Advanced Women's Health Specialists -
Abnormal Pap Smears/Colposcopy

If you receive a phone call from us informing you that your pap smear is abnormal, the following will help you understand your abnormality and what we will do to treat you.  Below is a basic understanding of categories of pap smears from normal to more abnormal.  Please do not panic as you DO NOT have cervical cancer.
  • Normal Pap Smear
  • Atypical Squamous Cells of Undetermined Significance without Human Papilloma Virus (ASCUS, neg HPV)
  • Atypical Squamous Cells of Undetermined Significance with Papilloma Virus (ASCUS, pos HPV)
  • Low Grade Squamous Intraepithelial Lesion
  • High Grade Squamous Intraepithelial Lesion
Any of the above pap smears that are bold and underlined will require a procedure called a colposcopy to evaluate your cervix.  A colposcopy will help determine if the abnormality requires any further treatment or whether I will need to follow you with additional pap smears through the year.
 
 
Colposcopy

This is a procedure that is done in the office.  Your cervix is examined  with a special microscope after applying a vinegar solution over the cervix.  The vinegar solution causes any significant abnormalities to appear white.

If any significant lesions are observed, I may need to do a biopsy of the area for evaluation in the lab.  DO NOT worry about this biopsy.  Most women do not even feel it being done, however, it can cause some cramping like menstrual cramps.  Your cervix does not have nerve endings like your skin.  I will then use medicine that will stop any bleeding at the biopsy site.   If you want to take some Ibuprofen prior to your procedure, this can help with the cramping.

The results from the colposcopy will take about 1-2 weeks to receive. 
 
 
Birth Control Pills

Birth control pills are one of the most beneficial medications in women’s health.  Birth control pills offer many additional health benefits outside of preventing pregnancy.

Benefits of Birth Control Pills:
  • Highly effective and reversible
  • Reduced risk of anemia
  • Reduced symptomatic endometriosis
  • Reduced risk of ovarian and endometrial cancer
  • Regulation of menstrual cycles
  • Reduced cramping
  • Reduced amount and duration of bleeding
  • Reduced  acne
  • Reduced risk of ovarian cysts
 
    Risks of Birth Control Pills:
    • Risk of blood clots and stroke 
    • Risk of increased blood pressure
    • Risk of migraine and headache
     
    Facts:
    • Birth control pills do not cause or increase risk for breast cancer
    • Birth control pills do not cause weight gain
    • Birth control pills do not cause abortion
    • Birth control pills prevent ovulation
    • Birth control pills do not prevent all cyst formation on ovaries
     
    All birth control pills are relatively similar.  All do the same job, but different formulations may work better for some individuals.

    When starting birth control pills, you may experience nausea or abnormal bleeding during the first 3-6 months of use until your body adjusts to the medication.  If these symptoms do not resolve after 6 months, call our office and we will consider a different pill that will work better for you.  If you skip a pill or take a pill late, you may experience breakthrough bleeding or bleeding in the middle of your cycle.  This does not indicate an underlying problem and can be resolved by taking your pill at the same time each day.

    Some women will not experience any periods at all during pill use.  This is safe and represents a good balance of estrogen and progesterone to prevent period bleeding.  However, if you have bled on a pill before and suddenly stop having periods, it is recommended you take a pregnancy test.

    All birth control pills can be safely used in a continuous manner for 3 to 4 months. This method of use would therefore produce a period only every 3 or 4 months.
    To use the pill in a continuous manner do the following:
    1. Start pill pack as directed.
    2. When you reach the green or inactive pills, do not take these pills.
    3. Instead, start a new pack with an active pill.
    4. You can do this for 3-4 months, thus inhibiting a period for that time.
    5. After 3-4 months, then take the green pills for to stimulate a period.
    6. Then, restart the process all over again.
     
    If you are unhappy with your current pill, contact us and we can change your pill with a simple phone call and typically does not require a visit to the office.
     
     
    Permanent Contraception
     
    The Essure procedure was designed with women like you in mind—with no slowing down to recover—so you won’t need to take time away from your busy life.  It is a hormone-free, permanent form of contraception.  The procedure is performed in the office with a local anesthetic .  During the procedure, which takes less than 10 minutes, small, soft inserts are passed through the natural pathways of your vagina and cervix into your fallopian tubes, so no surgery or incision is required.  The very tip of each insert remains visible to your doctor, providing immediate confirmation of proper placement.  The flexible Essure inserts are made out of the same trusted, silicone-free material used in heart stents, so they bend and conform to the shape of your fallopian tubes while remaining securely in place.
     
    Over the next three months, your body works with the Essure inserts to form a natural barrier within each of your fallopian tubes.  These barriers prevent sperm from reaching the eggs so that pregnancy cannot occur.  During this three-month time frame, you must continue to use another form of birth control.
     
    After three months, it’s time for your Essure Confirmation Test.  During this simple test, a special dye is introduced into your uterus and viewed on an x-ray, so your doctor can confirm that your fallopian tubes are completely blocked and the inserts are in place.  Once you receive this verification, you can rely on Essure for permanent birth control.
     
    Like all permanent birth control procedures, including tubal ligation and vasectomy, the Essure procedure should not be considered reversible, so you should be sure you do not want to get pregnant in the future.
     
     

    Heavy Bleeding

    Do you have heavy periods?  Do you change your pad or tampon more often than every 2 hours?  Here are your options:
     
    Hormones/IUD

    The simplest treatment is the use of hormones such as birth control pills or progesterone pills. However, many women are unable to use this option due to side effects or other medical conditions that prevent hormonal use.

    Another option is the use of an intrauterine device called Mirena.  The Mirena is used to either prevent pregnancy or treat heavy bleeding.  The device has a small amount of progesterone within its T-shaped structure and is placed at the fundus, or top of the uterus, in a short office visit.  This progesterone does minimally circulate throughout your body and affects the lining of the uterus to thin it down and reduce or eliminate periods.  It is very safe and you can become pregnant within 1 month of its removal.  I do tell patients that the Mirena device prevents pregnancy in many ways, but it does also prevent implantation of a fertilized egg.  You must be agreeable to this before this device can be inserted.
     
     
    Endometrial Ablation
     
    Endometrial Ablation is a procedure that can be performed either in the operating room, or less expensively, in the office.  Both are performed in the same manner.  This procedure is used to treat heavy bleeding.  After the procedure, 90-95% of women will be satisfied with the results.  Approximately 60-70% will no longer have any more periods or bleeding.  Another 20-30% will have very light periods in which they bleed very lightly, only using a pantyliner throughout the period.  Approximately 10% will fail the procedure and choose to manage bleeding as they have been doing, use hormones to control bleeding or opt for other surgical treatments such as Hysterectomy.

    If the ablation procedure does not work, you cannot repeat the procedure at a later time.  It is also very important to understand that you should not become pregnant after this procedure.  I encourage you to have a sterilization procedure in conjunction with an ablation.  An ablation is not meant to prevent pregnancy.
     
     
    Hysterectomy with or without ovary removal

    A Hysterectomy is the removal of the uterus and cervix, but not necessarily the removal of the ovaries.  Laparoscopic Assisted Vaginal Hysterectomy (LAVH) is the most common way that I choose to remove a patient's uterus and cervix.  In addition, a hysterectomy can be performed using the da Vinci robot.  This decrease surgical risk and improves recovery time.  These surgeries usually take 1-2 hours to perform and you would stay in the hospital overnight. 

    The case for keeping the ovaries is that hormones produced by the ovaries help keep bones strong, prevent heart disease, and prevent menopausal symptoms.  However, if a women keeps her ovaries, there is a risk for ovarian cancer or ovarian diseases that may require surgery in the future.  Some reasons for removing the ovaries are endometriosis, family history of ovarian cancer, pain associated with recurrent ovarian cysts, ovarian tumors, hormonal or menstrual migraines or post-menopausal or near menopausal women.
     
     
    Menopause and Hormone Replacement Therapy
     
    Menopause is defined as the cessation of periods for more than 12 months in women over the age of 40.  The average age of menopause in the U.S. is 51 years old.   Menopause usually starts gradually as the ovaries start making less and less estrogen and progesterone.  It is a normal and natural progression through life.
     
    Once you are menopausal, the decision to use estrogen and/or progesterones is up to you based on your symptoms.  If your symptoms are unbearable and inhibiting your enjoyment of life, I recommend the use of hormone replacement therapy (HRT).  If the symptoms are not affecting the quality of your life, then it is best not to start HRT.

    Symptoms of menopause that are reduced or eliminated with hormone use are:
    • Hot Flashes
    • Vaginal Dryness
    • Painful Sexual Intercourse
    • Mood Changes
    • Skin and Hair Changes
    • Irregular Sleep Patterns
    • Decreased Sex Drive
     
    You should not use hormones in menopause if:
    • You have had Breast Cancer
    • You have significant Heart Disease
     
    The risks of hormone replacement have been exaggerated by the media. We all take risks everyday to improve our lifestyles.  For example, we drive our cars everyday although we have a 1 in 12 chance of being involved in an auto accident every year.  Studies show that in women not using HRT, 3.3 per 1,000 women develop breast cancer versus 3.9 per 1,000 women using combination (estrogen and progesterone) HRT. Women who use estrogen only HRT do not have an increased risk of breast cancer.  All estrogens increase risk for blood clots and stroke slightly.

    Most women would not give up the use of their car because of the great benefits they receive from being able to drive. The same is true for hormone replacement.  If you feel dramatically better on hormone replacement, the small risks can be reasonable for the great benefits you receive.

    If HRT can improve your life and make the quality of life better for you, the benefits outweigh the risks.  If, however, your menopausal symptoms are tolerable for you, then I would recommend not using these medications.  The only way to know how you will feel on or off of hormones is to try one way or the other.
     
    I do recommend that you take the smallest amount of hormone for the shortest period of time to control your menopausal symptoms.  If you have any further questions about your hormones, I would be happy to address them during an office visit.
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