Common OB/GYN Disorders
Uterine fibroids (also referred to as myomas or leiomyomas) are benign tumors that originate from the muscular wall of the uterus. They are the most common benign tumor of the female reproductive tract, and in fact many can be asymptomatic.
Symptomatic fibroids can cause heavy or irregular menstrual bleeding, painful periods, pelvic pain, painful intercourse, pelvic pressure, infertility or urinary problems. They are often diagnosed during a pelvic exam, as well as with the help of imaging such as a pelvic ultrasound or MRI.
Treatment depends on the size, location, and number of fibroids present.Sometimes medication can control symptoms, but fibroids are one of the leading indications for hysterectomy, which is the definitive treatment of this condition. For patients desiring fertility, other surgical options may be available including myomectomy (removal of one or several fibroids) while preserving the uterus, which can often times be accomplished by a minimally invasive technique such as laparoscopy or hysteroscopy.
Endometriosis is a condition in which the cells that line the inside of the uterus (the endometrium) grow outside of the uterus. No one knows the exact mechanism as to why this happens in some women, although there are several popular theories. These growths, or implants, most often appear in the pelvis, around or behind the ovaries, behind the uterus and on the ligaments that support it, or even on the bowel or bladder. Some of these implants are tiny, and some can grow into large cysts, or endometriomas.
Symptoms include pelvic pain, painful intercourse, or cyclic pain with menstruation, and in some cases, pain with urination or defecation. It is often a cause of infertility.
Treatment may include medical or hormonal therapy, such as birth control pills, or surgical therapy to remove as much of the endometriosis as possible. The extent of surgery may depend on the patient’s desire for future fertility.
Bacterial vaginosis (BV) is a condition where the normal balance of bacteria in the vagina is disrupted and replaced by an overgrowth of certain bacteria.
Symptoms often include discharge, odor (especially after intercourse), pain, itching, or burning. The cause of BV is not fully understood. However, certain activities can increase the risk, including a new sexual partner and douching. BV during pregnancy may increase the risk of certain adverse pregnancy outcomes such as preterm delivery. It may also increase the risk of acquiring other STDs.
Treatment is usually simple with a short course of antibiotics. Other disorders characterized by vaginal discharge also need to be ruled out, including vulvovaginal candidiasis (yeast infection) or certain sexually transmitted infections such as trichomoniasis, gonorrhea or chlamydia.
Urinary incontinence, or involuntary leakage of urine, is a problem that affects many women; however most of these women do not seek medical help. There are several types, including urge incontinence (often referred to as overactive bladder, or detrusor instability), stress incontinence, and mixed. Patients with urge incontinence often have the sudden urge to urinate and frequently have accidents before getting to the restroom on time.
Stress incontinence is characterized by small amounts of leaking during activity such as a cough, sneeze, laugh, or during heavy lifting. A thorough history and physical exam, with the aid of a bladder diary and certain simple, in-office bladder tests (multichannel urodynamics) can help confirm the diagnosis.
Treatment depends on the type of incontinence, but can either be behavioral, medical, or surgical. We encourage you to speak to your physician if you have these symptoms, as it is a very common, and treatable, condition.
Endometrial ablation may be an alternative to hysterectomy for some women. If heavy and/or prolonged menstrual bleeding is interfering with your health, well-being, or quality of life, this procedure may be recommended by your doctor. Unlike hysterectomy, this procedure is performed in an outpatient facility or “Same Day Surgery” under light anesthesia. The patients are usually in and out in 4-5 hours. Most patients have little or no pain and can return to work the next day. The goal of this operation is to reduce or eliminate the patient’s abnormal menstrual pattern. In general, 40-60% of the patients will stop having menstrual periods. In another 35%, one or two days of light menstrual flow will occur. For reasons that are unclear, the procedure will not help 5-10% of the patients and hysterectomy may ultimately be necessary.
Endometrial ablation is not recommended if you want more children.
Though this procedure is not meant to replace a sterilization operation, most patients will be unable to become pregnant. To be sure that pregnancy will not occur in the future, a sterilization operation can be performed at the same time as the endometrial ablation. This operation is not a hysterectomy. Only the lining of the uterus is destroyed. You will still need yearly exams and pap smears. Because the uterus remains, the chance of uterine diseases (e.g., fibroid tumors) is still present.
Genital human papillomavirus (also called HPV) is the most common sexually transmitted infection (STI). There are more than 40 HPV types that can infect the genital areas of both males and females.
Many people who are infected with HPV do not even know they have it. Most people with HPV do not develop symptoms or health problems from it. In 90% of cases, the body’s immune system clears HPV naturally within two years. Certain high-risk HPV types can cause cervical cancer. Therefore it is important for all women to get regular cervical cancer screening, which can include a pap smear as well as HPV testing.Vaccines are available to help protect against HPV.
Gardasil is a vaccine available that helps protect against certain high-risk HPV strains that cause cervical cancer as well as certain HPV strains that cause genital warts, and is recommended for females age 9-26. Ask your doctor if this may be right for you.
Osteoporosis is a disease characterized by low bone mass and deterioration of bone tissue, making them fragile. This leads to an increased risk of fractures, typically in the wrist, hip and spine.
Risk factors for osteoporosis include being female, white/Caucasian, postmenopausal, and having a small body size, a low calcium diet and physical inactivity. Eating a diet rich in calcium and vitamin D is important for good bone health, as well as regular weight-bearing exercise and physical activity. A bone density test is the only way to diagnose osteoporosis before a fracture occurs.
After reviewing your medical and family history, physical exam, labs and bone scan results, you and your physician can develop a plan to help protect your bones. This may include diet and exercise, supplements, or osteoporosis medications. Prevention is often the key to healthy bones.