Gynecology Services

• Absence of periods (amenorrhea)
• Irregular periods
• Polycystic ovarian syndrome (PCOS)
• Heavy periods
• Prolonged periods (more than 7 days)
• Frequent periods
• Perimenopausal bleeding (irregular bleeding around time of menopause)
• Post menopausal bleeding (any bleeding more that 1 year after periods have stopped)

These conditions can be caused by hormonal problems, structural problems (such as fibroids or uterine polyps), blood clotting problems, or unknown causes.

Evaluation

• Physical/Pelvic Examination
• Blood tests (Blood count, Iron levels, Coagulation tests, Hormone testing)
• Pelvic Ultrasound
• Endometrial Biopsy (in office or via D & C)
• Pap smear/Cervical Biopsy (as indicated)

Treatment

Depends on the results and findings of a complete evaluation

• Hormonal management (pills, patches, IUD)
• Non hormonal (NSAIDs, Lysteda, Iron supplementation)
• D & C (including myomectomy or endometrial ablation if indicated)
• Hysterectomy (if indicated)

Pelvic pain can be either acute or chronic

• Acute Pain (lasts for a short period of time)
  and is usually due to a single cause that may be need immediate attention
• Chronic Pain (intermittent or constant pain that lasts for 6 months or longer)
  and is usually due to a variety of causes (sometimes many). A history of physical or sexual abuse is associated with chronic pelvic pain in about 50% of cases. And depression can be either a result of or an associated factor in many cases of pelvic pain

Pelvic pain can have gynecologic, urologic, digestive, musculoskeletal and psychologic causes.

Causes of Pelvic Pain

• Pelvic inflammatory disease (PID)
• Endometriosis
• Fibroids
• Urinary tract problems (UTI, kidney stones, interstitial cystitis)
• Digestive problems (Irritable Bowel Syndrome (IBS), Inflammatory Bowel Disease)
• Musculoskeletal problems (back pain, muscle spasms, obesity causing strain on ligaments and joints, poor posture, trigger points)

Evaluation

• History and physical exam
• Lab tests
• Pelvic ultrasound

Treatment

Depending on the cause, may include:

• Antibiotics
• Hormones or birth control pills
• Referral for counseling or treatment of depression
• Lifestyle changes/Nutrition therapy
• Physical therapy
• Surgery
• Pain medication
  Most pelvic pain (acute or chronic) can be managed with NSAIDs (Ibuprofen, Naproxin, Toradol). We sometimes also give very short, limited treatment with stronger pain medications but as a practice we do not prescribe chronic narcotic medications for pain. We are happy to refer you to a pain clinic if that is indicated.

We would like to assist women in their reproductive plans and provide preconception and contraceptive counseling based on your desires and preferences. There are now many options available and we are happy to help you choose and option that is best for you.

• Birth Control Pills (including patches or rings)
• Depo Provera
• LARC (Long acting reversible contraception)
• IUD (Intrauterine Device)
  • Mirena, Kyleena (5 years)
  • Skyla, Lyletta (3 years)
  • ParaGard (12 years)
• Nexplanon
• Permanent sterilization
  • Tubal ligation
  • Salpingectomy
  • Referral for Essure
• Emergency Contraception
• Plan B

In the event of an unintended pregnancy, we would like to assist you in making a choice that is appropriate for you. We offer referrals for all avenues of choice including continuing your pregnancy, referral for adoption and referral for termination of a pregnancy.

• Clinical breast exam and self breast exam
• Referral for screening mammography
• Referral for breast ultrasound
• Referral for breast biopsy

• Vaginal atrophy
• Yeast vaginitis
• Bacterial vaginosis
• Lichen sclerosus
• Lichen planus
• Lichen simplex chronicus
• Sexually transmitted infections
  
  • Trichomonas
  • Gonorrhea
  • Chlamydia
  • Herpes
  • Genital warts

DEXA scans are the best way to determine the density of your bones. It is a simple, painless test that is done in the Radiology department of most hospitals. The World Health Organization has established standards for the diagnosis of Osteoporosis and Osteopenia. This is not always a service that is covered by your insurance but it may be recommended, especially if you have certain conditions:

• Premature menopause (either natural or surgically induced)
• Long term use of steroids
• Long term use of Depo Provera, Nexplanon

Perimenopause is the transitional time period during which the body is undergoing major changes. The ovary’s production of estrogen decreases and ovulation is not always regular and monthly. Women may start to experience:

• Menstrual cycle changes
• Hot flashes, night sweats, sleep disruption
• Vaginal dryness, urinary symptoms
• Changes in sexual response and emotions

These symptoms may be mild or severe and not all women experience them in the same way. Changes in your cycle may be normal but is important to discuss them because they may be a sign of something more serious

Treatment of perimenopausal symptoms

• Hormonal Replacement Therapy
  Hormone therapy can help treat symptoms in the perimenopause. There are risks and benefits to hormone therapy which are related to your individual health and family history. Hormone therapy also can be taken various ways (orally, vaginally, transdermally and there are advantages and disadvantages to all of these. We are happy to discuss your individual care and help you make the best decision for you.
• Alternatives to Hormone Therapy
  
  • Medications
    • Antidepressants
    • Selective estrogen receptor modulators (SERMS)
  • Plant based alternatives
  • Bio-identical hormones
  • Vaginal lubricants and moisturizers

This is also a good time to assess your health and take better care of yourself.

• Healthy diet and regular exercise
• Maintain a healthy weight
• Quit smoking
• Limit alcohol intake
• Practice safe sex and use contraception

Menopause occurs when the ovaries no longer produce hormones and periods stop. By definition periods must have completely stopped for a year for woman to be completely in menopause. Any bleeding that may occur after that year, whether it seems like a normal period or not, should be evaluated.

The symptoms that started in perimenopause may intensify and treatment might be worth considering.

Treatment

• Vaginal symptoms
  • Vaginal lubricants or moisturizers
  • Vaginal estrogen (tablet, cream, ring)
  • Oral estrogen
• Hot flashes and night sweats (vasomotor symptoms)
  • Behavioral and Lifestyle changes
    • Avoid alcohol and caffeine
    • Layer clothing
  • Non hormonal treatment:
    • Gabapentin
    • Low dose antidepressant medications (SSRIs)
    • Clonidine
    • Black cohosh
  • Menopause Hormone Therapy (MHT) aka HRT (hormone replacement therapy)
    • Estrogen with or without Progesterone is the most effective treatment for menopausal symptoms but may slightly increase the risk of blood clots and breast cancer.
    • Treatment with MHT is a decision that must take into account individual risk factors, family history and symptoms. We will help you make that decision