Menorrhagia occurs in 1 out of every 5 women and is defined as unusually heavy and/or long-lasting menstrual periods. Many women do not seek treatment because they are embarrassed to discuss their periods; they think their bleeding is normal because it has always been that way; or they are afraid of the treatment options. If your period lasts a long time or is so heavy you need to change pads or tampons every 1 or 2 hours, then you may have monorrhagia.

There are several different ways to treat your heavy periods, including hormones, hormone-releasing lUD and D&C; and for women who are finished having children, hysterectomy and endometrial ablation are also options.

Endometrial ablation is a procedure that permanently removes the lining of the uterus through the quick delivery of radio frequency energy. Your ObGyn physician can perform endometrial ablation in the office with* or without general anesthesia that can put an end to your heavy periods and the resulting symptoms. Approximately 95% of patients experience little to no significant pain during the procedure and it does not require incisions. Patients go home the same day and are typically back to work in 1 or 2 days. Most women see a great decrease in their level of menstrual bleeding with about 91% of women reporting normal bleeding or less and 40-50% reporting no bleeding at all. Many women also had a significant reduction in painful periods and PMS symptoms.

You and your doctor can decide which treatment option is best for your menorrhagia.

A colposcopy is a procedure we may use at PHC OB/GYN to take a closer look at your cervix, vagina or vulva. It’s usually prompted by abnormal results from a Pap test and is used to help determine the reason for abnormal results. A colposcopy allows our physicians to magnify the area of concern and take tissue biopsies to diagnose cervical and vaginal cell and treat conditions to help prevent progression of precancerous or cancerous changes.

A woman’s health needs change throughout her stages of life. We specialize in helping women focus on healthy choices and lifestyles from young women to older adults. Some of the visits as relating to women’s health include physical examinations, thyroid and hormonal tests, mammograms (at age 40+), breast exams, Pap testing, HPV testing (at ages 30-65 on average), pelvic exams, STD testing and more. Discuss setting up your preventative care plan with your OB/GYN professional.

A hysteroscopy is a thin, flexible scope used to look into the uterus for imaging purposes. This procedure can be done in the office and involves no anesthetics and causes very little discomfort. A hysteroscopy allows our providers to obtain full detailed images of the uterus and fallopian tubes to reveal abnormalities.

There are many types of incontinence and various treatment options. Sometimes our medical providers will recommend surgery depending on the type and severity of the patient’s incontinence. Tension free vaginal obturator tape (or TVTO) can be an effective method in restoring proper bladder function in women. The tape is made of a permanent Prolene mesh and is positioned to support the middle of the urethra. This method has shown to be more effective than drug treatments and less invasive than other bladder correcting procedures that can leave one hospitalized.

A laparoscopic hysterectomy is a procedure to remove the uterus. Our OB/GYN physicians perform this procedure by making a few incisions on the abdomen and in the belly button. A camera allows the performing doctor to remove the uterus through the tiny incisions. Laparoscopic hysterectomies are typically performed on an outpatient basis.

The shift into menopause is a difficult time for a woman, but our medical team is educated and experienced in helping make the transition as smooth and comfortable as possible. Mood swings, hot flashes, difficulty sleeping, memory instability and even bone density loss all tie to menopause. While some of these symptoms can be helped with lifestyle changes (which can also be discussed with our physicians), the overall effects of the hormone shift may be eased with Menopausal Hormone Therapy (MHT) that involves progesterone and estrogen hormones to steady out the process. It’s important to talk to your doctor to find out if this option is best for you given your current health situation.

Minimally invasive surgery options can be performed in the office or in an outpatient setting. Advanced technologies means minimal scarring and fewer incisions. Laparoscopic practices are used to perform many different types of procedures such as hysterectomy and myomectomy (for treatment of endometriosis and ovarian cysts).

Vaginal surgery (through the vagina) is also a very minimally invasive procedure and has been proven to heal faster than abdominal surgeries. PHC OB/GYN has skilled physicians trained for the vNOTES procedure.

This procedure involves removing a small sample of the lining of your uterus for testing purposes. The cells can give our doctors a clearer picture of hormone levels, as well as look for or observe abnormal tissue. Endometrial biopsies may be needed for those experiencing difficulties getting pregnant, abnormal uterine bleeding or to check for uterine cancer.

In a portion of women diagnosed with some manner of reproductive cancer such as breast or ovarian cancers, a certain percentage have inherited that increased risk for it. PHC OB/GYN offers screenings and testing to help determine one’s potential risk for developing cancer. Family history is a consideration for additional testing outside of normal screenings such as Pap smears and mammograms. Our providers can discuss genetic and other diagnostic testing available to those who may be at higher risk and can discuss options for addressing those potential risks.

What is a pap smear?

The pap smear is a screening test for cervical cancer. Usually done annually, it collects cells from the cervix which are then reviewed by a pathologist for evidence of abnormal cells. The pap smear is an ideal screening test because cervical cancer usually takes several years to develop so regular pap smears allow us to diagnose the pre-cancerous changes so that we can intervene before they develop into cancer.

The results of your pap smear will be reported in several different categories:

Negative (normal)
Atypical squamous cells of undetermined significance (ASC-US)
Atypical squamous cells suspicious for high grade intraepithelial lesion (ASC-H) 4. Low grade intraepithelial lesions (LSIL). The LSIL category includes changes consistent with HPV, mild dysplasia, or CINI (grade 1 cervical intraepithelial neoplasia).
High grade intraepithelial lesions (HSIL). HSIL includes changes consistent with moderate or severe dysplasia, CIN n or HI, and carcinoma in situ (CIS).
Carcinoma
Atypical glandular cells (AGC) may be endocervical, endometrial, or other glandular cells
Endocervical adenocarcinoma in situ (AIS
Adenocarcinoma

What causes abnormal paps?

The most common abnormal paps that we see are ASCUS and LSIL. The majority of abnormal paps are caused by an infection with a virus known as the human papillomavirus (HPV). HPV is the most common sexually transmitted disease. By age 50, over 80% of women will have been infected with HPV. The majority of people do not have any symptoms of the infection and will clear the infection on their own.

There are over 100 strains of HPV and over 30 of them are involved with genital infections. The different strains are categorized into “low risk” and “high risk” groups. High risk strains cause abnormal paps and can lead to cancer of the cervix, vagina, vulva, anus or penis. Low risk strains can cause mildly abnormal changes in pap smears and also cause genital warts.

How do we manage abnormal paps?

Once you have an abnormal result on your pap smear, your doctor will probably recommend you undergo colposcopy. Colposcopy is a procedure done in the office during which your doctor will look carefully at your cervix with a colposcope (a kind of microscope for the cervix). If any abnormal cells are seen, biopsies will be taken. The procedure takes 15-20 minutes and does not require any anesthesia. You may want to take 600-800 mg of ibuprofen before the procedure to help with cramping.

If the biopsy shows evidence of dysplasia, management may include simply repeating your pap in 4-6 months, cryotherapy (freezing of the abnormal cells on the cervix) or removal of the infected part of the cervix (a procedure called a LEEP or a cone). Your doctor will tell you which is the best choice for you after the biopsy results come back.

You can also make some lifestyle changes that will help your body to clear the infection on its own. If you smoke, quit! Cigarette smoking helps the HPV virus to grow more quickly. If you are currently a smoker, quitting may be enough to return your pap smear to normal. Also, recent evidence suggests that increasing your folic acid to 800 micrograms a day may also help your body get rid of the infection.

Additional resources:

www.cdc.gov/std/HPV/STDFact-HPV.htm

http://www.cdc.gov/vaccines/vpd-vac/hpv/vac-faqs.htm

Essure Office Permanent Contraception

Essure is a permanent birth control procedure that works with your body to create a natural barrier against pregnancy. This gentle procedure can be performed in our office in just a few minutes and your time spent in our office is typically about one hour.

Trusted by women and doctors for over five years, Essure is covered by most insurance providers. If the Essure procedure is performed in a doctor’s office, depending on your specific insurance plan, payment may be as low as a simple co-pay.

Essure offers women what no birth control ever has:

• No cutting
• No going under general anesthesia
• No slowing down to recover No hormones
• No guessing – your doctor can confirm when you can rely on Essure for birth control
• Short procedure time – Essure only takes about 13 minutes to perform
• Trusted by women and doctors for over five years
• And you’ll never have to worry about unplanned pregnancy again.
• The Essure procedure is permanent and is NOT reversible. Therefore, you should be sure you do not want children in the future.

The Essure procedure does not require any cutting into the body. Instead, an Essure trained doctor inserts small flexible micro-inserts through the vagina and into your fallopian tubes.

The procedure can be performed in the comfort of our office with* or without general anesthesia, and most women resume their normal activities within one day.

During the 3 months following the procedure, your body and the micro-inserts work together to form a natural barrier that prevents sperm from reaching the egg. During this period, you must continue using another form of birth control (other than an lUD or lUS).

Three months after the Essure procedure, a doctor will perform an Essure Confirmation Test, to confirm that the tubes are fully blocked and that you can rely on Essure for permanent birth control.

Unlike birth control pills, rings, and some forms of lUDs, Essure does not contain hormones to interfere with your natural menstrual cycle. Your periods should more or less continue in their natural state.

LEEP is done after abnormal Pap test results have been confirmed by colposcopy and cervical biopsy. This procedure (loop electrosurgical excision) uses a thin, low-voltage electrified wire loop to cut out abnormal tissue. LEEP may be used to treat minor cell changes called low-grade squamous intraepithelial lesions (LSIL) that may be precancerous and that may persist after a period of watchful waiting.

It may also be used to treat moderate to severe cell changes that can be removed.

During LEEP, a small amount of normal cervical tissue is removed at the edge of the abnormal tissue area.The tissue that is removed can be examined for cancer that has grown deep into the cervical tissue. In this way,LEEP can help further diagnoses as well as treat the abnormal cells. If all of the abnormal cervical tissue is removed, no further surgery is needed, though abnormal cells may reoccur in the future.

Most women are able to return to normal activities within 1 to 3 days after LEEP is performed. Recovery time depends on how much was done during the procedure.

What is NEXPLANON™?

NEXPLANON™ is a single-rod implant for sub-dermal use that offers women up to 3 years of contraceptive protection. It was recently approved by the FDA for use in the U.S. The rod is implanted into the upper inside of the arm.

Who is a good candidate for receiving NEXPLANON™?

Any woman who is not currently pregnant and has no history of thrombosis or thromboembolic disorders; hepatic tumors or active liver disease; breast cancer or abnormal vaginal bleeding. We will require you to have a pregnancy test prior to inserting NEXPLANON unless the NEXPLANON is inserted while you are menstruating..

What if I need birth control for more than three years?

You must have NEXPLANON™ removed after three years; however, you may choose to have another NEXPLANON™ inserted after taking out the old one.

What are the most common side effects of NEXPLANON™?

The most common side effects are irregular and unpredictable bleeding. Other side effects are mood swings, weight gain, headache, acne and depression. Use of hormonal contraceptives is associated with increased risks of several serious cardiovascular conditions including heart attack, stroke, venous thromboembolism, deep venous thrombosis, retinal vem thrombosis and pulmonary embolism. NEXPLANON™ should be removed in the event of a thrombosis or in the event of long-term immobilization due to surgery or illness. Cigarette smoking increases the risk of serious cardiovascular side effects from the use of hormonal contraceptives. Women who use hormonal contraceptives are strongly advised not to smoke.

What if I should become pregnant while using NEXPLANON™?

You should see your provider right away to remove NEXPLANON™. Based on experience with birth control pills, NEXPLANON™ is not likely to cause birth defects.

Can I use NEXPLANON™ when I’m breastfeeding?

You may start NEXPLANON™ if you are breastfeeding and if you delivered your baby four or more weeks ago.

here are two main types of urinary incontinence. These are stress urinary incontinence (SUI) and urge urinary incontinence.

If you have stress urinary incontinence (SUI), you may lose urine when you:

• Laugh, sneeze or cough
• Walk or exercise
• Get up from a seated or lying position.

If you have urge urinary incontinence you might have:

• Sudden losses of urine without any warning
• The inability to reach the toilet soon enough when the urge to void arises
• To plot out a trip around town based on the location of certain restrooms.

What can I do if I think I have SUI?

First, talk to your provider. With your help, he or she can determine the type and cause of your incontinence, which is the first step toward finding the best treatment for you.

Your provider will probably examine you and will possibly suggest urodynamic measurement tests, which can easily be performed in our office. To learn more information about urodynamic measurement tests, please check out this web site.

If you are having symptoms of urinary incontinence, please feel free to discuss these with any of the providers at Piedmont HealthCare OB/GYN.

Infertility is a woman’s inability to get pregnant after an extended period of time of attempting to get pregnant, or the inability to keep a fertilized egg in the uterus once pregnant. The causes of infertility can vary widely, so discussing your situation with a OB/GYN provider can help you on your journey to becoming pregnant. Although risk factors for infertility for women and mend can include smoking, alcohol, poor diet, obesity, age, disease and other health problems, only a thorough exam can help diagnose issues affecting fertility.

There are many different kinds of birth control (contraception) made available to women today. Options can include hormone shots, pills, patches, IUDs (intrauterine devices) and permanent sterilization. If you no longer want children, tubal ligation is also a simple surgical procedure that is an effective form of preventing future pregnancies by sealing off the fallopian tubes. The providers at Piedmont HealthCare’s OB/GYN can discuss all available options for birth control and go over the best method that would work with your body’s chemistry.

Counseling is helpful when planning to become pregnant. During preconception counseling, our providers may ask questions about obstetric history (previous births, miscarriages or abortions), gynecological history, medical history, genetic concerns and even any mental health issues that need to be considered before attempting to conceive. Our doctors may order blood tests as well, to help confirm a woman is at her physical, emotional and mental best to increase the chances of a successful pregnancy. Your partner’s health and genetics are also taken into account when making the decision to try and conceive.