Well Woman Exams
A well woman visit is a part of the healthy routine. It offers an opportunity to identify lifestyle issues with an opportunity to discuss an implement a healthy living strategy. More importantly it also reingforces what you are doing right about your health and promotes physical and emotional well being. We do not offer obstetrical services. Our office has been dedicated to provide highly specialized gynecologic care exclusively for 25 years.
Evaluation and Surveillance of Abnormal Cervical Cytology-Pap Smears
Our approach to an abnormal cervical cytology is in accordance to the national guidelines presented by the US Preventive Services Task Force as applied by the American College of Obstetricians and Gynecologists. We also acknowledge the fact that guidelines are applied in an individual basis taking into consideration the patients specific risk factors and needs.
A colposcopy is a detailed examination of the uterine cervix. The procedure is indicated by an abnormality on the microscopic evaluation of a cervical cytology. A magnifying instrument called a colposcope is used to look for abnormal patterns in the cervix. A solution of acetic acid is applied to the cervix to facilitate the evaluation by enhancing areas of abnormality or abnormal vascular patterns. The procedure is operator dependent which means that the interpretation depends on the level of expertise and experience of the physicians performing the procedure. In our opinion a colposcopy examination should only be performed by a board certified gynecologist with some cases requiring a consultation and expertise of a gynecologic oncologist.
Our practice has acquired the latest generation of colposcopy equipment, a digital high resolution system with mapping capabilities known as the DYSIS® colposcope. It differs from traditional colposcopy by the digital presentation of abnormalities using the DYSISmap which establishes the need for biopsy with increased accuracy. The mapping system helps the physician in the identification of the area of biopsy with the potential for increased accuracy and reduced number of biopsies. The procedure takes about 20 minutes and a digital record is kept on your file.
A hysteroscopy is a procedure aimed at the evaluation of the uterine cavity. The procedure is carried on with a telescopic lens which allows for the direct visualization of the lining of the uterus. The image is then projected in an overhead screen with the patient and the doctor being able to visualize and discuss the findings. The most common indication for the procedure is in the evaluation of abnormal uterine bleeding and abnormalities found on a pelvic ultrasound such as endometrial polyps and fibroids. Classicaly the procedure was performed in the operating room under anesthesia. With the development of better lenses the procedure can be performed without pain or with minimal discomfort at the office setting. A flexible 3 mm lens facilitates the insertion through the cervix into the uterus to complete the evaluation. A sampling of the endometrium (inner lining of the uterus) is obtained at the end of the procedure and used in the clinical management of abnormal bleeding.
Hormone Replacement Therapy
The use of hormone replacement therapy has been thoroughly studied in gynecology for decades. Current clinical evidence support the use of hormone replacement therapy in healthy women with menopausal symptoms. The use of hormone replacement therapy in women with symptoms of menopause result in improved quality of life, physical and cognitive function. The use of hormone replacement therapy is best implemented through a dedicated consultation with a board certified gynecologist. The needs and expectations of a woman are delineated on consultation along with a disclosure of the efficacy and safety of a the different regimens available.
Management of Menopause Symptoms Without Hormones
Menopause is a progressive condition which deprives women of the full enjoyment of a healthy lifestyle. The impact of menopause in the quality of sleep, clarity of mind, performance of tasks requiring concentration, general wellbeing and sexual function is well known. Hormone replacement therapy is an option for most healthy women but in some patients hormone replacement therapy is not safe or contraindicated. A dedicated consultation with a board certified gynecologist will balance risks and benefits and establish if hormone replacement therapy is for you. Patients with estrogen receptor positive malignancies such as breast cancer, uterine cancer and those with previous thromboembolic conditions are among those women in which hormone replacement therapy should not be used. Patients with persistent menopausal symptoms and contraindications for the use of hormone replacement therapy have non-hormonal options that are safe and effective addressing symptoms of sexual dysfunction, painful intercourse, decreased energy, vasomotor symptoms (hot flashes) and impaired sleep. A consultation and surveillance of the symptoms has proven to be effective in the planning of a safe and effective regimen.
Diagnosis and Management of Abnormal Menses and Bleeding
Abnormal periods are distressing, inconvenient and impairing to a healthy lifestyle. The cause of abnormal menstruations are ovulatory, anovulatory and multifactorial. To a gynecologic specialist the specific risks of the different age groups establish a level of intervention and avoids the unnecessary testing. Abnormal menses have a variety of causes which include anovulation, hormonal causes, fibroids, polyps and abnormalities of the lining of the uterus such as hyperplasia and endometrial cancer. The evaluation and management of abnormal menstruation begins with a dedicated consultation in which a differential diagnosis (possible causes) is established and a course of evaluation is delineated. Special attention should be placed on the patients with post-menopausal bleeding, these are women that have stopped menstruating for over a year and see vaginal bleeding in many instances scanty. Women with post-menopausal bleeding should undergo evaluation directed to exclude malignancy of the uterus though imaging and frequently though an endometrial sampling or biopsy.