Surgical procedures performed by our providers include but are not limited to the following:

• Hysteroscopy
• Dilatation and Curettage (D&C)
• Laparoscopy
• Urinary Incontinence/Slings
• Cesarean Section
• Tubal Sterilization
• Rectocele/Cystocele Repair
• Uterine Prolapse Repair
• Ovarian Cyst removal
• Cervical Cone Biopsy
• Cervical Cerclage
• Vulvar Cyst Drainage/Excision
• Endometriosis treatment
• Hysterectomy
  • vaginal, laparoscopic
  • robotic, abdominal

Contraception management includes options such as natural family planning, barrier methods (such as condoms), hormonal therapies (oral contraceptives, progestin injections, vaginal hormonal contraceptives [such as NuvaRing or Annovera], progestin releasing intrauterine devices [IUDs], Nexplanon [progestin arm implant], Copper IUD (Paragard), and surgical sterilization.

The well woman visit provides an excellent opportunity to counsel patients about maintaining a healthy lifestyle and minimizing health risks. It includes a physical examination along with screening, evaluation, counseling, and immunizations based on age and risk factors.

Approximately 15% of couples do not achieve pregnancy after 1 year of trying. At Health Care for Women, our providers are able to provide evaluation for potential causes that may be contributing to this. Based on test results, we may be able to initiate treatment for you or if more complex therapies are needed, we can arrange referral to the appropriate fertility specialists that can assist you.

Premenstrual syndrome (PMS) refers to a variety of symptoms that occur in a predictable pattern in the week or two before menses. Symptoms can be numerous and may include anxiety, depressed mood, crying spells, mood swings, insomnia, headache, fatigue, breast tenderness to name some. For some women, the emotional stress and physical pain are enough to affect daily lives. If symptoms are particularly disabling, then the condition is termed Premenstrual Dysphoric Disorder (PMDD). Treatments may consist of antidepressants, anti-inflammatories, diuretics to reduce fluid retention, and hormonal contraceptives.

Perimenopause begins several years before menopause. It’s the time when the ovaries gradually begin to make less estrogen. Typically, it begins in the mid to late 40’s and lasts 4 years on average. It is common to experience irregular menses during the perimenopause and hot flashes may develop near its end. Hormonal therapies may be used to control abnormal uterine bleeding. Menopause refers to the time when the ovaries stop releasing eggs and menses cease. In menopause, the ovaries do not produce estrogen and symptoms including night sweats, hot flashes, and vaginal dryness may develop. Hot flashes may be controlled by dressing in layers, by hormone replacement therapy, and with the initiation of certain antidepressants.

The PAP smear is a test whereby cells from the cervix are collected with a small brush or spatula to screen for precancerous and cancerous vaginal and cervical conditions. The PAP is collected as part of a pelvic examination. It is often combined with a test that assesses for the presence or absence of high risk strains of Human papillomavirus which is a common sexually transmitted virus that is the main cause of PAP smear abnormalities. If PAP results are abnormal, then a procedure known as a colposcopy may be recommended based on the age of the patient and the degree of abnormality. Colposcopy is a procedure that is typically performed to evaluate abnormal PAP smears. It can also be employed to evaluate vaginal or vulvar abnormalities. The colposcope acts as a telescope magnifying the tissue being examined to see if appears normal or abnormal. Abnormal tissues are usually biopsied. The procedure commonly takes less than 10 minutes and may cause mild discomfort.

Cervical dysplasia is  a precancerous condition in which abnormal cell growth occurs on the surface lining of the cervix or on the endocervical canal which is the inside of the cervix. It is also called cervical intraepithelial neoplasia (CIN). Cervical dysplasia usually causes no symptoms and is most often discovered by a routine PAP test. It is typically caused by a virus known as the Human papillomavirus. This virus occurs in more than 50% of individuals. Cervical dysplasia is graded as mild, moderate, and severe. Mild cases resolve without treatment in the majority of cases and are usually followed without treatment unless they persist. Treatments are usually recommended for moderate or severe dysplasia, but based on patient age and childbearing desires, careful follow-up without immediate treatment may be offered. Common treatments include freezing (cryosurgery) or excising (Loop Electrosurgical Excision Procedure [LEEP] or Cone Biopsy) the abnormal tissue. Despite treatment, recurrences are not uncommon so long-term follow-up is needed.

Around the time women begin to menstruate until they reach menopause, they ovulate. This is the process where an egg is released from the ovary. A small, benign cyst about an inch in size results. The cyst usually resolves about 2 weeks after forming. In some cases, this ovulation cyst persists beyond a few weeks. It may or may not be painful. Other common cysts not caused by ovulation can develop. Fortunately, the vast majority of ovarian cysts are benign (non cancerous). Some may be painful if they grow or if they twist (known as ovarian torsion). Pelvic ultrasound is the typical imaging test to diagnose a cyst. In some cases if pelvic pain is present, a CAT scan may be ordered to look for other non-cyst causes of pain such as appendicitis, intestinal condition, or kidney stone. Complex appearing cysts which contain solid areas are more commonly seen in certain ovarian cancers. If the cyst appears benign and there is no pain or just mild pain, they are often managed with medicines such as Tylenol or ibuprofen with an anticipation that they will resolve on their own. Oral contraceptives can be used to decrease the risk of painful ovulation cyst formation. If pain is moderate to severe and cannot be controlled with medication, surgery (such as a laparoscopy) may be needed to remove the cyst. This is a surgery completed in the operating room through several small abdominal incisions.

The vulva has a number of glands, including oil-producing glands, Bartholin’s glands (near the vaginal opening), and Skene’s glands (on either side of the urethra). A cyst can form if these glands become clogged. The size of cysts varies, but most feel like small, hard lumps. If a cyst becomes infected, it is known as an abscess. Treatment is not typically needed for small, uninfected cysts that are not painful. Women with abscesses may require antibiotic treatment or incision and drainage of the affected tissue.

Pelvic pain is a common reason why women seek medical care. Pain may be related to gynecological organs such as the uterus, fallopian tubes, or ovaries; however, pain may not be of gynecological origin and may arise from the bladder, intestines, muscles, or skeletal system. In women of reproductive age, pregnancy must be excluded as ectopic pregnancy  and miscarriage may result in pain. Potential non-pregnancy causes of pain include endometriosis, uterine fibroids, pelvic infection, ovarian cysts, and less commonly cancers. Evaluation includes a physical examination and then appropriate diagnostic tests are ordered. These tests may include urinalyses assessing for bladder infection, pregnancy test, tests for pelvic infection if felt to be necessary, and possible pelvic ultrasound or in some cases, CAT scan of the abdomen and pelvis. Treatments are based on the results of these tests.

Endometriosis is a condition that occurs when the endometrium, the tissue that lines the inside of the uterus, grows outside of it. It occurs in about 10% of women and is more common if other family members have had it. Endometriosis may develop due to a number of reasons but a common cause is the movement of menstrual tissue during menses backwards, passing through the fallopian tubes, and entering into the abdomen. This tissue can implant on various abdominal organs including the uterus, ovaries, and intestines. In women who have endometriosis, they may experience a variety if symptoms including menstrual and non-menstrual abdomen and pelvic pain, pain with sexual intercourse, pain with bowel movements, and infertility. Obtaining a complete medical history combined with pelvic examination may suggest the diagnosis. The mainstay of medical treatment are hormonal contraceptives designed to decrease menstrual flow and prevent growth of endometriosis implants. Other endometriosis specific medicines, such as Orilissa, act to decrease estrogen production from the ovaries and may be used to treat pain. Surgery (typically laparoscopy) may be performed to confirm the diagnosis and excise or destroy abnormal tissue. For women who have completed childbearing, hysterectomy may be beneficial. Unfortunately, many women with endometriosis have recurrence of symptoms after treatment.

Abnormal uterine bleeding is vaginal bleeding from the uterus that occurs too often, lasts too long, is heavier than normal, or is irregular. Causes of bleeding are often based on the individual’s age and may include irregular ovulation, uterine polyps (overgrowths of the lining of the uterus), uterine fibroids (masses that develop from the muscle layer of the uterus), blood clotting disorders, infection, medication related conditions, and cancers. Evaluation starts with a complete medical history and pelvic examination. Appropriate tests and imaging studies (such as PAP smear collection, biopsy of the inside of the uterus, and pelvic ultrasound) may be ordered. Treatments are based on the results of tests and may include antibiotics, hormonal therapies, and surgeries.

Uterine fibroids are common growths that arise from the muscular layer of the uterine wall. 20-80% of women may have these. They are almost always benign (not cancerous). Not all women with fibroids have symptoms. For those women who have symptoms, they may include pain, heavy or irregular vaginal bleeding, abdominal bloating, and when large, abdominal enlargement. Diagnosis is usually made by pelvic ultrasound. MRI is sometimes used to gather more detail on fibroid location or when an ultrasound cannot determine whether a pelvic mass is a fibroid or if it might be an ovarian mass. Fibroid treatment is indicated when symptoms effect one’s quality of life. Hormonal therapies such as oral contraceptives and progestin releasing IUDs may be used to decrease menstrual bleeding and regulate cycles. Tranexamic acid is a nonhormonal medication that causes the uterine blood vessels causing bleeding to clot more quickly to decrease bleeding. It can be taken monthly during heavy bleeding for up to 5 days at a time. Newer medicines, Oriahnn and Myfembree, are a combination of 3 medicines. One acts to lower estrogen production from the ovaries to cause fibroids to decrease in size. The other two are low doses of estrogen and progesterone that work to decrease side effects from estrogen underproduction (bone loss, hot flashes). Oriahnn and Myfembree may lessen menstrual bleeding by 50-80%. Surgical treatments for fibroids include fibroid removal, uterine artery embolization (a procedure where a radiologist is able to pass a tube into blood vessels in the region of the groin to introduce particles that block off the blood supply to the uterus, thereby decreasing fibroid size), endometrial ablation (only performed in premenopausal women who have completed childbearing), and hysterectomy (removal of the uterus).

Pelvic organ prolapse refers to conditions where the vagina, urethra, cervix, or uterus descend towards the vaginal opening or protrude past the vaginal opening. Common symptoms may include fullness or pressure in he pelvic area, low back pain, painful sexual intercourse, a feeling that something is falling out of the vagina, urinary problems such as leaking urine, and constipation. Diagnosis is typically made during pelvic examination. Based on the degree of prolapse and severity of symptoms, treatment may include pelvic floor physical therapy, placing a device in the vagina to support tissues (the device is called a pessary and is made of silicone), and surgery to repair the affected tissues.

Urinary incontinence describes a condition when urine is passed involuntarily. There are numerous potential causes of incontinence but the most common causes of urine loss are stress incontinence which usually occurs with coughing, running, or laughing and urge incontinence (also known as overactive bladder) that occurs when bladder muscles involuntarily contract. Some women have a combination of stress and urge incontinence, known as mixed incontinence. Stress incontinence is more frequent in women who have previously given birth. Evaluation includes medical history taking, physical examination, urinalysis evaluation, and in some cases, more detailed diagnostic tests such as cystometrics. Treatments include pelvic floor physical therapy, medications for overactive bladder, pessary use (a silicone device placed into the vagina to support the bladder and urethra), and surgery, the most common of which is a midurethral sling. A sling is a permanent medical product used for stress incontinence that is surgically placed under the urethra to support it so urine loss does not occur with coughing, laughing, or running.