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Gynecology questions:

Our practitioners and doctors have listed answers and helpful links to common Pregnancy questions. For more personal advice relating to your needs, or if you have questions that we have not addressed here, please contact us to set up an appointment.


I’m only 45, but I think I’m having hot flashes. Is it too early for menopause? What can I do?

Your hot flashes could be a peri-menopausal symptom. The average age to stop periods is 51, but symptoms such as hot flashes, night sweats, moodiness, etc. can start a decade or more before your periods actually cease and is called perimenopause.  While there is no lab test to determine when you will enter menopause, there are effective treatments for symptoms. Also, these symptoms can mimic other disorders such as high or low thyroid and sugar imbalance. If this is a new symptom for you, consult your gyn provider. It would be wise to have a thorough check-up to determine what is causing your hot flashes so that appropriate therapy can be started.

My mother has osteoporosis. She has one of those dowager’s humps. I am afraid I might get it. What should I do? Should I be tested?

Osteoporosis can be hereditary.  A simple easy test, called a DEXA, measures your bone density and is used to diagnose osteoporosis.  Having a DEXA scan (or densitometry) will indicate if your bones are starting to thin (osteopenia), or if you have osteoporosis.  Often DEXA scans are ordered based upon your age, if you lose height or have medical conditions that make you higher risk.  You should have a review of your scan to determine if you need medication to improve the density of your bones. Regardless of your results, 1000-1200 milligrams of calcium and 800 to 1000 units of vitamin D is recommended every day along with weight-bearing or resistance (such as swimming) exercise three to five times a week. Contact us to set up an appointment to discuss bone health and testing options.

I have really bad PMS. Can you help me?

There is a lot that can be done to help. One of the things that you can do before your visit is to chart your symptoms for a couple of months. For example, get a calendar and write down when your periods are and if they are light, heavy, or moderate. Then think of your symptoms (for example, anger, depression, easily hurt feelings, bloating, fatigue) and record them also. When you come for your appointment bring the calendar and show it to your practitioner. We can help determine if it is PMS or some other kind of mood change or stress reaction.

Meanwhile, here are some things that you can do.  Trying aromatherapy (with lavender oil), meditation, healthy diet choices, aiming for a full night's rest and exercise can be helpful.  Try to get some form of exercise every day, even if you don’t feel like it.  There are many options to treat PMS including prescription medications, dietary supplements, and herbal remedies. Importantly, treating PMS is not a ‘one size fits all’ and tailoring your treatment can be done after careful review with your provider.  Contact us to set up an appointment to discuss your symptoms. 

I have heard some women are going on continuous oral contraceptives. Is it really okay to go without a period?

Yes, it is okay to not have a period if hormonally induced. More and more often oral contraceptives are being prescribed on a continuous basis (without a pill-free interval). For some women, this method is used simply for convenience to temporarily suppress menstrual bleeding for such events as vacations or honeymoons. For others, it is prescribed to help treat conditions such as endometriosis, menstrual migraines, menstrual irregularities, and PMS. Absent menstruation in women using hormonal contraceptives reflects endometrial suppression, not a gynecologic problem. If you feel you may benefit by using continuous oral contraceptives, contact us to set up an appointment.

I have always had terrible periods. Sometimes I’m in bed for two days. The bleeding is pretty heavy, but I’m more worried about the pain. Motrin or Midol don’t help, could it be endometriosis? What is that?

Severely painful and heavy periods may be something you have always had and seem normal to you, but they are not something that you have to live with. They are something about which you need to see your gyn provider.  Painful periods could be caused by endometriosis, a common disorder among women, or the pain could also be caused by some other condition.

Endometriosis is a condition in which microscopic bits of the endometrium (the lining of the uterus that sheds every month when you have your period) are found in the pelvis or elsewhere in the body. We don’t know why this happens to some women. These tiny cells of endometrial tissue become irritated each month. This process causes pain, inflammation, and eventually causes scar tissue and adhesions.

Endometriosis can cause serious problems besides painful periods. The most common are pain with sex, infertility, irregular bleeding and painful bowel movements.

There is only one way to diagnose endometriosis definitely and that is with laparoscopy. This is a one-day surgery performed by a gynecologist examining the inside of the pelvis through a fiber optic scope. Oral contraceptives or other hormonal medication can be used to decrease the pain of periods and hopefully stop the spread of the disease. It is very important to contact us to set up an appointment soon if you have these symptoms.

When should my daughter have her first gyn visit?

ACOG(American College of OBGYN) recommends that girls have their first appointment between the ages of 13-15 years to establish care, and most of the time that visit will not require an internal speculum examination.  Cervical cancer screening with Pap smear does not occur until age of 21years, but based upon clinical symptoms and risks, other testing and examination may be necessary.

What is BRCA testing? Should I have genetic testing?

BRCA stands for Breast Cancer gene and actually refers to two different genetic defects, BRCA 1 and 2 which are inherited genes conferring increased lifetime risk of breast, colon and ovarian cancer for patients who have them.  If you have close family members (parent, sibling or child) who have been diagnosed with any of those cancers younger than age 50 or have multiple members of family diagnosed with these cancers, then consideration should be given to having the test done to see if you have these genes. 

Should I get the HPV vaccine?

Gardasil is the name of the vaccination for HPV, and it is given to male and female patients aged 9-45 for prevention of cervical, vulvar, vaginal, anal and oropharyngeal cancers caused by 9 HPV types. This vaccine has been available since 2006, has been proven to be extremely safe, and has significantly decreased rates of cervical cancer in the US. Because of the high prevalence of HPV among sexually active individuals, it is recommended for everyone to receive it.  If adults did not complete the series as an adolescent, they can receive the vaccine up through age 45.

I was just diagnosed with HPV on my pap test. I read that this is the same as venereal warts. I have no idea how this happened and am really upset. What does this mean?

Many women are told that they have HPV (Human Papillomavirus) when they get the results of their pap smears. This is the virus that causes genital warts, but actual warts may never develop. HPV can also affect the cervix and lead to abnormal cells.  If not identified, these abnormal cells can lead to precancerous or cancerous changes to the cervix.  Most women are confused by the news of having HPV, wondering how they acquired this virus. Statistics show that upwards of 80% of the population has at least one of the strains of HPV. Many sources will relate that it is considered a sexually transmitted disease and for most people HPV probably is transmitted through any intimate contact, not just penetrative intercourse. Your gyn provider has probably recommended more frequent pap smears, or a colposcopy. It is important that you follow this advice and not delay having pap smears as scheduled.

I have begun leaking urine.  What can be done?

Urinary incontinence (leaking urine) is very common in women. In fact, it affects twice as many women compared to men.  Urinary incontinence can happen to women at any age, but it is more common in older women. This is probably because of hormonal changes during menopause. More than 4 in 10 women 65 and older have urinary incontinence. The two most common types of urinary incontinence are stress incontinence and urge incontinence, also called overactive bladder. This may be because pregnancy, childbirth, and menopause may make urinary incontinence more likely. Urinary incontinence is not a normal part of aging, and it can be treated.  Treatments can vary from pelvic floor exercises, medications or surgery depending on the type and severity of incontinence. Schedule an appointment to be evaluated and discuss treatment options. 


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