Gynecologist in Tampa Bay

Gynecology Care

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How can I prepare for my exam?

The most important thing to do before your gynecological exam is research. Women should be prepared to discuss their family medical history and be ready for questions about their menstrual cycle. Commonly asked questions your provider may ask to include:

  • When was your last period?
  • How long does your period typically last?
  • At what age did you start your period?
  • Are you sexually active?
  • What should I expect for my annual exam?

The pelvic exam only lasts a few minutes and the exam itself doesn’t hurt. Most physicians will explain the process before beginning the exam, asking questions throughout the process is encouraged. The pelvic exam consists of the following steps:

  • Your doctor will typically begin with a breast exam to check for lumps that may be a sign of cancer.
  • Your physician will then check the external genital area for irritations, cysts or other problems.
  • Next, the physician will insert a speculum, which is an instrument that is used to examine the cervix and vaginal walls. During this time, the doctor will also conduct a pap smear to check for cancerous and pre-cancerous cells.
  • The last step in the physical exam is for the physician to check the uterus, fallopian tubes and ovaries by inserting gloved fingers into the vagina and pressing on the abdomen.

Not only does the annual exam ensure that you maintain good gynecological health, but it is also an opportunity for you to catch health problems in the early stages.

Contraceptive counseling has great potential as a strategy to empower women who do not desire pregnancy to choose a method of birth control that she can use correctly and consistently over time, thereby reducing her individual risk of unintended pregnancy.
Many elements need to be considered by women, men, or couples at any given point in their lifetimes when choosing the most appropriate contraceptive method. These elements include safety, effectiveness, availability (including accessibility and affordability), and acceptability. Voluntary informed choice of contraceptive methods is an essential guiding principle, and contraceptive counseling, when applicable, might be an important contributor to the successful use of contraceptive methods.
In choosing a method of contraception, dual protection from the simultaneous risk for HIV and other STDs also should be considered. Although hormonal contraceptives and IUDs are highly effective at preventing pregnancy, they do not protect against STDs, including HIV. Consistent and correct use of the male latex condom reduces the risk for HIV infection and other STDs, including chlamydial infection, gonococcal infection, and trichomoniasis.

Mammography is the most widely used screening modality for the detection of breast cancer. There is evidence that it decreases breast cancer mortality in women aged 50 to 69 years and that it is associated with harms, including the detection of clinically insignificant cancers that pose no threat to life (overdiagnosis). Breast self-exam has been shown to have no mortality benefit. No results have been published on the outcomes of incidence or mortality for CBE (clinical breast exam).
Technologies such as ultrasound, magnetic resonance imaging, and molecular breast imaging are being evaluated, usually as adjuncts to mammography, and are not primary screening tools in the average population.

Bone Density Test

A bone density test (DXA) is the only test that can diagnose osteoporosis before a broken bone occurs. This test helps to estimate the density of your bones and your chance of breaking a bone.  DXA stands for dual energy x-ray absorptiometry.

You can find out whether you have osteoporosis or if you should be concerned about your bones by getting a bone density test. Some people also call it a bone mass measurement test. This test uses a machine to measure your bone density. It estimates the amount of bone in your hip, spine and sometimes other bones. Your test result will help your healthcare provider make recommendations to help you protect your bones.

Are you a postmenopausal woman age 50 and older? Have you recently broken a bone? If you answered “yes” to both questions, you should talk to your doctor or other healthcare provider about getting a bone density test if you’ve never had one.

What a Bone Density Test Can Do

A bone density test tells you if you have normal bone density, low bone density (osteopenia) or osteoporosis. It is the only test that can diagnose osteoporosis. The lower your bone density, the greater your risk of breaking a bone. A bone density test can help you and your healthcare provider:

  • learn if you have weak bones or osteoporosis before you break a bone
  • predict your chance of breaking a bone in the future
  • see if your bone density is improving, getting worse or staying the same
  • find out how well an osteoporosis medicine is working
  • let you know if you have osteoporosis after you break a bone

Who Should Have a Bone Density Test?

  • you are a woman age 65 or older
  • you break a bone after age 50
  • you are a woman of menopausal age with risk factors
  • you are a postmenopausal woman under age 65 with risk factors

A bone density test may also be necessary if you have any of the following:

  • an X-ray of your spine showing a break or bone loss in your spine
  • back pain with a possible break in your spine
  • height loss of ½ inch or more within one year
  • total height loss of 1½ inches from your original height

If you are sexually active, getting tested for STDs is one of the most important things you can do to protect your health. Make sure you have an open and honest conversation about your sexual history and STD testing with your doctor and ask whether you should be tested for STDs.

Below is a brief overview of STD testing recommendations. 

  • All adults and adolescents from ages 13 to 64 should be tested at least once for HIV.
  • All sexually active women younger than 25 years should be tested for gonorrhea and chlamydia every year. Women 25 years and older with risk factors such as new or multiple sex partners or a sex partner who has an STD should also be tested for gonorrhea and chlamydia every year.
  • All pregnant women should be tested for syphilis, HIV, and hepatitis B starting early in pregnancy. At-risk pregnant women should also be tested for chlamydia and gonorrhea starting early in pregnancy. Testing should be repeated as needed to protect the health of mothers and their infants.
  • All sexually active gay and bisexual men should be tested at least once a year for syphilis, chlamydia, and gonorrhea. Those who have multiple or anonymous partners should be tested more frequently for STDs (i.e., at 3- to 6-month intervals).
  • Sexually active gay and bisexual men may benefit from more frequent HIV testing (e.g., every 3 to 6 months).

Anyone who has unsafe sex or shares injection drug equipment should get tested for HIV at least once a year.

Two screening tests can help prevent cervical cancer or find it early—

  • The Pap test (or Pap smear) looks for precancers, cell changes on the cervix that might become cervical cancer if they are not treated appropriately.
  • The HPV test looks for the virus (human papilloma virus) that can cause these cell changes.

Both tests can be done in a doctor’s office or clinic. During the Pap test, the doctor will use a plastic or metal instrument, called a speculum, to widen your vagina. This helps the doctor examine the vagina and the cervix, and collect a few cells and mucus from the cervix and the area around it. The cells are sent to a laboratory.

  • If you are getting a Pap test, the cells will be checked to see if they look normal.
  • If you are getting an HPV test, the cells will be tested for HPV.

How to Prepare for Your Pap or HPV Test

You should not schedule your test for a time when you are having your period. If you are going to have a test in the next two days—

  • You should not douche (rinse the vagina with water or another fluid).
  • You should not use a tampon.
  • You should not have sex.
  • You should not use a birth control foam, cream, or jelly.
  • You should not use a medicine or cream in your vagina.

What is genetic testing?

Genetic testing looks for specific inherited changes (variants) in a person’s genes. Genetic variants can have harmful, beneficial, neutral (no effect), or unknown or uncertain effects on the risk of developing diseases. Harmful variants in some genes are known to be associated with an increased risk of developing cancer. These inherited variants are thought to contribute to about 5 to 10% of all cancers.

Cancer can sometimes appear to “run in families” even if it is not caused by an inherited variant. For example, a shared environment or lifestyle, such as tobacco use, can cause similar cancers to develop among family members. However, certain patterns that are seen in members of a family—such as the types of cancer that develop, other non-cancer conditions that are seen, and the ages at which cancer typically develops—may suggest the presence of inherited susceptibility to cancer.

Genes involved in many of the known inherited cancer susceptibility syndromes have been identified. Testing whether someone carries a harmful variant in one of these genes can confirm whether a condition is, indeed, the result of an inherited syndrome. Genetic testing is also done to determine whether family members who have not (yet) developed cancer have inherited the same variant as a family member who is known to carry a harmful (cancer susceptibility predisposing) variant.

From NCI

In general, infertility is defined as not being able to get pregnant (conceive) after one year (or longer) of unprotected sex. Because fertility in women is known to decline steadily with age, some providers evaluate and treat women aged 35 years or older after 6 months of unprotected sex. Women with infertility should consider making an appointment with a gynecologist. Your gynecologist may also be able to help women with recurrent pregnancy loss, defined as having two or more spontaneous miscarriages.

Pregnancy is the result of a process that has many steps.

To get pregnant

  • A woman’s body must release an egg from one of her ovaries.
  • A man’s sperm must join with the egg along the way (fertilize).
  • The fertilized egg must go through a fallopian tube toward the uterus.
  • The fertilized egg must attach to the inside of the uterus (implantation).

Infertility may result from a problem with any or several of these steps.

Infertility is not always a woman’s problem. Both men and women can contribute to infertility.  

Many couples struggle with infertility and seek help to become pregnant, but it is often thought of as only a woman’s condition. However, in about 35% of couples with infertility, a male factor is identified along with a female factor. In about 8% of couples with infertility, a male factor is the only identifiable cause.

Almost 9% of men aged 25 to 44 years in the United States reported that they or their partner saw a doctor for advice, testing, or treatment for infertility during their lifetime.

The following tests may be recommended as part of your infertility evaluation: 

Male Partner Semen Analysis: Although the semen analysis is obtained from the male partner, it is an essential part of the infertility evaluation.  A semen analysis should provide information about the number, movement, and shape of the sperm. A semen analysis is necessary even if the male partner has fathered a child before. 

Hysterosalpingogram (HSG): This is an X-ray procedure to see if the fallopian tubes are open and to if the shape of the uterine cavity is normal. A catheter is inserted into the opening of the cervix through the vagina. A liquid containing iodine (contrast) is injected through the catheter. The contrast fills the uterus and enters the tubes, outlining the length of the tubes, and spills out their ends if they are open. 

Transvaginal Ultrasonography:  An ultrasound probe placed in the vagina allows the clinician to check the uterus and ovaries for abnormalities such as fibroids and ovarian cysts. 

Ovarian Reserve Testing: When attempting to test for a woman’s ovarian reserve, the clinician is trying to predict whether she can produce an egg or eggs of good quality and how well her ovaries are responding to the hormonal signals from her brain.  The most common test to evaluate ovarian reserve is a blood test for follicle stimulating hormone (FSH) drawn on cycle day 3. In addition to the FSH level, your physician may recommend other blood tests, such as estradiol, antimüllerian hormone (AMH), and/or inhibin-B, as well as a transvaginal ultrasound to do an antral follicle count (the number of follicles or egg sacs seen during the early part of a menstrual cycle). 

Ovarian reserve testing is more important for women who have a higher risk of reduced ovarian reserve, such as women who: 

  1. are over age 35 years; 
  2. have a family history of early menopause; 
  3. have a single ovary; 
  4. have a history of previous ovarian surgery, chemotherapy, or pelvic radiation therapy; 
  5. have unexplained infertility; or 
  6. have shown poor response to gonadotropin ovarian stimulation.  

Other Blood Tests: Thyroid-stimulating hormone (TSH) and prolactin levels are useful to identify thyroid disorders and hyperprolactinemia, which may cause problems with fertility, menstrual irregularities, and repeated miscarriages. In women who are thought to have an increase in hirsutism (including hair on the face and/or down the middle of the chest or abdomen), blood tests for dehydroepiandrosterone sulfate (DHEAS), 17-α hydroxyprogesterone, and total testosterone should be considered. A blood progesterone level drawn in the second half of the menstrual cycle can help document whether ovulation has occurred.  .

Sonohysterography: This procedure uses transvaginal ultrasound after filling the uterus with saline (a salt solution). This improves detection of intrauterine problems such as endometrial polyps and fibroids compared with using transvaginal ultrasonography alone. If an abnormality is seen, a hysteroscopy is typically done. This test is often done in place of HSG.

Hysteroscopy: This is a surgical procedure in which a lighted telescope-like instrument (hysteroscope) is passed through the cervix to view the inside of the uterus. Hysteroscopy can help diagnose and treat abnormalities inside the uterine cavity such as polyps, fibroids, and adhesions (scar tissue). 

Laparoscopy: This is a surgical procedure in which a lighted telescope-like instrument (laparoscope) is inserted through the wall of the abdomen into the pelvic cavity. Laparoscopy is useful to evaluate the pelvic cavity for endometriosis, pelvic adhesions, and other abnormalities. Laparoscopy is not a first line option in the evaluation of a female patient.  Because of its higher costs and potential surgical risk, it may be recommended depending on the results of other testing and a woman’s history, such as pelvic pain and previous surgeries.

For best results, the infertility evaluation should be individualized based on each woman’s specific circumstances. 

Diagnosis

There are no unique physical findings or lab tests to positively diagnose the premenstrual syndrome. Your doctor may attribute a particular symptom to PMS if it’s part of your predictable premenstrual pattern.

To help establish a premenstrual pattern, your doctor may have you record your signs and symptoms on a calendar or in a diary for at least two menstrual cycles. Note the day that you first notice PMS symptoms, as well as the day they disappear. Also, be sure to mark the days your period starts and ends.

Certain conditions may mimic PMS, including chronic fatigue syndrome, thyroid disorders and mood disorders, such as depression and anxiety. Your health care provider may order tests, such as a thyroid function test or mood screening tests to help provide a clear diagnosis.

Treatment

For many women, lifestyle changes can help relieve PMS symptoms. But depending on the severity of your symptoms, your doctor may prescribe one or more medications for premenstrual syndrome.

The success of medications in relieving symptoms varies among women. Commonly prescribed medications for premenstrual syndrome include:

  • Antidepressants. Selective serotonin reuptake inhibitors (SSRIs) — which include fluoxetine (Prozac, Sarafem), paroxetine (Paxil, Pexeva), sertraline (Zoloft) and others — have been successful in reducing mood symptoms. SSRIs are the first line treatment for severe PMS or PMDD. These medications are generally taken daily. But for some women with PMS, use of antidepressants may be limited to the two weeks before menstruation begins.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs). Taken before or at the onset of your period, NSAIDs such as ibuprofen (Advil, Motrin IB, others) or naproxen sodium (Aleve) can ease cramping and breast discomfort.
  • Diuretics. When exercise and limiting salt intake aren’t enough to reduce the weight gain, swelling and bloating of PMS, taking water pills (diuretics) can help your body shed excess fluid through your kidneys. Spironolactone (Aldactone) is a diuretic that can help ease some of the symptoms of PMS.
  • Hormonal contraceptives. These prescription medications stop ovulation, which may bring relief from PMS symptoms.

Lifestyle and home remedies

You can sometimes manage or reduce the symptoms of premenstrual syndrome by making changes in the way you eat, exercise and approach daily life. Try these tips:

Modify your diet

  • Eat smaller, more-frequent meals to reduce bloating and the sensation of fullness.
  • Limit salt and salty foods to reduce bloating and fluid retention.
  • Choose foods high in complex carbohydrates, such as fruits, vegetables and whole grains.
  • Choose foods rich in calcium. If you can’t tolerate dairy products or aren’t getting adequate calcium in your diet, a daily calcium supplement may help.
  • Avoid caffeine and alcohol.

Incorporate exercise into your regular routine

Engage in at least 30 minutes of brisk walking, cycling, swimming or other aerobic activity most days of the week. Regular daily exercise can help improve your overall health and alleviate certain symptoms, such as fatigue and a depressed mood.

Reduce stress

  • Get plenty of sleep.
  • Practice progressive muscle relaxation or deep-breathing exercises to help reduce headaches, anxiety or trouble sleeping (insomnia).
  • Try yoga or massage to relax and relieve stress.

Record your symptoms for a few months

Keep a record to identify the triggers and timing of your symptoms. This will allow you to intervene with strategies that may help to lessen them.

Alternative medicine

Here’s what’s known about the effectiveness of complementary remedies used to soothe the symptoms of premenstrual syndrome:

  • Vitamin supplements. Calcium, magnesium, vitamin E and vitamin B-6 have all been reported to soothe symptoms, but evidence is limited or lacking.
  • Herbal remedies. Some women report relief of PMS symptoms with the use of herbs, such as ginkgo, ginger, chasteberry (Vitex agnus), evening primrose oil and St. John’s wort. However, few scientific studies have found that any herbs are effective for relief of PMS symptoms.

Herbal remedies also aren’t regulated by the Food and Drug Administration, so there’s no record of product safety or effectiveness. Talk with your doctor before taking any herbal products, as they may have side effects or interact with other medications you’re taking. St. John’s wort, for example, reduces the effectiveness of birth control pills.

Acupuncture. A practitioner of acupuncture inserts sterilized stainless steel needles into the skin at specific points on the body. Some women experience symptom relief after acupuncture treatment.

Diagnosis

Signs and symptoms of menopause are usually enough to tell most women that they’ve started the menopausal transition. If you have concerns about irregular periods or hot flashes, talk with your doctor. In some cases, further evaluation may be recommended.

Tests typically aren’t needed to diagnose menopause. But under certain circumstances, your doctor may recommend blood tests to check your level of:

  • Follicle-stimulating hormone (FSH) and estrogen (estradiol), because your FSH levels increase and estradiol levels decrease as menopause occurs
  • Thyroid-stimulating hormone (TSH), because an underactive thyroid (hypothyroidism) can cause symptoms similar to those of menopause

Lifestyle and home remedies

Fortunately, many of the signs and symptoms associated with menopause are temporary. Take these steps to help reduce or prevent their effects:

  • Cool hot flashes. Dress in layers, have a cold glass of water or go somewhere cooler. Try to pinpoint what triggers your hot flashes. For many women, triggers may include hot beverages, caffeine, spicy foods, alcohol, stress, hot weather and even a warm room.
  • Decrease vaginal discomfort. Try an over-the-counter, water-based vaginal lubricant (Astroglide, K-Y jelly, Sliquid, others) or a silicone-based lubricant or moisturizer (Uber Lube, Replens, K-Y Liquibeads, Sliquid, others).

You might consider choosing a product that doesn’t contain glycerin, which can cause burning or irritation if you’re sensitive to that chemical. Staying sexually active also helps with vaginal discomfort by increasing blood flow to the vagina.

  • Get enough sleep. Avoid caffeine, which can make it hard to get to sleep, and avoid drinking too much alcohol, which can interrupt sleep. Exercise during the day, although not right before bedtime. If hot flashes disturb your sleep, you may need to find a way to manage them before you can get adequate rest.
  • Practice relaxation techniques. Techniques such as deep breathing, paced breathing, guided imagery, massage and progressive muscle relaxation may help with menopausal symptoms. You can find a number of books and online offerings that show different relaxation exercises.
  • Strengthen your pelvic floor. Pelvic floor muscle exercises, called Kegel exercises, can improve some forms of urinary incontinence.
  • Eat a balanced diet. Include a variety of fruits, vegetables and whole grains. Limit saturated fats, oils and sugars. Ask your provider if you need calcium or vitamin D supplements to help meet daily requirements.
  • Don’t smoke. Smoking increases your risk of heart disease, stroke, osteoporosis, cancer and a range of other health problems. It may also increase hot flashes and bring on earlier menopause.
  • Exercise regularly. Get regular physical activity or exercise on most days to help protect against heart disease, diabetes, osteoporosis and other conditions associated with aging.

Alternative medicine

Many approaches have been promoted as aids in managing the symptoms of menopause, but few of them have scientific evidence to back up the claims. Some complementary and alternative treatments that have been or are being studied include:

  • Plant estrogens (phytoestrogens). These estrogens occur naturally in certain foods. There are two main types of phytoestrogens — isoflavones and lignans. Isoflavones are found in soybeans, lentils, chickpeas and other legumes. Lignans occur in flaxseed, whole grains, and some fruits and vegetables.

Whether the estrogens in these foods can relieve hot flashes and other menopausal symptoms remains to be proved, but most studies have found them ineffective. Isoflavones have some weak estrogen-like effects, so if you’ve had breast cancer, talk to your doctor before supplementing your diet with isoflavone pills.

The herb sage is thought to contain compounds with estrogen-like effects, and there’s good evidence that it can effectively manage menopause symptoms. The herb and its oils should be avoided in people who have an allergy to sage, and in pregnant or breast-feeding women. Use carefully in people with high blood pressure or epilepsy.

  • Bioidentical hormones. These hormones come from plant sources. The term “bioidentical” implies the hormones in the product are chemically identical to those your body produces. There are some commercially available bioidentical hormones approved by the Food and Drug Administration (FDA). But many preparations are compounded — mixed in a pharmacy according to a doctor’s prescription — and aren’t regulated by the FDA, so quality and risks could vary. There’s no scientific evidence that bioidentical hormones work any better than traditional hormone therapy in easing menopause symptoms. There’s also no evidence that they’re any less risky than traditional hormone therapy.
  • Black cohosh. Black cohosh has been popular among many women with menopausal symptoms. But there’s little evidence that black cohosh is effective, and the supplement can be harmful to the liver and may be unsafe for women with a history of breast cancer.
  • Yoga. There’s no evidence to support the practice of yoga in reducing menopausal symptoms. But balance exercises such as yoga or tai chi can improve strength and coordination and may help prevent falls that could lead to broken bones. Check with your doctor before starting balance exercises. Consider taking a class to learn how to perform postures and proper breathing techniques.
  • Acupuncture. Acupuncture may have some temporary benefit in helping to reduce hot flashes, but research hasn’t shown significant or consistent improvements. More research is needed.
  • Hypnosis. Hypnotherapy may decrease the incidence of hot flashes for some menopausal women, according to research from the National Center for Complementary and Integrative Health at the U.S. National Institutes of Health. Hypnotherapy also helped improve sleep and decreased interference in daily life, according to the study.

You may have heard of or tried other dietary supplements, such as red clover, kava, dong quai, DHEA, evening primrose oil and wild yam (natural progesterone cream). Scientific evidence on effectiveness is lacking, and some of these products may be harmful.

Talk with your doctor before taking any herbal or dietary supplements for menopausal symptoms. The FDA does not regulate herbal products, and some can be dangerous or interact with other medications you take, putting your health at risk.

Treatment

Menopause requires no medical treatment. Instead, treatments focus on relieving your signs and symptoms and preventing or managing chronic conditions that may occur with aging. Treatments may include:

  • Hormone therapy. Estrogen therapy is the most effective treatment option for relieving menopausal hot flashes. Depending on your personal and family medical history, your doctor may recommend estrogen in the lowest dose and the shortest time frame needed to provide symptom relief for you. If you still have your uterus, you’ll need progestin in addition to estrogen. Estrogen also helps prevent bone loss. Long-term use of hormone therapy may have some cardiovascular and breast cancer risks, but starting hormones around the time of menopause has shown benefits for some women. Talk to your doctor about the benefits and risks of hormone therapy and whether it’s a safe choice for you.
  • Vaginal estrogen. To relieve vaginal dryness, estrogen can be administered directly to the vagina using a vaginal cream, tablet or ring. This treatment releases just a small amount of estrogen, which is absorbed by the vaginal tissues. It can help relieve vaginal dryness, discomfort with intercourse and some urinary symptoms.
  • Low-dose antidepressants. Certain antidepressants related to the class of drugs called selective serotonin reuptake inhibitors (SSRIs) may decrease menopausal hot flashes. A low-dose antidepressant for management of hot flashes may be useful for women who can’t take estrogen for health reasons or for women who need an antidepressant for a mood disorder.
  • Gabapentin . Gabapentin is approved to treat seizures, but it has also been shown to help reduce hot flashes. This drug is useful in women who can’t use estrogen therapy and in those who also have nighttime hot flashes.
  • Medications to prevent or treat osteoporosis. Depending on individual needs, doctors may recommend medication to prevent or treat osteoporosis. Several medications are available that help reduce bone loss and risk of fractures. Your doctor might prescribe vitamin D supplements to help strengthen bones.

Before deciding on any form of treatment, talk with your doctor about your options and the risks and benefits involved with each. Review your options yearly, as your needs and treatment options may change.

What Is Abnormal Uterine Bleeding?

Abnormal uterine bleeding is when you bleed outside of your normal monthly period. You might hear it called anovulatory bleeding. Your flow could also be heavier or last longer than what’s typical.

When it comes to menstrual cycles, there’s a wide range of “normal.” But your period shouldn’t be a problem for you month after month. If it’s so heavy or unpredictable that it keeps you from doing some activities or makes you miss work or school, you may have a medical condition that should be treated.

Abnormal Uterine Bleeding Symptoms

The signs of abnormal uterine bleeding include:

  • Heavy period (menorrhagia)
  • Bleeding between your periods, after sex, or during menopause
  • Long periods (more than 7 days)
  • Irregular periods

Doctors check these things when diagnosing abnormal uterine bleeding:

  • How often you get your period. It should be fairly regular. The length of each cycle shouldn’t change by more than a week. If it’s shorter than 3 weeks or longer than 5, that could be a sign of a problem.
  • How long it lasts. A typical period lasts 4 or 5 days. If yours is often less than 2 days or longer than a week, that could mean something’s wrong.
  • How heavy it is. Most women only lose about 2 tablespoons of blood each period. More than 5 tablespoons is thought to be unusually heavy, but that’s hard to judge. Let your doctor know if you need more than one tampon or pad in an hour. Abnormally heavy menstrual bleeding is called menorrhagia.
  • Whether you have spotting between periods. 
  • Whether you have bleeding after sex. 

If you could be pregnant or you’re past menopause and have any kind of bleeding, call your doctor immediately.

Some spotting is common early in pregnancy, but bleeding can be a sign of a serious condition called an ectopic pregnancy. That’s when a fertilized egg implants somewhere outside your uterus, most commonly in a fallopian tube. It could also mean you’re having a miscarriage.

After menopause, women who take hormone replacement therapy may still have periods. But any bleeding should be checked out.

Abnormal Uterine Bleeding Causes

There are a few possible causes behind abnormal uterine bleeding:

Hormone changes. Problems with your hormones are the most common reason for abnormal uterine bleeding. When one of your ovaries releases an egg (called ovulation), certain hormones tell your body to build up and then shed the lining of your uterus (called the endometrium). With teenagers and women getting close to menopause, the endometrium can build up too much. That can lead to an irregular or heavy period or spotting between periods.

These things can throw off your hormones, too:

  • Birth control pills and other medicines like warfarin and hormone therapy
  • Fast weight loss or gain
  • Emotional or physical stress
  • An intrauterine device (IUD)
  • Polycystic ovary syndrome (PCOS)

Problems with your uterus. Another possible reason for abnormal bleeding is a physical problem with your uterus. Millions of women have fibroids — noncancerous tumors that grow in the muscles of the wall of the uterus. A polyp is another kind of growth that can form in the lining of your uterus. A condition called adenomyosis is where the cells similar to the ones that grow in the lining of the uterus start to grow in the muscle part of the uterus. Endometriosis can also cause abnormal bleeding. This is when tissue like the kind that lines the inside of your uterus grows outside of your uterus.

Other health conditions. These are much less common, but abnormal uterine bleeding also can result from:

  • Bleeding or clotting disorders or blood-thinning medicines
  • Cancer of the cervix, endometrium, or uterus
  • Illnesses that affect your kidneys, liver, thyroid, or adrenal glands
  • Infection of your cervix or endometrium
  • Sexually transmitted diseases

Abnormal Uterine Bleeding Diagnosis

It can help to take detailed notes over a few cycles so you can give the doctor specific information about your symptoms. They’ll also ask about your overall health and give you a physical exam. You’ll probably get a pregnancy test, and you may also have:

  • Blood work. Heavy bleeding can leave your body short of iron. A blood test can see if that’s a problem for you. It can also show if your hormones are out of balance or if you have a blood disorder or chronic disease.
  • Ultrasound . This uses sound waves to make images of the inside of your uterus so your doctor can look for fibroids or polyps.
  • Hysteroscopy. The doctor will look inside your uterus with a tiny lighted scope that they put in through your cervix.
  • Biopsy . The doctor may take out a small piece of tissue and check it under a microscope for abnormal cells.
  • Magnetic resonance imaging . This test uses radio waves and powerful magnets to make detailed pictures of your uterus. It isn’t used that often, but it can help spot adenomyosis.

Abnormal Uterine Bleeding Treatment

Your treatment will depend on the cause of the abnormal uterine bleeding — if a chronic illness or a blood disorder is at the root of your symptoms, treating that can help.

Treatment also can depend on whether you plan to have children. It might not be safe to get pregnant after some treatments, while others can make it impossible. If you’re close to menopause, the doctor may want to take a wait-and-see approach because your symptoms may get better on their own.

Drugs are usually the first thing your doctor will try. They include:

  • Hormones. Birth control pills and other hormone treatments may be able to give you regular menstrual cycles and lighter periods.
  • Gonadotropin-releasing hormone agonists (GnRHa). These stop your body from making certain hormones. They can shrink fibroids for a while, but they’re usually used along with other treatments.
  • NSAIDS . If you take anti-inflammatories like ibuprofen or naproxen a few days before your period starts, they may help lighten the bleeding.
  • Tranexamic acid . This is a pill that helps your blood clot and can control heavy uterine bleeding.
  • IUD. For some women, an IUD that releases a hormone called progestin can stop heavy bleeding. Many women who use one don’t get a period at all.

Sometimes surgery can be needed to stop the bleeding:

  • Endometrial ablation. This uses heat, cold, electricity, or a laser to destroy the lining of your uterus. It may end your periods entirely. You probably won’t be able to get pregnant after having it done, but it can be dangerous if you do. You’ll need to use birth control until menopause.
  • Myomectomy or uterine artery embolization. If you have fibroids, the doctor may take them out or cut off the vessels that supply them with blood.
  • Hysterectomy . This is when the doctor removes your uterus. You may need a hysterectomy if your fibroids are very large or you have endometrial or uterine cancer. Otherwise, it’s a last resort when other treatments haven’t worked.

Endometriosis Overview: What is Endometriosis?

Endometriosis is a disease in which the endometrium (the tissue that lines the inside of the uterus or womb) is present outside of the uterus. Endometriosis most commonly occurs in the lower abdomen or pelvis, but it can appear anywhere in the body. Symptoms of endometriosis include lower abdominal pain, pain with menstrual periods, pain with sexual intercourse, and difficulty getting pregnant. On the other hand, some women with endometriosis may not have any symptoms at all.

Symptoms of Endometriosis

Endometriosis Symptoms

Pain is the most common symptom of endometriosis.  Women with endometriosis can experience pelvic or lower abdominal pain, pain with menses (dysmenorrhea), pain with intercourse (dyspareunia) and pain during bowel movements (dyschezia).  Symptoms can be constant or “cyclical,” meaning that they worsen before and during the period, and then improve. Women may have constant pelvic or lower abdominal pain as well. Other symptoms include infertility, bowel and bladder symptoms (bloating, constipation, blood in the urine, or pain with urination), and possibly abnormal vaginal bleeding.

How is Endometriosis Diagnosed?

Some physicians may treat suspected endometriosis based on a woman’s symptoms or physical examination findings to see if they improve without proceeding to surgery.  However, to formally diagnose endometriosis, a doctor must perform laparoscopy (surgery in which a doctor looks in the abdomen with a camera through the belly button) to visualize and biopsy suspected endometriosis lesions.  Endometriosis lesions can vary in appearance. “Endometrioma” is the term for endometriosis within an ovary, and is often nicknamed “chocolate cyst” because the material inside the cyst looks like chocolate syrup.

How is Endometriosis Treated?

The most conservative therapy for endometriosis is with medications. Non-steroidal anti-inflammatory medications, like ibuprofen, may help with the pain associated with endometriosis. Medications that control a woman’s hormones may also help with endometriosis pain. Some examples are oral contraceptive pills and gonadotropin releasing hormone (GnRH) agonists, the latter of which put women into a “temporary” menopause-like state.

Surgery can diagnose endometriosis, and it can also treat endometriosis via removal (excision) or burning (fulguration) of endometriosis lesions.  With surgery, removal of scar tissue can alleviate pain and relocate the ovaries and fallopian tubes to their normal position in the pelvis. Surgery has been shown to help some women with endometriosis to become pregnant. If a woman with endometriosis is no longer interested in becoming pregnant, she and her doctor may decide to remove the ovaries and possibly the uterus. A woman cannot become pregnant if she does not have a uterus.

If a woman with endometriosis is having trouble getting pregnant, there are different medications and treatments available that can help her to become pregnant.

Urinary incontinence is an underdiagnosed and underreported problem that increases with age—affecting 50-84% of the elderly in long-term care facilities—and at any age is more than twice as common in females than in males.

Signs and symptoms

Types of urinary incontinence

  • Stress: Urine leakage associated with increased abdominal pressure from laughing, sneezing, coughing, climbing stairs, or other physical stressors on the abdominal cavity and, thus, the bladder
  • Urge: Involuntary leakage accompanied by or immediately preceded by urgency
  • Mixed: A combination of stress and urge incontinence, marked by involuntary leakage associated with urgency and also with exertion, effort, sneezing, or coughing
  • Functional: The inability to hold urine due to reasons other than neuro-urologic and lower urinary tract dysfunction (eg, delirium, psychiatric disorders, urinary infection, impaired mobility)

Diagnosis

Patients with urinary incontinence should undergo a basic evaluation that includes a history, physical examination, and urinalysis. In selected patients, the following may also be needed:

  • Voiding diary
  • Cotton swab test
  • Cough stress test
  • Measurement of postvoid residual (PVR) urine volume
  • Cystoscopy
  • Urodynamic studies

Management

Successful treatment of urinary incontinence must be tailored to the specific type of incontinence and its cause. The usual approaches are as follows:

  • Stress incontinence: Pelvic floor physiotherapy, anti-incontinence devices, and surgery
  • Urge incontinence: Changes in diet, behavioral modification, pelvic-floor exercises, and/or medications and new forms of surgical intervention
  • Mixed incontinence: Pelvic floor physical therapy, anticholinergic drugs, and surgery
  • Overflow incontinence: Catheterization regimen or diversion
  • Functional incontinence: Treatment of the underlying cause

Absorbent products may be used temporarily until a definitive treatment has a chance to work, in patients awaiting surgery, or long-term under the following circumstances:

  • Persistent incontinence despite all appropriate treatments
  • Inability to participate in behavioral programs, due to illness or disability
  • Presence of an incontinence disorder that cannot be helped by medications
  • Presence of an incontinence disorder that cannot be corrected by surgery

Pelvic organ prolapse is the abnormal descent or herniation of the pelvic organs from their normal attachment sites or their normal position in the pelvis. The pelvic structures that may be involved include the uterus (uterine prolapse) or vaginal apex (apical vaginal prolapse), anterior vagina (cystocele), or posterior vagina (rectocele). Many parous women may have some degree of prolapse when examined; however, most prolapses are not clinically bothersome without specific pelvic symptoms, and they may not require an intervention.

Etiology

Pelvic floor defects may be created as a result of childbirth and are caused by the stretching and tearing of the endopelvic fascia and the levator muscles and perineal body. Pregnancy itself, without vaginal birth has been sited as a risk factor as well. Studies suggests that vaginal birth and operative vaginal birth increase an individual’s risk for urinary incontinence and pelvic organ prolapse 5-10 years after delivery when compared with cesarean delivery without labor.

Evaluation

Note significant medical history (eg, obesity, asthma, long-term steroid use) that may have contributed to prolapse or urinary incontinence. If possible, attempting to correct some of these problems before any surgical treatment may be wise. Recurrences may be more likely if such conditions are not addressed.

Most clinicians routinely use the ICS classification (POP-Q) system, which is classified as follows:

  • Stage 0 – No prolapse
  • Stage I – Descent of the most distal portion of prolapse is more than 1 cm above the level of the hymen.
  • Stage II – Maximal descent of prolapse is between 1 cm above and 1 cm below the hymen.
  • Stage III – Prolapse extends more than 1 cm beyond the hymen, but no more than within 2 cm of the total vaginal length.
  • Stage IV – Total or complete vaginal eversion

Pelvic Organ Prolapse Treatment & Management

Medical Therapy

Nonsurgical (conservative) management of pelvic organ prolapse is often recommended and should be attempted before surgery is contemplated. Conservative management confers several advantages: it is safe and inexpensive, it is not usually associated with morbidity and mortality, it is minimally invasive, it can lead to a high patient satisfaction, and it may be used for patients awaiting surgery or patients who are not interested in surgical management. Pelvic muscle exercises (PMEs) and vaginal support devices (pessaries) are the main nonsurgical treatments for patients with pelvic organ prolapse.

Surgical Therapy

The recommended management strategy for severe symptomatic pelvic organ prolapse for patients who failed or refused a trial of pessary management is surgery. A variety of surgical approaches are available to correct pelvic organ prolapse.

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