Bone Density Scans (DEXA)

DEXA Scan stands for “Dual Energy X-Ray Absorptiometry.” It is a method of Bone Mineral Density Assessment, which is used to screen for osteoporosis. In general, women with a family history of osteoporosis, early menopause, history of bone fracture, certain medication usage and other factors are recommended to have DEXA scans. After reviewing your history and discussing it with you your doctor will determine if you are a candidate for a DEXA scan.

How DEXA Scans are Performed

DEXA is a completely painless, non-invasive test. While lying on the scan table, fully clothed and breathing normally, a scanner passes over your lower spine and hip area. A dual energy beam of very low dose x-rays passes through that area of your body and is measured by a detector. You will not feel anything during the exam. The technology works by measuring the amount of x-rays that are absorbed by the bones in your body. The dual x-ray energies allow the machine to differentiate between bone and soft tissue, giving an accurate estimate of bone density. A report is produced for your physician based on the bone density measurements and your medical history.

For more information, here is a link to the page on American College of Radiology/Radiology Society of North America’s patient education website regarding DEXA scan:
http://www.radiologyinfo.org/en/info.cfm?pg=dexa&bhcp=1

If you are scheduled for a DEXA Scan at our office:
Patient Risk Assesssment Form

Cervical Cryotherapy

Cryotherapy destroys abnormal tissue on the cervix by freezing it. Cryotherapy destroys some normal tissue along with the abnormal tissue. During cryotherapy, liquid nitrogen, which is very cold, circulates through a probe placed next to the abnormal tissue. This freezes the tissue for 2 to 3 minutes. It may be allowed to thaw and then be refrozen for another 2 to 3 minutes. A single freeze treatment for 5 minutes may also be used. One cervical cryotherapy is usually sufficient to destroy the abnormal tissue.

How Cervical Cryotherapy is Performed

Your doctor will place a small freeze-probe (cryoprobe) against the cervix that cools the cervix to sub-zero temperatures. The cells destroyed by freezing are shed afterwards in a heavy watery discharge. The freezing usually lasts about five minutes with a slight amount of discomfort.

For more information on Cervical Cryotherapy:
http://www.webmd.com/cancer/cervical-cancer/cryotherapy-for-abnormal-cervical-cell-changes

If you are scheduled for Cervical Cryotherapy at our office:
Patient Instructions and Consent Forms

Colposcopy

When your Pap test results indicate abnormal cells, or, if your doctor wants to assess problems such as genital warts on the cervix, an inflamed cervix (cervicitis) or, to check the result of treatment, your doctor may recommend a colposcopy. This is a medical procedure that uses a small binocular microscope (a colposcope) to examine your cervix.

You should not use vaginal medication, douches or tampons, and avoid having sexual intercourse for 24hrs prior to the colposcopy. Also, this test should not be done when menstruating.

How Colposcopy is Performed

This procedure is done in our Libertyville office, and is similar to what you experience during a Pap test. The doctor will place a speculum into your vagina to see your cervix. The colposcope is then used to view your cervix from outside your body – it is not inserted internally. Diluted vinegar is applied to your cervix and areas that are abnormal turn white and can be seen more easily. A biopsy can then be taken of any abnormal areas. This may cause mild pain and cramping (much like menstrual cramps). Cells are usually also removed from the endocervical canal (the opening to the uterus in the center of the cervix) with a small spoon-shaped tool called a curette; this takes about 10 seconds. All specimens are sent to the lab for review by a pathologist.

You may have a brownish discharge for a few days afterward. Over the next several days your cervix will heal and to help prevent infection you should avoid tampons, douching and sexual intercourse.

For more information on colposcopy:
http://www.cancer.gov/cancertopics/understandingcervicalchanges
http://www.acog.org/publications/patient_education/bp135.cfm
http://www.mayoclinic.com/health/colposcopy/WO00097

If you are scheduled for a Colposcopy at our office:
Patient Instructions and Consent Form

Endometrial Ablation

Women who are experiencing heavy menstrual bleeding and who have completed childbearing may be good candidates for endometrial ablation – treatment of the lining (endometrium) of the uterus, which reduces, or eliminates, future bleeding.   Endometrial ablation is a safe, simple procedure that controls heavy menstrual bleeding without the need for hormones and may be an alternative to a hysterectomy for some patients.

There are several ways to perform an endometrial ablation using various devices (i.e. Novasure, ThermaChoice, and HydroThermAblator).   Our physicians are familiar with all of these methods and will determine which is right for you. Most endometrial ablations can be performed under local anesthesia at our Libertyville office.

If you are planning to become pregnant in the future, endometrial ablation is not for you. Pregnancy following endometrial ablation is very dangerous for both the mother and the fetus and should not be attempted. Some form of birth control should be used after endometrial ablation.

Your doctor will discuss this option with you to determine if it is right for your condition.

How NovaSure® Endometrial Ablation is Performed

NovaSure uses radio frequency (RF) to remove the lining of the uterus.   Performed in the office, using local anesthetic, your doctor slightly dilates the cervix and inserts a slender wand through the cervix into the uterus (1). The doctor then extends a triangular mesh material through the wand, where it expands to conform to the dimensions of the uterine cavity (2). Radio Frequency energy is then delivered into the uterus for approximately 90 seconds (3). The triangular mesh array is then removed from the uterus (4).

For a patient brochure on NovaSure®
http://www.novasure.com/irregular-period/novasure-procedure.cfm?src=aw&camp=S&gclid=COyKtJHQyZICFQE8xwodhkNibA

How GyneCare ThermaChoice ® Uterine Balloon Procedure is Performed

After receiving local anesthetic, the doctor inserts a balloon through the neck of the womb (cervix) and into the uterus. Through a catheter connected to a controller console, the balloon is inflated with fluid and heated to 188 F (87 C) for eight minutes to destroy the uterine lining.

For a patient brochure on this ThermaChoice ® Uterine Balloon System:
http://www.endheavyperiods.com/about.html

How the Hydro ThermAblator ® is Performed

After receiving local anesthetic, this office procedure involves delivery of hot salt water (saline solution) into the uterus through a tube inserted into the cervix. The hot water destroys the uterine lining in about 10 minutes. The doctor uses a hysteroscope for viewing the uterus during the procedure.

For patient education information on HydroThermAblator ®:
http://www.uterus1.com/care/uterusprocedure20.cfm/15?CFID=118223604&CFTOKEN=98564578

If you are scheduled for Endometrial Ablation at our office:
Patient Instructions and Consent Form

Endometrial biopsy

An endometrial biopsy is a way for your doctor to take a small sample of the lining of the uterus (endometrium). The sample is looked at under a microscope for abnormal cells. An endometrial biopsy helps your doctor find many problems in the endometrium. It also allows your doctor to check to see if your body's hormone levels that affect the endometrium are in balance.

An endometrial biopsy may be done for various reasons. When a woman is having a hard time becoming pregnant, an endometrial biopsy may be done to see whether the lining of her uterus can support a pregnancy. An endometrial biopsy may also be done to find the cause of abnormal uterine bleeding, to check for overgrowth of the lining (endometrial hyperplasia), or, to check for cancer.

How An Endometrial Biopsy is Performed

This test is performed in our office and does not require any anesthesia. Once a speculum is placed in the vagina, the cervix is cleansed with an antiseptic solution and a thin, flexible catheter (a pipelle) is inserted into the uterus. The catheter is moved in and out of the cervix, about three times, to collect small pieces of endometrial tissue. The tissue is then placed in a preservative and sent to the lab for analysis by a pathologist. The entire procedure takes slightly longer than the amount of time it takes to obtain a Pap smear. The test usually causes some cramping which may be alleviated by taking 400-600mg of ibuprofen prior to the biopsy or shortly thereafter. There is often 2-3 days of light bleeding after the biopsy is performed.

For more information on Endometrial Biopsy:
http://women.webmd.com/endometrial-biopsy

http://www.acog.org/publications/patient_education/bp095.cfm

If you are scheduled for Endometrial Biopsy at our office:
Patient Instructions and Consent Form

Non-invasive Tubal Occlusion (elective sterilization) via Hysteroscopy (i.e. ESSURE System ®)

For those women who decide they want permanent sterilization as their method of birth control, the FDA has approved a procedure that is an alternative to the traditional method of surgical tubal ligation (fallopian tubes severed and sealed or "pinched shut", in order to prevent fertilization).

Performed in our Libertyville office, your doctor will use the Hysteroscope to insert spring-like coils, called “micro-inserts” into your fallopian tubes. There is no cutting into the body. During the three months following the procedure your body forms scar tissue that completely blocks the fallopian tubes.

This method is NOT reversible and is recommended only for women who do not want to become pregnant in the future. Consult your doctor to determine if Non-invasive Tubal Occlusion is right for you.

For patient information on the ESSURE System ®:
http://www.essure.com/Home/Downloading/EssureProcedure/tabid/99/Default.aspx

If you are scheduled for an ESSURE procedure:
Patient Instructions and Consent Form

Hysteroscopy

A hysteroscopy is a way for your doctor to look inside of your uterus. This procedure can be performed in our Libertyville office. Your doctor uses a thin viewing tool called a hysteroscope. This instrument has a light and a camera hooked to it so your doctor can see the inside of the uterus on a video screen.

There are several reasons for performing a hysteroscopy. It is often done to find the cause of abnormal bleeding or bleeding that occurs after a woman has passed menopause. It may also be used to see if there is problem in the uterus that may be the reason a woman cannot become pregnant (infertility) or has repeated miscarriages. In addition, a hysteroscopy can be used to treat growths in the uterus, such as fibroids or polyps. It is also used to place contraceptive implants (Essure) into the opening of the fallopian tubes as a method of permanent sterilization.

How Hysteroscopy is Performed

A local anesthetic is used to numb the cervix. The tip of the hysteroscope is gently moved through the cervix into the uterus. A liquid is then released through the hysteroscope to expand the uterus for better visualization. The inside of the uterus and the openings to the fallopian tubes can then be inspected by your doctor. A small instrument can be inserted through the hysteroscope to take a biopsy if necessary.

After the procedure you may experience slight vaginal bleeding and cramps.

For more information on Hysteroscopy:
http://www.health.harvard.edu/diagnostic-tests/hysteroscopy.htm
http://www.acog.org/publications/patient_education/bp084.cfm

If you are scheduled for a Hysteroscopy at our office:
Patient Instructions and Consent Form

Loop Electrosurgical Excision Procedure (LEEP)

The loop electrosurgical excision procedure (LEEP) is used to remove the abnormal area of cells on the surface of the cervix. The presence of abnormal cells does not mean you have cancer, but treatment of the abnormal area is important to prevent the cells from developing into cervical cancer.

How LEEP is performed

A speculum is inserted into the vagina to view the cervix. A vinegar solution is then applied to the cervix to make the abnormal cells visible. Your physician then places a colposcope (small binocular microscope) near the opening of the vagina. The colposcope, which remains outside of the vagina, provides a magnified view of the cervix.
The cervix is then numbed with local anesthesia. A fine wire loop which is attached to a high-frequency electrical generator is inserted through the speculum and up to the cervix. This loop allows very precise removal of abnormal tissue from your cervix. Because the procedure is so exact, and the loop very thin, there is very little damage to the tissue surrounding the area that needs to be removed. The electric current allows for the blood vessels surrounding the area to be sealed so there is very little bleeding. You may experience a dull ache or cramp during the procedure. Finally, a medicated paste may be applied to the area to prevent bleeding.

After the procedure, there may be bleeding (lighter than a period), mild cramping and possibly a brownish discharge from the medication used to prevent excess bleeding. The cervix takes several weeks to heal so tampons, douches and sexual intercourse should be avoided. Also, heavy lifting and exercise should not be done for a few days after the procedure.

This technique allows your physician to send the excised tissue to the lab for further evaluation, ensuring that the lesion was completely removed, as well as allowing for a more accurate assessment of the abnormal area.

For more information about the LEEP Procedure: http://www.acog.org/publications/patient_education/bp110.cfm http://www.clevelandclinic.org/health/health-info/docs/0600/0642.asp?index=4711

If you are scheduled for a LEEP at our office:
Patient Instructions and Consent Form

Intrauterine Device (IUD) Placement/Removal

The intrauterine device (IUD) is an effective long-term birth control method. The two types of IUDs that are available in the United States are the hormonal IUD, which releases a small amount of hormone (levonorgestrel) directly to the uterus, and the copper IUD. The hormonal IUD can be used for up to five years before it needs to be replaced and the copper IUD can be left in place for ten years. Both IUDs can be removed sooner if pregnancy is desired. Your doctor will explain the differences between the IUDs and you can determine which is best suited for you. IUDs can be placed in either of our offices in a quick and simple procedure. You can check that the IUD is in place by feeling for this string. Do not attempt to remove your IUD – your doctor will remove it safely.

How the IUD is Inserted

IUDs are usually placed during the first five days of your menses. This is done for two reasons, it ensures that you are not already pregnant and it also makes the procedure easier because your cervix is slightly dilated during the menstrual flow.

Your doctor will do a bimanual pelvic exam to determine the position of your uterus. She will then insert a speculum into your vagina to visualize the cervix and cleanse the cervix with an antiseptic. A probe is placed into your uterus to determine its length. The IUD insertion tube is then passed through the cervix to the top of the uterus and the IUD is released as the insertion tube is removed. The IUD string which hangs down through the cervix is trimmed to 1-2 inches from the cervix and the procedure is completed. Slight cramping is expected during the procedure and may last for a short time afterward.

A follow-up appointment is usually scheduled for 6 weeks after IUD insertion to check that the IUD is in place. Thereafter, you can check that the IUD is in place by feeling for the string in the vagina near the cervix. Do NOT attempt to remove your IUD---it can be safely removed by your doctor.

For more information on the IUD: http://www.acog.org/publications/patient_education/bp014.cfm
http://www.webmd.com/sex/birth-control/intrauterine-device-iud-for-birth-control
http://www.paragard.com
http://www.mirena-us.com

Ultrasound

Unlike x-rays which use radiation, ultrasound is a technology that uses sound waves (sonography) that produce images of internal organs, and, for pregnant women, the image of their fetus inside the uterus. It is commonly used in gynecology to examine the ovaries to detect abnormalities, such as cysts or masses, and to examine the uterus and endometrial lining to diagnose the reason for abnormal menstrual bleeding. Ob-Gyne Associates of Libertyville offers ultrasound testing for our patients at our Libertyville office.

For more information on Ultrasound:
http://www.acog.org/publications/patient_education/bp025.cfm

Fetal Non Stress Testing

The Fetal Non-Stress Test (NST) is a simple, non-invasive test performed in pregnancies over 28 weeks gestation, which poses no risks or side effects for the mother or baby. The test is named “non-stress” because no stress is placed on the fetus during the test.

How NST is Performed

The test involves attaching one belt to the mother’s abdomen to measure fetal heart rate and another belt to measure contractions. Movement, heart rate and “reactivity” of heart rate to movement is measured for 20-30 minutes. If the baby does not move, it does not necessarily indicate that there is a problem; the baby could just be asleep. A nurse may use a small “buzzer” to wake the baby for the remainder of the test. Your doctor may recommend the test if you if you are diabetic, have high blood pressure, are beyond your due date, some changes in fetal movement or growth are noted, or are considered high risk for any reason.

For more information on the fetal NST:
http://www.webmd.com/content/pages/2/3608_848.htm