Pelvic Pain

There are many causes of pelvic pain. Pain can be caused by infection, ovarian cysts, endometriosis, uterine fibroids, bladder problems, adhesions from previous surgeries, previous trauma or abuse, even intestinal problems. Your doctor will perform a pelvic examination and probably order tests to screen for infection. A pelvic ultrasound may be performed as well. The specific treatment for the pain will depend on the cause. This may include medications or in some cases a minimally invasive procedure, or laparoscopy. Please visit with your physician if you suffer from pelvic pain.

Contraception

There are many options of contraception – ways to prevent pregnancy – available today. You may have special needs or circumstances that would make one choice better than another. Common contraception options include: birth control pills, the vaginal ring, the contraceptive patch, the intrauterine device, the birth control shot, the implantable rod, barrier methods such as the condom or diaphragm, or permant sterilization such as the tubal ligation. Your doctor will visit with you and help you to decide which is the best method for your particular needs.

Urinary Incontinence

Many women leak small amounts of urine from time to time. Often women are hesitant to discuss this symptom with their doctor. They may believe that it is a normal part of aging and that there is no treatment. Any uncontrollable leakage of urine should be discussed with your doctor. Your doctor will perform a pelvic examination to determine if any pelvic support problems exist, a urinalysis will be done to rule out infection, and your hormone status and side effects of any medications will be evaluated. Your doctor may recommend that you undergo urodynamic testing. This testing is available at Women’s Healthcare Associates. This involves placing small catheters into the urethra and vagina and measuring the bladder pressure, bladder capacity and bladder sensation. You will be given a “bladder diary” to record how often you are emptying your bladder and how much urine it contains each time you void. In most cases, you do not have to be referred to another facility for this testing. We offer this testing through our office. Please let your doctor know if urinary incontinence is a problem for you. There are many treatments your doctor can advise, depending on the exact cause of your problem.

Painful Periods/Menstrual Discomfort

Painful periods (dysmenorrhea) affect more than half of all the menstruating women. Some women experience enough pain that they lose time from work, school or other activities. The most common cause of dysmenorrhea is over production of a group of chemicals called prostaglandins. These chemicals stimulate the mild contractions of the uterus that help to shed the uterine lining. You need to see your doctor when the symptoms are severe or if simple measures such as applying a heating pad, using non-steroidal anti-flammatory agents (ibuprofen or naproxen), and exercise no longer helps with the symptoms. In some cases, oral contraceptive pills or a prescription strength non-steroidal anti-flammatory agent may help relieve the menstrual pain.

Heavy Vaginal Bleeding

Heavy vaginal bleeding may be due to a variety of causes.  Menstrual cycles may be irregular and consist of large clots or heavy flow.  Anemia (low blood count) may occur and cause fatigue and other problems.  Your doctor will perform a history and physical examination including a pelvic examination.  In some cases, an endometrial biopsy may be performed.  This is an easy, well tolerated, in-office test that diagnoses abnormal cells in the uterine lining.  Laboratory studies and an ultrasound may be obtained.

Treatment will depend on the cause of the bleeding.  There are many non-surgical options to treating abnormal bleeding. Often, medication can be prescribed.  In other cases, a minimally invasive procedure called an endometrial (uterine) ablation may be performed.  This procedure uses a balloon-tipped catheter that is inserted into the uterine cavity.  Fluid is circulated into the balloon and heated.  This heated fluid works to “ablate” or permanently hinder the uterine lining’s ability to grow.  This does not alter hormone production from the ovaries.  It is a one-time treatment.  This procedure is available as an in-office, out-patient procedure in most healthy patients and does not require a hospital visit.  This in-office, minimally invasive procedure is offered at Women’s Healthcare Associates.

A hysterectomy may be considered as well.  This is the surgical removal of the uterus.  It is done either through a vaginal incision, abdominal incision or through a laparoscope which uses tiny incisions in the abdomen.

Remember, effective treatments are available for heavy vaginal bleeding.  If you are among the one out of five women that suffer from heavy periods, please discuss this with your care provider.

Abnormal Pap Smears

A pap smear is a test that looks at cells taken from the cervix.  The cervix is the lower, narrow end of a woman’s uterus.  It opens into the vagina.  It is covered by a thin layer of tissue that is like the skin inside your mouth.  The cells that make up this tissue are constantly changing and growing.  Some of these cells may become abnormal as they grow and change.  Some abnormal cells may be precancer, or rarely, cancer.  Precancer is when there are changes in the cells that may, but do not always become cancer if left untreated.  A pap smear may be reported as normal, or negative.  It may also be called atypical or show low grade or high grade squamous intraepithelial lesion.  An abnormal pap smear is usually caused by an infection such as human papillomavirus (HPV).  However, most women infected with HPV have normal pap test results.  It is a very common infection that can be passed from person to person.  There is no treatment for this type of infection.  Many people have it and, in many cases, it does not cause problems.  Certain types of HPV are more likely to be linked to cancer of the cervix.  In some cases, a pap smear may determine if a high risk type of HPV is present.  There is now a vaccine that is available and recommended for all girls and women between age 9 and 26 to help prevent infection with HPV.  This is offered at Women’s Healthcare Associates.

Further testing is usually required for an abnormal pap smear.  Often a repeat pap test is obtained.  In some cases, a colposcopic examination of the cervix is recommended.  In this test, your doctor uses a device similar to a microscope to look at your cervix.  This is used to help diagnose the abnormal cells.  If an abnormal area of cells is seen, your doctor may recommend a biopsy.  A small sample of tissue is removed and sent to a lab to be reviewed.  Colposcopy is available at Women’s Healthcare Associates.   Frequent follow up is required after getting an abnormal pap smear.  Changes may return and progress.  An electrosurgical excision procedure may be recommended in some cases.  A local anesthetic is given to the cervix and a thin wire loop that carries an electric current is used to remove abnormal areas of the cervix.  This is usually done at the clinic and is an outpatient procedure.