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Gynecology


 

Gynecology

Birth Control Methods

Short Acting Contraceptives

- Oral Contraceptives

Starting the Pill

You may start the pill on the first day of your period or wait until the first Sunday after your period has started. Use back-up birth control for 2 weeks.

New pill users can be nauseated on their first pack. In this case, you may try to take the pill with food or at night before you go to bed.

Taking the Pill

Because the pill contains such a low dose of hormones, you must take it every day at about the same time for it to be effective in preventing pregnancy and irregular bleeding. Irregular bleeding is common in the first 3 packs and will resolve with continued daily use.

You may take the pill with other medicines such as cold remedies, vitamins or calcium. The use of antibiotics reduces the effectiveness of your pill in preventing pregnancy. Use condoms while on antibiotics.

Missing a Pill

If you miss one pill, take one as soon as you remember and then take one pill at the regular time. If you miss two pills, then take two when you remember and one pill at the regular time. You must use back-up birth control (condoms) for one week to prevent pregnancy.

If you miss the first pill of the pack, you must start the pack as soon as possible and then use back-up birth control for 2 weeks!! This is a common reason for unplanned pregnancy. Always keep a pack of your pills on hand and monitor your refill number at the pharmacy. You must return to the office yearly to get a refill.

Call if you experience

Irregular bleeding after 3 months
Worsening acne or headaches
Chest, leg or calf pain
Unusual abdominal pain
More Information
The pill will not work if you do not take it daily. The drug is gone 24 hours after your last dose. The pill is safe and beneficial for long term use. You do not have to take a “break” from the pill.

Health Benefits

The birth control pill often reduces the amount of pain and cramping that you experience with a period. You may bleed less and sometimes not bleed at all during your period. The pill will not cause birth defects or cancer. The pill will not protect you against sexually transmitted diseases. Women also experience fewer problems with their ovaries and enjoy being able to predict their periods weeks in advance.

Pills should not cause weight gain and can improve mild to moderate acne. The pill can prevent pregnancy now, but will not interfere with your ability to get pregnant in the future.

Smoking increases the risk of heart attack and stroke in pill users. You should stop smoking to protect your health or use another method of birth control.

- Progesterone-only Birth Control Pills

Progesterone-only birth control pills (POPs), also called the "mini pill," contain progesterone instead of progesterone and estrogen which are the ingredients found in a regular birth control pill.

Estrogen-containing pills can increase the risk of clotting in women with high blood pressure, diabetes, migraine, clotting disorders and smokers. These women are encouraged to use products without estrogen. Estrogen can also decrease the production of milk in breastfeeding women. Women who want to continue to breast feed should avoid products containing estrogen.

A regular birth control pill is 93-99% effective in the first year of use and 97-99% in subsequent years of use. A progesterone-only birth control pill is effective at 97-99%.

With all birth control pills, effective pregnancy prevention relies upon the regular, daily use of the product.

Many generics are available.

The most common complaint of women using progesterone-only birth control pills is irregular periods - Not heavy bleeding, but possibly unpredictable bleeding. Most women experience lighter periods over months of use and do develop some type of pattern to their periods. Some women will experience no period after many months of taking progesterone-only birth control pills. This is not harmful. Periods will return when the pill is discontinued.

Long Acting Reversible Contraceptives

- Depo-Provera

Depo-Provera (Depo) is an injectable form of birth control that is 99.7% effective in preventing pregnancy. Depo works to prevent pregnancy by preventing ovulation in some women. The drug also thickens mucus in the genital tract, obstructing the forward movement of sperm, and reduces the ability of the uterine lining to be receptive to pregnancy.

The first dose of Depo must be injected during the first five days of the menstrual cycle. Subsequent doses of Depo will be administered every 12 weeks or 84 days. Doses of Depo can be given earlier than 12 weeks, but no later than 13 weeks or 91 days without a lapse in birth control.

If a subsequent Depo dose is not obtained by 91 days, then it will not be administered unless you are on your menses or have abstained from intercourse for two weeks and have a negative pregnancy test. If you are late for your injection then your new injection will not be effective birth control for up to two weeks.

Remember: emergency birth control is available over-the-counter at your pharmacy and is safe and effective.

Recommended injection site is the buttocks. Although the site will be sore , resist massaging it. This will disperse the medication too quickly.

Common side effects of Depo include: irregular bleeding, breast tenderness, bloating; weight gain (5 pounds the first year, 0 - 3 pounds every year after), acne, headache, worsening depressive symptoms.

If irregular bleeding bothers you, you may obtain a Depo injection sooner than 12 weeks. Ask your doctor about this option.

After the fourth injection, most women do not menstruate anymore. This is not permanent but after discontinuing Depo regular menstruation may not resume for 3 - 12 months.

Depo effectively prevents pregnancy two weeks after the first injection. Birth control is continuous provided you obtain subsequent injections of Depo when you are due.

Depo does not protect you from sexually transmitted infections.

Because Depo decreases your estrogen levels, the drug can also reduce your bone strength. We recommend that you take a daily vitamin and calcium supplement. Your calcium goal is 1200 mg. daily.

- Intrauterine Device (IUD)

"IUD" stands for "intrauterine device." Shaped like a "T" and a bit bigger than a quarter, an IUD fits inside your uterus. It prevents pregnancy by stopping sperm from reaching and fertilizing eggs.

Please visit webMD to learn more.

If you are over 40 years old, Depo may lead to irreversible bone loss. Ask your health care provider about other options for birth control that have no impact on your bone health.

- Nexplanon

Nexplanon is a small, thin plastic rod that is inserted under the skin to prevent pregnancy. The rod slowly releases etonogestrel into the body over a 3-year period. Etonogestrel is similar to a natural hormone made in your body.

It works mainly by preventing the release of an egg (ovulation) during your menstrual cycle. It also makes vaginal fluid thicker to help prevent sperm from reaching an egg (fertilization) and changes the lining of the uterus (womb) to prevent attachment of a fertilized egg. This product does not contain any estrogen.

Please visit webMD to learn more.

Permanent Contraception

- Tubal Ligation

At some point in life you may decide that you would not like to be pregnant again. Some women will choose permanent sterilization to prevent pregnancy for the remainder of their reproductive years.

There are several options for sterilization or permanent birth control. Sterilization, otherwise known as tubal ligation (tying your tubes), can be done through a small incision in your belly button or through the uterus without any incisions. The tubal ligation with the incision is done under general anesthesia and requires 2-7 days off of work for recovery.

The incisionless tubal ligation (Essure or Adiana) is performed in the hospital under sedation using a camera in the uterus to place plugs in the fallopian tubes. Most women recover from this procedure rapidly and return to work in 1-2 days.

Before making a decision to permanently remove the possibility of future pregnancy, your physician will want to discuss your decision to choose permanent birth control. Your doctor wants to be certain that you have examined all of your choices and considered all other reversible methods of birth control. You should understand that tubal ligation or Essure/Adiana procedures are non-reversible and meant to be permanent.

Modern sterilization procedures for women, although not 100% effective, are generally much more effective than typical birth control pill, Depo-Provera or condom use. Modern IUDs are as effective as tubal ligation and may be an alternative method for you, offering 5-10 years of birth control without undergoing a surgical procedure.

We offer both of these procedures in the hospital. Click on the links to learn more about Adiana, Essure or webMD

- Hysterectomy

A hysterectomy is an operation to remove a woman's uterus. A woman may have a hysterectomy for different reasons, including:

  • Uterine fibroids that cause pain, bleeding, or other problems
  • Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal
  • Cancer of the uterus, cervix, or ovaries
  • Endometriosis
  • Abnormal vaginal bleeding
  • Chronic pelvic pain
  • Adenomyosis, or a thickening of the uterus

Hysterectomy for noncancerous reasons is usually considered only after all other treatment approaches have been tried without success.

Please visit webMD to learn more.

Emergency Contraception

Emergency contraception is birth control you can use to prevent pregnancy up to five days (120 hours) after unprotected sex. The morning-after pill is safe and effective and available at health centers and drugstores. Costs vary from $10 to $70.

What Is the Morning-After Pill (Emergency Contraception)?

The morning-after pill goes by brand names of Ella, Next Choice and Plan B One-Step. It can be used up to five days (120 hours) after unprotected intercourse.

How Does the Morning-After Pill Work?

Two brands of the morning-after pill — Plan B One-Step and Next Choice — are made of one of the hormones found in birth control pills called progestin. The other brand of the morning-after pill — Ella — is made of a medication called ulipristal acetate.

All brands of the morning-after pill work by keeping a woman's ovaries from releasing eggs — ovulation. Pregnancy cannot happen if there is no egg to join with sperm. The hormone in the morning-after pill also prevents pregnancy by thickening a woman's cervical mucus. The mucus blocks sperm and keeps it from joining with an egg. The morning-after pill can also thin the lining of the uterus. In theory, this could prevent pregnancy by keeping a fertilized egg from attaching and implanting into the uterine lining.

You might have also heard that the morning-after pill causes an abortion, but that's not true. The morning-after pill is not the abortion pill. Emergency contraception is birth control, not abortion.

How Effective Is the Morning-After Pill?

Emergency contraception can be started up to 120 hours — five days — after unprotected intercourse. The sooner it is started, the better it works. It can reduce the risk of pregnancy by 89 percent when started within 72 hours after unprotected intercourse. It continues to reduce the risk of pregnancy up to 120 hours after unprotected intercourse, but it is less effective as time passes.

You need to use the morning-after pill to prevent pregnancy after each time you have unprotected intercourse. The morning-after pill will not prevent pregnancy for any unprotected intercourse you may have after taking the pills. If you do not have your period within three weeks after taking emergency contraception, you may want to consider taking a pregnancy test.

The morning-after pill offers no protection against sexually transmitted diseases or infections. You may want to consider STD testing if there is a possibility that unprotected sex put you at risk.

How Safe Is the Morning-After Pill?

Emergency contraception is safe, and millions of women have used it. Various forms of emergency contraception have been used for more than 30 years. There have been no reports of serious complications.

Even though Plan B One-Step and Next Choice are made of one of the same hormones used in the birth control pill, the morning-after pill does not have the same risks as taking the pill or other hormonal birth control methods continuously. That's because the hormone in the morning-after pill is not in your body as long as it is with ongoing birth control.

What Are the Disadvantages of the Morning-After Pill?

Although most women use the morning after pill with few problems, you may experience some undesirable side effects while using this medication. Nausea and throwing up are the most common side effects. Less than 1 out of 4 women feel sick when they take them. You can use anti-nausea medicine one hour before taking emergency contraception if you are concerned about being nauseous. Many women also find it helpful to take the emergency contraception pills with a full stomach.

Other side effects of the morning-after pill may include

  • breast tenderness
  • irregular bleeding
  • dizziness
  • headaches

If you use the morning-after pill frequently, it may cause your period to be irregular. It may be earlier or later than usual. It may be heavier, lighter, more spotty, or the same as usual. Remember, if you do not have your period within three weeks after taking emergency contraception, or if you have any symptoms of pregnancy, take a pregnancy test or schedule an appointment with your health care provider.

Emergency contraception should not be used as a form of ongoing birth control because there are other forms of birth control that are much more effective.

How Do I Get the Morning-After Pill?

Plan B One-Step and Next Choice are available from drugstores and health centers without a prescription for women and men 17 and older. If you are interested in getting emergency contraception and are 17 or older, you can try your local drugstore. If you are younger than 17, you'll need to go to a health care center or private health care provider for a prescription.

We all like to be prepared. That is why it's a great idea to keep some emergency contraception in your medicine cabinet or bedside table in case of an accident. Having the morning-after pill on hand will let you take it as soon as possible after unprotected intercourse, when it is most effective.


Infertility Treatments

Using Medications

Medications like Clomid (Clomiphine Citrate) are widely used ovulation induction drugs and are frequently a first-line fertility treatment for women who have irregular ovulation or who do not ovulate at all.

Lack of ovulation (anovulation) is one of the most common causes for infertility. Once successful ovulation is achieved, fertility is often restored. Clomid is successful in inducing ovulation in about 80% of women. Ultimately, about half of these women will get pregnant.

  • Clomid is a tablet taken orally. It works by increasing levels of follicle stimulation hormone (FSH).
  • Clomid is usually started at 50 mg. on day 3 or 5 of the menstrual cycle for five days. If this dose does not produce eggs, then the dose can be increased to 100 mg. and then 150 mg.
  • Clomid can produce more than one egg per cycle (super ovulation). Despite this, the success rate per cycle is 10-20%. The twinning rate is 8-10%. The triplet rate is about 1%.

In rare cases Clomid can make too many eggs (hyperstimulation). There are times that your fertility program has to be suspended and a birth control pill used for three months to calm the ovaries down. Some women have been hospitalized and have had surgery to drain the ovaries when they make too many eggs.

If ovulation occurs on a dose of Clomid, there is usually no benefit in increasing the dose in a subsequent cycle. In fact, increasing the dose of Clomid could increase the side effects with no increase in successful pregnancy.

Clomid should not be used without close monitoring by your doctor or for more than 6 months. If a patient has not been able to achieve pregnancy in this time, the efficacy of Clomid may have already been maximized. Use of Clomid beyond 6 months is not associated with increased rates of pregnancy, but does delay more aggressive treatment offered by a fertility specialist. This is especially important for mature women with declining ovarian function.

Clomid can produce side effects. Clomid's adverse reactions range from ovarian enlargement (too many eggs), hot flushes, abdominal discomfort and cramping, breast discomfort, nausea, vomiting, visual symptoms (blurring), headache, abnormal uterine bleeding, and multiple births. Clomid's side effects are usually transient and not severe. If you are experiencing severe or persistent abdominal pain, you should consult your doctor immediately.

We now know that over 47% of infertile couples will have a male component. Therefore, semen analysis should always be performed prior to initiating Clomid.

During your fertility treatment please keep a detailed calendar. This calendar should include your period, days you took Clomid, ovulated, had sex, etc.

Many studies show that pregnancy is likely to result sooner when a reproductive endocrinologist is consulted. Your doctor can recommend a specialist if you would like a consultation.

Other medications used to treat infertility include Bromocriptine & Cabergoline; Human Chronic Gonadotropin (hCG); Follicle Stimulating Hormone (FSH); Human Menopausal Gonadotropins (hMG); and Gonadotropin Releasing Hormone (GnRH) to name a few.

For more information on Infertility Treatment visit American Pregnancy Association.

Intrauterine Insemination (IUI)

Artificial insemination is a procedure that can treat male and female infertility. In intrauterine insemination, the man's sperm are directly inserted into the woman's uterus. This prevents any complications the sperm may have in reaching the uterus.

IUI is the most common form of artificial insemination. This may be a good choice when the man's sperm count is low or when the woman has endometriosis. Some hinderances to success include a woman's older age, poor egg or sperm quality, or severe fallopian tube damage.

For more information on Intrauterine Insemination (IUI) visit webMD.

In Vitro Fertilization (IVF)

During in vitro fertilization (IVF), eggs and sperm are brought together in a laboratory glass dish to allow the sperm to fertilize an egg. With IVF, you can use any combination of your own eggs and sperm and donor eggs and sperm.

For more information on In Vitro Fertilization (IVF) visit webMD.


Heavy Menstrual bleeding Treatments

Using NovaSure

Do you suffer from heavy periods? Do you experience nausea, bad cramps and headaches? There is help!

We perform an in-office procedure called NovaSure®. Read more about NovaSure®.

Endometrial Ablation (Thermal Balloon Therapy)

Endometrial ablation is a procedure that destroys (ablates) the uterine lining, or endometrium. This procedure is used to treat abnormal uterine bleeding. Sometimes a lighted viewing instrument (hysteroscope) is used to see inside the uterus.

For more information on In Vitro Fertilization (IVF) visit webMD.


Abnormal bleeding

Abnormal bleeding

Many women experience abnormal vaginal bleeding or spotting between periods sometime in their lives. Vaginal bleeding is considered to be abnormal if it occurs:

  • When you are not expecting your menstrual period.
  • When your menstrual flow is lighter or heavier than what is normal for you.
  • At a time in life when it is not expected, such as before age 9, when you are pregnant, or after menopause.

For more information on Abnormal Bleeding, visit webMD.


Perimenopausal care

Perimenopausal care

Perimenopause, or menopause transition, begins several years before menopause. It's the time when the ovaries gradually begin to make less estrogen. It usually starts in a woman's 40s, but can start in her 30s or even earlier.

Perimenopause lasts up until menopause, the point when the ovaries stop releasing eggs. In the last 1 to 2 years of perimenopause, this drop in estrogen speeds up. At this stage, many women have menopause symptoms.

For more information, visit webMD.


Menopausal Management

Menopausal Management

Menopause is signaled by 12 months since last menstruation.

Common symptoms include hot flashes and vaginal dryness. There may also be sleep disturbances. The combination of these symptoms can cause anxiety or depression.

Menopause is a natural process with treatments that focus on symptomatic relief. Vaginal dryness is treated with topical lubricants or estrogens. Medications aimed at reducing the severity and frequency of hot flashes include venlafaxine and gabapentin. In special circumstances, oral hormone therapy may be prescribed.

For more information on Menopausal Management, visit webMD.


Hormonal Replacement

Hormonal Replacement

HRT (also known as hormone therapy, menopausal hormone therapy, and estrogen replacement therapy) uses female hormones -- estrogen and progesterone -- to treat common symptoms of menopause and aging. Doctors can prescribe it during or after menopause.

For more information on Hormonal Replacement, visit webMD.


Osteoporosis

Osteoporosis

Osteoporosis, or thinning bones, can result in painful fractures. Risk factors for osteoporosis include aging, being female, low body weight, low sex hormones or menopause, smoking, and some medications. Prevention and treatment include calcium and vitamin D, exercise, and osteoporosis medications.

For more information on Osteoporosis, visit webMD.


Prolapse 

Uterine Prolapse

A uterine prolapse occurs when a woman's pelvic muscles and ligaments become weak. This causes the uterus to drop from its normal position. This allows the neck of the uterus (cervix) to bulge down into the vagina.

For more information on Uterine Prolapse, visit webMD.

Pelvic Organ Prolapse

Pelvic organ prolapse, a type of pelvic floor disorder, can affect many women. In fact, about one-third of all women are affected by prolapse or similar conditions over their lifetime.

For more information on Pelvic organ prolapse, visit webMD.


Urinary Incontinence

Urinary Incontinence (UI)

Millions of women experience involuntary loss of urine called urinary incontinence (UI). Some women may lose a few drops of urine while running, coughing or sneezing. Others may feel a strong, sudden urge to urinate just before losing a large amount of urine. Many women experience both symptoms. UI can be slightly bothersome or totally debilitating. For some women, the risk of public embarrassment keeps them from enjoying many activities with their family and friends. Urine loss can also occur during sexual activity and cause tremendous emotional distress.

Women experience UI twice as often as men. Pregnancy and childbirth, menopause, and the structure of the female urinary tract account for this difference. But both women and men can become incontinent from neurologic injury, birth defects, stroke, multiple sclerosis, and physical problems associated with aging.

Older women experience UI more often than younger women. But incontinence is not inevitable with age. UI is a medical problem. Your doctor or nurse can help you find a solution. No single treatment works for everyone, but many women can find improvement without surgery.

What are the types of incontinence?

Stress Incontinence

If coughing, laughing, sneezing, or other movements that put pressure on the bladder cause you to leak urine, you may have stress incontinence. Physical changes resulting from pregnancy, childbirth, and menopause often cause stress incontinence. This type of incontinence is common in women and, in many cases, can be treated.

Childbirth and other events can injure the scaffolding that helps support the bladder in women. Pelvic floor muscles, the vagina, and ligaments support your bladder (see figure 2). If these structures weaken, your bladder can move downward, pushing slightly out of the bottom of the pelvis toward the vagina. This prevents muscles that ordinarily force the urethra shut from squeezing as tightly as they should. As a result, urine can leak into the urethra during moments of physical stress. Stress incontinence also occurs if the squeezing muscles weaken.

Urinary Incontinence

Stress incontinence can worsen during the week before your menstrual period. At that time, lowered estrogen levels might lead to lower muscular pressure around the urethra, increasing chances of leakage. The incidence of stress incontinence increases following menopause.

Urge Incontinence

If you lose urine for no apparent reason after suddenly feeling the need or urge to urinate, you may have urge incontinence. A common cause of urge incontinence is inappropriate bladder contractions. Abnormal nerve signals might be the cause of these bladder spasms.

Urge incontinence can mean that your bladder empties during sleep, after drinking a small amount of water, or when you touch water or hear it running (as when washing dishes or hearing someone else taking a shower). Certain fluids and medications such as diuretics or emotional states such as anxiety can worsen this condition. Some medical conditions, such as hyperthyroidism and uncontrolled diabetes, can also lead to or worsen urge incontinence.

Involuntary actions of bladder muscles can occur because of damage to the nerves of the bladder, to the nervous system (spinal cord and brain), or to the muscles themselves. Multiple sclerosis, Parkinson's disease, Alzheimer's disease, stroke, and injury-including injury that occurs during surgery-all can harm bladder nerves or muscles.

How is incontinence evaluated?

The first step toward relief is to see a doctor who has experience treating incontinence to learn what type you have.

To diagnose the problem, your doctor will first ask about symptoms and medical history. Your pattern of voiding and urine leakage may suggest the type of incontinence you have. Thus, many specialists begin with having you fill out a bladder diary over several days. These diaries can reveal obvious factors that can help define the problem-including straining and discomfort, fluid intake, use of drugs, recent surgery, and illness. Often you can begin treatment at the first medical visit.

Your doctor will physically examine you for signs of medical conditions causing incontinence, including treatable blockages from bowel or pelvic growths. In addition, weakness of the pelvic floor leading to incontinence may cause a condition called prolapse, where the vagina or bladder begins to protrude out of your body. This condition is also important to diagnose at the time of an evaluation.

  • Urinalysis and urine culture-Laboratory technicians test your urine for evidence of infection, urinary stones, or other contributing causes.
  • Ultrasound-This test uses sound waves to create an image of the kidneys, ureters, bladder, and urethra.
  • Cystoscopy-The doctor inserts a thin tube with a tiny camera in the urethra to see inside the urethra and bladder.
  • Urodynamics-Various techniques measure pressure in the bladder and the flow of urine.

How is incontinence treated?

Behavioral Remedies: Bladder Retraining and Kegel Exercises

By looking at your bladder diary, the doctor may see a pattern and suggest making it a point to use the bathroom at regular timed intervals, a habit called timed voiding. As you gain control, you can extend the time between scheduled trips to the bathroom. Behavioral treatment also includes Kegel exercises to strengthen the muscles that help hold in urine.

How do you do Kegel exercises?

Read more on Kegel exercises at WebMD.

Location
A'fina Houston OB/GYN
13920 Osprey Court, Suite A
Webster, TX 77598
Phone: 281-241-6339
Fax: 281-464-8864
Office Hours

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281-241-6339