Gynecologic Care at Mt Hood Women's Health
The physicians and midwives at Mt Hood Women’s Health provide care from adolescence through post menopause for all women. We focus on disease prevention through screening services and patient education. Our physicians provide both hospital based and in office gynecologic surgery.
Mt Hood Women's Health, P.C. is a member of the American Congress of Obstetricians and Gynecologists (ACOG). We have included links to selected ACOG pamphlets whenever possible. Click a topic to learn more.
Abnormal uterine bleeding is not an uncommon occurrence for women during their reproductive years and in the perimenopause and menopause. During your visit your provider will perform a history and physical exam. It is helpful to bring a calendar of your abnormal bleeding pattern with you. Any postmenopausal bleeding should be evaluated, please contact your provider.
Your first gynecologic visit should be between the ages of 13-15. This will give you an opportunity to establish care, discuss health and female related topics and most likely will not involve a pelvic exam. In addition to routine visits we offer information about menstruation, contraception,and screening for sexually transmitted diseases. These concerns can also be discussed with your pediatrician. We also offer information about the Gardisil HPV vaccine.
All Mt Hood Women's Health providers offer a well woman and preventive care exam which involves a physical, breast and pelvic exam. The American College of Obstetricians and Gynecologists (ACOG) recently revised their guidelines for how often women should be screened for cervical cancer:
- Pap smears are not recommended for women under 21 years of age regardless of sexual activity.
- If pap smears are normal, women can reduce their screening to every two years for women 21-29.
- Women over 30 can benefit from HPV testing, which is typically covered on all insurance plans.
- If you have a negative pap smear and HPV test and have had three consecutive normal Pap tests, it is now recommended that you repeat your Pap smear in three years. However, we strongly advise that you continue with your annual visits for your breast and pelvic exams. At your visit you will be updated on current Pap smear guidelines and recommendations.
Bioidentical hormones refer to hormones that are biochemically similar or identical to those produced by the ovaries. Bioidentical hormones can be found in both synthetic hormone products or compounded hormones. Compounded hormones are plant-derived hormones that are prepared, mixed, assembled, packaged, and labeled as a drug by a compounding pharmacist. These preparations can be custom made for patients according to a provider’s specifications and are not always covered on insurance plans.
The providers at Mt Hood Women’s Health recognize that all women are unique and that what works for one may not work for all patients. If you are experiencing symptoms of perimenopause or menopause and would like to discuss bioidentical hormone therapy as an option for you, please call our office for a consultation.
According to ACOG and the FDA, most compounded products, including bioidentical hormones, have not undergone rigorous clinical testing for either safety or efficacy. This is thought to be due to lack of large clinical trials. They both believe that the benefits and risks are likely to be the same as all other hormone products.
Committee Opinion on Compounded Bioidentical Hormones, ACOG Committee on Gynecologic Practice, Number 322, November 2005, Reaffirmed 2007.
Birth Control Pills
Hormonal Birth Control
Natural Family Planning
Sterilization by Laparoscopy
Sterilization for Women and Men
We offer both reversible and permanent (non-reversible) methods of birth control. There are many options available to women and we work with each patient individually to find a suitable method of contraception.
- Birth control pill instructions (PDF)
- Hormonal patch (Ortho Evra)
- Hormonal ring (NuvaRing)
- 3 month injectable (Depo-Provera)
- 3 year implant (Nexplanon)
- 5 year intrauterine device (Mirena)
- 10 year intrauterine device (ParaGard)
- Natural Family Planning (CycleBeads)
- Hysteroscopic tubal occlusion (Adiana and Essure)
Breast health exams are ideally completed annually by your healthcare provider, and breast self exams are ideally performed monthly by you. Most women experience changes in their breasts each month as part of their cycle. Completing a breast self-exam at the same time each month helps you learn what normal feels like for you. If you’re still menstruating, breast self-exams should be completed around the time your period ends. They consist of a visual inspection to look for changes, as well as a manual inspection to feel the breast tissue for changes.
Emergency contraception is birth control to help keep a woman from getting pregnant after she has had sex without using birth control or if the birth control method failed. Emergency contraception can be used to prevent pregnancy up to 72-120 hours after unprotected intercourse, depending on the method you use (see below). If you are already pregnant, emergency contraception will not work.
Use emergency contraception if:
- You did not use birth control.
- You were forced to have sex.
- The condom broke or came off.
- Your diaphragm slips out of place.
- He did not pull out in time.
- You missed at least two or three active birth control pills in a row (depending on which pill brand you use).
- You were late getting your Depo-Provera shot.
- You have reason to think your regular birth control might have failed.
There are several methods of emergency contraception available — either a birth control pill or placement of a copper IUD, which is an in office procedure. Plan B and Next Choice are pills that must be taken with 72 hours (three days) of unprotected intercourse. Ella, which is new pill, must be taken with 120 hours (five days) of unprotected intercourse.
- Plan B One-Step and Next Choice are approved for sale without prescription to women and men 17 and older. Women aged 16 and younger need a prescription.
- Plan B (the original version, which contains 2 pills instead of one) is still carried in some pharmacies but is being phased out.
- Ella is sold by prescription only, regardless of age.
Please contact your provider for further advice or an appointment.
If heavy vaginal bleeding is a problem, a hysterectomy may not be your only option. The providers at Mt Hood Women's Health can help you find the best medical or surgical treatment, such as hormonal adjustments, placement of an intrauterine device (IUD), or endometrial ablation. An endometrial ablation is a special instrument used to treat the lining of the uterus in order to alleviate heavy bleeding. The procedure can be performed in the office or in the hospital, with most patients back to routine activities within one or two days. Two popular types of endometrial ablation are:
Endometriosis is a condition where endometrial tissue, which makes up the lining of the uterus, is found outside the uterus. A healthy woman’s endometrium changes in response to hormones during her menstrual cycle to prepare for a potential pregnancy. If a pregnancy does not occur, the endometrium is shed during menstruation and the process begins again.
In the case of endometriosis, endometrial tissue is found outside of the uterus, sometimes on the ovaries, fallopian tubes or the surface of the uterus and other structures. This tissue responds the same way to hormones as the uterine lining, with bleeding during the menstrual cycle, which can cause pain and lead to scar tissue over time.
Human Papilloma Virus
HPV is a very common infection in women and men. Genital HPV infections can be passed from person to person through sexual contact. Some types of HPV infections are insignificant, but some types can cause genital warts and some types can lead to cervical cancer. Changes to cervical cells that lead to cancer occur over a long period of time and can be detected through a Pap test.
Your provider will help you determine the best schedule for you for getting Pap tests. They can also discuss treatments for genital warts and whether the HPV vaccine is right for you.
Human Papilloma Virus
Like all vaccines, the HPV vaccine (Gardisil) boosts the ability of a woman’s own immune system to fight off certain types of HPV when she is exposed to them. The vaccine is designed to protect against four types of HPV – two that can lead to 70% of cervical cancer and two that can cause genital warts.
Because HPV is so common among the sexually active, Mt Hood Women’s Health follows the ACOG guidelines in recommending the vaccine for girls beginning at age nine. It has recently been approved for use in young boys, as well. While it is ideal to administer the vaccine before a young woman becomes sexually active, because the vaccine protects against several types of the virus, we still recommend it for teens and young women to age 26. The vaccine is administered in three doses given over a six-month period of time.
The inability for you and your partner to conceive can be a frustrating and challenging time. The providers at Mt Hood Women’s Health will proceed with the initial evaluation of a couple’s inability to conceive. At your first visit it is helpful to have both you and your partner present to discuss medical and surgical histories. We also offer pre-conceptual diagnostic testing. If your infertility issues require specialty care we work closely with reproductive endocrinologists in the Portland area.
Menopause and perimenopause are times of great change and the experience is different for all women. The years leading up to menopause is called perimenopause, when a shift in hormone levels can affect ovulation and cause changes in the menstrual cycle. Menopausal symptoms can range from mild to severe, including hot flashes, night sweats, emotional changes, sleep disturbances, mental changes and vaginal dryness. During these changes we feel it is important to focus on symptom relief as well as the prevention of other health issues to include bone loss, breast health, and cardiovascular disease.
Our providers have experience in managing perimenopause and menopausal changes with hormonal and non-hormonal supplements in addition to discussing bioidentical hormones.
Osteoporosis or "porous bone," is a condition in which bones become weak and can break from something as simple as a minor fall. The condition affects four times as many women as men. In fact, one in every two women over age 50 is likely to have some evidence of low bone density. What's more, osteoporosis can progress completely painlessly until a fracture occurs, most often in the hip, spine, or wrist. Hip fractures are especially worrying since they usually require major surgery and can result in permanent loss of mobility. The good news is that osteoporosis can be detected and treated. Painless, non-invasive bone density screening is available using state-of-the-art technology called a DEXA scan. This can be discussed more thoroughly with your provider.
Pelvic pain is a common complaint in women that involves a detailed history and physical exam. At your visit your provider will help to determine the cause of your symptoms which may be related to gynecologic or non gynecologic issues. Gynecologic causes of pelvic pain include endometriosis, ovarian cysts, uterine fibroids, pelvic inflammatory disease (PID), and others causes. Non gynecologic disease may include bladder problems like a urinary tract infection, digestive problems or something more serious.
Polycystic Ovary Syndrome
Polycystic ovary syndrome (PCOS) is the most common hormonal disorder among women of reproductive age. Infrequent or prolonged menstrual periods, excess hair growth, acne and obesity can all occur in women with polycystic ovary syndrome. Menstrual abnormality may signal the condition in adolescence, or PCOS may become apparent later following weight gain or difficulty becoming pregnant.
The exact cause of polycystic ovary syndrome is unknown. Women with polycystic ovary syndrome may have trouble becoming pregnant due to infrequent or lack of ovulation. Early diagnosis and treatment of PCOS can help reduce the risk of long term complications, such as type 2 diabetes, heart disease and stroke.
Premenstrual syndrome (PMS) or premenstrual dysphoric discorder (PMDD) is the name given to the collection of physical or emotional symptoms a woman may experience before the start of menstruation. Emotional symptoms can include irritability, anxiety, depression or changes in sexual desire, among others. Physical symptoms can include breast tenderness, bloating, weight gain or fatigue, among others.
Talk to your provider about your symptoms. She may recommend lifestyle changes such as exercise, diet or supplements. If your symptoms are more severe, medication may be recommended.
Sexually transmitted diseases are caused by infections that are passed from one person to another during sexual contact. Sexual contact includes vaginal, anal or oral sex. Individuals with an STD may not have any symptoms or know that they have an infection (sexually transmitted infection or STI).
STDs are caused by bacterial or viral infection. Symptoms of an STD can range from vaginal discharge and mild irritation to severe pain. Often, symptoms occur only if the disease becomes more advanced. In most cases, long-term health problems can be avoided by early diagnosis and treatment. STDs can be prevented by using latex condoms and being vaccinated against viruses such as hepatitis B and HPV.
Every woman should know how to protect herself and her partners from STDs. If you think you have an STD, please contract our office to make an appointment.
The physicians at Mt Hood Women’s Health have years of gynecologic surgical experience. We provide both hospital based and in office procedures for our patients. We see patients at both Legacy Mount Hood Medical Center and Providence Portland Medical Center.
Gynecological surgery does not always require large incisions and a long hospital stay. Often, such surgeries can be performed using much smaller incisions that are less painful and heal more easily. The biggest advantage of minimally invasive surgery is that it can frequently be performed on an outpatient basis, allowing the patient to go home the same day. Recovery and return to work, exercise, and daily activities are often faster. Other benefits can include less blood loss, lower rates of infection, shorter hospital stays, and the need for less postoperative pain medication.
Today, minimally invasive surgery may be used for:
- Hysterectomy, vaginal, laparoscopic, or robotic approach
- Laparoscopy for sterilization, endometriosis, ovarian masses, hysterectomy.
- Hysteroscopy for removal of polyps and fibroids
- Endometrial ablation, treatment for heavy bleeding
The most important things to remember are: not all surgeries can be performed using minimally invasive techniques, and not all patients are candidates for this approach. Some of the above procedures, for example endometrial ablation, can be performed in the office. Talk to your physician – your safety is our first priority.
Endometrial ablation (NovaSure) is a simple, quick and safe in office or hospital treatment for women with unusual heavy or prolonged menstrual cycles. The one time, 90 second NovaSure procedure has been proved to reduce heavy menstrual bleeding.
An intrauterine device (IUD) is a reversible method of birth control that is inserted through the cervix into the uterus by our healthcare providers in the office. There are two types of IUD on the market, the five year progesterone releasing Mirena IUD and the ten year hormone-free ParaGard IUD.
Nexplanon (Nexplanon) is a reversible method of birth control for up to three years. It is a single contraceptive rod that is placed under the skin during a short office visit.
LEEP. If you have an abnormal Pap test result, your doctor may suggest that you have a loop electrosurgical excision procedure (LEEP) as part of the evaluation or for treatment. LEEP is used to remove the area containing abnormal cells from your cervix.
General guidelines to follow after an in office or hospital procedure.
- If you have had a general anesthetic you should eat lightly until your appetite returns. If you have nausea stay with clear liquids until your nausea resolves.
- Take your pain medication as directed.
- Include a stool softener or high fiber diet if you are taking narcotic pain medication. If you have not had a bowel movement within three days of your surgery you should take Milk of Magnesia or Senokot as directed. If you have not had a bowel movement by day four, please call the office.
- If you have an abdominal incision, keep it clean and dry.
- You may shower 24 hours after surgery; use an antibacterial soap. If you have steri-strips pat the incision dry and use a blower dryer on low until dry.
- Your steri-strips may be removed at 7-10 days after surgery or at your 2 weeks office visit.
- Do not do any heavy lifting (>10 lbs) or vigorous exercise if you have had abdominal or vaginal surgery.
- Light activity includes walking daily, climbing stairs and riding in a car.
- Do not drive for two weeks or if you are on narcotics.
- Avoid tampon use and sexual activity until you see your physician.
- No tub baths, hot tubs or swimming until you discuss this with your physician.
Please notify your physician if you experience:
- Severe abdominal pain that is not relieved with your prescription medication.
- Intractable nausea and vomiting.
- Fever >100.4°.
- Heavy vaginal bleeding (more than two pads/two hours).
- Foul odor to your discharge.
- Redness or drainage from your incision site.
- Shortness of breath or chest pain.
Post LEEP procedure (PDF)
Post D&C, hysteroscopy (PDF)
Call the office for your two week post-op appointment.