Gynecological care — is this normal?

Most women would rather not discuss symptoms like abnormal bleeding, pelvic pain, or involuntary urinating when they laugh. However, sharing this kind of highly personal information with your medical provider can help you lead a more comfortable, and potentially longer, life.

Let’s start with uterine bleeding. From the time women have their first menses until menopause, monthly bleeding is the norm—but how much is too much? The first step is diagnosis, or figuring out the cause of the problem. Abnormal uterine bleeding is typically caused by hormonal imbalances, fibroids, or cancer, and the sooner you know what’s wrong, the sooner you can address it. We often perform a hysteroscopy to diagnose the problem; that is, we look inside the uterus with a scope. If there are polyps or fibroids, we can often remove them through the vagina right then and there. If it looks like cancer, you’ll be referred to a gynecological oncologist.

Sometimes endometriosis can cause heavy bleeding. In years past, if medicine didn’t fix the problem, the only option was a hysterectomy, a major surgical procedure to remove the uterus. But now, an effective option for many is ablation, or sealing the lining of the uterus, which is an outpatient procedure with no incisions and only takes about 20 minutes. Both ablations and hysterectomies end a woman’s ability to bear children, so these options are not right for everyone.

Abnormal bleeding doesn’t always mean too much bleeding. It can mean too little. If nonmenopausal women do not have regular periods, their bodies can store up all that blood and then bleed too much all at once causing anemia and other problems. A lack of bleeding is often accompanied by not ovulating, which can lead to fertility problems and other health problems.

It may indicate polycystic ovarian syndrome, which increases the risk of diabetes, high blood pressure, high cholesterol, uterine cancer and ovarian cancer. So, although it may be convenient not to bleed each month, it isn’t healthy.

The next big symptom is pelvic pain. Pelvic pain has many causes. To diagnose the underlying causes of pain, we typically start with a blood test or ultrasound, a scan that uses high-frequency sound waves to capture live images from the inside of your body. Sometimes, however, we need to do exploratory surgery using laparoscopic (or minimally invasive) techniques. Laparoscopy can serve as the tool for both diagnosis and treatment because once we’re able to view the problem, we can often take care of it on the spot.

Common causes of pain include ovarian cysts, scarring, and adhesions. Most cysts are benign, or non-cancerous, and they only cause pain when they twist, leak, or rupture. Many cysts disappear on their own, but some must be surgically removed. Scarring and adhesions can be caused by prior surgeries or other bodily trauma, so fixing the problem can be difficult: more surgery may fix the old adhesion but create a new one, and some people are more susceptible to scarring than others.

Although surgery is often a last resort, sometimes it is the very best option. A tubal ligation, or having your tubes tied, is a safe and effective surgical intervention for permanent sterilization, and when women opt to have their fallopian tubes removed entirely, they can reduce the risk of ovarian cancer significantly.

The last problem I’ll mention here is prolapse of the uterus, bladder, and/or rectum, common in women older than 50. Prolapse means a relaxing of the tissues that hold these organs in place, and it can lead to involuntary urination (i.e., urine loss when you laugh), the feeling of having a bulge between your legs, or trouble with bowel movements. Nonsurgical interventions include strengthening the muscles of the pelvic floor, estrogen therapy, and pessaries, plastic devices that support the pelvic region. Surgical interventions are also available.

Visiting your medical provider annually is a great way to stay healthy. You’ll be screened for cancer and sexually transmitted infections and asked questions about your psychological health and domestic safety. These confidential visits can provide you with the support you need to feel healthy and safe.

Dr. Smith is an obstetrician and gynecologist at Care for Her, the women’s health service at MCHC Health Centers, a local, nonprofit, federally qualified health center offering medical, dental and behavioral health care to people in Lake and Mendocino counties.