Gynecology


 

Common Medical Conditions

Cervical Dysplasia

Cervical dysplasia describes the presence of abnormal, precancerous cells on the surface of the cervix or its canal. Doctors recognize two types of dysplasia: low-grade squamous intraepithelial lesions (LGSIL) and high-grade squamous intraepithelial lesions (HGSIL). The abnormal cells present in LGSIL usually return to normal on their own within 18 to 24 months, but the HGSIL cells, if not treated, can progress to cancer of the cervix. To detect these changes early, it is essential to have regular Pap smears.

Cervical dysplasia can occur at any age after puberty but is most common between the ages of 25 and 35. The condition has been linked to exposure to specific strains of the human papillomavirus (HPV), which causes genital warts. The risk of cervical dysplasia is increased in women who have multiple sex partners, who had unprotected sex at a young age (under 18) or with partners who have had multiple partners, or who have a history of sexually transmitted diseases or who smoke cigarettes.

Symptoms and Diagnosis 

Cervical dysplasia often produces no symptoms, but some women have bleeding or spotting after intercourse. Abnormal cells in the cervix are usually found on a routine Pap smear. To confirm the diagnosis after an abnormal Pap smear, a doctor will perform a colposcopy, an examination of the cervix using an instrument with a lighted magnifying lens. Doctors often take a sample of tissue for analysis under a microscope (biopsy) during a colposcopy to determine if dysplasia is present and, if so, to evaluate it and classify it as LGSIL or HGSIL. Some doctors also take a swab of cells from the cervix to determine if HPV is present and, if so, if it is one of the strains of the virus that are strongly linked to cervical cancer.

Treatment

LGSIL (mild) dysplasia often returns to normal on its own and usually can be managed with frequent follow-up care, including Pap smears every four to six months. More severe dysplasia (HGSIL), which is more likely to develop into cervical cancer, is usually treated surgically. The procedure doctors use most often to treat dysplasia is called by two names — LEEP (loop electrosurgical excision procedure) or LLETZ (large-loop excision of the transformation zone). Both names refer to the removal of the outer layer of cervical cells, which are at highest risk of becoming cancerous. The removed tissue is sent to a laboratory for examination to make sure that all the abnormal cells were removed. Your doctor will advise you not to have intercourse or use tampons for four weeks after the procedure. The doctor will recommend a Pap smear every four months for the first year after the procedure, which has a 95 percent success rate in removing abnormal tissue.

If the area of abnormal tissue extends up into the cervical canal, a procedure called a cone biopsy (in which the doctor removes a cone-shaped piece of tissue) may be required. The tissue is sent to a laboratory to look for cancer cells. This procedure is usually performed in an operating room using a local anesthetic during an outpatient visit. Afterward, you may need to rest for a day or so. In very rare cases, a cone biopsy can increase the risk of premature delivery in a future pregnancy so, if you have had a cone biopsy and become pregnant, tell your doctor that you have had the procedure.

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Excerpted from: Family Medical Guide, Fourth Edition, American Medical Association, 2004.

If you would like information about purchasing Family Medical Guide, click here.

Related Articles

Human Papillomaviruses and Cancer: Questions and Answers

JAMA Patient Page: Papillomavirus:

The Pap Test

Cervical Cancer

Loop Electrosurgical Excision Procedure

© Copyright 2004 American Medical Association All rights reserved.

Urinary Tract Infections

About one of every five women will have a urinary tract infection (UTI) during her life. Some women will have more than one or get them often. Most UTIs are not serious. They are easy to treat with antibiotics.

A Woman’s Urinary Tract The urinary tract includes:

The kidneys, which make urine

Tubes called ureters that carry urine to the bladder where it is stored

The urethra, a short, narrow tube that urine passes through on its way out of the body

How Urine Is Made

The kidneys are organs located in the lower back. They produce urine. Each has many nephrons — units that filter the blood in a two-step process.

Storage and Release

The ureters transport urine from the kidneys to the bladder (where urine is stored).

Types of Urinary Tract Infections 

Most UTIs start in the lower urinary tract. Bacteria can enter through the urethra and spread upward to the bladder. This causes cystitis, a bladder infection. In most cases, urethritis occurs at the same time.

Causes 

Urinary tract infections often are caused by bacteria from the bowel that live on the skin near the rectum or in the vagina.

Sex is one of the causes of UTIs. Because of their anatomy, women are prone to UTIs after having sex.

Urinary tract infections also tend to occur in women who change sexual partners or begin having sex more often.

Symptoms Symptoms of UTIs can come on quickly. The first sign of a UTI is a strong urge to urinate (urgency) that cannot be delayed. As urine is released, a sharp pain or burning (dysuria) will be felt in the urethra. Very little urine is released.

Diagnosis

Urinary tract infections are diagnosed on the basis of the number of bacteria and white blood cells found in a urine sample.

Treatment

Antibiotics are used to treat UTIs.

Repeated Infections

Urinary tract infections may recur a few weeks after treatment. These are recurrent infections. They can be frustrating, stressful, time-consuming and hard to treat.

Often the cause of repeated UTIs is never found.

Testing

After you have had a few UTIs, or maybe a single kidney infection, your doctor may refer you to a urologist. A urologist is a doctor who specializes in problems of the urinary tract.

How You Can Prevent Urinary Tract Infections There are a number of ways to try to prevent UTIs. Some of them work some of the time or in only some women. It is likely you will find one that works for you:

Practice good hygiene.

Drink plenty of fluids to flush bacteria out of your urinary system.

Empty your bladder as soon as you feel the urge or about every two to three hours.

Drink cranberry juice or eat blueberries to help prevent the growth of bacteria.

Wear underwear with a cotton crotch.

During sex, you may want to try different positions that cause less friction to your urethra from your partner’s penis.

Finally … Urinary tract infections are common and painful. In most cases, they last only a few days. If you have symptoms of a UTI, see your doctor right away.

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This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright November 1999 American College of Obstetricians and Gynecologists

Endometriosis

What Is Endometriosis? Endometriosis occurs when tissue like that which lines the inside of uterus grows outside the uterus, usually on the surfaces of organs in the pelvic and abdominal areas, in places that it is not supposed to grow.

The word endometriosis comes from the word “endometrium” — endo means “inside” and metrium means “mother.” Health care providers call the tissue that lines the inside of the uterus (where a mother carries her baby) the endometrium.

Health care providers may call areas of endometriosis by different names, such as implants, lesions or nodules.

In What Places, Outside of the Uterus, Do Areas of Endometriosis Grow? 

Most endometriosis is found in the pelvic cavity:

On or under the ovaries

Behind the uterus

On the tissues that hold the uterus in place

On the bowels or bladder

In extremely rare cases, endometriosis areas can grow in the lungs or other parts of the body.

What Are The Symptoms of Endometriosis? 

One of the most common symptoms of endometriosis is pain, mostly in the abdomen, lower back, and pelvic areas. The amount of pain a woman feels is not linked to how much endometriosis she has. Some women have no pain even though their endometriosis is extensive, meaning that the affected areas are large, or that there is scarring. Some women, on the other hand, have severe pain even though they have only a few small areas of endometriosis.

General symptoms of endometriosis can include (but are not limited to):

Extremely painful (or disabling) menstrual cramps; pain may get worse over time

Chronic pelvic pain (includes lower back pain and pelvic pain)

Pain during or after sex

Intestinal pain

Painful bowel movements or painful urination during menstrual periods

Heavy menstrual periods

Premenstrual spotting or bleeding between periods

Infertility

In addition, women who are diagnosed with endometriosis may have gastrointestinal symptoms that resemble a bowel disorder, as well as fatigue.

Who Gets Endometriosis? 

Endometriosis can affect any menstruating woman, from the time of her first period to menopause, regardless of whether or not she has children, her race or ethnicity, or her socio-economic status. Endometriosis can sometimes persist after menopause; or hormones taken for menopausal symptoms may cause the symptoms of endometriosis to continue.

Current estimates place the number of women with endometriosis between 2 percent and 10 percent of women of reproductive age. But, it’s important to note that these are only estimates, and that such statistics can vary widely.

Does Having Endometriosis Mean I’ll Be Infertile or Unable to Have Children? 

About 30 percent to 40 percent of women with endometriosis are infertile, making it one of the top three causes of female infertility. Some women don’t find out that they have endometriosis until they have trouble getting pregnant.

If you have endometriosis and want to get pregnant, your health care provider may suggest that you have unprotected sex for six months to a year before you have any treatment for the endometriosis.

The relationship between endometriosis and infertility is an active area of research. Some studies suggest that the condition may change the uterus so it does not accept an embryo. Other work explores whether endometriosis changes the egg, or whether endometriosis gets in the way of moving a fertilized egg to the uterus.

What Causes Endometriosis? 

We don’t know the exact cause of endometriosis. Right now, a number of theories try to explain the disease.

Endometriosis may result from something called “retrograde menstrual flow,” in which some of the tissue that a woman sheds during her period flows into her pelvis. While most women who get their periods have some retrograde menstrual flow, not all of these women have endometriosis. Researchers are trying to uncover what other factors might cause the tissue to grow in some women, but not in others.

Another theory about the cause of endometriosis involves genes. This disease could be inherited, or it could result from genetic errors, making some women more likely than others to develop the condition. If researchers can find a specific gene or genes related to endometriosis in some women, genetic testing might allow health care providers to detect endometriosis much earlier, or even prevent it from happening at all.

Researchers are exploring other possible causes, as well. Estrogen, a hormone involved in the female reproductive cycle, appears to promote the growth of endometriosis. Therefore, some research is looking into endometriosis as a disease of the endocrine system, the body’s system of glands, hormones, and other secretions. Or, it may be that a woman’s immune system does not remove the menstrual fluid in the pelvic cavity properly, or the chemicals made by areas of endometriosis may irritate or promote growth of more areas. So, other researchers are studying the role of the immune system in either stimulating, or reacting to endometriosis.

Other research focuses on determining whether environmental agents, such as exposure to man-made chemicals, cause endometriosis. Additional research is trying to understand what, if any, factors influence the course of the disease. We just don’t have answers on the causes yet.

Another important area of NICHD research is the search for endometriosis markers. These markers are substances made by or in response to endometriosis that health care providers can measure in the blood or urine. If markers are found, health care providers could diagnose endometriosis by testing a woman’s blood or urine, which might reduce the need for surgery.

How Do I Know That I Have Endometriosis? 

Currently, health care providers use a number of tests for endometriosis. Sometimes, they will use imaging tests to produce a “picture” of the inside of the body, which allows them to locate larger endometriosis areas, such as nodules or cysts. The two most common imaging tests are ultrasound, a machine that uses sound waves to make the picture, and magnetic resonance imaging (MRI), a machine that uses magnets and radio waves to make the picture.

The only way to know for sure that you have the condition is by having surgery. The most common type of surgery is called laparoscopy. In this procedure, the surgeon inflates the abdomen slightly with a harmless gas. After making a small cut in the abdomen, the surgeon uses a small viewing instrument with a light, called a laparoscope, to look at the reproductive organs, intestines, and other surfaces to see if there is any endometriosis. He or she can make a diagnosis based on the characteristic appearance of endometriosis. This diagnosis can then be confirmed by doing a biopsy, which involves taking a small tissue sample and studying it under a microscope.

Your health care provider will only do a laparoscopy after learning your full medical history and giving you a complete physical and pelvic exam. This information, in addition to the results of an ultrasound or MRI, will help you and your health care provider make more informed decisions about treatment.

Why Does Having Endometriosis Cause Pain? 

How endometriosis causes pain is the topic of much research. Because many women with endometriosis feel pain during or related to their periods, some researchers are focusing on the menstrual cycle in their search for answers about pain.

Normally, if a woman is not pregnant, her endometrial tissue builds up inside her uterus, breaks down into blood and tissue, and is shed as her menstrual flow or period. This cycle of growth and shedding happens every month or so.

The endometriosis areas growing outside the uterus also go through a similar cycle; they grow, break down into blood and tissue, and are shed once a month. But, because this tissue isn’t where it’s supposed to be, it can’t leave the body the way a woman’s period normally does. As part of this process, endometriosis areas make chemicals that may irritate the nearby tissue, as well as some other chemicals that are known to cause pain.

Over time, in the process of going through this monthly cycle, endometriosis areas can grow and become nodules or bumps on the surface of pelvic organs, or become cysts (fluid-filled sacs) in the ovaries. Sometimes the chemicals produced by the endometriosis can cause the organs in the pelvic area to scar, and even to scar together, so they appear as one large organ.

Is There a Cure For Endometriosis? 

Currently, we have no cure for endometriosis. Even having a hysterectomy or removing the ovaries does not guarantee that the endometriosis areas and/or the symptoms of endometriosis will not come back.

Are There Treatments For Endometriosis? 

There are a number of treatments for both pain and infertility related to endometriosis.

First, let’s focus on the treatments for endometriosis pain. They include:

Pain medication — Works well if your pain or other symptoms are mild. These medications range from over-the-counter remedies to strong prescription drugs.

Hormone therapy— Is effective if your areas are small and/or you have minimal pain. Hormones can come in pill form, by shot or injection, or in a nasal spray. Common hormones used to treat endometriosis pain are progesterone, birth control pills, danocrine, and gonadatropin-releasing hormone (GnRH). Go to the next section, “What Are The Hormone Treatments for Endometriosis Pain?” for more information.

Surgical treatment — Is usually the best choice if your endometriosis is extensive, or if you have more severe pain. Surgical treatments range from minor to major surgical procedures. Go to the “What Are The Surgical Treatments for Endometriosis Pain?” section for more information about these options.

What Are The Hormone Treatments for Endometriosis Pain? Because hormones cause endometriosis to go through a cycle similar to the menstrual cycle, hormones can also be effective in treating the symptoms of endometriosis. In fact, if a woman’s symptoms do not respond to hormone therapy, health care providers may go over their diagnosis of endometriosis again, to make sure she really has the condition. Health care providers may suggest one of the following hormone treatments:

Oral contraceptives or birth control pills — regulate the growth of the tissue that lines the uterus and often decrease the amount of menstrual flow. In general, the therapy contains two hormones, estrogen and progestin.

It often works as long as you take the pills. Once you stop the treatment, your ability to get pregnant returns, and your symptoms of endometriosis may also return. Many women continue the treatment indefinitely.

Some women take birth control pills continuously, without using the sugar pills that signal the body to go through menstruation. When birth control pills are taken in this way, the menstrual period may stop altogether, which can reduce pain or get rid of it entirely.

Some birth control pills contain only progestin, a progesterone-like hormone. Women who can’t take estrogen use these pills to reduce menstrual flow.

Some women may not have pain for several years after stopping treatment.

You may have some mild side effects from these hormones, such as weight gain, bleeding between periods, and bloating.

Progesterone and progestin — improve symptoms by reducing a woman’s period or stopping it completely.

As a pill taken daily, these hormones will reduce menstrual flow without causing the lining of the uterus to grow. As soon as you stop taking the pill form, you can get pregnant and your symptoms may return.

As an injection taken every three months, these hormones will usually stop menstrual flow. It may take a few months for your period to return after you stop taking the injections. When your period returns, so does your ability to get pregnant.

You may gain weight or feel depressed while taking these hormones.

Danocrine — stops the release of hormones that are involved in the menstrual cycle.

You will probably get your period only now and then while taking this drug; or, you may not get it at all.

You should take steps to prevent pregnancy while you are on this medication because danocrine can harm a baby growing in the uterus. Because you should avoid taking other hormones, like birth control pills, while on danocrine, health care providers recommend that you use condoms, a diaphragm or other “barrier” methods to prevent pregnancy.

Common side effects include oily skin, pimples or acne, weight gain, muscle cramps, tiredness, smaller breasts and breast tenderness.

You may also have headaches, dizziness, weakness, hot flashes or a deepening of your voice while on this treatment.

Gonadatropin-Releasing Hormone (GnRH) Agonists — block the production of certain hormones to prevent menstruation, which slows or stops the growth of endometriosis, sending the body into a “menopausal” state.

GnRH agonist is used daily in a nose spray, or as an injection given once a month or every three months.

Most health care providers recommend that you stay on the GnRH agonist for about six months. After that time, your body will come out of the menopausal state. You’ll start having your period again and could get pregnant.

After women stop taking GnRH agonists for six months, about 50 percent have some return of their endometriosis symptoms.

These medications also have side effects, including hot flashes, tiredness, problems sleeping, headaches, depression, bone loss and vaginal dryness.

Current research is exploring the use of other hormones in treating endometriosis and pain related to endometriosis. Some of these include GnRH antagonists, selective progesterone receptor modifiers, and selective estrogen receptor modulators, also known as SERMs. For more information about these hormones, talk to your health care provider. Some women also have less pain from endometriosis after pregnancy, but the reason for this is unclear. Researchers are trying to determine whether it is because the hormones released by the body during pregnancy also lessen the growth of endometriosis, or if pregnancy causes changes in the uterus or endometrium that lessen the growth of endometriosis.

What Are The Surgical Treatments for Endometriosis Pain?

If you have severe pain from endometriosis, your health care provider may suggest surgery. At surgery, your health care provider can locate any endometriosis and see the size and degree of growth; he or she may also remove the endometriosis at that time. You and your health care provider should talk about possible options for removing endometriosis before your surgery. Then, based on the findings and treatment at surgery, you and your health care provider can discuss medical treatment options for after surgery. Health care providers may suggest one of the following surgical treatments:

Laparoscopy — a way to diagnose and treat endometriosis without making large cuts in the abdomen.

Laparoscopy involves a small cut in the abdomen, inflating the abdomen with a harmless gas, and then passing a viewing instrument with a light (called a laparoscope) into the abdomen. The surgeon uses the laparoscope to see the growths.

To treat the endometriosis, the doctor can then remove the areas, a process called excising, or destroy them with intense heat and seal the blood vessels without stitches, a process called cauterizing, or vaporizing. The goal is to treat the endometriosis without harming the healthy tissue around it.

If your surgeon is going to treat the endometriosis during your laparoscopy, he or she must make at least two more cuts in your lower abdomen, to pass lasers or other small surgical instruments into your abdomen to remove or vaporize the tissue.

Doctors don’t know the exact role of scar tissue in causing endometriosis pain, but some will remove the scar tissue in case it is causing the pain.

Usually, laparoscopy does not require an overnight stay in the hospital. Recovery from laparoscopy is much faster than for major surgery, like laparotomy, a procedure described below.

Major abdominal surgery, or laparotomy — a more involved surgical procedure, which requires longer recovery time (often one-to-two months).

During laparotomy, doctors either remove the endometriosis and/or remove the uterus (a process called hysterectomy).

Doctors may also remove the ovaries and fallopian tubes at the time of a hysterectomy, if the ovaries have endometriosis on them, or if damage is severe. This process is called total hysterectomy and bilateral salpingo-oophorectomy.

Health care providers recommend major surgery as a last resort for endometriosis treatment. Having the surgery does not guarantee that the endometriosis will not return or that the pain will go away.

If a woman’s pain is extreme, doctors may recommend more drastic procedures that cut the nerves in the pelvis to lessen the pain. One such procedure can be done during either laparoscopy or laparotomy. Another procedure, called a laparoscopic uterine nerve ablation (LUNA) is done during a laparoscopy. Because these procedures cannot be reversed, you and your health care provider will need to talk about these options in great detail before making the final decision about treatment.

What Are The Treatments for Infertility Related to Endometriosis? 

In vitro fertilization (IVF) procedures are effective in improving fertility in many women with endometriosis. IVF makes it possible to combine sperm and eggs in a laboratory and then place the resulting embryos into the woman’s uterus. IVF is one type of assisted reproductive technology that may be an option for women and families affected by infertility related to endometriosis.

In the early stages of IVF, a woman takes hormones to cause “superovulation,” which triggers her body to produce many eggs at one time. Once mature, the eggs are collected from the woman, using a probe inserted into the vagina and guided by ultrasound. The collected eggs are placed in a dish for fertilization with a man’s sperm. The fertilized cells are then placed in an incubator, a machine that keeps them warm and allows them to develop into embryos. After three-to-five days, the embryos are transferred to the woman’s uterus. It takes about two weeks to know if the process is successful.

Even though the use of hormones in IVF is successful in treating infertility related to endometriosis, other forms of hormone therapy are not as successful. For instance, hormone therapy that prevents a woman from getting her period, or from ovulating each month, does not seem to improve infertility related to endometriosis. But, researchers are still looking into hormone treatments for infertility due to endometriosis.

Laparoscopy to remove or vaporize the growths in women who have mild or minimal endometriosis is also effective in improving fertility. Some studies show that surgery can double the pregnancy rate. You can review the “What Are the Surgical Treatments for Endometriosis Pain?” section of this publication for more information on laparoscopy.

Is Endometriosis The Same As Endometrial Cancer? 

Endometriosis is not the same as endometrial cancer. Remember that the word endometrium describes the tissue that lines the inside of the uterus. Endometrial cancer is a type of cancer that affects the lining of the inside of the uterus. Endometriosis itself is not a form of cancer.

Does Endometriosis Lead to Cancer? 

Current research does not prove an association between endometriosis and endometrial, cervical, uterine, or ovarian cancers. In very rare cases (less than 1 percent) endometriosis is seen with a certain type of cancer, called endometrioid cancer; but, endometriosis is not known to cause this cancer.

But, scientists still don’t know what causes endometriosis or what its mechanisms are in the body. In addition, many women are never diagnosed as having endometriosis, which makes linking the condition to other diseases more difficult.

For this reason, women who are diagnosed with endometriosis need to be especially watchful of changes to or in their bodies; they need to communicate these changes to their health care providers as soon as possible, to ensure their own health.

Does Endometriosis Ever Go Away? 

In most cases, the symptoms of endometriosis lessen after menopause because the growths gradually get smaller. For some women, however, this is not the case.

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Revision Date: May 5, 2004

Source: National Cancer Institute, National Institutes of HealthEmergency contraception is used to prevent pregnancy after having sex without birth control or if a problem occurred with the method of birth control used. It is a good option for women who have had unprotected sex and do not want to become pregnant.

Reproduction 

A woman can get pregnant if she has sex around the time of ovulation. During sex, the man ejaculates sperm into the vagina. The sperm travel up through the cervix and into the fallopian tubes.

If a sperm meets an egg in the fallopian tube, fertilization — union of egg and sperm — can occur.

About Emergency Contraception 

Emergency contraception is a type of hormonal birth control. It can be used if you have unprotected sex and don’t want to get pregnant. It should not be used on a routine basis. You may need emergency contraception if:

You didn’t use any birth control.

You had sex when you didn’t plan to.

A condom broke or slipped off.

A diaphragm or cervical cap became dislodged.

Birth control was not used correctly.

You were forced to have sex (rape).

The most commonly used method of emergency contraception is pills (also known as the “morning-after pill”). The intrauterine device (IUD) also can be used for emergency contraception.

If you have had unprotected sex, call your doctor’s office right away. Be sure to tell them you need treatment without delay. In some cases, your doctor can call in a prescription for you to your drugstore. You also can call the Emergency Contraception Hotline (888-NOT-2-LATE) to find a doctor who will provide you with a prescription.

Do not use emergency contraception routinely instead of birth control. Regular use of a birth control method is not only more effective, but provides health benefits that emergency contraception does not have.

How Emergency Contraception Works 

Emergency contraception is highly effective in preventing pregnancy. Pills must be started within 72 hours of having unprotected sex and will reduce the risk of pregnancy by at least 75 percent. If you are already pregnant, emergency contraception will not work.

There are two types of emergency contraception pills. One type is combined birth control pills (containing both estrogen and progestin). The other type contains only progestin and is safer for women who can’t take estrogen.

Both types of pills work the same way. The hormones in these pills prevent pregnancy because they disrupt the normal patterns in the menstrual cycle. Depending on where a woman is in her menstrual cycle, these pills may:

Prevent ovulation

Block fertilization

Keep a fertilized egg from implanting in the uterus

How to Take Emergency Contraception 

Emergency contraception pills may be prescribed to you in one of three forms:

A specific dosage of regular birth control pills (contains estrogen and progestin)

A prepared kit of four pills (contains estrogen and progestin) that may come with a pregnancy test

A package with two pills (contains progestin only)

For the pills to work, timing is everything. The sooner you start them, the better. The pills are given in two doses. To prevent pregnancy, the first dose of pills must be taken by mouth within 72 hours of having unprotected sex. A second dose is taken 12 hours after the first dose.

Side Effects 

Besides the typical side effects of nausea and vomiting, other side effects may include:

Abdominal pain and cramps

Tender breasts

Headache

Dizziness

Fatigue

Follow-up Care 

If you use emergency contraception pills within 72 hours of unprotected sex, your chance of getting pregnant is greatly reduced. However, there is still a chance you could become pregnant. If you do become pregnant, emergency contraception will not have any effect on the pregnancy or the health of the baby.

Keep in mind that emergency contraception does not prevent sexually transmitted diseases (STDs).

Finally … Using birth control when you have sex is the best way to prevent unwanted pregnancy. However, if you have sex without birth control, you can use emergency contraception. It is simple and safe.

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This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © February 2003 The American College of Obstetricians and Gynecologists

Uterine Fibroids

Uterine fibroids are benign (not cancer) growths in the uterus. They are the most common type of growth found in a woman’s pelvis. They occur in about 25 percent to 50 percent of all women.

Types of Fibroids 

Uterine fibroids are growths that develop from the cells that make up the muscle of the uterus. They are also called leiomyomas or myomas.

The size, shape, and location of fibroids can vary greatly. They may appear inside the uterus, on its outer surface, within its wall, or attached to it by a stemlike structure.

Causes 

Fibroids are most common in women aged 30-40 years, but they can occur at any age. Fibroids occur more often in black women than in white women. They also seem to occur at a younger age in black women and grow more quickly.

Although fibroids are quite common, little is known about what causes them.

Symptoms Most fibroids, even large ones, produce no symptoms at all. When symptoms do occur, they often include:

Changes in menstruation

Pain

Pressure

Enlarged uterus and abdomen

Miscarriages and infertility

Diagnosis 

The first signs of fibroids may be detected during a routine pelvic exam. There are a number of tests that may show more information about fibroids:

Ultrasonography

Hysteroscopy

Hysterosalpingography (HSG)

Laparoscopy

Imaging tests, such as magnetic resonance imaging (MRI) and computed tomography (CT) scans, may be used but are rarely needed.

Complications

Although most fibroids do not cause problems, there can be complications. Fibroids that are attached to the uterus by a stem may twist. This can cause pain, nausea or fever. Fibroids may become infected. In most cases, this happens only when there is an infection already in the area. In very rare cases, rapid growth of the fibroid and other symptoms may signal cancer.

Treatment 

Fibroids that do not cause symptoms, are small, or occur in a woman nearing menopause often do not require treatment. Certain signs and symptoms, though, may signal the need for treatment:

Heavy or painful menstrual periods

Bleeding between periods

Uncertainty whether the growth is a fibroid or another type of tumor, such as an ovarian tumor

Rapid increase in growth of the fibroid

Infertility

Pelvic pain

Fibroids may be treated with surgery. Drugs, such as gonadotropin-releasing hormone (GnRH) agonists, may be used to shrink fibroids temporarily and to control bleeding to prepare for surgery. The choice of treatment depends on factors such as your own wishes and your doctor’s medical advice about the size and location of the fibroids.

Myomectomy

Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have children.

Fibroids may develop again, even after the procedure. If they do, more surgery is needed in 20 percent to 40 percent of cases.

Uterine Artery Embolization

Another way to treat fibroids is called uterine artery embolization (UAE). With this procedure, the blood vessels to the uterus are blocked. This helps stop the blood flow that allows fibroids to grow.

This procedure usually is performed in a hospital by a specially trained radiologist.

Although rare, there can be some complications with UAE. Complications may include infection and uterine injury. In most women, regular menstrual periods return shortly after the procedure. In rare cases, however, menstrual periods do not resume and menopause begins. The effects of UAE on a woman’s fertility are not known.

Hysterectomy

Hysterectomy is the removal of the uterus. The ovaries may or may not be removed. It depends on other factors.

Hysterectomy may be needed if:

Pain or abnormal bleeding persists

Fibroids are very large

Other treatments are not possible

Uterine Fibroids and Pregnancy

A small number of pregnant women have uterine fibroids. If you are pregnant and have fibroids, they likely won’t cause problems for you or your baby.

During pregnancy, fibroids may increase in size. Coupled with the extra demands placed on the body by pregnancy, growth of fibroids may cause discomfort, feelings of pressure, or pain. Fibroids decrease in size after pregnancy in most cases.

Finally… Uterine fibroids are benign growths that occur quite often in women. About one in four or five women older than 35 years has them. Fibroids may cause no symptoms and require no treatment.

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This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © February 2005 The American College of Obstetricians and Gynecologistshe intrauterine device (IUD) is a type of birth control. It is a small, plastic device that is inserted and left inside the uterus to prevent pregnancy.

Types of Intrauterine Devices 

Although there have been several types of IUDs, currently only two are available in the United States: the hormonal and the copper. The hormonal IUD must be replaced every five years. The copper IUD can remain in your body for as long as 10 years.

The IUD is a very popular method of birth control throughout the world. However, in the United States, less than 1 percent of women using birth control use an IUD.

How an IUD Works 

Both types of IUDs are T-shaped, but they work in different ways. The hormonal IUD releases a small amount of progestin into the uterus. This thickens the cervical mucus, which blocks the sperm from entering the cervix.

The copper IUD releases a small amount of copper into the uterus. A copper IUD does not affect ovulation or the menstrual cycle. It causes a reaction inside the uterus and fallopian tubes. This can prevent the egg from being fertilized or attaching to the wall of the uterus. The copper seems to work as a kind of spermicide.

Inserting the IUD 

A doctor must insert and remove the IUD.

Benefits 

During the first year of use, about eight out of 1,000 women using the copper IUD will become pregnant. This makes it one of the most effective forms of birth control available. The hormonal IUD is even more effective.

Risks 

Serious complications from use of an IUD are rare. However, some women do have problems. These problems usually happen during, or soon after, insertion:

Expulsion: The IUD is pushed out of the uterus into the vagina. It happens within the first year of use in about 5 percent of users.

Perforation: The IUD can perforate (or pierce) the wall of the uterus during insertion.

Infections: Infections in the uterus or fallopian tubes can occur. This may cause scarring in the reproductive organs, making it harder to become pregnant later.

Pregnancy: Rarely, pregnancy may occur while a woman is using an IUD.

Side Effects 

Menstrual pain and bleeding are increased with the copper IUD, but decreased with the hormonal IUD.

Finally … The IUD offers safe, effective and reversible protection against pregnancy for many women. Weighing the benefits and risks of using an IUD, and knowing your medical and sexual history, will help you and your doctor decide whether this method of birth control is right for you.

________________

This excerpt from ACOG’s Patient Education Pamphlet is provided for your information. It is not medical advice and should not be relied upon as a substitute for visiting your doctor. If you need medical care, have any questions, or wish to receive the full text of this Patient Education Pamphlet, please contact your obstetrician-gynecologist.

To ensure the information is current and accurate, ACOG titles are reviewed every 18 months.

Copyright © March 2003 The American College of Obstetricians and Gynecologists

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