Abnormal Pap and Cervical Dysplasia Follow Up Plans

Knowing what to do next after an abnormal pap can be both confusing, anxiety producing and a matter of the prevailing gynecologic thought. So if you thing your gyno has been changing her mind, you are lightly right, but you may also have choices. We are most concerned with women who have been diagnosed with the most severe pap smear changes that are not cervical cancers, but have to be carefully monitored.Moderate and severe dysplasia, also called CIN II and III is diagnosed in 500,000 American women each year. Aggressive diagnosis and treatment has lead to successful prevention of cancer and death. But then what is next for these women? Here is where guidelines for care have gotten a bit confusing. Choice and careful follow up is usually the best. For many of us who treat young women it’s important to be able to discuss what may be recommended by the next gyno, as many women will move and have several gynos over time and several follow up strategies offered. Your abnormal pap condition may have been treated, but remember, the virus or the condition that led to the acquisition of the virus is often still present, and the future gyno plan is debated among eperts, as explained in the November "Green Journal" Obstetrics and Gynecology, talks about women who have been completely treated, with clear margins on LEEP or conizations (operations to clear the CIN) can be followed by some combination of pelvic exams, HPV tests, type specific HPV plans, pap smears and colposcopies. And the guidelines do offer some flexibilities. No where do women have unlimited medical coverage for these follow up tests, so that cost effectiveness was the goal of the recent study undertaken by the newest group to look into this. The article clearly states that the precise order of tests, the timing of the tests, and the number of tests that an individual woman should have to maximize safety or to be reasonably safe has actually not yet been determined. This article evaluated 12 (!) different strategies on the most moderate risk individuals, as women with extensive residual disease, and multifocal (lots of spots, like in the vagina as well as on the cervix, or in the rectum) disease are the most high risk. They don't talk about women who have complicating STDs like Herpes or CT at the time of follow up, those are also separate cases. Other strategies are possibly as effective or more effective, just so women can know that they need to understand some basics when evaluating what advice they are getting.So, to make this clear, you need to sit down with your gyno and come up with a personal plan, based on your own goals, and your own risks, and your own cost effectiveness thoughts.

Passing Your Uterine Lining, Menstrual Period Norms

Decidual Cast Periods can be fairly easy, passing some tissue at a time, or off can come the whole lining in one piece called a decidual cast. Generally the lining of the uterus is only 6-8 mm thick at the time of the menstrual period, and it is shed gradually, a few cells at a time. The decidual cast is when the entire lining passes spontaneously. It's not uncommon, but it usually both uncomfortable, and alarming to some. But us women are designed to have some sort of periods Or Not? We have to pass tissue each month. Or Not? Are they good for us? Or Not? Do we want them? Or Not? Is this something that is individual? Or Not? It's a complex topic that I will be discussing a lot over my time in this blog. So lets start with basics: How much do we bleed and what are we loosing, and just what was this that the patient passed? And another basic: track your periods, and the Women's Health Practice site http://www.womenshealthpractice.com/media/pdf/menstrual_chart.pdf you...

You Have an IUD: But a Positive Pregnancy Test

Fortunately IUD pregnancy failures are rare. But if you have an IUD for contraception, and you get a positive pregnancy test, you probably ask yourself, what next? Well, make your gyno appointment promptly, this is a condition that is not typically an emergency, but it can be and it’s not handled over the phone or on a blog, or through self diagnosis! That being said, some researchers from University of Texas Southwestern Medical Center in Dallas decided to look back at over 4100 women who had IUDs and of those 42 cases who became pregnant in their institution, over about a year period of time, to help understand what these women could expect when they got to their gyno and what actually happened to their pregnancies. Accurate pregnancy diagnosis, pelvic examination, and pelvic ultrasound were the cornerstones of the evaluations. They had very specific ways they looked at their ultrasound to prove there was no pregnancy in the fallopian tube, or partially in the fallopian tube...

Post-Endometrial Ablation Syndrome

If you have had an endometrial ablation and have developed symptoms of pelvic pain you might have post endometrial ablation syndrome. What is post-endometrial ablation syndrome? It is a constellation of symptoms due to entrapped blood or tissue within a uterus that has previously undergone an endometrial ablation. We are able to diagnose this at Women's Health Practic e but occasionally other conditions are causing similar symptoms. Other complications of endometrial ablation include pregnancy, risks from pre-existing conditions such as a polyp or fibroid, an infection of the uterus, or a pregnancy. If you have had a tubal ligation then it is possible that the condition could be post-ablation tubal sterilization syndrome. The ablation procedure is designed to destroy all lining tissue, but in fact there is no way to confirm the completeness of the ablation. It is thought that either residual or regrowth of the tissue is producing the symptoms of post-endometrial ablation syndrom...

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