Treatment options in gynecologic problems

Cervical Disease

The Pap test can detect changes in the cells of the cervix at an early stage. Some of the changes include infections, exposure to the wart virus, dysplasia (pre-cancerous changes of the cervix), cancer of the cervix.

Colposcopy: Colposcopy is the next test performed if a Pap test is abnormal. This is an office procedure, and is minimally painful. The cervix is looked at through a magnifying instrument, which helps the doctor to see the abnormal cells better. If the areas of abnormality are of significance, small biopsies are performed. These small pieces of cervix are evaluated under the microscope by Doctors to detect any dysplasia and to be classified----mild, moderate, severe or precancerous growth. Sometimes colposcopic biopsies reveal slight infection and inflammation as opposed to dysplasia.

Leep Procedure: Loop electrocautery excision of the cervix is an office procedure. When the colposcopic biopsies come back consistent with dysplasia, a leep may be performed. After application of local anesthesia, with the help of a special instrument the superficial layers of the cervix will be removed and sent to pathology for further evaluation. The biopsied area of the cervix will be cauterized to avoid any bleeding . Evaluation by pathologists allow us to evaluate the extent of the growth of dysplasia and will assure us removal of all abnormal cells. The cure rate for dysplasia by the Leep procedure is 90-95%. Patients will be followed with Pap smears for some time after the procedure.

Cone Biopsy: Cone Biopsy is an extensive removal of the abnormal cells of the cervix. This procedure is reserved for patients with severe dysplasia (pre-cancerous cells) and carcinoma insitu (one step below cancer). This procedure is either performed in the office or at an outpatient facility.

Abnormal Bleeding-/Irregular Cycles

Menstrual cycles of 21-35 days are considered normal . Cycles longer or shorter than this are irregular and should be evaluated by your doctor. Irregular cycles may occur because of weight loss or gain, vigorous exercise, stress illness, or other changes that affect your body. For the first few years after menarche, menstrual periods are often irregular. A young woman may have only three or four periods a year. Menstrual cycles usually become lighter and less frequent as menopause approaches and hormone levels decrease. In some cases the cycles will become erratic and heavier around perimenopause. 

Bleeding that is heavier than usual, or lasts longer than a week may also be abnormal. It can have a number of abnormal causes such as hormonal imbalance, coagulation disorders( problems with blood clotting) uterine polyps, uterine fibroids (benign tumors of the uterine muscle), uterine adenomyosis (sponginess), hyperplasia (pre-cancerous growth), cancer.

Non-Surgical Treatments: Medical treatment with birth control pills, hormones , and other homeopathic and conventional medications is the first line of therapy for the treatment of irregular bleeding and heavy periods in our practice.

Surgical Treatments: If medical options do not work or are not the appropriate treatment option for the disorder, the following surgical options can be recommended.

• Dilation and Curettage: D&C is a very common surgical operation . The procedure is performed under general anesthesia which is very safe. The cervix(opening to the uterus) is dilated with the help of instruments, and the lining of uterus is then removed .Sometimes doctors may perform hysteroscopy at the same time as the D&C . A thin telescope – like instrument is inserted through the cervix and allows the doctors to visualize the lining of the uterus directly. These procedures are performed to empty the uterus after a miscarriage, 
  • to remove polyps in the uterus which may cause irregular bleeding 
  • to remove pre-cancerous or cancerous overgrowth of the lining of the uterus
    
• Balloon Ablation: This is a procedure which is performed at the time of a D&C. The lining of the uterus is burned with special equipment under general anesthesia. Patients do not feel any burning pain. The scar tissue which forms from the burning process will either stop any bleeding from the uterus, or minimize it during the menses. The success rate of this procedure in our practice is 60-65%.This procedure is performed as a treatment for the following problems:
  • Heavy menstrual cycles
  • Adenomyosis - which causes heavy bleeding
  • Uterine fibroids
    
• Cryotherapy of Uterus: Freezing of the lining of uterus
  • The concept is the same as Balloon Ablation except instead of using heat the lining of the uterus is frozen.
    
• Myomectomy: is a surgical procedure that removes only the fibroid, leaving the uterus intact. Fibroids are overgrowths of the smooth muscle of the uterine wall. Fibroids can occur as one single growth or multiple growths. Myomectomy can be performed through an open abdominal incision or through laparoscopic techniques(small abdominal incisions through which instruments are introduced to the abdomen to perform the myomectomy). Myomectomy is performed in patients that are interested in future fertility or preservation of the uterus for other reasons.
  
• Radiologic Fibroid Embolization: is a procedure that blocks the blood supply to the fibroids, causing them to shrink. This procedure is performed in the hospital by Interventional Radiologists. This procedure is less invasive than conventional surgery and has a success rate 60-75%. Embolization is reserved for patients who are done with child bearing, and are perimenopausal or menopausal.
• Hysterectomy
  • vaginal ,abdominal
  • Laporoscopic supracervical
  • Laporoscopic total

The goal in our practice is to allow every patient to explore all options prior to definitive surgery. We feel it is your right to know that there are other methods of treatment besides hysterectomy, and we are willing to try all options.

Hysterectomy is the removal of the uterus and is one of the most common types of surgery performed in women. A hysterectomy is one way of treating problems affecting the uterus. In our practice we explore all options with our patients prior to recommending a hysterectomy. Some of the reasons women end up with a hysterectomy are: uterine fibroids, endometriosis, uterine prolapse, cancer, endometrial hyperplasia (heavy growth of uterine lining), menstrual and menopausal symptoms, cervical dysplasia (precancerous changes) and pain.

There are different kinds of hysterectomy -

1. partial or supracervical - cervix is left behind
2. total hysterectomy - uterus and cervix are removed completely
3. radical - for cases of cancerous growth
4. hysterectomy can be combined with the removal of the tubes and the ovaries - this is called salpingo-oopherectomy

There are different methods to perform a hysterectomy

1. Vaginal Hysterectomy - the uterus, cervix and tubes and ovaries are removed through incisions through the vagina. All the blood vessels are sutured vaginally. Most patients can go home from the hospital the day after the surgery and they can return to work or normal activity within 2-4 weeks after surgery.
2. Abdominal Hysterectomy - the uterus, cervix and tubes and ovaries are removed through an incision in the lower abdomen. Most patients can go home within24-48 hours after surgery. And they can return to work or normal activity within 4-6 weeks after surgery.
3. Laproscopic Supracervical Hysterectomy - the uterus and tubes and ovaries are removed through very small abdominal incisions. Through these incisions small operative instruments are introduced, and the procedure is performed. Most patients can go home the day after surgery, and can return to normal activity within 1-2 weeks. Click here for more information on this subject.
4. Laproscopic Assisted Vaginal Hysterectomy - combination of a vaginal hysterectomy and laporoscopy will allow the doctors to release adhesions and assist in removal of the uterus without an abdominal incesion.

*It is important to understand that your physicians will educate you about the best route of surgery for your particular case. Our goal is to have our patients have the safest, most comfortable surgery and to be able to return to normal activity as soon as possible.

Pelvic Pain

There are many different causes of pelvic pain and painful menstruations. Some patients may also have pain with intercourse and other activities. Appropriate diagnosis of pelvic pain is the key to successful treatment of the symptoms.

Some of the reasons for Acute (sudden) and Chronic pelvic pain are as follows:

• Enlarged ovarian or tubal cysts
• Ovarian or tubal torsion or twisting
• Pelvic infections and pelvic inflammatory disease
• Fibroids- benign muscular growths of the uterus
• Endometriosis- implantion of the lining of uterus
  Outside the uterus
• Adenomyosis- implantation of the lining of the Uterus in the muscle of the uterus
• Pelvic adhesions and scar tissues
• Pregnancy,miscarriage or ectopic pregnancy
• Non-gynecological reasons including bowel and bladder problems

Steps towards diagnosis of the cause of the pelvic pain are multiple and include medical and surgical evaluations. The following list is some of the steps that we can take towards diagnosis and treatment of the patients:

• Physical and laboratory examination
• Cervical cultures to rule out infections
• Pelvic ultrasound for ruling out ovarian cysts, fibroids, tubal pregnancy
• Diagnostic laparoscopy - a surgical procedure in which a slender, Light-transmitting instrument is used to view the pelvic organs and look for abnormalities
• Laparoscopic release of adhesions, removal of endometriosis or removal of ovarian cysts. With the help of telescope - like cameras and instruments which are placed in patients abdomen through small incisions, the doctors are able to perform the procedures without having to open the abdomen.
• Myomectomy and fibroid treatments 
• Hysterectomy - Click here for more information on this subject.

Uterine and Vaginal Relaxation

Sometimes the supportive tissues in the female genital track can be compromised and therefore the uterus, bladder and rectum can be prolapsed.  Treatment options are vast and include non-surgical and surgical. Drs. Simons and Grade will work with every individual to find the best possible solution to their specific relaxation problems.

Female Urological Disorders

Urinary incontinence is defined as uncontrolled leakage of urine.  There are different categories of incontinence.  Our goal is to identify the different types and render the appropriate treatment options. Both doctors are will trained in the treatment options - both state of the art surgical and non-surgical.  Please contact the office for a consultation appointment.