Uterine fibroids: Uterine fibroids (leiomyomata) are non-cancerous growths that develop in or just outside a woman’s uterus. They develop from normal uterus muscle cells that start growing, causing the uterus to become much larger in size. The cause is unknown, but their growth seems to depend on estrogen, the female hormone. They primarily develop after age 30, and women may first become aware of them when they note an increasing waist size. Uterine fibroids shrink or disappear after menopause, when estrogen levels fall. Uterine fibroids are often responsible for very heavy menses leading to anemia.

Abnormal menstrual bleeding: Periods are considered abnormal if they last more than seven days, have fewer than 24 days or more than 35 days between starting dates of each menses, and are very irregular or very heavy. Bleeding is considered very heavy when a woman has to change her sanitary protection (tampons or pads) more than every one to two hours. Clots larger than one inch are also indicative of very heavy menses. This type of bleeding is typically due to fibroids, but an endometrial polyp, uterine cancer or a hormonal imbalance, such as seen with polycystic ovarian syndrome, can be the cause.

Endometriosis: Endometriosis is a female health disorder that occurs when cells from the lining of the womb (uterus) grow in other areas of the body. This condition can lead to pain, irregular bleeding, and problems getting pregnant (infertility). Both hormonal and surgical approaches to management can be effective in endometriosis treatment.

Pelvic pain: Pelvic pain can be a sign that there is a problem with one of the organs in the pelvic area, such as the uterus, ovaries, fallopian tubes, cervix or vagina. It could also be a symptom of infection, or a problem with the urinary tract, lower intestines, rectum, muscle or bone. A pelvic examination and possibly a pelvic ultrasound should be done to evaluate the reason for the pain. Our expertise is in hormonal and surgical management of this condition. For women who need chronic pain medication, a referral to a pain center will be made.

Abnormal pap smears: The first step to manage an abnormal Pap smear of the cervix is to check the cervix with a magnifying instrument (a colposcope) to evaluate where the abnormal cells are originating from and make sure they are treated appropriately.

Blocked fallopian tubes: This condition can cause both infertility and chronic pelvic pain. A first step is to be sure there are no pelvic anomalies noted on a pelvic ultrasound.

High-risk conditions for ovarian cancer: Women at high risk for ovarian cancer are evaluated for whether or not they would benefit from prophylactic removal of their ovaries and fallopian tubes.

Adolescent gynecologic disorders: Young women from puberty to age 24 with gynecologic pathology are cared for by the multi-disciplinary team of physicians. Disorders include vaginal and introital conditions, ovarian cysts and masses, pelvic pain and endometriosis. Women who cannot have the usual vaginal probe can be offered the translabial ultrasound.

Pelvic Congestion Syndrome: Pelvic pain in women can be due to varicosities of the pelvic vessels. Our multi-specialty group treats these conditions non-surgically such that patients are usually treated on an outpatient basis.

Other pelvic and uterine problems: Dermoid cysts of the ovaries, genital skin conditions and vulvodynia are all conditions that can cause pain. Appropriate evaluation and management is determined on a case by case basis.

Office procedures for immediate diagnosis of problems, imaging studies, uterine conservation options, and robotic, laparoscopic and hysteroscopic techniques are provided. These services include:

Colposcopy: A special magnifying device is utilized to look at your vulva, vagina, and cervix. If a problem is seen during colposcopy, a small sample of tissue (biopsy) may be taken from the cervix or from inside the opening of the cervix (endocervical canal).

Endometrial biopsy: A small sample of the lining of the uterus is removed by an instrument placed through your vagina.

Pelvic ultrasound: A pelvic ultrasound uses sound waves to make a picture of the organs and structures in the lower abdomen (pelvis), including the bladder, ovaries, uterus, cervix and fallopian tubes. Ultrasound can also be used to insert an IUD or perform an endometrial biopsy. Our site is able to perform transabdominal, transvaginal and translabial ultrasounds.

Sonohysterogram: This procedure involves the insertion of a tiny catheter through the cervix into the uterus. A small amount of sterile liquid is infused into the catheter, which allows the lining of the uterus to be more clearly seen. This procedure uses vaginal ultrasound and is usually pain free or slightly uncomfortable (like a menstrual cramp). This test is useful for determining if there are small polyps or fibroids in the uterus and if the fallopian tubes are blocked.

Hysteroscopy: This diagnostic and surgical procedure enables physicians to examine the inside of the uterus without making an abdominal cut (incision). During this procedure, a lighted viewing instrument called a hysteroscope is inserted through the vagina and the cervix and into the uterus. Treatment can also be done through the hysteroscope during the same procedure. This procedure is used to diagnose uterine abnormalities, including conditions that cause abnormal uterine bleeding, infertility, repeated miscarriages, adhesions, fibroids and polyps. It can also be used to locate and remove displaced intrauterine devices (IUDs).

Myomectomy: This surgery removes only the fibroids and leaves the rest of the uterus intact.

Endometrial ablation: This procedure causes surgical destruction of the lining tissues of the uterus, known as the endometrium. It is one type of treatment for abnormal uterine bleeding. This procedure usually needs no incisions, as the instrument is inserted through the vagina and the cervix and into the uterine cavity. Some instruments use extreme cold, while others use heated fluids, microwave energy or high-energy radiofrequencies.

Ovarian Cystectomy: This procedure is performed during either a laparoscopy or a laparotomy. It involves a smaller incision, but a laparotomy is more often used when there are concerns of cancer, as the larger incision provides a better view of the abdominal and pelvic organs. During either of the surgeries, which are performed under general anesthesia, the doctor may remove the cyst or cysts on the ovary. This procedure, the ovarian cystectomy, preserves the rest of the ovary.

Endometriosis excision: In this procedure, the surgeon cuts around and removes the endometriotic tissue that is located in areas other than the uterine cavity.

Permanent birth control: Sterilization is considered a permanent method of birth control that a man or woman chooses. There are many ways to perform this procedure in women. In certain cases, sterilization, or a tubal ligation for women and vasectomy for men, can sometimes be reversed.

Tubal Occlusion is a surgery to block a woman's fallopian tubes such that fertilization cannot occur. The tubes connect the ovaries to the uterus. A woman who has this surgery has decided that she does not want a future pregnancy. Usually this procedure is done through the laparoscope. In this way, the tubes can be tied with sutures, have a ring or clip placed, or be cauterized. However, sterilization by hysteroscopy involves no incisions, minimal anesthesia, and virtually no recovery time. Because there are no incisions, it eliminates the risks associated with tubal ligation. The procedure involves placement of extremely small devices into the opening of each fallopian tube as the tube enters the uterine cavity (the inside of the uterus).

Our specialists also are experienced in a variety of minimally invasive techniques in the event patients require either all or part of their uterus, or womb, removed. Following this surgery, called a hysterectomy, a woman no longer has menstrual periods and cannot become pregnant.

Vaginal Hysterectomy is a minimally invasive technique for the removal of the uterus through the vagina. With this surgery, there are no incisions on the abdomen.

DaVinci-assisted Total and Partial Hysterectomy is a laparoscopic procedure for removing the uterus through small abdominal incisions. The entire uterus can be removed (called TLH, or total laparoscopic hysterectomy), or the cervix can be left in place (LSH, or laparoscopic supra-cervical hysterectomy). With both procedures, the ovaries can be removed without additional incisions. Laparoscopic hysterectomies are done under general anesthesia and the Robert Wood Johnson University Hospital inpatient stay is minimal.