WOMEN’S HEALTH & GYNECOLOGY
The updated 2012 guidelines for the timing of cervical cancer screening (otherwise known as your “pap smear”) have drastically changed from the 2007 guidelines. Please take the time to familiarize yourself with these new guidelines and become an advocate of your own health!
- No screening pap smear under the age of 21.
- Women age 21 to 65, screening every 3 years.
- Women age 30 to 65 may opt to screen every 5 years with combination cytology and HPV testing.
- Women over age 65 may cease screening.
- Women who have had a hysterectomy with removal of the cervix no longer require screening–unless medically indicated.
- The above recommendations apply to those women have had adequate prior screening and are not high risk for cervical cancer. Each individual will have their treatment plan modified based on their personal history and risk factors.
We stress the importance of continuing annual examinations for breast examinations, pelvic examinations and annual blood work if required. Your health is worth the time.
Every Fenom doctor can care for adolescents and their gynecological needs. In addition to seeing young women in the downtown office, Dr. Palmer also holds clinic at Girls to Women Adolescent Clinic in Fort Worth. Conditions treated include, but are not limited to:
- Painful or heavy menstrual cycles
- Absent or infrequent menstrual cycles
- Vaginal discharge
- Pregnancy prevention, including placement of long-acting reversible contraceptive devices
- Polycystic ovarian syndrome
- Pelvic pain
- Reconstructive management of basic vaginal anomalies
There is no cookie cutter treatment for hormonal imbalance as every woman has a different experience. Women experience symptoms to varying degrees – some experience no symptoms at all, while others have a huge amount of discomfort. No matter the degree of discomfort, if left untreated, patients are at risk for issues from obesity to heart disease to diabetes. However, the condition is entirely treatable. Our physicians can recommend personalized solutions which not only alleviate symptoms but also protect your future health. Please do not become content with discomfort. Your health and happiness are your rights as a woman. Let us help. Hormonal imbalances include but are not limited to:
- Polycystic ovary syndrome (PCOS), resulting from abnormal levels of certain hormones, is the most common endocrine disorder among women of reproductive age, affecting 5-10% of premenopausal females. This hormonal imbalance is associated with irregular menstrual periods, endometrial hyperplasia, infertility, obesity and increased risk for diabetes and cardiovascular disease (metabolic syndrome).
- Premature ovarian failure, also known as premature menopause, occurs when ovarian functions cease prior to the average age of menopause, which is forty-five. This is an uncommon condition which can be diagnosed and treated to prevent the long-term sequelae of menopause. If you experience an early onset of menopausal symptoms, please invest in your health and consult a physician.
- PMDD or premenstrual dysphoric disorder. Many women experience varying degrees of moodiness prior to the onset of menses. You aren’t crazy – this is a very real, but luckily treatable condition. Our physicians offer many therapies to treat these symptoms, some conventional and some alternative.
This is a very exciting field of medicine. We are still learning a great deal as women live longer, healthier and more productive lives. Menopause is defined as that period of time in a woman’s life after which menses has ceased for 6 months or more. Many women transition to and through menopause with few or no symptoms; however, many others will experience significant symptoms including but not limited to hot flashes, emotional lability (mood swings), vaginal dryness, insomnia and decreased libido. This is a natural transition but often the symptoms are difficult to manage. We offer many treatment options, including traditional hormone replacement therapy, “bioidentical” hormone therapy and non-hormonal options. There is no one therapy that will work for all women, so understanding each woman’s goals, fears, risk factors and desires is essential to choosing the most beneficial therapy. Naturally, as women transition, there can be associated symptoms and some long-term risk factors. We can help each woman understand her relative risks, ease the transition and help to decrease the overall lifetime risks.
Since women live half their lives in this state, it’s important to see a physician right at the onset of menopause to provide solutions. Hormone therapy and other recommendations for dealing with discomforts can reduce risk factors for heart disease, diabetes and other ailments to ultimately extend life expectancy. If you wait too long, those risk factors increase and it may be too late to provide treatment. Make an investment in your lifelong health.
For more information, visit: https://www.acog.org/Patients/FAQs/The-Menopause-Years
Also known as insulin resistance syndrome, this disorder is associated with a number of risk factors that confers an increased risk for cardiovascular disease and premature death. It is diagnosed when three or more of the following criteria are present: abdominal obesity (waist circumference >88cm or 35 in.), serum triglycerides (TG) 150 mg/dl or greater, serum high-density lipoprotein cholesterol (HDL) less than 50 mg/dl, blood pressure (BP) >130/85 mmHg and serum fasting glucose >110 mg/dl. Treatment requires medication as well as therapeutic lifestyle changes with regard to diet, weight loss (only 5-10%) and increased exercise to combat disease.
Osteoporosis is a skeletal disease characterized by low bone mass and loss of bone tissue. This condition leaves the bone frail and susceptible to fracture. The diagnosis of osteoporosis was previously made after a woman had suffered a clinically significant fracture. Now, we can measure bone mass to make the diagnosis of osteoporosis before the fracture occurs. Imaging technology, called dual X-ray absorptiometry (DXA), is preferred by most doctors to measure bone mass in the post-menopausal or high-risk patient.
The ovaries are two small organs, one on each side of the uterus, which produce an egg every month during your menstrual cycle. Ovarian cysts are common in women and can result from changes in hormone levels; they can vary in size from as small as a pea to as big as a grapefruit. Different types of ovarian cysts can cause a variety of symptoms. Functional cysts result from the normal process of ovulation and are normally resolved within a few months. Dermoid cysts contain both fluid and solid tissue and can vary in size, typically requiring surgical removal. Cystadenomas are normally benign cysts that can grow large, causing pain and requiring removal. Endometriomas or “chocolate cysts” associated with endometriosis can contain endometrial tissue and blood, causing pain and possible infertility. Multiple small cysts, commonly seen in PCOS, can form, causing irregular menstrual periods and infertility. Although each of these conditions sounds intimidating, annual screenings can help to diagnose and treat these problems before they become life-threatening. Take the time to invest in the future of your health.
PELVIC PAIN, SUPPORT PROBLEMS & INCONTINENCE
The pelvic organs include the urethra, bladder, small and large intestines, rectum, uterus and vagina. These are normally held in place by muscles, ligaments and fascia that can be stretched and damaged over time, causing symptoms of pelvic heaviness or fullness, pulling or aching in the lower abdomen, leakage of urine or problems having a bowel movement. Proper diagnosis is the key to treatment and may require special testing called Urodynamics or evaluation with cystoscopy or anoscopy. Treatment includes pelvic floor muscle therapy, exercising, making dietary changes, weight loss, smoking cessation and avoiding heavy lifting and straining. Medication, surgery and a special device called a pessary may be helpful. We also offer pelvic floor physical therapy in our office. These conditions are entirely treatable, but require women to bring the respective symptoms to the attention of their physicians. Do not let pain define your life as women. Take control of your health.
For more information, visit: https://www.acog.org/Patients/FAQs/Pelvic-Support-Problems
Most therapy focuses on the phase of sexual response cycle that is disrupted. The first-stage “desire phase” disruptions are characterized by a loss of interest in sexual activity, commonly caused by depression and relationship discord. “Excitement phase” disorders include failure of erection in the man and vaginal lubrication in the female. Vaginismus is a condition that is secondary to involuntary spasm of vaginal introital and levator ani muscles. Spasms can make penetration either painful or impossible. Orgasmic dysfunction is quite common; 10-15% of women have never had an orgasm through any form of sexual stimulation and another 25-35% will have difficulty reaching orgasm on a particular occasion. Dyspareunia is pain felt by women either on insertion or during thrusting or deep penetration. Identification and treatment of infectious causes like cystitis, vaginitis (yeast or bacterial vaginosis) and STIs should be performed first. Treatment includes couple counseling, vaginal lubrication, sensate focus exercises and medications. Always keep in mind that decreased libido can be a sign of too much stress or depression. We believe in empowering women to get the most out of their lady business. Communication can be difficult, but key to developing a desired response.
This growth (also known as a fibroid tumor or leiomyoma) is typically a non-cancerous growth of muscle within the uterine cavity. These benign growths can become quite large and cause irregular, heavy bleeding in women. They can be treated with medicine, minor surgery (hysteroscopy), major surgery (myomectomy and hysterectomy) and minimally invasive radiological techniques (uterine artery embolization).
OBSTETRICS & FERTILITY
Obstetrics is the part of our practice involving all aspects of pregnancy. All of our physicians take pride in caring for pregnant women and assisting in the delivery of new life.
In general, we evaluate our patients after the 5th week of pregnancy, but before the 10th week. Most women have a positive pregnancy test when the menstrual period is a day or more late. Since we date pregnancy from the age of the egg, in a predictable 28-day cycle, most women are 4-5 weeks pregnant when they have their first positive pregnancy test. We like for women to schedule an appointment with our nursing staff in order to obtain an accurate medical history and early screening blood tests. This way, we can ensure the best possible care for you and your baby! After this appointment, we will schedule your first New Ob exam, which often includes cervical cultures and a Pap smear. The physician may also order or perform a first trimester sonogram to verify dates and placement of the pregnancy. We encourage you to write down any questions you have so that all of your concerns can be addressed. We know pregnancy can be exciting and intimidating all at once and are prepared to assist our fellow women through this amazing time.
We know pregnancy can be exciting and intimidating all at once, and are prepared to assist our fellow women through this amazing time. Our staff is committed to ensuring that each and every one of your questions and concerns are addressed.
There are many medical conditions which can complicate pregnancy; our staff will ascertain these from your personal and family history.
- Miscarriage is very common, yet nonetheless difficult. Almost a third of all pregnancies end in miscarriage. Many risk factors and medical conditions can be discovered when a pregnancy fails. Some of these conditions are treatable, which our staff will diagnose so that subsequent pregnancies are successful. We encourage women who have experienced a failed pregnancy to understand that miscarriages are seldom caused by the woman herself, but rather, by a random misstep of cell division. Our bodies are capable of amazing things but do not always run every process perfectly. If recurrent miscarriages have occurred, we encourage testing of both partners to try to ascertain a treatable cause. As part of the medical history, we will search for risk factors for pregnancy loss in an attempt to prevent failed pregnancies.
- Chronic medical conditions: Since women are waiting longer to start their families, we are seeing many more pregnancies complicated by conditions such as diabetes, hypertension, asthma, thyroid disease and heart disease. Although optimal health is preferred, many of these conditions can be safely treated so that pregnancy can continue.
- Pregnancy-related medical complications: The condition of pregnancy, though natural and healthy, is associated with certain medical conditions. The most common are gestational diabetes and hypertensive disorders. Our physicians are experienced in diagnosing and managing these complications to make your pregnancy as safe and comfortable as possible.
- Multiple gestations: This involves caring for women who are pregnant with twins, triplets, etc. Our physicians can diagnose multiple gestations with an early ultrasound. We are experienced in caring for and delivering both twins and triplets. We often involve our perinatologists in risk management to assist in the growth of your family.
- Routinely offered screening tests: Many screening tests are done when pregnancy is diagnosed. In early pregnancy, this includes blood type and Rh factor, blood count, screening for hepatitis, HIV, syphilis and MMR. As pregnancy progresses, a patient may be offered blood screening for Down’s syndrome or a Penta screen. In the third trimester, we will screen for gestational diabetes and group B strep. We utilize these tests to ensure the health of you and your baby.
All of our physicians deliver babies. We share calls during the weekend and at night in order to make sure that you feel comfortable and informed. During your prenatal appointments, your physician will assist you with your birth plan and answer any questions you may have. We are all dedicated to empowering your decision-making in the delivery of your child!
An ectopic pregnancy is any pregnancy that occurs outside of the uterus. The most common place an ectopic pregnancy grows is in the Fallopian tube. The causes of ectopic pregnancy include prior pelvic inflammatory disease caused by infection or endometriosis, prior ectopic pregnancy, cigarette smoking, previous tubal surgery and increasing age. A patient will usually experience pain and bleeding with this type of pregnancy. Diagnosis often includes ultrasonography and blood tests. Treatment varies depending on the size and location of this type of pregnancy, but our doctors will work to preserve fertility, as is possible in most cases.
Although we are not specialists in this field, there are many aspects of infertility that we can address. A couple is considered to have impaired fertility if they have ovulatory timed intercourse regularly without using contraception for two years or more and are unable to conceive. If a couple is 35 or older, the interval is shortened to one year. While this can be frustrating for couples, don’t give up hope! We recommend an evaluation including laboratory testing of both partners, evaluation of uterine and fallopian tube anatomy as well as ovulatory function. We can treat many minor abnormalities, including induction, using oral medications. If the infertility involves more complex problems, we would help the couple access reproductive endocrinology specialists who may further assist them in achieving pregnancy.
SURGICAL SERVICES & PROCEDURES
Our doctors share experience in a variety of gynecologic surgeries, each catering to particular women and their respective conditions. Your physician will discuss all options with you as you consider which operation is best for your lifelong health.
Total Vaginal Hysterectomy
Removal of the uterus without an abdominal incision. The advantages are less pain, shorter hospitalization and more rapid recovery.
Total Abdominal Hysterectomy
Removal of the uterus with a traditional midline or Pfannenstiel (bikini cut) incision. Typically reserved for the very large uterus, when severe scarring is present or malignancy is suspected.
Removal or repair of ovarian or uterine tumors via abdominal incision. We reserve this for procedures we feel cannot be safely or effectively performed with the laparoscope.
After a thorough evaluation, many pelvic floor weaknesses can be treated with vaginal, abdominal or laparoscopic surgery. As part of our surgical workup, we will ascertain and address a history of any pelvic floor weakness.
Intuitive da Vinci Robotic Assisted GYN Surgeries
Our physicians are trained in using this innovative technology to avoid surgical incisions in complicated surgical situations. Learn more about this process at www.davincisurgery.com
This procedure is often performed when a pap smear shows abnormal cells that could lead to cancer. Colposcopy may also be used to further assess pain, bleeding, polyps, genital warts and cervicitis. It is a special way of looking at the cervix through a magnifying device that can enlarge the normal view by 2-60 times to allow for identification of areas with abnormal cells. A biopsy, removal of abnormal tissue, may be taken from both the external cervix and cervical canal to aid in diagnosis and treatment. Minimal discomfort is reported, and some patients may experience vaginal soreness and light bleeding for a few days. However, this procedure is an instrumental preemptive practice for maintaining a healthy female life.
Loop Electrosurgical Excision Procedure (LEEP)
LEEP is an effective and simple way to treat cervical dysplasia. Dysplasia is when cervical cells become abnormal, increasing the risk for cervical cancer. Abnormal cells are most often detected by the Pap smear and confirmed with biopsies during colposcopy. LEEP uses a thin wire loop with an electrical current, which cuts away a thin layer of the surface cells. Pain medication and local anesthesia are given, with patients reporting a sensation of dull ache or cramping during the procedure.
Endometrial Biopsy (EMB)
Rapid, safe and inexpensive sampling of the endometrial lining is a common procedure in the workup of women with abnormal vaginal bleeding. Tissue is aspirated from the endometrium using a narrow pipelle. The patient will experience uterine cramping during the short time that the instrument is inside the uterus, but any discomfort will end once the procedure is completed.
Intrauterine Device (IUD)
An intrauterine device (IUD) is a small, often T-shaped birth control unit inserted into a woman’s uterus to prevent pregnancy. It is one form of long-acting reversible birth control and the procedure is performed in our office.
Birth Control Implant
Nexplanon is a birth control implant that consists of a single rod containing etonogestrel. Nexplanon birth control device insertion and removal is offered on-site at our office.
Biopsies for vulvar cancer can be handled at our office to test samples for possible malignant cell growth.
Bartholin Cyst Drainage
A Bartholin cyst occurs when a gland at the opening of the vagina is blocked and becomes inflamed. Drainage may be recommended if the cyst causes pain or other issues and can be performed in our office.
With the addition of office-based anesthesia, we also have the ability to perform both diagnostic and treatment procedures in a more comfortable and convenient setting. Who says health has to be a hassle?
MINIMALLY INVASIVE SURGERIES
A surgical procedure done through very small incisions, often as an outpatient.
This is used for evaluation of infertility and or pelvic pain or abnormal findings. If an abnormality is found, it can be corrected at that time.
When patients have difficulty conceiving, laparoscopy can be a useful surgery to discover pelvic abnormalities that may be corrected.
Conventional female sterilization procedures can be performed via laparoscopy using multiple techniques.
There are three laparoscopic hysterectomy techniques:
- LAVH, Laparoscopic Assisted Vaginal Hysterectomy (the entire uterus is removed, including the cervix. The surgery uses combined laparoscopic techniques and intravaginal techniques to affect the removal of the uterus. The ovaries may be left or removed, depending on the circumstances).
- LASH, Laparoscopic Assisted Supracervical Hysterectomy (removal of the uterus above the cervix; ovaries may be removed or left, depending on the circumstances).
- TLH, Total Laparoscopic Hysterectomy (the entire uterus is removed laparoscopically, with or without robotic assistance, and removal of the ovaries is optional).
A surgical procedure whereby the surgeon examines the inside of the uterine cavity. This may be done either under general anesthesia as an outpatient procedure, or under local anesthesia in the office.
Abnormalities, like fibroids or congenital abnormalities, may be evaluated and treated via the hysteroscope.
Tubal occlusive devices like Essure and others, which have yet to be made available, can make permanent sterilization simpler and available as an office procedure.
For evaluation of abnormal bleeding, biopsy and treatment.
Excessive Uterine Bleeding/Endometrial Ablation
Abnormal bleeding is a common problem for many women. Our physicians share experience in a variety of treatment methods, but a woman who has completed her childbearing and does not desire or is not a good candidate for a hysterectomy can consider endometrial ablation. This involves evaluating the uterus to be sure there is no cancer, then using one of several techniques which scar the uterine lining to prevent further bleeding. Don’t worry, this is done without affecting female hormone levels. Many of these procedures can be performed in the office or under general anesthesia.
Many of our physicians can utilize the revolutionary Da Vinci robot in certain hysterectomy procedures. The Da Vinci robot assists surgeons through a high-definition 3-D camera and the use of EndoWrist® Instruments, which offer surgeons a greater range of motion than the human hand, allowing for more dexterous small incisions and overall enhanced control. This results in non-invasive surgical options which offer shorter recovery times than traditional surgeries as well as less pain.