Abnormal Pap Smears

What is a pap smear?

The pap smear is a screening test for cervical cancer. Your provider collects cells from the cervix which are then reviewed by a pathologist for evidence of abnormal cells. The pap smear is an ideal screening test because cervical cancer usually takes several years to develop so pap smears allow us to diagnose the pre-cancerous changes so we can intervene before they develop into cancer.


The results of your pap smear will be reported in several different categories: 


  • Negative (normal) Atypical squamous cells of undetermined significance (ASC-US) 
  • Atypical squamous cells suspicious for high grade intraepithelial lesion (ASC-H)
  • Low grade intraepithelial lesions (LSIL). The LSIL category includes changes consistent with HPV, mild dysplasia, or CIN I (grade 1 cervical intraepithelial neoplasia).
  • High grade intraepithelial lesions (HSIL). HSIL includes changes consistent with moderate or severe dysplasia, CIN II or III, and carcinoma in situ (CIS).
  • Carcinoma
  • Atypical glandular cells (AGC) may be endocervical, endometrial, or other glandular cells
  • Endocervical adenocarcinoma in situ (AIS)Adenocarcinoma


What causes abnormal paps?

The most common abnormal pap results that we see are ASCUS and LSIL. The majority of abnormal paps are caused by an infection with a virus known as the human papillomavirus (HPV). HPV is the most common sexually transmitted disease. By age 50, over 80% of women will have been infected with HPV. The majority of people do not have any symptoms of the infection and will clear the infection on their own.


There are over 100 strains of HPV and over 30 of them are involved with genital infections. The different strains are categorized into “low risk” and “high risk” groups. High risk strains cause abnormal paps and can lead to cancer of the cervix, vagina, vulva, anus or penis. Low risk strains can cause mildly abnormal changes in pap smears and also cause genital warts.


How do we manage abnormal paps?

Once you have an abnormal result on your pap smear, your doctor may recommend you undergo colposcopy. Colposcopy is a procedure done in the office during which your doctor will look carefully at your cervix with a colposcope (a kind of microscope for the cervix). If any abnormal cells are seen, biopsies will be taken. The procedure takes 15-20 minutes and does not require any anesthesia. You may want to take 600-800 mg of ibuprofen before the procedure to help with cramping from the biopsy.


If the biopsy shows evidence of dysplasia or abnormality, management may include simply repeating your pap in 6 months, cryotherapy (freezing of the abnormal cells on the cervix) or removal of the affected part of the cervix (a procedure called a LEEP or a cone). Your doctor will tell you which is the best choice for you after the biopsy results come back.


You can also make some lifestyle changes that will help your body to clear the infection on its own. If you smoke, quit! Cigarette smoking helps the HPV virus to grow more quickly. If you are currently a smoker, quitting may be enough to return your pap smear to normal. Also, recent evidence suggests that increasing your folic acid to 800 micrograms a day may also help your body get rid of the infection.


Additional resources:



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Birth Control Pills

Birth control pills (also called oral contraceptives or “the pill”) are used by millions of women in the United States to prevent pregnancy. The pill is safe and effective for most women.




To understand how birth control pills work, you should know what happens during reproduction. A woman has two ovaries, one on each side of the uterus. Each month, one of the ovaries releases an egg into a fallopian tube. This is called ovulation. It typically occurs about 12-14 days before the start of the menstrual period.A woman can get pregnant if she has sex around the time of ovulation. During sex, the man ejaculates sperm into the vagina. The sperm travel up through the cervix and into the fallopian tubes.When a sperm meets an egg in the fallopian tube, fertilization-union of egg and sperm-can occur. The fertilized egg then moves down the fallopian tube to the uterus. It then attaches to the lining of the uterus and grows into a fetus.


Birth Control Pills

Birth control pills are made of hormones that prevent ovulation. The hormones in the pill also cause changes in the cervical mucus and the lining of the uterus. The cervical mucus thickens, which blocks the sperm from entering the cervix. The lining of the uterus thins, making it less likely that a fertilized egg can attach to it. Together, these events make it very unlikely that someone taking the pill will become pregnant.The pill is a very effective form of birth control. When women use the pill correctly, fewer than 1 in 100 will get pregnant over 1 year. But, about 8 in 100 typical users (8%) will become pregnant. This is because one or more pills may be missed or are not absorbed (due to vomiting for instance). If this occurs, a backup method of birth control, such as a condom or spermicides, should be used. If pills are missed and a backup method is not used, emergency contraception can be used to prevent pregnancy.The birth control pill is easy to use and convenient. But it does not protect against sexually transmitted diseases (STDs). If you are at risk for STDs, you should use condoms for protection.Although rare, some types of pills can cause severe illness in some women. The most serious problems are blood clots in the legs or lungs, heart attack, or stroke. Other rare problems that may occur include high blood pressure and problems with the liver and gallbladder. So, before your doctor or nurse will prescribe birth control pills for you, he or she will ask some questions about your health and your family history. He or she also may do a physical exam, which may include a pelvic exam and a breast exam.


Combination Pills

Combination birth control pills contain the hormones estrogen and progestin (a synthetic form of the hormone progesterone).There are many different brands with different does of hormones. This gives a woman a choice in finding a pill that is right for her.

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Breast Cancer Genetic Testing (BRCA)

A breast cancer (BRCA) gene test is a blood test to check for specific changes (mutations) in genes that help control normal cell growth. Finding changes in these genes, called BRCA1 and BRCA2, can help determine your chance of developing breast cancer and ovarian cancer. A BRCA gene test does not test for cancer itself. This test is only done for people with a strong family history of breast cancer, ovarian cancer and sometimes for those who already have one of these diseases. Genetic counseling before and after a BRCA test is very important to help you understand the benefits, risks, and possible outcomes of the test.A woman’s risk of breast and ovarian cancer is higher if she has BRCA1 or BRCA2 gene changes. Breast cancer is extremely rare in men but BRCA2 gene changes have been linked to male breast cancer and possibly prostate, may also be higher. The gene changes can be inherited from either your mother’s or father’s side of the family.Certain people have a higher chance of inheriting BRCA1 or BRCA2 gene changes.Individuals with a personal history of, or a close blood relative (1st, 2nd or 3rd degree in the maternal or paternal lineage) with, any one of the Red Flags are at increased risk of hereditary breast and ovarian cancer (HBOC). Further clinical evaluation by a qualified healthcare professional to determine the appropriateness of genetic testing is warranted. “Breast cancer” includes both invasive cancer and ductal carcinoma in situ (DCIS). “Ovarian cancer” includes epithelial ovarian cancer, fallopian tube cancer and primary peritoneal cancer. Red Flags are not intended to be used as a guide for insurance coverage purposes.


Red Flags in You or a Relative 


  • Breast cancer diagnosed at age 50 or younger
  • Ovarian cancer at any age
  • Two primary breast cancers
  • Male breast cancer
  • Triple Negative Breast Cancer
  • Pancreatic cancer with a breast or ovarian cancer
  • Ashkenazi Jewish ancestry with an HBOC-associated cancer
  • Two or more relatives with breast cancer, one under age 50
  • Three or more relatives with breast cancer at any age
  • A previously identified BRCA mutation in the family 

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Dysmenorrhea (Cramps)

Causes of Menstrual Pain

The uterus is a muscle, and like all muscles, it contracts and relaxes. This happens throughout the menstrual cycle. During your period, the uterus contracts more strongly. These contractions are caused by prostaglandins – a substance made by the endometrium. Sometimes, when the uterus contracts, it produces a cramping pain.Before your period, the level of prostaglandins in your body increases. Prostaglandin is released when your period starts. As you menstruate, prostaglandin levels drop. This is why pain tends to lessen after the first few days of your period.


Types of Dysmenorrhea


There are two types of dysmenorrhea. Pain during your period can be classified as either primary or secondary dysmenorrhea.


Primary Dysmenorrhea 

Primary dysmenorrhea is pelvic pain that is the result of having your period. Women with primary dysmenorrhea may have any of the following symptoms:


  • Cramps or pain in the lower abdomen or lower back
  • Pulling feeling in the inner thighs
  • Diarrhea
  • Nausea
  • Vomiting
  • Headache
  • Dizziness


Primary dysmenorrhea often begins soon after a girl begins having menstrual periods. As a woman gets older, her periods may become less painful. The pain may lessen after a woman gives birth. Not every woman is the same, however, and some do continue to have pain during their periods. Some cycles may be more painful than others. 


Secondary Dysmenorrhea

Secondary dysmenorrhea is menstrual pain that has another cause in addition to menstruation. With secondary dysmenorrhea, pain often begins earlier in the menstrual cycle. It usually lasts longer than normal cramps. For example, it may begin long before your period starts, it may get worse with your period, or it may not go away after your period ends.


Some of the most common causes of secondary dysmenorrhea are: 



A condition in which endometrial tissue is found in other areas in the body, such as the ovaries and fallopian tubes. This tissue acts like tissue in the uterus. Endometrial tissue outside the uterus responds to monthly changes in hormones the same way it does inside the uterus. It also breaks down and bleeds. This bleeding can cause pain, especially during your period



Tumors or growths that form on the outside, inside, or in the wall of the uterus. They are not cancerous, but they can cause more pain and heavier bleeding with periods.


Pelvic Inflammatory Disease

An infection of the uterus, fallopian tubes, or ovaries. Most cases develop from sexually transmitted diseases (STDs).


Intrauterine Device (IUD)

A device placed in the uterus to prevent pregnancy. It can cause pelvic pain and cramping and may make normal menstrual cramps worse.


Diagnosing Dysmenorrhea

Dysmenorrhea is diagnosed by exams and tests. For your doctor to diagnose a cause for dysmenorrhea, you will be asked to describe your history, symptoms, and menstrual cycles. Your doctor will then do a pelvic exam to check for anything abnormal in the reproductive organs. An ultrasound exam of the pelvic organs may also be done to further check for anything abnormal.


In some cases, the doctor can learn more by looking directly inside your body with laparoscopy. Laparoscopy is done with general anesthesia. This requires admission to an outpatient surgery unit. During laparoscopy, the doctor makes a small cut near your navel. A thin lighted scope – a laparoscope – is then inserted into your abdomen. The laparoscope allows the doctor to view the pelvic organs.


Sometimes, the doctor is able to find a cause for the dysmenorrhea. But, often there is no known cause. Based on the results of the tests, you and your doctor will decide which treatment is best for you.



There are effective ways to treat menstrual pain. Your doctor can prescribe or suggest medications that can help relieve your discomfort.


NSAIDS (nonsteroidal anti-inflammatory drugs)Drugs that block the production of the prostaglandins that cause menstrual cramps. These drugs also can prevent the other symptoms caused by prostaglandins, such as nausea, diarrhea, and pain. You can buy most NSAIDs, such as ibuprofen(Motrin) or naproxen(Aleve), over the counter. If these do not relieve your pain, talk to your doctor. He or she may prescribe some stronger medications.


NSAIDs work best when they are taken at the first sign of your period or pain. You usually need to take them only for 1 or 2 days. Do not take more pills than the package recommends. You should avoid taking NSAIDs while driking alcohol. Women with bleeding disorders, liver damage, stomach disorders, or ulcers should not take NSAIDs.


Oral Contraceptives

Taking oral contraceptives (birth control pills) also reduces menstrual pain. The birth control pill causes less growth of the endometrium. Less prostaglandin is produced, and there are fewer strong contractions, less flow, and less pain. Birth control pills can be used along with NSAIDs if necessary.


Finally…Pain during the menstrual period is a common problem for women. Most of the pain is mild and can be treated with over-the-counter medications. Sometimes, however, menstrual pain is severe and requires medical treatment.If you have severe menstrual cramps or cramps that last more than 2 or 3 days, call your doctor. He or she can examine you and help find a way to relieve the pain. 

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Emergency Contraception

Emergency Contraception can stop a pregnancy before it starts. (That means it’s not the abortion pill.) It works up to five days, or 120 hours, after unprotected sex, but take it sooner rather than later to reduce the possibility of getting pregnant. 


There are three types of Emergency Contraception: 



The newest form of EC in the U.S. is a one-pill formula available by prescription only. Ella blocks the hormones your body needs to conceive. This is completely effective for 5 days after unprotected sex. Effectiveness: Ella 70%. 


Plan B/Next Choice 

This is available over-the-counter without a prescription if you’re 17 or older. It works like birth control pills, but at a much higher dose and taken temporarily. It works up to 5 days after unprotected sex, but effectiveness decreases each day. Next Choice is a two-pill formula where you take one right away and the second within 12 hours. The newer version, called Plan B-One Step, is a bit more expensive but is just one pill. Effectiveness: Plan B 50%. 



This is the most effective EC there is. Have a doctor insert it within 5 days of a misstep and lower your chance of pregnancy. Effectiveness: IUD 95%. 


When Might You Need It? 


Swept up in the moment

Maybe it was because of alcohol. Maybe you thought you could go without birth control just this once. Maybe you didn’t think at all. No matter the reason, if you didn’t use any protection during sex and now wish you had, EC might be right for you – as long as it’s been fewer than 5 days since you had that unprotected encounter.


You had a “whoops” moment with your contraception

If the condom broke, or you forgot to take your pill, insert your ring, apply your patch, or if your diaphragm slipped – anything like that – you may want to take EC.


Withdrawal gone wrong

If he didn’t pull out in time, that’s another reason for EC.


For scary situations. 

If you are a victim of sexual assault please seek care as soon as possible in the ER. If you’ve been raped, or you had sex with someone who refused to use another form of contraception, consider EC.


Keep some on hand.

The sooner you take EC, the more effective it is. It’s not a bad idea to keep a box on hand, just in case you need it. EC has a shelf life of up to 3 years.


How much does it cost?

Over-the-counter, for women and men over 17 years old, EC costs $35. You will need a prescription if you are younger than 17, so cost varies based on insurance.


Where can I get it?

Emergency Contraception is available over the counter for women and men 17 and older – no appointment needed.


What are the side effects of Emergency Contraceptives?

Positive “side effects?” You bet. There are actually a lot of things about birth control that are good for your body as well as your sex life.


  • Offers protection and peace of mind after a “whoops” moment.
  • It’s safe to use. Women have been using it for 30 years.
  • Some EC options don’t have the same potential negative side effects as the pill, because you don’t take it continuously.
  • Even women who can’t usually use hormonal methods for medical reasons can use EC once in a while.


Everyone worries about negative side effects, but for many women, they’re not a problem. And if you do experience side effects with EC, they’ll probably go away after 24 hours.


  • Can cause an upset stomach and vomiting.
  • Could cause breast tenderness, irregular bleeding, dizziness, and headaches.
  • Frequent use can lead to irregular periods. 

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The Endometrium

The lining of the uterus responds to changes that take place during a woman’s monthly menstrual cycle. The cycle usually is about 28 days. First, the endometrium grows and thickens to prepare for a possible pregnancy. If pregnancy does not occur, the endometrium is shed by bleeding and then thins. These changes are triggered by hormones (estrogen and progesterone) made by the ovaries. 


There are three types of Emergency Contraception: 

With endometriosis, endometrial tissue is found in other areas of the body. It looks and acts like tissue in the uterus. It most often appears in places within the pelvis:


  • Ovaries
  • Fallopian tubes
  • Surface of the uterus
  • Cul-de-sac (the space behind the uterus)
  • Bowel
  • Bladder and ureters
  • Rectum 


Endometrial tissue may attach to organs in the pelvis or to the peritoneum, the tissue that lines the inside of pelvis and abdomen. In rare cases, it also may be found in other parts of the body. Endometrial tissue that grows in the ovaries may cause a cyst (also known as an endometrioma) to form.


Endometrial tissue outside the uterus responds to changes in hormones. It breaks down and bleeds like the lining of the uterus during the menstrual cycle. The breakdown and bleeding of this tissue each month can cause scar tissue, called adhesions. Adhesions can cause pain. Sometimes, adhesions bind organs together.


The symptoms of endometriosis often worsen over time. In many cases, treatment may help keep the condition from getting worse.


Who Is at Risk?


Endometriosis is most common in women in their 30s and 40s, but it can occur any time in women who menstruate. Endometriosis occurs more often in women who have never had children. Women with a relative who has had endometriosis are more likely to have it. Endometriosis is found in about three quarters of women who have chronic pelvic pain.



The main symptom of endometriosis is pelvic pain. Pain may occur with sex, during bowel movements or urination, or just before or during your menstrual cycle. Menstrual bleeding may occur more than once a month. Endometriosis also may cause infertility. 


No one is certain of the cause of endometriosis. For most women, a small amount of blood flows through the fallopian tubes into the abdomen during their periods. For women with endometriosis, the blood that flows through the tubes attach to other places and grow. Endometrial cells also may be carried through blood and lymph vessels.


The amount of pain does not tell you how severe your condition is. Some women with slight pain may have a severe case. Others who have a lot of pain may have a mild case.


Many women with endometriosis have no symptoms. In fact, they may first find out they have endometriosis if they are not able to get pregnant. Endometriosis is found in about one third of infertile women.


Women often find that symptoms are relieved while they are pregnant. In fact, many of the drugs used to relieve symptoms of endometriosis are based on the effects of hormones produced during pregnancy.



If you have symptoms of endometriosis, your doctor may do a physical exam, including a pelvic exam. If other causes of pelvic pain can be ruled out, your doctor may treat endometriosis without doing any further exams or surgery.


Endometriosis can be mild, moderate, or severe. The extent of the disease can be confirmed by looking directly inside the body. This can be done by laparoscopy. Sometimes a small amount of tissue is removed during the procedure. This is called a biopsy. The tissue then will be studied in a lab. You will be given general anesthesia for these procedures. Endometriosis also can be treated during a laparoscopy. If endometrial tissue is found during the laparoscopy, your doctor may decide to remove it right away.



Treatment for endometriosis depends on the extent of the disease, your symptoms, and whether you want to have children. It may be treated with medication surgery, or both. Although treatments may relieve pain and infertility for a time, symptoms may come back after treatment. 



In some cases of endometriosis, medications or NSAIDs (nonsteroidal anti-inflammatory drugs) may be used to relieve pain. These drugs will not treat any other symptoms of endometriosis.


Hormones also may be used to relieve pain. The hormones also may help slow the growth of the endometrial tissue and prevent growth of new adhesions, but will not make them go away. 


Some of the hormones most often prescribed include:


  • Oral contraceptives
  • Gonadotropin-releasing hormone (GnRH)
  • Progestin


These medications are not for all women. As with most medications, there are some side effects linked to hormone treatment. Some women may find the relief of pain is worth the side effects. These medications do not relieve pain in all women. 


Oral Contraceptives

Birth control pills often are prescribed to treat symptoms of endometriosis. The hormones in them help keep the menstrual period regular, lighter, and shorter and can relieve pain. Your doctor may prescribe the pill in a way that prevents you from having periods.


Gonadotropin-releasing hormone

GnRH is a hormone that helps control the menstrual cycle. GnRH agonists are drugs that are like human GnRH but many times stronger than the natural substance. They lower estrogen levels by turning off the ovaries. This causes a short-term condition that is much like menopause.


GnRH can be given as a shot, an implant, or nasal spray. In most cases, endometriosis shrinks and pain is relieved with GnRH use. 


Side effects in women taking this medication may include:


  • Hot flushes
  • Headaches
  • Vaginal dryness
  • Decrease in bone density


Treatment with GnRH most often last at least 3 months. To help reduce the amount of bone loss from long-term use, your doctor may prescribe certain hormones or medications to take along with GnRH agonists. In many cases, this therapy also may reduce other side effects. After stopping GnRH treatment, you should have periods again in about 6-10 weeks.



The hormone progestin also can be used to shrink endometriosis. Progestin works against the effects of estrogen on the tissue. Although you will no longer have a monthly menstrual period when taking progestin, you may have irregular vaginal bleeding. Progestin is taken as a pill or injection. 


Side effects in women taking this medication may include:


  • Mood changes
  • Weight changes
  • Bloating
  • Sexual problems



Surgery may be done to remove endometriosis and the scarred tissue around it. In most severe cases of endometriosis, surgery often is the best choice for treatment.


Surgery most often is done by laparoscopy. During laparoscopy, endometriosis can be removed or burned away. Not all cases can be handled with laparoscopy. Sometimes a procedure called laparotomy may be needed. Discuss with your doctor which method may be best for you.


After surgery, you may have relief from pain. Symptoms may return, though. Many patients are treated with both surgery and medications to help extend the symptom-free period.


Symptoms return within 1 year in about one-half of women who have had surgery. The more severe the disease, the more likely it is to return.


If pain is severe and does not go away after treatment, a hysterectomy (surgery to remove you uterus) may be an option. Endometriosis is less likely to come back if your ovaries also are removed. After this procedure, a woman will no longer have periods or be able to get pregnant. There is a small chance that your symptoms will come back even if your uterus and ovaries are removed.



Endometriosis is a long-term condition. Many women have symptoms that occur off and on until menopause. Keep in mind that there are treatment options. A woman can work with her doctor to decide which treatment is right for her. 


Uterine fibroids are growths that develop from the cells that make up the muscle of the uterus. They are also called leiomyomas or myomas.


The size, shape, and location of fibroids can vary greatly. They may appear inside the uterus, on its outer surface, within its wall, or attached to it by a stemlike structure.


Fibroids can range in size from small, pea-sized growths to large, round ones that may be more than 6 inches wide. As they grow, they can distort the inside as well as the outside of the uterus. Sometimes fibroids grow large enough to completely fill the pelvis or abdomen.


A woman may have only one fibroid or many of varying sizes. They may remain very small for a long time, suddenly grow rapidly, or grow slowly over a number of years. Because it is hard to predict their growth, fibroids can be hard to treat. 



Fibroids are most common in women aged 30-40, but they can occur at any age. Fibroids occur more often in black women than in white women. They also seem to occur at a younger age in black women and to grow more quickly.


Although fibroids are quite common, little is known about what causes them. The female hormone estrogen seems to increase their growth. The levels of estrogen in the body can rise or fall based on natural events. For instance, pregnancy causes a decrease. Medications also may cause a change in estrogen levels.



Most fibroids, even large ones, produce no symptoms at all. When symptoms occur, they often include:


  • Changes in menstruation
  • Heavier Menstrual bleeding
  • Longer or more frequent periods
  • Menstrual pain (cramps)
  • Vaginal bleeding at times other than menstruationAnemia (from blood loss)Pain In the abdomen or lower back (often dull, heavy and aching, but may be sharp)
  • Pressure
  • Difficulty urinating or frequent urination
  • Constipation, rectal pain, or difficult bowel movements
  • Abdominal cramps
  • Miscarriages and infertility


These symptoms also may be signs of other problems. Therefore, you should see your doctor if you have any symptoms.



During a routine pelvic exam, the first signs of fibroids can be found. There are a number of tests that may show more information about fibroids:


  • Ultrasound uses sound waves to create a picture of the uterus or of the pelvic organs
  • Hysteroscopy uses a slender device (the hysteroscope) to help the doctor see the inside of the uterus. It is inserted through the vagina and cervix (opening of the uterus). This permits the doctor to see some fibroids inside the uterine cavity.
  • Hysterosalpingography (HSG) is a special X-ray test. It may detect abnormal changes in the size and shape of the uterus and fallopian tubes.
  • Laparoscopy uses a slender device (the laparoscope) to help the doctor see the inside of the abdomen. It is inserted through a small cut just below or through the navel. The doctor can see fibroids on the outside of the uterus and some inside the uterine wall with the laparoscope.


Imaging tests, such as magnetic resonance imaging (MRI) and computed tomography (CT) scans, may be used but are rarely needed. Sometimes fibroids are found when these or other procedures are used to check some other medical problem or symptoms. Some of these tests may be helpful in checking on the growth of the fibroid over time.



Although most fibroids do not cause problems, there can be complications. Fibroids that are attached to the uterus by a stem may twist. This can cause pain, nausea, or fever. Fibroids may become infected. In most cases, this happens only when there is an infection already in the area. In very rare cases, very rapid growth of the fibroid and other symptoms may signal cancer.


A very large fibroid may cause swelling of the abdomen. This can make it hard to do a thorough pelvic exam.


Fibroids also may cause infertility. Other factors should be explored before fibroids are called the cause of a couple’s infertility. When fibroids are thought to be a cause, many women are able to become pregnant after they are treated.



Fibroids that do not cause symptoms, are small, or occur in a woman nearing menopause often do not require treatment. Certain signs and symptoms, though, may signal the need for treatment:


  • Heavy or painful menstrual periods
  • Bleeding between periods
  • Uncertainty whether the growth is a fibroid or another type of tumor, such as an ovarian tumor
  • Rapid increase in growth of the fibroid
  • Infertility
  • Pelvic Pain


If you have fibroids or have had them in the past, make sure to have regular checkups. If you have symptoms of fibroids, see your doctor right away. There is no need to limit your sexual activity unless the fibroids cause pain during sex.Fibroids may be treated by removing them with surgery. Drugs, such as gonadotropin-releasing hormone (GnRH) agonists (Lupron), may be used to shrink fibroids temporarily and to control bleeding to prepare for surgery.


The fibroids may be removed with myomectomy or hysterectomy. The choice of treatment depends on factors such as your own wishes and medical advice about the size and location of the fibroids.



Myomectomy is the surgical removal of fibroids, leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have children. If a woman does become pregnant after a myomectomy, she may need to have a cesarean delivery. Sometimes, though, a myomectomy causes internal scarring that can lead to infertility.


Fibroids may develop again, even after the procedure. If they do, more surgery is needed in 20-40% of cases.


Myomectomy may be done in a number of ways:


  • Laparotomy
  • Laparoscopy
  • Hysteroscopy


The method used depends on the location and size of the fibroids. For a laparotomy, an incision (cut) is made in the abdomen. The fibroids then are removed through the incision. Fibroids also can be removed through the incision. Fibroids also can be removed through laparoscope that is used to view the inside of the abdomen.


Hysteroscopy can be used to remove fibroids that protrude into the cavity of the uterus. The fibroids may be removed with a resectoscope, a tiny wire loop that uses electric power, or with a laser. Either of these instruments can be inserted through the hysteroscope. Although it cannot remove fibroids deep in the walls of the uterus, it often can control the bleeding these fibroids cause. This type of treatment is often done with pain relief, but you may not need to stay in the hospital.



Hysterectomy is the normal removal of the uterus. The ovaries may or may not be removed. It depends on other factors. Hysterectomy may be needed if:

  • Pain or abnormal bleeding persists
  • Fibroids are very large
  • Other treatments are not possible
  • A woman no longer wants children


If your doctor thinks you need a hysterectomy, he or she will first rule out other problems with the uterus, such diseases of the endometrium (the lining of the uterus).


Uterine Fibroids and Pregnancy

A small number of pregnant women have uterine fibroids. If you are pregnant and have fibroids, they likely won’t cause problems for you or your baby.


During pregnancy, fibroids may increase in size. Most of the growth occurs from blood flowing to the uterus. Coupled with the extra demands placed on the body by pregnancy, growth of fibroids may cause discomfort, feelings of pressure, or pain. Fibroids decrease in size after pregnancy in most cases.


Fibroids can increase the risk of:


  • Miscarriage (in which the pregnancy ends before 20 weeks)
  • Preterm birth
  • Breech birth (in which the baby is in a position other than head down)


Rarely, a large fibroid can block the opening of the uterus or keep the baby from passing into the birth canal. In this case, a cesarean delivery is done. In most cases, even a large fibroid will move out of the fetus’s way as the uterus expands during pregnancy. Women with large fibroids may have more blood loss after delivery.


Often no treatment of fibroids is needed during pregnancy. If you are having symptoms such as pain or discomfort your doctor may prescribe rest. Sometimes a pregnant woman with fibroids will need to stay in the hospital for a time because of pain, bleeding, or threatened preterm labor. Very rarely, myomectomy may be performed in a pregnant woman. Cesarean birth may be needed after myomectomy.


Finally…Uterine fibroids are benign growths that occur quite often in women. About one in four or five women over age 35 has them. Fibroids may cause no symptoms and require no treatment.


If you have uterine fibroids or have had them in the past, you should be checked by your doctor on a regular basis. Getting regular checkups and being alert to warning signs will help you be aware of changes that my require treatment. 

Vaginal Infections

Vaginitis: When do I Treat Over-the-Counter?

With the availability of over the counter medications to treat yeast infections, we are seeing a number of women self-diagnosing vaginal infections. Sometimes correctly. Sometimes not!


So, what is normal discharge and what is not? Most women have a vaginal discharge to some extent. Typically, it is a clear, whitish discharge that does not produce a foul odor or cause itching or pain. It may vary during the menstrual cycle, with pregnancy, and with age.


There are several common vaginal infections: yeast, bacterial vaginosis (BV), trichomonasis, gonorrhea, and chlamydia.


Yeast infection symptoms often include a “cottage cheese” white discharge, itching, burning, and pain with intercourse. However, while these are the most common symptoms, they are not the only symptoms nor do all of these symptoms need to be present to be a yeast infection.


Bacterial vaginosis is another common vaginal infection. Its symptoms include a thin milky white or yellow discharge, mild vulvar irritation, and a fishy odor. It can not be treated with a yeast medication and usually requires an office visit for evaluation.


Trichomonasis, gonorrhea, and chlamydia are sexually transmitted. There are many symptoms which may include an unusual discharge, pelvic pain, pain with intercourse, a partner with symptoms, painful urination, redness of the vulva, or burning or itching in the vagina. Sometimes these infections are asymptomatic.Who needs to come in for an appointment and who can treat themselves at home?


You should make an appointment if:


  • you have never been diagnosed in the office before and this is your first infection
  • you have tried an over-the-counter treatment and are still experiencing symptoms
  • you are worried about an STDyour symptoms are different than a yeast infection


Remember not to use an OTC medication in the vagina for at least 48 hours before your appointment. Also, we are unable to see you for vaginitis while you are on your period. We will usually see you within 24 hours of your call. 


Guidelines for Vulva / Vaginal Skin Care

Laundry Products

Use a detergent free of dyes, enzymes and perfumes (such as ALL Free and Clear or Earth-Rite) on any clothing that comes in contact with your vulva such as your underwear, exercise clothes, towels or pajama bottoms. Use 1/3 to ½ the suggested amount per load. Other clothing may be washed in the laundry soap of your choice.


  • Do not use a fabric softener in the washer or dryer on these articles of clothing. If you do not use dryer sheets with the rest of your clothes, for any loads, you must hang dry your underwear, towels, and any other clothing that comes in contact with your vulva.
  • Stain Removing Products. 
  • Soak and rinse in clear water all underwear and towels on which you have used a stain removing product. Then wash in your regular washing cycle. This removes as much of the product as possible.



Wear white all cotton underwear, not nylon with a cotton crotch. Cotton allows air in and moisture out. Thong or G-string type underwear is not recommended on a daily basis.

Avoid pantyhose. If you must wear them, either cut out the diamond crotch (if you cut out the crotch be sure to leave ¼ to ½ inch of fabric from the seam to prevent running) or wear thigh high hose. Many stores now carry thigh high nylons.

Avoid tight clothing, especially clothing made from synthetic fabrics. Remove wet bathing and exercise clothing as soon as you can.


Bathing and Hygiene 

  • Avoid bath soaps, lotions, gels, etc. which contain perfume. These may smell nice but can be irritating. This includes many baby products and feminine hygiene products marked “gentle” or “mild”. We suggest any of the following soaps: Dove-Hypoallergenic, Neutrogena, Basis, or Pears. Do not use soap directly on the vulvar skin just warm water and your hand will keep the vulvar area clean without irritating the skin.
  • Avoid all bubble baths, baths salts, and scented oils.
  • Do not scrub vulvar skin with a washcloth; washing with your hand is adequate for good cleaning.
  • Do not use hot water while bathing or showering. Luke-warm water should be used.
  • Pat dry rather than rubbing with a towel or use a hairdryer on a cool setting to dry the vulva.
  • Baking Soda soaks. Soak in lukewarm (not hot) bathwater with 4-5 tablespoons of baking soda to help soothe vulvar itching and burning. A sitz bath that goes on the toilet is best. Soak 1 to 3 times a day for 10-15minutes when you have vulvar symptoms.
  • Use white, unscented toilet paper. If paper has a perfumed scent or lotion, avoid using it. Avoid “wiping” after urinating; blot or dab only.
  • Avoid all feminine hygiene sprays, perfumes, adult or baby wipes. Pour lukewarm water over the vulva after urinating if urine causes burning of the skin. Pat dry rather than rubbing with a towel.
  • Avoid the use of deodorized pads and tampons. Tampons should be used when the blood flow is heavy enough to soak one tampon in four hours or less. Tampons are safe for most women, but wearing them too long or when the blood flow is light may result in vaginal infection, increased discharge, odor, or toxic shock syndrome. Also, use only pads that have a cotton liner that comes in contact with your skin (no dry weave pads).
  • Do not use over-the-counter creams or ointments until you ask your health care provider. When buying ointments, be sure that they are paraben and fragrance free.Small amounts of extra virgin olive oil, vegetable oil, or solid shortening may be applied to your vulva as often as needed to protect and moisturize the skin. It also helps to decrease skin irritation during your period and when you urinate.
  • DO NOT DOUCHE. Baking soda soaks will help rinse away extra discharge and help with odor.DO NOT SHAVE, wax or laser the vulvar area (the bikini line is ok).
  • Some women may have problems with chronic dampness. 
  • Keeping dry is important.
  • Do not wear pads daily.
  • Choose cotton fabrics whenever you can.
  • Keep an extra pair of underwear with you in a small bag and change if you become damp during the day at work/ school.
  • Gold Bond Powder or Zeosorb Powder may be applied to the vulva and groin area one to two times per day to help absorb moisture.
  • Dryness and irritation during intercourse may be helped by using a lubricant. Use a small amount of pure vegetable oil/olive oil or Crisco (solid or oil). The vegetable oils contain no chemicals to irritate vulvar/vaginal skin. Vegetable oils will rinse away with water and will not increase your chances of infection. Water-based products like K-Y Jelly tend to dry before intercourse is over and also contain chemicals that can irritate your vulvar skin. If may be helpful to use a non-lubricated, non-spermicidal condom, and use vegetable oil as the lubricant. This will help keep the semen off the skin which can decrease burning and irritation after intercourse.


Birth Control Options

  • All hormonal contraceptives will have an effect on vaginal secretions but should not increase your frequency of vaginitis.
  • Lubricated condoms, contraceptive jellies, creams, or sponges may cause itching and burning. Ask your health care provider for help.
  • The use of latex condoms with a vegetable oil as lubricant is suggested to protect your skin. Oil based lubricants may affect the integrity of condoms when used for birth control or prevention of sexually transmitted disease. Our experience has not found this to be a problem with vegetable based oils. However, the Center for Disease Control recommends that condoms not be used with any oil based lubricants for birth control or prevention of sexually transmitted diseases. 

Genital Herpes

What is genital herpes?

Genital herpes is a sexually transmitted disease (STD) caused by the herpes simplex viruses type 1 (HSV-1) or type 2 (HSV-2). 


How common is genital herpes?

CDC estimates that, annually, 776,000 people in the United States get new herpes infections. Genital herpes infection is common in the United States. Nationwide, 16.2%, or about one out of six, people aged 14 to 49 years have genital HSV-2 infection. Transmission from an infected male to his female partner is more likely than from an infected female to her male partner. Because of this, genital HSV-2 infection is more common in women (approximately one out of five women aged 14 to 49 years) than in men.


What are the symptoms of genital herpes?

Most individuals infected with HSV-1 or HSV-2 experience either no symptoms or have very mild symptoms that go unnoticed or are mistaken for another skin condition. Because of this, most people infected with HSV-2 are not aware of their infection. When symptoms do occur, they typically appear as one or more blisters on or around the genitals, rectum or mouth. The blisters break and leave painful sores that may take two to four weeks to heal. Experiencing these symptoms is sometimes referred to as having an “outbreak.” The first time someone has an outbreak they may also experience flu-like symptoms such as fever, body aches and swollen glands.


Repeat outbreaks of genital herpes are common, in particular during the first year of infection. Symptoms of repeat outbreaks are typically shorter in duration and less severe than the first outbreak of genital herpes. Although the infection can stay in the body indefinitely, the number of outbreaks tends to decrease over a period of years.


How do people get genital herpes?

People get herpes by having sex with someone who has the disease. “Having sex” means anal, vaginal, or oral sex. HSV-1 and HSV-2 can be found in and released from the sores that the viruses cause. The viruses can also be released from skin that does not appear to have a sore. Generally, a person can only get HSV-2 infection during sexual contact with someone who has a genital HSV-2 infection. Transmission can occur from an infected partner who does not have a visible sore and may not know that he or she is infected. HSV-1 can cause sores in the genital area and infections of the mouth and lips, so-called “fever blisters.” HSV-1 infection of the genitals is caused by mouth to genital or genital to genital contact with a person who has HSV-1 infection.


What are the complications of genital herpes?

Genital herpes can cause painful genital sores in many adults and can be severe in people with suppressed immune systems. If a person with genital herpes touches their sores or the fluids from the sores, they may transfer herpes to another part of the body. This is particularly problematic if it is a sensitive location such as the eyes. This can be avoided by not touching the sores or fluids. If they are touched, immediate and thorough hand-washing make the transfer less likely.


Some people who contract genital herpes have concerns about how it will impact their overall health, sex life, and relationships. It is best to talk to a health care provider about those concerns, but it also is important to recognize that while herpes is not curable, it is a manageable condition. Since a genital herpes diagnosis may affect perceptions about existing or future sexual relationships, it is important to understand how to talk to sexual partners about STDs.


How does genital herpes affect a pregnant woman and her baby?

It is crucial that pregnant women infected with HSV-1 or HSV-2 go to prenatal care visits and tell their doctor if they have ever experienced any symptoms of, been exposed to, or been diagnosed with genital herpes. Sometimes genital herpes infection can lead to miscarriage or premature birth. Herpes infection can be passed from mother to child resulting in a potentially fatal infection (neonatal herpes). It is important that women avoid contracting herpes during pregnancy.


A woman with genital herpes may be offered antiviral medication from 36 weeks gestation through delivery to reduce the risk of an outbreak. At the time of delivery a woman with genital herpes should undergo careful examination. If herpes symptoms are present at delivery, a cesarean delivery (also called a ‘C-section’) is usually performed.


How is genital herpes diagnosed?

Health care providers can diagnose genital herpes by visual inspection if the outbreak is typical. Providers can also take a sample from the sore(s) and test it. Sometimes, HSV infections can be diagnosed between outbreaks with a blood test. A person should discuss such testing options with their health care provider.


Is there a cure or treatment for genital herpes?

There is no treatment that can cure herpes. Antiviral medications can, however, prevent or shorten outbreaks during the period of time the person takes the medication. In addition, daily suppressive therapy (i.e., daily use of antiviral medication) for herpes can reduce the likelihood of transmission to partners.


How can genital herpes be prevented?

Correct and consistent use of latex condoms can reduce the risk of genital herpes, because herpes symptoms can occur in both male and female genital areas that are covered or protected by a latex condom. However, outbreaks can occur in areas that are not covered by a condom.


The surest way to avoid transmission of sexually transmitted diseases, including genital herpes, is to abstain from sexual contact, or to be in a long term mutually monogamous relationship with a partner who has been tested and is known to be uninfected.


Persons with herpes should abstain from sexual activity with partners when sores or other symptoms of herpes are present. It is important to know that even if a person does not have any symptoms, he or she can still infect sex partners. Sex partners of infected persons should be advised that they may become infected and they should use condoms to reduce the risk. Sex partners can seek testing to determine if they are infected with HSV. 

Hormone Replacement Therapy

Much has been written about hormone therapy in the recent past, especially about studies suggesting that postmenopausal hormone replacement therapy may increase health risks. Although it was believed from previous studies that hormone therapy was protective against heart disease, strokes and other medical problems, recent studies have indicated otherwise and have caused understandable concern among those patients using it.


At the present time, only two benefits are securely attributed to hormone replacement therapy – relief from menopausal symptoms and bone density preservation. While no other medication, supplement or practice has been shown to be as effective as estrogen for treating symptoms, we now have other effective medications to prevent and treat osteoporosis. In the end, estrogen therapy should be reserved for short term therapy of severe perimenopausal symptoms, and then at the lowest dose that gives adequate relief.


If you and your provider decide that hormone replacement is for you, there are a number of options. It should be remembered, however, that whenever any estrogen is given to a woman with a uterus for a significant amount of time, a progesterone-type medication must also be given, to avoid increasing the chance of cancer of the uterus.


Estrogen may be given as a pill, by way of a patch, as a gel applied to the skin, as a vaginal cream or pill, or in the form of a soft plastic vaginal ring that stays in place for up to a month. While a pill may be the most convenient way to take hormones, variations in absorption from the intestine, and in how the hormones are broken down by an individual’s liver may make one of the other delivery methods more safe for many women.


The dose of estrogen prescribed should be tailored to the patient’s symptoms, aiming for the lowest effective dose. Realizing that almost all women experience a natural gradual tapering off of menopausal symptoms, your doctor will try decreasing your dose after a suitable period of time. Eventually, you should be able to do well without hormone therapy. Whenever a dose decrease is contemplated, however, realize that symptoms may increase for a time, and that this can be decreased by a gradual “weaning” to the new dose.


Hormone replacement therapy is certainly not for everyone, but may be helpful for some women having severe menopausal transition symptoms. Please do not hesitate to ask questions of your health care provider on this complex subject. 

HPV Vaccine (Gardasil)

What is HPV?

Human Papilloma Virus (HPV) is a common virus. In 2005, the Centers for Disease Control (CDC) estimated that 20 million people in the U.S. had this virus. There are many different types of HPV; some cause no harm. Others can cause diseases of the genital area. For most people, the virus goes away on its own. When the virus does not go away, it can develop into cervical cancer, precancerous lesions, or genital warts, depending on the HPV type. The immunization helps protect against four types of HPV.


Who is at risk for HPV?

In 2005, the CDC estimated that at least 50% of sexually active people catch HPV during their lifetime. Many people who have HPV may not show any signs or symptoms. This means they can pass on the virus to others and not know it.


Who should receive the HPV vaccine?

All girls and women 9 through 26 years of age. The vaccine has also been approved for use in men.


Will the vaccine help me if I already have HPV?

You may benefit if you already have HPV because most people are not infected with all four types of HPV contained in the vaccine.


How is the HPV vaccine given?

HPV vaccine is given as an injection. You will receive 3 doses of the vaccine: your first dose, a second dose 2 months after the first dose, and a third dose 6 months after the first dose.


Are there possible side effects of the HPV vaccine?

The most commonly reported side effects include swelling, pain, itching and redness at the injection site and fever.


If you have further questions about the HPV vaccine, please contact your Women’s Care Consultants provider or visit www.cdc.gov/vaccines/vpd-vac/hpv. If you are interested in receiving this vaccine, please call us at 314-432-3669 to schedule your appointments. 

Human Papillomavirus Infection (HPV)

What is HPV?

Human Papilloma Virus (HPV) is a common virus. In 2005, the Centers for Disease Control (CDC) estimated that 20 million people in the U.S. had this virus. There are many different types of HPV; some cause no harm. Others can cause diseases of the genital area. For most people, the virus goes away on its own. When the virus does not go away, it can develop into cervical cancer, precancerous lesions, or genital warts, depending on the HPV type. The immunization helps protect against four types of HPV.


Who is at risk for HPV?

In 2005, the CDC estimated that at least 50% of sexually active people catch HPV during their lifetime. Many people who have HPV may not show any signs or symptoms. This means they can pass on the virus to others and not know it.


Who should receive the HPV vaccine?

All girls and women 9 through 26 years of age. The vaccine has also been approved for use in men.


Will the vaccine help me if I already have HPV?

You may benefit if you already have HPV because most people are not infected with all four types of HPV contained in the vaccine.


How is the HPV vaccine given?

HPV vaccine is given as an injection. You will receive 3 doses of the vaccine: your first dose, a second dose 2 months after the first dose, and a third dose 6 months after the first dose.


Are there possible side effects of the HPV vaccine?

The most commonly reported side effects include swelling, pain, itching and redness at the injection site and fever.


If you have further questions about the HPV vaccine, please contact your Women’s Care Consultants provider or visit www.cdc.gov/vaccines/vpd-vac/hpv. If you are interested in receiving this vaccine, please call us at 314-432-3669 to schedule your appointments. 

Ovarian Cysts

The ovaries are two small organs located on either side of a woman’s uterus. An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms on the ovary. It is normal for a small cyst to develop in the ovaries. In most cases, cysts are harmless and go away on their own. In other cases, they may cause problems and need treatment.


Types of Cysts

Ovarian cysts are quite common in women during their childbearing years. A woman can develop one cyst or many cysts. Ovarian cysts can vary in size. There are many different types of ovarian cysts. Most cysts are benign (not cancerous). Rarely, a few cysts may turn out to be malignant (cancerous). For this reason, all cysts should be checked by your health care provider.


Functional Cysts

The most common type of ovarian cyst is called a functional cyst because it forms as a result of ovulation, a normal function. Each month, an egg, encased in a sac called a follicle, grows inside the ovary. The egg is released from the ovary at the middle of the menstrual cycle.


There are two types of functional cysts:

  • Follicle cysts form when the follicle does not open to release the egg.
  • Corpus luteum cysts form when the follicle that held the egg seals off after the egg is released. 


Both types of cysts usually cause no symptoms or only mild ones. They go away in 6-8 weeks. 


Dermoid Cysts

Dermoid cysts form from a type of cell capable of developing into different kinds of tissues, such as skin, hair, fat, and teeth. Dermoid cysts may be present from birth but grow during a woman’s reproductive years. These cysts may be found on one or both ovaries. Dermoid cysts often are small and may not cause symptoms. If they become large, they may cause pain.



Cystadenomas are cysts that develop from cells on the outer surface of the ovary. Sometimes they are filled with a watery fluid or a thick, sticky gel. They usually are benign, but they can grow very large and cause pain.



Endometriomas are ovarian cysts that form as a result of endometriosis. In this condition, endometrial tissue- tissue that usually lines the uterus- grows in areas outside of the uterus, such as the ovaries. This tissue responds to monthly changes in hormones. Eventually, an endometrioma may form as the endometrial tissue continues to bleed with each menstrual cycle. These cysts are sometimes called “chocolate cysts” because they are filled with dark, reddish-brown blood.



Most ovarian cysts are small and do not cause symptoms. Some cysts may cause a dull or sharp ache in the abdomen and pain during certain activities. Larger cysts may cause torsion (twisting) of the ovary that causes pain. Cysts that bleed or rupture (burst) may lead to serious problems requiring prompt treatment.


In rare cases, a cyst may be cancerous. In its early stages, ovarian cancer often has no symptoms, so you should be aware of its warning signs. Be sure to see your doctor if you have any of these signs. Ovarian cancer is very rare in young women, but the risk increases as a woman ages.


Warning Signs of Cancer in the Ovary 

  • Bloating
  • Pelvic Pain
  • Back pain
  • Enlargement or swelling of the abdomen
  • Inability to eat normally
  • Unexplained weight loss
  • Urinary frequency or incontinence
  • Constipation
  • Feeling tired
  • Indigestion 



An ovarian cyst may be found during a routine pelvic exam. If your health care provider finds an enlarged ovary, tests may be recommended to provide more information:


Vaginal Ultrasound

This procedure uses sounds waves to create pictures of the internal organs that can be viewed on a screen. For this test, a slender instrument called a transducer is placed in the vagina. The views created by the sound waves show the shape, size, location, and make-up of the cyst.



In this type of surgery, a laparoscope- a thin tube with a camera- is inserted into the abdomen to view the pelvic organs. Laparoscopy also can be used to treat cysts.


Blood Tests

If you are past menopause, in addition to an ultrasound exam, you may be given a test that measures the amount of a substance called CA 125 in your blood. An increased CA 125 level may be a sign of ovarian cancer in woman past menopause. In premenopausal woman, an increased CA 125 level can be caused by many other conditions besides cancer. Therefore, this test is not a good indicator of ovarian cancer in premenopausal women.


If your health care provider thinks that your cyst may be cancer, more tests may be ordered. It may be recommended that you see a doctor who socializes in gynecologic cancer.



Several treatment options are available. Choosing an option depends on many factors, including the type of cyst, whether you have symptoms, your family history, how large the cyst is, and your age.


“Watchful” Waiting

If your cyst is not causing any symptoms, your health care provider may simply monitor it for 1-2 months and check to see whether it has changed in size. Most functional cysts go away on their own after one or two menstrual cycles.


If you are past menopause and have concerns about cancer, your health care provider may recommend regular ultrasound exams to monitor your condition. If the appearance of your cyst changes or if it gets bigger, treatment may be needed.


Birth Control Pills

If you keep having functional cysts, birth control pills may be prescribed to prevent you from ovulating. You are much less likely to form new cysts if you do not ovulate. This treatment will not make cysts you already have go away, but it will prevent new functional cysts from forming.



If your cyst is large or causing symptoms, your health care provider may suggest surgery. The extent and type of surgery that is needed depends on several factors:


Size and type of cyst

  • Your age
  • Your symptoms
  • Your desire to have children 


Sometimes, a cyst can be removed without having to remove the ovary. This surgery is called cystectomy. In other cases, one or both of the ovaries may have to be removed. Your doctor may not know which procedure is needed until after the surgery begins. 

Polycystic Ovary Syndrome

Key Hormones in Women

Hormones are produced by the body to send messages from one area to another. They are produced in both men and women in different amounts. Certain hormones control a woman’s menstrual cycle and her ability to get pregnant.


Follicle-stimulating hormone (FSH) and luteinizing hormone (LH) are made by the pituitary gland, a small organ at the base of the brain. FSH causes eggs to mature in the ovaries. LH triggers their release from the ovaries (ovulation).

Estrogen and progesterone are produced by the ovaries. Estrogen signals the endometrium to thicken during each menstrual cycle. After ovulation, progesterone causes blood vessels in the endometrium to swell and other changes to occur to prepare for a possible pregnancy.

Androgens, so-called male hormones, are made by the ovaries in women and the tests in men. They are used by the ovaries to make estrogen, the so-called female hormone. 


The Condition


Reproductive Hormones


To understand PCOS, it helps to know how certain hormones affect a woman’s body. If hormone levels are abnormal, PCOS may occur.


Each month a follicle, containing an egg, matures and is released from a woman’s ovary. If the egg is fertilized by a sperm, pregnancy occurs. If not, the endometrium (the lining of the uterus) is shed and menstruation occurs. In a normal ovary, one follicle matures and an egg is released each month. In a polycystic ovary, there are many follicles but they do not mature and an egg is not released.


Because the eggs are not released, progesterone levels are too low and androgen and estrogen are too high. This may cause irregular periods and other symptoms of PCOS.



Another hormone that plays a role in PCOS is insulin. Insulin is a hormone that controls the body’s use of sugar (glucose). Many women with PCOS produce too much insulin or the insulin they produce doesn’t work as it should. This is one reason why women with PCOS tend to gain weight or have a hard time losing weight. They also have an increased risk of diabetes (a condition in which the levels of sugar in the blood are too high).


Insulin interrupts the normal growth of the follicle in the ovaries. The ovaries slowly become enlarged because of the number of follicles they contain.


Long-Term Health Risks

Many women with PCOS are at an increased risk for health problems. They may need to be tested more often and may require treatment. Treatment will help prevent other problems.


For instance, PCOS is linked to heart disease, diabetes, and high blood pressure. Also, the presence of estrogen without progesterone increases the risk that the lining of the uterus (endometrium) will grow too much. This is a condition known as endometrial hyperplasia. If not treated, endometrial hyperplasia may turn into cancer.


Signs and Symptoms

In some women with PCOS, hormone changes may begin as early as very first menstrual cycle. In other women with PCOS, changes occur over time.


Signs and symptoms vary in women with PCOS and may include:


  • Excess hair on the face and body (known as hirsutism)
  • AcneDark color and change in texture of the skin along the neck, armpits, groin and inner thighs.
  • Obesity
  • Irregular menstrual periods or no periods
  • Trouble getting pregnant
  • Vaginal yeast infectionsHair loss 



To diagnose PCOS, your doctor will ask you questions about your health, your menstrual cycle, and your family history. He or she also will do a complete exam that may include blood tests to check levels of insulin, other hormones, and blood glucose.


A pelvic ultrasound may be done to look at the ovaries. It also can be used to check the lining of the uterus to see if it is thickened.



PCOS is a lifelong condition, but it can be treated in a number of ways. Treatment depends on your symptoms and whether you want to become pregnant. Long-term treatment may be needed if other medical problems arise.


Lifestyle Changes

Lowering insulin levels is a key to managing PCOS. Daily exercise improves the body’s use of insulin. Polycystic ovary syndrome may be relieved by daily exercise for at least 45 minutes a day.


In some women with PCOS, weight loss will lower insulin levels enough to allow ovulation to begin. It also may help relieve some of the symptoms of PCOS, such as less new hair growth and less risk of endometrial hyperplasia.


Changes in the type of foods that you eat also may help lower insulin levels. Women with PCOS should decrease their intake of foods high in carbohydrates. Carbohydrates are found in breads, pasta, potatoes, and foods that are sweet. A nutritionist may help.



To treat irregular menstrual periods, your doctor may prescribe either the hormone progesterone or birth control pills. Women who wish to become pregnant may be given medications to help them ovulate. Some women with PCOS will be prescribed medication to lower their insulin levels.


Your doctor also may prescribe birth control pills and other medications to help slow growth of new body hair. It may take a number of months for you to notice any results. These medications likely will not remove hair that is already there. To remove unwanted hair, you may want to try shaving, electrolysis, or other hair removal methods.



With proper treatment, PCOS can be managed and your symptoms can be relieved. You should have long-term health care to look for disorders that may arise. If you have PCOS, changes in your lifestyle will improve your health. 

Sexually Transmitted Diseases

Sexually transmitted diseases (STDs) are infections you can get through sexual contact: vaginal, oral, or anal. More than 20 STDs have been identified so far.


With more than 15 million new cases in the US each year, STDs are more common than most people think. Young people have a particularly high risk. In fact, each year 1 out of 4 sexually active teens gets an STD.


Most STDs are easily cured if they’re caught early. Unfortunately, many people don’t seek treatment because they have no symptoms and thus don’t even know they have an infection. Other people have symptoms, but don’t go to the doctor because they are too embarrassed or don’t realize that their symptoms are a warning sign of a serious infection. This is tragic, because untreated STDs can cause severe health problems and may even result in death. Also, when left untreated, they’re likely to continue spreading from one person to another.


Laboratory tests can help your doctor detect most STDs, but these infections can’t be diagnosed unless you decide to seek medical help.


Important facts about STDs

  • Your risk of acquiring an STD begins the first time you have sex. The more partners you have, the greater your risk.
  • STDs can lead to cancer, infertility, long-term pain, and ectopic pregnancy.
  • Mothers can pass STDs on to their babies before, during, or after birth.
  • Some STDs are not curable and stay with you for life.
  • Early diagnosis and treatment can either cure you or help you avoid most of the serious complications. 


Do I have an STD? 

Understanding the symptoms of STDs and how they are transmitted is the first step to early treatment and prevention. Here’s a quick guide to the most common symptoms of STDs and the specific diseases that may be causing them:


Chlamydia, gonorrhea, trichomoniasis, yeast

Unusual discharge from penis, or vagina


Herpes, HPV

Bumps, blisters, or warts



Painless sores on mouth, penis, vagina


Viral hepatitis

Jaundice (yellow skin), fatigue, and abdominal pain


Trichomoniasis, chlamydia, gonorrhea, herpes

Pain or burning during urination or sex


Herpes, pubic lice (crabs), trichomoniasis, yeast infection

Itching or burning around penis, vagina, or anus



Yellow-green discharge from vagina with odor


HIV/AIDS, herpes, syphilis

Flu-like symptoms


Chlamydia, gonorrhea, trich, hepatitis

Abdominal pain



Bleeding between periods



Unexplained weight loss


How can I reduce my risk of getting or passing on an STD?

The only way to be sure you won’t get an STD is abstinence (not having sex). If you do have sex, limit your risk by practicing “safer” sex:

  • Use a latex condom every time you have sex, even oral sex. But remember that condoms must be used properly to prevent STDs, and even proper use does not ensure you won’t be infected. Some STDs, such as herpes, HPV, and syphilis, can be transmitted through skin-to-skin contact in areas that the condom does not cover.
  • Limit the number of people with whom you have sex and don’t go back and forth between partners. It’s safest to have only one partner (one who doesn’t have an STD!).
  • Before you have sex with a new partner, ask if he or she has an STD or any unusual symptoms. If so, don’t have sex until you’re sure the infection is cured or you learn how to protect yourself.
  • Be open and honest about STDs with your partner. If either of you has an STD, both of you should be tested and treated if necessary. Otherwise, you could repeatedly pass the infection back and forth to each other.
  • Both you and your partner need to be treated for STDs. Otherwise, you may become infected again.
  • Talk to your doctor about your risk of getting an STD and ways to avoid it. 

Urinary Incontinence

There are two main types of urinary incontinence. These are stress urinary incontinence (SUI) and urge urinary incontinence. If you have stress urinary incontinence (SUI), you may lose urine when you:

  • Laugh, sneeze or cough
  • Walk or exercise
  • Get up from a seated or lying position.
  • Have intercourse 


If you have urge urinary incontinence you might have: 

  • Sudden losses of urine without any warning
  • The inability to reach the toilet soon enough when the urge to void arises
  • To plot out a trip around town based on the location of certain restrooms 


What Can You Do If You Have Incontinence 

First, talk to your provider. With your help, he or she can determine the type and cause of your incontinence, which is the first step toward finding the best treatment for you. There are many treatment options for incontinence including pelvic physical therapy, pessary placement, and minimally invasive surgical procedures. 

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