Do I have to have a hysterectomy for heavy periods?
Absolutely not! There are many options today to manage your heavy periods, and you should speak to your doctor to see which options are available for you. If you do not have large fibroids, you may qualify for an endometrial ablation. This is a procedure that can be done in the office, as well. A hysteroscope is placed through your cervix and into your uterus to evaluate the inside of your uterus. Afterwards, a biopsy will be taken to sample the lining of your uterus. Then, the endometrial ablation will begin. There are several different methods for performing the ablation. At our office, we use the Minerva device.
https://minervasurgical.com/devices/minerva-es/
How do you know if you have a bladder infection?
Acute cystitis (also known as UTI and bladder infection) is a very common diagnosis, but the symptoms of other more concerning problems can mascarade as signs of a bladder infection. Many times if you have never had a bladder infection or have had recurrent infection symptoms, you healthcare provider will recommend further testing before treatment can begin.
The gold standard test for a bladder infection is a urine culture, for many reasons. A simple urine dipstick result can be influenced by many different factors, contamination from skin cells, medications (like Azo and pyridium), hydration status, etc. For this reason, a urine culture is the best test to perform to correctly identify a bladder infection. Not only can it identify the bacteria causing the infection, it can also suggest the correct antibiotic to use. This is very helpful in patients with recurrent infections.
The best time to culture the urine is before any treatment begins. Performing a culture after antibiotics have been started will often give vague, non-diagnostic results due to the inability of the offending bacteria to form colonies on the growth media. This will also affect any sensitivity testing, which could then in turn lead to inappropriate antibiotic choice.
Sometimes, you may be asked to come in for repeat testing to assure that the infection has cleared. Some examples of these instances include pregnancy and recurrent infections.
If the urine culture doesn’t show any bacteria present, your healthcare provider may recommend more testing to rule out other etiologies that could cause the same symptoms as an infection. For example, interstitial cystitis commonly causes similar symptoms that seem to recur despite antibiotics. If this is suspected, you may need a referral to a urologist. Other common causes of these symptoms include vaginal candidiasis, some sexually transmitted infections, atrophic vaginitis, etc.
For more information, please visit http://uptodate.com/contents/urinary-tract-infections-in-adolescents-and-adults-beyond-the-basics?source=outline_link&view=text&anchor=H3#H3
How should I clean “down there”?
The vagina contains good bacteria that keep everything in balance. That is why cleaning the genitalia should only include a wet wash cloth and only to the outer genitalia. Women should not apply ANY kind of soap or feminine wash to the genitalia. One last super important note…NEVER DOUCHE!
How can I protect my bones from developing osteoporosis?
Prevention is KEY! Women should be sure that they get enough calcium either from their diet or supplementation starting at age 30, but it becomes super important after menopause. A menopausal woman should get 1200 mg of Calcium with at least 800 IU of Vitamin D daily. This can either come from your diet or a supplement. The best thing that you can do for your bones, though, is to build your muscles. That’s right ladies…We need to strength train! The goal should be to get at least 45 minutes of strength training twice weekly. This means that we need to be doing our pushups, squats, lunges, bicep curls, tricep dips, etc.
How do I know if I am in menopause? Is there a test?
No, unfortunately, there is no test for menopause. Many physicians will order an FSH test to make their best guess, but the true test of menopause is your periods. The definition of menopause is 1 year without any bleeding on your own (not because of a birth control pill or contraceptive device). Once you reach this, you are considered menopausal. So, what is an FSH level? FSH is a hormone that is released by your brain to tell your ovaries to make more eggs. The older we get, the less our ovaries will work to make eggs. This causes our brain to pump out more FSH. Thus, as we get older our FSH gets higher. Even though the laboratories assign an FSH level that is consistent with menopause, it is not diagnostic of menopause. You have to use your periods. What if you had a hysterectomy prior to menopause? Unfortunately, you won’t really know for sure at what age that you went through menopause. It will just have to be an educated guess.
At what age should I start getting mammograms?
We recommend that you get yearly mammograms beginning at age 40, if you are considered at average risk of breast cancer. If you have a strong family history of breast cancer or have inherited a hereditary cancer gene (like BRCA), then you will likely need mammograms beginning at an earlier age.
When should I bring my daughter in for her first visit?
We recommend that the first visit for an adolescent be between 13 and 15 years old. Many times, this will be just a “talking visit”, meaning that she will be completely clothed the whole visit. We find that it is best to meet your gynecologist for the first time as an adolescent when the likelihood of needing a pelvic exam is low. It seems to significantly decrease the anxiety of a pelvic exam if she is already familiar with our office.
Do you recommend the Gardasil vaccine?
Yes!!! We recommend the Gardasil vaccine for both boys and girls. This vaccine protects against the 9 most common HPV strains. The Human Papilloma Virus is responsible for causing up to 90% of cervical cancer, but can also cause anal/rectal cancer, oral cancer, and throat cancer. It is not treatable once you have it, and not everyone can clear the virus with their immune system. For these reasons, we recommend it. For more information visit: https://www.gardasil9.com/ and https://www.cdc.gov/vaccines/vpd/hpv/public/index.html.
What is HPV?
HPV is the Human Papilloma Virus, and it is the most common sexually transmitted infection. It is responsible for several types of cancer, including cervical, anal/rectal, oral, and throat. Approximately, 80% of the population has HPV. There are many different strains of HPV including low risk and high risk strains. The low risk strains typically cause genital warts. The high risk strains are the ones responsible for causing cancer, and the most high risk strains are HPV 16, 18.
HPV can cause pap smear abnormalities that are NOT cancer, but if left unchecked could lead to cancer in the future. That is why it is very important to continue to get routine pap smears yearly if you have had a history of HPV. For more information on HPV, visit https://www.cdc.gov/std/hpv/stdfact-hpv.htm.
When do I need my hormones checked?
The honest answer is almost never. I know this statement is controversial, but “hormones” are blamed for so many different symptoms. The truth is that if they really caused all of that we could fix almost every symptom that walked through our door by giving “hormones.” We wish that it was that simple, but it isn’t.
Blood (and saliva) testing for hormone concentrations are unreliable tests that can vary widely from day to day in pre- and peri-menopausal women. After menopause, your ovaries no longer release a significant amount of hormones, so there is really no need to check at this point.
A check at one point in time only gives you an answer for where the levels are at that very moment. Tomorrow, they will likely be different. Also, the only FDA approved hormonal medications are birth control pills and postmenopausal hormone replacement therapy. Very seldom would checking hormones cause a patient to be placed on one of these treatments. For these reasons, we do not routinely check blood hormone levels in our patients.
How often should I come in for a Well Woman Exam?
We recommend a well woman exam every year. You may not be in need of a pap smear, but so much else is done at these exams. It is a chance for your provider to review your history to make sure that you are receiving all of the screening tests that you need. For instance, if you have a significant family history of breast or colon cancer, then you may need to start screening for these prior to others who are at average risk of these disease. A well woman exam also gives your provider a chance to do a thorough exam to be sure that everything appears as it should.
What kind of vitamins are good to take?
The best way to get the vitamins and minerals that you need is to eat a healthy, balanced diet that is rich in veggies. A good way to think about this is to eat the rainbow! Try to make your meals colorful by using brightly colored vegetables and fruit. For veggies, think: red and yellow bell peppers, rainbow carrots, eggplant, kale, tomatoes, etc. For fruits, think: berries, citrus fruits, cherries, and kiwi. Try to get your fats from what we call “good fats”, like avocado and nuts. These are considered “good” because they are low in saturated fat, which contributes to heart disease. Check out this website for more info: https://www.health.harvard.edu/blog/phytonutrients-paint-your-plate-with-the-colors-of-the-rainbow-2019042516501.
If you do choose to take a supplement, try to stick to either ones that your health care provider recommends or ones that can be found in the normal pharmacy. There are so many products online that are not vetted and may actually be dangerous. So, be careful when purchasing online.
