What are the causes of pelvic pain? What can I do to help with my symptoms?

Pelvic pain may be caused by a multitude of reasons (musculo-skeletal, intestinal, endometriosis, large fibroids, pain with ovulation, etc…). A  work up done by your gynecologist is a good place to start. Surgery is typically unnecessary but can be helpful, particularly when symptoms persist, in diagnosing the cause of the pain.  The doctors also may consult  with specialists in other disciplines including GI doctors and pelvic floor physical therapists. We do not recommend the routine use of narcotics medication for chronic pelvic pain as they are usually masking the real cause of the problem and can create dependence.

How long/often should my period be?

On average, your cycles can be anywhere between 23 – 35 days with 28 days being the average. They should last between 3 – 5 days. Heavy bleeding (in excess of 1 soaked pad per hour or the presence of blood clots) should prompt a call to the office.

What can I do for heavy vaginal bleeding?

By definition, a heavy period is defined by losing 80ml or more of blood. If at any time you need to change your pad more than once every hour, you should consult your gynecologist right away or go seek urgent care if you feel dizzy or lightheaded. If your heavy bleeding is caused by fibroids or polyps, they can be removed and this will often solve the problem. If it is caused by a hormonal imbalance, your symptoms may be helped by taking the birth control pill or using an levonorgestrel intrauterine device (IUD).

Is it ok to have less than 6 periods per year?

Having a monthly period is a good sign that you are ovulating and that your reproductive system is working as it should. It is ok to sometimes skip a period in times of stress (of course, pregnancy should be ruled out if you have had sex with a man). If you have less than 6 periods per year, this may be a sign that you are not ovulating and thus your uterus is not receiving the appropriate “signal” that it is time to shed the lining of your uterus. Over time, the lining of your uterus may grow abnormally causing very heavy period, have cells that are slightly abnormal, and impair your fertility.

What are fibroids? Should I worry about them?

Fibroids are benign growth of the uterus. Many women have them (as many as 30%) and they do not cause problems. Sometimes, they grow to be quite large and start causing symptoms such as pressure on the bladder and/or the rectum, irregular vaginal bleeding or heavy bleeding. Depending on where your fibroid is located, even a small fibroid can cause problems. If they do not cause symptoms, you shouldn’t have to worry about them unless you notice that you have a rapid increase in abdominal girth or feel early satiety (feel full after eating sooner than before).

How often should I have a pap smear? What about mammograms?

Long gone are the days when women received a pap smear every year. Pap smears are used to look at the cells of the cervix to see early changes that could lead to cervical cancer. The current recommendations is to start having pap smear at the age of 21 (not before!) and then every 3 years until the age of 30 if all your previous pap smears are normal. After the age of 30, you can have your pap smear every 5 years if a co-test looking for the HPV virus is performed at the same time as the pap (again, if your previous pap smears were normal). Different organizations have different opinions regarding mammograms but all agree that they are part of a well-woman screening examination starting between the age of 40 to 50 year old,  on an annual or biennial basis. Depending on your family history, screenings for breast cancer may also be suggested at an earlier age.

My Daughter is 13 but not yet sexually active. Do you have any advice?

Yes! It is now recommended that all teenagers receive vaccination for prevention of HPV. By receiving the Gardasil vaccine, patients can achieve protective antibodies against the most dangerous forms of Human Papilloma Virus, the causative organism responsible for some forms of cervical, vulvar (and penile) cancer. The administration of the vaccine is a shot received 3 months apart for 3 doses and can be coordinated through our office. The vaccine can be effective if given at any age up to age 25 but is ideal for teenagers not yet sexually active. The vaccine is not an ok to have sex but rather, a responsible approach to the reality of later sex in protecting future generations of young people.

At what age should I start seeing a gynecologist?

Even though young women should not have a pap smear before the age of 21, a gynecologist can provide other routine health care along with reproductive health screenings and contraception. ACOG (American Congress of OB/GYN) recommend that the first visit should occur between the age of 13-15. This initial visit does not need to include a pelvic exam but may include a discussion of Gardasil (HPV vaccination).

I want to get pregnant in the future. Is there anything I can do before I get pregnant to get ready?

Yes! Stop smoking, get your partner to stop smoking, work at getting to a healthy weight, exercise and take a folic acid supplement. Folic acid at a dose of 1 mg per day can be effective in preventing such birth defects as spina bifida or other neural tube defects. The reason it should be started prior to getting pregnant is because the neural tube forms in the fetus by the 5th week or pregnancy (3rd week after a missed period). For many women, this then occurs before they even find out they are pregnant. If you find yourself pregnant but had not started Prenatal vitamins or folic acid, no worries. Neural tube defects are still rare and are also prevented by a good diet (rich in fruits, grains and vegetables).

I was told that I had a cyst on an ovary. Should I be worried?

Ovaries make cysts and having one does not necessarily means that there is something wrong. Most cysts are physiologic, benign and are without symptoms. They come and go as part of a normal menstrual cycle but typically remain small (less than 4 cm). They may cause pain when they rupture but they are often limited and best treated with over-the-counter pain medicine and local heat. When a cyst becomes especially large, they may cause the ovary to torse (twist). Symptoms of an ovarian torsion include nausea, vomiting and extreme pain. Those symptoms demands immediate attention. A cyst can also form when a woman suffers from endometriosis. If you have pain or any other symptoms that you think might be caused by a cyst, please call our office to be evaluated. Reassurance, more often than not, will be the outcome. An pelvic ultrasound can help if there is any question as to the source of any given symptom.

What other screenings can I get at my gynecologist?

Other than cervical cancer screening and sexually transmitted screenings, gynecologists can also screen for thyroid disease, depression, diabetes, hypertension and other chronic issues. Not all gynecologists will treat those conditions but they can and will refer as appropriate.

If I am trying to conceive, when should I start worrying about not being able to get pregnant?

Most couples will be able to conceive within a year of having unprotected intercourse. If you are not pregnant after one year, a consultation with your gynecologist may be warranted in order to rule-out common causes of infertility. Also, as fertility decreases over time, we usually advise women over the age of 35 to consult after 6 months of unprotected intercourse. If you have a history of endometriosis or polycystic ovarian syndrome, talk to your gynecologist about optimizing your chances of conceiving. At this time, our office does not offer insemination services, semen analysis or freezing.

What are the signs of a sexually transmitted infection?

Depending of the nature of the infection, one may experience an unusual vaginal discharge, irritation or genital sores. You can also have no symptom at all. If you have any concerns about exposure to a sexually transmitted infection, call the office and request an appointment for testing.

Which birth control is best for me?

With many options available, choosing a birth control method that fits your needs is often based on your medical history and your lifestyle. Are you planning to delay childbearing for 3 or more years? Don’t want to think about birth control every day? A reversible long acting methods such as an implant or an IUD may be the answer. Do you have painful or heavy periods?  An oral contraceptive (the pill) may help. Our office can offer you all those options in addition to a permanent solution such as tubal ligation.

How will I know I’m in menopause?

Depending on many factors including genetic predispositions, many women start experiencing irregular cycles in their late 40’s. This is usually the first sign of menopause (defined by the absence of a menstrual period over a one year).  This transition usually takes place over a 2-7 years.  The average age of menopause is 52. As estrogen levels are decreasing, some women experience symptoms such as hot flushes, vaginal dryness, changes in mood and libido along with sleep disturbances. If those symptoms are interfering with your life, treatment may include certain medications, including a short term course of hormonal replacement therapy and lifestyle modifications.

What are the causes of vulvar pain?

Vulvar or vaginal pain may have several causes including an infection (either fungal,  viral or bacterial), an allergic/immune reaction or muscular spasms. Tracking your symptoms and history will be invaluable in helping your doctor finding the cause of your pain. Are you using a new laundry detergent, bath product or soap? Do you have a new sexual partner?  Do you have pain with intercourse or with inserting a tampon?  Is your pain associated with an unusual discharge, odor, rash or bleeding? Treatment for vulvar or vaginal pain is as varied as its causes and may include medications or consultation with a pelvic floor physical therapist.

If there was a doctor who was interested in being trained, would you be willing to teach them?

Yes, absolutely! I consider it one of my greatest passions and my calling to teach as many providers as I can. The best way for me to serve the populations I am passionate about in a sustainable, thoughtful way is to train as many providers to do what I do. If someone you know has expressed interest, have them call our office at (650)570-2270 or email us at mail@marcibowers.com so we can set something up!