What are the treatment options for excessive bleeding?

Excessive bleeding during menstrual periods can be defined by either the volume of blood loss or the duration of the bleeding. Typically bleeding of more than 80 ml (more than 5 tampons or pads per day) or bleeding for more than 7 days is clinically categorized as excessive bleeding or Menorrhagia. Treatment is determined by the conditions effect on the patient’s lifestyle and underlying cause.

Some of the causes are:
• No identified abnormality
• Hormonal imbalance (especially involving the ovaries)
• Fibroids
• Coagulation disorders
• Cancer of the uterine lining
• Polyps within the uterine
• Pelvic inflammatory disease (PID)
• Endometriosis
• Adenomyosis

If treatment is necessary it can range from drug therapies to manage hormone level to the surgical removal of the uterus (hysterectomy). A minimally invasive alternative to a hysterectomy is called Hydro-thermal Ablation (HTA). One of the few Ob Gyn practices in the Salinas and Monterey County area to offer HTA is Health Care For Women adjacent to the Salinas Valley Memorial Hospital.

Since HTA can be performed as an outpatient without any surgical incisions, it usually takes only about 30 minutes. The procedure can be done with local anesthesia with some sedation, and the patient can resume normal activities within 24-48 hours. The procedure consists of inserting a small device (hysteroscope) into the uterus, sealing the cervix and filling the uterus with saline (salt water). Using the hysteroscope, the fluid in the uterus is heated to destroy the lining and eliminate or reduce menstrual bleeding. The uterus is then rinsed with room temperature saline to complete the procedure.

An important consideration before receiving HTA is the decision that the patient has completed their family and does not anticipate any future pregnancies. Although the procedure does not prevent pregnancy, any conception after the ablation of the uterine lining must be treated as high risk and may result in miscarriage. After the procedure, it is highly recommended to ensure effective birth control or sterilization such as insertion of Essure to prevent potential complications of post-HTA pregnancy.

For more information regarding abnormal menstruation, including excessive bleeding, irregular bleeding, bleeding after menopause or other Salinas ObGyn or Monterey ObGyn care, call Health Care for Women in Salinas, California or go to hcfw.com.
To make an appointment with an expert women’s health professional to discuss obstetrics or gynecology concerns, healthy pregnancies or general women’s healthcare, please call 831-758-8223.

Physicians Specializing in Women’s Health

What is the difference between Obstetrics and Gynecology?

Healthcare for women can be divided into two medical disciplines based on the reproductive status of a woman. Obstetrics is concerned with the treatment of pregnancy including pre-natal and post-natal care. Gynecology, from the Greek meaning “the study of women”, deals with the overall female reproductive system throughout a woman’s life from her first menstruation through post-menopause, other than those times when she is pregnant. Together these two disciplines are combined to comprise the practice of OBGYN. OBGYN physicians are experts in diagnosing problems related to the organs of the female reproductive system, as well as treating those conditions medically or surgically as the case requires.

The Monterey Peninsula area and surrounding areas of California, including Carmel, Gilroy, Greenfield, Hollister, Marina, Salinas, Seaside, and Soledad, have a higher than average proportion of its population comprised of women of child bearing age which creates high demand for OBGYN physicians. In addition to caring for expectant mothers and delivering babies, Salinas OBGYN physicians treat conditions such as cancer, osteoporosis (weakened bones), and endometriosis. Key diagnostics services include PAP Smears, ultrasound imaging, and bone density scans.

The most common services sought from Salinas OBGYN practices by healthy women are prenatal care, pap smears and birth control(both family planning and permanent sterilization, such as Essure). If you are a woman seeking expert professional medical care, call Health Care for Women in Salinas, California, or for any questions or concerns you may have concerning gynecology, obstetrics, healthy pregnancies or general women’s healthcare, please call 832-758-8223, or visit the Health Care for Women website today.

Amniocentesis and Your Pregnancy

What is Amniocentesis?

Amniocentesis, also referred to as an amniotic fluid test, or simply an “amnio”, is a prenatal procedure used to collect a small amount of the amniotic fluid that surrounds the baby in the uterus. The collected amniotic fluid contains cells shed by the developing baby and each of these shed cells contains a complete set of the baby’s DNA. The cells can be cultured and the DNA analyzed in order to detect and identify certain potential health problems the fetus may have.

Why Amniocentesis?

The most common reason for having an amniocentesis is to allow early detection of certain genetic disorders or chromosomal abnormalities in the developing fetus. While an “amnio” can detect hundreds of genetic abnormalities, the most common abnormalities tested for are Down Syndrome (Trisomy 21) and Edward’s Syndrome (Trisomy 18). Also, neural tube defects, which are problems with the formation of a baby’s central nervous system such as spina bifida and anencephaly, can be detected with an amniotic fluid test.

The test is usually performed early enough in the pregnancy (between the 15th and 20th weeks) in order to provide the parents with time to consider their options should serious abnormalities be discovered. In some cases when a serious genetic disorder is discovered, the parents can choose to terminate the pregnancy or they may decide to continue it. It is important to realize that having an amniocentesis in no way obligates you to terminate the pregnancy if an abnormality is discovered. For some conditions, simply having a clear diagnosis can better prepare you and your physicians for taking care of a baby with special needs before and after birth.

Call HEALTH CARE FOR WOMEN in Salinas, California today to talk to a trained obstetrician and schedule an appointment to have your amniocentesis performed.

Also, in cases where an early delivery is being considered due to medical reasons, your obstetrician may perform an “amnio” to determine the maturity of the baby’s lungs. Amniocentesis can also be used to diagnose a uterine infection, determine the gender of the baby or to evaluate any significant health issues that can arise when the mother’s blood type is different from the baby’s. (see Rh sensitization)

What is Involved?

A local anesthetic may or may not be given before the actual procedure. While you are lying down, your doctor will locate a pocket of amniotic fluid a safe distance from the baby using ultrasound. The doctor then inserts a syringe into the amniotic sac around the baby and a small amount of amniotic fluid is drawn for testing. The whole procedure takes only a few minutes.

After the procedure is performed, your doctor or nurse will watch for any uterine contractions or fetal distress while you rest for 15 – 45 minutes before leaving. It is suggested that you take it easy for the remainder of the day so be sure to arrange for someone to drive you home. Heavy lifting, intercourse, and air travel should be avoided for the next 48 -72 hours. It can take 1 – 2 weeks for the collected cells to be cultured and the results of the test diagnosed.

If you are interested in learning more about amniocentesis or you would like to schedule an appointment to have an amniocentesis performed, please contact Health Care For Women at our Salinas office or by filling out a Quick Contact on their website at www.hcfw.com

Who Should Be Tested?

All pregnant women are candidates for amniocentesis. Since the risk of having a baby with a chromosomal disorder can be relative to age of the mother, amniocentesis is routinely suggested to all pregnant women over the age of 35. Women who previously have had a child with a genetic abnormality or have a family history of certain birth defects, are also suggested to undergo an amniotic fluid test.

Risks Involved

Amniocentesis increases the risk of miscarriage by less than 1 percent over the baseline risk for miscarriage. Amniocentesis does not increase the risk of birth defects.

For patients who want information about their risk of birth defects, there are three main alternatives to amniocentesis.

The first is ultrasound, which is done routinely for all pregnancies. Ultrasound can detect some but not all types of birth defects and is less specific for the diagnosis of some syndromes. Routine ultrasounds for this purpose are done between 18 and 22 weeks of gestation.

An alternative screening method that can be done earlier in the pregnancy is the use of maternal blood markers to assess the risk of defects (sometimes called “AFP” or “quad testing”). When combined with a special ultrasound called a Nuchal Translucency measurement, this type of testing can give information about Down and Edward’s syndromes as early as 11-14 weeks. Without this special ultrasound, the testing is done at 15-20 weeks. It is important to understand that this testing, similar to ultrasound, does not provide a definitive diagnosis.

For an earlier, definitive diagnosis, a procedure called Chorionic Villus Sampling (CVS) can be done between 8 and 12 weeks. More technically difficult, it carries a slightly higher risk of miscarriage than amniocentesis, but the results are available much earlier.

To schedule your ”amnio” or any other prenatal testing call Health Care for Women in Salinas, California, or for any other questions or concerns you may have concerning gynecology, obstetrics, healthy pregnancies or general women’s healthcare, please call 831-758-8223, or visit the Health Care for Women website and get in contact today.

Abnormal Periods

The Female Reproductive Cycle

To understand abnormal bleeding, it helps to understand what is normal. Vaginal bleeding, or menstruation, is what takes place as a normal part of the reproductive cycle and is commonly referred to as a “period”. Normally, each month an egg is released from one ovary and travels through the fallopian tube to the uterus to await fertilization. When fertilization doesn’t occur the uterus sheds its inner lining (endometrium) through the vagina in order to prepare the uterus to accept a new embryo during the next cycle. The amount of fluid and blood that is shed during normal menstruation varies but is usually between 4 and 12 teaspoons. The length of the menstrual cycle can vary from 21 days to 35 days with the average length of a cycle being 28 days. A normal period lasts from 2 to 7 days.

Abnormal Bleeding

When periods are heavier than a woman would expect or the flow takes place at the wrong time during the month (i.e., irregularly), it is considered abnormal, and it is suggested that you consult your gynecologist in order to determine the cause.

Bleeding is always considered abnormal, regardless of the quantity, if it occurs more than once every 21 days (counting from the start of one episode to the start of the next, regardless of how many days each episode lasts), after intercourse, or after menopause. Bleeding is also considered abnormal if your regular period becomes heavier or lasts longer than it used to. If you are experiencing any of these conditions you should consult with your ob gyn to discover the cause.

Sometimes irregular bleeding may be your first indication of pregnancy, and a pregnancy test is one of the first tests your doctor is likely to do. If pregnancy is confirmed your doctor will continue to monitor you for any new episodes since vaginal bleeding during the pregnancy can be an indication of miscarriage or ectopic pregnancy.

If you are not pregnant, it can be helpful for you to provide your gynecologist a bleeding diary that details your bleeding pattern and the amount of bleeding you experience each day. Though quantifying the amount that you bleed can be difficult, your doctor will want to know how often you have to change your sanitary pad or tampon, if you pass blood clots, and if you have had problems with anemia as a result of too much blood loss.

What are the causes of abnormal bleeding?

There are many causes of abnormal bleeding. Concerns range from pregnancy complications to cancer. Common reasons for abnormal bleeding are fibroid tumors of the uterus, polyps of the endometrium, and hormonal imbalances that cause disruption of the normal ovulation cycle. By providing a good bleeding history, you can help your doctor determine the cause.

After hearing your history, your doctor will determine which tests are necessary to make a diagnosis. Your work-up might include blood tests, a pelvic ultrasound, a pap smear, and/or a biopsy of the endometrium.

How is irregular vaginal bleeding treated?

The first priority is to determine what causes the irregular bleeding. Once the cause is diagnosed, your gynecologist can consult with you to decide if treatment is actually necessary. In some cases, if the dangerous causes have been ruled out, you and your doctor may decide that the irregular bleeding may not be enough of a problem to warrant medication or treatment.

If the abnormal bleeding is determined to be serious enough to threaten your health or if you feel that treatment is necessary because of the impact it is having on your lifestyle, then your doctor will recommend treatment that is appropriate for your specific diagnosis. Sometimes treatment with medications is likely to help; other times, surgical treatment is more appropriate. Most medications used for bleeding problems contain hormones, though there are some non-hormonal treatments available as well. Surgeries often performed for abnormal bleeding include using a camera to remove polyps and other growths from the uterine cavity (hysteroscopy), destruction of the uterine lining (endometrial ablation), removal of fibroid tumors (myomectomy), or removal of the uterus (hysterectomy).

To schedule an examination call Health Care for Women in Salinas, California, or for any other questions or concerns you may have concerning gynecology, obstetrics, healthy pregnancies or general women’s healthcare, please call 831-758-8223, or visit the Health Care for Women website and get in contact today.

Prenatal Genetic Screening Tests: Nuchal Translucency And Blood

Once you’ve discovered you’re pregnant, the joy and wonder you feel for the new life growing within you may sometimes be diminished by worries about whether or not your new baby will be born healthy. You may start to recall every single piece of junk food you’ve ever eaten or every time you’ve somehow found yourself in a smoke-filled room and wonder if your unborn child has been affected in some way. Every expectant mother hopes that her baby will be healthy at birth and, in fact, the vast majority of babies are. Since 96 to 97 out of every 100 babies are born healthy, there is little real cause for concern.

However, these numbers also mean that the other 3-4% of all babies born will have some type of defect. To any expectant mother, the thought of your new baby being anything less than perfect can be heartbreaking, but it’s important to note that not all birth defects are severe. Many defects are treatable, often immediately following birth or, in some cases, even before the baby is born. Other defects can be of a more serious nature.

Do all you can to insure the health of your unborn child. Call HEALTH CARE FOR WOMEN in Salinas, CA to learn more about the importance of proper prenatal care during your pregnancy.

The Difference Between Screening And Diagnostic Tests

Prenatal testing to detect genetic abnormalities in the fetus fall into two different categories: screening and diagnostic. Screening tests, like a nuchal translucency scan, do not diagnose the presence or absence of disease. Instead, the nuchal translucency scan is used as an indicator of whether the possibility of disease is higher or lower than the norm – it doesn’t provide a diagnosis, but it can assess your baby’s risk for certain problems. Diagnostic tests, such as an amniocentesis are used to verify, or diagnose the presence of disease.

Who Should Be Screened?

Statistically, the chances of a baby having Down syndrome are related to the age of the mother. For mothers under the age of 25, the chances of having a child with Down syndrome are 1 in 1,400. At the age of 35, the chances are now 1 in 350. At the age of 40, the odds are about 1 in 100. Because of these statistics, the age of the expectant mother has always been factored into the decision to pursue screening for genetic abnormalities. Now however, the American Congress of Obstetricians and Gynecologists recommends that women of all ages be offered first and second-trimester screening and diagnostic testing options.

The Nuchal Translucency Screening or NT screening

Doctors began using this type of prenatal screening in the mid-nineties and the Nuchal Translucency Screening, or the nuchal scan, has been in widespread use since 2003. This relatively new, but very effective, screening tool is performed during your first trimester, usually along with a maternal blood test in order to safely evaluate the possibility that a genetic disorder or heart defect may exist in the developing fetus.

This procedure is non-invasive and safe. Perhaps your biggest challenge will be the level of anxiety you may experience when thinking about ”what might be”. Try to remember that the odds of you having a healthy child are overwhelmingly in your favor. Again, the NT screening isn’t a diagnostic test. The results of the nuchal scan, combined with other factors that may or may not statistically place the fetus in a higher risk group, simply indicate whether or not additional testing (diagnostic) would be advised.

Using high-resolution ultrasound equipment, your doctor or sonographer will first verify your baby’s fetal age by measuring your baby from crown to rump. This is critical to the accuracy of the NT screening because during weeks 11 to 14, the base of your baby’s neck – the nuchal fold – is still transparent and the amount of fluid can be accurately measured. After 14 weeks, the nuchal fold becomes less transparent and the continuing development of your baby’s lymph system may drain the amount of excess fluid in the nuchal fold, allowing possible abnormalities to go undetected.

Once the baby’s fetal age has been verified, your doctor then locates and measures the size of the nuchal fold. A larger-than-normal nuchal fold indicates excessive fluid in the area which may mean your baby may be at increased risk of having a genetic abnormality.

Health Care for Women in Salinas, California performs Nuchal Translucency screenings. The doctors there can answer any questions you may have about prenatal testing, maternal blood tests, or for any other questions or concerns you may have concerning gynecology, obstetrics, healthy pregnancies or general women’s healthcare, please call 831-758-8223, or visit the Health Care for Women website and get in contact today.

Maternal Blood Test

Typically, the NT screening is performed along with a maternal blood test. The blood sample is tested for specific indicators that are only present during pregnancy, as the NT measurement alone cannot be used for risk assessment. These test results return either ”Screen Negative”, indicating the pregnancy is at a low risk of Down syndrome (Trisomy 21) or Edward’s syndrome (Trisomy 18), or ”Screen Positive” which means the mother is in a higher risk group.

These results, used in conjunction with the nuchal scan, provide clear indicators of whether or not additional diagnostic testing would be advised. Again, it is important to note that, based on these indicators alone, you shouldn’t assume that you are carrying a child with a genetic abnormality. These indicators also do not conclusively prove that you are not. These tests are simply another tool to help evaluate the possibility of your baby having a genetic abnormality and whether diagnostic testing is advised.

Diagnostic Testing

If the results of these tests indicate that your baby may be at a higher risk of having a genetic abnormality, then diagnostic tests, such as an amniocentesis should be considered. Further testing allows you to confirm your baby’s condition. If a diagnosis is confirmed, this will provides you with the opportunity to:

  • Begin planning for raising a child with special needs
  • Anticipate changes in your lifestyle that may be required
  • Locate resources and support groups
  • Decide whether or not to carry the child to full term.

As soon as your pregnancy is confirmed you will want to discuss with your ob gyn the different prenatal tests and procedures that are available in order to properly assess your baby’s health and development. Each of these tests and procedures has its own unique advantages, disadvantages and limitations. At this stage of your pregnancy, your doctor’s training and experience will serve as an invaluable tool to help you understand everything you need to in order to make an informed decision about which screenings and tests you would want to pursue in order to do all you can for the health of your unborn child. Talk to your obstetrician, ask questions and gather as much information as you can.

If you are interested in learning more about Nuchal Translucency Screening, or you would like to schedule a nuchal translucency screening, please contact Health Care For Women at our Salinas office or by filling out a Quick Contact on their website at www.hcfw.com

Getting Help

The feelings that many parents experience when they discover they have a child diagnosed with Down syndrome can be overwhelming. Learning all you can about Down syndrome may help to alleviate some of your fears and questions about the future.

There are a variety of excellent resources available today to help you. Check with your doctor or a social worker to learn what resources are available in your area.