Gynecological Care

The Pap test, also called a Pap smear or cervical cytology screening, checks for abnormal changes in the cells of the cervix and allows early treatment so that they do not become cancer. Regular use of the Pap test has greatly reduced the number of cases of cervical cancer in the United States. 

If you are told that you have an abnormal Pap test result, you may need further testing. The follow-up that you receive after an abnormal Pap test result depends on your age and the grade of dysplasia. Sometimes, there is more than one option for further testing. You and your health care provider will discuss each option and decide which is best for you. 

Repeat Pap Test

For some women, one further testing option is to repeat the Pap test a few months later. This may give time for the changes to go away on their own. 

HPV Testing

Another option for some women is an HPV test. This test detects the presence of cancer-causing types of HPV in cervical cells. The cells used for the initial Pap test often can be tested, so a woman does not need to return to the office for another test. 

Colposcopy, Biopsy, and Endocervical Sampling

Colposcopy lets your doctor look at the cervix in more detail through a magnifying device. It can detect problems of the cervix that cannot be seen with the eye alone. If an area of abnormal cells is seen, your doctor may decide that a biopsy is needed. For a biopsy, the doctor removes a small sample of tissue and sends it to a lab to be studied. Endocervical sampling also may be done. A small brush or other instrument is used to take a tissue sample from the cervical canal. 

Endometrial Sampling

In this test, a sample of the endometrium (the lining of the uterus) is collected for study.

Treatment

If you have an abnormal Pap test result, talk to your doctor about what the result means and the recommended next steps. Keep in mind that many women with some types of abnormal Pap test results do not need treatment, only follow-up testing. It is important to have regular Pap tests to detect these problems. If treatment is needed, it can be done early enough to prevent cancer before it develops.

Infertility is defined as the inability of a couple to conceive a baby after one year of unprotected intercourse, or 6 months of trying if the woman is over the age of 35. However, if you and your partner have been struggling to get pregnant after 9 months of trying, it may be worth reaching out to your OB/GYN physician.

Causes of infertility include:

• Ovulation disfunction
• Fallopian tube damage
• Endometriosis
• Sperm issues

Unfortunately, in 30% of couples that struggle with infertility the cause remains unexplained.

Treatment options for infertility depend on the cause. A woman may just need to take a little bit of medication to help her to ovulate or she may need to take a medication to help with her hormone levels to correct the ovulation disfunction.

If you and your partner are struggling with infertility please reach out to your provider and make an appointment.

Changes in hormone levels may cause your period to be later or earlier and sometimes heavier than normal. Symptoms of dysfunctional uterine bleeding may include:

• Bleeding or spotting from the vagina between periods
• Periods that occur less than 28 days apart (more common) or more than 35 days apart
• Time between periods changes each month
• Heavier bleeding (such as passing large clots, needing to change protection during the night, soaking through a sanitary pad or tampon every hour for 2 - 3 hours in a row)
• Bleeding lasts for more days than normal or for more than 7 days 

Treatment

Treatment will depend  the cause of the bleeding, your age and whether you want to have children. Treatment options include medications, such as hormones or surgery. You may decide with your doctor to “watch and wait” before trying the other two treatments. Most women can be treated with medications. If you think you may be pregnant, be sure to let your doctor know before starting any treatment.

Hormones

Hormones can control some abnormal bleeding. It may take a few months. Your periods may be heavier at first. However, they usually will lighten over time. If they do not, let your doctor know. The type of hormone you take will depend on whether you want to get pregnant as well as your age. Hormones can be given in pill form, such as an oral contraceptive, or as an injection, vaginal cream, or through an IUD that releases hormones.

Surgery

• Some women may need to have surgery to remove growths (such as polyps or fibroids) that cause bleeding. This often can be done with hysteroscopy. Sometimes other techniques are used.
• Endometrial ablation may be used to control bleeding. This treatment uses electricity, laser, heat, or freezing to destroy the lining of the uterus. It is intended to stop or reduce bleeding permanently. A woman may not be able to get pregnant after ablation. An endometrial biopsy is needed before ablation is considered.
• Hysterectomy may be done when other forms of treatment have failed or are not an option. This is major surgery. Afterward, a woman no longer has periods and cannot get pregnant. Discuss all of your options with your doctor before choosing a treatment.

What is a LEEP procedure?

LEEP stands for Loop Electrosurgical Excision Procedure. It's a procedure done in the doctor's office after you receive an abnormal pap smear. Most abnormal pap smears are caused by the HPV virus which many women are exposed to throughout their life. Many of these changes will resolve on their own, but sometimes they can progress to precancerous changes which need to be treated. Usually an abnormal pap smear is followed up and confirmed by a colposcopy in the office. When the abnormal findings are confirmed -- it can be treated with the LEEP procedure.

What should I expect?

The procedure is done in the physician's office and takes about 20 minutes. It's similar to a pelvic exam. A thin wire loop is used to remove the affected tissue. The tissue is sent to the lab for further testing. A colposcopy is often done at the same time or prior to the procedure to help identify the abnormal areas.

What are the risks of the Loop Electrosurgical Excision Procedure?

Complications are minor and may include minor bleeding and cramping. You should report any heavy bleeding to your doctor immediately. Taking an over the counter pain reliever like ibuprofen before the procedure can help alleviate any cramping. Your physician will instruct you to avoid things like taking baths, intercourse, and tampons for up to six weeks.

What is the follow up for a Loop Electrosurgical Excision Procedure?

Your physician will require a follow up Pap smear in six months to make sure abnormal cervical cells don't redevelop. Remember early detection is key.

What is a minimally invasive hysterectomy?

A hysterectomy is an operation to remove a woman's uterus. In most cases, we no longer have to use the old fashioned method which requires a big abdominal incision and major down time. Now we can do this with three tiny incisions. There are a couple of ways to do the surgery.

Who’s a candidate for a minimally invasive hysterectomy?

Almost all women are candidates for a minimally invasive hysterectomy. Women with a range of gynecological conditions are prime candidates. The conditions include pain, bleeding, fibroids, and endometriosis. We can even remove a very large uterus with minimally invasive surgery.

What should I expect?

You will be put to sleep for this procedure. It will take anywhere from 90 minutes to two and half hours. We will make three small incisions. The first incision is for the camera so we can see inside. The two other incisions are for the instruments, so we can operate and maneuver.

What are the benefits?

The minimally invasive surgery results in a shorter hospital stay, less pain, less blood loss, lower risk of infection, and quicker recovery.

What are the risks?

The risks with surgery include bleeding, infection, and damage to nearby structures. Using the minimally invasive approach we can reduce the risk.

Learn more about our Pelvic Health Center and treatments, as well as post-partum pelvic health physical therapy.

Polycystic ovary syndrome (PCOS) is a condition in which a woman has an imbalance of estrogen, progesterone and androgen. This may lead to menstrual cycle changes, cysts in the ovaries, trouble getting pregnant, skin, changes and, development of male-like characteristics .

PCOS Symptoms

Symptoms of PCOS include changes in your period (menstrual cycle).  Some changes are:

• No period after you have had one or more normal ones during puberty (secondary amenorrhea)
• Irregular periods, that may come and go and may be very light to very heavy

PCOS can cause you to develop male-like characteristics. This is called virilization. Symptoms include:

• Body hair growing on the chest, belly, face, and around the nipples
• Decreased breast size
• Enlargement of the clitoris
• Thinning of the hair on the head, called male-pattern baldness
• Voice gets deeper

You may also have skin changes:

• Acne that gets worse
• Dark or thick skin markings and creases around the armpits, groin, neck, and breasts

Treatment for PCOS

Weight gain and obesity is common in women with PCOS. Losing weight can help treat the hormone changes and health conditions such as diabetes, high blood pressure, or high cholesterol. Losing just 5% of your body weight can help your hormone imbalance and may make it easier to get pregnant. For a 160-pound woman, that's just 8 pounds! Your doctor may recommend birth control pills to make your periods more regular. Such medicines may also help reduce abnormal hair growth after you take them for a few months.

A diabetes medicine called glucophage (metformin) may also be recommended to:

• Make your periods regular
• Prevent type 2 diabetes
• Help you lose weight when you follow a healthy diet

Other medicines that may be prescribed to help make your periods regular and help you get pregnant are:

• LH-releasing hormone (LHRH) analogs
• Clomiphene citrate, which helps your ovaries grow and release eggs

Your doctor or nurse may also suggest other treatments for abnormal hair growth. Some are:

• Spironolactone or flutamide pills
• Eflornithine cream

Permanent hair removal options include:

• Electrolysis
• Laser hair removal - works best on very dark hair that covers large areas

Treatments can be expensive and multiple treatments may be needed. A pelvic laparoscopy may be done to remove or alter an ovary to treat infertility. The effects are temporary.

What is premenstrual syndrome (PMS)? Nine out of ten women suffer from PMS, a combination of symptoms one to two weeks before their periods. This condition  is thought to be caused by fluctuating hormones. 

PMS symptoms:

• Bloating
• Headache / back pain
• Irritability, mood swings, anxiety, depression
• Tiredness /sleeping disturbances
• Constipation or diarrhea
• Appetite changes

Dealing with PMS:

• Be active throughout the month: Physical, and especially aerobic, activity can alleviate depression, fatigue and other symptoms of PMS.
• Eat healthily every day.
• Avoid caffeine, salt and sugar two weeks before your period.
• Get lots of sleep: lack of sleep can make PMS worse.
• Not smoking and not vaping: according to one study, smokers are twice as likely to suffer from moderate or severe PMS.
• Keep track: write down when you have your period - and what you feel - so you can notice patterns of what is normal for you and what makes your PMS worse.
• Take a closer look: not everything is PMS. Those headaches may really be migraines, fatigue can indicate a thyroid problem, or moodiness can indicate anxiety or depression that should be treated.

Severe PMS can be a sign of premenstrual dysphoric disorder (PMDD), which occurs in less than 5% of women of childbearing age. If you have severe PMS or other questions about your menstrual cycle, contact your ob-gyn.

Our CHI Health Women's Health providers provide comprehensive and caring prenatal care for pregnant woman. 

Learn more.

It’s normal to feel a little nervous about beginning OB/GYN care. Let our experts put you at ease as you take this next step. We understand the challenges of puberty and young adulthood, and will help you prepare for the changes ahead.

If you’re anxious about the Pap smear or physical exam, you can relax. Your First OB/GYN Visit is mostly a chance to talk about puberty and get acquainted. In fact, a Pap smear is generally not recommended until age 21. If there’s a medical problem which requires an exam, we will talk you through the process so there are no surprises.

Our first concern is making sure you are informed and comfortable with the changes Puberty brings. In fact, the information and care we provide is about much more than reproductive health. There are at least 9 Reasons to See an OB/GYN Before Age 18. It’s about keeping you healthy and building a trusted and healthy partnership for the future. 

9 Reasons to See an OB/GYN before Age 18

1. Puberty can be challenging. Learn how to prepare for its many changes.
2. Periods can be confusing. Find out what’s normal and what to expect
3. Periods can be painful or heavy. Get help when you’re uncomfortable
4. Bleeding can occur between periods. Find out if it’s cause for concern.
5. Premenstrual syndrome (PMS) can be annoying. Get advice for coping.
6. Vaginal itching, discharge or odor shouldn’t be ignored. Receive expert care.
7. Urinary tract infections need prompt care. See us for relief and treatment.
8. Hormone surges can cause body changes, like acne. Find out what you can do.
9. Reproductive health is important. Get informed so you can be responsible.

Uterine fibroids are noncancerous (benign) tumors that develop in the womb (uterus), a female reproductive organ. Uterine fibroids are common. As many as 1 in 5 women may have fibroids during their childbearing years (the time after starting menstruation for the first time and before menopause). Half of all women have fibroids by age 50. Fibroids are rare in women under age 20. They are more common in African-Americans than Caucasians.

The cause of uterine fibroids is unknown. However, their growth has been linked to the hormone estrogen. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly. Fibroids can be so tiny that you need a microscope to see them. However, they can grow very large. They may fill the entire uterus, and may weigh several pounds. Although it is possible for just one fibroid to develop, usually there are more than one. Fibroids are often described by their location in the uterus:

• Myometrial -- in the muscle wall of the uterus
• Submucosal -- just under the surface of the uterine lining
• Subserosal -- just under the outside covering of the uterus
• Pendunculated -- occurring on a long stalk on the outside of the uterus or inside the cavity of the uterus

Symptoms

More common symptoms of uterine fibroids are:

• Bleeding between periods
• Heavy menstrual bleeding (menorrhagia), sometimes with the passage of blood clots
• Menstrual periods that may last longer than normal
• Need to urinate more often
• Pelvic cramping or pain with periods
• Sensation of fullness or pressure in lower abdomen
• Pain during intercourse

Note: There are often no symptoms. Your health care provider may find them during a physical exam or other test. Fibroids often shrink and cause no symptoms in women who have gone through menopause.

Signs and tests

The health care provider will perform a pelvic exam. This may show that you have a change in the shape of your womb (uterus). It can be difficult to diagnose fibroids, especially if you are extremely overweight. An ultrasound may be done to confirm the diagnosis of fibroids. Sometimes, a pelvic MRI is done. An endometrial biopsy (biopsy of the uterine lining) or laparoscopy may be needed to rule out cancer.

Treatment

Treatment depends on several things, including:

• Your age
• General health
• Severity of symptoms
• Type of fibroids
• Whether you are pregnant
• If you want children in the future

Some women may just need pelvic exams or ultrasounds every once in a while to monitor the fibroid's growth. Treatment for the symptoms of fibroids may include:

• Birth control pills (oral contraceptives) to help control heavy periods
• Intrauterine devices (IUDs) that release the hormone progestin to help reduce heavy bleeding and pain
• Iron supplements to prevent or treat anemia due to heavy periods
• Nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen or naprosyn for cramps or pain
• Short-term hormonal therapy injections to help shrink the fibroids

Surgery and procedures used to treat fibroids include:

• Hysteroscopic resection of fibroids: Women who have fibroids growing inside the uterine cavity may need this outpatient procedure to remove the fibroid tumors.
• Uterine artery embolization: This procedure stops the blood supply to the fibroid, causing it to die and shrink. Women who may want to become pregnant in the future should discuss this procedure with their health care provider.
• Myomectomy: This surgery removes the fibroids. It is often the chosen treatment for women who want to have children, because it usually can preserve fertility. More fibroids can develop after a myomectomy.
• Hysterectomy: This invasive surgery may be an option if medicines do not work and other surgeries and procedures are not an option.

Vaginitis is the general term that describes a combination of vaginal conditions caused by inflammation, infection, and changes in the normal vaginal flora.

Most Common Symptoms of Vaginitis are: 

• Itching
• Increased discharge
• Odor
• Burning sensation 

If you develop any of these symptoms, it is very important that you schedule an appointment at your clinic to be evaluated. Even though there are many over-the-counter medications that you can buy to treat vaginitis, not all cases of vaginitis are caused by the same pathogen. It is very important to determine which one is causing your symptoms so your doctor can treat you more effectively.

Prevent Vaginitis by Avoiding: 

• Douching
• Internal use of chemicals
• Soaps
• Scented water
• Powder
• Baby wipes 

When you see your doctor for vaginitis, you can expect a pelvic exam. Your doctor is going to use a swab to take a small sample of the discharge and then send it to the lab or analyze it under the microscope. By doing this, your doctor can determine which exact pathogen is causing your symptoms and then provide you with the most effective therapy for it.

During your annual well woman exam, you will be screened for potential gynecologic health problems. These screenings may include a pelvic exam, pap smear, breast exam, laboratory testing, as well as contraceptive or menopause management counseling.  Your well woman exam is also the time for you to ask questions and discuss gynecologic health concerns you have with your care provider.

Teen years

The American College of Obstetricians and Gynecologists recommends that the first gynecologic visit for young females occurs between the ages of 13 and 15. The first visit may just be a discussion between you and your doctor. Depending on your current health care needs, there may also be exams performed. Exams may include a pelvic exam, pap test and breast exam.

20s & 30s

We recommend patients in their 20s and 30s have an annual well woman exam. This exam may include a pap smear, pelvic exam, breast exam and instructions on how to perform breast self exams. During your well woman exam your care provider will discuss healthy lifestyle choices including healthy diet and exercise, not smoking and alcohol only in moderation. A baseline mammogram is offered between the ages of 35 and 40.

40's & 50's

We recommend patients in their 40's and 50's have an annual well woman exam. This exam may include a pap smear, pelvic exam, breast exam and instructions on how to perform breast self exams. An annual mammogram is also recommended. This visit may also include counseling for osteoporosis prevention and Bone Density Testing if needed. Other discussion for this visit includes possible peri-menopausal or age related changes you can expect, as well as contraceptive needs and the prevention of sexually transmitted infections. During your well woman exam your care provider will discuss healthy lifestyle choices including visiting your primary care provider for regular health screenings, healthy diet and exercise, not smoking and alcohol only in moderation.

Menopausal Years and Beyond

An annual well woman exam is recommended during the menopausal years and after. This exam may include a pap smear, pelvic exam, breast exam and instructions on how to perform breast self exams. In addition to an annual mammogram, a bone density scan is recommended approximately every other year. During your well woman exam your care provider will address issues including vaginal dryness, incontinence and urinary frequency and as well as any concerns you may have. If indicated, hormone therapy may be discussed. During your well woman exam your care provider will discuss healthy lifestyle choices including visiting your primary care provider for regular health screenings, taking calcium and exercising to prevent bone loss, healthy diet, not smoking and alcohol only in moderation.