What is abnormal uterine bleeding?

Any irregular bleeding from the uterus that is heavier than usual, lasts longer than usual, or occurs outside your normal menstrual period, may be abnormal uterine bleeding (AUB). Your doctor may diagnose abnormal uterine bleeding if:

• Your periods are fewer than 21 days apart or more than 35 days apart. Your period last longer than a week.
• You are passing clots or soaking through your tampon or sanitary pad in an hour or two or more hours. If this occurs, your bleeding is considered severe and you should call your doctor right away.

Who should have a Pap smear?

• A Pap smear screens for cervical cancer and usually takes place during a patient’s general pelvic examination. In general, women between the ages of 21 and 65 should have a Pap smear every three years, although your doctor may recommend a different screening schedule for you depending on your risk factors and the results of previous Pap smears. In some cases, such as after a total hysterectomy for non-cancerous conditions, your doctor may choose to discontinue Pap smear screening entirely.

What happens during a Pap smear?

• The Pap smear is a simple procedure performed in the office; you will be able to return to your regular activities right after your appointment. The doctor inserts an instrument (speculum) into the vagina and gently removes a few cells from your cervix using a special brush or spatula-type device. The cells are preserved and sent to a lab for testing and interpretation. You should not have sexual intercourse the night before your Pap smear and you should avoid scheduling the test during your menstrual period.

What if my Pap smear is abnormal?

• A positive, or abnormal, Pap smear doesn't necessarily mean you are at risk for cervical cancer. In some cases, the doctor may recommend further diagnostic testing to rule out or confirm the presence of worrisome viruses, cells, or lesions. Sometimes, if the changes are low grade in nature, your doctor may recommend more frequent Pap smears to monitor the progression of any abnormal tissue. Depending on the type of changes in your cervix, your doctor may perform a procedure known as a colposcopy to visually examine the tissues of the cervix, vulva, and vagina using a colposcope, which is a magnifying instrument. You may also need a biopsy, or tissue sample, to correctly diagnose your condition.

How do I know if I'm in menopause?

Menopause is officially defined as the end of your menstrual cycle, usually 12 months after your last period has occurred. It can happen any time in your 40s or 50s, although 51 is the average age for American women. In most cases, you'll know you're approaching menopause when you begin to experience the following symptoms:

• Irregular periods
• Night sweats
• Hot flashes
• Vaginal dryness
• Weight gain due to slowed metabolism
• Dry skin; thinning hair
• Mood changes
• Insomnia
• Breast changes, loss of breast fullness

The period leading up to complete cessation of your menstrual periods is known as perimenopause. It's possible, although unlikely, for you to become pregnant during perimenopause.

What medications, including HRT, can I use to relieve my symptoms?

Hormone replacement therapy (HRT) is the most common treatment for menopause symptoms. Depending on your medical history, your doctor may recommend treatment with different forms of estrogen and sometimes progestin, if you still have your uterus.

Other menopause medications may include certain low dose antidepressants, which may help with hot flashes in women for whom HRT is not recommended. Your doctor may also prescribe medications to prevent osteoporosis. Some women have also turned to bioidentical hormones, considering them a more natural approach to hormone replacement therapy.

What can I do at home to manage menopause symptoms?

Fortunately, menopause symptoms are only temporary, but you can still take steps to reduce their effects on your health and well-being:

• Avoid hot beverages, caffeine, alcohol, and spicy foods if these trigger hot flashes.
• Use water-based vaginal moisturizers, such as Replens to decrease discomfort.
• Avoid preparations with glycerine, as many women are sensitive to it.
• Practice Kegel exercises to strengthen the pelvic muscles.
• Exercise regularly to reduce stress and ward off conditions, such as heart disease and osteoporosis that are associated with aging.
• Learn relaxation techniques, such as yoga, to help manage symptoms.
• Eat a healthy diet with plenty of fruits, vegetables, grains, and healthy fats.
• Ask your doctor about vitamin D supplements.

Some women have experimented with alternative remedies, such as acupuncture or dietary supplements. Ask your doctor before taking any herbal supplements, however, as these may interfere with other medications you currently take or even put your health at risk.

When should I begin prenatal care?

You should schedule an appointment with your OB doctor as soon as you think you may be pregnant. During your first visit, your doctor will:

• Take a complete health history, including family history, past pregnancies, menstrual patterns, medication usage, and lifestyle factors including tobacco, alcohol, and caffeine use.
• Perform a physical exam, including height and weight to help determine your target weight gain during pregnancy, and pelvic examination to confirm the stage of pregnancy and due date, and evaluate the condition of your uterus, cervix, and vagina.
• Order lab tests to check your hemoglobin, immunity to certain diseases, and exposure to infections. She may also order fetal screening tests.

You may want to bring your partner or spouse to your first prenatal visit.

What happens during a prenatal visit?

Your first prenatal visit will usually take much longer than your routine prenatal visits throughout the remainder of your pregnancy. During a routine prenatal visit, your doctor will track your blood pressure and weight and check your urine for any signs of blood or markers for gestational diabetes or eclampsia. She will also measure your uterus to monitor the baby's growth and check your baby's heartbeat. At certain visits, your doctor may order routine lab tests or imaging studies. You'll see the doctor every four weeks until the later stages of your pregnancy, when you'll have appointments about every two weeks until your baby is born.

What should I do to stay healthy during pregnancy?

While every pregnancy is different, there are things you can do to promote good health during pregnancy:

• See your OB-GYN as soon as possible and keep all your scheduled appointments.
• Eat a healthy diet and take any prenatal vitamins and supplements your doctor recommends.
• Get regular exercise; ask your doctor if you are concerned about your current exercise routine.
• Try to get at least eight hours of sleep at night and take naps if you are feeling tired during the day. Limit your caffeine consumption and avoid alcohol while you are pregnant.

What are the symptoms of uterine fibroids?

Uterine fibroids, or myomas, are benign growths in the uterus; they are not cancerous and do not indicate a higher risk of developing cancer. They range in size from tiny "seedlings" to masses that enlarge the uterus and cause pain. Some women have no symptoms with fibroids, while others experience one or more of the following:

Heavy periods that last longer than one week Frequent urination or trouble emptying your bladder Pelvic pressure or pain; pain in the back and legs Constipation

You should call your doctor if you have any of these symptoms and seek emergency care if you experience severe bleeding or sudden sharp pelvic pain.

What causes fibroids?

Medical researchers aren't sure what causes fibroids to develop in some women and not others. Clinical experience suggests that there may be hormonal or genetic factors at work. Fibroids contain more hormone receptors than other uterine tissue and tend to shrink after menopause, when the body's hormone levels decrease.

You may be at increased risk for developing fibroids if any of the following applies to you:

• Family history of fibroids
• Early onset of menstruation
• Use of birth control pills
• Obesity
• Alcohol consumption
• Vitamin D deficiency

What treatment options are available for fibroids?

Occasionally, your doctor will identify fibroids during a routine pelvic examination, or will suspect they are present based on your symptoms. The most common way to diagnose fibroids is with an ultrasound scan, although other, more advanced testing may be required to confirm them.

If you have fibroids, but they aren't causing any symptoms, in most cases, your doctor will take a "watch and wait" approach to management. If you are having symptoms, your doctor may recommend treatment with oral medications or an IUD. For more complex cases, there are several noninvasive and minimally invasive treatment options, such as MRI guided focused ultrasound surgery (FUS) or laparoscopic removal. Traditional surgical options are also available, including abdominal myomectomy or hysterectomy.

Are there gynecological surgery options to treat incontinence?

Urinary incontinence can be divided into two main types: Overactive bladder (urge incontinence) and stress incontinence, which occurs when you laugh, sneeze, cough, or perform certain physical activities. Many women experience incontinence as a result of pregnancy, vaginal childbirth, trauma, or excessive weight gain. About 25 percent of all women experience incontinence at some point in their lifetimes.

If treatment with exercise and medication is ineffective, there are minimally invasive gynecological surgeries and procedures that can be performed to relieve your symptoms. Urethral injections and bladder sling surgery are two of the more common procedures used in treatment of incontinence.

What is gynecological laparoscopy surgery used for?

Diagnostic laparoscopy is a minimally invasive procedure in which a tiny incision is made near the belly button to allow for the insertion of a tiny scope (called a laparoscope) in order to view the internal organs. During the procedure, a small amount of gas is placed in the abdomen to create more space for the doctor to see the organs more clearly. If anything is identified during the initial procedure, the surgeon can insert other small implements through the incision to treat the condition. Gynecological laparoscopy surgeries are often used to treat:

• Ovarian cysts
• Uterine fibroids
• Removal of scar tissue and adhesions
• Tipped or retroverted uterus
• Incontinence (bladder sling)
• Uterine bleeding

How long is the recovery period for gynecological surgeries?

Each surgical procedure is different and recovery time will depend on a number of factors, such as the type of procedure performed, the health of the person undergoing surgery, the surgical approach, and the type of anesthesia used. With most laparoscopic procedures, you will be able to go home the same day, although occasionally, an overnight stay in the hospital is required. You may have some pain and discomfort for a few days after the procedure, but your doctor will prescribe medications to help manage it. In most cases, you can return to normal activity within a week or two after surgery.

What happens during pelvic organ prolapse?

The strain of vaginal childbirth is most often linked to pelvic organ prolapse, when the muscles supporting the pelvic organs become weakened and stretched. It can be worsened by obesity, a prolonged cough, constipation, or even pelvic tumors. If the pelvic muscles are no longer able to support the pelvic organs in their proper position, they slip, or prolapse. The most common organs involved in pelvic organ prolapse include:

• the bladder (the most common prolapse, also called a cystocele)
• the uterus
• the urethra
• the vagina
• the small bowel
• the rectum

Pelvic organ prolapse isn't usually a major health problem, but it can be painful. Occasionally, a prolapse will heal on its own over time.

When should I call the doctor if I suspect pelvic organ prolapse?

If you notice any of the following, make an appointment with your doctor:

• Bulging inside or outside the vagina
• Pulling or pelvic pressure that goes away when you lie down
• Painful intercourse
• Vaginal spotting or bleeding
• Urinary incontinence
• Trouble passing a bowel movement

A gynecologist is your best source of medical care if you suspect pelvic organ prolapse.

How is pelvic organ prolapse treated?

In many cases, when symptoms are mild and do not interfere with daily activities, women can reduce their symptoms with nonsurgical treatments, such as targeted exercises, lifestyle changes, or use of a pessary, which helps support the pelvic organs. However, in the case of more severe symptoms, such as incontinence, painful intercourse, or severe pain and pressure, surgery may be required to correct the prolapse.

Surgical treatment for pelvic organ prolapse may include:

• Repair of the tissues and muscles that support the prolapse organ
• Vaginal wall surgery
• Removal of the uterus (hysterectomy), most often performed when it is causing prolapse of the vagina and other organs

You can prevent or minimize symptoms of pelvic organ prolapse by performing Kegel exercises to strengthen the pelvic muscles, preventing constipation, avoiding heavy lifting, and maintaining a healthy body composition.

How do I choose the right birth control option?

There are so many effective forms of birth control available today, it's easier than ever to find an option that works for you. Before you see your doctor for birth control, ask yourself the following questions, the answers to which will help you and your doctor choose the right type:

Do I want to become pregnant in the future? A "yes" excludes permanent types of birth control.

How would an unplanned pregnancy affect my life right now? Some types of birth control are more effective than others. How much effort do I want to put into birth control? Some methods require more proactive planning than others.

How much can I afford to spend on birth control? There are more and less expensive options.

Is an IUD a good choice for me?

An IUD (intrauterine device) works by preventing the ovum from being fertilized by sperm, initiating a pregnancy. There are two main types of IUDs:

• Hormonal IUDs work by releasing a small amount of hormones, similar to those used in birth control pills, into your body. They may cause you to have lighter periods, making them a good option if you have heavy menstrual cycles.
• Copper IUDs work by stimulating an immune system response in your body that is toxic to sperm. Copper IUDs may cause heavier periods, especially at first, but they lasts longer than hormonal IUDs.

Most healthy women can use IUDs for birth control, but if you have had a recent pelvic infection, have a history of cervical or uterine cancer, or have unexplained vaginal bleeding, an IUD may not be right for you. It's important to note that IUDs do not protect against sexually transmitted diseases.

Do I need a prescription for birth control?

Some types of birth control are available over the counter without a prescription. These include: Condoms, both male and female, diaphragms, spermicidal sponges, creams, foams, and gels. These offer some protection against STDs.

Non-prescription forms of birth control are generally less effective than birth control methods that require a doctor's supervision, which can be 90 percent to 99 percent effective when used correctly.