Prevention and Wellness

Gynecologic Health

Premier Health doctors answer frequently asked questions about prevention and wellness for women.

What role does estrogen play in a woman’s well-being?

Estrogen is the primary female hormone, according to the North American Menopause SocietyOff Site Icon (NAMS).

Estrogen promotes the health of a woman’s reproductive organs, and it helps the vagina stay moist, elastic and well-supplied with blood, according to the NAMS.

Additionally, estrogen serves as a stimulant for the growth of breast tissue, causes the uterine lining to thicken during the menstrual cycle, and protects bones, according to the NAMS.

This protection of the bones is especially important for women after their bone density plateaus in their 30s, according to Premier Health Specialists’ physicians.

Estrogen helps to maintain the bones until menopause causes changes.

Talk to your physician for more information about estrogen and what it does for a woman’s body.

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How is a woman’s hormonal state different if one or both ovaries are removed?

By removing the ovaries, you are removing the production centers for estrogen and progesterone, according to Premier Health Specialists’ (PHS) physicians.

If only one ovary is removed, the remaining ovary will compensate for the one that was removed, according to PHS physicians. In most cases, women who have only one ovary still have normal menstrual cycles, can still become pregnant, and do not experience any symptoms of hormonal changes.

If both of the ovaries are removed during a hysterectomy, a woman will immediately experience menopause, according to the American College of Obstetricians and GynecologistsOff Site Icon (ACOG).

Menopause occurs because without any ovaries, the body no longer has estrogen or progesterone. Menopause can cause symptoms including hot flashes, moodiness, slowed metabolism, and vaginal dryness, according to the ACOG.

For more information about what happens to a woman’s hormonal state when one or both ovaries are removed, talk with your doctor.

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What are a woman’s hormone options when she experiences a surgical menopause?

Surgical menopause is menopause that didn’t occur naturally, but rather, was induced by having the ovaries removed, according to the National Institutes of HealthOff Site Icon (NIH).

There also are a variety of ways to treat menopause symptoms, according to the NIH. Those include:

  • Diet and lifestyle changes
  • Hormone therapy
  • Hormone therapy alternatives, including antidepressants, blood pressure medication, and hot flash-reducing medication

Women who choose hormone therapy have a variety of options for receiving the replacement hormones after surgical menopause, include taking them orally or vaginally, or using topical or vaginal sprays, creams, or gels, according to Premier Health Specialists’ (PHS) physicians.

Talk to your physician for more information about hormone options after surgical menopause.

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What is cervical dysplasia, how is it found, and does it always lead to cervical cancer?

Cervical dysplasia is an abnormal change in cells around the cervix, which is the lower part of the uterus that opens at the top of the vagina, according to the National Institutes of HealthOff Site Icon (NIH).

The changes in these cells are not cancer, but they can lead to cancer if they are not treated, according to the NIH.

Cervical dysplasia is found by having a pelvic exam that includes a Pap smear, according to the NIH. If the Pap smear shows abnormal cells or cervical dysplasia, you will need additional testing, which could include a follow up Pap smear or a biopsy.

Talk to your doctor for more information about cervical dysplasia.

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What is HPV, and how is it related to cervical dysplasia?

Human papillomavirus – commonly known as HPV – is the most common sexually transmitted infection (STI) in the U.S., according to the Centers for Disease Control and PreventionOff Site Icon (CDC).

There are more than 100 kinds of HPV, most of them are harmless, according the National Institutes of HealthOff Site Icon (NIH). But, about 30 can cause cervical dysplasia – changes to cells on the surface of the uterus that can be a sign of cancer.

The best way to prevent HPV is to get the HPV vaccine, according to the NIH. If girls get the vaccine before becoming sexually active, they reduce their chances of getting cervical cancer.

The vaccine is recommended for girls and women ages 11 through 26, and boys and men ages 11 through 21. It is given in three doses over a six month period, according to the CDC.

For people who are sexually active, using condoms from start to finish of every sex act can help lower the risk of HPV, but they do not fully protect against it, according to the CDC.

For more information about HPV and how to prevent it, talk with your doctor.

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Does either HPV or cervical dysplasia have symptoms?

Most of the time there are no symptoms when someone has cervical dysplasia, according to the National Institutes of HealthOff Site Icon (NIH).

HPV also does not have symptoms in most cases, and in 90 percent of cases, your immune system will clear up the HPV within two years, according to the Centers for Disease Control and PreventionOff Site Icon (CDC).

The problem is, there is no way to know whether the HPV you have will clear up on it’s on or turn into another health issue, such as cancer, according to the CDC.

In some cases, the type of HPV will cause genital warts. In very rare cases, those warts can also spread to the throat.

For more information about symptoms of HPV and cervical dysplasia, talk with your doctor.

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What steps can women take to reduce the risk of these conditions?

The best way to prevent HPV is to get the HPV vaccine, according to the National Institutes of HealthOff Site Icon (NIH). If girls get the vaccine before becoming sexually active, they reduce their chances of getting cervical cancer.

The vaccine is recommended for girls and women ages 11 through 26, and boys and men ages 11 through 21. It is given in three doses over a six month period, according to the Centers for Disease Control and PreventionOff Site Icon (CDC).

For people who are sexually active, using condoms from start to finish of every sex act can help lower the risk of HPV, but they do not fully protect against it, according to the CDC.

Because HPV is the most common cause of cervical dysplasia, getting the HPV vaccine also will help prevent cervical dysplasia. The risk of cervical dysplasia also can be decreased, according to the NIH, by:

  • Not having a baby before age 16
  • Not having multiple sexual partners
  • Not having sex before age 18
  • Not smoking

For more information about HPV and cervical dysplasia, and how to prevent them, talk with your doctor.

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How often do I need to have a Pap smear?

How often you need to get a Pap smear done depends on your age, according to the American Cancer SocietyOff Site Icon (ACS).

For women younger between 21 and 30, being screened by a Pap smear every three years is safe and decreases the number of false positives there had been when Pap smears used to be recommended annually, according to the ACS.

Once a woman turns 30, the ACS recommends she have both and HPV test and Pap smear because having both tests does an even better job at decreasing the risk of cancer. If both test results are normal, they can be repeated every five years.

Women 65 and older who have been screened on a regular basis or who have had a hysterectomy for non-cancerous reasons do not need to continue getting screened, according to the ACS.

For more information about the how often to have a Pap smear, talk with your doctor.

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What is endometriosis?

Dr. Heather Hilkowitz talks about endometriosis. Click play to watch the video or read the transcript.

 

Endometriosis is a condition that affects one in ten women between the ages of 30 and 40, and occurs when the lining of the uterus grows outside the uterus, according to the American College of Obstetricians and Gynecologists: American College of Obstetricians and GynecologistsOff Site Icon. The displaced tissue affects areas in the abdomen, commonly the fallopian tubes, ovaries, bladder, and intestines. Women who have endometriosis may have difficulty getting pregnant, according to the ACOG.

The U.S. Department of Health and Human Services Office on Women’s HealthOff Site Icon, estimates that endometriosis affects about five million women in the United States. Endometriosis can be painful, and while there is no cure, there are several treatment options available, according to HHS.

For more information about endometriosis, talk to your doctor.

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What causes endometriosis?

Dr. Heather Hilkowitz talks about the potential causes of endometriosis. Click play to watch the video or read the transcript.

 

While no one is certain of what causes endometriosis, researchers have identified some potentially contributing factors, according to the Mayo Clinic [Add off-site icon with alt tag: You are leaving the Premier Health website, link to http://www.mayoclinic.org/ in a new window]. According to the Mayo Clinic, researchers are investigating whether endometriosis may be caused by:

  • Problems with menstrual flow
  • Genetics
  • Immune system problems
  • Hormones
  • Surgery

There is no way to prevent endometriosis, however, you may decrease the likelihood of developing endometriosis by lowering the estrogen levels in your body, according to the U.S. Department of Health and Human Services Office on Women’s HealthOff Site Icon. According to HHS, you can lower estrogen levels by:

  • Talking to your doctor about birth control options
  • Exercising regularly
  • Avoiding alcohol
  • Avoiding caffeine

Ask your doctor about lowering estrogen levels, and the potential causes of endometriosis.

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What are symptoms of endometriosis?

Dr. Heather Hilkowitz discusses the symptoms of endometriosis. Click play to watch the video or read the transcript.

 

A common symptom of endometriosis is mild to severe pain in the pelvis and/or abdomen, according to the U.S. Department of Health and Human Services Office on Women’s HealthOff Site Icon. According to HHS, the type of pain can include:

  • Severe menstrual cramps
  • Long-term pain in the lower back and pelvis
  • Pain before or during a menstrual cycle
  • Pain during or after sex
  • Intestinal discomfort
  • Painful bowel movements or urination during a menstrual cycle
  • Trouble getting pregnant

Other symptoms of endometriosis include heavy menstrual cycles, bleeding or spotting between periods, stomach and digestive problems, or infertility, according to HHS.

Talk to your doctor about symptoms of endometriosis.

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What health problems can result from endometriosis?

Dr. Heather Hilkowitz discusses other health problems that can arise because of endometriosis. Click play to watch the video or read the transcript.

 

Endometriosis growths are not cancerous, but they can cause other health problems, according to the U.S. Department of Health and Human Services Office on Women’s HealthOff Site Icon. Endometriosis occurs when tissue inside the uterus grows outside the uterus. This tissue hemorrhages during the menstrual cycle and becomes trapped, causing swelling and pain, and the growths may continue to expand to other areas, according to HHS.

Studies have shown a link between endometriosis and other health problems, according to the National Institutes of HealthOff Site Icon. These include:

  • Immune disorders
  • Chronic fatigue syndrome
  • Fibromyalgia
  • Asthma
  • Allergies
  • Skin conditions
  • Endocrine diseases

For more information health problems associated with endometriosis, talk with your physician.

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How is endometriosis diagnosed?

Dr. Heather Hilkowitz talks about diagnosing endometriosis. Click play to watch the video or read the transcript.

 

Consult a physician if you have symptoms of endometriosis. After a physical exam, your doctor may recommend a laparoscopy to diagnose your condition, according to the American Association of Family PhysiciansOff Site Icon. Laparoscopy is a minimally-invasive procedure that allows the physician to see inside the uterus using a small camera attached to a probe, according to the AAFP.

There are other diagnostic methods your doctor may suggest, according to U.S. Department of Health and Human Services Office on Women’s HealthOff Site Icon. These diagnostics include:

  • Pelvic exam
  • Laparoscopic surgery
  • Hormonal treatment
  • Imaging tests

Talk to your doctor about diagnosing endometriosis.

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Can I get pregnant if I have endometriosis?

Dr. Heather Hilkowitz talks about endometriosis and pregnancy. Click play to watch the video or read the transcript.

 

Women with endometriosis can get pregnant, but may find it harder to conceive, according to the U.S. Department of Health and Human Services Office on Women’s HealthOff Site Icon. Endometriosis affects about one-half of women with infertility, according to the HHS.

There are different levels of endometriosis, and the severity of your condition may affect your ability to become pregnant, according to the American Society for Reproductive MedicineOff Site Icon. Fortunately, there are treatment options and procedures available for more advanced cases of endometriosis that may increase your chances of becoming pregnant, according to the ASRM.

For more information about fertility and endometriosis, talk to your doctor.

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What are the treatments for endometriosis?

Dr. Heather Hilkowitz talks about treatments for endometriosis. Click play to watch the video or read the transcript.

 

There are many treatment options available to you if you have endometriosis, including medication, surgery or both, according to the American Congress of Obstetricians and GynecologistsOff Site Icon . Surgery may relieve pain and increase fertility, but it is not a cure, and the more severe the condition, the greater the likelihood that the discomfort will return, according to the ACOG.

Treatment options can depend on whether or not you are trying to get pregnant, according to the U.S. Department of Health and Human Services Office on Women’s HealthOff Site Icon. According to HHS, treatment options include:

  • Extended-cycle birth control – for women who don’t wish to become pregnant
  • Intrauterine device - for women who don’t wish to become pregnant
  • Gonadotropin-releasing hormone (GnRH) agonists - for women who are trying to get pregnant
  • Surgery – usually performed in severe cases when hormones are not effective, or for women with fertility problems
  • Pain medication – for mild symptoms to relieve discomfort
  • Complementary and alternative medicine – options include acupuncture, chiropractic therapy, or herbs and vitamin supplements.

Talk to your doctor about treatment options for endometriosis.

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What are uterine fibroid tumors, and how can women know they might have them?

Uterine fibroids are muscular tumors the grow in the wall of the uterus, according to the U.S. Department of Health and Human ServicesOff Site Icon (HHS).

Fibroids are the most common noncancerous tumors found in women of childbearing ages, according to the Centers for Disease Control and PreventionOff Site Icon (CDC).

Symptoms that might let a woman know she has uterine fibroids, according to the CDC, include:

  • Bleeding in between periods
  • Heavy and painful periods
  • Lower back pain
  • Pain during intercourse
  • Reproductive problems such as difficulty getting pregnant, multiple miscarriages, and pre-term labor
  • Urinating often

For more information about uterine fibroids, talk with your doctor.

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Are there specific risk factors that predispose women to fibroids?

There are a variety of risk factors that could cause a woman to be predisposed to have fibroids. According to the U.S. Department of Department of Health and Human ServicesOff Site Icon (HHS), including:

  • Age: Fibroids are more common as women age, especially as women go through their 30s and 40s though the time they start menopause
  • Eating habits: Eating a lot of ham and red meat is linked with having a higher risk of fibroids. Eating green vegetables can help women prevent fibroids
  • Ethnicity: Black women are more likely to develop fibroids than other women
  • Family history: If fibroids run in your family, you are at a higher risk of developing them also. A woman whose mother had fibroids is at three times higher risk of developing them
  • Obesity: Being overweight puts women at two to three times higher risk of having fibroids

For more information about risk factors of uterine fibroids, talk with your doctor.

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How are fibroids usually diagnosed?

Fibroids can be diagnosed via a gynecological exam or by using imaging tests, according to the National Institutes of HealthOff Site Icon (NIH). Those tests include an ultrasound, MRI, X-rays and Cat scan (CT).

If you are found to have fibroids, you might need surgery to remove or you may also need surgery to determine if you actually have fibroids, including laparoscopy and hysteroscopy, according to the NIH. Most fibroids are non-cancerous.

For more information about how uterine fibroids are diagnosed, talk with your doctor.

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What treatments are available for uterine fibroids?

Some fibroids need to be removed to avoid other health problems, according to the U.S. Department of Department of Health and Human ServicesOff Site Icon (HHS).

Treatments for fibroids, according to the HHS, include:

  • Endometrial ablation
  • Hysterectomy
  • Medication
  • MRI-guided ultrasound surgery
  • Myomectomy
  • Myolysis
  • Uterine fibroid embolization

In the past, hysterectomy was the most common solution to take care of uterine fibroids, according to the HHS. While it is the only way to completely cure uterine fibroids and ensure they don’t return, the other less invasive treatments have proven to be an effective solution for many women.

Talk to your physician for more information treatment options for uterine fibroids.

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What is puberty, and at what age does a girl experience it?

Clinical Nurse Practitioner Amanda Fox discusses puberty and when girls experience it. Click play to watch the video or read the transcript.

 

Puberty is a time in life when the body starts changing from childhood to adulthood, according to the American Academy of PediatricsOff Site Icon (AAP).

Hormones cause many changes in the body, including the growth of breasts, pubic hair, pimples, menstruation, and more, according to the AAP.

For girls, puberty usually starts between age 8 and 13, but there is no correct time for it to begin, according to the AAP. Every person experiences puberty differently and changes in their own way, at their own pace.

For more information about puberty and when it starts in girls, talk with your physician.

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What is perimenopause, and at what age does a woman experience it?

Clinical Nurse Practitioner Amanda Fox discusses perimenopause and when women experience it. Click play to watch the video or read the transcript.

 

Perimenopause is a time before a woman goes through menopause. It can last two to 10 years, according to the Association of Reproductive Health ProfessionalsOff Site Icon (ARHP).

Perimenopause can start anytime from a woman’s mid-to late-30s to a woman’s mid-40s. Symptoms of perimenopause can include vaginal dryness, menstrual cycle changes, decreased bone density, skin changes and breast tenderness, according to the ARHP.

Talk with your doctor for more information about perimenopause.

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How can perimenopause or menopause cause mood disorders, such as depression or anxiety?

Dr. Amin discusses how perimenopause or menopause can cause mood disorders. Click play to watch the video or read the transcript.

 

Some women can have serious bouts of depression and anxiety as they go through perimenopause and into menopause because of the intense hormone changes during these stages of life, according to the Office of Women’s HealthOff Site Icon (OWH), part of the U.S. Department of Health and Human ServicesOff Site Icon (HHS).

The hormonal changes women experience can cause various symptoms, according to Premier HealthNet physicians, including:

  • Acne
  • Hot flashes
  • Insomnia
  • Weight gain

Along with the hormones themselves, these symptoms can lead women to feel depressed and anxious.

Talk to your doctor for more information about how perimenopause and menopause can cause anxiety and depression.

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What can a woman do to alleviate the symptoms of depression and anxiety during perimenopause or menopause?

Dr. Amin discusses what women can do to alleviate symptoms of depression and anxiety during perimenopause or menopause. Click play to watch the video or read the transcript.

 

If you are in the midst of perimenopause or menopause and are feeling the effects of depression and anxiety, the first step is to have an honest talk with your doctor or advanced practice provider, according to the Office of Women’s HealthOff Site Icon (OWH), part of the U.S. Department of Health and Human ServicesOff Site Icon (HHS).

Once your healthcare provider knows how you are feeling, he or she can work with you to find the best treatment option.

The OWH states treatments include:

  • Anti-anxiety medication or antidepressants – an option for women who are not able to use menopausal hormone therapy (also known as MHT)
  • Menopausal hormone therapy – taking these hormones can help women to control the symptoms of menopause; if this is the option a woman chooses, it is recommended she use the lowest helpful dose for the shortest needed time
  • Talk therapy – conversational group or one-on-one therapy sessions

To learn more about treating symptoms of depression and anxiety caused by perimenopause or menopause, talk with your doctor.

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Is it difficult to connect symptoms of depression and anxiety with perimenopause or menopause?

Dr. Amin discusses difficulty in connecting symptoms of depression and anxiety with perimenopause and menopause. Click play to watch the video or read the transcript.

 

It can be difficult to connect depression and anxiety symptoms with perimenopause and menopause, according to Premier HealthNet PHN physicians.

Before healthcare providers can diagnose menopause or perimenopause as the cause of depression and anxiety, they must rule out other health issues as the cause, including hypothyroidism, according to PHN physicians.

Talking with your doctor and detailing symptoms can help make sure that you get the treatment you need for your depression or anxiety.

For more information about depression or anxiety symptoms related to menopause or perimenopause, talk with your doctor.

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What is pelvic organ prolapse?

Dr. William Rush explains pelvic organ prolapse. Click play to watch the video or read the transcript.

 

Pelvic organ prolapse is a condition in which pelvic organs either bulge or drop from their normal position into the vagina, according to the International Urogynecological AssociationOff Site Icon. This occurs when the supporting tissue around the pelvic organs weaken, according to the IUS.

Pelvic organs include the bladder, uterus, cervix, urethra and rectum. Pelvic floor muscles and tissue may deteriorate through childbirth or age, resulting in the displacement, or prolapse, of pelvic organs, according to the Food and Drug AdministrationOff Site Icon. Most commonly, the bladder is the organ involved in pelvic organ prolapse, according to the FDA.

For more information about pelvic organ prolapse, talk to your doctor.

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What are the risk factors for pelvic organ prolapse?

Dr. William Rush explains the risk factors involved with pelvic organ prolapse. Click play to watch the video or read the transcript.

 

Many factors, including age and obesity, may put a woman at risk for developing pelvic organ prolapse, according to the American Academy of Family PhysiciansOff Site Icon. Menopause, pregnancy, hysterectomies and previous prolapse surgeries may also be contributing factors, according to AAFP.

According to the Mayo Clinic [Add off-site icon with alt tag: You are leaving the Premier Health website, link to http://www.mayoclinic.org/ in a new window], other risk factors include:

  • Chronic coughing
  • Ethnicity (white or Hispanic)
  • Frequent heavy lifting
  • Frequent straining during bowel movements
  • Genetic predisposition
  • Giving birth to a large baby
  • Vaginal birth

Ask your doctor about risk factors for pelvic organ prolapse.

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How can I prevent pelvic organ prolapse?

Dr. William Rush explains how to prevent pelvic organ prolapse. Click play to watch the video or read the transcript.

 

While pelvic organ prolapse is not entirely preventable, there are some ways to decrease the chances of developing the condition, according to the Cleveland ClinicOff Site Icon:

  • Consider estrogen replacement therapy after menopause
  • Don’t smoke
  • Exercise regularly, including Kegel exercises
  • Maintain a healthy body weight
  • Maintain a healthy diet
  • Use correct lifting techniques

Kegel exercises, or pelvic floor muscle exercises, are strength-building techniques that focus on muscles in the pelvic floor, according to the National Institutes of HealthOff Site Icon. The NIH recommends these steps to performing these exercises:

  1. Empty your bladder
  2. Tighten the pelvic floor muscles, and hold for a count of 10
  3. Relax the muscles completely for a count of 10
  4. Do 10 repetitions, three to five times a day

To learn more about pelvic organ prolapse prevention, talk to your doctor.

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What are the symptoms of pelvic organ prolapse?

Dr. William Rush explains the symptoms of pelvic organ prolapse. Click play to watch the video or read the transcript.

 

Most women experience mild cases of pelvic organ prolapse, and the symptoms can be mild too, according to the American Congress of Obstetricians and GynecologistsOff Site Icon . Because organs sometimes drop slightly, the symptoms of pelvic organ prolapse may be difficult to identify, according to the ACOG.

According to the International Urogynecological AssociationOff Site Icon, mild to severe symptoms of pelvic organ prolapse can include:

  • Difficulty with bowel movements
  • Discomfort during sexual intercourse
  • Feeling a lump in the vagina or near the vagina
  • Heavy and/or painful feeling in the vagina or lower back
  • Irregular urination: frequent or slow urination; urgent desire to urinate; or feeling of incomplete urination

For more information about the symptoms of pelvic organ prolapse, talk to your doctor.

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What is the prevalence of pelvic organ prolapse?

Dr. William Rush explains the prevalence of pelvic organ prolapse. Click play to watch the video or read the transcript.

 

It’s estimated that 24 percent of American women have a form of pelvic organ prolapse, according to the National Women’s Health Resource CenterOff Site Icon.

Pelvic organ prolapse is fairly common, occurring more often after child birthing years and in advanced age, according to the American Urogynecologic SocietyOff Site Icon. The stress and pressure of childbirth can sometimes lead to the development of pelvic organ prolapse, according to the AUGS.

One in three women who have given birth to one child or more are affected by pelvic organ prolapse, according to the International Urogynecological AssociationOff Site Icon. The condition can occur during pregnancy or take years to develop, according to the IUGA. Pelvic organ prolapse is also found in older women of postmenopausal age, according to the American Academy of Family PhysiciansOff Site Icon. A Women’s Health Initiative study found a 41 percent prevalence of pelvic organ prolapse in women over 60 who had not had a hysterectomy, according to the AAFP.

Talk to your doctor about the prevalence of pelvic organ prolapse.

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When should I seek help if I think I have pelvic organ prolapse?

Dr. William Rush talks about seeking help for pelvic organ prolapse. Click play to watch the video or read the transcript.

 

Women who have signs of pelvic organ prolapse should consult a doctor as soon as the symptoms appear, according to the American Urogynecologic SocietyOff Site Icon. With consideration of the symptoms, pelvic organ prolapse can be detected through a routine physical exam, at which time treatment options can be explored, according to the AUGS.

Early detection of pelvic organ prolapse can produce positive outcomes, according to the National Association for ContinenceOff Site Icon. Proper treatment suited to a woman’s individual need can be planned once the cause of the prolapse is found, according to the NAFC. Talk to your doctor about seeking help for pelvic organ prolapse.

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What is the difference between pelvic organ prolapse and incontinence, or do all patients with pelvic organ prolapse have incontinence?

Dr. William Rush talks about the difference between pelvic organ prolapse and incontinence. Click play to watch the video or read the transcript.

 

Incontinence is a symptom of a health condition, while pelvic organ prolapse is the health condition itself that can cause incontinence, according to the according to the National Association for ContinenceOff Site Icon.

Not all pelvic organ prolapse patients experience incontinence, although it is a common symptom of the disorder, according to the National Women’s Health Resource CenterOff Site Icon.

For more information about pelvic organ prolapse and incontinence, talk to your doctor.

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What are the treatment options for pelvic organ prolapse?

Dr. William Rush talks about the treatment options for pelvic organ prolapse. Click play to watch the video or read the transcript.

 

There are a number of ways that pelvic organ prolapse can be treated, depending on the patient’s diagnosis. Many cases of pelvic organ prolapse are minor and can be treated through non-surgical methods, according to the International Urogynecological AssociationOff Site Icon. Non-surgical options can include specialized exercises and the use of a pessary, an inserted device that helps to support the pelvic floor, according to the IUGA.

In acute cases of pelvic organ prolapse, surgical options may be necessary, according to the Food and Drug AdministrationOff Site Icon. Surgical methods are usually recommended for women who are experiencing profound discomfort, and whose condition significantly impacts their day-to-day life, according to the FDA.

For more information about treatment options for pelvic organ prolapse, talk to your doctor.

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Is there a danger that pelvic organ prolapse is an indicator of something else?

Dr. William Rush discusses the relationship between pelvic organ prolapse and other disorders. Click play to watch the video or read the transcript.

 

Pelvic organ prolapse is related to other disorders, but is typically not a sign of another health problem, according to the National Women’s Health Resource CenterOff Site Icon. Pelvic organ prolapse is associated with bladder control and bowel incontinence, but is not believed to be an indicator of other health issues, according to the National Women’s Health Resource Center.

For more information about pelvic organ prolapse and related conditions, talk to your doctor.

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What is the best age to have surgery for pelvic organ prolapse? Is there a risk to waiting?

Dr. William Rush discusses the best age to have surgery for pelvic organ prolapse. Click play to watch the video or read the transcript.

 

Women with severe symptoms of pelvic organ prolapse who have tried all non-surgical treatments without relief should explore surgical options, according to American Congress of Obstetricians and GynecologistsOff Site Icon. Patients should include factors such as age, current health conditions, and childbearing plans as they consider surgery, according to the ACOG.

Family planning is also a factor when considering surgery for pelvic organ prolapse, according to the International Urogynecological AssociationOff Site Icon. Women who plan to have children may choose to delay surgery and opt for non-surgical treatments instead, according to the IUGA.

For more information about pelvic organ prolapse surgery, talk to your doctor.

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What is minimally invasive gynecologic surgery?

Dr. Keith Watson explains minimally invasive gynecologic surgery. Click play to watch the video or read the transcript.

 

Minimally invasive gynecologic surgery is a procedure done with small or no incisions rather than one large one, according to the American Society for Reproductive MedicineOff Site Icon. The surgeon is able to see with a small camera or telescope attached to the instruments, according to the ASRM.

Some common conditions treated with minimally invasive gynecologic surgery are irregular menstrual periods, pelvic pain, ovarian cysts, and numerous miscarriages, according to the Mayo ClinicOff Site Icon.

For more information about minimally invasive gynecologic surgery, talk to your doctor.

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What gynecologic conditions can be treated with minimally invasive surgery techniques?

Dr. Keith Watson explains what gynecologic conditions can be treated with minimally invasive surgery techniques. Click play to watch the video or read the transcript.

 

Hospitals vary in their use of minimally invasive gynecologic surgery, according to Johns Hopkins MedicineOff Site Icon.

Hysterectomy is a common minimally invasive gynecologic procedure, according to the American Institute of Minimally Invasive SurgeryOff Site Icon. Minimally invasive gynecologic surgery is also used to treat the following conditions, according to the AIMIS:

  • Chronic pelvic pain
  • Endometriosis
  • Pelvic organ prolapse
  • Tubal ligation
  • Urinary incontinence
  • Uterine fibroids

Ask your doctor about conditions that are treated with minimally invasive gynecologic surgery.

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What are the potential benefits of minimally invasive gynecologic surgery?

Dr. Keith Watson explains the potential benefits of minimally invasive gynecologic surgery. Click play to watch the video or read the transcript.

 

ecause it’s done with fewer incisions, minimally invasive gynecologic surgery has some benefits that open surgical procedures don’t, according to the Mayo ClinicOff Site Icon.

According to the American Society for Reproductive MedicineOff Site Icon, minimally invasive gynecologic surgery can have the following benefits:

  • Faster recovery time
  • Fewer scarring
  • Less bleeding
  • Less medication due to less pain
  • Less pain
  • Shorter hospital stays

For more information about the benefits of minimally invasive gynecologic surgery, talk to your doctor.

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Who is a candidate for minimally invasive, laparoscopic, and robotic surgery?

Dr. Keith Watson explains who is a candidate for minimally invasive, laparoscopic, and robotic surgery. Click play to watch the video or read the transcript.

 

Not everyone is a candidate for minimally invasive gynecologic surgery, according to the Mayo ClinicOff Site Icon. According to American Society for Reproductive MedicineOff Site Icon, minimally invasive gynecologic surgery isn’t recommended for women who have had previous “open” surgeries in the abdominal area. The choice of surgery depends on the condition, as minimally invasive techniques are only currently used to treat certain ailments, according to the ASRM.

Ask your doctor who may qualify for minimally invasive gynecologic surgery, laparoscopic surgery or robotic surgery.

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What is the difference between minimally invasive, laparoscopic, and robotic surgery?

Dr. Keith Watson explains the difference between minimally invasive, laparoscopic, and robotic surgery. Click play to watch the video or read the transcript.

 

Common types of minimally invasive gynecologic surgery are laparoscopy, robotic surgery and hysteroscopy, according to the American Society for Reproductive MedicineOff Site Icon.

According to Johns Hopkins MedicineOff Site Icon, the procedures vary in the following ways:

  • Laparoscopy – insertion of a lighted telescope equipped with a camera through a small incision in the belly button
  • Robotic surgery – similar to laparoscopy, only the surgeon operates the robotics while seated at a console
  • Hysteroscopy – done with no incision at all; a lighted telescope is inserted through the vagina and cervix to the inside of the uterus

For more information about the difference between minimally invasive gynecologic surgery and other procedures, talk to your doctor.

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How do you decide if a patient is treated laparoscopically or robotically?

Dr. Keith Watson explains how laparoscopic and robotic surgeries are chosen. Click play to watch the video or read the transcript.

 

The choice of minimally invasive gynecologic procedure may depend on the condition that requires treatment, according to the American College of SurgeonsOff Site Icon.

Hysterectomies for the treatment of gynecologic disease is a common minimally invasive gynecologic procedure, according to the Journal of the American Medical AssociationOff Site Icon. These procedures, as well as some other gynecologic surgeries, can be done laparoscopically, which allow for a two-dimensional view, according to JAMA. Robotic surgery allows greater visibility and precision, and is chosen when those factors are seen as benefits in a given procedure, according to JAMA.

For more information about choosing laparoscopic or robotic surgery, talk to your doctor.

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What is the normal recovery time after minimally invasive gynecologic surgery?

Dr. Keith Watson explains the normal recovery time after minimally invasive gynecologic surgery?. Click play to watch the video or read the transcript.

 

Because minimally invasive gynecologic surgery involves fewer to no incisions, there is less bleeding, scarring and pain, according to the Mayo ClinicOff Site Icon.

According to the American Society for Reproductive MedicineOff Site Icon, those benefits result in faster recovery times. Patients undergo a minimally invasive gynecologic procedure aren’t required to stay in the hospital, whereas open procedures require two to four days of hospitalization after surgery, according to the ASRM. This could mean that a woman’s overall recovery time could be cut by weeks with a minimally invasive procedure, according to the ASRM.

Ask your doctor about recovery time after minimally invasive gynecologic surgery.

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What training is involved for the surgeon?

Dr. Keith Watson explains the training involved in minimally invasive gynecologic surgery. Click play to watch the video or read the transcript.

 

Minimally invasive gynecologic surgery requires special training and equipment, according to the American Society for Reproductive MedicineOff Site Icon.

Postgraduate training in minimally invasive surgery is on the rise, according to the National Institutes of HealthOff Site Icon. In a survey of surgery program directors, more than 80 percent of those who responded reported a residency program, varying in size, for minimally invasive procedures. For those surgeons already in practice, there are classes and training programs available for minimally invasive surgical techniques, according to the NIH.

For more information about how surgeons are trained in minimally invasive gynecologic surgery, talk to your doctor.

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Can minimally invasive surgery treat gynecologic cancers?

Dr. Keith Watson explains if minimally invasive surgery treat gynecologic cancers. Click play to watch the video or read the transcript.

 

Oncologic surgeries have been done with open procedures, but some can be performed using minimally invasive gynecologic surgery, according to the American Society for Reproductive MedicineOff Site Icon.

A condition commonly treated with minimally invasive techniques is uterine, or endometrial, cancer, according to the Mayo ClinicOff Site Icon. Other matters factor into the decision to use minimally invasive means, and technological advances continue to open possibilities to treat other cancers this way, according to the Mayo Clinic.

Ask your doctor about treating cancer using minimally invasive gynecologic surgery.

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What is the future of minimally invasive gynecologic surgery?

Dr. Keith Watson discusses the future of minimally invasive gynecologic surgery. Click play to watch the video or read the transcript.

 

Minimally invasive gynecologic surgery, like any field, continues to evolve and change, according to the National Institutes of HealthOff Site Icon. The goal in technological advances in minimally invasive gynecologic surgery is to improve the procedure for better patient outcomes, according to the NIH.

Some changes on the horizon are ways to do surgeries with less incisions, or in some cases of gynecological surgery, performing the procedures through natural orifices in the body, according to the NIH.

For more information about the future of minimally invasive gynecologic surgery, talk to your doctor.

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What is urinary incontinence?

Premier Health’s Dr. Jerome Yaklic defines urinary incontinence, a common women’s health issue. Click play to watch the video or read the transcript.

 

The National Institutes of HealthOff Site Icon (NIH) Medline PlusOff Site Icon defines urinary incontinence (UI) as the loss of bladder control. However, people may experience the loss of bladder control differently. Some may experience leaking urine while others experience strong, sudden urges to urinate.

The Office on Women’s HealthOff Site Icon outlines five different types of urinary incontinence:

  • Stress incontinence
    Urine leaks as a result of pressure on the bladder, such as when you cough, sneeze or lift a heavy object.
  • Urge incontinence
    Urine is released because a person experiences a strong sudden urge to urinate and may not make it to the bathroom in time. This type of urinary incontinence is also known as overactive bladder (OAB).
  • Overflow incontinence
    Urine leaks because a person’s bladder does not empty completely when they go to the bathroom.
  • Functional incontinence
    Urine leaks because a person cannot make it to the toilet on time because of a physical or mental impairment.
  • Mixed incontinence
    A person experiences symptoms of more than one type of urinary incontinence.

Stress incontinence is more common among women, especially women who have had children. Overflow incontinence, on the other hand, is more common in men who have had prostate problems and/or prostate surgery.

Talk to your doctor to learn more about urinary incontinence.

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What causes urinary incontinence?

Premier Health’s Dr. Jerome Yaklic discusses the causes of urinary incontinence in women. Click play to watch the video or read the transcript.

 

There are a number of causes of urinary incontinence (UI). According to The Office on Women’s HealthOff Site Icon, temporary urinary incontinence may be caused by:

  • Diuretics—food and drinks that stimulate bladder muscles and/or increase the volume of urine held in the bladder
  • Urinary tract infections
  • Constipation

However, some types of urinary incontinence are more prevalent among women. For instance, stress urinary incontinence (SUI)—urine leakage when pressure is exerted on the bladder during sneezing, coughing, laughing or heavy lifting—is often the result of weakness in the muscles of the pelvic floor. As the Office on Women’s Health points out, urinary incontinence is twice as common in women as in men is because many of the causes of pelvic muscle weakness are unique to women, such as:

  • Pregnancy
  • Childbirth
  • Hysterectomy
  • Menopause

Pelvic muscles may be physically stretched and/or damaged during pregnancy and childbirth, but changes in hormone levels also affect muscle strength and the integrity of the bladder and urethra lining.

Overflow urinary incontinence is often caused by a blockage. Obstructions may result from:

  • Enlarged prostate
  • A tumor along the urinary tract

Other common causes of urinary incontinence include:

  • Overactive bladder muscles
  • Neurological disorders and/or nerve damage
  • Vascular disease
  • Diabetes
  • Alzheimer’s disease
  • Multiple sclerosis
  • Excess weight

As Dr. Yaklic points out, there are rarer causes of UI, such as holes between the bladder and vagina or fistulas.

Ask your doctor about what may be causing your urinary incontinence.

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How do I know if I have urinary incontinence issues, and when should I seek help?

Premier Health’s Dr. Jerome Yaklic talks about symptoms of urinary incontinence and when to seek treatment. Click play to watch the video or read the transcript.

 

The symptoms of urinary incontinence (UI) vary depending on the type of UI you have. According to The Office on Women’s HealthOff Site Icon, you may experience:

  • Urine leaks during activity and/or when pressure is exerted on the bladder, such as when you cough or sneeze (stress urinary incontinence or SUI)
  • Sudden intense urges to empty your bladder, which you may or may not be able to restrain until you reach the bathroom (urge incontinence, also known as overactive bladder or OAB)
  • Frequent or constant dribbling of urine (overflow incontinence)

Your doctor may diagnose urinary incontinence based on your medical history and symptoms alone. However, there are additional diagnostic tests and procedures, such as:

  • Bladder stress test—stress is put on the bladder by bearing down or coughing so that the doctor can observe any urine leakage
  • Urinalysis—urine is tested to see if infection may be causing incontinence
  • Ultrasound—sound waves create an image of the kidneys, bladder and urethra so that the doctor may see any structural abnormalities or blockages
  • Cystoscopy—a catheter with a camera is inserted up the urethra and into the bladder, allowing the doctor to see inside
  • Urodynamics—a water-filled tube is inserted into the bladder to test for pressure inside the bladder

These tests can determine the cause of urinary incontinence and point to the most effective treatment.

Urinary incontinence is not a life-threatening condition, but it can cause lifestyle changes. Some people feel they cannot go places if they will be too far from a bathroom and/or away too long. Some people give up activities. If urinary incontinence gets in the way of your normal, active life, that is when you should seek help from your doctor.

To learn more about diagnosis and treatment options for urinary incontinence, talk to your doctor.

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Is incontinence normal?

Premier Health’s Dr. Jerome Yaklic discusses urinary incontinence, a common women’s health issue. Click play to watch the video or read the transcript.

 

According to Urology Care FoundationOff Site Icon, urinary incontinence affects millions of Americans. More than 33 million men and women have overactive bladder (OAB) alone.

There are a number of risk factors associated with urinary incontinence, some that affect men and women alike, and some that affect only men or women. Risk factors that affect everyone include:

  • Increased age
  • Poor overall health
  • Obesity
  • Diabetes
  • Stroke
  • High blood pressure

Prostate problems increase the incidence of urinary incontinence in men. In women, urinary incontinence may result from:

  • Pregnancy
  • Childbirth (vaginal or cesarean section delivery)
  • Menopause

UI experienced during pregnancy is more likely to persist after delivery, and the chances of experiencing urinary incontinence increase with each pregnancy and delivery.

As. Dr. Yaklic points out, while urinary incontinence is a common issue, it need not be considered a normal part of getting older or having children. If symptoms affect your lifestyle, there are a number of non-surgical treatments that can improve bladder control.

Talk to your doctor to learn more about treatments available for urinary incontinence.

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What are the treatment options for urinary incontinence?

Premier Health’s Dr. Jerome Yaklic discusses treatment options for women experiencing urinary incontinence. Click play to watch the video or read the transcript.

 

The Office on Women’s HealthOff Site Icon outlines a variety of treatments available for urinary incontinence:

  • Behavioral treatments
  • Physical therapy
  • Medicines for bladder control
  • Devices
  • Nerve stimulation
  • Biofeedback
  • Surgery
  • Catheterization

Many of the medical devices used for urinary incontinence treatment are FDA-approved devices that require a prescription for at-home use. Your doctor will help you understand how the device works and how to operate the device so that you can perform treatments from the convenience and comfort of your home. You will likely need follow-up visits for your doctor to assess your progress with the device and make any modifications to your treatment program.

Some devices, such as a pessary, are inserted during a brief in-office procedure. This device helps support the bladder neck, preventing the bladder from dropping and leaking urine.

Your doctor will determine the best treatment based on the type of urinary incontinence you have and your medical history. Doctors try conservative, non-invasive methods first, but patients who do not respond well to conservative therapies like behavioral modifications or who cannot tolerate side effects of drugs may require more intensive treatments.

Ask your doctor to learn more about treatments available for your type of urinary incontinence.

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What are behavior modifications?

Premier Health’s Dr. Jerome Yaklic talks about behavioral modifications to treat urinary incontinence. Click play to watch the video or read the transcript.

 

Many people experience significant relief from symptoms of urinary incontinence through behavioral modifications and lifestyle changes.

The Office on Women’s HealthOff Site Icon and the National Institute on AgingOff Site Icon identify five behavioral modifications commonly used to treat urinary incontinence.

  • Bladder (re)training
    The purpose of this behavioral modification is to delay voiding when you experience the urge to urinate. You begin by delaying the time between urge and voiding by 10 minutes and continue to lengthen the time until you are able to wait two to four hours between trips to the toilet.
  • Timed voiding
    People with overactive bladder (OAB) may benefit from going to the toilet on a timed schedule rather than when they feel an urge.
  • Fluid and diet management
    Alcohol, caffeine and acidic foods are known to exacerbate urinary incontinence, so avoiding them may help reduce symptoms. Reducing liquid consumption may also help.
  • Pelvic floor exercises
    Strengthening the Kegel muscles can reduce leakage caused by stress urinary incontinence. A doctor or nurse may instruct you how to properly work these muscles at first, but exercises can be done at home.
  • Lifestyle changes
    Because excess weight and smoking can increase the risk for developing urinary incontinence, losing weight and quitting smoking can help reduce symptoms.

For more information about behavior modifications for urinary incontinence treatment, talk to your doctor.

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Is urinary incontinence just a woman’s issue?

Premier Health’s Dr. Jerome Yaklic discusses urinary incontinence among women. Click play to watch the video or read the transcript.

 

Urinary incontinence is not just a woman’s health issue. Millions of men experience urinary incontinence as well—up to 30% of men have overactive bladder (OAB) alone, according to the Urology Care FoundationOff Site Icon. However, as Dr. Yaklic points out, most men experience urinary incontinence as a result of prostate problems and/or cancer. Women, on the other hand, experience urinary incontinence more frequently as a result of life events, such as:

  • Pregnancy
  • Childbirth
  • Menopause

Carrying and delivering children can weaken pelvic floor muscles, even possibly damage pelvic nerves. Loss of muscle and/or nerve function to the bladder makes urine leakage a common problem, one that increases with the number of children a woman has. According to The Office on Women’s HealthOff Site Icon, the loss of estrogen during menopause is believed to result in weakened vaginal and urethral tissue, also contributing to urine leakage.

To learn more about urinary incontinence and how it relates to women’s health, talk to your doctor.

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What are Kegels and why are they important?

Premier Health’s Dr. Jerome Yaklic explains the importance of Kegels, pelvic muscles that aid bladder control. Click play to watch the video or read the transcript.

 

Stress urinary incontinence is often caused by weakened muscles in the pelvic floor. For women, pelvic muscles are often weakened by pregnancy and childbirth. However, these muscles—the Kegels—can be exercised, and the increased strength can help minimize or stop urine leakage.

The Office on Women’s HealthOff Site Icon provides directions for Kegel exercises:

  1. Tighten the muscles in the genital area as if trying to stop the flow of urine without using the muscles in your stomach, legs or buttocks.
  2. Hold the contraction for ten seconds.
  3. Relax for ten seconds.
  4. Repeat to complete a set of ten contractions three times each day.

At first, you may not have the strength to hold the contraction for ten seconds. You can build up strength slowly—holding the contraction for two seconds, relaxing for three seconds and then repeating. Progressively increase the length of time you hold the contractions until you are able to sustain the contraction for the full ten seconds.

It takes time to build up muscle strength to control urine flow. FamilyDoctor.orgOff Site Icon notes it may take three to six months before you see an improvement in urinary incontinence symptoms.

As Dr. Yaklic observes, pelvic floor exercises are effective if people do them correctly. However, people often contract muscles in their abdomen, legs and/or buttocks instead of their Kegels. To make sure that you are isolating the correct muscle group, your doctor may have you perform the exercises during a visit, refer you to a physical therapist or recommend biofeedback.

To learn more about pelvic exercises for urinary incontinence treatment, talk to your doctor.

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Are there non-surgical treatment options for urinary incontinence?

Premier Health’s Dr. Jerome Yaklic discusses non-surgical options to treat urinary incontinence. Click play to watch the video or read the transcript.

 

There are a variety of non-surgical treatment options for urinary incontinence. The least invasive treatments include:

  • Behavioral modifications
  • Physical therapy
  • Pelvic muscle (Kegels) exercises
  • Medications

However, if patients do not find these treatments effective, there are still a number of therapies available. The Office on Women’s HealthOff Site Icon identifies electrical nerve stimulation (also called neuromodulation), devices (such as a pessary) and catheterization as non-surgical treatment options.

Nerve stimulation is often an effective treatment for urge incontinence and overactive bladder (OAB) when other therapies have not worked. This treatment entails gentle electrical pulses delivered to the sacral nerves to interfere with errant signals between the brain and the bladder believed to cause the sudden urges and bladder muscle spasms. Premier Health specialists prefer two electrical stimulation systems:

  • Bladder Control TherapyOff Site Icon This method uses an implantable device similar to a pacemaker to continuously send gentle electrical pulses to the sacral nerves to relieve the symptoms of urinary incontinence. Your doctor will determine if you are a good candidate for bladder control therapy by conducting an evaluation using a portable stimulator and recording your symptoms.
  • Uroplasty Urgent® PCOff Site Icon The Urgent PC system is an in-office treatment. During an office visit, your doctor inserts a small electrode into your ankle. The hand-held stimulator delivers gentle electrical pulses that travel up to the sacral nerves. Effective treatment requires 12 weekly treatments followed by monthly treatments for maintenance. Each treatment lasts about 30 minutes.

Premier Health specialists also use devices that allow patients to effectively perform pelvic floor exercises at home and get biofeedback from their exercise sessions. For patients with stress, urge or mixed incontinence, doctors may prescribe In-ToneOff Site Icon, a medical device that helps strengthen the Kegels in the pelvic floor and the detrusor muscle that comprises the bladder wall.

Premier Health specialists may also recommend an outpatient procedure that uses the body’s natural healing process to bulk up and strengthen tissues in the pelvic area. The LyretteOff Site Icon procedure entails inserting a small catheter into your urethra and inflating a small balloon at the base of the bladder. Radiofrequency energy is emitted for about 10 minutes to gently damage the lining of the urethra and bladder neck. As your body heals, it produces more collagen, resulting in thicker, stronger walls of the urethra and bladder neck, which helps to control urine leakage.

For patients who cannot respond well or tolerate these non-surgical options, catheterization may be considered for urinary incontinence management. While catheterization does not treat urinary incontinence, it does provide relief from leakage and sudden urges. The Urology Care FoundationOff Site Icon describes two types of indwelling catheters that may be used:

  • Suprapubic catheters
  • Foley catheters

While catheters may provide people with more freedom from symptoms of urinary incontinence, they should not be considered a permanent solution. Surgery may still be recommended for long-term treatment.

For more information about non-surgical options that may give you relief from urinary incontinence, talk to your doctor.

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Is rectal incontinence also a common issue?

Premier Health’s Dr. Jerome Yaklic discusses rectal incontinence, an issue that may co-occur with urinary incontinence. Click play to watch the video or read the transcript.

 

Many of the reasons that contribute to urinary incontinence in women may also result in rectal incontinence (also known as fecal or bowel incontinence). The effects of pregnancy, childbirth and the loss of estrogen that comes with aging are not isolated to the muscles and tissues that control urine elimination. The muscles that control the rectum may be weakened as well.

Many of the treatments that are effective in reducing the symptoms of urinary incontinence work for rectal incontinence as well, such as:

  • Biofeedback
  • Sacral nerve stimulation

Although bowel training focuses on different muscles and urges, the concept is the same as for bladder training—scheduling trips to the toilet to regain control of elimination.

Talk to your doctor for more information and to start treatment for rectal incontinence.

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What is perimenopause? What are some of the signs and symptoms women experience?

Dr. J. Scott Bembry discusses the most common sign of early menopause or perimenopause. Click play to watch the video or read the transcript.

 

Perimenopause is when your body starts to transition to menopause. During this time, your body makes less estrogen. The most common sign or symptom you might have in perimenopause is abnormal bleeding. You should be evaluated by a doctor if you have abnormal bleeding because it could also be a sign of something concerning, such as uterine cancer. Another symptom you might feel in perimenopause is hot flashes. They may come and go in perimenopause, like they do in menopause, because of lower levels of estrogen. Generally, your levels of estrogen are higher in perimenopause than they are in menopause. 

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    What is menopause?

    Dr. J. Scott Bembry discusses the most common sign of early menopause or perimenopause. Click play to watch the video or read the transcript.

     

    Menopause comes from the Greek words “meno” and “pause.” “Meno” means month, and “pause” means to stop. Basically it's when your ovaries stop working and no longer respond to stimulation from the pituitary gland. The follicle doesn't form. It doesn’t produce estrogen. There’s no further ovulation and there’s also significantly less production of estrogen, progesterone and testosterone.

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      Are there tests to diagnose menopause?

      Dr. J. Scott Bembry discusses the tests doctors use to diagnose menopause. Click play to watch the video or read the transcript.

       

      There’s no really good absolute test. The most common test that we do is to check your levels of follicle stimulating hormone and luteinizing hormone. These are hormones that normally are produced by the pituitary. They drive the ovary to form a follicle and to produce estrogen, and to ovulate and to produce progesterone. After menopause — after the ovaries stop working — the hormones from the pituitary become elevated and stay elevated.

      Elevated hormone levels are good indicators that menopause has occurred. However, even if your hormone levels are elevated, you may still ovulate. The biggest test for menopause and for monitoring menopause is you, the patient. What kind of symptoms are you having? That’s what I base treatment on, is whether your symptoms are being relieved. 

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        How long does menopause last?

        Dr. J. Scott Bembry discusses how long menopause symptoms usually last. Click play to watch the video or read the transcript.

         

        We can break menopause into two different segments. What most people consider menopause is actually early menopause. That’s when your ovaries stop ovulating and stop producing the hormones that are associated with the ovaries. Then, there’s late menopause. This stage occurs usually five or six years after the ovaries stop functioning.

        Symptoms of menopause usually begin around age 51, but the range is anywhere from 45 to 56. The initial symptoms that most people associate with early menopause usually last about five years, sometimes less. Symptoms associated with late menopause may last for the rest of your life. 

         

          Are there conditions that can cause early menopause?

          Dr. J. Scott Bembry discusses how existing health conditions like autoimmune or rheumatic disease can cause menopause to begin before age 40. Click play to watch the video or read the transcript.

           

          In some patients, menopause can occur much earlier than expected, even in the late 30s. Usually, we don’t know why someone goes through premature menopause. What we do when that occurs is an evaluation to check for rheumatic disease or autoimmune disease. These conditions can be associated with premature menopause. If you begin menopause before the age of 40, your doctor should evaluate you. 

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          Why do women experience weight gain before menopause?

          Dr. J. Scott Bembry discusses the ties for women between weight gain, aging and menopause. Click play to watch the video or read the transcript.

           

          That’s one of the biggest complaints that I get from patients, is that they attribute weight gain to menopause. Where we have to sort things out is what’s attributable to menopause? What's attributable to just aging? In men and women, the biggest part of weight gain is attributed to just aging. That has to do more with the adrenal glands than the ovaries. Hormone therapy may help with that. It may not.

          Generally, we have to make adjustments in dietary intake and exercise that’s going to help us lose weight. There’s unfortunately no magic cure for that problem and it's the most common thing that people complain about, but it’s not absolutely related to menopause.

          There’s a lot of marketing on commercials for products that you hear about on the radio that describe weight gain as the biggest concern and symptom of menopause, but that’s not exactly correct. It’s more to do with aging.

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          What is the treatment for menopause?

          Dr. J. Scott Bembry discusses the best treatment for a woman’s menopause symptoms. Click play to watch the video or read the transcript.

           

          The best treatment for menopause is to treat the specific symptoms that are bothering you. That generally is going to be hormone replacement therapy (also called menopausal hormone therapy), unless there are reasons why we shouldn’t use it for you. Then we try to focus on your specific condition, complaints and symptoms. What I try to tell patients is that the best therapy is what's going to alleviate your symptoms.

          What is hormone replacement therapy?

          Dr. J. Scott Bembry discusses how hormone replacement therapy restores low levels of hormones to treat symptoms like hot flashes. Click play to watch the video or read the transcript.

           

          The particular combination of hormone therapy that we use is very patient dependent. We try to use the lowest dose of therapy that’s going to make you feel better. Most patients will need estrogen and progesterone. 

          You can’t take estrogen alone, because it can promote overgrowth of the lining of the uterus and increase the risk of endometrial cancer. If you’ve had a hysterectomy, though, you can just take estrogen. When the uterus is not present, you do not need progesterone and shouldn't take progesterone. Of the two hormones, progesterone probably creates more of a risk of breast cancer than estrogen.

          The way that estrogen or hormone therapy is given — whether it’s orally or with a transdermal patch — also depends on your specific symptoms.

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          What are some lifestyle factors, like exercise, that can help to control menopause symptoms?

          Dr. J. Scott Bembry discusses how exercise, losing weight and wearing loose clothing can help ease menopause symptoms such as hot flashes. Click play to watch the video or read the transcript.

           

          There are several lifestyle changes you can make to lessen the symptoms of menopause. With hot flashes, looser fitting clothes can be helpful. Having a fan on at night can be helpful if you are not taking hormone therapy. Weight loss and exercise is always good. A healthy diet is going to help with symptoms.

          Learn more:

          Don’t Let Menopause Wreck Your Life

           

            Are there any lifestyle practices that can complicate menopause?

            Dr. J. Scott Bembry discusses why menopause symptoms may worsen with conditions like sleep apnea, weight gain and not exercising. Click play to watch the video or read the transcript.

             

            Certainly symptoms can be worse if there are other things going on. That’s why it’s important to be evaluated. You might complain about menopause symptoms, but you might have a condition such as sleep apnea. Other issues can also exacerbate the way you feel.

            As far as lifestyle changes, obviously weight gain, not getting adequate exercise and not getting adequate sleep are going to worsen the symptoms of menopause. along with your general feeling of well-being.

              How do pre-existing, chronic conditions affect those experiencing menopause?

              Dr. J. Scott Bembry discusses why menopause may exacerbate conditions like osteoporosis and heart problems. Click play to watch the video or read the transcript.

               

              If you have muscular or skeletal complains such as osteoporosis, those can be exacerbated by a lack of estrogen.

              Heart conditions can also be affected. Cardiovascular changes occur during menopause. There can be adverse lipid changes. One of the benefits of hormone replacement therapy is that it can lessen those lipid changes, causing an increase in HDL and lowering the LDL.

              If started late, hormone replacement therapy can increase your risk for an adverse cardiac event, because of the increased risk of clot formation. It’s something that you should discuss with your doctor if you have an underlying cardiac problem. You should talk with your gynecologist or family doctor or cardiologist to find out if hormone therapy is in your best interest. There are some patients with some cardiac problems that probably should not be started on hormone replacement therapy.

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                Are there factors that increase a woman’s risk for incontinence?

                Physician Assistant Elyse Weber discusses factors that can increase a woman’s risk for incontinence. Click play to watch the video or read the transcript.

                 

                There are a variety of factors that can increase your risk for urinary incontinence, according to the Office on Women’s HealthOff Site Icon(OWH), an office of the U.S. Department of Health and Human ServicesOff Site Icon(HHS).

                Women are twice as likely as men to experience urinary incontinence. Some factors that affect only women make it more likely we will have urinary incontinence, according to the OWH. Those include:

                • Childbirth – After giving birth, many of us leak because labor and vaginal birth weaken our pelvic floor support and damage nerves that control the bladder.
                • Menopause – For some women, bladder control problems start after they stop having periods. Our bodies stop making estrogen, which some experts believe weakens urethral tissue
                • Pregnancy – Growing babies push against our bladders, urethras, and pelvic floor muscles. The pressure can weaken our pelvic floor support, which leads to bladder leakage.

                Other factors that can lead to urinary incontinence in both women and men, according to the OWH, include:

                • Alcohol
                • Caffeine
                • Constipation
                • Excess weight
                • Infection
                • Medicines
                • Nerve damage

                For more information about factors that can cause an increased risk of urinary incontinence in women, talk with your doctor.

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                What symptoms should be signals to a woman that she needs to talk to her doctor about incontinence?

                Physician Assistant Elyse Weber discusses symptoms that should signal a woman to talk to her doctor about incontinence. Click play to watch the video or read the transcript.

                 

                For women experiencing urinary incontinence problems, it’s important that we talk to our doctor to find a solution. Urinary incontinence is a common problem among women, and your physician can work with you to find a diagnosis and to decide what steps you can take to make improvements

                Premier Physician Network (PPN) physicians say that everyone can leak now and again. But, if you find yourself leaking enough that it makes you uncomfortable or interferes with your life, you should talk to your doctor.

                The Office on Women’s HealthOff Site Icon (OWH), an office of the U.S. Department of Health and Human ServicesOff Site Icon (HHS), says your doctor will talk about your symptoms and also take a medical history, including:

                • How much you leak
                • How often you go to the bathroom to urinate
                • How often you leak
                • When you leak

                Your doctor will also do a physical exam, and will probably ask you to keep a record of these specifics for about a week. This bladder journal will help your doctor determine next steps when it comes to combating urinary incontinence.

                For more information about symptoms of urinary incontinence, talk with your doctor.

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                Is female incontinence curable?

                Physician Assistant Elyse Weber discusses factors that can increase a woman’s risk for incontinence. Click play to watch the video or read the transcript.

                Premier Physician Network (PPN) physicians say female incontinence might not be totally curable, but it can be treated and improved. 

                Your doctor can help you decide what steps are best for you to take to treat your level of urinary incontinence.

                The National Institutes of HealthOff Site Icon (NIH) says there are a variety of treatments, including:

                • Bladder training: By changing your urination habits, you can decrease incidents of urinary incontinence. 
                • Bulking agents: Collagen and carbon beads can be injected near your urinary sphincter to treat urinary incontinence. 
                • Lifestyle changes: These could include drinking more water, consuming less caffeine, consuming less diet soda, drinking less late in the day, limiting alcohol, quitting smoking, managing constipation, and exercising. 
                • Medical devices: A pessary is another device. It’s a stiff ring inserted into your vagina. It provides pressure against the vaginal wall to help reposition the urethra, causing less leakage. 
                • Pelvic floor muscle exercise: Known as Kegel exercises, these require you to practice tightening and relaxing the muscles that control your urine flow. 
                • Surgery: A few surgical options are available for treating urinary incontinence, including retropubic suspension and sling. During a retropubic suspension the doctor performs a procedure to raise the bladder neck or urethra to limit leaks. A sling procedure attaches an internal sling to cradle the bladder neck or urethra to limit leaks. 

                Your doctor will also do a physical exam, and will probably ask you to keep a record of these specifics for about a week. This bladder journal will help your doctor determine next steps when it comes to combating urinary incontinence.

                For more information about whether urinary incontinence is curable, talk with your doctor. 

                Learn more:

                What is InterStim®?

                Physician Assistant Elyse Weber discusses factors that can increase a woman’s risk for incontinence. Click play to watch the video or read the transcript.

                InterStim is a device your doctor can surgically implant to help treat urinary incontinence.

                According to the MedtronicOff Site Icon company website, InterStim targets the nerves that control your bladder to help it function normally, without consistent leaks.

                The system sends small electrical impulses to the nerves to allow your brain to communicate better with your bladder, according to Premier Physician Network (PPN) physicians. This helps control leaks.

                For more information about InterStim, talk with your doctor.

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                Who is the ideal candidate for InterStim®?

                Physician Assistant Elyse Weber discusses factors that can increase a woman’s risk for incontinence. Click play to watch the video or read the transcript.

                The InterStim system might be a good option for you if you have already tried other types of medical treatment for your urinary incontinence, according to Premier Physician Network (PPN) physicians.

                The system can be a useful therapy for urinary incontinence that is caused by a variety of issues, including urge incontinency, frequency, urgency, and non-obstructive urinary retention, according to PPN physicians.

                For more information about who is a good candidate for InterStim, talk to your doctor.

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                How can the use of InterStim® affect a woman’s quality of life?

                Physician Assistant Elyse Weber discusses factors that can increase a woman’s risk for incontinence. Click play to watch the video or read the transcript.

                The InterStim implant typically helps women have an about 80 percent reduction in symptoms of urinary incontinence, according to Premier Physician Network (PPN) physicians.

                The physicians say it can help make the difference, for example, from you having three or four urinary incontinence issues each day to having three to four per week.

                For more information about how InterStim can affect a woman’s quality of life, talk with your doctor.

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                How does menopause affect a woman’s ability to be intimate with her partner?

                During menopause, women experience a mix of both physical and emotional changes.

                For some women, physical changes from menopause including vaginal dryness and hot flashes can make intimacy seem less exciting, according to Premier Physician Network (PPN) physicians.

                For other women, emotional changes such as mood swings and decreased libido can interfere with intimacy.

                Whatever the reason, it’s important for women to find a way to work through the challenges menopause can cause, should they want to.

                For more information about how menopause can affect a woman’s ability to be intimate, talk with your doctor.

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                What is a good way for a woman to start the conversation with her health care provider about menopause and intimacy?

                The best way to start a conversation with your physician about menopause and its effect on intimacy is to be honest, according to Premier Physician Network (PPN) physicians.

                Though it can seem like a delicate subject to some people and might feel uncomfortable to talk about at first, it’s important to be honest with your doctor.

                If you have a physical issue, such as vaginal dryness, it’s important to be clear and tell your doctor the issue so he or she can work with you to find a solution.

                If it’s a matter of decreased desire, you could tell your doctor you’re not as interested in intimacy as you used to be and need help to find out why. Your doctor will be happy to work with you to find a solution that meets your personal needs.

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                What are steps a woman can take to address menopause and intimacy issues?

                If you’re facing intimacy issues related to menopause, there are steps you can take to improve the problem.

                Treatment needs are different for every woman, but major improvements can be made with minor changes, according to Premier Physician Network (PPN) physicians. Some of those changes include:

                • Adding new medications
                • Changing ongoing medications
                • Changing your schedule
                • Decreasing stress
                • Using moisturizers

                Being honest with your partner, compromising on how and when to be intimate, and experimenting with new positions and sensual activities are all also ways to help work through intimacy issues related to menopause, according to Harvard Medical SchoolOff Site Icon (HMS).

                Talk to your doctor for more information about what steps you can take to address intimacy issues during menopause.

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                What is a vaginal yeast infection?

                A vaginal yeast infection is an infection of your vagina. It is caused by an overgrowth of the fungus Candida, according to the Office on Women’s HealthOff Site Icon (OWH), an office of the U.S. Department of Health and Human ServicesOff Site Icon (HHS).

                Your vulva and the area around your vulva will itch and burn when you have a yeast infection.

                Most women get at least one vaginal yeast infection some time in their life. Women and girls can get this type of infection at any age.

                Talk to your health care provider for more information about vaginal yeast infections.

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                Are some women at higher risk for yeast infections?

                Even though any girl or woman can get a vaginal yeast infection, some of us are at higher risk than others. 

                According to the Office on Women’s HealthOff Site Icon (OWH), an office of the U.S. Department of Health and Human ServicesOff Site Icon (HHS), you are at higher risk for a vaginal yeast infection if you: 

                • Are pregnant
                • Douche
                • Have diabetes
                • Have a weakened immune system
                • Took antibiotics recently
                • Use hormonal birth control that has higher doses of estrogen
                • Use vaginal sprays

                Talk to your health care provider for more information about why some women are at higher risk for yeast infections.

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                What are the symptoms of a yeast infection?

                Extreme itching around your vagina is the most common symptom of a vaginal yeast infection, according to the Office on Women’s HealthOff Site Icon (OWH), an office of the U.S. Department of Health and Human ServicesOff Site Icon (HHS).

                Other symptoms could include:

                • Burning vagina and vulva
                • Painful sex
                • Pain while urinating
                • Redness of the vagina and vulva
                • Soreness
                • Swelling of the vagina and vulva
                • Thick, white vaginal discharge that looks like cottage cheese but does not smell bad
                • Your symptoms could be anywhere from mild to severe and differ each time you have a vaginal yeast infection.
                • Talk to your health care provider for more information about symptoms of vaginal yeast infections.

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                How is a yeast infection treated?

                You can treat a vaginal yeast infection with an antifungal medicine, according to the  Office on Women’s HealthOff Site Icon (OWH), an office of the U.S. Department of Health and Human ServicesOff Site Icon (HHS).

                Though you can buy over-the-counter antifungal medicine to treat a yeast infection, you should visit your doctor first to make sure you have a yeast infection and not a different kind of infection.

                The over-the counter medicine comes as a cream, tablets, ointment or suppositories to put in your vagina. The can be used for between one and seven days, depending on the type you choose to buy.

                Your doctor might also recommend a medicine you take by mouth, especially if the over-the-counter treatment doesn’t work or if you have frequent vaginal yeast infections.

                Talk to your health care provider for more information about treating vaginal yeast infections.

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                Can yeast infection symptoms be a sign of something else?

                Sometimes, it can seem like you have a yeast infection, but the symptoms are actually a sign of something else.

                What looks like a yeast infection could be a sign of a different kind of infection, Premier Physician Network (PPN) physicians say.

                It could be a different infection called vaginitis or something more serious like herpes. Because it can be difficult to tell the difference at first, it’s important to visit your health care provider to find the best treatment option for you.

                Talk to your provider for more information about whether yeast infection symptoms can be a sign of something else.

                At what age do girls typically get their first period?

                Certified Nurse Midwife Jalana Lazar discusses the age a girl should start seeing an OB-Gyn provider. Click play to watch the video or read the transcript.

                Most girls get their period between ages 12 and 14, but it can happen years earlier or later, according to the American College of Obstetricians and GynecologistsOff Site Icon (ACOG).

                Some girls get their first period as young as 9 or as old as 15 or 16, Premier Physician Network (PPN) providers say.

                For most girls, their period starts about two years after they first start to grow breasts, according to the U.S. Department of Health and Human ServicesOff Site Icon (HHS).

                For more information about when girls typically get their first period, talk to your doctor.

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                How old should my daughter be when I talk to her about her period?

                Certified Nurse Midwife Jalana Lazar discusses how old your daughter should be when you talk to her about her period. Click play to watch the video or read the transcript.

                It’s good to start talking to your daughter about her period and other body changes she can expect during puberty before she experiences them.

                Once you start to notice some physical changes, such as body odor, hair in her armpits or pubic area, it can be a good time to have a conversation about her period, Premier Physician Network (PPN) providers say.

                Make sure to talk to your daughter about her period by the time she starts growing breast buds, because she will likely start her period within two years after that.

                Talk to your doctor for more information about when to talk to your daughter about her period.

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                What are steps I can take to help my daughter prepare for her first period?

                Certified Nurse Midwife Jalana Lazar discusses how to help your daughter prepare for her first period. Click play to watch the video or read the transcript.

                 

                You can help your daughter prepare to have her first period by talking to her about what she can expect to happen with her body and also talking about your own experiences.

                After you talk to her about what to expect when her period comes, take her to buy products she’ll need, including menstrual pads and tampons, Premier Physician Network (PPN) providers say.

                Even if she is going to start with pads and not use tampons right away, having them can help her understand and feel comfortable with them.

                Once she has pads, she can tuck some in her backpack in a discreet place so she can be prepared in case her first period comes while she is at school.

                Without worrying her, also talk to your daughter about menstrual cramps, feelings of tiredness, and mood swings. Help her to understand that these are normal changes that can come along with a period, but don’t affect everyone the same way.

                It’s important also to let her know that she will have a clear or white vaginal discharge for months before her first period comes, which is normal and nothing to worry about, according to the U.S. Department of Health and Human ServicesOff Site Icon (HHS).

                Menstrual cycle hygiene – including how often to bathe and how often to change tampons and pads – is another important topic. It’s good to talk about before your daughter gets her period, but she’ll probably need gentle reminders after her period comes.

                And, make sure she knows that having her period shouldn’t keep her from being active and doing the things she loves. She’ll still be able to participate in team sports, gym class, swimming, gymnastics and anything else she enjoys.

                For more information about how to help your daughter prepare for her first period, talk with your doctor.

                Learn more:

                At what age should a girl start to see an OB-Gyn provider?

                Certified Nurse Midwife Jalana Lazar discusses how to help your daughter prepare for her first period. Click play to watch the video or read the transcript.

                 

                Though girls typically start their first period between 9 and 16, it’s not necessary for them to regularly start visiting an OB-Gyn provider for their gynecologic health until they turn