects are seen 12 weeks after the treatment.

Hair loss can be an embarrassing issue! Male and female pattern hair loss is a genetic problem that can leave you feeling helpless. Options, like prescription drugs, are often partially effective and carry the potential for unwanted side effects. Surgical hair restoration can be expensive and does not treat the underlying medical problems. Now there is an affordable way for you to improve your hair density without surgery or harmful side effects. Platelet-Rich Plasma (PRP) for hair restoration involves a simple injection of your own platelets into the vascular layer of your scalp. PRP for Hair Regrowth Increases blood supply to the follicle Increase shaft size (thickness) Triggers and maintain the growth phase Control hair growth cycle Decreases hair loss How PRP Works Platelets contain healing growth factors. Those growth factors are like signal callers that give instructions to your tissue to regenerate and multiply. This has lead different fields of medicine to utilize PRP for wound healing speed up recovery and time and regrow healthier, stronger tissue. Now doctors have discovered new benefits for hair thickening and regrowth. With PRP for Hair, your growth factors and stem cells work together to reverse the miniaturization of the hair follicle and jumpstarting dormant hair back into the growth stage. PRP for Hair Loss This quick injection involves the collection and concentration of your body’s own platelets using a very easy three-step process. Step 1 A special collection tube is used to draw your blood and is placed in the centrifuge. Step 2 After 10 minutes of centrifugation, the platelets are concentrated and drawn up into a syringe. Step 3 Using a small needle, the platelets are then injected strategically into your scalp in the areas that need improvement. Hair-Raising Fast Facts The percentage of men who have noticeable hair loss; Age 35 – 60 : 40% Age 60 – 80 : 65% Age 80 – 85 : 70% Age 85+ : 80% The average number of hair follicles on the scalp is 110,000. The average number of hair lost daily is 100. There is an average of 35 million men and 21 million women in the U.S. who are experiencing hair loss. 80% of women will have noticeable hair loss by the age of 60. The worldwide number of hair-loss sufferers is 811,363 that are seeking professional hair treatment.

A hysterectomy pertains to the removal of the uterus (or womb) resulting from problems of excessive bleeding, pain, prolapse, or excessive growth. The decision to surgically remove the uterus can be a difficult one. The Department of Health and Human Services reports that one-third of US women will undergo this procedure by age 60. Helping You Explore Your Options When it comes to considering a hysterectomy, you’re not alone. It is the second most common major operation that women undergo. In this section, we’ve outlined the surgical options for you to consider, and what questions to ask. This section of our website is written under the assumption that alternatives to a hysterectomy have already been considered and the decision to proceed with surgery has been made by you and your doctor. How will the procedure be performed? There are four basic ways to perform a hysterectomy. The method chosen will be determined by your physician based on their experience and expert opinion in handling your condition.

An Advanced & Minimally Invasive Surgical Option Woodlands OBGYN Associates is pleased to offer the advanced technology of the da Vinci® Robot Surgery system as a viable option for safe and minimally invasive gynecological surgeries. In gynecology, da Vinci® Robot surgery is utilized for conditions requiring hysterectomy, myomectomy (removal of uterine fibroids), and pelvic prolapse. If you need surgery, we encourage you to become educated on the benefits of robotic surgery. Advanced Surgical Technology with Benefits The da Vinci® Robot is an innovative tool that gives a surgeon improved visualization and control during complex surgeries. During some gynecologic procedures, surgeons can access the targeted anatomy using a vaginal approach, which may not require an external incision. But for complex hysterectomies and other gynecologic procedures, surgery with the da Vinci® Surgical System may be the most effective, and least invasive treatment option. Through small incisions, surgeons using da Vinci® system can operate with greater precision and control using the magnified high definition 3D image. At the same time, state-of-the-art robotic and computer technologies scale, filter and seamlessly translate the surgeon’s hand movements into precise micro-movements of the da Vinci® instruments. This will minimize the pain and risk associated with large incisions, while also increasing the likelihood of a much faster recovery and excellent clinical outcome. da Vinci® Robotic Surgery with Woodlands OBGYN In our Woodlands OBGYN practice, da Vinci® Robot surgery is done to perform the following procedures: Hysterectomy Myomectomy (Removal of Uterine Fibroids) Complex Removal of Endometriosis Ovarian Tumors Sacrocolpopexy (Vaginal Suspension for Prolapse)

Feel Free to Enjoy Life Again Heavy menstrual bleeding is not normal and can be treated effectively through a procedure called an endometrial ablation. This innovative and minimally invasive procedure offers a quick, safe, and simple way to lighten – and possibly stop, heavy periods. The endometrial procedure addresses the issue of heavy bleeding without the use of hormones or the risks associated with hysterectomy. Heavy Bleeding Under Control If you are experiencing heavy bleeding and your family is complete, ask your Woodlands OBGYN doctor if uterine ablation is right for you. Below are some simple questions to help you decide if NovaSure and Minerva endometrial ablation is for right you: Does your period affect your quality of life? Are your periods heavy or do they last longer than 5-7 days? Would your quality of life improve if you could decrease or potentially eliminate your heavy periods? Do your heavy periods affect your social, athletic or sexual activities or cause you to miss work? Do you change protection frequently or carry large quantities of feminine products and/or a change of clothes? Do your heavy periods cause anxiety, or pain? Advantages Endometrial Ablation We offer both the NovaSure and Minerva technologies. Simple in-office procedure with minimal recovery. Most patients return to normal activity the next day 9 out of 10 patients experience reduced bleeding during their cycles 97% avoidance of hysterectomy at five years post-procedure 93% patient satisfaction in the pivotal trial Usually covered by insurance At Woodlands OBGYN Associates, we perform the NovaSure and Minerva Endometrial Ablation procedure in our office with a board-certified anesthesiologist. Under IV sedation, your doctor and anesthesiologist will monitor you continuously for your safety. After a short recovery period in our office, you will be able to return home and rest. You will be required to have someone drive you home after this procedure. To learn more about what to expect from this procedure, click NovaSure and Minerva. If you would like to consider endometrial ablation, please contact our office. We would be happy to speak with you about whether or not you are a good candidate for this procedure. CALL 281-364-9898

Myomectomy Surgery At Woodlands OBGYN Associates, we understand that making the decision to have gynecological surgery before becoming pregnant can be a scary one, especially for women who still desire to have children. A myomectomy is an effective surgical procedure that is performed to remove uterine fibroids, or “myomas”. Unlike a hysterectomy, where the uterus is also removed along with the fibroids, in a myomectomy, the uterus is left intact, minus the fibroids. Ultimately, this allows women to preserve their options. Surgical Myomectomy Options @Woodlands OBGYN Myomectomy is the preferred surgical treatment for removing fibroids in women who want to become pregnant. Once the decision is made, most women anticipate how myomectomy surgery will change their quality of life. In most cases, the heavy menstrual flow and painful cramps decrease. At Woodlands OBGYN, we offer various methods for removing fibroids. Such methods include: robot-assisted laparoscopy, laparoscopy, and laparotomy (abdominal incision). The choice will be dependent on several factors, such as the size of the fibroid(s), location(s), and number. The newest method available to you for myomectomy is the da Vinci® Robot system. Using robotics-assisted technology, your physician is able to be more precise than ever before. The result is less risk of healthy tissue loss, less bleeding intraoperatively, less pain, and a shorter recovery time in comparison to laparoscopy alone, or a laparotomy. Although a laparotomy may require a longer recovery time, in some cases it may maximize your chances for future pregnancy. There are multiple factors your physician will consider before recommending a treatment plan. Consulting with Woodlands OBGYN Associates If you have questions, and you will, write them down and take the 1st step… Call us for a consultation. During your appointment, be sure to bring your written questions to ask, along with any other tests you’ve already had. To Schedule Your Appointment CALL 281-364-9898

Laparoscopy is a Very Common Procedure Laparoscopic surgery is the most common procedure used to diagnose and treat causes of pelvic pain, such as endometriosis and ovarian cysts. Instead of using a large abdominal incision, the surgeon inserts a lighted viewing instrument called a laparoscope through a small incision. Directly viewing the pelvic organs is the only way to confirm whether you have endometriosis. Checking & Treating Pelvic Issues with Laparoscopy Laparoscopy is used to examine the pelvic organs and to remove implants and endometrial scar tissue. When examining and viewing the pelvic region with the laparoscope, if endometriosis or scar tissue needs to be removed, we will use one of various techniques to do so. Surgical techniques include: cutting and removing tissue (excision), or destroying it with a laser beam or electric current (electrocautery). This procedure is typically used for checking and treating: Severe endometriosis and scar tissue that is thought to be interfering with internal organs, such as the bowel or bladder. Endometriosis pain that has continued or returned after hormone therapy. Severe endometriosis pain (some women and their doctors choose to skip medicine treatment). An endometriosis cyst on an ovary (endometrioma). Endometriosis as a possible cause of infertility. The Woodlands OBGYN surgeon usually removes any visible implants and scar tissue. This may improve fertility. *** Post op recovery time is usually rapid, over 3-5 days. Full recovery is within 2 weeks. Woodlands OBGYN Associates Gives You Options Our office offers a wide range of treatments for pelvic pain, endometriosis, uterine fibroids, infertility, and ovarian cysts using operative laparoscopy. Depending on your unique medical situation, the experienced physicians of Woodlands OBGYN will work with you to help determine which options will best meet your needs and help you live well! To Schedule Your Appointment CALL 281-364-9898 Surgical Services Surgical Hysterectomy da Vinci® Robot Surgery Endometrial Ablation Myomectomy Laparoscopy PREGNANCY GYNECOLOGY LIFESTYLE PATIENT PORTAL 281-364-9898