Women's Health

Common Concerns & Medical Issues

I have bad cramps with my period. Should I be worried?

Some pain during periods is normal. Pain in the lower belly may begin several days before you have your period or just at the start. It should improve as menstrual bleeding becomes lighter. Some women find using heat on their belly helps. Ibuprofen (brand-names include Motrin and Advil) and other over-the-counter medications may help.

Most women adjust to the pain, but some find it hard to carry out daily activities. For these women, pain disrupts their normal routine for several days. The medical term for very painful periods is dysmenorrhea. If your periods cause severe pain, contact your doctor. Medications may help, or you may want to consider other treatments.

How often do I need a Pap test?

It is important for all women to have Pap tests and pelvic exams as part of their routine health care. You need a Pap test if you are 21 years or older, or as soon as you become sexually active. Pap tests save lives by finding early signs of cervical cancer, infections and other problems of the reproductive organs.

Your doctor will do a Pap test during your pelvic exam by taking a tissue from your cervix, which is evaluated by a lab. There may be some discomfort, like a pinch, when the tissue is removed. In general, avoid the use of douches, vaginal medications, tampons or or sexual intercourse during the 24 hours before your appointment.

After menopause, you still need regular pelvic exams and Pap tests. Federal guidelines suggest Pap tests every two years until age 30. If after age 30 you have had normal tests for three years in a row, you may be able to have them less frequently. After age 65 you may be able to stop having them. These decisions should be made after talking with your doctor.

What kinds of birth control are available?

You and your doctor can discuss which choices will work best for you, and can explain how effective each form of birth control will be when used correctly. Below is a list of commonly prescribed birth control choices.

  • condoms
  • spermicide
  • diaphragms and cervical cap
  • vaginal sponge
  • combination birth control pills, mini-pill, three month pill
  • morning-after pill
  • progestin implants
  • hormone injections
  • skin patch
  • vaginal ring
  • intrauterine device, or IUD
  • natural family planning
  • tubal ligation or vasectomy

For more information, visit the National Institutes of Health.

I’d like to become pregnant. Do I need to see a doctor first?

It’s always a good idea to have the best health possible before becoming pregnant. Your doctor can make sure you are generally healthy and give you information about eating the right kinds of foods, and about the vitamins or supplements you should take.

Recommended prenatal care includes these steps:

  • Good nutrition and healthy habits before and during pregnancy
  • Frequent prenatal examinations
  • Routine ultrasounds to detect problems
  • Routine screening for:
    • Blood pressure problems
    • Blood type problems (Rh factor and ABO)
    • Diabetes
    • Genetic disorders when there is a family history or if the mother’s age may present a risk
    • Rubella immunity
    • Sexually transmitted diseases
    • Urine protein

What tests and exams will my doctor give me after I become pregnant?

On your first visit, we’ll take a blood sample to check for any problems or diseases you may not be aware of. We can also look for genetic markers, and screen for Rh markers in your blood type.

An ultrasound (also called sonogram or echogram) is usually taken between 18 and 20 weeks to look at the anatomy of the developing fetus. Ultrasound uses high-pitched sound waves that echo off your body to create an image of the fetus inside. They help us follow the health of mother and unborn child in high-risk pregnancies. In normal pregnancies, they help us evaluate the growth, heartbeat and breathing movements, and allow us to see if you are carrying more than one fetus. Often the ultrasound allows us to see abnormalities that may affect your pregnancy or delivery.

Between 16 and 18 weeks, you may have an alpha-fetoprotein screening (AFP) and a multiple marker screening. These tests look for hormonal and blood protein problems. Amniocentesis (also called amnio) uses a needle to remove a sample of the fluid from the womb surrounding the developing fetus. Chorionic villus sampling (CVS) is a more invasive procedure during which a tissue sample is removed from the amniotic sac. These purpose of these tests is to look for abnormalities such as Down syndrome or spina bifida.

A nuchal translucency screening is another ultrasound exam that’s sometimes used to help identify the risk of Down syndrome. Periumbilical blood sampling takes fetal blood for testing as a follow-up when other tests such as amniocentesis or chorionic villus sampling have shown indications of Rh incompatibility or chromosomal issues.

My doctor says I have preeclampsia. What does that mean?

Preeclampsia is a condition that occurs in at least 5 to 8 percent of all pregnancies. It is a rapidly progressing illness that can affect the mother and the unborn baby and requires immediate attention. It is diagnosed when a pregnant woman has high blood pressure. There may also be protein in the urine. Swelling, sudden weight gain, headaches and changes in vision are important symptoms. Prompt treatment can save the life of the mother and unborn child. Early diagnosis is possible through screening, good prenatal care and regular check-ups during pregnancy.

For more information, visit the Preeclampsia Foundation.

What is endometriosis? Can you help?

Endometriosis can cause painful periods, cramps, heavy bleeding and sometimes infertility. It occurs when tissue similar to the lining of the uterus forms around the Fallopian tubes, ovaries, or anywhere in the body, including the lungs or spine. The pain may be severe. Endometriosis can also cause scar tissue. An estimated 30-40 percent of women with endometriosis may not be able to have children.

It may be treated with over-the-counter medication or prescription medication. Nutritional therapy, hormonal therapy and surgery may also be considered. In the end, combining several approaches may work best.

For more information visit Endometriosis.org, a global clearinghouse for information.

We treat endometriosis as part of our general gynecology care. Our reproductive team also treats the infertility it may cause.

What can I expect before and during menopause?

In your mid- to late 40s, you may experience changes in your period and monthly cycle. This time is called perimenopause. You may have hot flashes, mood swings or difficulty remembering words. On the other hand, some women feel a sense of freedom and energy. Others feel few changes at all. Menopause results from declining levels of estrogen and progesterone and takes place when you’ve had your last period. It’s a good idea to see a doctor when your symptoms begin. If they become disruptive or if you have very heavy or irregular bleeding, you should see your doctor. You may become pregnant during this time. Generally menopause is considered to have ended one year after your last period.

For more information, visit the National Institutes of Health’s webpage on menopause.

Is there anything you can do to help me stop losing urine?

Loss of urine, known as incontinence, is a condition that affects men as well as women, though it is more common in women. The good news is that treatment can help or eliminate this problem. Kegel exercises and bladder conditioning (training) can help. We offer these and other non-surgical interventions -- biofeedback, electrical stimulation and collagen injections. When conservative measures do not provide relief, elective procedures are also available. These surgical options include the transvaginal tape and other surgeries. They are prescribed when appropriate and in close consultation with the patient.

When is a hysterectomy prescribed?

Hysterectomy is a major procedure that may be necessary for life-threatening diseases like cancer. Or, you may choose it as an elective surgery to help with problems such as fibroids or heavy, irregular bleeding.

During a hysterectomy, your uterus (or womb), is removed. Sometimes the ovaries and fallopian tubes are also removed. It is estimated that one in three women in the United States have had a hysterectomy by age 60.

This procedure is sometimes recommended or necessary to treat these conditions:

  • Fibroids
  • Endometriosis not helped by medicine or surgery
  • Uterine prolapsed (when the uterus drops into the vagina)
  • Cancer of the uterus, cervix, or ovaries
  • Vaginal bleeding that persists despite treatment
  • Chronic pelvic pain (after other treatments have failed)

Be sure to discuss all options with your health care provider. After this procedure you will no longer have periods and you cannot become pregnant. You will also enter menopause if both ovaries are removed.

What is a colposcopy?

Your doctor may do a colposcopy during your pelvic exam to check for abnormal tissue inside your vagina and cervix. During the colposcopy, your doctor applies a vinegar solution to the cervix and vagina with a cotton ball or swab. The vinegar makes abnormal tissue turn white so your doctor can identify areas that need more evaluation.

You may be more comfortable if you empty your bladder and bowels before the procedure. In general, avoid the use of douches, vaginal medications, tampons or sexual intercourse during the 24 hours before your appointment.