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Devine Ob/Gyn

Health Education

 New patient forms: Download and bring to your appointment.

 For information you can trust from the leading experts in women's health care, please click this link to The American Congress of Obstetricians and Gynecologists, where you find resources on many women's health topics.  This site has many different topics that you can scroll through and review.  

March of Dimes also has a site discussing many women's health issues. To learn about fertility treatments go to marchofdimes.com/fertility.  Other websites recommended are the site maintained by the U.S. Department of Health and Human Services and the American Cancer Society.  


 

Treatment options for Bleeding and Pain in Non-pregnant Women

While most women are not having life threatening amounts of bleeding, it is our first objective to be sure you are not low on fluids and are hemodynamically stable, meaning no sign of severe anemia.  This kind of bleeding needs to be stressed to our staff when calling or messaging us and is a medical emergency, so should require immediate office and admission for hospital evaluation.

The causes of abnormal uterine bleeding including heavy menstrual and intermenstrual bleeding are classified in medical terms based on a PALM-COEIN system: Polyp, Adenomyosis, Leiomyoma, Malignancy and hyperplasia, Coagulopathy, Ovulatory dysfunction, Endometrial, Iatrogenic, and Not otherwise classified. The first four are structural causes and the last 5 are non-structural causes.

When considering options for the treatment of abnormal uterine bleeding or gynecologic pain we would like to supplement our office discussions and the ACOG site listed above with the links attached here.  The options include medical or surgical treatment. 

The medical options include intravenous conjugated estrogens for 24 hours in women with very heavy bleeding. Hormones like combined oral contraceptive pills as well as medroxyprogesterone acetate or progestin.  A newer option of Lysteda works well for some patients.  The Mirena intrauterine system works not only for contraception, but is FDA approved for the use of decreasing uterine bleeding. 

 Surgical options vary depending on your desires for future pregnancies.  Hysteroscopy is a procedure where we look at the lining of the uterus with a special scope and treat polyps and sample any abnormalities.  A dilation and curettage or D and C of the uterus can also be helpful, and is done with or without hysteroscopy.  We offer Novasure  as an endometrial ablation if you are sure you do not want any more pregnancies.  Laparoscopy can be used to evaluate for endometriosis and treat abnormalites like adhesions or ovarian cysts.  Hysterectomy or removal of the uterus with or without the tubes and ovaries is sometimes the best option.  Many of our patients have found the site for HysterSisters helpful in making decisions.  Additionally we offer minimally invasive surgery with Da Vinci Robotic surgery at Covenant Hospital or at University Medical Center. 

 

Contraceptive options

Contraception is such an important topic in women's health.  Permanent options for contraception to review are Laparoscopic tubal ligation, Essure or hysteroscopic tubal occlusion, tubal ligation done at the time admission for delivery or vasectomy for your partner.  

Long active reversible contraception is a good option for women today. There are now three choices of intrauterine systems or IUDs including Mirena which lasts 5 years, Skyla is a smaller IUD and lasts 3 years and Paragard the copper IUD which provides contraception for 10 years.   Nexplanon is a progesterone-only implant which lasts 3 years.

The hormonal methods of the patches, vaginal rings and combination pills are all useful methods of birth control. The combination estrogen and progesterone ring, Nuvaring and patch, Ortho-Evra have similar horomonal regimens to oral contraceptive pills, but a different route of administration, that many women prefer.  Daily combination oral contraceptive pills are one of the most commonly used options for birth control. Progesterone only options of the Depo-Provera injection or progesterone only pill decrease some risks of headache and are better for most women who are currently breastfeeding.  There is no estrogen in either Depo-Provera or progesterone only "mini-pill.'

 

Emergency contraception with birth control is an option if taken within 72 hours of unprotected intercourse.  Non-hormonal options include barrier methods such as condom or diaphragm, and periodic abstinence, which is also called natural family planning

 

 Pelvic prolapse: ACOG videos on uterine prolapse rectocele, cystocele and enterocele. 

 

Pain management in labor and delivery

 It is important to be informed about your options for management of pain in labor and delivery. A good source for information about epidurals in labor is found by clicking this link to the site for Northstar Anesthesia.

 

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