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Category: Gynecologic/Women's Health Concerns

When Should I Get My First Mammogram?

The recommended time for getting mammograms is at age 40 and yearly thereafter.  However, I like to get one around age 35 as a baseline and age 40 thereafter.  The reason is that in my practice area, there seems to be higher incidence of breast cancer, especially in younger women.  So because of this demographic I get the earlier screening.

Talk to your doctor about what is best for you!

Thanks and I’ll talk to you soon.


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What Is This Quad All About?

We spend a good amount of time explaining tests and test results to patients during routine office visits.  One particular test often leads patients’ to anxiety and misunderstanding: The Quad Screen.


The Quad Screen is a test from the mothers blood, drawn between 15 and 20 weeks of pregnancy.  The goal of the test is to evaluate the risk (or chance) that the current pregnancy is affected by Down’s Syndrome, or, more rarely, other chromosome abnormalities.

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Types of Hysterectomies

There are always confusion regarding the type of hysterectomy that we do.  The term “partial hysterectomy” or “total hysterectomy” is often used by our patients.  Unfortunately, these terms are used so loosely that it gives us little information.

The key thing with hysterectomy is whether the ovaries are left in or not.  Some one that undergoes a hysterectomy and have both ovaries removed is termed hysterectomy with bilateral oophrectomy (removal of ovary).  If the right ovary is removed, its termed right oophrectomy and vice versa for the left.  Hysterectomy with both ovaries left in is just a hysterectomy.  Supracervical hysterectomy is when we take the uterus out but leave the cervix behind.

Hopefully this clears it up a bit.

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Oops...Do I Need Emergency Contraception

A woman may utilize emergency contraception after a sexual encounter without protection or contraception.  Common indications include condom breakage and individual missing doses of oral contraception.

The US market offers two major products.  One contains estrogen and progesterone taken 12 hours apart.  The other contains progesterone only taken in a single dose or 12 hours apart.

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When Should I Take My Daughter For Her First "Female" Exam?

I get this question from moms all the time.  The current recommendation is that for both sexually and non-sexually active teen, age 21 should be the first Pap.

However, I feel that if they are sexually active, they need to be screened for sexually transmitted diseases, and the first Pap should be done within 3 years of sexual activity.

But, if they have problems with periods or other gynecologic issues, then they should be seen at the time of problems.

Hope that clears it up.



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"My Daughters' Periods Are Terrible!"

This is something we encounter daily as gynecologists.  Patients will often have questions regarding their daughters.  Whether just starting their periods or have terrible periods.

When girls start their periods, it means that their reproductive function is becoming active.  She is doing what evolution dictates.  Mainly reproduce.  However, sometimes it doesn’t work out as smoothly as people think.

The reason is that it takes a myriad of “hormone-dance” in order to have the perfect cycle.  It is not uncommon for girls that start the pubertal process to have hiccups in this hormonal-dance.  The resultant fluctuations in hormones can lead to irregular and unpredictable periods, painful periods and heavy periods.  Not to mention mood swings.

So those of you out there that are experiencing this, know that it is normal in most instances.  However, there are things we can do to help these poor girls to feel better and cope better with their periods.  Talk to your gynecologists and they should guide you through these interesting times.


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Sexually transmitted diseases are generally understood to be transmitted through sexual contact, though implied, is the concept of ‘disease’, generally meaning some visible sign of infection (vaginal discharge, burning on urination, pain or a sore/bump.)  With HPV, there may not be visible signs of infection, you may only learn of it because of an abnormal pap smear result.  HPV is an extremely common virus, the CDC noting that 50% of men and women may get the virus at some time in their lives.  HPV causes genital warts and cervical cancer, and can be detected early on a pap smear, without any noticeable sign of having the infection.  The CDC uses the terms sexually transmitted disease and sexually transmitted infection simultaneously, recognizing that some STD’s may be present even in the absence of any symptom.  So in answering the question is HPV a STD, I’d say it’s a sexually transmitted infection, but the general answer is still YES…condoms everyone!

Suzanne Hall, MD

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Is It Hot?

Is it hot…or is it just me?

Well if you’re experiencing menopause related hot flashes, it’s not just you. Approximately 60-80% of menopausal women have hot flashes.  Hot flashes are described as wave of warmth or heat sensation involving mostly your chest, head, and neck area.  Some women feel a bit anxious with it happens, others may feel their heart beating faster.  For many women the sensation is more intense or may occur mostly at night, thus the term night sweats.  The episode generally resolves on it’s own within 2-4 minutes, but may leave you feeling chills, clammy or wet from the sweat. Night sweats can be especially bothersome because they may interrupt sleep, leading to next day fatigue.  The mainstay of treatment for significantly disturbing hot flashes has been hormone replacement therapy.  Others suggest herbal or plant derived products. There’s so much to discuss regarding menopause, we’ll be covering it over several posts. Look for more on symptoms of menopause, and risk versus benefits of various treatment options in the next few posts…

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When Can I Stop My Pap?

One misconception among women is that a Pap equates a speculum exam or vice versa.  A Pap smear is a simple smearing of the cervical cells when we do a speculum exam.  A speculum is the way we can visualize the cervix itself.  There are many other reasons we’ll do a speculum exam without actually doing the Pap smear (i.e. check for vaginal infections).


The current recommendation is that it is reasonable to discontinue Pap smears at either 65 or 70 years of age if they had 3 consecutive normal Paps.  They also have to have had normal Paps in the last 10 years.  If screening is discontinued, risk factors should be assessed yearly to see if it needs to be reinstituted.


Now this doesn’t mean you don’t need a pelvic exam ladies.  Even though a Pap may not be needed, you still need yearly breast, pelvic and rectal exams to screen for other problems.


I know many of you were hoping that you can get out of pelvic exam.  Sorry :(



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A Colorful Explanation of...Endometriosis

I often jokingly comment to my patients, “No matter what our skin color is on the outside, We’re all the same color on the ‘inside’…literally.” And it’s the truth. From an anatomical perspective, our inner organs are all the same color, despite skin color or race!

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Why Do I Need a Colonoscopy?

Let’s admit it, who really wants to have a colonoscopy?  I’m not in line to volunteer yet.  But I will when I turn 50.  It can save your life.

Colonoscopy is when a small camera is inserted through the rectum and it is snaked around your entire colon to look for polyps or cancerous lesions.  It is recommended for both men and women starting at age 50 for colon cancer screening.  If you have a family history of colon cancer (first degree relative), you may need to get it earlier.

The prep is probably the worst.  You have to drink a bowel prep of your doctor’s choice until you run clean.  The procedure itself is not terrible since most people are sedated.

So don’t put it off too long.  Talk to your doctor about screening colonoscopies.  I will be getting one when I turn 50.


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Why Do I Need a Hysterectomy?

This is a topic that a lot of patients have questions on.  When women are told they need a hysterectomy, questions start swirling in their heads.  One of the most common question is WHY?

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'How' Will My Hysterectomy be Performed?

Understanding the Routes of Hysterectomy

When you and your gynecologist have decided on hysterectomy as the treatment of choice for your gynecologic diagnosis, there are several routes by which a hysterectomy may be accomplished. A total hysterectomy is the surgical removal of the uterus, and when indicated, the additional removal of the fallopian tubes and ovaries (termed salpingoophorectomy) may be recommended.

There are several routes by which a hysterectomy can be performed. You and your gynecologist will decide on the safest route for your hysterectomy based upon the reasons and clinical circumstances for the hysterectomy, your health history and the surgeon's clinical expertise.

The 4 main routes by which a hysterectomy is performed are abdominally, laparoscopically, Davinci assisted laparoscopically or vaginally. In an abdominal hysterectomy an abdominal skin incision (similar to a cesarean section incision) is made to accomplish the surgery. This route is especially advantageous when large uterine fibroids or significant abdominal adhesions are anticipated, allowing for more exposure to accomplish the surgery safely. Compared with the other minimally invasive routes, abdominal hysterectomy generally requires a longer hospital stay and longer recovery time.

Laparoscopic hysterectomy involves the use of a narrow camera (termed a laparoscope) and surgical instruments placed through small abdominal skin incisions to detach the uterus, which is then most commonly delivered through the vagina. This route may be selected when abdominal adhesions or a moderate-to-large sized uterus are suspected. The advantage with this minimally invasive approach is a shorter hospital stay and faster recovery time, when compared with abdominal hysterectomy. Your surgeon may offer Davinci hysterectomy, an advanced form of laparoscopic surgery, with proposed improved precision, visualization, and technical capabilities, for more complex procedures.

In the vaginal route (termed vaginal hysterectomy) the uterus is completely removed through the vagina, thereby avoiding any abdominal incisions. This route may be selected for a normal-to- moderately enlarged uterus, for pelvic organ prolapse, or when significant abdominal adhesions are not suspected. As with laparoscopic and Davinci hysterectomy, a shorter hospital stay and faster recovery are expected.

Though hysterectomies are the most common gynecologic surgery performed among women in the United States , any surgical procedure has inherent risks. Hysterectomy may be the best choice for your gynecologic condition. Be sure to consult with your physician in understanding the risks versus benefits…and your options.


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