GYNECOLOGY

Providing comprehensive health services for women from adolescence through post-menopause.

CERVICAL CANCER SCREENING (PAP SMEAR)

The Pap smear is a preventative screening test for cancer of the cervix, and for changes of the cells of the cervix that could lead to cancer. Routine screening is done every 3 years, beginning at age 21 and going until age 65.

To collect a Pap smear, a speculum is inserted into the vagina, and by opening the speculum, the cervix can been seen. While the speculum is inside the vagina, cells will be collected for the Pap smear, and any discharge for an infection check, or to evaluate a problem. You may feel a little cramp or twinge during the Pap smear. You also may have a little bleeding, which is normal.

You will receive your Pap smear results within one week.  The results will fall into one of the following categories:

  • Normal:  no abnormal cells were seen.
  • Atypical cells:  the cells are not clearly normal or abnormal.  This may be due to HPV, vaginal infections, or a processing issue in the lab.
  • Abnormal:  the cells are precancerous, or dysplastic.  These will be further categorized as mildly abnormal or severely abnormal.  These abnormal cells are caused by exposure to a sexually-transmitted infection called HPV, or Human Papillomavirus.

ABNORMAL PAP EVALUATION

The Pap smear is a preventative method of cervical cancer screening used to detect potentially pre-cancerous and cancerous cells in the cervix. Abnormal findings are often followed up by more diagnostic procedures. Although cervical cancer is rare (about 10,000 new cases per year in the US), the precancerous cells are quite common. Over 3 million women are diagnosed with an abnormal Pap every year.

The first step in the evaluation of an abnormal pap is a procedure called colposcopy, in a microscope is used to look at the cervix. Cells may be sampled by a biopsy to confirm if the abnormality is mild or severe.

Abnormal Paps are divided into two categories — mild, or low-grade / CIN I, and severe, or high-grade / CIN II and III. The prognosis and treatment is different for each of these categories. In 98% of the cases of mild dysplasia, with time, your body will repair the abnormal cells and suppress the HPV. For this reason, mild dysplasia can be simply monitored with repeat Paps every 3-4 months. However, only 65% of severe dysplasia will resolve on its own. These cases are normally treated with an in-office procedure that removes the abnormal cells, called a LEEP, which is over 99% effective in curing dysplasia.

While receiving the call that you have an abnormal Pap may be scary, it is important to remember that this is very common, and in most cases your body knows exactly what to do to heal and repair the condition. Even in cases where your body doesn't take care of it, there is a simple treatment to cure the condition. Most importantly, you should make sure that you come to all of your follow-up appointments. With careful monitoring, your abnormal Pap won't cause any serious health problems in the future.

BONE DENSITY TESTING (ordered but not done in office)

A bone density test is a special X-ray that screens for osteoporosis and thinning of the bones.  It measures how much calcium and other bone minerals are present.

Bones density testing is recommended for women who are:

  • Over age 65
  • Between 50 and 65 who are thin or who are smokers
  • Taking steroids
  • Have had a bone fracture

Bone density testing is not done in our office but can be ordered and conducted at a radiology facility, in a pharmacy or in a doctor's office.  The X-ray is usually taken of your lower spine, hip, or forearm.  The test is non-invasive and does not hurt.  You will receive the results from your doctor in a few days.

BRCA TESTING

The BRCA gene test is a blood test that uses DNA analysis to identify harmful changes (mutations) in either one of the two breast cancer susceptibility genes — BRCA1 and BRCA2. Women who have inherited mutations in these genes face a much higher risk of developing breast cancer and ovarian cancer compared with the general population.

A blood or saliva sample can be done to genetically test for the BRCA mutations.  Your doctor can discuss your family history to see if you are a candidate for BRCA testing. The test is usually conducted for women who have:

  • A first-degree relative with breast cancer before age 50
  • A personal history of breast or ovarian cancer
  • A family history of ovarian cancer
  • A family history of male breast cancer
  • More than two relatives with breast cancer

BRCA testing is often covered by insurance but every plan is different.  Your insurance company will let you know if this is a covered benefit.

COLPOSCOPY

Colposcopy is an office procedure to closely examine your cervix, vagina and vulva for signs of disease, and to evaluate abnormal pap smears. During colposcopy, your doctor uses a special instrument called a colposcope to visualize the cervix and identify abnormal cells. Your doctor may recommend colposcopy if your Pap Smear test has shown abnormal results. If your doctor finds an unusual area of cells during colposcopy, a sample of tissue can be collected for laboratory testing (biopsy).

The procedure typically takes 10 to 20 minutes. You'll lie on your back on a table with your feet in supports, just as during a pelvic exam or Pap test. The doctor places a metal speculum in your vagina. The speculum holds open the walls of your vagina so that your doctor can see your cervix. Your doctor positions the special magnifying instrument, called a colposcope, a few inches away from your vulva. A bright light is shown into your vagina, and your doctor looks through the lens, as if using binoculars.

Your cervix and vagina are swabbed with cotton to clear away any mucus. Your doctor may apply a solution of vinegar or another type of solution to the area. This may cause a burning or tingling sensation. The solution helps highlight any areas of suspicious cells.

After the procedure, you can expect some mild cramping, light bleeding, or vaginal discharge for the next few days. Refraining from use of tampons or sexual activity is required for the next 2-5 days.

The biopsy results are typically ready in a few days. They will be discussed with you and a follow up plan will be made.

CONTRACEPTION COUNSELING

A contraceptive is a method or device used to prevent pregnancy. Not all contraceptive methods are appropriate for all situations, and the most appropriate method of birth control depends on a woman's overall health, age, frequency of sexual activity, number of sexual partners, and family history of certain diseases. Consult your doctor to determine which method of birth control is best for you.

The different methods of contraception include:

  • Barrier methods - include the diaphragm, cervical cap, and condoms for men and women.  These methods block the passage of sperm so that fertilization of an egg cannot occur.
  • Hormonal methods - include birth control pills, the vaginal ring, the patch, implants, and injections.  These methods work by delivering a steady state of hormones that stops the natural process of ovulation so an egg is not released.
  • Intrauterine methods - is a small T shaped device that is inserted into the uterus.  It prevents pregnancy by affecting the way sperm swim through the uterus so fertilization cannot occur.  Some IUDs that contain a hormone also prevent ovulation.
  • Sterilization - Sterilization is a surgical procedure that results in permanent contraception.  In men, a vasectomy closes the tubes that carry sperm.  In women, a tubal ligation blocks the passageway of the Fallopian tubes so sperm cannot meet an egg.
  • Rhythm method – this involves a woman charting her menstrual cycle to understand when her most fertile days are, and she then abstains from intercourse during that time.

There are many contraception options so it's important to ask Dr. Firouzbakht which may be best for you.

DIAPHRAGM FITTING

A diaphragm is a cervical barrier type of birth control. It is a soft latex or silicone dome with a spring molded into the rim, which creates a seal against the walls of the vagina. The diaphragm is 85% effective at preventing pregnancy. Diaphragms come in many sizes.  Your doctor will determine which size is the best for you by evaluating the vaginal canal and inserting a sample device.  You will then receive a prescription for the correctly sized device to take to your local pharmacy.

Your doctor or a nurse will teach you how to put the diaphragm in and take it out. You also should read the directions from the company that made your diaphragm

To be sure that you know how to use your diaphragm, you will need to practice putting it in and taking it out while you are in our office. Dr. Firouzbakht will check to see that the diaphragm fits right.

To lower your risk of getting pregnant, you must use your diaphragm correctly and use it every time you have sex. You must also use the diaphragm with spermicide (a gel or cream that kills sperm trying to enter the cervix) in order to prevent pregnancy. You can put the diaphragm in your vagina up to 1 hour before you have sex. Once in place, the diaphragm provides protection for 6 hours. You can use your diaphragm for years as long as it doesn't develop any cracks or holes. You may need a new size if you've had a baby, significant weight gain or loss, or pelvic surgery.

DILATION AND CURETTAGE

Dilation and curettage (D&C) is a procedure to remove tissue from inside your uterus. It is usually performed under a light anesthesia in an operating room but can also be done with local anesthesia in an office. Dr. Firouzbakht performs dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage.

In a dilation and curettage, Dr. Firouzbakht uses small instruments or a medication to open (dilate) your cervix — the lower, narrow part of your uterus. Then a surgical instrument called a curette is used to remove uterine tissue. .

The procedure lasts 5-10 minutes. Patients will be able to go home on the same day and resume normal activities on the following day.

ENDOMETRIAL BIOPSY

An endometrial biopsy (EMB) is a way to take a small sample of the lining of the uterus (endometrium). The sample is looked at under a microscope for abnormal cells by a pathologist and results are sent to our office.

An endometrial biopsy helps find problems in the endometrium, for example, to find the cause of abnormal uterine bleeding, to check for overgrowth of the lining (endometrial hyperplasia), or to check for cancer. When a woman is having a hard time getting pregnant, an endometrial biopsy may also be done to see whether the lining of her uterus can support a pregnancy.

It also determines if your body's hormone levels that affect the endometrium are in balance.

While the Pap smear collects cells from the surface of the cervix, the EMB goes deeper into the cavity of the uterus.  A speculum is first placed into the vagina.  The cervical canal is opened slightly.  Then a thin plastic tube, called a pipelle, is threaded through the cervix and into the uterus itself.  The pipelle rubs against the walls of the uterus to collect the cells. The procedure lasts less than 5 minutes.

The sample is sent to the lab for analysis under the microscope.  You can expect the results in about one week.

Some women have mild cramping during the procedure while others do not feel it at all.  The cramping usually subsides within 15 minutes.

ENDOMETRIOSIS

Endometriosis is a chronic condition in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus (endometrial implant). Endometriosis most commonly involves your ovaries, bowel or the tissue lining your pelvis. Since the symptoms of endometriosis can be vague, the average time to diagnosis is more than 7 years.

In endometriosis, displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal tissue that binds organs together.

Endometriosis can cause pain — sometimes severe — especially during your period. Fertility problems also may develop. Fortunately, effective treatments are available.

An accurate diagnosis of endometriosis can only be made by visualizing the endometrial implants in surgery.  There are no other tests that can be done to confirm its presence.  It cannot be seen on an X-ray, ultrasound, CT, or MRI.  For this reason, women may be treated for endometriosis based on their symptoms alone.  If a woman has debilitating pelvic pain at the time of menses, a doctor may presume that she has endometriosis and treat her accordingly.

While there is no cure, the treatment of endometriosis involves medications, and in more severe cases, surgery.  Hormonal birth control methods, like the pill, shot, or ring, will shut down your ovulation and periods will be lighter.  Periods will be lighter.  As a result, the bleeding from endometrial implants lessens as well.  Anit-inflammatory drugs, like ibuprofen, will decrease the inflammation from the implants and the pain. Alternative therapies have been suggested such as herbal medications (blue cohosh, cranberry, St. John's wort) and acupuncture.

If the medical treatments aren't effective, surgery is another treatment option.  The endometrial implants and scar tissue can be removed laparoscopically.  In the most severe cases, a hysterectomy with removal of the ovaries may be necessary.

If you have painful periods or infertility, talk to Dr. Firouzbakht about the possibility of having Endometriosis.

EVALUATION OF ABNORMAL BLEEDING

As much as 14% of women experience irregular or excessively heavy menstrual bleeding. Bleeding that occurs between cycles, is heavier than normal, or happens after menopause requires further evaluation, as this may indicate a risk for uterine cancer. This includes menstrual bleeding for three or more menstrual cycles that:

  • Occurs more frequently than every 21 days or farther apart than 35 days (a normal teen menstrual cycle can last up to 45 days).
  • Lasts longer than 7 days.
  • Consists of more than 80 mL (3 fl oz.) of blood lost or involves passing blood clots and soaking through your usual pads or tampons each hour for 2 or more hours.
 

The most common causes of abnormal vaginal bleeding are:

  • Hormonal imbalances – due to thyroid problems, lack of ovulation, or menopause
  • Growths in the uterus or on the cervix – such as fibroids, polyps, uterine cancer, cervical cancer
  • Pregnancy
  • Vaginal infections – such as yeast, bacterial vaginosis, chlamydia

At the doctor visit, you may be asked about your normal cycles, when the abnormal bleeding began, whether you are using any hormones, and your sexual history. You may also have a complete pelvic exam, testing for vaginal infections, an ultrasound, or a uterine biopsy.

The treatment of abnormal vaginal bleeding depends on its cause. When an infection is identified, it will be appropriately treated. If a growth or tumor is found, it can be removed. Hormonal changes can be treated with hormone replacement or birth control pills. In some cases, no treatment is necessary and the condition will resolve on its own. Dr. Firouzbakht will discuss options with you at length so you can make an informed decision.

FIBROIDS

Uterine fibroids are lumps that grow on your uterus. You can have fibroids on the inside, on the outside or in the wall of your uterus. They may be called fibroid tumors, leiomyomas, or myomas.

Fibroids are very common in women in their 30s and 40s. But fibroids are not cancer and they usually do not cause problems. You do not need to do anything about them unless they are causing problems.

Medical researchers are not sure what causes fibroids. But the female hormones estrogen and progesterone seem to make them grow. Your body makes the highest levels of these hormones during the years when you have periods.

Your body makes less of these hormones after you stop having periods (menopause). Fibroids usually shrink after menopause and stop causing symptoms.

Often fibroids do not cause symptoms. Or the symptoms may be mild, like periods that are a little heavier than normal. If the fibroids bleed or press on your organs, the symptoms may make it hard for you to enjoy life.

Fibroid treatment depends on the size and location of the tumors. Dr. Firouzbakht can explain which treatments may help you the most.

UTERINE FIBROID SURGERY

Uterine fibroids are noncancerous growths that develop in or just outside a woman's uterus (womb). They are extremely common. In fact, many women have uterine fibroids at some point in life.

Uterine fibroids develop from normal uterus muscle cells that start growing abnormally. As the cells grow, they form a benign tumor. Uterine fibroids cause a variety of symptoms including heavy periods, bleeding between periods, pelvic pain, miscarriage, and frequent urination. If the symptoms become severe, surgery may be required.

Surgery to treat fibroids includes hysterectomy (removal of the entire uterus) and myomectomy (removal of the fibroids only). Hysterectomies are usually performed on women who do not desire any more children, who have multiple fibroids, and who desire definitive therapy. It may be done through an abdominal incision or vaginally.

A myomectomy is a surgical procedure in which the fibroids are removed and the uterus is repaired. The approach for a myomectomy depends on the fibroid's size and location. If a fibroid is small (less than 3cm) and located within the uterine cavity (submucosal), it can be removed by a vaginal procedure called hysteroscopic resection. For fibroids within the muscular wall of the uterus (intramural) or on the outside of the uterus (subserosal), the procedure is done through an abdominal incision or laparoscopically.

The decision about surgery for fibroids involves many factors. Talk to Dr. Firouzbakht about which approach is appropriate for you.

HORMONE REPLACEMENT THERAPY (HRT)

HRT (also known as hormone therapy, menopausal hormone therapy and estrogen replacement therapy) uses female hormones -- estrogen and progesterone -- to treat common symptoms of menopause and aging. Dr. Firouzbakht can prescribe it during or after menopause.

After your period stops, your hormone levels fall, causing uncomfortable symptoms like hot flashes and vaginal dryness, and sometimes conditions like osteoporosis. HRT replaces hormones your body no longer makes. It's the most effective treatment for menopause symptoms. You should not take HRT if you have a history of blood clots, stroke, heart attack, breast or uterine cancer or undiagnosed vaginal bleeding.

Benefits of HRT:


  • Relieves hot flashes and insomnia

  • Prevents the rapid bone loss that occurs in early menopause

  • Relieves vaginal dryness and painful intercourse

Risks of HRT:


  • Increases the risk of stroke and blood clots

  • Combined: increases the risk of breast cancer

  • Estrogen only: increase risk of uterine cancer

If you are healthy, you can use HRT to alleviate many of the symptoms of menopause. Usually these hormones are taken during the menopause transition and discontinued once the hormone levels have stabilized (less than 5 years).

Currently, there are two forms of HRT available – a traditional prescription from a pharmacy or a "bioidentical" hormone from a compounding pharmacy. Hormones produced by pharmaceutical companies may be made from plants, animals, or from other chemicals. They are regulated by the FDA and come in standardized doses. Bioidentical hormones are hormones that are identical to hormones produced in the body. They are not found in this form in nature, but are synthesized from a plant chemical that is extracted from yams and soy. Bioidentical hormones are made in a compounding pharmacy according to your doctor's specifications.

Advantage to bioidentical hormones:

  • Greater dose flexibility
  • Availability of low-dose preparations
  • Possible lower cost
  • Replicate the hormones that are made by the human body: estradiol, estriol, estrone, and progesterone

Disadvantage to bioidentical hormones:

  • Not regulated by the FDA
  • Not tested for purity, potency or safety

While bioidentical hormones are not necessarily safer or better than traditional ones, they have the advantage that their doses can be more easily titrated to alleviate a woman's symptoms. Talk to Dr. Firouzbakht if you have questions about which therapy may be right for you.

HPV TESTING

A human papillomavirus (HPV) test is done to check for a high-risk HPV infection in women. HPV is a sexually transmitted infection (STI). An HPV test checks for the genetic material, or DNA, of the human papillomavirus. Like a Pap test, an HPV test is done on a sample of cells collected from the cervix.

There are many types of HPV. Some types cause warts that you can see or feel. Other types do not cause any symptoms. Most people do not know they have an HPV infection.

This test will show whether a high-risk type of HPV is present. In women, high-risk types of HPV cause changes in the cells of the cervix that can be seen as abnormal changes on a Pap test. Abnormal cervical cell changes may resolve on their own without treatment. But some untreated cervical cell changes can progress to serious abnormalities and may lead to cervical cancer over time if they are not treated.

Although HPV is found in both men and women, this test is not used on men. The HPV test is used to detect only high-risk types of HPV. Your doctor may diagnose genital warts that are seen during a physical exam. This test is not used to diagnose genital warts caused by low-risk types of HPV.

HPV VACCINATION

A hysterectomy is an operation to remove a woman's uterus. A woman may have a hysterectomy for different reasons, including:

  • Uterine fibroids that cause pain, bleeding, or other problems
  • Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal
  • Cancer of the uterus, cervix, or ovaries
  • Endometriosis
  • Abnormal vaginal bleeding
  • Chronic pelvic pain
  • Adenomyosis, or a thickening of the uterus

Hysterectomy for noncancerous reasons is usually considered only after all other treatment approaches have been tried without success.

A hysterectomy can be performed in a number of ways:

  1. Robotically-assisted TLH / TCH – Is the removal of the uterus and cervix through four small (1/2'- 1') abdominal incisions while using a robot to assist.
  2. Total Laparoscopic Hysterectomy - Is the removal of the uterus and cervix through four small (1/2'- 1') abdominal incisions.
  3. Open abdominal hysterectomy – the uterus is removed through a skin incision 5-6 inches in length. This approach is used when the uterus is large or when cancer is suspected.
  4. Vaginal hysterectomy – the uterus is removed through the vagina. This is most commonly used when the uterus is small or the procedure is done for proplapse.
  5. Laparoscopic-assisted vaginal hysterectomy (LAVH) – a camera is inserted through the belly button and instruments are placed through small incisions in the abdomen. The uterus is freed from its abdominal connections laparoscopically, and then ultimately removed from the body vaginally.

Dr. Firouzbakht utilizes mostly minimally-invasive procedures and rarely the open abdominal procedule. Her skills in minimally invasive procedures are at an advanced level, and she prefers this procedure as it decreases pain and recovery time.

Dr. Firouzbakht will explain the options for hysterectomy and help you decide which approach is right for you.

HYSTERECTOMY

A hysterectomy is an operation to remove a woman's uterus. A woman may have a hysterectomy for different reasons, including:

  • Uterine fibroids that cause pain, bleeding, or other problems
  • Uterine prolapse, which is a sliding of the uterus from its normal position into the vaginal canal
  • Cancer of the uterus, cervix, or ovaries
  • Endometriosis
  • Abnormal vaginal bleeding
  • Chronic pelvic pain
  • Adenomyosis, or a thickening of the uterus

Hysterectomy for noncancerous reasons is usually considered only after all other treatment approaches have been tried without success.

A hysterectomy can be performed in a number of ways:

  1. Robotically-assisted TLH / TCH – Is the removal of the uterus and cervix through four small (1/2'- 1') abdominal incisions while using a robot to assist.
  2. Total Laparoscopic Hysterectomy - Is the removal of the uterus and cervix through four small (1/2'- 1') abdominal incisions.
  3. Open abdominal hysterectomy – the uterus is removed through a skin incision 5-6 inches in length. This approach is used when the uterus is large or when cancer is suspected.
  4. Vaginal hysterectomy – the uterus is removed through the vagina. This is most commonly used when the uterus is small or the procedure is done for proplapse.
  5. Laparoscopic-assisted vaginal hysterectomy (LAVH) – a camera is inserted through the belly button and instruments are placed through small incisions in the abdomen. The uterus is freed from its abdominal connections laparoscopically, and then ultimately removed from the body vaginally.

Dr. Firouzbakht utilizes mostly minimally-invasive procedures and rarely the open abdominal procedule. Her skills in minimally invasive procedures are at an advanced level, and she prefers this procedure as it decreases pain and recovery time.

Dr. Firouzbakht will explain the options for hysterectomy and help you decide which approach is right for you.

HYSTEROSCOPY

A hysteroscopy is a way to see the lining of your uterus using a thin viewing tool called a hysteroscope. The procedure can be done in the office or at the hospital, depending on the insurance plan you have.

The tip of the hysteroscope is put into your vagina and gently moved through the cervix into the uterus. The hysteroscope has a light and camera hooked to it so your doctor can see the lining (endometrium) on a video screen.

A hysteroscopy may be done to find the cause of abnormal bleeding or bleeding that occurs after a woman has passed menopause. It also may be done to see if a problem in your uterus is preventing you from becoming pregnant (infertility). A hysteroscopy can be used to remove growths in the uterus, such as fibroids or polyps, or scar tissue.

Dr. Firouzbakht may take a small sample of tissue (biopsy). The sample is looked at under a microscope for problems. Another surgery, called alaparoscopy, may also be done at the same time as a hysteroscopy if infertility is a problem.

INFERTILITY

Infertility means not being able to become pregnant despite unprotected intercourse for 12 months. If a woman can get pregnant but keeps having miscarriages or stillbirths, that's also called infertility.

Infertility is fairly common. After one year of having unprotected sex, about 15 percent of couples are unable to get pregnant. About a third of the time, infertility can be traced to the woman. In another third of cases, it is because of the man. The rest of the time, it is because of both partners or no cause can be found.

A basic fertility evaluation consists of:

  • Semen analysis
  • Hormonal blood tests to check the ovarian function (FSH, estradiol, AMH)
  • Hormonal blood test to confirm ovulation (progesterone)
  • X-ray called a hysterosalpingogram (HSG) to evaluate any blockages or growths in the uterus or tubes

Treatment of infertility depends on its cause. Dr.Firouzbakht offers Clomid surgery, HTV injections and CKS sonogram.

Medications can be used to encourage ovulation. Surgery can be performed to correct uterine or tubal problems. Intrauterine insemination can be done if sperm count is an issue. Ultimately the decision on treatment will be between you and Dr. Firouzbakht or a fertility specialist.

IUD INSERTION

An IUD, or intrauterine device, is a contraceptive that is placed inside the uterine cavity to prevent pregnancy. Currently, there are 3 IUD's on the market:

  • Paraguard – hormone free, lasts for 10 years, associated with slightly heavier periods
  • Liletta - contains progesterone, lasts for 5 years, associated with no periods
  • Mirena – contains progesterone, lasts for 5 years, associated with no periods
  • Skyla – contains progesterone, lasts for 3 years, associated with light periods

Before having an intrauterine device (IUD) inserted, you will probably have:

A pregnancy test, especially if you have not been using an effective method of birth control, have been sexually active in the past month, and are not having your menstrual period at the time of the procedure.

Testing for sexually transmitted infections (STIs), because the insertion procedure can carry an infection through the cervix and into the uterus, causing pelvic inflammatory disease (PID).

The process for IUD insertion is the same for each of the three devices.

  • A speculum is placed into the vagina to allow visualization of the cervix
  • The cervix is opened, or dilated, with a small thin instrument
  • The IUD is threaded through the cervix and into place at the top of the uterus
  • The strings of the IUD are trimmed so they extend just outside the cervical opening

After the IUD is inserted, you may experience:

  • Mild abdominal cramping, which is usually relieved with Motrin or Advil
  • Vaginal spotting, which can continue for 2-4 weeks after insertion
  • Vaginal discharge, which can last 1-2 months after insertion

If you have severe pain, heavy bleeding, fevers, or copious discharge, you should contact Dr. Firouzbakht. You should not have sex for 72 hours after placement. Your IUD will be effective for contraception immediately.

LAPAROSCOPY

A laparoscopy is a surgical method that involves inserting a camera, or laparoscope, into the abdomen. Laparoscopies can be used to diagnose pelvic problems, to treat endometriosis, and to remove ovarian cysts, fibroids, or the uterus.

Laparoscopic surgeries are done under general anesthesia. The laparoscope is usually inserted through the belly button. Carbon dioxide gas is infused into the abdomen so the pelvic organs can be seen. A few small incisions are also made in the lower abdomen so other surgical instruments can be placed.

The benefits of laparoscopy are small incisions, quicker recovery time, less pain, and lower risk of infection. The procedure is usually performed as an out-patient. Many patients can return to normal activities within a few days.

LEEP

A Loop Electrosurgical Excision Procedure, or LEEP, is an effective therapy for precancerous cells on the cervix. It uses a thin, low-voltage electrified wire look to cut out abnormal tissue. This procedure is usually performed to treat women who have severe cervical dysplasia or mild dysplasia that has persisted for more than a year. LEEP is done at Dr. Firouzbakht's office, a clinic, or a hospital as an outpatient procedure. You do not have to spend a night in the hospital.

During a LEEP, a speculum is inserted into the vagina so the cervix can be seen. A local anesthesia is injected and an electrified wire loop is used to cut away and remove the abnormal cervical tissue. The procedure usually lasts 5-10 minutes, and you can resume your activities immediately afterward.

You may have some mild cramping during and after the procedure. You can expect irregular vaginal bleeding and discharge for the first two weeks. The discharge may be red, brown, or yellow. You should not douche or have sex for one week after the procedure.

MENOPAUSAL COUNSELING

At Dr. Firouzbakht's office, we take a knowledgeable and compassionate approach to treating menopause. While menopause is a natural part of the aging process, the emotional and physical symptoms can be difficult to endure. Our experienced staff can ease the transition by providing you with effective menopause counseling and treatment.

As menopause nears, your ovaries produce less estrogen. This change can affect your menstrual cycle, causing irregular periods. Over time, your estrogen levels will continue to decrease until your periods stop completely. While going through this transition, many women experience depression, irritability, fatigue, anxiety, nervousness, and insomnia. The common physical symptoms of menopause are hot flashes, night sweats, vaginal dryness, and decreased libido.

At menopause, the rate of bone loss accelerates. This puts women at increased risk for bone fracture. Menopausal women are more likely to develop certain health conditions such as osteoporosis, cardiovascular disease, and urinary incontinence. Dr. Firouzbakht and her staff can help minimize these risks and prevent menopause-related health problems.

Treatments that relieve the symptoms of menopause:

Hormone therapy is an effective treatment for menopause. After discussing the benefits and risks with Dr. Firouzbakht, you may wish to start hormone therapy when your periods stop. Combination estrogen and progesterone hormonal replacement therapy can be used to treat moderate to severe menopause symptoms. If you have had a hysterectomy, we can also provide estrogen-only hormone therapy. If you cannot or do not want to take hormones for menopausal symptoms, there are alternatives available. Please ask Dr. Firouzbakht for a recommendation.

Hormone therapy can provide relief from certain menopause symptoms such as hot flashes and vaginal dryness. It can also help women prevent bone loss. However, there are risks associated with hormone therapy. Certain studies have shown that combination estrogen and progesterone hormonal therapy may increase the risk of heart disease, breast cancer, blood clots, and stroke.

Women who choose not to undergo hormone therapy may benefit from healthy lifestyle changes that can help minimize menopause symptoms. Menopausal women should adopt a balanced diet plan and regular exercise program. Many women use sexual lubricants to treat vaginal dryness. Prescription medications can help increase bone density and reduce the risk of fractures.

Choosing the right menopause treatment can be difficult. Personalized menopause counseling at Dr. Firouzbakht's office can help you understand the risks and benefits of various treatments. If you are interested in menopause counseling, call our office at 817-878-2667.

OVARIAN CYST SURGERY

An ovarian cyst is a benign tumor of the ovary. It can vary in size from a dime to a basketball. Some ovarian cysts develop during a normal menstrual cycle and will go away on their own (functional cysts). Others are true tumors of the ovary and will not go away unless surgically removed.

Ovarian cysts can cause pelvic pain, pain during intercourse, pressure or fullness in the abdomen, and nausea. Many cysts do not cause any symptoms and are found during your annual woman wellness exam. If the cyst is large, is growing, or is causing significant symptoms, it may need to be removed surgically.

The surgical approach to the removal of an ovarian cyst depends on its size and type. Small cysts may be removed through a procedure called a laparoscopic cystectomy. In this procedure, a camera is inserted through the belly button and the cyst is removed from the ovary. For larger or more complicated cysts, an abdominal incision may be needed. If a woman is postmenopausal, usually the whole ovary is removed (called oopherectomy).

If you have an ovarian cyst, your Dr. Firouzbakht can explain the surgical choices and help you decide which treatment may be right for you.

PELVIC ULTRASOUND

A pelvic ultrasound is a noninvasive examination of the female pelvis and is one of the best tests for evaluating the uterus and ovaries. In this exam, a transducer is placed either on the belly (abdominal ultrasound) or into the vagina (vaginal ultrasound). The transducer sends out sound waves that bounce off the organs and return to the transducer. These waves are then converted into a picture a screen. There is no radiation in this procedure.

Pelvic ultrasounds can show:

  • The size and shape of the uterus and ovaries
  • The thickness of the uterine lining, or endometrium
  • The length of the cervix
  • Presence of fibroids in the uterus
  • Presence of ovarian cysts
  • Uterine and ectopic pregnancies
  • Fetal anatomy

Pelvic ultrasounds are performed by an ultrasound technician in Dr. Firouzbakht's office. The procedure has no serious side effects and allows immediate answers to questions about abnormal uterine bleeding, pelvic pain, as well as the well-being of a fetus.

PMS COUNSELING

Premenstrual syndrome, or PMS, is a group of symptoms that are related to hormonal changes due to the menstrual cycle.  During the first half of a menstrual cycle, an egg begins to grow and the ovary produces estrogen.  At mid-cycle, the egg is released in a process called ovulation.  After ovulation, the ovary begins to produce a second female hormone called progesterone.  Progesterone is important in supporting an early pregnancy if one should occur.  But it is also responsible for all of the symptoms of PMS.

The most common symptoms are:

  • Mood changes including irritability, anxiety, low energy
  • Abdominal bloating, fluid retention
  • Breast tenderness
  • Dizziness
  • Appetite changes including craving of sweets and salt

The diagnosis of PMS is made simply by taking a history.  The symptoms usually appear 7-10 days before the period starts.  Once the menstrual flow begins, the symptoms disappear.  There are no blood tests to confirm the diagnosis.  Having PMS does not mean you have a "hormonal imbalance".  In fact, the hormones are acting exactly as they were designed.

Treatment of PMS involves lifestyle changes as well as medications.  For mild symptoms, calcium and vitamin B6 have been shown to be helpful.  In addition, decreasing caffeine intake and exercise will alleviate bloating, headaches, and some mood changes.

For women with more significant symptoms, taking oral contraceptive pills can be curative.  Birth control stops ovulation so the hormone responsible for PMS is not produced and the symptoms do not occur.  For mood changes, a mild antidepressant can be taken during the last 10 days of the menstrual cycle.

STD TESTING

STDs, or sexually transmitted diseases, are infections that are passed from one person to another via sexual contact such as vaginal intercourse, anal sex or oral sex. Dr. Firouzbakht's office offers STD screening, which can be done at your annual wellness exam or any other time that you have a concern. For patients without insurance, we provide a 7-test STD panel for $90.

The following STD's can be detected via a vaginal swab:

  • HPV
  • Chlamydia
  • Gonorrhea
  • Herpes
  • Trichomonas 

Blood tests are required to identify the following STDs:

  • Syphilis
  • HIV
  • Hepatitis B
  • Hepatitis C

A visual exam by your doctor can detect:

  • Crabs
  • Genital Warts
  • Scabies.

Proper use of condoms greatly reduces the risk of most STDs.  However, the condom will only protect the area that it covers.  Therefore, it is important that new partners should be testing prior to initiating sexual contact.

TREATMENT OF GENITAL WARTS

Genital warts are raised, asymptomatic lesions that occur on the vulva, mons pubis or near the rectum.  They occur because of exposure to HPV. Dr. Firouzbakht can make the diagnosis by looking at them or by doing a biopsy.

If genital warts are small, they may resolve on their own with time.  However, if they are large or there are multiple lesions, treatment may be needed.

Treatment for genital warts depends on the type of warts you have and where they are located. You do not need treatment if there are no visible warts.

There are two main types of treatment for genital warts:

  • applying a cream, lotion or chemical to the warts (topical treatment)
  • destroying the tissue of the warts by freezing, heating or removing them (physical ablation)

Most topical treatments tend to work better on softer warts, and physical ablation tends to work better on harder and rougher-feeling warts. Sometimes, a combination of topical treatments is recommended.

For some people, treatment can take several months to remove the warts, so it is important to persevere.

You may be advised to avoid perfumed soap, bath bubbles or lotions while you are having treatment for warts as these can sometimes irritate the skin.

The most common treatments for genital warts are:

  • Imiquimod:  This is a cream that you can apply at home three times per week for 3-4 months.  It stimulates your local immune system to fight the virus.
  • Trichloroacetic acid (TCA):  TCA is a chemical that destroys the warts.  It is applied by your doctor weekly until the lesions resolve.
  • Surgery:  Warts can be surgically removed or cauterized under anesthesia.  This treatment is recommended when the warts are especially large.