GYNECOLOGY

There are many different causes for abnormal bleeding in women.  The typical menstrual cycle in adults is approximately 21 to 35 days.  There can be more variability  in the first 10 years after the period starts and the 10 years before menopause (average age of menopause in the US is 51.5years).  Common causes for abnormal bleeding include hormonal irregularities, concurrent medical conditions such as thyroid disorders, structural abnormalities (fibroids and polyps), the use of certain medications, infection, pregnancy, and neoplasm.  The typical work-up for abnormal bleeding includes a complete history and physical.  At that time it can be determined whether labwork, ultrasound, or a biopsy needs to be done.

Bio-Identical hormone therapy is a menopause treatment that copies the molecular structure of the hormones our bodies produce. These replacement hormones are made from soy and yam extracts and can be processed and metabolized in the body in the same manner as the hormones we produce. Treatment with these replacement hormones reduce the side effects that are common to conventional hormone replacement therapies. Bio-identical hormone therapy is a safe and natural replacement for the hormones that our bodies lack during and after menopause, the absence of which can cause symptoms like hot flashes, night sweats, irritability and weight gain. However, hormone therapy is not the only solution to some of these symptoms and should only be used after natural remedies like diet, stress reduction and exercise fail to produce results.

• Traditional oral contraceptive pills that are taken daily and result in a monthly period.  Very low doses are available for patients who would like to limit the amount of hormones they take.
• Contraceptive pills that are taken daily, but result in a period every three months.
• Contraceptive patch that is worn on a weekly basis. Normal monthly periods are experienced.
• Contraceptive ring which is worn vaginally for 21 days.  The patient can expect to have a monthly period.
• Contraceptive arm implant, which is a 4cm progesterone based rod that is placed in the patient’s arm.  This method is approved to provide contraception for 3 years and the most common side effect is irregular vaginal bleeding.
• Contraceptive Intrauterine Device, a progesterone based IUD that is approved for 5 years of contraception and that is commonly used to treat patients with heavy bleeding.
• Contraceptive Intrauterine Device, a non-hormonal device which can be used for up to 10 years.
• Contraceptive Diaphragm, a soft latex or silicone dome with a spring molded into the rim that acts as a cervical barrier.
• Permanent Sterilization options including laparoscopic tubal ligation.

An ectopic pregnancy is one where there is abnormal implantation of the embryo outside of the womb (uterus).  Development most commonly occurs in the fallopian tubes but can also take place in the ovary or cervix.  In the scenario where there is abnormal implantation, the developing fetus cannot survive.  Many cases are caused by blockage of the fallopian tube, which impedes the transit of the fertilized egg to the uterus.  A history of pelvic infections or past surgery on the tubes can cause this condition, although sometimes the cause is unknown.  Symptoms of an ectopic pregnancy include pelvic pain and abnormal bleeding.  Both medical and surgical treatments are available for this serious complication of pregnancy.

Endometriosis is a common condition, where cells that typically line the uterus grow in other areas of the body.  Every month, a woman’s ovaries produce hormones that tell the cells lining the uterus (womb) to swell and get thicker. The body is able to expel these cells through the process of menstruation.  If these cells (called endometrial cells) implant and grow outside the uterus, endometriosis results. The growths are called endometrial tissue implants. Women with endometriosis typically have tissue implants on the ovaries, bowel, rectum, bladder, and on the lining of the pelvic area. They can occur in other areas of the body, too.  Unlike the endometrial cells found in the uterus, the tissue implants outside the uterus stay in place during menstruation. They sometimes bleed a little bit. They grow again during the next period. This ongoing process leads to pain and other symptoms. The cause of endometriosis is unknown. One theory is that the endometrial cells shed during menstruation and travel backwards through the fallopian tubes into the pelvis, where they implant and grow. This is called retrograde menstruation. This backward menstrual flow occurs in many women, but researchers think the immune system may be different in women with endometriosis.Endometriosis is common. Sometimes, it may run in the family. Although endometriosis is typically diagnosed between ages 25 to 35, the condition probably begins about the time that regular menstruation begins.  The classic symptoms of a women with endometriosis include cyclical pelvic pain at the time of menstruation.  The most common treatments include birth control pills, other hormonal regimens, or surgery.

Human Papilloma Virus, or HPV, is a type of virus that can be transmitted sexually and is very prevalent in the US population with over 100 strains in existence.  It has been estimated that 75-80% of adults will, at some point before the age of 50, be infected with HPV.  HPV in some cases can lead to genital warts, cervical pre-cancers, or cancers of the cervix, vulva, vagina or anus.  There are 2 predominant types of HPV:  low risk which is associated with warts and high risk which is often found with an abnormal pap smear.  Once contracted, HPV is fought by the body’s immune system.  We recommend taking a multivitamin with anti-oxidants, exercising regularly, and abstaining from smoking.  Your physician may choose other methods to treat HPV in certain cases. There are currently two vaccines available for the prevention of HPV, which are often given to women between the ages of 9 and 26.  Vaccines offers immunity to HPV types 6 and 11 (low risk) and 16 and 18 (high risk).  It is known that types 16 and 18 are responsible for over 70% of cervical cancers in the United States.

Urinary incontinence is defined as the involuntary loss of urine.  This is a very common condition for women and one that is at times difficult or embarrassing to discuss with your physician.  There are many reasons for incontinence, but the two most common are the weakening of the urethra (outflow tract of the bladder) or spasm of the bladder muscle.  There is quite a bit of information that can be gathered regarding a woman’s incontinence through history and a  physical exam.  In addition,we can perform a urodynamics test in the office to assist our evaluation.  The Woman’s Group offers many types of therapies including medical, behavioral with physical therapy, and a variety of surgeries to remedy this condition.

Infertility is defined as the inability to conceive after a year of unprotected regular intercourse.  This can be a very stressful situation for a couple, and there are many known causes.  When looking at the reasons why a couple is infertile, 40% of them are typically due to female factors, 40% to male factors and 20%, even after work-up, remain unknown.  There are a variety of tests that can be done to try to determine the cause of infertility.  If a couple meets the criteria for infertility, they should make an appointment with a physician so that an evaluation can be done and an appropriate course of action can be developed.

The average age of menopause in the united States is 51.5 years. Menopause is  defined as the absence of menses for one full year.  The cause of menopause is the decline in ovarian function over time and thus the decline of the menstrual hormones.  The most common symptoms experienced are hot flashes, night sweats, insomnia, mood swings, and vaginal dryness.  These symptoms can occur as a woman’s hormone levels change, sometimes years before the periods stop.  There are no reliable tests available to predict the timing, onset, or severity of menopause.  Typically, the patient is treated based on her symptoms and their severity.  There are many different types of medications available, which can be tailored to the particular symptom. It is essential that a woman take an adequate amount of calcium with vitamin D when approaching the menopausal years.  The highest rate of bone loss in women takes place during the first 5 years after menopause.

Pre-menstrual syndrome (PMS) or pre-menstrual dysphoric disorder (PMDD) are common conditions that many women will experience throughout their lives.  These conditions can have associated symptoms including bloating, cramping, fatigue, moodiness, sleep disturbance, and depression. PMS can be experienced by many women, but PMDD is a more serious disorder that should be diagnosed and treated by a professional.   There are many solutions possible  including behavioral modification, exercise, eating healthfully, acquiring good sleep patterns, managing  stress, limiting alcohol consumption and refraining from smoking.  Hormonal therapy (OCPs) can be used to control many of the symptoms.  In addition, anti-depressants may be of benefit to some patients.