Contemporary Women's Care Health Library

Robotic-Assisted Gynecologic Surgery

Sun, 08 Jul 2007 17:55:54 -0400

Many gynecologic surgeries today are still too complex to accomplish with conventional minimally invasive technologies. Until now, these patients have required a large open incision for their surgery. Many of these surgeries are myomectomies (removal of fibroids) or hysterectomies (removal of the uterus). More than half the hysterectomies performed in the U.S. still need to be done using large incisions. The dexterity needed to remove fibroid tumors and suture the uterus properly is challenging to impossible via traditional laparoscopy. Robotic surgical enhancements today make this possible. Robotic assisted hysterectomy is a progressive, dynamic alternative to conventional laparoscopic and abdominal hysterectomy.

The da Vinci Surgical Robotic System incorporates the latest advances in robotics and computer technology to give surgeons exceptional control of instruments and clear three-dimensional views similar to those obtained in traditional open surgery. The instruments and 3-D cameras are inserted into the patient through small incisions, about the size of a keyhole. A special console gives the surgeon magnified 3-D views of the procedure. Precise, computer-enhanced controls manipulate the tiny surgical instruments in a natural, intuitive manner that mimics the hands of the surgeon.

With the Robot, the magnification is improved, the images are 3-D and the dexterity is excellent. Complex procedures during a hysterectomy, such as securing the uterine vessels, performing an accurate culdotomy and over sewing the vaginal cuff, are facilitated by the Robot, providing unique advantages over conventional surgery and improved patient outcomes post-procedure.

This advanced procedure benefits patients in many ways:

* Reduced trauma to the body
* Reduced blood loss and need for transfusion
* Less postoperative pain and discomfort
* Reduced risk of infection
* Shorter hospital stay
* Faster recovery and return to normal daily activities
* Less scarring and improved cosmetic appearance

Dr. Jennifer Hayes, of Contemporary Women’s Care, is the first OB/GYN surgeon in Pinellas County to offer Robotic-assisted gynecologic surgery for non-cancerous gynecologic conditions as an exciting alternative for minimally invasive procedures at Morton Plant Hospital.

To read more about Robotic-Assisted Hysterectomy and the da Vinci robot, you can download a brochure here requires acrobat reader.

Waterbirths

Sun, 08 Jul 2007 18:05:46 -0400

Waterbirth profoundly demonstrates that women are empowered by “giving birth” and co-creating their own delivery. Health care providers see women take charge of their birth experiences. They, in turn, do everything they can do to facilitate a gentle birth.

What are the benefits of waterbirth and water labor?

* Gives a mother more feelings of control.
* Provides significant pain relief.
* Promotes relaxation.
* Enables a mother to assume any position which is comfortable for labor and birth.
* Conserves her energy.
* Reduces her need for drugs and interventions.
* Gives a mother a private protected space.
* May speed-up labor.
* Reduces blood pressure.
* Reduces perineal trauma and eliminates episiotomies.
* Is highly rated by mothers — typically stating they would consider giving birth in water again.
* Encourages an easier birth for mother and a gentle welcome for baby.

What prevents a baby from breathing under water? Several factors prevent the baby from inhaling water at the time of birth, such as:

* One important inhibitory factor involves the larynx. The larynx has 5X more taste buds than the entire surface of the tongue. When water hits the back of the throat and touches the larynx, the taste buds interpret ‘water’ and the larynx automatically closes. The water is then swallowed, going ‘down the right pipe’.
* Prostaglandin E2 levels from the placenta cause a slowing down of the fetal breathing movements. When the baby is born, the Prostaglandin level is high, temporarily suspending the baby’s breathing reflex.
* Water is a more dilute than the fluid in the baby’s lungs so water doesn’t go into the lungs at birth. The baby is brought up to the water’s surface and takes his or her first breath.

What is the water temperature? Water is monitored at a temperature that is comfortable for the mother, usually between 95-100 degrees Fahrenheit. It is a good idea to have cold cloths for the mother’s face and neck. A cool facial mist from a spray bottle is a welcome relief as well.

Does insurance pay for waterbirths? It’s always safe to inform the insurance company that the baby was born vaginally. Whether the baby was born in the bath or on the bed, it is still a vaginal birth.

How long is baby in the water after the birth? Practitioners at CWC bring the baby out of the water within seconds after birth. There is no physiological reason to leave the baby under the water for any length of time. During and right after the waterbirth, the placenta supports the baby with oxygen.

When should I get into the water? A woman is encouraged to use the jacuzzi labor pool whenever she wants, once labor is established. Morton Plant has one water birth room. It’s available for labor on a first come, first serve basis.

Some mothers find a bath in early labor useful for its calming effect and to determine if labor has actually started. If contractions are strong and regular, no matter how dilated the cervix is, a bath may help the mother to relax enough to dilate further.

How can I reserve the jacuzzi labor pool? Talk to your CWC doctor or midwife at the start of your labor.

Medical Records

Sun, 08 Jul 2007 16:32:28 -0400

A signed authorization for release of medical records is required. At a patient’s request, the release can be mailed or faxed to the patient. The law allows 30 days for records maintained on site and 60 if records are stored off site. We usually try to get the records sent within 10 business days of receiving the signed release. There may also be a fee for copying the records.

Missed Appointment Policy

Mon, 02 Jul 2007 11:44:21 -0400

We’re glad you have chosen us to provide your medical care, but if you miss your appointments, you compromise that care. We want to remind you of our office policies regarding missed appointments.

A missed appointment is when you fail to show up for an appointment without a phone call, or cancel without at least 24-hour notice.

A doctor/patient relationship is built on mutual trust and respect. As such, we strive to be on time for your scheduled appointments, and ask that you give us the courtesy of a call when you are unable to keep your appointment. Below, our missed appointment policies are outlined.

Let’s work together to provide you with the best possible care you deserve.
Routine Office Visits:

1. 1st Missed Appointment: We’ll call and offer to reschedule your appointment.
You may be charged a missed appointment fee of $25.
2. 2nd missed Appointment: We’ll call and offer to reschedule your appointment.
You may be charged a missed appointment fee of $25.
3. 3rd Missed Appointment: You will be charged a missed appointment fee of $25.
This may result in a discharge from the practice.

Ultrasound Appointments:

1. 1st Missed Appointment: We’ll call and offer to reschedule your appointment. You WILL be charged a missed appointment fee of $50.
2. 2nd missed Appointment: We’ll call and give you a prescription with instructions to call and schedule an appointment at an out patient facility.
You will be charged a missed appointment fee of $50.

Office Procedure Appointments:

1. 1st Missed Appointment: We’ll call and offer to reschedule your appointment.
You will be charged a missed appointment fee of $50.
2. 2nd missed Appointment: We’ll call and offer to reschedule your appointment.
You will be charged a missed appointment fee of $75.
3. 3rd Missed Appointment: This may result in a discharge from the practice.
You will be charged a missed appointment fee of $75.

Prescription Guidelines

Sun, 08 Jul 2007 16:44:10 -0400

We thank you for choosing us as your OB/GYN healthcare provider. Our goal is to provide excellent patient care. One way our office does that is by having a nurse available to take and return patient calls with urgent problems and questions. Although we experience a high call volume, your calls are important and returned in order of urgency.

One way we try to keep our nurses available for patient calls is by limiting pharmacy calls. We have developed a policy for handling prescription refills in the hope that our time may be spent caring for our patients.

Please let your provider and her nurse know if you take your prescriptions to a local pharmacy or use mail order. Also let them know if you get a 30 or 90 day supply of medications.

You will be given prescriptions at the time of your visit. Take these prescriptions to your pharmacy for filling.

If you use a mail order pharmacy, you must mail the original prescription, not a photocopy.

When necessary, prescription refills are ONLY done during our regular business hours.

Your pharmacy can fax your refill request to our office. On those rare occasions when a refill by phone is necessary, please be prepared to provide the name of the medication, dose and the pharmacy number. The refill cannot be completed without the information.

Allow 72 hours for prescription refills to be called to the pharmacy.

Always check with the pharmacy before calling the office to see if the refill is complete.

Please be sure to pick up your refill promptly at your pharmacy, as most pharmacies will hold prescriptions for only 1 week before medications are returned to stock.

Remember to check the number of refills left on your current prescription. When you have 2 refills left, it is time to call and schedule your annual exam.

Insurance medication lists, also called formularies, change regularly. Although we try to keep current with the medications on the list, we prescribe based on your needs and not always what is covered under your insurance plan. If your pharmacist offers a generic replacement, you may accept it. However, not all generics are as effective as the name brand.

What is a Nurse Practitioner?

Mon, 02 Jul 2007 11:44:21 -0400

A nurse practitioner is a Registered Nurse (R.N.) who has advanced education and clinical training in a health care specialty area. The nurse practitioner works with people of all ages and their families providing information people need to make informed decisions about their health care and lifestyle choices. Nurse practitioners practice under the rules and regulations of the Nurse Practice Act of the State in which they work. They are recognized as expert health care providers.

Nurse practitioners serve as regular health care providers for children and adults during health and illness. They can provide the following services:

* Obtain medical histories and perform physical examinations.
* Order, perform and interpret diagnostic studies such as lab work and x-rays.
* Prescribe medications and other treatments.
* Provide prenatal care, family planning services and treat menopause issues.
* Provide health maintenance care for adults including annual exams and collaborate with the physicians and other health care professionals, as needed.

This information was provided by American Academy of Nurse Practitioners.

What is a D.O?

Mon, 02 Jul 2007 11:44:21 -0400

Osteopathic medicine is a mainstream and complimentary form of American medical care that was developed in 1874 by frontier doctor Andrew Taylor Still. Dr. Still was dissatisfied with the effectiveness of medical treatments in the 19th century and believed them to be often as bad as, if not worse than, the diseases themselves. He was a maverick in his own time believing in optimizing the body’s own health, circulation, and muscle alignment to prevent illness. He pioneered the wellness concept over 120 years ago.

Both MDs and DOs attend a standard four-year medical school and continue on into the specialty residency training of their choice. Both MDs and DOs have the same practice rights throughout the United States. The Doctors of Contemporary Women’s Care, both MDs and DOs, are resident-trained and board certified in Obstetrics and Gynecology.

Absence of Periods

Mon, 09 Jul 2007 16:13:33 -0400

Amenorrhea is a term used to describe the absence of menstrual cycles. There are many causes of amenorrhea. Primary amenorrhea is the absence of any menstruation by the age of 16. Secondary amenorrhea is the absence of menses for more than 3 cycles in a woman who was previously menstruating. This is the most common form of amenorrhea and pregnancy is the most common cause. Other causes include thryroid disease, eating disorders, excessive exercising, stress or prolonged illness. Polycystic ovarian disease, dysfunction of the pituitary gland, and certain medications can also cause menstrual cycles to stop or become infrequent.

Your practitioner will take a detailed history and do a thorough physical exam. She will most likely have certain blood tests performed to help find the cause.

Abnormal Pap Smears

Sun, 08 Jul 2007 16:37:06 -0400

Abnormal results on a Pap test mean that there are changes in the cells of the cervix — the opening of the uterus (womb). Cervical cell changes are most often caused by inflammation.

Inflammation may be the result of infections such as gonorrhea, herpes, or the HPV (Human Papilloma Virus), the virus that causes genital warts, bacterial vaginosis, Chlamydia, trichomonis, or yeast infections.

Cervical cell changes can also signal precancerous or cancerous conditions that need to be examined further by your physician.

For the vast majority of women, an abnormal pap test does not lead ultimately to the diagnosis of cancer. Early treatment of precancerous conditions can prevent cancer from ever occurring. Yearly pap tests and complete follow up care ensure that even if cervical cancer is present, it will be detected early enough that it can usually be treated successfully.

If dysplasia, or precancerous cells, are found, your physician may recommend a colposcopy which is a procedure performed in your doctor’s office, allowing direct viewing of the cervix through a special magnifying microscope (colposcope). Any abnormal cells may be biopsied (taking a small sample of the cervix) to accurately diagnose the problem. It may cause some slight discomfort for a few seconds.

Treatment of dysplasia may involve a LEEP (Loop electrode excision procedure) removing abnormal areas of the cervix with a thin electrode or a cone biopsy, removing a larger sample of tissue. Cryosurgery which freezes the affected tissue can be used to treat mild dysplasia or changes associated with HPV infection.

Colposcopy

Mon, 09 Jul 2007 16:14:00 -0400

A colposcopy is an office procedure done to evaluate your cervix or vagina if you have an abnormal pap smear result. A colposcope is a special microscope used to look at your cervix more closely and help direct biosies for diagnosis of precancerous or cancerous cells. Your practitioner will use two special stains, acetic acid and an iodine solution to help define the abnormal cells. These stains may burn or sting slightly. If there are abnormal areas seen with the colposcope, she may take biopsies of the abnormal areas. These small bits of tissue will then be sent to a lab where a trained pathologist will determine if there truly are abnormal cells present. These biopsies feel like a pinch when performed. Afterwards she will place a solution on your cervix to help stop any bleeding. This solution will produce a brown-black discharge for several days and it is recommended you wear a pad or liner to protect your clothing. You will have certain activities restricted for several days after the procedure. The results are generally available in 10-14 days. To make your procedure more comfortable, you may take 2 Advil or Motrin to lessen any cramping.

Endometriosis

Sun, 08 Jul 2007 16:44:44 -0400

Endometriosis is a chronic condition where the cells that line the inside of the uterus are found outside the uterus in other areas of the body. These cells develop into lesions or “implants”. The most common locations for implants are in the pelvic region near the ovaries, tubes, ligaments, on the bladder, bowel or on the lining of the pelvic cavity. Endometriosis cells respond to the hormones made from the ovary of the normal menstral cycle. They can cause inflmmation and scarring in the abdomen and pelvis.

The symptoms of “Endo” are pain related to periods, painful intercourse, infertility and abnormal bleeding. It can also be the cause of pain with bowel movements, and back pain with periods. The amount of pain is not necessarily related to the severity of the disease.

Endometriosis is diagnosed by an outpatient surgical procedure called a Laparoscopy. Gynecologists trained in this procedure use carbon dioxide to distend the abdomen and through a small incision place a camera inside to closely inspect all the areas where endo is known to hide. Further treatment is designed to lower the hormonal levels by suppressing normal ovarian function with medications.

Even with proper diagnosis and treatment, endometriosis can be a recurrent disease.

Birth Control Options

Sun, 08 Jul 2007 16:43:42 -0400

Choosing the right contraception is an important decision. A method that is not effective can lead to an unintended pregnancy. The best method is one that is safe and that will actually be used correctly and consistently.

1. BIRTH CONTROL PILLS. Birth control pills contain hormones that prevent pregnancy. Progesterone provides most of the birth control activity. Estrogen provides better cycle control. Pills do not protect or prevent against sexually transmitted infections. Add condoms, there’s your protection.

Risks of Birth Control Pills include blood clots, hypertension, stroke, MI, cervical cancer and breast cancer. Confounding factors are cigarette smoking, number of sexual partners and lack of Pap smears.

2. CONDOMS, SPERMICIDES. When used consistently and correctly, male and female condoms can prevent pregnancy and many sexually transmitted infections, including infectious with the HIV virus.

Condoms are inexpensive, available without a prescription and easy to use. By preventing sexually transmitted infections, condoms help protect future fertility. Clients potentially at risk for sexually transmitted infections should be encouraged to use condoms along with birth control pills, implants, injectables, IUD'S, spermicides, sterilization including hysterectomy.

Spermicides are simple and available without a prescription. They can be used intermittently with little advanced planning. Spermicides provide little, if any, protection against transmission of sexually transmitted infection, do not protect against the HIV virus.

3. DIAPHRAGM, VAGINAL BARRIERS. The vaginal barriers are relatively simple to use and can be used intermittently with little advanced planning. Consistent and correct use is essential for vaginal barrier effectiveness. Most pregnancies occur because the method is not used. The diaphragm is a dome-shaped rubber cup that has a flexible ring. It is inserted into the vagina before intercourse. Once inserted, the diaphragm provides effective contraceptive protection for six hours. If a longer interval has elapsed, insertion of additional fresh spermicide with an applicator is indicated. After intercourse, the diaphragm must be left in place for at least six hours.

4. NuvaRing® and ORTHO EVRA PATCH. The newer combined hormonal methods. The vaginal ring and weekly patches were developed to combine the effectiveness and noncontraceptive benefit of combined pills with longer acting delivery system in order to reduce the demand placed by daily administration of pills.

The NuvaRing® is placed in the vagina once every 28 days. The ring is kept in place for 21 days and removed for a seven day ring-free period to permit a withdrawal bleed or period.

The Ortho Evra patch lasts seven days. Women replace the patch each week for three weeks each cycle, then have a seven day patch-free week, during which time they will start the withdrawal bleed or period.

5. DEPO-PROVERA, IMPLANON™ AND THE MINI-PILL. Progesterone only contraceptives are particularly important to women who cannot use contraception that contains estrogen. Lactating women may use progesterone only contraception. Progesterone only methods provide no protection against sexually transmitted infections. Condoms should be used consistently and correctly, if intercourse poses any risk of transmitting sexually transmitted infections including the HIV virus.

The Depo-Provera injection is given every 12 weeks. Once the Depo-Provera has been used longer than 12 weeks, most women will have no withdrawal bleed or period.

Implanon™ is a type of birth control for women. It is a flexible plastic rod the size of a matchstick that is put under the skin of your arm. It contains progesterone only hormone.

The mini-pill or progesterone only pill is taken on a daily basis and taken every day with no hormone free days. Many breast-feeding women are placed on the mini-pill.

6. CONTRACEPTIVE SPONGE. The sponge is a one size over-the-counter product. It is moistened with tap water prior to use and inserted deep in the vagina. The sponge protects up to 24 hours no matter how many times intercourse occurs. It should be left in place at least six hours after intercourse, and then it is discarded.

7. IUD or INTRAUTERINE DEVICES. The intrauterine contraceptive provides long term protection against pregnancy and is promptly reversible. IUD'S work primarily by preventing sperm from fertilizing eggs.

There is no protection against sexually transmitted infections, and this includes the HIV virus, therefore, condoms should be used along with the IUD if there is a risk of sexually transmitted infections. There are two types of IUD'S available. ParaGard, which has a ten year use, and the Mirena, which has a five year use.

8. NATURAL FAMILY PLANNING OR FERTILITY AWARENESS BASED METHODS.Fertility awareness helps couples understand how to avoid pregnancy or how to become pregnant. Regardless of whether they use family planning or which method they use, every woman and man value in learning fertility awareness.

Family awareness based methods of family planning use one or more indicators to identify the beginning and end of the fertile time during menstrual cycles. These would include calendar rhythm methods, ovulation predictor methods or thermal methods which includes basal body temperature charting.

9. FEMALE AND MALE STERILIZATION. Sterilization is one of the safest most effective and most cost effective contraceptive methods.

Sterilization for women involves cutting or mechanically blocking the fallopian tubes to prevent the sperm and the egg from uniting. Female sterilization is ideal for those persons who are certain they want no further children or any children and need a reliable contraceptive method.

The surgeons at Contemporary Women’ Care offer the Essure® method of sterilization. Essure is a minimally invasive sterilization procedure done vaginally. Essure tubal sterilization is a permanent non-reversible procedure. In clinical trials, there have been 0 failures (i.e. unintended pregnancies). Essure requires no cutting into the body. Spring-like coils are inserted through the vagina, cervix and uterus and into each fallopian tube. Essure does not contain any hormones and should not interfere with your natural menstrual cycle.

Vasectomy is the male sterilization operation that blocks the vas to prevent the passage of sperm into the seminal fluid. Vasectomy continues to be a simple safe less expensive and is effective as female sterilization.

Information provided by Contraceptive Technology

First Gynecological Exam

Sun, 08 Jul 2007 16:43:12 -0400

Who, when, what, how are the part of the many questions parents ask when considering their daughter’s health. Adolescent girls are growing up faster and OB/GYN practitioners can help with their choices in health care. Both gynecologists and ARNP’s have the clinical skills necessary to perform the appropriate assessments.

Making a young woman’s first GYN exam a positive experience will influence further decisions in her health. Women practitioners seem to put their patients at ease. They tend to be less critical, less judgmental, less threatening and talk more.

When do adolescents need to be seen? The recommended age for the first OB/GYN visit for preventative services and screenings is 13-15. The recommended age for the first pelvic exam and Pap smear is 21 or younger, if the patient is sexually active. Practitioners address many issues with adolescents during this visit.

The sensitive issues and risky behaviors include substance abuse, smoking, domestic abuse, sexual abuse, STD’s and contraception. Questions are both welcomed and encouraged. Written information is made available.

The first visit starts with establishing rapport with the adolescent, including the adolescent in all the aspects of decisions. We include issues of privacy and confidentiality, especially when dealing with older adolescents. It is important the adolescent has someone to confide in, and we encourage parents to trust us to be that someone for their child.

Certain topics may be discussed in the first visit or at the next follow up, if needed. The adolescent is given the choice to have their parent present during the exam. The most important aspect of the exam is “looking”, to offer the use of a mirror, to keep the conversation open, to explain what it is to be done before touching and showing the instrument used.

After the exam is complete, the practitioner congratulates the adolescent for her cooperation, discusses the results of the exam, the diagnosis and the management plan with the patient and her parents once she is dressed. An adolescent girl’s first pelvic exam is one she will always remember. This is the best time to give information and set a good example for her health care.

HPV/Gardasil Vaccine

Sun, 08 Jul 2007 16:39:00 -0400

THE HPV VACCINE IS HERE!!!!
The new vaccine against the common Human Papillomavirus (HPV) is available. Gardasil is a vaccine that protects against the 4 most common strains of HPV, numbers 6,11,16 and 18. These viruses cause cancer of the cervix, vagina and vulva. HPV also causes genital warts. The vaccine is actually 3 injections given over 6 months. It is currently recommended for women age 9 to 26, especially before sexual activity has occurred. The vaccine still has proven benefit to women even if they already have HPV or cervical changes caused by the virus. Protection is not proven until all 3 vaccines have been given.

Gardasil does not protect against every strain of HPV.

Human Papillomavirus (HPV)

Sun, 08 Jul 2007 16:39:22 -0400

Human Papillomavirus (HPV) is an extremely common virus that affects males and females, affecting approximately 20 million Americans. It is transmitted through any skin to skin genital contact, and condoms do not prevent its spread. There are about 30 different strains of HPV that affect the genital area, and these strains are grouped into categories based on their virilence or ability to cause disease. These categories are “Low risk” or “High risk” types of the virus.

These viruses may not show any signs or symptoms, therefore many people do not know they carry the virus, or that they are spreading the virus. HPV is responsible for causing growths on the genital areas of both males and females called warts. More worrisome is that this virus causes cancer of the genital tract in women. HPV is capable of causing cancer and precancerous changes of the vulva, vagina and cervix. A pap smear performed yearly can help detect these precancerous cell changes early and avoid the development of cervical cancer. Newer technology now is available to detect the DNA of HPV off the pap smear collection, even in those with normal pap smear results.

There is now a vaccine available to prevent the acquisition of 4 of the most common strains of the virus. In most people, our immune system is capable of clearing the virus in time.

The Menopause Years

Sun, 08 Jul 2007 16:41:20 -0400

Menopause is the time in a woman’s life when she stops having menstrual periods. The years leading up to this point are called perimenopause, or “around menopause.” Menopause marks the end of the reproductive years that began in puberty.

The average age that women go through menopause is 51 years. Most women enjoy a healthy lifestyle for years afterward.

What is Menopause?
Estrogen and Menstrual Changes

As menopause nears, the ovaries make less estrogen. One of the earliest and most common signs that menopause may be approaching is a change in your menstrual periods. You may skip one or more periods. The amount of flow may become lighter or heavier.

At some point, the ovaries stop making enough estrogen to thicken the lining of the uterus. This is when the menstrual periods stop.
What to Expect

Menopause is a natural part of aging. The lower amounts of estrogen that come with menopause will cause changes in your body.
Hot Flushes

The most common symptom of menopause is hot flushes (hot flashes). As many as 75% of menopausal women in the United States will have them. A hot flush is a sudden feeling of heat that rushes to the upper body and face. The skin may redden like a blush. You also may break out in a sweat.
Sleep Problems

Hot flushes can cause a lack of sleep, often waking a woman from a deep sleep. A lack of sleep may be one of the biggest problems you face as you approach menopause.
Vaginal and Urinary Tract Changes

Loss of estrogen causes changes in the vagina. Its lining may become thin and dry. These changes can cause pain during sexual intercourse. They also can make the vagina more prone to infection, which can cause burning and itching.
Bone and Other Body Changes

Bone loss is a normal part of aging. At menopause, the rate of bone loss increases. Osteoporosis, a result of this bone loss, increases the risk of breaking bones in older women. The bones of the hip, wrist and spine are affected most often.
Emotional Changes

Menopause does not cause sudden mood swings or depression. However, the change in hormone levels may make you feel nervous, irritable, or very tired. These feelings may be linked to other symptoms of menopause, such as lack of sleep.
Sexuality

Menopause does not have to affect your ability to enjoy sex. Although the lack of estrogen may make the vagina dry, vaginal lubricants can help moisten the vagina and make sex more comfortable.

Regular sex may help the vagina keep its natural elasticity.

Some women find that they have less interest in sex around and after menopause. Lower hormone levels may decrease the sex drive.

You are not completely free of the risk of pregnancy until one year after your last period.
The Gynecologic Visit

Routine visits to your doctor for breast, pelvic, and rectal exams are recommended for all women. Your doctor will do a Pap test to check for cancer of the cervix. Between visits you should perform a breast self-exam once a month.

Depending on your age, your doctor may recommend that you have a mammogram. (Women older than 40 years should have a mammogram every one to two years, and then every year beginning at age 50 years.)/

Hormone Therapy

Hormone therapy (HT) can help relieve the symptoms of menopause. It replaces female hormones no longer made by the ovaries. Depending on your situation, you may begin HT before menopause. If you are taking birth control pills, they will be stopped when you begin treatment.
Benefits

Many of the symptoms of menopause can be eased by taking estrogen.
Risks

Like any treatment, hormone therapy is not free of risk. In women with a uterus, using estrogen alone can increase the risk of endometrial cancer because estrogen causes the lining of the uterus to grow. Taking a progestin will help reduce the risk of uterine problems. The drawback of using a progestin is that menopausal women may start bleeding again.

There is an increased risk of breast cancer in women who use combined hormone therapy.
Other Therapies

Women also can take selective estrogen receptor modulators (SERMs) to help prevent some of the bone problems that can occur during menopause. SERMs are a type of medication that strengthen tissues of the bones.

If a woman does not take hormone therapy or SERMs, there are some other options for preventing bone loss. A medication called calcitonin slows the breaking down of bone. Other medications used to slow bone breakdown are bisphosphonates.
Staying Healthy
Good Nutrition.

Eating a balanced diet will help you stay healthy before, during, and after menopause. It’s important to eat a variety of foods to make sure you get all the essential nutrients. Choose a low-fat, low-cholesterol diet. Also, be sure to include enough calcium in your diet to help maintain strong bones.
Exercise.

Exercise is very important, especially as you get older. Regular exercise slows down bone loss and improves your overall health. Follow a program of regular weight-bearing exercise, such as walking and aerobics.
Finally...

Menopause is a natural event. Today, women can expect to live one third of their lives after menopause. The physical changes that occur around menopause should not prevent you from enjoying this time of your life.

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © March 2003 The American College of Obstetricians and Gynecologists

Osteoporosis

Sun, 08 Jul 2007 16:42:19 -0400

Osteoporosis means “porous bone.” It affects one out of every four women over the age of 50. Normally the inside of the bone looks something like a sponge. With osteoporosis it is as if the holes in the sponge become larger and more numerous so the bones become weaker and are much more likely to break. Everyone’s bones get weaker with age. In fact, we all begin to lose some bone as early as 30 years old. For women, menopause changes the picture dramatically. When women reach menopause, or “the change of life” (usually around 50 years of age), their estrogen levels go way down and their periods stop. This will lead to bones becoming thin and weak. This continues, painlessly, year after year and is not noticed until you break a bone.

Osteoporosis is a serious disease leading to nearly 200,000 women fracturing a hip each year. One fifth of women who breaks a hip will die of complications within a year. Many of those women who do not die will require long term nursing home care. One fourth of women above the age of 60 have broken bones in her spine which may greatly limit daily activities and lead to serious deforming (dowager’s hump) as well.

Osteoporosis can be detected by a DEXA or “bone density scan” and treated in its early phases. This is ordered by your Gynecologist as part of your preventive medicine screening every 1 to 5 years, depending on your clinical picture.

Painful Peroids

Sun, 08 Jul 2007 16:51:08 -0400

Painful periods or “dysmenorrhea” is associated with long-term, intermittent chronic pain associated with a woman’s menstrual cycle. Although some mild pain is common with a woman’s menstrual period, some women have severe pain with their periods. It may be caused by a prostaglandin, a hormone made by the lining of the uterus (endometrium).

It causes spasms or cramping of the uterus. There may be other causes such as endometriosis. Drugs that reduce inflammation, such as ibuprofen, can lessen the pain of dysmenorrhea. These drugs block the production of prostaglandins which cause the uterus to contract. Ibuprofen can be purchased over the counter. If these do not work, prescription medications may be necessary.

For other problems, treatment with hormones may help. Combination oral contraceptives (birth control pills) can be used to relieve pain from menstrual cramps. Other hormones can shrink some types of growths, such as endometriosis, fibroids and certain types of benign tumors.

If the pain is chronic and starts to be present most days of the month, a laparoscopic procedure may be recommended. With this procedure, a slender camera is inserted under the navel while you are under anesthesia to look for the causes of chronic pain.

Pap Smears

Mon, 09 Jul 2007 16:20:00 -0400

The pap smear is a screening test for abnormal cells on the cervix or vagina. Named for the inventor of the special stain, Dr. Papanicolou, this test has saved millions of lives and detected cervical cancer in its earliest stages. It is obtained by using a soft brush and spatula on the cervix or vagina to collect the microscopic cells.

Precancerous cell changes, called dysplasia, are where there are changes in the cells that may develop into cancer. Pathologists rate the degree of abnormality, and group them into low grade dysplasia and high grade dysplasia. Another category of mildly abnormal cells is called ASCUS- Atypical Squamous Cells of Undetermined Significance.

If your pap is abnormal, your practitioner will recommend further evaluation called a colposcopy and biopsy. Most low grade dysplasia will resolve on its own and your practitioner will want to monitor them. More severe abnormalities will require treatment to remove the abnormal cells.

Pelvic Inflammatory Disease (PID)

Sun, 08 Jul 2007 16:51:51 -0400

Pelvic Inflammatory Disease (PID) is a broad term used to refer to infection of the uterus, fallopian tubes or ovaries. It is one of the most common and serious illnesses effecting women today. About one million women are treated for PID in the U.S. yearly. About one in seven women are treated for PID at some point in their lives.

PID usually affects sexually active women during their childbearing years. Most cases of PID are thought to develop from sexually transmitted diseases (STDs). The 2 most important of such diseases are gonorrhea and Chlamydia. Without treatment for these infections, which can occur without symptoms, PID may develop.

PID can occur from a bacteria infecting the cervix (the opening of the uterus) and finding their way to the uterus, tubes and ovaries. Another possible, but less common cause of PID is the introduction of the infecting organism after an induced abortion, following the delivery of a child, or by insertion of an IUD.

The dangers of PID are that it can lead to scarring the tissue of the fallopian tubes which can damage or block them completely. This can lead to an ectopic pregnancy (tubal pregnancy), abscess formation, chronic pain, and infertility.

Symptoms of PID include vaginal discharge with an unpleasant odor, painful urination, pain in the lower abdomen, which is usually mild, aching in nature, abnormal uterine bleeding, fever, chills, and/or nausea and vomiting.

The treatment of PID is antibiotics and hospitalization may be required.

Perimenopause

Sun, 08 Jul 2007 16:52:55 -0400

Perimenopause marks the time when your body begins its move into menopause. It includes the years leading up to menopause — anywhere from two to eight years — plus the first year after your final period. There is no way to tell in advance how long it will last OR how long it will take you to go through it. It's a natural part of aging that signals the ending of your reproductive years.

Signs and Symptoms

Perimenopause causes some changes in your body that may not be noticeable. For most women, the discomforts associated with perimenopause are minimal and manageable. Some things you might experience include:

* Changes in your menstrual cycle (longer or shorter periods, heavier or lighter periods, or missed periods)
* Hot flashes (sudden rush of heat from your chest to your head)
* Night sweats (hot flashes that happen while you sleep)
* Vaginal dryness
* Sleep problems
* Mood changes (mood swings, depression, or irritability)
* Pain during sex
* More urinary infections
* Urinary incontinence
* Less interest in sex
* Increase in body fat around your waist
* Problems with concentration and memory

As you start to notice some of these signs, monitor your menstrual cycle and record your signs and symptoms for several months. This way you will have have valuable information to discuss with your health care provider at Contemporary Women’s Care.

There are many healthy options available to help relieve the discomfort of perimenopause.

PMS Guide for Symptom Relief

Sun, 08 Jul 2007 16:54:06 -0400

PMS Guide for Symptom Relief
10 Self-Help Suggestions

PMS is a complex set of symptoms which occur regularly in the same phase of each menstrual cycle, followed by a symptom-free phase in each cycle. Some symptoms are less problematic than others in the same woman. Although women may share similar experiences, each may respond differently to the various suggestion listed below.

Dietary Changes: Blood sugar levels are known to fluctuate depending upon what you eat as well as the stress you may be experiencing at the same time. During the premenstruum (the interval immediately preceding your menstrual cycle) your baseline may be higher than usual thus creating hypoglycemic reactions. We suggest eating small, frequent meals, i.e., eat something high in protein or complex carbohydrate every three hours (cheese, peanuts, sunflower seeds, eggs, fresh fruit, yogurt, whole wheat bread). You do not have to increase caloric intake to do this. Just change the pattern of when you eat. Keeping your blood sugar constant will decrease irritability, nervousness, dizziness, etc. Cravings are your body’s way of telling you there is deficiency or allergy. Avoid caffeine and sugar. Caffeine may increase your irritability or breast tenderness.

Salt: Salt retains water. Premenstrual irritability and bloatedness are attributed to this. Avoid high sodium foods such as pork, bacon, cold cuts, sausages, ice cream unless natural, and beets. Do not add table salt to your food.

Stress: Stress aggravates the symptoms of PMS. If you are able to avoid stressful situations, do so. If you know a particular event or circumstance will cause unnecessary stress, don’t allow yourself to be placed in the situation. Begin now to examine areas in your life that are stressful and learn ways to cope.

Sleep: Lack of sleep will exaggerate your symptoms and lessen your ability to cope with certain situations in ways you usually do. If you have trouble sleeping at night, try to rest during the day. Treat yourself to a warm bath, or ask a friend for a massage. Relaxation techniques or self-hypnosis may also help you cope with stress or difficulty in sleeping. Try taking your calcium or tryptophan supplement at night as another alternative.

Vitamins: The following vitamins have been known to alleviate some of the symptoms of PMS.

1. Calcium (Ca++). Approximately 10 days prior to menstruation, the blood calcium level drops steadily and progressively in may women, resulting in nervousness, headaches, insomnia, bloatedness, weight gain, and lowering of resistance to allergies plus infections and muscle spasms.
* When menstral cramps occur, 1 0r 2 Calcium tablets every hour bring relief. Supplementation should be started about 2 weeks prior to menstruation. Vitamin D helps Calcium absorption. Consult your physician before taking or increasing your Calcium intake if you have a history of kidney problems.
* Dosage: Calcium can be taken in two forms (1) bone Meal which has Vitamin D, A, Phosphorous – a necessary balance. Take 2-3 tablets daily for ten days premenstrually. (2) Calcium (250-500 mg) and magnesium (125-150 mg) in separate tablets. You can take up to 1000 mgs of Calcium daily. If taken separately, add Vitamin D, 1000 units.
2. Potassium (K+). Potassium is essential to the contraction of every muscle in the body. The typical American diet creates a deficiency of Potassium in most people. Supplementation helps relieves–headaches, muscle fatigue/weakness and edema. Bananas, apricos, and tomatoes are good sourcesof Potassioum.
* Dosage: 99 mg tablets (10-20 per day) of Postassioum Gluconate.
3. Vitamin E. Vitamin E is known to help with the production and metabolism of the sex hormones.
* Dosage: 400 units daily.
4. B-Complex. Individuals deficient in Vitamins B1, B6, Niacinamide and Pantothenic Acid quickly become fatigues, depressed, forgetful, irritable, confused, anxious, restless, insomniac, paranoid, quarrelsome, and have clouding of consciousness.
* Dosage: Recommendations of B6 (in addition to the B-Complex) from 50 mg to 1000 mg have been made especially for depression. It’s important to never take one of the B Vitamins without supplementation of the others. Taking a megadose is recommended during the premenstrual time, i.e., B-Complex – 100mg; Vitamin B6 – 750-1000 mg. Increase the dosage approximately two weeks before your period is due.
* NOTE: Problems have been encountered with excessive amounts of B vitamins.
5. Oil of Evening Primrose (Linoleic Acid). An essential fatty acid necessary for hormone production, decreases hunger by retarding emptying time of stomach, and also helps symptoms of breast tenderness.
* Dosage: 500 mg capsules, 8 capsules per day for two months – then decrease to 4 capsules daily
6. Zinc: Deficiency can lead to depression and psychosis.
* Dosage: 30 mg daily. If you take iron, do not take Zinc at the same time.
7. Tryptophan: An essential amino acid shown to alleviate depression (in addition to Vitamin B6, and Niainamide Vitamin B3).
* Dosage: 3 grams daily for depression. Lower doses are useful for insomnia.

Decision Making: Many women complain of a feeling of confusion or an inability to concentrate during the premenstruum. If this is one of your symptoms, postponing a decision or employing the assistance of a family member or friend may make the decision process easier.

Headaches: Some casual factors of headaches can be (1) long periods without food (2) eyestrain (3) stress (4) allergic reaction to foods or chemical inhalation. Stuffiness and running nose symptoms can often be relieved by taking Potassioum Gluconate.

Alcohol: Many women crave alcohol premenstrually while others’ tolerance is decreased. Mostly we suggest minimal or no alcohol intake during the premenstruum because it can increase edema, headaches, decrease coping mechanisms, and add to depression. If it helps with cramps, drink moderately.

Alteration in Lifestyle/Work: Arranging social gatherings or planning of events postmenstrual will enhance both guests’ and hostess’ enjoyment and participation. Remember to avoid stress, if possible.

Exercise: You may be the person who benefits from exercise. Regular jogging or even brisk walking is known to alleviate the symptoms of depression. Some women are too fatigued to do strenuous exercise; however, a walk, especially in the evening, can help relieve irritability and tension.

Premenstrual Syndrome (PMS)

Sun, 08 Jul 2007 16:54:48 -0400

Nearly every woman at some point has some symptoms related to fluctuating hormone levels as menstruation approaches. For about half of these women, symptoms are mild and do not affect normal daily life. The other half of women report symptoms severe enough to impact daily life and relationships. Between 3-5% of women report extremely severe symptoms.

In general, PMS is a set of physical, emotional and behavioral symptoms that occur during the last week of the luteal phase (a week before menstruation) in most cycles.The symptoms should typically resolve within 4 days after bleeding starts and not start until at least day 13 in the cycle. Women may begin to experience PMS symptoms at any time during the reproductive years. Once established, the symptoms remain fairly constant until menopause, although they can vary from cycle to cycle. Symptoms may include: breast engorgement and tenderness, abdominal bloating, constipation or diarrhea, acne, headache, alcohol intolerance, fluid retention, weight gain, clumsiness, nausea and vomiting, heart palpitations, cyclical breast pain, depression, anxiety, insomnia, change in sexual desire, irritability, hostility and outbursts of anger. In severe cases violence towards one self or others can occur. PMDD (premenstrual dysphoric disorder) is a condition of marked severe depression, irritability and tension.

First line therapies include lifestyle modification, especially exercise. Over the counter pain relievers may be helpful. Vitamins B6 and calcium are recommended.

In severe cases, SSRIs (Selective Serotonin Re-uptake Inhibitors — a widely used group of antidepressants) or other antidepressive medications, birth control pills or diuretics can be used.

Sexually Transmitted Diseases

Sun, 08 Jul 2007 16:55:21 -0400

Everyone who has sex with another person can get an STD. People with an STD may not even know they have it. Often there are no signs or symptoms.

STDs can cause damage to your body — even death. STDs can be passed to others through contacts with skin, genitals, mouth, rectum, or body fluids.

Symptoms of an STD can range from no symptoms, to mild irritation to severe pain. STDs are caused by tiny living organisms called bacteria, viruses, or parasites. Infections caused by viruses cannot be cured, but symptoms can often be treated.
STDsinclude:STDs include:

* Gonorrhea — a bacteria. 800,000 people in the U.S. are infected annually.
* Chlamydia — a bacteria. About 4 million get infected yearly.
* HPV — human papilloma virus is a virus which causes genital warts. Some strains are associated with cancer or precancer of the cervix.
* Syphilis — caused by a bacteria called a spirochete. If not treated in can infect many other parts of the body causing major health problems, even death.
* Herpes — may be the most common of the STDs. Most common symptom is sores around the genital area. It is caused by a virus.
* HIV — a virus that causes AIDS.
* Trichomonis — a microscopic parasite.
* Hepatitis — serious viral infections of the liver that can be fatal.

Condoms are important in preventing the spread of STDs. Unfortunately it is still possible to contract some STDs even with perfect condom use.

Spouse Abuse

Sun, 08 Jul 2007 16:56:07 -0400

Family violence is one of the best kept secrets in America. Millions of women are subject to abuse from their boyfriends or husbands. Every couple has arguments, but there is a big difference between arguing and abuse. How can you tell the difference?

Ask yourself:

* When your spouse or boyfriend gets angry does he hurt you physically?
* Does he prevent you from seeing friends or family?
* Does he make you have sex against your will?
* Does he threaten you or yell at you?
* Does he make you feel worthless or powerless?
* And yet despite these bad moments, is he sometimes as sweet and reasonable as you’d like him to be?

If the answer is yes to many of these questions, then you may be in a domestic violence relationship.

Men who batter women do so many times because they themselves were abused as children or witnessed abuse at home while growing up. Battering is a learned behavior and a number of organizations exist for men who batter.

Sometimes a woman stays in a destructive relationship because she lacks confidence or self esteem. She may be afraid she won’t be able to support herself or her children. She may fear for her life if she does leave her partner.

You can protect yourself by coming up with a plan of action if a situation becomes too dangerous. You can talk to your doctor, nurse, a family member, a close friend or a clergy member.

Below is a list of organizations to contact for help or information:
DomesticViolenceCenters:Domestic Violence Centers:
Bradenton Hope Family Services HopeFamilyService.org 941-755-6805
Clearwater The HAVEN of RCS HavenRCS.org 727-442-4128
Dade City Sunrise of Pasco County SunrisePasco.org 352-521-3120
St. Petersburg CASA Casa-StPete.org 727-895-4912
Lakeland Peace River Center Peace-River.com 863-413-2700
Palmetto Hope Family Services HopeFamilyService.org 941-755-6805
Port Richey Salvation Army 727-856-5797
Sarasota SPARCC Sparcc.net 941-365-1976
Tampa The Spring TheSpring.org 813-247-7233
Sherifft Pinellas County Sheriff Department pcsoweb.com 727-587-6279
Largo Police Dept Domestic Violence Specialists domesticviolence@largo.com 727-586-7481
St. Petersburg St. Petersburg Police Dept. stpete.org/police 727-893-7618
CommunityServices/Resources:Community Services/Resources:
Florida Abuse Hotline 800-962-2873
Abuse Registry 800-342-9152
Florida Statewide
Violence Hotline 800-500-1119 www.dcf.state.fl.us/domesticviolence
Child Abuse Hotline 800-962-2873
Elder Abuse Hotline 800-453-5145
Elder Helpline 800-963-5337
Morton Plant Mease 24-Hour Mental Health Help Line

Toxic Shock Syndrome

Sun, 08 Jul 2007 16:56:54 -0400

Toxic Shock Syndrome (TSS) is a sudden severe illness accompanied by a fever and a rash that is caused by an infection with a bacteria. It is a very serious illness which can lead to failure of many organs in the body. About 50% of the cases of TSS are related to a woman’s menses. In these cases TSS has been related to the presence of a foreign body in the vagina, usually either a tampon or a diaphragm. TSS can also result from a staph infection of the skin following a surgical procedure.

The mortality rate or the number of people who die from TSS is fairly high, about 2-8%. If a woman has experienced TSS secondary to a history of tampon use, it can occur again if tampons are used again.

The rash associated with TSS occurs during the first 48 hours and appears similar to an intense sunburn. This rash continues and changes over the next 12-15 days until the skin begins to flake and is completely sloughed off over the palms and soles.

Management of severe TSS requires hospitalization, usually in the Intensive Care Unit with the skills of an expert in critical care medicine.

Urinary Incontinence

Sun, 08 Jul 2007 16:57:39 -0400

Many women leak urine from time to time. Leakage of urine can happen with certain movements, during pregnancy, or during physical activities. Some women find they lose urine with the sound of running water or lose urine with the first sensation of the need to urinate.
There are 3 types of incontinence:

* Urge: this is the most common type. It is due to spasms of the detrussor muscle (the muscle of the bladder). This leads to loss or urine with the sensation of the need to urinate.
* Stress: this occurs when pressure inside the bladder, which moves urine out is greater than pressure in the urethra, which keeps urine in. This leads to a loss of urine with cough, sneeze, laughing, or physical activity. The cause is due to weakening of the muscles surrounding and supporting the urethra and bladder.
* Overflow: this occurs when the bladder fails to empty during voiding. The result is a steady leakage of small amounts of urine. This is less common is due to the detrussor muscle being underactive.

The causes may be also due to a urinary tract infection, pelvic support problems, abnormalities of the urinary tract, medications, neuromuscular problems, or physical limitations.

Your doctor can diagnose which type of incontinence you have based on your medical history, physical examination and through specific tests.

Treatment may include behavioral modifications, medications, surgery or pessaries (a device inserted into the vagina to support the pelvic organs). Kegel exercises may be recommended to strengthen the pelvic muscles that support the bladder and urethra.

Women and Heart Disease

Sun, 08 Jul 2007 17:42:14 -0400

Heart disease is the leading cause of death in post-menopausal women. Studies have shown that a woman’s risk of heart disease is much less than a man’s — presumably because she has naturally protective levels of the hormone estrogen. With menopause, however, her estrogen production decreases. This increases a woman’s risk of heart disease by 2-3 times.

Cholesterol and special proteins combine to form “lipoproteins” which are found in the blood stream. These include LDL (low-density lipoprotein cholesterol) and HDL (high-density lipoprotein cholesterol). Before menopause most women have higher levels of the “good” HDL cholesterol than men. Levels of the “bad” LDL cholesterol tend to rise and HDL levels may decline. In women, lowering levels of HDL are thought to be a greater risk factor to predict heart disease.

For all these reasons it is important to have preventative medicine screening tests done including cholesterol blood tests, usually ordered by your primary care physician. By maintaining a low cholesterol diet, performing regular exercise, maintaining a healthy weight and controlling diseases such as diabetes and high blood pressure by careful monitoring and diligent care to take medications as prescribed, you can lower your chance of developing heart disease.

Endometrial Ablation

Mon, 09 Jul 2007 16:20:26 -0400

The lining of the uterus (the endometrium) is shed each month during a woman’s period. Sometimes the period is too heavy or too long and can cause anemia (low iron count). If the bleeding does not respond to medications, an endometrial ablation may be suggested. During this procedure the lining of the uterus is cauterized to control or stop the bleeding altogether. Several different techniques are available including hydrothermal endometrial ablation (HTA) and thermachoice which use extremely hot water to treat the endometrium. Ask your CWC provider if either of these procedures might be right for you.

Endometrial Polypectomy

Mon, 09 Jul 2007 16:41:42 -0400

Polypectomy refers to the removal of a polyp. Polyps can grow in several areas of the body including sinuses and the colon as well as the endometrium (the lining of the uterus). Polyps are tissue areas that “grow too much. ” Polyps are generally small and usually do not cause symptoms but if they do, symptoms may include heavy periods, longer periods or bleeding between periods or after intercourse. Polyps can often easily be removed using a hysteroscope, as an outpatient.

Essure

Mon, 09 Jul 2007 16:42:07 -0400

Many women would like to have a tubal ligation but would like to avoid abdominal surgery. Essure is a new, minimally invasive steriliation procedure done vaginally. Essure tubal sterilization is a permanent non-reversible procedure. In clinical trials, there have been no failures (i.e. unintended pregnancies). Essure requires no cutting into the body. Spring-like coils are inserted through the vagina, cervix and uterus and into each fallopian tube. Essure does not contain any hormones and should not interfere with your natural menstrual cycle.

Most CWC physicians are Essure trained. Please check with your CWC provider.

Hysteroscopy

Mon, 09 Jul 2007 16:42:30 -0400

A hysteroscope is a telescope-like device used to look inside the uterus. Hysteroscopy can be used to diagnose and/or treat problems in the inside of the uterus (endometrium). It is often combined with other procedures such a D&C (dilation and curettage). Endometrial ablation or removal of a polyp or fibroid in the endometrium are often performed with a hysteroscopy.

LAVH (Laparoscopic Assisted Vaginal Hysterectomy)

Mon, 09 Jul 2007 16:43:44 -0400

LAVH is a minimally-invasive surgical procedure using laparoscopic techniques and instruments to remove the uterus through the vagina. Sometimes one or both fallopian tubes and ovaries are also removed. The greatest advantage of a LAVH is that the potential to convert what would have been an abdominal hysterectomy into a vaginal hysterectomy with a shorter hospital stay and a shorter recovery time and less post-operative pain compared to an abdominal hysterectomy.

All CWC physicians are skilled laparoscopists and trained in LAVH.

LEEP (Loop Electrosurgical Excision Procedure)

Mon, 09 Jul 2007 16:44:17 -0400

The cervix is covered by a thin layer of cells that are constantly shedding and being replaced by new cells. Sometimes these cells become abnormal (dysplasia). Mild forms of dysplasia may go away on their own. More severe forms may not go away and may progress into cervical cancer. Exposure to HPV (Human Papilloma Virus) also increase a woman’s risk of cancer of the cervix.

The LEEP procedure uses a thin wire loop as a scalpel to remove a thin layer of abnormal surface cells. The procedure is usually done in the office using medicine to numb the cervix. Recovery is usually unremarkable except a bloody vaginal discharge for a few weeks.

LSH (Laparoscopic Supracervical Hysterectomy)

Sun, 08 Jul 2007 17:45:12 -0400

LSH is one of our newest minimally invasive hysterectomy techniques. It uses a laparoscope and several small abdominal incisions through which instruments are used to separate the uterus from the cervix and remove it through one of the small abdominal incisions. LSH does not require a large abdominal incision and therefore involves less post-operative pain, scarring and recovery time. Most women will require only an overnight hospital stay and are back to normal activities in less than 2 weeks.

Urethral Sling

Mon, 09 Jul 2007 16:44:39 -0400

Urethral slings are used to treat urinary incontinence associate with a drooping urethra. They involve placing a sling around the urethra to lift it back to its normal position and to aid in urinary retention. The sling is attached to the abdominal wall. Several different materials are used. Please check with your CWC provider and see which is right for you.

Infertility

Mon, 09 Jul 2007 16:51:14 -0400

About 15% of couples in the United States are infertile. Infertility is a condition in which a couple has been unable to get pregnant after 12 months without the use of any form of birth control. Before being treated for infertility, you and your partner must be evaluated by a doctor. This may help pinpoint the cause or causes of infertility. The type of treatment you receive depends on what may be causing the infertility. This pamphlet will tell you about:

* Causes of infertility
* Treatment options
* Other choices

Infertility often can be treated. Lifestyle changes, medication, surgery, or assisted reproductive technologies may help.
Causes of Infertility

For healthy, young couples having sexual intercourse, the odds are about 20% that a woman will become pregnant during any one menstrual cycle. This figure starts to decrease in a woman’s late 20s and early 30s and decreases even more after age 35 years. A man’s fertility also declines with age, but not as early. Many women and couples today choose to delay parenthood. Because they are older, they then may have problems conceiving.

Infertility may be caused by a problem with the woman, the man, the couple, or their lifestyle. Sexually transmitted diseases (STDs) also may reduce a couple’s fertility. Infertility may be caused by more than one factor. Sometimes a cause of infertility cannot be found.

If you are unable to become pregnant after a year of unprotected sex, your doctor can evaluate you and your partner. If you are older than 35 years or have certain medical problems, tests may be done earlier.
TreatmentsTreatments

To treat infertility, your doctor may suggest medication, surgery, or assisted reproductive technologies or may refer you to a doctor who specializes in treating infertility. In some cases, treatments are combined to improve results. For instance, drugs and insemination may be used at the same time. Whether the problem is with one or both partners, a number of treatment options can be considered.

With normal ovulation, each month an egg is released (1) and moves into one of the fallopian tubes (2). If a woman has sex around this time, an egg may meet a sperm in the fallopian tube and the two will join (3). This is called fertilization. The fertilized egg then moves through the fallopian tube into the uterus and becomes attached there to grow during pregnancy (4). You should know the expected success rates of the treatment you use and how success is defined. Some clinics define success based on the number of live births. Others define success based on the number of pregnancies achieved (even if it does not result in a live birth). The Centers for Disease Control and Prevention (CDC) list the success rates for most clinics in the United States on their web site. Discuss the success rates of your options with your doctor.

If the problem is linked to lifestyle, there are things you can do to help. For instance, your doctor may suggest you change when and how often you have sex. You may need to lose or gain weight, increase or decrease exercise, or stop smoking.

Medical treatment may be needed to help you become pregnant. If so, you should be aware of what is involved. Some treatments require much expense and effort from both partners. You may want to check your health insurance to see if the treatments are covered.
Ovulation Induction

If the woman does not ovulate (release an egg from one of her ovaries), she may be given medications to cause ovulation. Some women who ovulate need to release more eggs in order to get pregnant.

The medication used most often to cause ovulation is clomiphene citrate. It may be used for several cycles. The dosage may be increased over time if ovulation does not occur.

If pregnancy does not occur after treatment with clomiphene citrate, a medication called hMG may be given by injection. This drug stimulates the eggs to develop. Blood tests and ultrasound often are used to monitor the development of eggs.

Most women who take ovulation induction drugs begin to ovulate regularly. If there are no other problems, more than half of these women become pregnant within 6 treatment cycles. If a woman does not start ovulating, other tests may be done.

A multiple pregnancy may occur with the use of these drugs. The risk is higher with hMG than with clomiphene citrate. Rarely, a condition called ovarian hyperstimulation syndrome may arise. If you are at risk for this condition, treatment may be altered, and you will be closely monitored.
Surgery

If the fallopian tubes are blocked, surgery may be done to open or remove them. Surgery also may be done to:

* Remove growths such as polyps or fibroids
* Remove scarring from a previous surgery, infection, or endometriosis
* Treat endometriosis (if found)

If the problem is with the man’s sperm, surgery can sometimes correct it. The success of surgery depends on the type and extent of the problem.
Assisted Reproductive Technologies

Assisted reproductive technologies (ART) involve processing human eggs and sperm or both to help an infertile couple conceive a child. This is done in a lab. Sometimes, ART treatments use donor eggs or donor sperm. The sperm also may be obtained through masturbation or with a special condom used during intercourse. In some cases, sperm may be obtained surgically through sperm aspiration or testicular biopsy. Following are some of the ART treatments available to couples trying to conceive.

Insemination. With insemination, sperm is placed in a woman’s uterus by means other than sex. In most cases, the sperm are treated in a lab to decrease the risk of infections and increase the chance of fertilization. Around the time of ovulation, the sperm are placed into the uterus by the doctor.

The woman’s partner or a donor may provide the sperm for insemination. Sperm from a donor is frozen, and the donor is checked to be sure he is free of certain medical problems. These problems include some genetic disorders and STDs, including human immunodeficiency virus (HIV). Talk with your doctor about the specific tests that are done at the lab where you are treated.

In Vitro Fertilization. With in vitro fertilization (IVF), sperm from the man are used to fertilize eggs from the woman in a lab. The fertilized egg then is placed in the woman’s uterus to grow.

For IVF, eggs are removed from the ovary just before ovulation. Medication usually is used to cause more than one egg to mature. Eggs are removed with a needle that is inserted through the vagina and into the ovary. Ultrasound is used to guide the needle. The eggs then are withdrawn through the needle. Pain relief or a sedative may be given. Either your partner’s or a donor’s sperm may be used for IVF.

The eggs are combined with healthy sperm and watched in the lab to see if they become fertilized. A few days later, one or more fertilized eggs (embryos) are placed in the woman’s uterus through her vagina. This is called embryo transfer. The unused fertilized eggs can be frozen and stored for later use.

The success rate of IVF depends on the woman’s age and the reason for the infertility. As with ovulation medications or other procedures, possible side effects of IVF include a multiple pregnancy and ovarian hyperstimulation syndrome.

Gamete Intrafallopian Transfer. Gamete intrafallopian transfer (GIFT) is similar to IVF. Like IVF, eggs are removed from the ovaries using a needle and ultrasound guidance. Unlike IVF, eggs are fertilized in the woman’s body, not in a lab. During laparoscopy, eggs and sperm are placed in the fallopian tube, where fertilization may result. GIFT has about the same success rates as IVF. It is more costly, though. The possible side effects include a multiple pregnancy and ovarian hyperstimulation syndrome.

Zygote Intrafallopian Transfer. Zygote intrafallopian transfer (ZIFT) is a combination of IVF and GIFT. With this procedure, the eggs from a woman’s ovaries are fertilized in a lab and one or more embryos are placed in the fallopian tubes rather than the uterus. This is done by laparoscopy.

The success of this technique is about the same as IVF and GIFT. It also is more costly. The possible side effects include a multiple pregnancy and ovarian hyperstimulation syndrome.

Intracytoplasmic Sperm Injection. Intracytoplas-mic sperm injection (ICSI) is most often done if there is a problem with the man’s sperm. Healthy sperm are removed from the man’s semen and eggs are retrieved from the woman. The sperm may be obtained through masturbation or using a special condom during intercourse. Sometimes sperm aspiration or testicular biopsy may be used if sperm cannot be obtained through masturbation.

In a lab, one sperm is injected into each egg’s center. The eggs are checked later to see if any are fertilized. Fertilized eggs, which have now developed into an embryo, are then placed in the woman’s uterus to grow. They also may be frozen for later use.

ICSI offers some couples who have had few options in the past a way to conceive their own child. Pregnancy rates with ICSI are about the same as those with IVF.
Other Choices

You and your partner should give careful thought to all your options. You may want to think about other choices, such as adoption or childfree living. Discuss your feelings with your partner. Sometimes counseling can help to sort out these feelings. Support groups made up of other infertile couples also may help.
Finally...

Infertility often can be treated. Lifestyle changes, medication, surgery, or assisted reproductive technologies may help. After your evaluation, talk with your doctor about treatment options for you and your partner. Infertility evaluation and treatment requires a big commitment from both partners.

LSH (Laparoscopic Supracervical Hysterectomy)

Mon, 09 Jul 2007 16:43:11 -0400

4D Ultrasound

Sun, 08 Jul 2007 18:01:07 -0400

Contemporary Women’s Care now has 4D ultrasound available! This technology allows you to see your baby…before he or she is even born! You can watch your baby LIVE with your family and friends on our 45" plasma TV screen. You can decide if your baby looks more like mom or dad. Every OB patient that has seen their baby in their womb has left their 4D appointment FULL of excitement and joy.

What is 3D and 4D ultrasound? 3D ultrasound is the still image that shows the surface of your baby–much like a photograph. Unlike 2D ultrasound, 3D ultrasound will not show your babies organs, and skeletal system. 4D ultrasound is 3D ultrasound in real time–that is you will be seeing your baby’s movements as the’re actually occurring in the womb.
31 Weeks

Will my insurance cover my 4D ultrasound? No. Currently insurance does not cover that cost of 4D ultrasound. This is a completely elective procedure, and does not take the place of your physician’s diagnostic ultrasound. This is NOT a diagnostic test. Payment will be required at the time of service.

Does this take the place of my Doctor’s ultrasound? The 4D ultrasound is a completely elective, non-diagnostic exam, and should in no way be used in place of your physician’s diagnostic exam. At Contemporary Women’s Care we offer you the convenience of having your 4D ultrasound in the same location as your OB office at a very competitive price.

Is it safe? Will the baby or me be at risk? Extensive studies over the past 30 years have found that ultrasound has not shown any harmful effects to mother or baby. 3D/4D ultrasound uses the exact same intensity as a normal 2D ultrasound. No ultrasound uses any type of radiation or harmful agents; the images are simply created with the use of sound waves.

At CWC, the same experienced and highly trained sonographers that take your diagnositic ultrasounds, will perform your 3D/4D ultrasounds. Both of our ultrasound techs are excellent trained Registered Diagnostic Medical Sonographers.

When is the best time to receive my 4D ultrasound? The scan done is between 24 and 32 weeks, with the optimal time between 26-30 weeks.

Will I always get great pictures? Most of the time. We can’t guarantee the baby will be in a position to get the very best photos, nor can we promise that your baby’s pictures will look the same as the examples you’ve seen. Our sonographers are very experienced and will always do their best to ensure the highest quality images possible.

What can I do to ensure the best pictures of my baby? There are a few things you can do to get your baby ready for his or her first photograph. Have a good meal 30 to 60 minutes prior to your appointment. Drink plenty of fluids in the weeks/days leading up to your scan. More fluid around your baby tends to make the images clearer. Have a full bladder when you come in for your appointment.

Can you tell me the sex of my baby? Yes! If you do not wish to know the sex of your baby please do not be afraid to still have a 4D ultrasound. Our technicians are highly trained, and know exactly which body part they are viewing at all times. If you inform the technician that you wish to keep the baby’s gender a surprise, they won’t scan near this region.

Can I bring my family and friends? Absolutely — we encourage you to share this amazing experience with everyone. We have a very comfortable atmosphere. Bring your friends and family and watch the 3D/4D images on our 45" plasma screen.

How much does it cost? The package we offer to our patients cost $200. You get both printed photos and a C.D. of the photos so you can print them out at home and share them with family and friends.

Be sure to ask our staff for more details regarding these new services.

Bio-Identical Hormones

Sun, 08 Jul 2007 18:01:59 -0400

Many of our patients wish to ease the transition of menopause with low-dose Hormone Replacement Therapy (HRT). HRT is way for a woman to replace the sex hormones estrogen, progesterone & testosterone when her ovaries stop producing them naturally at menopause or when the ovaries need to be removed surgically.

Several years ago negative news and media hype led women to search for alternatives to traditional HRT. As a result, there has been increasing interest in treatment options with bioidentical hormones.

Bioidentical hormones have exactly the same biologic make-up as the hormones we make in our own bodies. Women’s ovaries produce 3 estrogens (estradiol, estriol, and estrone), progesterone, and testosterone.

Bioidentical hormones can now be routinely obtained at any compounding pharmacy. Compounding pharmacies are pharmacies that are not associated with large, national, retail chains. A benefit of going this route is that your hormone dosage can be customized to your individual needs by the compounding pharmacist once you and your doctor go over your symptoms together.

Through compounding pharmacies, women can get Estradiol, Triest or Biest. Triest contains estradiol, estriol, & estrone, while Biest contains both estriol and estradiol. Also available at these specialized pharmacies are micronized testosterone, which is the bioidentical alternative to meythyl testoserone. Natural progesterone is also available at the compounding pharmacy.

For patients that want to use their insurance co-pay, there are some traditional prescription brands that also use bioidentical estradiol. Currently, these are Estrace, Femring, Vivelle Patch, Climara Patch, Menostar, Estrogel, and Estrasorb Cream. The one brand that contains natural progesterone is Prometrium.

If this type of HRT interests you, speak to your Contemporary Women’s Care gynecologist.

Endometrial Ablation

Sun, 08 Jul 2007 18:04:33 -0400

Endometrial ablation is a minimally invasive technique that treats excessively heavy menstral bleeding. There are a variety of techniques used for endometrial ablation. With an endometrial ablation, the inner lining of the uterus (the endometrium), where the period comes from, is removed or destroyed. The surgeons at Contemporary Women’s Care utilize several endometrial ablation techniques, depending on each individual woman and her specific condition. The ablation techniques utilized are the Thermachoice Balloon endometrial ablation which uses hot water circulating through a balloon to destroy the lining of the uterus and HTA Hydrothermablator, which uses hot circulating water to destroy the lining of the uterus.

Why is an endometrial ablation performed? Endometrial ablation is an alternative to hysterectomy for the treatment of menorrhagia in women who wish to keep their uterus or avoid major surgery. Instead of removing the whole uterus, only the inner lining is gone.

Who is a good candidate for endometrial ablation?

* Women who are pre-menopausal
* Heavy bleeding caused by a benign (non-cancerous) condition
* Women who have finished having children and are not interested in future fertility.
* Women who wish to retain their uterus.

What does an endometrial ablation involve? An endometrial ablation is an outpatient procedure with a short recovery. It can either be performed in the office, or as an outpatient procedure in the operating room. A woman may experience some cramping after the procedure; ibuprofen is usually adequate to treat pain. It is common to have a vaginal discharge for approximately 2-4 weeks after the procedure. Most women are typically back to their normal activities in 1-2 days.

How successful is an endometrial ablation
in treating heavy bleeding? Success rates vary depending on the technique used. When combining all the different techniques:

* About 40% of women will have no periods (amenorrhea) after an endometrial ablation.
* About 85-90% of women have either no periods or decreased bleeding. They are satisfied with the outcome of the ablation and do not need further treatment.
* About 10-15% of women will require additional treatment, such as a hysterectomy.

HPV Vaccine Information and FAQ

Sun, 08 Jul 2007 18:05:09 -0400

ABOUT HPV: Human papillomavirus is the most common sexually transmitted disease in the U.S., affecting about 20-million people at any time. Each year, there are about 6.2 million new infections, according to the CDC.

People with HPV rarely exhibit any symptoms. However, some strains of the virus can carry serious consequences, causing cervical cancer and genital warts.

About 10,000 women in the U.S. are diagnosed with cervical cancer each year, about 3,700 die from it. According to the Journal of the American Medical Association, nearly 27% of women ages 14 to 59 have some form of HPV. Although only 3% have one of the strains covered by the new vaccine, the strains of HPV the vaccine does cover are blamed for about 70% of fatal cervical cancers and 90% of genital warts.

ABOUT THE VACCINE: Gardasil is the FDA-approved vaccine that blocks the 4 most common strains of HPV, #6, #11, #16 and #18.
Common Questions

Below are the answers from the Department of Health and Human Services to some of the most commonly asked questions.

Why Get Vaccinated? HPV vaccine is an inactivated (not live) vaccine that protects against 4 major types of HPV. HPV can prevent most genital warts and most cases of cervical cancer. Women will still need to get cervical cancer screenings because the vaccine does not protect against ALL types of HPV that cause cervical cancer.

Who should get HPV vaccine and when? The vaccine is routinely recommended for girls 11-12 years of age but doctors may give it to girls as young as 9. The vaccine is given in 3 doses. It is important to have the vaccine BEFORE their first sexual contact…before exposure to HPV. In this way, the vaccine can prevent almost 100% of diseases caused by the 4 types of HPV targeted by the vaccine. The vaccine is also recommended for girls and women 13-26 years of age who did not receive it when they were younger. HPV vaccine may be given at the same time as other vaccines.

Some girls or women should not get HPV vaccine or should wait. Anyone who has ever had a life-threatening allergic reaction to yeast, or any other component of HPV vaccine, or to a previous dose of HPV vaccine should not get the vaccine. Tell the doctor if the person getting the vaccine has any severe allergies. Also those who are mildly ill can get HPV vaccine but if the illness is moderate or severe, people should wait until they recover.

What about pregant women? Pregnant women should not get the vaccine. The vaccine appears to be safe for both the mother and her unborn baby, but it is still being studied. Receiving HPV vaccine when pregnant is NOT a reason for termination. Women who are breast feeding may safely get the vaccine.

What are the risks from the HPV vaccine? HPV vaccine does not appear to cause any serious side effects. However, a vaccine, like any medicine, could possibly cause serious problems, such as severe allergic reactions. The risk of any vaccine causing serious harm, or death, is extremely small.

Some mild problems may occur such as: pain at the injection site (about 8 out of 10), redness or swelling at the injection site (about 1 out of 4), mild fever (100) (about 1 out of 10), itching at the injection site (about 1 out of 30), and moderate fever (102) (about 1 in 65). These symptoms do not last long and go away on their own. Life-threatening allergic reactions from vaccines are very rare and if they do occur, it would be within a few minutes to a few hours after the vaccination.

What if there is a severe reaction? Any unusual condition, such as a high fever or behavior changes are a sign of a serious allergetic reaction. Other signs may include difficulty breathing, hoarseness or wheezing, hives, paleness, weakness, a fast heart beat or dizziness.

In the event of a severe reaction, call a doctor or get the person to a doctor right away. Tell the doctor what happened, the date and time it happened, and when the vaccination was given. Ask your doctor, nurse, or health department to report the reaction by filing a Vaccine Adverse Even Reporting System (VAERS) form. Or you can file a report at www.vaers.hhs.gov or by calling 1-800-822-7967. VAERS does not provide medical advice.

Where to learn more information. Ask your doctor or nurse. They can show you the vaccine package insert or suggest other sources of information. Call your local or state health department.

Contact the Centers for Disease Control and Prevention (CDC):
Call 1-800-232-4636 (1-800-CDC-INFO)
Visit CDC’s website at www.cdc.gov/std/hpv and www.cdc.gov/nip