Answers to Common Gynecology Questions
Many women have questions about conditions and procedures they may have heard about through friends, family, and even medical professionals. As a way to help reduce some of your anxiety and educate you, we have listed several commonly asked gynecological questions. Please keep in mind that this is provided for informational purposes only and is not intended to serve as medical advice. Please contact a medical professional for any serious medical concern.
Yes, and it is a major patient convenience. Although it is an expensive service to provide, we believe the mammogram is one of the most important tests all eligible women should have. If eligible, scheduling your well exam along with a mammogram is a perfect and convenient combination.
It is important to know that although the chances for pregnancy are reduced following an endometrial ablation procedure, it is still possible to become pregnant.
However, pregnancy following endometrial ablation is very dangerous for both the mother and the fetus and you should use some form of birth control if you decide to have endometrial ablation. Please discuss these options with your physician.
Hysterectomy, or surgical removal of the uterus, is the only definitive treatment for menorrhagia. Hysterectomy is a major procedure, performed in the hospital most often under general anesthesia, and is accompanied by surgical risks, hospitalization, and, depending on the technique used, a recovery period of up to 6 weeks.
A pelvic exam by the healthcare provider is usually the first step towards diagnosing fibroids. The uterus will feel enlarged or irregular. He or she may describe the uterus as being "12 weeks" or "14 weeks" meaning it is the size of a twelve week pregnancy.
Once your uterus has been identified as being enlarged or irregularly shaped, the presence of fibroids can be seen by ultrasound. An ultrasound can specify the number and size of the tumors. A hysteroscopy may be recommended - with this procedure the physician can see inside the uterine cavity by inserting a small telescope-like instrument (hysteroscope) through the cervix into the uterus.
The vagina is a delicate ecosystem. Douching may disrupt this balance, leading to an overgrowth in yeast or bacteria. If you already have an infection, douching can make it worse. Using scented toilet paper or sanitary napkins, feminine deodorants, spermicides, harsh soaps or detergents can cause irritation, either leading to an infection or making it worse.
Always change out of a wet bathing suit immediately; the yeast and bacteria that cause vaginal infections love moisture. Dry yourself thoroughly after bathing or showering. Avoid tight clothing, especially while exercising, and always wear cotton undergarments that absorb moisture.
Keep the vaginal area clean, always wipe from the labia towards the rectum after a bowel movement to avoid spreading organisms from the rectum to the vagina.
Common symptoms of fibrocystic breast changes include:
- Dense, irregular and bumpy feeling breasts, especially in the outer quadrants
- Breast pain that may come and go, or be persistent
- Breasts feel heavy, full
- Premenstrual pain and swelling
- Pain improves after menstrual cycle
- Change in nipple sensation, itching
To relieve these symptoms, try one or a combination of the following:
- Avoid caffeine (coffee, tea, cola, chocolate) for a few months
- Take over the counter NSAIDS (Advil, Motrin, Aleve, etc.)
- 400 IU of Vitamin E daily in divided doses
- Decrease salt intake, especially the week before menstruation
- In severe cases, oral contraceptives can help
A pelvic exam is the first step. The doctor or midwife will examine your cervix and vagina, along with feeling for any lumps or tender points on the uterus, fallopian tubes, and ovaries. Sometimes the endometrial implants can be felt upon examination (but not always).
When your medical history and exam suggest endometriosis as a possibility, a laparoscopy may be offered to diagnose endometriosis. This surgical procedure allows the doctor to see the internal pelvic structures directly.
Laparoscopy is a simple, outpatient procedure. A thin, lighted tube is inserted into a small incision in the navel, allowing the physician to view the organs on a television screen. The physician can note the location, size, and extent of any endometrial implant.
Fibrocystic breast disease is a benign breast condition affecting about 60% of women during their childbearing years, especially ages 30 to 50 that is characterized by your breast becoming lumpy and painful, especially the week before you period.
The breasts are made up of milk producing glands, fat and fibrous tissue. The glands are linked by thin tubes called ducts. Each month in response to estrogen and progesterone released by the ovaries, the milk glands and ducts enlarge and the breasts retain water which causes the breasts to feel swollen, lumpy and tender. After menstruation the breasts feel less tender and lumpy.
As this hormonal stimulation continues repeatedly, pockets of fluid called cysts may form and there is an increase in the firmness of the breast tissue. The tissue may feel "ropey" on exam. These are fibrocystic changes.
Fibroids are tumors consisting of an overgrowth of muscle and connective tissue. Fibroids may grow into the uterine cavity, from the uterine wall to the outside of the uterus, or may be confined within the uterine wall. Twenty-five to fifty percent of women have fibroids and under most circumstances they are benign. The incidence increases with age (20% in their 20's, 30% in their 30's, 40% in their 40's).
Since Fibroids tend to run in families if another member of your family has fibroids, you are at an increased risk of getting them. The risk increases if you are heavy for your height, but decreases if you smoke or have had a child.
The benefits of HRT are that it provides relief from menopausal symptoms including hot flashes, insomnia, vaginal dryness and atrophy. It also helps to prevent osteoporosis.
However, there are also risks associated with HRT. Unopposed estrogen (taking estrogen without progesterone if you have a uterus) increases the risk of endometrial cancer.
There appears to be the possibility of a slightly increased risk of developing breast cancer with prolonged use of estrogen. Many studies have shown no increase in risk but for long-term use, the incidence of breast cancer may raise to 8 per 10,0000 women.
Whatever you decide concerning HRT you should remember that menopause is a naturally occurring event in the lives of all women and that one third of your life will probably happen after menopause. The symptoms and physical changes that occur with menopause should not prevent you from enjoying this phase of your life. If you have any questions or concerns you should discuss them with your doctor or midwife.
The two most common symptoms are abnormal uterine bleeding and pelvic pressure. Menstrual periods with fibroids may be very long and very heavy. There may be pressure in the pelvic region from the enlarged uterine size caused by the fibroids. Symptoms from the pressure are often related to where the fibroid is exerting pressure. Also, there may be urinary frequency, constipation or difficulty with bowel movements. However, many women with fibroids never have any symptoms at all!
The presence of fibroids in the uterus can cause a variety of reproductive problems - recurrent miscarriage, infertility, premature labor or complications of labor.
Vaginal infections are the most common gynecologic disorder and are usually caused when the normal vaginal flora that are found in the vagina become imbalance. Symptoms of vaginal infections can range from mildly annoying to extremely uncomfortable. The key to successful treatment lies with an accurate diagnosis of the agent causing the infection. Therefore, before you use any over the counter medication such as a treatment for vaginal yeast infection you should be sure it is the right drug to treat the problem. Using the wrong sort of medication may make the situation worse. If you have any doubt you should consult your doctor or mid-wife.
The most common vaginal infections include:
- Yeast infections
- Bacterial vaginosis (BV)
The following are some of the post-operative discomforts associated with any endometrial ablation procedure.
You may experience some post-operative uterine cramping and discomfort shortly after the procedure, which can generally be treated with mild pain medication such as Ibuprofen (e.g. Advil® or Motrin®).
Some patients may experience nausea and vomiting as a result of the anesthesia. Watery and/or bloody discharge after an endometrial ablation is also common for several weeks after the procedure.
Most women can return to normal activities within a day or two of their treatment. Sexual activity can be resumed in 7 to 10 days.
You should call your physician if you develop a fever higher than 100.4ºF, worsening pelvic pain that is not relieved by ibuprofen or other medication prescribed by your physician, nausea, vomiting, shortness of breath, dizziness, bowel or bladder problems, and/or a greenish vaginal discharge.
There is no simple explanation for endometriosis. One school of thought is that it is caused by "retrograde menstruation," meaning the flow during the menstrual period backs up into the fallopian tubes. This flow carries endometrial tissue that attaches to the ovaries, uterus, and other organs. This theory though, does not explain why women who have had a tubal ligation continue to develop endometriosis. Only one in ten women with known retrograde menstruation develops endometriosis.
Another idea is that all the tissues where endometriosis is found develop from the same part of the embryo. It is thought that the irritation of wandering menstrual blood causes these tissues to change into functioning endometrial tissue. There is no conclusive evidence, though, that tissues from a common embryonic source can change this way. Another suggestion is the "immune defect" theory. This theory is based on the high levels of certain antibodies in the blood of endometriosis patients and the fact that women with close relatives with the disease are at greater risk. These women may have an immune reaction against their own tissues. Research into this theory is ongoing.
Fibroid growth seems to be related to estrogen production, but the experts are not clear why some women develop them and other women do not. Fibroids are slow growing during the reproductive years, but may increase in size with pregnancy. In women who don't use estrogen replacement therapy after menopause, many times the fibroids begin to shrink in size. The estrogen only affects the fibroid, though, after it has already developed. What causes the initial fibroid to develop is unknown. There may be a genetic component. Researchers are now investigating chromosome abnormalities that may play a part in the production of fibroids.
A laparoscope is a long, narrow tube with a fiber optic light at one end. It is inserted into the abdomen through an incision in or under the navel. It can be maneuvered in any direction to allow views of the internal organs. Generally two to three other small incisions will be made below the bikini line to allow surgical instruments or a laser to be inserted into the lower abdomen.
These infections are caused by a fungus called Candida. Yeast may be found in small amounts in the normal vagina. When there is an imbalance in the normal vaginal flora, the yeast can take hold and overgrow. Taking antibiotics that may kill the lactobacilli found in a normal vagina can cause this imbalance.
Lactobacilli excrete hydrogen peroxide, which is a natural disinfectant that acts to maintain the normal balance of organisms in the vagina. Other factors that may lead to the imbalance are:
- taking oral contraceptives
- steroid use
- wearing clothing that traps heat and moisture (such as nylon)
- a diet high in sugars and starches
The classic symptoms of a yeast infection include vulvar itching, redness and irritation. In severe cases, the vulva may be swollen with fissures, or breaks in the skin. When there is a vaginal discharge, it is thick, white and "cheesy" or curd-like. Your health care provider can diagnose the infection by vaginal culture, or looking at a drop of the vaginal secretions under a microscope.
There are many treatments for yeast infections including oral and vaginal medications, prescription and over-the-counter.
Bacterial Vaginosis is the most common vaginal infection. The bacteria that cause the infection occur naturally in the vagina. The infection occurs when there is an overgrowth and the normal vaginal bacteria are replaced.
The primary symptom of BV is a thin, white, or grayish discharge with an unmistakable fishy odor. The odor usually increases after intercourse or during menstruation. There may be mild irritation or itching, but quite often it is the offensive odor that causes the woman to seek treatment. The diagnosis is made by checking the vaginal pH (it is abnormally high with BV), evidence of the discharge upon exam, the fishy odor, and the abnormal appearance of cells that line the vaginal wall.
BV is treated with antibiotics, either orally or intravaginally. These medications are only available with a prescription. It is important to finish all the antibiotics as prescribed.
Endometriosis is a common cause of pelvic pain that strikes 10-20% of American women. Normally, during the menstrual cycle tissue builds up and breaks down within the uterus. In endometriosis, endometrial tissue (tissue from the lining of the uterus) is found outside the uterus. During the menstrual cycle this tissue builds up and breaks down in the same way but there is no way for it to leave the body. The implants bleed internally, causing irritation, inflammation, and scarring.
Women with endometriosis have symptoms ranging from mild to severe, although some women have no symptoms at all. Symptoms can include menstrual cramps, pain during sex, low back pain, constipation, pain with bowel movements, and infertility. Some women have chronic pelvic pain. Symptoms are usually at their peak just prior to and with the menstrual period. Symptoms are not indicative of the severity of the endometriosis. A woman with severe pain may have minimal disease, while a woman with severe disease may have no symptoms.
Hormone Replacement Therapy is the use of two hormones – estrogen and progesterone - to help relieve the symptoms of menopause. Because there are both risks and benefits to HRT choosing whether or not to take hormone replacement therapy (HRT) can be a difficult decision to make and there has been much made of HRT, both pro and con, in the popular press. Your decision should be based on a number of factors including:
- The severity of your menopausal symptoms and how they are affecting your life.
- Your individual risk for blood clots, heart disease, bone loss, breast and reproductive tract cancer.
If you have had your uterus surgically removed, then you will only need to take estrogen. Progesterone is added for those with a uterus to cut the risk of uterine cancer that exists with unopposed estrogen (estrogen without progesterone).
Menorrhagia is excessive menstrual bleeding commonly referred to as heavy bleeding and about 1 in 5 women suffer from this condition. If your bleeding lasts seven or more days per cycle, or is so excessive that you need to change protection nearly every hour, you may have menorrhagia. Only your doctor can tell you for sure.
Women suffering from menorrhagia can experience fatigue, anemia, embarrassing accidents, and restricted activity. And there are now more treatment options available to you.
"Trich" is a common sexually transmitted disease (STD) that is caused by a protozoan. Although it is usually transmitted through sexual intercourse, in rare instances it has been passed through wet towels, washcloths or bathing suits. Trichomoniasis can occur without symptoms. When there are symptoms, they are usually within 4 to 20 days after exposure, although it may be years before the symptoms appear. The symptoms in women include a yellow-green vaginal discharge that may be frothy. The labia may be irritated, red and itchy. There may be spotting after intercourse, and a foul vaginal odor. If the infection involves the urinary tract, there may be burning with urination.
Trichomoniasis is usually diagnosed by culture or by identifying the protozoan under a microscope. Sometimes the infections may be picked up on Pap Smear. The infection is treated with oral antibiotics for the woman and her partner. It is important that both be treated so as to prevent re-infection.
Endometriosis is a chronic condition with no real cure. There are many factors to consider when you and the doctor choose a treatment method. One factor is whether to preserve fertility – do you want to become pregnant, either now or in the future? Another factor is the severity of your symptoms. Endometriosis can be treated with medication, surgery, or a combination of both.
Hormones may help slow the growth of the endometrial implants. They do not, though, reduce adhesions (scar tissue) that cause pain. The most commonly used hormones are birth control pills, progestins, gonadotropin-releasing hormone (GnRH) agonists and Danazol.
- Birth Control Pills - The hormones in birth control pills keep the menstrual flow lighter and shorter, which can help relieve pain.
- Progestin - Progestin is used to shrink endometrial implants. It works against the effects of estrogen on the endometriosis. You probably won't have a period while on the medication.
- Gonadotropin-releasing hormone (GnRH) agonists - This medication causes a pseudo-menopausal state. It shuts down the ovaries, without surgically removing them. It does this by overloading the pituitary so FSH and LH are not produced. This pseudo-menopausal state stops the growth of endometrial tissue (inside and outside the uterus) and reduces the pain of endometriosis. The side effects, though, are the symptoms of menopause - hot flashes, headaches, and vaginal dryness. There is also an increased risk of osteoporosis. Treatment usually does not last for more than six months without the addition of estrogen or bone density monitoring. The side effects abate when treatment is discontinued.
- Danazol - Danazol is a synthetic hormone that also reduces the pituitary's production of the hormones FSH (follicle stimulating hormone) and LH (lutenizing hormone). Like the GnRH agonists, Danazol causes a pseudo menopausal state. The endometrial implants shrink and pain is reduced. Treatment can last from 3 to 9 months. Side effects include hair, skin, mood, voice, and sex drive change. Some women complain of weight gain, bloating, and vaginal dryness.
Excision is now the recommended method to remove endometriosis implants and the scar tissue associated with it. In most cases this procedure can be successfully completed with a laparoscope.
A laparotomy, which involves opening up the abdominal cavity, is sometimes required for more widespread disease that can't be reached through the tiny incision used in the laparoscopy.
If you plan to have no more children, complete hysterectomy may be the final surgical approach. If the disease is seriously affecting your health and lifestyle, you may wish for a definitive treatment.
Drug Therapy is typically the first treatment option, consisting of oral contraceptives or other hormones that treat hormonal imbalances. This therapy is effective only about 50% of the time, and usually must be continued in order to remain effective. Some women have undesirable side effects, including headaches, weight change, and nausea.
Dilation and curettage (D & C) is frequently the second option if drug therapy is ineffective. It is a common surgical procedure that involves scraping of the inside of the uterus. However, for the majority of women with menorrhagia, it's only a temporary solution that reduces bleeding for a few cycles.
Endometrial ablation. If you do not plan to have any more children, your doctor may suggest minimally invasive surgical treatment options. Several methods are currently available:
- Conventional endometrial ablation removes the lining of the uterus with an electrosurgical tool or laser. This method effectively reduces bleeding in approximately 85% of patients, and most women return to work within 3 days. Risks include perforation of the uterus, bleeding, infection, or even heart failure due to fluids used to open up or distend the uterus.
- A new generation of endometrial ablation devices is now available. These devices vary in the way they abolish the lining of the uterus. Some use heated fluid, others radiofrequency, and still others freezing. Your provider can discuss the best option available for your specific condition.
The only cure for fibroids is a hysterectomy. If you are still considering having children this may not be an option for you. Hysterectomies are performed either abdominally (through an incision in the abdomen), vaginally (through an incision in the vagina), or through a laparoscope abdominally. The method used depends on your situation and will be based on the size of your uterus and your medical history.
One of the first treatments usually tried for the abnormal uterine bleeding associated with fibroids is the use of oral contraceptives or progestin. Also, GnRH agonists (gonadotropin-releasing hormone) have been shown to temporarily shrink fibroids by blocking estrogen production. This class of hormone causes menstrual symptoms, such as hot flashes, vaginal dryness, and bone loss. Using a low dose of estrogen and progesterone along with the GnRH agonist may prolong the length of time the medication can be used.
Another procedure, called a myomectomy, removes only the fibroids, leaving the uterus intact. This procedure can be performed by laparoscopy or through an open incision in the abdomen (laparotomy). The type performed depends on whether the fibroids are superficial or deep. Because a myomectomy is major surgery and may be more complicated than a hysterectomy consideration as to whether or not you plan to bear children has to be given when evaluating whether it is the right option for you.
It may take as long as or longer than a hysterectomy and can cause more blood loss with a greater risk or need for a transfusion. Scarring of the uterus following a myomectomy may cause fertility problems. And, the procedure does not prevent the growth of new fibroids and the need for future surgery.
The final two newly emerging options for fibroid treatment are uterine artery embolization and ultrasound guided cryotherapy. If you are interested in more information about these options, contact your provider for the latest updates.
Many conditions are diagnosed and treated with the use of the laparoscope, including:
- Ectopic pregnancy
- Ovarian cysts
Learn more about laparoscopies on our Procedures and Surgeries page.
Usually the test does not hurt. You may feel the scraper or brush being wiped across your cervix, which sometimes causes a slight twinge. Many women report the most uncomfortable part of the exam is the pressure caused by the opening of the speculum. You can help make the exam more comfortable by breathing deeply and trying to relax the muscles at the opening of your vagina.