Diet, exercise, and vitamin supplementation have been found to be very helpful for many women. Vitamin B6, evening primrose oil, and calcium are what we recommend. Exercise releases the endorphins in the body to help alleviate the emotional highs and lows. A diet low in caffeine, soda, and sugars has also been helpful.
Age increases your risk for urinary leakage but the symptoms are treatable.
No. Behavioral techniques are commonly used and very effective. Over 50% of patients with incontinence can notice improvement or cure with behavioral techniques. Medication is also another option.
In general, yes. Each plan has different coverage and a referral is necessary from all HMOs. Contact the office for referral information.
Treatment, including behavioral techniques for bowel and bladder control problems is offered through the Continence Program at the Center for Women’s Health.
Your first visit should be scheduled around the age 21 unless you are sexually active or have a gynecological problem. It is also best to see a doctor or nurse practitioner prior to the onset of sexual activity.
How old should I be when I have my first mammogram? What if I have a history of breast cancer in my family?
A baseline mammogram is offered between the ages of 35 and 40. Most professional health organizations recommend yearly mammograms after the age of 40. If your family history includes a mother or sibling with the onset of breast cancer prior to menopause, some experts would recommend beginning screening mammograms starting 10 years prior to the onset of the cancer in your first degree relative.
When blood is present in the Pap smear specimen, cells from the sample may be obscured by the blood. This results in a less than optimal Pap smear. Due to scheduling difficulties and the demands of your job you may decide to have the Pap smear performed when there is just light bleeding despite the fact that it will not be an optimal specimen. Sexual activity, vaginal medications and douching should also be avoided for 48 hours prior to a Pap smear.
Although much less common, precancerous or early cancer of the vagina can be detected by a Pap smear even after a hysterectomy. Certainly if the indication for the hysterectomy was for precancerous or cancer of the cervix or uterus, regular Pap smears are indicated.
Abnormal Pap Smears and Precancerous Changes of the Cervix.
The purpose of the Pap smear, in a patient who comes for regular visits to the gynecologist, is not meant to find cancer. Our hope is to pick up precancerous changes of the cervix, changes which occur before a cancer ever starts. The beauty of cervical cancer is that there is a gradual change from normal to cancer; it does not develop overnight. While the Pap smear is not perfect (it can miss abnormalities 3 out of 10 times), if it is done frequently enough it will pick up the precancerous changes years before the cancer ever starts. And if these changes are severe enough, they can be treated with minor surgery, called a conization, so that cancer never develops. This makes it possible to have a normal life without affecting fertility, child bearing or the need to remove the uterus.
Precancerous changes of the cervix and, in some cases, eventually cancer, are caused by a virus called HPV (Human Papilloma Virus). HPV is nearly always sexually transmitted. Since up to 7 in 10 women between the ages of 18 and 30 carry HPV virus, it is a very common diagnosis. But in the vast majority of cases it will never be detected. HPV can express itself in four ways.
- It can live in your body and it will never affect you or be found.
- It can cause warts on the vagina or penis.
- It can cause precancerous or cancerous changes of the cervix as discussed above.
- It can cause cancer of the vagina, perineum (skin outside the vagina) and anus.
New technology allows us to look for the presence of HPV virus in the Pap smear specimen if a Pap smear comes back with findings that show a minor abnormality. One in 10 Pap smears will show “atypical cells of undetermined significance” or cells that look a little funny but the doctor cannot tell if they are precancerous or just affected by the normal vaginal environment. This is the case where this new technology is most often used. If HPV is present in the Pap smear specimen or the cells look sufficiently abnormal, a colposcopy will be recommended.
A colposcopy is when the doctor looks at the cervix under a microscope. Just like a Pap smear, a speculum is inserted into the vagina so that the cervix can be seen. The vagina and cervix are washed with vinegar (this may burn a little) and then looked at under a microscope (or colposcope). Most often biopsies (very small pieces of cervix) are taken and sent to the laboratory. The pathologist can then prepare the biopsies and look at them under a microscope to tell us if there is a significant problem. Based on the seriousness of the biopsy results, we will recommend either observation with repeated Pap smears and/or colposcopies or minor surgery called a conization.
You might be wondering why we would not treat all people with precancerous changes of the cervix, and that is a very good question. When the biopsies reveal mild precancerous changes (also known as cervical dysplasia or cervical intraepithelial neoplasia for those of you who are internet aficionados), this basically means that they see very minor effects of the virus but no significant precancerous changes. These changes are likely to go away without treatment in 8 out of 10 cases. If the changes are moderate or severe, then the conization procedure is performed because the chances of developing a cancer are much higher. Even though the conization will prevent a cancer from starting in the short term, it does not eradicate or remove the virus from the body. Therefore the precancerous changes can return. For this reason in cases of mild changes there is most often no benefit to treatment.
If you have mild precancerous changes of the cervix it is very important to follow up with the observation plan recommended by your doctor. If this is not done, and years go by without follow-up, true cancer can develop. This would be a shame since cervical cancer is a preventable disease.
HPV, or Human Papiloma Virus, is the cause of genital warts, precancerous cells, and cancer of the cervix. The present recommendations for testing are for those people whose Pap smear results show abnormal cells of undetermined reasons. In other words, the cells appear abnormal but not quite cancerous or precancerous.
The other recommendation is to use the test in women over age 30 that have no history of abnormal Pap smears and are low risk for cervical cancer. If the test is negative, Pap smears need only be performed every three years. This does not mean that yearly visits to the gynecologist are not necessary. Because this is new technology and our personal experience with it so far is limited, the physicians at the Center for Women’s Health are not ready to completely trust this method of testing. We do believe that it can serve as another tool in determining the correct treatment for our patients on an individual basis.
Yes. If you miss more than one pill or start the pack of pills later than you should have otherwise you will not be protected against pregnancy. Missing a pill may cause bleeding in the middle of the cycle. This does not indicate something is wrong. The best way to keep from missing a pill is to place the pill pack in a location that is used every day, even on weekends and vacations, such as next to your toothbrush.
If I am on the pill and I start bleeding what should I do? Continue taking the pills? Make an appointment?
Occasionally when you are on the pill there will be what is called “breakthrough bleeding”, bleeding which occurs other than the time it is expected. This happens most frequently during the first month or two after the pill is started. It also occurs in most women at least once a year, especially if a pill is missed. It is not harmful, but sure can be a nuisance.
Yes. Until your cycles are completely over and you have gone through menopause, there is still a chance of pregnancy. This chance can exist until the age of 50 or older. Consult your healthcare provider for appropriate options.
What is hormone replacement therapy? Is there any other way to alleviate symptoms of menopause?
Hormone replacement therapy is substituting man made hormones that are very similar to the ones the ovaries made prior to the time they ceased to function, known as the menopause. At the present time, the only indication for hormone replacement is for vasomotor symptoms, or hot flashes. Half of women will experience only minor flashes if any at all. However, for many women, these symptoms can be quite uncomfortable. They can interfere in the workplace or prevent adequate sleep at night. Sleep deprivation can lead to depression and loss of function during the day.
Some women will get relief from these symptoms with over the counter preparations containing soy products, which themselves contain estrogen like compounds called isoflavens. Since these preparations are not standardized, their safety and effectiveness has been difficult to determine. There are many studies presently being performed to answer these questions.
Another treatment for hot flashes is a class of medications called Selective Serotonin Uptake Inhibitors, or SSRIs. While these medications were originally developed to treat depression, a beneficial side effect that many women noticed was the relief of hot flashes.
What is a yeast infection? Why do I have to come in for an office visit rather than just get a prescription?
A yeast infection can cause an abnormal vaginal discharge and/or vaginal irritation and burning. One in seven women carries yeast in her vagina. When conditions permit the yeast to overgrow and outnumber the normal bacteria in the vagina, symptoms develop and it is now considered to be an infection. Many studies reveal that when women self-diagnose their condition and buy over the counter yeast medication, up to 80% of the time the symptoms are caused by something other than yeast. That is why the physicians and nurse practitioners at the Center for Women’s Health recommend an accurate diagnosis before treatment of any suspected infection. This can only occur with a thorough examination and testing.
A urinary tract infection occurs when bacteria pass through the urethra into the bladder and multiply. The bladder is normally free of any bacteria. Symptoms of a urinary tract infection can vary widely among women and may be different in the same person during different infections. Some of the more common symptoms include burning or lower pelvic pain with urination, going to the bathroom frequently and never feeling quite empty, or the presence of blood in the urine. While drinking cranberry juice between infections has been shown to possibly reduce the number of infections, it has not shown to be an effective treatment once an infection has been established. UTIs are best treated with antibiotics. It is important to flush the bladder with as much fluid as possible during treatment to help the antibiotics eliminate the bacteria from the bladder.