Gynecology

We offer gynecologic care which includes, but is not limited to:


Pelvic Pain

Pelvic pain is a very common complaint when a patient has a gynecological visit. It has been reported that 15-40% of women of childbearing age had or currently have pelvic pain. There are many different causes of pelvic pain, including:

  • Gynecologic – relating to the female reproductive system
  • Urologic – relating to the kidney/ bladder. For example urinary tract infections or kidney stones.
  • Gastrointestinal – relating to the stomach and intestines. For example appendicitis, constipation or irritable bowel syndrome.
  • Musculoskeletal – muscle strains
  • Psychological – depression

For the purpose of this discussion, we will focus on the gynecological causes for pelvic pain. These can include pelvic inflammatory disease (PID)endometriosisfibroidsovarian cystsdysmenorrhea (painful menstrual cycles) or ectopic pregnancy.

The evaluation of pelvic pain will significantly be guided by a patient’s history and physical examination.

A detailed history will be obtained and a thorough physical examination will be performed at the visit.

Important questions included in the history will include:

  • Onset of the pain – When did the pain start?
  • Nature of the pain – Is the pain sharp or dull? Is the pain constant or intermittent-does it come and go?
  • Duration and location of the pain – Where exactly does the pain occur and how long does the pain last?
  • Pain scale – On a scale of 1 to 10 with 10 being the worst pain you have ever experienced, what number would you rate the pain?
  • Factors that improve/worsen the pain – What makes that pain worse or better?

These questions help us to personalize your plan of care as far as diagnostic testing and treatment.Sometimes, it can be very difficult to diagnose the cause of pelvic pain. The process usually involves evaluating individual systems in your body and eliminating some of the possible causes listed above until we have narrowed it down. The evaluation can include laboratory studies, ultrasound, CT scan, sexually transmitted disease screening and pelvic examination.

There are many modalities of treatment for pelvic pain. In our practice, all our physicians are well versed in the various forms of surgical, hormonal and pain management.

Each patient will receive individualized care and hopefully relief from pain. The etiology of your pain will dictate YOUR plan of care.

Uterine Fibroids

Uterine fibroids, also known as leiomyomas, are benign, non-cancerous muscular tumors that can grow anywhere on a woman’s uterus. They are the most common type of growth found in a woman’s pelvis. Uterine fibroids are made up of the cells that make up the muscle of the uterus, and can grow outside, against, or even inside the uterine lining. The size, shape, number, and location of uterine fibroids vary greatly depending on the woman and her specific case. They can be as small as a pea, or as large as a grapefruit, causing the uterine wall to distort and change. They can even grow large enough to completely fill the pelvis or the abdomen, making the woman appear pregnant. Their growth is unpredictable. 

What Causes Uterine Fibroids?

Although fibroids are extremely common, there is not much known about what causes them. However, it is known that the female hormone estrogen can increase their growth. Uterine fibroids are most common among women around the ages of 40 and early 50's, and more common in African-American women.  Although they can occur at any age, about 20 to 80 percent of women may develop fibroids by age 50. Fibroids can be linked to family history, obesity and consuming a diet high in red meat.

Signs And Symptoms

Many uterine fibroids can be asymptomatic (cause no symptoms), or they can cause many severe symptoms in a woman. Most common symptoms are:

  • Pain
    • during intercourse
    • in the abdomen or lower back (dull, heavy aching)
  • Changes in menstruation
    • Longer or more frequent periods
    • Heavier bleeding
    • More painful cramps
    • Anemia from blood loss
    • Vaginal bleeding at times other than menstruation
  • Pressure
    • abdominal cramps
    • difficulty urinating or frequent urination,
    • constipation, rectal pain, or difficulty passing bowel movements, in rare cases
  • Miscarriages and infertility, although rather uncommon
  • Potential complications during pregnancy and labor, including a six-times greater risk of cesarean section, preterm labor.

These symptoms are also very general and could be indicative of other problems. If you have any of these symptoms, you should still see your doctor to determine the cause.

How Are Uterine Fibroids Diagnosed?

The first signs of uterine fibroids may be found during pelvic exams performed by your gynecologist. If he or she finds signs of fibroids, your doctor may perform one or more of these tests:

  • Ultrasound: test that use sound waves to create a clear picture of the pelvic organs
  • Magnetic resonance imaging (MRI), uses magnets and radio waves to produce a picture
  • Hysteroscopy, a thin, telescope-like device with an attached camera is inserted into the cervix to provide the doctor an inside view of your uterus
  • Hysterosalpingogram (HSG), special fluid dye is inserted into your uterus and mapped with a certain x-ray machine to take pictures of any changes in size or shape of the uterus.
  • Laparoscopy, a slender, camera instrument is inserted into the abdomen (which is inflated with gas) to see any fibroids that may have grown on the outside of the uterus.

If you have been diagnosed in the past with uterine fibroids, you will need to have regular check-ups with your doctor to monitor their growth and to make sure that you are healthy.

Treatment Options

If the uterine fibroids are small and asymptomatic, many do not need to be treated. However, those that develop severe symptoms, as described above, often require treatment.  Rapid increase in growth of a fibroid requires medical attention and proper treatment.

  • Myomectomy: surgery to remove only the fibroids and preserving the ability to have future children.  Unfortunately there is a chance for more fibroids to grow back in the future.
  • Hysterectomy: surgery to remove the uterus including the fibroids but not necessarily the ovaries.  This is the only definitive cure of uterine fibroids.  There are many ways of performing hysterectomies, laparoscopic, vaginal, abdominal or robotic.  Your doctor will discuss with you the differences and his/her recommendation for you. 
  • Endometrial ablation: surgery to burn or destroy the lining of the uterus to control heavy bleeding.  There are many methods to do this and all are considered minor surgery.
  • Uterine Fibroid Embolization (UFE), or Uterine Artery Embolization (UAE): a specialized Radiologist will thread a small catheter to the blood vessel supplying the fibroid.  Small particles are then injected to block the blood supply and cause the fibroid to shrink.
  • Myolysis: a needle is inserted into the fibroid, usually guided by laparoscopy, and electric current or freezing is used to destroy the fibroid.
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