Gynecological Services in Manchester, NH

We provide a wide range of quality Gynecological services to women of all ages. Please click on the Gynecological services we provide to learn more about it.

Annual Gynecological Exams


What is an annual Exam?
 
Your annual exam is your yearly preventative health visit. At this visit, you will first meet with your physician or nurse practitioner in his or her office, and discuss any concerns that have arisen over the past year. We will update your history, review your health habits, and determine what screening tests may be due. You will then have a full physical exam, with breast exam, pelvic exam, and Pap smear if needed. Finally, if you have medications prescribed through our office, such as contraceptives or hormonal therapy, we will refill those for you if needed. Remember, the annual is not a problem visit. Sometimes minor issues may be addressed at your annual. However, if you have a specific problem (for example; heavy periods, urine leakage, difficulty getting pregnant, etc.) they will need to be addressed at a separate office visit.
Do I need a Pap Smear?
 
Recently, Pap smear guidelines were updated such that some women do not need yearly pap smears. It is important to realize that even if you are not due for a pap smear, you still need an annual exam! The Pap smear is only one small part of the annual exam. The Pap smear screens for precancerous or cancerous changes of the cervix. If you have risk factors for cervical changes, including age less than 30 years, a history of severe cervical changes or surgery for cervical changes, or certain medical conditions that affect your immune system, pap smears will still be done on a yearly basis. However, if you are over 30 years old, and have never had any abnormal pap smears that have required treatment, you should have a pap smear every 3 years. And if you have had a hysterectomy or are over 65-70 years old, you may not need a pap smear at all.
 

Breast Exam


Clinical breast exams by a health care provider are a routine part of the annual gynecologic exam and can be important for finding breast cancer early. Your health care provider will examine your breasts by feeling them with the pads of his or her fingers is a systematic, structured way for detection of any changes in texture or lumps. The nipple and arm pit area will be examined as well, due to the fact that breast tissue extends into the armpit area. Your health care provider is experienced in detecting changes that need further testing. Breast exams along with mammograms can improve the chances of detecting breast cancer early.

Colposcopy


What is Colposcopy?
 
Simply put, colposcopy involves your doctor looking at your cervix through a microscope. A speculum in placed in your vagina, like when you have your Pap smear. A solution of weak acetic acid (white vinegar) is placed on the cervix. Abnormal areas of the cervix turn white while normal cervical skin stays pink. If abnormal areas are seen, a biopsy may be performed. The biopsy is very quick, and usually is felt as a small pinch or cramp. The biopsy is then sent to pathology, to determine if you will need further treatment or not. You should wear or bring a pad for your colposcopy, as sometimes there is a bit of spotting or discharge. You should not use tampons or have sex for several days. Otherwise there are no activity changes after colposcopy.

Contraception


There are many options available to help prevent unintended pregnancy. We are happy to schedule a consult with you to discuss which form best meets your needs. The following is a brief overview of the methods available to you.
Combined hormonal birth control
 
This includes oral contraceptives (“the pill”), the Ortho-Evra patch, and the NuvaRing vaginal ring. These methods are highly effective when used correctly, and have the added benefits of making periods lighter, less crampy, and more regular. However, all depend on you remembering to use them correctly, and some women cannot use these medications due to other medical conditions.
Progesterone only methods
 
These include progesterone only pills (the mini-pill), Depo Provera (an injection given every 3 months), Nexplanon (an implantable rod that is inserted under the skin in the arm), and the Mirena IUD. Except for the “mini-pill”, all of these methods are easier to use, as they require less effort on your part. The Depo injection is given in the office every 3 months, the Nexplanon lasts three years, and the Mirena lasts five years. Many women who cannot take the pill can use these methods.
IUDs
 
The intrauterine device (IUD) is a small plastic T-shaped device that is placed in your uterus in the office. There are two kinds of IUD. The Mirena IUD does contain hormones and lasts for 5 years. The Paragard, or copper IUD, lasts 10 years and has no hormones. Both are over 99% effective at preventing pregnancy, and are reversible, meaning you can remove them if you would like to become pregnant.
Sterilization
 
 
Sterilization is a permanent and irreversible procedure for women who have completed their families. Tubal ligation is female sterilization, and can be performed in several ways but is usually done via an outpatient surgical procedure. Vasectomy is male sterilization; this would be performed by a urologist.
Which form of birth control is most appropriate for you depends on your wishes regarding future children, your other medical conditions, and your comfort with the various methods. Feel free to call for a consult to discuss this with us.

Endometrial Ablation


Endometrial ablation is a minimally invasive, hysteroscopic procedure that is done to destroy the endometrial glands or menstrual lining to decrease heavy menstrual flow.

There are several types of endometrial ablations that use different techniques to remove the menstrual lining. These methods may utilize electrical energy, freezing temperatures or heated fluid.

Each technique has benefits, risks and indications for use. A discussion with your provider will help you decide which method may be the best choice for you. In general, all techniques have a 90% success rate in treating heavy bleeding. In office and outpatient procedures are available.

Essure


Essure is a permanent birth control procedure (sterilization) that can take as little as 10 minutes to perform. A small, soft insert is put through your cervix at the top of the vagina and placed into the fallopian tubes with the help of a small camera system. It avoids incisions in the abdominal wall under anesthesia, which traditionally were done for tubal ligation procedures. These inserts cause gradual scarring over 3 months which block the tubes so that the sperm and egg cannot meet, which prevents pregnancy. An X-Ray at the end of the 3 months is done to confirm the blockage. This is considered permanent and not reversible. It can be performed in an office setting or at a Surgicenter. When performed in the office you will only need mild pain medication and you will be awake during the procedure. You may be able to return to work without restrictions in less than a day. Back up birth control, such as condoms or birth control pills, for the first 3 months is required.

Gardasil


Gardasil is a vaccine that targets four strains of human papillomavirus (HPV). Infection with one of these four strains of HPV is responsible for most, but NOT all, cases of cervical cancer and genital warts. The vaccine is indicated for girls and women between the ages of 9 and 26. It is given as a series of three injections over a six-month period. After the first injection, doses are given two months later and six months later to complete the series.

The vaccine is highly effective for at least five years. Whether additional future injections (“booster shots”) will be needed is not known at this time.

The vaccine is made up of viral-like particles, NOT live virus. It cannot cause an infection with HPV. The vaccine can only prevent against future HPV infection with one of the four strains in the vaccine. It does NOT cure HPV or abnormal pap smears. It is best when the vaccine is given to young women who have not yet had sex. However, it is still indicated for sexually active women and for women with a history of abnormal pap smears or HPV infection.

Common side effects of the vaccine include injection site reactions, (pain, redness, swelling, and fever). Less commonly, difficulty breathing, nausea, vomiting, diarrhea, headache or arthritis has been reported. The vaccine does not contain mercury or its derivatives.

The vaccine should not be given to females who are pregnant, breastfeeding, have a known allergy to the vaccine, have a bleeding disorder, or have a disease that compromises the immune system. HPV vaccination does not replace routine gynecologic care. Girls and women who have been vaccinated should continue to have scheduled examinations and pap smears.

Hysteroscopy


Hysteroscopy is a diagnostic or therapeutic procedure done either in the hospital or the office. During hysteroscopy the physician uses a small optical instrument like a small telescope to see inside the uterus. A clear solution is placed in the uterus allowing visualization of the full lining of the uterus as well as the openings to the tubes. Many lesions can be easily removed or treated by utilizing small flexible instruments.

Hysteroscopy is used to diagnose and treat abnormalities of the inside (lining) of the uterus. It is used to treat and diagnose polyps, fibroids, scar tissue, blocked tubes, cancer and heavy bleeding. It is also used to find IUD'S and along with other medical procedures such as Essure sterilization or endometrial ablations.

Hysterectomy


Hysterectomy is an operation to remove a woman's uterus (womb). Reasons or conditions may vary from irregular bleeding, endometriosis, fibroids, pain, cancer or prolapse. The type of hysterectomy depends on the indication and the woman's state of health. These types include removing the complete uterus (Total), or only part of the uterus (Supracervical) and may include removal of the ovaries and tubes. Healing time and recovery will be affected by the approach. Sometimes other reconstructive repairs, such as cystocele correction, may be combined with the hysterectomy.

The open or abdominal hysterectomy approach involves an incision in the lower abdomen with a 2-3 day stay in the hospital.

The other approaches involve a less invasive approach (minimally invasive procedure) with either a vaginal approach or smaller incisions with a shorter recovery.

These include:

  • Vaginal hysterectomy (the uterus is removed through the vagina)
  • Laparoscopic hysterectomy/ Laparoscopic assisted hysterectomy (small incisions with guidance by a camera)
  • Robot Assisted Laparoscopic Hysterectomy (using a Robotic system of surgical tools from outside the body through small incisions that assist to perform the surgery)

Laparoscopy


Laparoscopy is an approach to surgery that uses a thin, lighted tube that is placed through a small incision in the abdomen (belly) to view the female organs and pelvis.

This type of surgery is used to find problems such as ovarian cysts, scar tissue, infections as well as other causes of illness. Other indications to perform a laparoscopy may include pain issues, endometriosis and difficulty getting pregnant. This is done under general anesthesia in a surgical center or hospital setting. If indicated at the time of the laparoscopy, treatments can be performed for the conditions through other small incisions (minimally invasive surgery). Operations that can be done include a variety of procedures from removing an ovarian cyst or endometriosis to doing a hysterectomy. The length of this surgery will vary depending on the reason and the goals for the procedure. Often, one can go home the same day of surgery.

A variety of instruments are available to allow these procedures to be done more easily. One such tool is a laser. This tool is a beam of light aimed through these small incisions which can often allow a finer dissection of tissue with such conditions such as endometriosis.

Leep


A LEEP (loop electrosurgical excision procedure) is the procedure used to treat cervical dysplasia, or precancerous changes of the cervix. LEEP is used to remove the area of the cervix that contains the abnormal cells.

LEEP uses a thin wire loop that acts like a knife when an electric current passes through it. In this way, your doctor will remove a thin layer of the cervix. This takes only a few minutes.

During the procedure, you will lie on the exam table with your legs in stirrups. Just like when you have your Pap smear, a speculum will be placed in the vagina so your doctor can see your cervix. A local anesthetic, to numb the area, will be injected into the cervix and the LEEP performed. It may surprise you that most women feel little to no pain during a LEEP.

After the LEEP is done, your doctor may apply a paste called Monsel's solution to your cervix to stop bleeding. You may have some spotting or discharge after the procedure and may have some mild cramping.

The results of the LEEP should be back within the week. The LEEP is highly effective at getting rid of all the abnormal cells, but close follow up with Pap smears is essential. Your first Pap will generally be 4-6 months after the procedure.

Novasure


NovaSure is a type of endometrial ablation that uses electrical energy to destroy the endometrial lining to decrease heavy menstrual bleeding. It is a brief procedure that can be done in our office or as outpatient surgery. A significant decrease in menses occurs in over 90% of patients after a NovaSure ablation. Hundreds of our patients have been very satisfied with the convenience and results of this procedure.

Pelvic Reconstruction


Pelvic reconstruction is a general term that covers a variety of surgical procedures to repair problems related to the weakness of the supports of the female pelvic organs. These supports include pelvic floor structures such as muscles and ligaments which may have been damaged in child birth, repeated heavy lifting, or from chronic diseases. Symptoms can include feeling pressure, pain, discomfort as well as urinary incontinence and difficulty with passing of stool. One can often feel bulging of the vaginal walls which is the bladder or rectum bulging into the vagina (cystocele, rectocele). This bulging can also occur after hysterectomy from the top of the vagina. Pelvic reconstruction will often improve these procedures and can be performed through the vagina without abdominal incisions as an outpatient or 1 night stay in the hospital. Occasionally, more severe forms of weakness to the pelvic floor require artificial materials or other approaches.

The goal of reconstructions is to restore the normal structure and function of the pelvis.

Da Vinci robotic Surgery


DaVinci Robotic Surgery is an approach to perform minimally invasive surgery through small incisions (operating ports). It utilizes similar instruments as laparoscopy but further enhances their functions. The instruments are controlled by very fine movements of robotic arms which the surgeon controls while sitting at a command console. These tools function like your hand and wrist giving more flexibility than traditional laparoscopic operating instruments with the addition of 3 D viewing of the operative field. The advantages can be helpful in certain types of gynecologic surgery.

Sonohysterography


A sonohysterogram is a special ultrasound used primarily to check abnormalities in the lining (endometrium) of the uterus. When a patient experiences irregular bleeding a sonohysterogram can be used to check for thick endometrium, uterine polyps or fibroid location. The procedure is very simple and not much more than a regular routine vaginal ultrasound. In the ultrasound room a small catheter will be placed into the uterus, sterile water is then administered into the uterus and images of the endometrial space are obtained. With this information we can determine the best treatment available for each patient.

Therma Choice


ThermaChoice is one of the many ways to treat heavy bleeding in women. This is done by destroying (ablating) the lining of the uterus with heat. Afterwards, one can expect either no menstrual flow or a reduction to very light flow in up to 85% of patients treated. In some patients it may be a relatively simple way to avoid a major operation like a hysterectomy. It is NOT meant for women who wish to have children in the future. It can be done in an office setting (with pain medications while awake) or at a Surgicenter. The actual procedure takes around 15 minutes. It involves placing a soft, flexible balloon through your cervix into the uterus and allowing warm fluid inside the balloon to gradually heat the lining for 8 minutes. You can return to work without restrictions the next day.

Tubal Ligation


Tubal ligation is a general term used to describe the process by which the fallopian tubes are blocked to permanently sterilize a women so that she will not be able to get pregnant again. The procedure can be done vaginally - hysteroscopically, postpartum, at cesarean section and through the belly button. Vaginally the procedure is called Essure. Tubal ligation using Laparoscopy is done when there is not a recent pregnancy. Under general anesthesia the laparoscope is placed though the umbilicus and an additional instrument is placed just at the pubic hair line. The tubes are blocked with clips, rings or cautery depending on the surgeon's preference. Tubal sterilization is a very safe procedure but complications can occur. Your provider can discuss this in depth with you as well as give you written information about the procedure. Tubal ligations considered permanent and should not be used in women who are considering additional pregnancies however there is a failure rate of up to one in fifty procedures.

Urodynamic Testing


Urodynamic tests are measurements taken to evaluate the bladder function and to look for causes and treatments of urinary incontinence.

When you arrive at our office for your scheduled urodynamic procedure, you will be asked to come in with a comfortably full bladder. You will be instructed to empty your bladder into a special toilet for evaluation of your urination pattern. Your bladder will then be assessed for residual urine, which is the amount of urine that is still remaining in your bladder. A catheter is then inserted into the bladder to refill the bladder with sterile fluid. Sensors are used in the bladder and vagina to measure pressures in your abdomen and bladder to assess for bladder spasms.

During the procedure you will be asked questions about the sensations in your bladder. You will be asked to strain, cough, and jump to see if there is any urinary leakage. You will empty your bladder again and the procedure is finished.

We have a specially trained medical staff to perform this test and help you with incontinence management. Once the tests are completed, the nurse will review your results with your physician.

Gynecological Conditions


Abnormal Pap Smears
 
 
A Pap smear is a procedure that collects a sample of cells using soft brushes from your cervix. This is done as part of your annual exam. The Pap smear is done to screen for cervical dysplasia (precancerous changes) or cervical cancer.
What happens if my Pap smear is abnormal?
 
 
Abnormal Pap smears are broadly classified into ASCUS (abnormal cells of uncertain significance), LSIL (“low-grade”) and HSIL (“high-grade”). Low grade changes return to normal without any treatment over 90% of the time. High grade changes have a higher chance of becoming cancerous if not treated. An ASCUS Pap smear has a small risk of progressing as well. To further evaluate an abnormal Pap smear, you will need to have a procedure called colposcopy.
Cytocele
 
 
A cystocele is a form of organ prolapse in the pelvis where the bladder is bulging through the vaginal opening. It occurs when the wall of the bladder presses against and moves the wall of the vagina. It can be considered similar to a hernia within the vagina. This can be felt by a woman herself or by her doctor during a physical exam. Some women with a cystocele have no symptoms. Other women develop symptoms such as pressure, urinary frequency, or difficulty urinating. A feeling of fullness in the vagina can occur especially when standing. This bulge may feel like you are sitting on an egg. Activities that put strain on the pelvis, such as childbirth, chronic constipation, or heavy lifting, can lead to this condition.

If symptoms occur, there are treatments available. A cystocele can be repaired surgically through the vagina by repairing the loose tissues to strengthen the vaginal wall. This procedure is called a colporrhaphy. If a patient is not a candidate for surgery or desires to avoid surgery, an intravaginal device a pessary may provide some relief. This can be inserted comfortably in the office.
Dysplasia
 
 
Dysplasia of the cervix is a very common problem. It occurs when the skin, or rarely the gland cells, of the cervix (the lower most opening of the uterus located at the top of the vagina) get abnormal microscopic changes. Dysplasia is graded as low or high grade.

Dysplasia is almost always asymptomatic and found on a routine pap smear. Rarely it occurs in a cervical polyp or is seen at an exam as a wart. HPV (human papilloma virus) is the most common cause of cervical dysplasia and progression to higher grade and even cancer is often associated with smoking.

When a pap smear shows HPV or Dysplastic abnormal cells a definitive diagnosis is obtained by having a colposcopy with biopsies in the office. The result of the biopsy will guide as to what treatment will be necessary. When the biopsies are negative or low grade, treatment is usually not necessary except follow up pap smears. Within two years low grade most often will resolve on its own. High grade lesions do require treatment. This is usually accomplished with a LEEP procedure done in the office. Rarely some lesions will require hospital outpatient and treatment with laser and sometimes a conization of the cervix. Hysterectomy is occasionally done when there is recurrent dysplasia or when the dysplasia is glandular. Follow up for dysplasia usually is with pap smears every four to six months until there are at least three normal pap smears. After treatment of high grade lesions, pap smears are usually performed yearly for 20 years.
Endometriosis
 
 
Endometriosis is a condition in which tissue that lines the inside of the uterus (womb) can be found on structures/organs outside the uterus. These implants of tissue respond just like your period flow does with bleeding into the pelvic cavity. Endometriosis is not cancer. Those involved areas can become inflamed or swollen within the body producing scars in that area. The cause of this displaced tissue has many theories. Approximately, 10% of the females have this condition.

Symptoms range from none to severe depending on the location and severity. Some of the symptoms may include painful menstrual cramps, painful bowel movements and urinary discomfort especially during menses, abnormal bleeding, painful sexual intercourse and difficulty becoming pregnant. Other conditions can sometimes cause similar complaints.

There is no known cure for endometriosis. It can be diagnosed by laparoscopy. Most of the time the symptoms can be controlled either through destruction of the implants at the time of the time of the laparoscopy or with medications. The extent of the surgery will depend on the patient's goals and the severity of her symptoms.
Fibroids
 
 
Uterine fibroids or leiomyoma are benign muscle growths of the uterus. They can be single or multiple and can be found though out the uterus including inside the cavity and hanging outside as well. Sizes can vary greatly from less than an inch to 10 inches or more.

Many fibroids are asymptomatic and are found incidentally on exam, at surgery or on ultrasound. Fibroids can been associated with heavy menstrual bleeding, spotting, pelvic pressure, pelvic pain, cramping, pain with intercourse, urinary frequency, infertility and miscarriage. In very rare instances especially in post menopausal women fibroids can become malignant.

Diagnosis of fibroids is usually made at pelvic exam and then confirmed on pelvic ultrasound. Additional studies are done to further document the location including sonohysterogram, hysteroscopy and laparoscopy.

Treatment will depend on symptoms, your age and desire for pregnancy. Most often conservative management is used. This includes taking ibuprofen, utilization of hormonal treatment including birth control pills, progesterone tablets or shot and the use of the Mirena IUD. If conservative treatment does not work there are many surgical options to manage fibroids. If they are located within the cavity of the uterus then your doctor may recommend a hysteroscopy to remove them. Patients desiring future children or reluctant to have a hysterectomy will be offered myomectomy or removal of the fibroids this may be done laparoscopically – through the belly button or laparotomy – an incision in the abdomen.

For more information on fibroids and discussion on management we are happy to see and evaluate you problems at Manchester OG/GYN associates. Additional information can be found at:

National Library of Medicine information on Fibroids

ACOG information on Fibroids
Heavy bleeding
 
 
Menorrhagia is the medical term for menstrual periods with heavy or prolonged bleeding.

Signs and symptoms may include:
* soaking through multiple sanitary pads/tampons for several hours
* needing to use double sanitary protection
* bleeding for more than 7 days
* needing to wake up at night to change sanitary protection
* restricting daily activities due to heavy flow
* passing large clots
* symptoms of anemia such as fatigue or shortness of breath

There are many causes of heavy menstrual bleeding. Your provider may recommend an exam, lab work, biopsy of the endometrial lining and ultrasound as part of your evaluation.

Multiple treatment options are available and will be discussed to treat your menorrhagia in the best possible manner.
Hot Flashes
 
 
Hot flashes and night sweats are very common. Women describe hot flashes as a wave of heat spreading throughout their body. They can occur any time of the day in varying intensities and number. Hot flashes are often accompanied by sweating, especially during night hours. Hot flashes and night sweats can be very bothersome and interrupt your daily activities and sleep.

Most women assume that the onset of hot flashes is a sign of menopause – the change. Menopause is the most common reason for persistent or severe symptoms, but many other instances of hot flashes do occur. Hormone use, perimenopause, certain medications, thyroid disease – these and many other clinical situations can cause hot flashes and night sweats. In some cases women get hot flashes for no apparent reason.

Management of hot flashes is based on their severity and cause. If due to menopause, your provider will talk with you regarding the use of hormones or other medications to alleviate you symptoms. Management for other reasons for hot flashes is based on the clinical situation (for example, thyroid medication for thyroid disease). Non medical treatment includes good hydration, dressing in layers, staying cool during the day and night, sleeping in a cool room with a light blanket and avoiding alcohol, hot beverages, or other triggers or situations that increase your problem. Some patients find certain foods and vitamins help. If you are bothered by hot flashes and sweats, call for an appointment to discuss the options to improve your symptoms so you can get back to normal.
HPV
 
 
HPV is a virus that is transmitted from person to person by direct contact including vaginal intercourse, oral and anal sex and skin to skin contact. HPV is one of the most common venereal diseases in the world. There are over 100 different HPV viruses and 30 of those can cause disease in the genital area.

HPV is the major inciting event of most cervical cancers. It is also associated with vaginal, vulva, anal, penile and head and neck cancers. The virus also causes genital warts which occur throughout male and female genital areas. Infection with the virus most often show no symptoms and in many cases, especially in young women, the body produces antibodies and removes the virus. Cigarette smoking increases the risk of HPV associated diseases.

Avoidance of HPV is of paramount importance in reducing the risk of cancer, precancer and warts. There are now vaccines available to young men and women that avert infection with the virus. Both vaccines cover types 16 and 18 which are most responsible for the cancers and one covers the two types most associated with the warts. Early vaccination produces the greatest protection. There is no greater way to avoid infection with HPV than safe sexual practices with careful use of condoms and other measures to avoid transmission.

Diagnosis of the HPV virus is easy when there are external warts and treatment will be based on the number and location of the warts. To diagnose precancerous lesion or infection with the virus a visit with your doctor or nurse practitioner is necessary. Rarely lesions are associated with visible abnormalities and most often HPV changes are found on the pap smear and possibly the HPV culture. You should speak with your provider regarding testing. More recently there have been recommendations to do "contesting", which is doing a pap smear and culturing for HPV at the same time. If both are negative testing is repeated at five year intervals.

Fortunately early diagnosis and evaluation of HPV helps us avoid almost all cancers of the genital tract. Precancerous lesions can often be treated in a conservative or local fashion without any additional complications including infertility. Speak with you provider at Manchester OB/Gyn associates to learn more about HPV infections and their diagnosis and treatment.
Infertility
 
 
Manchester OB/GYN Associates providing care to women in the Manchester New Hampshire area since 1919 is proud to offer a full range of infertility services. Our medical director, Dr. Gary A. Wasserman, works in conjunction with our infertility coordinators work to bring patients cutting edge diagnosis and treatment.

Our infertility evaluation includes all necessary blood work, semen analysis as well as other indicated testing, including in office ultrasound and sonohysterogram - when water is placed in the uterus and an ultrasound is done to look for abnormalities that can prevent pregnancy. Office and hospital hysteroscopy are performed to diagnose and treat uterine abnormalities. Hysterosalpingogram is often done, where dye is placed into the uterus to check for tubal blockage and other abnormalities that may interfere with your fertility.

Our treatments for infertility include sperm washing and intrauterine insemination where we place the washed sperm into the uterus around the time of ovulation. In addition we have available the use of donor sperm from reputable labs. Fertility enhancing medications are used as necessary including Clomid and Gonadotropins – fertility shots. Blood tests and ultrasound monitoring are used to closely watch for the number of eggs and ovulation. We work closely with several IVF (in vitro fertilization) centers to keep your care local by performing blood work and ultrasounds locally.
Menopause
 
 
Menopause, a natural process, is the time in a women's life when the ovaries begin to reduce their production of hormones. By definition menopause is diagnosed when there has been no periods for a year. But more often it is diagnosed based on signs and symptoms a woman is having. The average age of menopause is just over 51 years old, but varies greatly from mid forties to late fifties.

The symptoms of menopause are multiple and varied. The most common are hot flashes or waves of heat that often occur without warning, irregular or no menstrual flows and difficulty sleeping. Decreased sexual interest, vaginal dryness, fatigue, difficulty concentrating, difficulty reaching orgasm, excess hair growth, dry skin, and irritability have all been associated with menopause. Each woman will experience menopause in an individual fashion with varied symptoms. No woman has to suffer from her symptoms.

The management of menopause requires communication between you and your provider. With a thorough history and physical, your provider can make recommendations regarding therapy. If irregular bleeding is an issue then evaluation with a biopsy and ultrasound may be done and treatment aimed at the problem. Mild symptoms will be managed individually. This may include mild sleeping aids, vaginal lubricants, exercise, dietary change, vitamins and a multitude of other options to help you feel normal and healthy.

Hormonal therapy in the menopause is controversial. Your provider will discuss with you at length the risks and benefits of treatment. Options include vaginal estrogen, as well as oral and transdermal (through the skin) medications. The dose, timing and delivery method are tailored to your needs.

Each patient will work with our office and her provider to create the optimal plan to transition into menopause as naturally as possible with the least inconvenience to your daily activities. With good care and communication you may not feel a thing.
Pelvic Pain
 
 
Pelvic pain is lower abdominal pain that may occur in various locations and has many potential causes. This pain may be short lived or of a chronic nature. The pelvis contains many organs (bladder, uterus, ovaries, and intestines), muscles with their attachments, and nerve tissue. Abnormalities of any of these structures can cause pain. Some of the gynecological conditions causing pelvic pain include ovarian cysts, endometriosis, adhesions (scar tissue), fibroids, and pelvic prolapse. Because the pelvis holds other organs such as the bladder or bowels, conditions such as constipation or inflammation of the bladder wall can also cause pain, which often makes a specific diagnosis difficult. Other conditions such as injury to muscles, tendons and nerves, which occur from stressful physical activities or previous surgery, can further confuse the cause.

A complete history and physical exam is needed to define some of the causes. Diagnostic testing can include ultrasound, specialist opinions, or a laparoscopy (a surgical procedure during which a small telescope is inserted into the abdomen). Other testing may also be indicated. Treatments can range from observation to medications to surgery.
PMS
 
 
Premenstrual syndrome (PMS) is a variety of physical and emotional symptoms occurring during the 1-2 weeks prior to menses and resolving once your menses have started. Changes in hormones during the menstrual cycle and possibly chemical changes in the brain may be involved.

There is a wide range of PMS symptoms that vary from woman to woman. Formal definitions of PMS require the presence of emotional symptoms such as anxiety, depression, irritability or sleep difficulties. Physical symptoms can include bloating, breast tenderness, acne, and bowel changes. It is estimated that 85% of women have one or more PMS symptoms as part of their menstrual cycle.

Severe symptoms can be troublesome and even disabling in some cases. If you think you have PMS, keeping a daily record of your symptoms can be helpful for evaluation and treatment. Treatment for PMS can range from lifestyle changes and stress management to medications
Rectocele
 
 
A rectocele is a soft bulge of tissue that can be felt in your vaginal opening. The back wall of the vagina prolapses when the wall that separates the rectum from the vagina weakens, allowing the vaginal wall to bulge (hernia). This bulge is the front wall of the rectum. Childbirth and other activities put pressure on this wall which creates the bulge. Chronic constipation with straining is another example of pressure that can weaken this area. Symptoms can range from minimal, to a feeling of incomplete emptying after a bowel movement with rectal pressure, to having to use your fingers vaginally on the bulge to help evacuate your bowel movements (splinting).

Repair of the rectocele can often be done vaginally by repairing the torn or weakened tissues with a procedure called colporrhaphy. It is also important to alter the activity that caused the rectocele. Outcomes tend to be excellent with good long term results. An intravaginal device called a pessary may be of benefit for those who are not candidates for surgery or prefer to avoid surgery.
STD
 
 
Sexually transmitted diseases (STD's) are a defined as infections that are transmitted through sexual contact including vaginal, oral and anal. The more common infections include Gonorrhea, Chlamydia, Human Papilloma Virus (HPV), HIV, viral hepatitis, Syphilis, Herpes and Trichomonas. Lymphogranuloma venerum and Chancroid are among the rare infections.

Each year worldwide these infections account for a tremendous amount of suffering due to pain, infertility, weakness and death. The personal and societal financial costs are staggering. STD's occur in men and women of all ages, races, nationalities and classes.

The best treatment of STD's is prevention. The best prevention is safe sex practices. The use of condoms with any new or high risk partner is essential and condoms should be used till both partners are certain that there is no significant risk for infections. All relationships both heterosexual and homosexual require awareness. In addition, high risk situations including excessive alcohol and drugs can lead to risky behavior and unfortunately forced situations including rape.

To prevent long term consequences of these infections early detection and treatment is essential. If you feel you have been exposed to an infected partner you should schedule an appointment as soon as possible to be checked, evaluated and treated. Abnormal growths on you vulva, unusual discharge, fever and pain and other symptoms should prompt a visit for evaluation.
Urinary Issues
 
 
Urinary incontinence is the loss of bladder control and is a common and often embarrassing problem. The symptoms can range from occasional minor leaks to spontaneous loss of large volumes of urine.

There are several types of incontinence:


Stress Incontinence
 
 
This is the loss of urine when pressure or “stress” is exerted on the bladder by coughing, sneezing, lifting, laughing or exercising. This occurs when the pelvic muscles that support the bladder are weakened. This can occur as a result of pregnancy, childbirth and menopause. This type of incontinence is very common in women.
Urge Incontinence
 
 
This is a sudden intense urge to urinate followed by an involuntary loss of urine. It is caused by bladder muscle contractions that may give only a brief warning or ‘urge' to get to a toilet. Urge incontinence can cause a frequent need to urinate including at night. The term ‘overactive bladder' is often used for the symptoms of frequency or frequent mild bladder contractions. This type of incontinence is caused by urinary tract infections, bladder irritants, injury or nervous system damage such as MS, stroke or Parkinson's disease.
Mixed incontinence
 
 
A combination of more than one type of incontinence
Functional incontinence
 
 
Adults with physical or mental impairments may prevent them from making it to the bathroom in time to prevent an accident. You may feel uncomfortable discussing there symptoms with your provider, but treatment can greatly improve one's quality of life. If incontinence is affecting your quality of life or causing you to restrict your activities or social interactions in order to avoid an embarrassing situation, then evaluation is important. All of the providers at Manchester Ob/GYN can address your concerns and approach your evaluation in comfortable and respectful manner.