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Gyn Questions

Frequently Asked Questions

DO I NEED TO RESCHEDULE MY PAP SMEAR IF I HAVE MY PERIOD?
With the newer pap smear kits, it can be done while you have your period as long as the flow is not very heavy.

WHAT DO I DO IF I MISS A BIRTH CONTROL PILL?
If you miss one pill, take two the next day. You are still protected from becoming pregnant. If you miss two pills, take two pills on the next two days. You must use a backup method of contraception such as condoms for the remainder of the month. If you are late or miss pills you will often have breakthrough bleeding or spotting or irregular bleeding. Check a pregnancy test if your period is late.

WHEN DO I NEED TO START GETTING MAMMOGRAMS?
Women starting at age 40 should have an annual mammogram.  Women with an increased risk of breast cancer should talk with their doctor about whether to have mammograms before age 40. We can get you referred quickly for your mammogram. Most insurances now cover mammograms. If you don’t have insurance at this time, we can give you a coupon for a great discounted price.

WHAT ARE BIOIDENTICAL HORMONES?
Bioidentical Hormone Replacement Therapy (BHRT) describes supplementation of hormones that are molecularly identical to those hormones produced in the human body. Unlike manufactured Conventional Hormone Therapy (CHT), such as conjugated estrogens (premarin) and medroxyprogesterone acetate (MPA or Provera). BHRT hormones do not contain extra structural moieties or parts which may alter hormone receptor binding and function in the human body.  They are often referred to as “natural hormones.”

BHRT can be used to alleviate many symptoms women suffer with on a daily basis. These include premenstrual symptoms (PMS), joint pain, decreased libido, fatigue and exhaustion, difficulty concentrating, and many more.

The drug companies that make CHT are gigantic and have deep pockets that have led most of the research in hormone replacement. The most notorious study being the WHI study (see next section). One of the main points physicians make against the use of BHRT is that many of them are made by a compounding pharmacy. Thus they are not FDA approved and will claim they can’t be trusted because you never know what you are getting with each compounding pharmacy. This is simply not true. Click compounding pharmacy to learn more.

So why do I offer BHRT? Because it works and I believe has less side effects than CHT. Some of the bioidentical hormones I recommend are FDA approved and are given by many healthcare professionals who might not even know they are bioidentical. In some patients I also recommend compounded hormones that help support your thyroid and adrenal glands. Just as we are each made with unique fingerprints, we are also each designed with hormone levels that are optimal for us as individuals. I will work with you to find your body’s natural sweet spot by beginning with the lowest dose and slowly increasing until symptoms are resolved and your body is back in balance.

WHAT ARE THE RISKS OF TAKING HORMONES?
The use of hormone replacement drastically changed in 2002 when a study called the Womens Health Initiative (WHI) was published showing that there was no benefit to prevention of cardiovascular disease and that there was an increase risk in a few areas. This led to hundreds of thousands of women going off of hormone replacement because of this scare.

Well since the WHI study was published we have learned much more about the actual risks of hormones and when it should not be used. Numerous studies have been recently published in the last 10 years showing that hormone replacement is safe in woman that are perimenopausal and early menopause (50’s). The small risks that I will mention shortly were in women that were in their mid 60’s or older. In fact women that were less than 60 years old had decreased risk of cardiovascular events (heart attacks) and breast caner. Those that had increased risk of heart attacks had been in menopause for over 10 years and it was in there first year of taking the medication. Also the medication they used in the study is Prempro which is a combination of Premarin and Provera. Both of which are not bioidentical hormones. I do not use Premarin in the office and rarely will use Provera. I will use a short course of Provera in young women with irregular bleeding to help stop the irregular bleeding.

So the risks of the conventional hormone therapy (ie Prempro) are out of 10,000 women/yr, there will be 7 more women with cardiovascular events, 8 more breast cancers, 8 more strokes, and 18 more venous blood clots. Again that is out of 10,000! We know that bioidentical hormones have less side effects and risks because they are the same biological structure as the hormones your own body produces. So in those patients that can benefit from BHRT I will start at a low dose and titrate upwards until symptoms are improved.

WHAT ARE THE BENEFITS OF TAKING HORMONES?
It is usually taken to help relieve symptoms of menopause which may include hot flushes, night sweats, vaginal dryness, mood changes, skin changes, etc. We also know that they help prevent osteoporosis and thus hip and spine fractures and decrease your risk of colon cancer.

There are many women though that are in their mid 30’s to perimenopause that also may benefit from hormone replacement. If you have some of the symptoms listed in the Questionnaires above, this can be linked to a decrease in your hormones produced by your ovaries, thyroid gland and adrenal gland.

How can a woman in her 30’s be affected by a hormonal imbalance? A woman’s ovaries generally function best between a few years after puberty until around age thirty. However, as a woman ages, so do her ovaries. By the time a woman reaches thirty-five years of age she is over halfway through her menstrual life and her ovarian function begins to falter. The ovaries are the primary site for the production of both estrogen and progesterone. But while both estrogen and progesterone levels decline with age, progesterone declines much more dramatically. By menopause, a woman’s progesterone level is likely to be a mere 1/120 of the level she experienced in her early twenties. In contrast, her postmenopausal estrogen level may remain at 40 percent of the level she experienced in early adulthood, because even when her ovaries no longer produce estrogen, her fat cells continue to do so.

Another reason why estrogen dominance becomes more common with age is that as a woman ages she begins to have anovulatory cycles, menstrual cycles during which her ovaries do not release eggs. When a woman does not ovulate, her ovaries produce no progesterone at all. The stimulatory effects of estrogen unopposed by progesterone can cause the endometrial lining to become abnormally thickened, resulting in heavier periods, clotting, and painful menstrual cramps. As women enter their thirties, anovulatory cycles become more common, and symptoms of estrogen dominance become progressively more severe.

You may be interested in reading more about hormonal imbalance that frequently occurs in women and the symptoms that arise from this. If that is the case then I encourage you to read an eBook by Dr. Steven Hotze called Your Guide to Bioidentical Hormones. He also has eBooks on thyroid and adrenal hormones and explains how they can be unbalanced. He describes how with appropriate treatment, bioidentical hormones can bring great relief to symptoms that you have been living with for a long time. Call our office today and make an appointment to be evaluated by Dr. Lee and start on your road to health and wellness.

WHY IS MY LIBIDO LOW?
“Libido” is a term to describe a man or woman’s interest or desire in sex. As woman get older their libido often declines. This can be fine with them if they are not in a relationship but if they are in a relationship this can be bring much conflict. God has intended for intimacy and sex to be enjoyed in marriage and if it is not occurring then it can bring emotional separation and distancing. I was recently reading a book where the author said that evidence of a healthy marriage is that the couple pray together frequently and are intimate with each other regularly.

There are many possible reasons for a decreased libido. They include psychological causes such as depression, post traumatic stress disorder, history of abuse, depression medications, etc. They also can be physical in etiology such as pain with intercourse, urinary incontinence with intercourse and low hormone levels. Specifically testosterone which we will discuss further below.

But before we discuss the testosterone aspect we need to address a major cause that is not discussed in the medical literature. That is a woman’s loss of interest in sex coming from her husband or male companion showing no interest in her throughout the day. She feels that she is ignored and not treasured from sun up to sun down, and then in the bedroom the husband is desiring sex and she is wanting to hurt him… not be intimate. There is numerous studies to show that woman are more responsive to men who understand that lovemaking is an ongoing experience of affection.

So that being understood, there are woman who have loving caring husbands who just have little interest in sexual intimacy. It often can be due to a low testosterone level. Signs and symptoms of low testosterone include blunted motivation, fatigue, depression and/or anxiety, low blood levels or free testosterone. Estrogen dominance as described in the last section can decrease the effectiveness of testosterone as well. The solution is obvious: supplementation with small, physiologic replacement doses of testosterone to restore levels to those of a healthy young woman. Sadly, this option is rarely offered to women by most health professionals. Call today and make an appointment to be evaluated by Dr. Lee and see whether or not you may benefit in a boost of your testosterone.

WHAT CAN BE CAUSING SEX TO BE PAINFUL?
First of all, it is very common for a woman not to be seen by their OB/GYN because they are embarrassed to discuss they are having a tremendous amount of pain with intercourse. They often won’t communicate this to their partner as well. There a numerous causes for a woman’s pain during intercourse. It can be anything from scar tissue from a previous abdominal surgery to a history of prior sexual abuse. The vast majority of the time the source can be found and treated effectively. Things you may want to try prior to coming to making an appointment include:

1.Use a lubricant. There are many types of lubricants. Water-soluble lubricants are a good choice if you experience vaginal irritation or sensitivity. One popular over-the-counter product is called Zestra. Silicone-based lubricants last longer and tend to be more slippery than water-soluble lubricants. Do not use petroleum jelly, baby oil, or mineral oil with condoms. They can dissolve the latex and cause the condom to break.

2. Take pain-relieving steps before sex: empty your bladder, take a warm bath, or take an over-the-counter pain reliever before intercourse.

3.To relieve burning after intercourse, apply ice or a frozen gel pack wrapped in a small towel to the vulva (the area surrounding the opening of your vagina.)

If none of these measures alleviate your pain, then you should make an appointment to be seen. I know that often this is avoided by patients because they are in so much pain and dread any form of pelvic exam. I promise that myself and the staff will be very gentle and will carefully assess in a systematic approach what is causing your pain and come up with a treatment to bring an end to this!

ARE ALL HYSTERECTOMIES THE SAME?
First of all there is great confusion often among patients on the nomenclature used by health professionals in regards to hysterectomies. I hope the following information will bring some clarity.

When describing what is removed during a hysterectomy the terms include:

When describing the approach the surgeon takes in doing the hysterectomy the terms include:

  • Vaginal Hysterectomy– The uterus is removed through the vagina. With this type of surgery, you will not have an incision (cut) on your abdomen. Because the incision is inside the vagina, the healing time is shorter than with abdominal surgery. There usually is less pain during recovery. To use the vaginal route, a woman must not have cancer or a large uterus. It also helps to have had a baby or two vaginally, which widens the vagina and relaxes the connections of the uterus so it can be brought down into the vagina to do the surgery. The only problems with this route are that the surgeon cannot always get the ovaries out when they absolutely need to come out in certain occasions, we also cannot examine the upper abdomen and examine for and remove endometriosis if the patient is having pelvic pain.
  • Abdominal Hysterectomy– The doctor makes an incision through the skin and tissue in the lower abdomen to reach the uterus. The incision may be vertical or horizontal. The recovery time is is longer and there is more postoperative pain involved. This type is still done, but only for women who cannot or should not have less invasive techniques listed below.
  • Laparoscopic Hysterectomy– A laparoscope is used to guide the surgery. A laparoscope is a thin, lighted tube with a camera that is inserted into the abdomen through a small incision in or around the navel. It allows the surgeon to see the pelvic organs on a screen. Additional small incisions are made in the abdomen for other instruments used in the surgery.

There are three kinds of laparoscopic hysterectomies:

1. Total Laparoscopic Hysterectomy (TLH)- A small incision is made in the navel for the laparoscope, and two or more small incisions are made in the abdomen for other instruments. The uterus is detached from inside the body. It then is removed in small pieces through the incisions, or the pieces are passed out of the body through the vagina. If only the uterus is removed and the cervix is left in place, it is called a supracervical laparoscopic hysterectomy.

2. Laparoscopically Assisted Vaginal Hysterectomy (LAVH)- A vaginal hysterectomy is done with laparoscopic assistance. For example, the ovaries and fallopian tubes may be detached using laparoscopy, and then the uterus is detached and all of the organs are removed through the vagina.

3. Robot-assisted Laparoscopic Hysterectomy– This is like a TLH, small incisions are made. However the robot technology allows for a surgeon to do use the laparoscopic instruments in a whole new way that is not capable with traditional laparoscopic surgery.  Thus complex cases that were not previously done with traditional laparoscopic surgery are able to be done robotically.  Also the robot assist is easier for the surgeon compared to traditional laparoscopic surgery, thus it is widely being adopted by many surgeons. In appropriate candidates, Dr. Lee performs the hysterectomy through one incision at the belly button.

WHAT IS GYNECOLOGIC MINIMALLY INVASIVE SURGERY?
Minimally invasive surgery means using the latest surgical technology to complete the entire operation through small skin incisions. This promotes rapid recovery, less postoperative pain, less blood loss and need for transfusion.

Gone are the days of your mother’s hysterectomy. With the advancement of technology there is the ability to have a hysterectomy and be out of the hospital the next morning. You can be back to work in 1-2 weeks. Unfortunately too many women are still only offered an abdominal hysterectomy, the type of hysterectomy their mother had. This is often the only option given when patients have a large uterus secondary to uterine fibroids. Dr. Lee performs the latest technology of laparoscopic hysterectomy, thus your large fibroid uterus will be removed through very small skin incisions and you will be able to leave the hospital the same night or early the next morning.

Not only does gynecologic minimally invasive surgery include the hysterectomy procedure but Dr. Lee can also perform laparoscopic evaluation and treatment of endometriosis, Essure procedure for sterilization, Novasure Endometrial Ablation procedure for abnormal uterine bleeding or heavy menstrual bleeding, and Myosure procedure for removing uterine fibroids without making a skin incision.

WHAT IS HPV AND CAN IT BE PREVENTED?
HPV is a very common virus. Some research suggests that at least three out of four people who have sex will get a genital HPV infection at some time during their lives.

HPV is primarily spread through vaginal, anal, or oral sex, but sexual intercourse is not required for infection to occur. HPV is spread by skin-to-skin contact. Sexual contact with an infected partner, regardless of the sex of the partner, is the most common way the virus is spread.

Like many other sexually transmitted diseases (STDs), there often are no signs or symptoms of genital HPV infection. The infected person often is not aware that he or she has been infected.

Approximately 12 types of HPV cause genital warts.Two types, types 6 and 11, are the main cause of genital warts. These growths may appear on the outside or inside of the vagina or on the penis and can spread to nearby skin. Genital warts also can grow around the anus, on the vulva, or on the cervix.

Approximately 15 types of HPV are linked to cancer of the anus, cervix, vulva, vagina, and penis. Most cases of cervical cancer are caused by just two types of HPV—types 16 and 18. Although certain types of HPV can cause cancer of the cervix, very few women infected with HPV develop this type of cancer. In most women, the immune system destroys the virus before it causes cancer. But in some women, HPV is not destroyed by the immune system and does not go away. In these cases, HPV can lead to cancer or, more commonly, precancer.

There is no medical cure for HPV—it is best to take steps to prevent it. Young women can prevent certain types of HPV infection by being vaccinated. You can decrease your risk of infection by avoiding contact with the virus. Thus use of condoms and monogamous relationship can help prevent infection. Click Gardasil to learn more about HPV vaccination.

I HAVE HAD AN ABNORMAL PAP SMEAR, NOW WHAT?
If you have recently had an abnormal pap smear you will need to follow up for further evaluation. The good news is that the likelihood that you have cervical cancer is very low. However, it it important that you follow up soon with your physician to go over what the next step is. Click abnormal pap for a chart that will help you understand what is next in your evaluation.

HOW DO I DO A PROPER SELF BREAST EXAM?
There has been a lot of controversy over whether breast self exams (BSE) are beneficial in preventing breast cancer. I think they are important in helping you know what is normal for you. The best time to do BSE is 2 or 3 days after the end of your period, when your breasts are least likely to be tender or swollen. A woman who no longer has periods may find it helpful to pick a particular day, such as the first day of the month, to remind herself that it is time to do BSE.

If you discover anything unusual, such as a lump, a discharge from the nipple, or dimpling or puckering of the skin, you should call the office for an appointment. Remember, 8 out of 10 biopsied breast lumps are not cancer.

Many women have irregular or “lumpy” breasts. The term “benign breast condition” refers to those changes in a woman’s breasts that are not cancerous. Many doctors believe that nearly all women have some benign breast changes after age 30. But any change is best diagnosed by your doctor. Remember a BSE is not to be used as a substitute for your regular mammogram or exam by your doctor.

To see a description on performing a BSE click breast self exam.

WHAT IS PCOS?
Polycystic ovary syndrome (PCOS) is a disorder that affects as many as 5–10% of women. PCOS has three key features: 1) high levels of hormones called androgens; 2) irregular menstrual periods or lack of periods; and (3) the presence of cysts on the ovaries. Many women with PCOS have other signs and symptoms as well.

Signs and Symptoms
PCOS has many different signs and symptoms. Some women may not be aware that seemingly unrelated symptoms are actually those of PCOS. Common PCOS signs and symptoms include the following:

  • Irregular menstrual periods—Menstrual bleeding may be absent, heavy, or unpredictable.
  • Infertility—PCOS is one of the most common causes of female infertility.
  • Obesity—Up to 80% of women with PCOS are obese.
  • Excess hair growth on the face, chest, abdomen, or upper thighs—This condition, called hirsutism, affects more than 70% of women with PCOS.
  • Severe acne or acne that occurs after adolescence and does not respond to usual treatment
  • Oily skin
  • Patches of thickened, velvety, darkened skin called acanthosis nigricans
  • Multiple small cysts on the ovaries

What Causes PCOS?
Although the cause of PCOS is not known, it appears that PCOS may be related to many different factors working together. These factors include insulin resistance, increased androgen levels, and an irregular menstrual cycle.

Insulin Resistance
Insulin resistance plays a key role in PCOS. If the body’s cells do not respond to the effects of insulin, the level of glucose in the blood increases. Higher than normal blood glucose levels may eventually lead to diabetes mellitus. High insulin levels may cause the appetite to increase and lead to imbalances in other hormones.

High Androgen Levels
High levels of androgens are a hallmark of PCOS. Androgens are hormones made by the ovaries and adrenal glands (small glands that rest on top of the kidneys). All women produce a certain amount of these hormones. When higher than normal levels of androgens are produced, it can prevent the ovaries from releasing an egg each month (a process called ovulation). High androgen levels also cause the unwanted hair growth and acne seen in many women with PCOS.

Irregular Menstrual Periods
Women with PCOS often have irregular menstrual periods. Some have infertility. These problems are caused by lack of regular ovulation. Women who do not ovulate regularly may form multiple ovarian cysts.

Treatment
A variety of treatments are available to address the problems of PCOS. Treatment is tailored to each woman according to symptoms, other health problems, and whether she wants to become pregnant. variety of treatments are available to address the problems of PCOS. Treatment is tailored to each woman according to symptoms, other health problems, and whether she wants to become pregnant. If you have any of the symptoms of PCOS and especially if you have a family history, make an appointment at our office.

OVARIAN CANCER SCREENING…SHOULD I HAVE IT?
There has been a lot of buzz on the TV and Internet about ovarian cancer screening. Many woman have had a friend or family member diagnosed with it. Unfortunately ovarian cancer is usually diagnosed in a late stage of the disease process. To read about screening for ovarian cancer click ovarian cancer screening.

WHAT DO I NEED TO DO AND TAKE TO HAVE AN OPTIMALLY HEALTHY LIFE?
We all have heard of the myriad of dietary supplements, vitamins, weight loss programs, etc. It can be confusing on what really does lead to long lasting wellness. I have written a short and sweet outline of what research for sure has shown to be effective. It basically comes down to exercise, low fat diet, sleep, vitamins, meditation/prayer, preventative disease screenings, and more exercise. Click healthy life to read more.

IS THERE A HEREDITARY CANCER SCREENING TEST FOR BREAST AND OVARIAN CANCER? Yes, there is a test that looks for the BRCA 1 and 2 mutations that are hereditary.  We can perform this test in our office. Click here to see if you may be a candidate for this test.

  • Minimally Invasive Surgery

    Minimally Invasive Surgery has changed the way of Operative Gynecology. Click here to read more. Check out these cases performed by Dr. Lee.
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    4302 South Sugar Road Suite 201
    Edinburg TX 78539