What is abnormal uterine bleeding?
Bleeding that occurs irregularly or excessively is considered to be abnormal uterine bleeding. Any uterine bleeding that occurs before menarche (first period) or occurs after a woman has entered menopause and is not taking hormone therapy is also considered to be abnormal.

What causes abnormal uterine bleeding?
There are many conditions that can cause abnormal uterine bleeding and can occur at different times in a woman’s life.
Common causes include:
› Menstrual/ovulation cycle has not yet regulated during the first few months after a girl’s first menstrual period
› Hormonal changes during perimenopause (transition into menopause)
› Pregnancy
› Uterine fibroids, uterine adenomyosis, endometrial polyps
› Women who use hormonal birth control
› Cervical or endometrialcancer
› Infection/inflammation of the cervix or endometrium
› Bleeding disorders
› Medical illnesses: hypothyroidism, liver disease, kidney disease

How is abnormal uterine bleeding diagnosed?
Your doctor will conduct a thorough history by reviewing the duration/amount of bleeding, associated symptoms, family history, personal medical history, current medications, and other risk factors. Your doctor will also perform a physical examination including a pelvic exam. Other laboratory tests and imaging studies may also be utilized to rule in/out certain conditions.

What are the treatments for abnormal uterine bleeding?
– Contraceptives (oral birth control, lUDs, implants)
– Hormone therapy
– Medications to lessen bleeding
– Surgery

Infertility can be an incredibly challenging journey for couples. The cycle of hope and despair can often place immense strain on a couple’s relationship. The anxiety^ stress, and sadness that can accompany infertility can infiltrate every aspect of their lives. At The OB/GYN Center, we understand that there are numerous potential causes behind infertility, and we are here to provide support, guidance, and medical expertise.

How common is infertility?
Infertility is fairly common in the United States. Approximately 15% of couples who are trying to conceive will experience infertility.

What tests are done for infertility?
– When a couple is having difficulties with getting pregnant, both partners will typically be evaluated to try to diagnose and treat the cause. These difficulties can be due to medical problems with one or both partners, and in some cases, there may not be a specific cause.
– The evaluation of female infertility can involve several elements:
⇒ Medical history
⇒ Menstrual history
⇒ Physical exam
⇒ Blood tests
⇒ Further evaluation of the uterus and fallopian tubes
⇒ Genetic tests

What are the most common reasons that women are unable to conceive?
– Ovulation issues: Pregnancy occurs when the sperm fertilizes the egg after ovulation. If you are unable to ovulate on a regular basis or at all, it can be more difficult to become pregnant. Blood tests can provide information about hormonal imbalances that might contribute to ovulation problems.
– Problems with the uterus or fallopian tubes:
Uterine abnormalities such as structural abnormalities, fibroids, polyps, and scar tissue can contribute to infertility
Scar tissue and obstruction of the fallopian tubes can cause a physical blockage that prevents the sperm from reaching the egg to fertilize
-Endometriosis: Inflammation and scarring resulting from endometriosis can lead to further changes that increase the risk of infertility

What treatments are available for infertility?
There are many treatment options that are available for both male and female infertility. Since treatment is highly individualized, your physician will discuss what option is most appropriate for you and your partner.

What is gestational diabetes?
Insulin is a hormone that helps sugar in the blood enter the body’s cells for energy. This helps to reduce the amount of sugar that builds up in the blood. During pregnancy, the fetus and placenta produce hormones that make the mother’s insulin less effective. Most pregnant women make extra insulin to keep their blood sugar normal, but some women can’t make enough, leading to an increase in blood sugar and eventually gestational diabetes. Gestational diabetes affects 2-10% of pregnancies in the United States.

Who is at increased risk for developing gestational diabetes?
> Women who were diagnosed with gestational diabetes during a previous pregnancy
> Women who are overweight
> Women with a family history of diabetes
> Women who are older than 25, and especially women who are older than 40
> Women of Hispanic American, African American, Native American, South or East Asian, or Pacific Islander descent

What are the complications of gestational diabetes?
> Having an overly large baby (more than 9lbs)
> Stillbirth
> Low blood sugar in baby after birth
> Preeclampsia

How is gestational diabetes diagnosed?
> Testing for gestational diabetes typically occurs between the 24th and 28th weeks of pregnancy. However, if you have certain risk factors for gestational diabetes, your doctor might perform this test earlier In the prenatal period.
> Gestational diabetes is diagnosed using a specialized test known as a “glucose tolerance test.” This test includes checking your blood sugar level after fasting and then again approximately 1-2 hours after drinking a glucose solution. If your blood sugar levels are elevated, it strongly indicates the presence of gestational diabetes.

What is the treatment for gestational diabetes?
> Regular blood sugar monitoring
> Diet changes
> Exercise
> Medications

What is gestational hypertension and preeclampsia?
Gestational (pregnancy-related) hypertension is when a pregnant woman develops high blood pressure after the 20th week of pregnancy. Hypertension is diagnosed when there is persistent elevation in systolic blood pressure of > 140mmHg and/or diastolic blood pressure of > 90mmHg (requires several readings showing high blood pressure). Up to 50% of patients with gestational hypertension may eventually develop signs/symptoms of preeclampsia.

Preeclampsia is the combination of gestational hypertension plus one or more types of organ injury. This can include injury to the kidneys, liver, lungs, brain, and platelets. Preeclampsia can be found in 3- 4% of pregnancies in the United States.

What causes preeclampsia?
Preeclampsia is associated with issues involving the placenta during the early stages of pregnancy. The exact cause and why it only affects some women and not others is not yet fully understood.

Who is at increased risk for preeclampsia?
Preeclampsia can affect any pregnant woman, however the likelihood of developing preeclampsia is higher if you have any of the following risk factors:

• • This is your first pregnancy (not counting miscarriages or abortions)
  • You had chronic conditions such as high blood pressure, kidney disease, lupus, or diabetes before getting pregnant
  • You had preeclampsia in a previous pregnancy
  • You developed gestational diabetes during this pregnancy
  • You’re expecting twins or triplets
  • Your sister or mother had preeclampsia in their pregnancies
  • You’re under 20 years old
  • Obesity

What are the signs/symptoms of preeclampsia?
Many women with preedampsia have slightly high blood pressure and a small amount of protein in their urine. They may not experience any symptoms. That Is why prenatal visits to check blood pressure occur more often later in the pregnancy. Preeclampsia doesn’t go away on its own and can get worse, sometimes over days or weeks, or more rapidly, if one of the following signs or symptoms are present, it is considered severe preedampsia.

• • A severe headache that does not improve
  • Vision problems such as blurry/double vision, blind spots, or loss of vision
  • Difficulty breathing due to fluid in the lungs
  • Abdominal pain in the middle or upper-right area (similar to heartburn)
  • Very high blood pressure (> 160/110 mmHg)
  • Abnormal kidney/liver tests
  • Low platelet count
  • Fluid in the lungs (pulmonary edema)
  • Seizures (known as eclampsia)

Preedampsia can affect how the placenta nourishes and provides oxygen to the fetus. This can lead to:

• • Slower fetal growth
  • Decreased amniotic fluid around the fetus
  • Reduced blood flow through the umbilical cord
  • Abnormal tests such as a nonreactive nonstress test or low biophysical physical score

What is the treatment for preedampsia?
The only cure for preeclampsia is to deliver the baby and the placenta. Rest and medications can be used to lower blood pressure however it does not fix the placental problem causing the disease. The specific management of preeclampsia depends on several factors such as how far along the pregnancy is and the severity of the disease. When preeclampsia happens at or after 37 weeks of pregnancy, the baby is delivered to stop the disease and protect the mother and the baby. If preedampsia develops before 37 weeks and there are no severe complications, it may be possible to wait until 37 weeks before delivering the baby. If preeclampsia becomes severe, the baby will likely be delivered early to prevent more problems for the mother or the baby.

What is a high-risk pregnancy?
Any pregnancy that has an increased or higher-than-normal chance of health complications for the pregnant person, fetus, or both is considered high-risk.

What factors can make a pregnancy be considered as high-risk?
– Advanced maternal age (> 35 years old)
– Lifestyle choices such as use of cigarettes, alcohol, or illicit drugs
– Maternal health problems
– Pregnancy complications
– Multiple pregnancy (more than one fetus)
– Complications during previous pregnancies

What are the potential complications of a high-risk pregnancy?
– Preeclampsia/eclampsia
– Preterm labor
– C-section
– Excessive bleeding
– Birth defects or problems with the fetus’ development
– Miscarriage
– Stillbirth

How are high-risk pregnancies diagnosed and monitored?
– Closer prenatal care/evaluations
– Blood/urine testing
– Ultrasounds
 – Genetic testing
– Consultation with other medical specialists if needed
– Monitoring of medications for preexisting conditions
– Treatment of health problems before/during pregnancy

How can I prevent a high-risk pregnancy?
– Avoiding smoking, drugs, and alcohol
– Managing preexisting health conditions
– Maintaining a healthy lifestyle through diet and exercise

What is a hysterectomy?
A hysterectomy is a surgical procedure to remove the uterus. It is important to note that following a hysterectomy, you will no longer have a menstrual cycle and pregnancy is no longer possible. Your doctor may also remove your cervix, ovaries, or fallopian tubes along with the uterus if needed.

How are hysterectomies performed?
⇒ Open abdominal surgery
⇒ Minimally invasive surgery
⇒ Vaginal surgery

What reasons might someone need a hysterectomy?
⇒ Abnormal uterine bleeding
⇒ Fibroids
⇒ Pelvic organ prolapse
⇒ Cancer or precancer
⇒ Pelvic pain

What are the risks of hysterectomy?
Possible risks include but are not limited to:
– Infection
– Bleeding
– Wound opening
– Injury to nearby organs
– Blood clots

What is a myomectomy?
A myomectomy is the surgical removal of uterine fibroids while keeping the uterus intact.

How are myomectomies performed?
– There are a number of approaches that are available including: 
Laparoscopic surgery: recommended in patients with symptomatic intramural or subserosal fibroids and wish to have children in the future.
Hysteroscopic surgery: recommended in patients with symptomatic submucosal fibroids and some intramural fibroids.
Open abdominal surgery: recommended in patients with symptomatic intramural, transmural, subserosal fibroids who wish to have children in the future and for whom hysteroscopic or laparoscopic myomectomy is not a suitable option.

– The type of surgery used to perform a myomectomy depends on the type, location, size, and number
of fibroids present. The choice of procedure is also dependent on the patient’s desire (or lack of) for
future childbearing.

What are the risks of myomectomy?
Possible risks include but are not limited to:
⇒ Bleeding
⇒ Infection
⇒ Formation of adhesions (internal scar tissue)
⇒ Injury to nearby organs
⇒ Postoperative ileus
⇒ Small bowel obstruction

What is minimally invasive surgery?
Minimally invasive surgery refers to medical procedures that are performed through small incisions instead of larger incisions traditionally used in open surgery. It often involves the use of specialized instruments and a camera to visualize and access the area.

What are the benefits of minimally invasive surgery?
⇒ Shorter hospital stay
⇒ Faster recovery
⇒ Less pain
⇒ Less bleeding
⇒ Less likelihood of developing adhesions (internal scar tissue)
⇒ Less likelihood of complications
⇒ Smaller scar

What conditions can be treated with minimally invasive surgery?
– Uterine fibroids
– Endometriosis
– Ovarian cysts
– Abnormal uterine bleeding
– Pelvic organ prolapse
– Adhesions
– Adenomyosis
– Pelvic pain
– Ectopic pregnancy

What types of minimally invasive surgery are available?
⇒ Hysteroscopic surgery: procedure involving the insertion of a small scope (camera) through the cervix to visualize the uterine cavity and diagnose/treat conditions. This does not require incisions in the abdomen.
⇒ Laparoscopic surgery: requires multiple small incisions in the abdomen allowing for a scope and surgical instruments to be inserted and manipulated by the surgeon to perform procedures.
⇒Robotic-assisted surgery: similar to traditional laparoscopic surgery, the da Vinci Robotic-assisted surgery requires a few small incisions in the abdomen to allow for a scope and surgical instruments to be inserted. The surgeon is then able to view a high-definition 3D image of the surgical site and use a console to perform the procedure through the robotic instruments with better precision, control, and visualization.

What is polycystic ovarian syndrome (PCOS)?
PCOS is a common hormonal disorder affecting about 5-8% of all women.

What causes PCOS?
The cause of PCOS is not yet completely understood. However, there is believed to be an association between abnormally elevated levels of “male hormone (testosterone) and PCOS. About once a month, the ovaries develop a structure called a “follicle.” As the follicle grows, it makes hormones and then releases an egg. This process is called ovulation. In people with PCOS, the ovary makes multiple small follicles instead of one big follicle which can lead to hormonal imbalances and disrupted ovulation cycles.

What are the signs/symptoms of PCOS?
– Irregular menstrual cycles
– Weight gain and obesity
– Excess facial/body hair
– Acne
– Male pattern baldness
– Infertility

How is PCOS diagnosed?
There is no single test to determine the diagnosis of PCOS. Your doctor will typically start with obtaining a careful history and physical examination. Your doctor will also likely order laboratory
studies as well as imaging studies to rule out other possible medical conditions that can cause your signs/symptoms and to monitor over time.

Most expert groups have determined that women must have two out of three of the following to be diagnosed with PCOS:
» Irregular ovulation (irregular/absent menstrual cycles)
» Elevated androgen levels (either through blood tests or on physical exam)
» Polycystic ovaries on pelvic ultrasound

What are the treatments for PCOS?
– Birth control medications
– Lifestyle changes such as a healthy diet, weight loss, exercise, and quitting smoking
– Hormonotherapy
– Fertility treatments
– Acne treatments
– Laser hair removal or electrolysis for extra hair

What other conditions are PCOS associated with?
Women who have PCOS are at a greater risk for other health problems including:
» Diabetes, high cholesterol, high blood pressure, depression or anxiety, sleep apnea, eating disorders, lower sexual satisfaction, endometrial cancer, and stroke

Wound care after surgery:
Open abdominal surgery

• • You will likely receive one of the following wound closures after your procedure: staples, regular stitches, stitches under Steri-strips (skin tape), or skin glue. The removal process varies:
    • Staples and some stitches are typically taken out before you leave the hospital or during office visit, about 7-14 days after surgery. Occasionally, the stitches are absorbable and do not require removal. Your doctor will  inform you about the type of stitches used.
    • If there is a bandage on your incision, your surgeon will provide instructions on when to remove the bandage, typically 1-2 days after surgery.
    • Steri-strips can usually be removed about 1 week after surgery. To facilitate easier removal, use a warm wet cloth or take a shower.
    • Skin glue generally peels off on its own. If it has not fully peeled off after 10 days, you gently use antibiotic ointment or petroleum jelly to aid removal.
  • While your incision heals, avoid scrubbing the area to prevent reopening. A simple rinse with water during showering is sufficient for cleaning.

Laparoscopic surgery

• • For laparoscopic surgeries, small incisions will be made on your abdomen. These incisions will be sealed with stitches, which can be nonabsorbable (requires removal later) or absorbable (no removal needed). They may also be covered with Steri-strips or skin glue. The aftercare for these incisions is similarto that for open abdominal surgery.

Pain management after surgery:

• Following many gynecologic procedures, some level of discomfort or pain may be experienced. The location and intensity of the discomfort vary depending on the type of procedure. For instance, individuals undergoing procedures involving a skin incision (such as open abdominal or laparoscopic surgery) may experience pain around the incision site. Conversely, procedures performed inside the uterus (like hysteroscopy or endometrial ablation) might lead to a cramp-like sensation, similar to menstrual cramps.
• It’s common to experience occasional abdominal discomfort, characterized by cramps and bloating, following surgery. This discomfort is typically due to the accumulation of gas in the intestines. Fortunately, it’s usually short-lived and will go away after passing gas or having a bowel movement. Some people find relief with over-the-counter medications like simethicone (e.g., Gas-X). However, if the pain and bloating persist or become severe, it’s advisable to contact your surgeon for guidance.
• In the case of laparoscopic surgery, you may also experience shoulder pain, which results from the gas used to expand the abdomen during the procedure. This shoulder discomfort can persist for a few days.
• Aside from medication, it may also be helpful to avoid uncomfortable positions or activities, provide support to your abdomen with a folded blanket or pillow, or use a supportive binder. Applying a warm water bottle or heating pad over the abdominal area (with a towel/cloth between your skin and the bottle/pad) may also help.
• Pain relief medications are available as over-the-encounter or can be obtained through a prescription, and they fall into two categories: non-opioid and opioid. Non-opioid pain medications encompass acetaminophen (e.g., Tylenol) and ibuprofen (e.g., Advil, Motrin). Consistently taking non-opioid medications at specified intervals (such as every four to six hours) can assist in maintaining pain at a man ageable level and potentially reduce the requirement for more potent opioid medications.
• Opioid pain relievers encompass tramadol, oxycodone, hydrocodone, and hydromorphone. Additionally, there are pain medications that combine acetaminophen with an opioid. It’s crucial to be aware of whether your opioid medication includes acetaminophen to avoid taking other drugs that contain acetaminophen. Consuming excessive acetaminophen can lead to liver issues. While on opioid pain medications, do not consume alcohol, drive, or engage in tasks requiring focus/attention,
• If you are taking any other medications, make sure that each of your prescribers are aware of your medication regimen so that they can confirm if it is safe to take them at the same time. If your pain is not relieved with your pain medication regimen, ask your doctor for advice. Do not take more medication than prescribed.

Bleeding after surgery:
It is common to experience some light vaginal spotting/bleedin g after gynecologic surgery and it may persist for several weeks. In some cases, especially during the first week after surgery, you may have some heavy bleeding or pass a blood clot. Contact your surgeon if the bleeding is heavy (more than a usual menstrual period or if it completely saturates a large pad within one hour).

Activity after surgery:

• You may likely feel tired especially the first few days after surgery. It is important to rest when you are tired, however it is also important to walk around at least a few times a day if you can. This will help prevent blood clots in your legs, pneumonia, and gas pains. Gradually increase your activity level when you feel comfortable.
• Avoid taking baths and swimming until your surgeon says it Is safe to do so. You can still shower as normal after your procedure. Avoiding submerging your body in water helps prevent the risk of infection.
• It is usually recommended to refrain from heavy lifting for about 6 weeks following a major abdominal/vaginal surgery and 1-2 weeks after a minor procedure such as a laparoscopy. If you did not receive an incision, there is no need to restrict from lifting.

When to call your doctor after surgery:

• Please seek immediate medical attention and call your surgeon if you experience any of the following after surgery:
  • Severe abdominal pain or bloating lasting for more than 1 hour, even after taking pain medication
  • Shortness of breath or chest pain
  • Heavy vaginal bleeding (more than a usual menstrual period or if it completely saturates a large pad within one hour)
  • Nausea/vomiting for more than 1 day or prevents you from eating or drinking
  • Fever exceeding 101“F (use a thermometer to measure your temperature)
  • Changes to your skin incision such as redness, fluid/pus discharge, or the incision opening
  • Significant swelling in one extremity (leg or arm) compared to the other
  • Foul-smelling, green, or dark yellow vaginal discharge
  • Inability to empty the bladder or burning during urination
  • Inability to have a bowel movement for 3 days
  • Having loose or watery stools more than 2 times per day or experiencing bloody stools

Follow-up after surgery:
You will be asked to make a follow-up appointment with your surgeon about 2-6 weeks after surgery. During this time, your surgeon will examine the surgical site to ensure that the tissues are healing as expected. Your surgeon will also go over details about your procedure, answer any questions/concerns, and go over what to expect moving forward.

What is preterm labor?

• • Preterm labor is labor that starts prior to 37 weeks of pregnancy. Pregnancy typically lasts about 40
    weeks, starting from the first day of your last menstrual period.

Who is at increased risk for preterm labor?

• • Women with a prior history of preterm labor
  • Women who are pregnant with more than 1 baby (twins, triplets)
  • Women with a short cervix
  • Women whose “water breaks” before 37 weeks of pregnancy
  • Women who have been diagnosed with placental abruption
  • Women who smoke or use illicit drugs
  • Women who develop infections in the uterus or other parts of the body
  • Women with uterine abnormalities
  • Women with a history of cervical surgery

What are the signs/symptoms of preterm labor?

• • Contractions
  • Change in vaginal discharge
  • Pain/pressure in the lower belly or pelvis
  • Lower back pain
  • Abdominal cramping
  • Light bleeding or spotting
  • “Water breaking” or sudden gush of fluid from the vagina

Does preterm labor automatically mean that the baby will be born prematurely?

• • No, not all women with preterm labor will deliver early. It is estimated that between 30-50% of women with preterm labor will deliver their baby at full term.

What is the treatment for preterm labor?

• • Treatment varies with each individual. It is our goal to ultimately protect the health of you and your baby. Treatment can depend on:
    – What is causing the preterm labor
    – How far along you are
    – If you or your baby have any medical problems

What is repeat pregnancy loss?
A pregnancy loss, or “miscarriage/’ is when a pregnancy ends on its own before 20 weeks. Repeat pregnancy loss is the medical term for when a person has had 2 or more miscarriages.

What causes repeat pregnancy loss?
– Chromosome problems in the fetus
– Conditions that change the shape of the Inside of your uterus
– An autoimmune condition
– Other medical conditions
– Unknown causes

What tests can 1 do for repeat pregnancy loss?
– Pelvic exam
– Blood tests
– Imaging tests
– Scope to look inside the uterus
– Genetic tests

How is repeat pregnancy loss treated?
If there is a cause that can be treated, your doctor will treat it appropriately. Some treatments include surgery and/or medications depending on the cause.

What are uterine fibroids?
Fibroids are abnormal growths that form in the muscle of the uterus. Fibroids are also called uterine leiomyomas or myomas. There are different types of fibroids that can be found in different areas of the uterus. Fibroids are not cancerous and are very common. Approximately 80% of females will develop fibroids in their lifetime.

What causes uterine fibroids?
The cause of fibroids is still unknown. Several possible risk factors include age at menarche (first period), genetics, lifestyle, race, and pregnancy history. Many people can develop fibroids without any known risk factors.

What are the signs/symptoms of uterine fibroids?
Most fibroids are small and do not cause any symptoms. Fibroids are more likely to cause symptoms if they are large in size, if there are multiple fibroids, or if they are located in specific places in the uterus.
These symptoms can include:
– Heavy menstrual cycles Abdominal/pelvic pain and/or pressure
– Frequent urination
– Constipation
– Infertility

How are uterine fibroids diagnosed?
Your doctor will obtain a complete history by discussing your symptoms as well as a physical ination. Your doctor may also perform a pelvic ultrasound to visualize the presence of uterine fibroids.

What are the treatments for uterine fibroids?
The treatment for fibroids depends on each individual. If the fibroids are not causing any symptoms, you can opt to not have treatment. Otherwise, treatments typically include symptom management via
medications or surgery if your symptoms are not improving with medications or if the size of the fibroid is causing difficulties with pregnancy or other symptoms.

Medications
» NSAIDs (nonsteroidal anti-inflammatory drugs) such as ibuprofen and naproxen for menstrual cramping
» Iron supplements and multivitamins for iron deficiency anemia
» Hormonal birth control
» Antifibrinolytic medications (clotting medications)
» Medications to suppress estrogen/progesterone release

Surgical/interventional treatment
» Myomectomy
» Uterine artery embolization
» Magnetic resonance-guided focused ultrasound
» Ultrasound-guided radiofrequency ablation
» Endometrial ablation
» Hysterectomy