Gynecology

+ Contraception

The availability of family planning services allows individuals to achieve desired birth spacing and family size, and contributes to improved health outcomes for infants, children, women, and families. For many women, a family planning clinic is their entry point into the health care system and one they consider their usual source of care.

Birth control, also known as contraception, is designed to prevent pregnancy. Birth control methods may work in a number of different ways. At WHC, we can help figure out which method of contraception is best for you.

+ Infertility

We at WHC understand how difficult infertility is for you and are ready to provide a comprehensive evaluation and treatment plan that is individualized to your needs. Infertility is defined as the lack of conception after 12 months of regular intercourse without contraception in a woman younger than 35 years old, or after 6 months in a woman older than 35. The most common causes of infertility are male factors, ovulatory dysfunction, and mechanical factors (like tubal damage). A significant percentage of infertility is unexplained (where no cause is found).

At Women's Health Consultants, the recommended workup usually involves a history and physical exam, blood work, an assessment of the uterus and fallopian tubes, and a semen analysis. Reversible causes of infertility can then be treated. In more complicated cases, patients are referred to a reproductive endocrinologist, who is a fellowship-trained specialist in infertility.

Procedures & Treatments

• A Hysterosalpingogram procedure (HSG): This is a procedure that involves the injection of dye into the uterus to outline the anatomy of your uterus and fallopian tubes.

• Treatment with medications: This treatment works by stimulating an increase in the amount of hormones that support the growth and release of a mature egg (ovulation). Note: this medication is not recommended for women whose ovaries no longer make eggs properly.

+ Abnormal Bleeding

Abnormal uterine bleeding occurs at various stages of a woman's life for different reasons. Causes of bleeding may be grouped into anatomical (polyps, fibroids), hormonal, and physiological. While not all abnormal bleeding is dangerous, it can be inconvenient and uncomfortable and affect a woman's normal daily living. The physicians at Women's Health Consultants can help you find a solution to this complex problem — a solution that fits your lifestyle.

Evaluation

The first step in evaluating abnormal bleeding is a thorough history and review of patient risks. A complete history and physical examination will help guide the workup. Hormonal and endocrine blood tests are often needed. A pelvic ultrasound is routinely performed to make sure anatomical disorders are not the cause. Generally, in women older than age 35, the workup may include an endometrial biopsy in the office. Specialized studies such as saline infusion sonogram and diagnostic hysteroscopy may also be recommended: these studies help visualize the uterine lining and are conveniently performed in our office.

Treatment

Treatment of abnormal uterine bleeding is based on the underlying cause. Depending on your age, the severity of bleeding, and desire for fertility, there are several treatment options available. Hormones such as combined oral contraceptives and progestins, and the Mirena IUD are often used to treat bleeding that is due to hormonal changes and irregularities. Women who have completed childbearing and have heavy menstrual bleeding can consider a procedure such as endometrial ablation. Surgery may be necessary to remove abnormal uterine structures (e.g., fibroids, polyps). Finally, hysterectomy may be the treatment option for many patients.

We understand the various underlying causes of abnormal uterine bleeding. We also understand the need for individualized treatment plans. You can trust that we will spend the time to discuss the issues and find the most suitable solution to your bleeding problem.

+ Abnormal Pap Smears

A pap smear is a scraping of the surface cells of the cervix to look for abnormal cells. The cervix is also often checked for an infection with a virus called human papilloma virus, or HPV.

The doctors at Women's Health Consultants are trained in the evaluation of the abnormal pap smear. We may recommend that you have a pap smear repeated at more frequent intervals; a colposcopy, which is a visual evaluation with a microscope; or possibly a biopsy.

Depending on the result of the evaluation, we will advise you on the recommended follow-up or treatment. Pap smears may be performed at your referring doctor's office or at Women's Health Consultants. If surgical treatment is recommended, that can usually be performed in our office.

+ Pelvic Pain

Pelvic pain is a general term used to describe pain that occurs mostly in the lower-abdomen area. The pain may be acute (sudden in onset) or chronic (lasting more than 6 months). Pelvic pain is initially evaluated in the clinic. We assess the history of symptoms and perform a careful physical examination.

Pelvic pain is commonly caused by dysfunction in the female genital organs; however, it can also be caused by diseases of the lower intestines or urinary tract. Sometimes, pelvic pain can be caused by muscular or skeletal problems.

Pelvic pain is commonly caused by dysfunction in the female genital organs; however, it can also be caused by diseases of the lower intestines or urinary tract. Sometimes, pelvic pain can be caused by muscular or skeletal problems.

What Conditions Cause Pelvic Pain?

There are several causes of pelvic pain, and symptoms often differ by diagnosis. Here are the most common health conditions that are often associated with pelvic pain:

• Dysmenorrhea: pain during the menstrual period Endometriosis: pain caused by inflammation and uterine tissue that is growing outside the uterus Pelvic inflammatory disease (PID): pain caused by an infection of the uterus and/or fallopian tubes Ovarian cyst: when the ovary produces a large, painful cyst, which may rupture
• Ovarian torsion: when the ovary is twisted in a way that interferes with its blood supply
• Ectopic pregnancy: a pregnancy implanted outside the uterus, often within the fallopian tube
• Vulvodynia: pain in the vulva or external genital area Uterine fibroids: noncancerous tumors that grow within and around the wall of the uterus
• Pelvic joint instability: pain caused by misaligned pelvic joints or abnormal stretching of pelvic ligaments

What is the Treatment for Pelvic Pain?

Treatment for pelvic pain depends on the exact cause as well as the duration and severity of the pain. Your evaluation will include a thorough history and physical exam. Additional testing may include blood and urine tests, pelvic ultrasound, or other imaging such as CT or MRI, screenings for STDs or other infections, and sometimes surgical evaluation.

Mild pelvic pain can often be treated with over-the-counter medications such as Tylenol or Ibuprofen. Other medical treatments include:

• Prescription pain medications or anti-inflammatory medications
• Antibiotic pills or creams
• Hormone pills or creams
• Surgery
• Physical therapy
• Complementary treatments such as acupuncture, relaxation, biofeedback

+ Pelvic Organ Prolapse

Pelvic support problems occur when the uterus, vagina, bladder, or rectum slips down — or prolapses. There are many causes of pelvic organ prolapse. Symptomatic pelvic organ prolapse can have a negative impact on a woman's life.

We offer testing and conservative management for mild to severe prolapse. Management options range from the conservative choice of inserting a pessary device into the vagina to the consideration of surgery.

At Women's Health Consultants we believe that women need to learn about all of their options after a careful examination to determine the type and severity of their prolapse.

+ Uterine Fibroids

Physicians at Women's Health Consultants have extensive expertise in the diagnosis and treatment of fibroids. We provide diagnosis with a combination of physical exam and in-office pelvic ultrasound at both of our locations, and treatment options include both surgical and nonsurgical approaches.

Treatment of symptomatic fibroids may include medications to reduce pain and bleeding. In some women, surgical treatment is needed. We provide a full range of surgical treatment of fibroids:

• Hysteroscopic myomectomy
• Laparoscopic myomectomy
• Robotic-assisted (da Vinci) hysterectomy
• Abdominal myomectomy
• Endometrial ablation
• Laparoscopic hysterectomy
• Laparoscopic-assisted vaginal hysterectomy
• Robotic-assisted (da Vinci) hysterectomy
• Vaginal hysterectomy
• Abdominal hysterectomy

+ Sexual Dysfunction

Sexual dysfunction is a common problem in women in all stages of life. Our evaluation begins with a careful history and physical examination. It is important for the patient to include her use of medications and supplements. Some issues have a simple solution, and others are more complex requiring several visits. Referral to other professionals such as physical therapists, counselors, or sex therapists may also be helpful.

+ Sexually Transmitted Infections (STIs)

Routine screening for STIs is very important for the health of all sexually active women. Our clinic offers routine STI screening as well as personalized counseling and discussion regarding STI risk, transmission, and treatment.

If you test positive for an STI, the next step is to consider further testing and then to get treatment as recommended by your provider. In addition, inform your sex partners, as they will need to be evaluated and treated, too. If you believe that you may have put yourself at risk or if you are having STI symptoms, make an appointment for testing as soon as possible.