SIMEDHealth

Breast Cancer Prevention Guide

photo of a mammography machine saying you should get a mammography when you turn 40

For Breast Cancer Awareness Month, SIMED gynecologist Dr. Prethi Vaddadi compiled the best information from the American Congress of Obstetricians and Gynecologists (ACOG) on breast cancer screenings, mammographies and breast cancer to equip our patients with everything they need to protect their breasts.

Why Breast Cancer Screenings Are Important

In the United States, 1 in 8 women will develop breast cancer by age 75. Regular breast cancer screenings can help find cancer at an early and more curable stage. Screenings can also find breast problems that are not cancer, according to the ACOG.

Screening for breast cancer is done using a mammography. A mammography uses X-ray technology to view the breasts. The images are called a mammogram.

A mammography is done:

1. As a screening test to check for breast cancer in women who do not have signs or symptoms of the disease
2. As a diagnostic test to check lumps or other symptoms that you have found yourself or that have been found by an OBGYN or other healthcare provider.

When You Should Start Having Mammography Screenings

If you have average risk of breast cancer, screening mammography is recommended beginning at 40 years old. If you have not started screening in your 40s, you should start having a screening done no later than 50 years old. Screenings should continue until you are at least 75, the ACOG said.

How to Prepare for a Mammography

The day of your test, make sure not to wear powders, lotions, or deodorants as they can show up on the X-ray and make your mammogram more difficult to interpret. For your mammogram, you will need to undress from the waist up and put on a gown, according to the ACOG.

If you still have periods, you may want to wait until a week after one of your periods to have the test done as breasts are often less tender after a period.

What to Expect

You will be asked to stand in front of an X-Ray machine, and your breasts will be placed between two flat plastic plates. You will feel pressure as the plates will flatten your breasts as much as possible so the most tissue can be viewed. Sometimes mammograms can cause the breasts to ache, but only briefly, the ACOG said.

What Your Screening Score Means

After your mammogram, your results will be given as a score ranging from 0 to 5.

0 – More information is needed. You may need another mammogram
1 – Nothing abnormal is seen. Keep having routine screenings.
2 – Benign conditions, such as cysts (a noncancerous sac-like structure), are seen. Continue having normal screenings.
3 – Something is seen that is probably not cancer. A repeat mammogram should be done within 6 months.
4 - Something is seen that is suspicious for cancer. You may need a biopsy (a sample of tissue taken from the body to be examined).
5 – Something is seen that is highly suggestive of cancer. You will need a biopsy.

If the biopsy indicates breast cancer, the patient will be referred to a surgeon and oncologist for further evalauation and management, according to the ACOG.

What Breast Density on Your Report Means

infographic on breast cancer including facts and testing and risk factors

Breast density means the breasts have more fibrous tissue and less fat which is normal, but may make it harder for a radiologist to see cancer. If your report says you have dense breasts, you may need to discuss other screening tests in addition to the mammography with your gynecologist or health care professional, the ACOG said.

What the Risk Factors for Breast Cancer Are

Risk factors include family history of breast cancer, ovarian cancer, or other inherited types of cancer, chest radiation at a young age, a history of high-risk breast biopsy results, and obesity. Women without these factors have average risk.

What a Breast Exam Entails

In a clinical breast exam done by your ob-gyn or other health care professional, your doctor will examine your breasts. The exafdm may be done while you are lying down or sitting up. Your breasts will be checked for any changes in size or shape, puckers, dimples, or redness of the skin. Your doctor may feel for changes in each breast and under each arm. A breast exam should be done at least annually and more often if an abnormality is found, according to the ACOG.

Why Self-Breast Exams Are Important

Breast cancer is most often found by the woman herself. In almost half of all cases of breast cancer in women 50 and older, breast cancer is found by the woman herself. In woman younger than 50, more than 70% of cases of breast cancer are found by the woman herself.

How to Perform a Self-Breast Exam

Average risk women should become familiar with and aware of the normal appearance and feel of their breasts. If they recognize a change, they should contact their gynecologist or other health care provider, according to the ACOG.

For women of greater than average risk, a breast self-examination involves examining the breasts in a systematic way. For instruction, consult with your gynecologist.

What a Benign Breast Condition Is

A benign breast condition is one that is not cancerous. These conditions usually go away on their own and are easily treated. Because a few benign conditions can increase your risk of breast cancer, you should get follow-up tests with your gynecologist, the ACOG said.

Different Types of Benign Breast Conditions Include 

Benign breast problems include pain, lumps or masses, infections, nipple discharge, and skin changes.

What Causes Benign Breast Pain

There are two types of breast pain:

1. Cyclic breast pain – It occurs in response to changes in hormone levels. Your breasts may feel swollen, more sensitive, or painful before your menstrual period. Similar symptoms may also be presented if you use combined hormonal contraceptives.
2. Noncyclic breast pain – It is not related to your menstrual cycle and usually occurs in one breast in one specific location. Many things can cause the pain including infection, i njury, and medication. In rare cases, the pain can be caused by breast cancer. 

What the Different Types of Benign Breast Lumps or Masses Are

In general there are three main types of benign breast masses, according to the ACOG.

1. Nonproliferative – This type of mass has normal cells. An example is a cyst. Cysts are usually small and go away by themselves or can be drained with a needle.  Another example is a simple fibroadenoma which usually shrinks or goes away on its own. If it is larger or keeps growing, it may need to be surgically removed.
2. Proliferative without atypia – In this breast mass type, the cells are increasing in number but otherwise remain normal. Having this type of lump slightly increases risk of breast cancer in the long term. They are usually surgically removed, but sometimes can just be watched to ensure they are not growing.
3. Atypical hyperplasia – The cells increase in number, but also do not look normal under a microscope. This type greatly increases the risk of developing future breast cancer. Surgery is recommended, along with close follow-ups.

woman with breast cancer ribbon pointing to the ribbonWhat Nipple Discharge to Watch Out For

Benign discharge usually occurs in both breasts and only when the breast or nipple is squeezed. It is usually milky white or greenish in color. Bloody or clear discharge is more concerning and is a common benign breast symptom. During pregnancy, discharge is normal as breasts prepare to produce milk, but in women who are not pregnant, it can be caused by hormonal changes and some medications. It should be checked by your gynecologist or other health care professional, the ACOG said.

What Skin Changes Can Affect the Breast

Psoriasis and eczema can affect the breast. Yeast infection of the skin folds under the breast is also common, especially among women with larger breasts. Some skin conditions can increase concern of breast cancer. These include dimpling of the skin, redness, warmth, and ulcers (small, red, painful blisters). Nipple changes like crusting, scaling, or changing shape can also raise concern. If you notice any of these symptoms, talk with your gynecologist.

How Benign Breast Conditions Are Evaluated

If you show symptoms, let your gynecologist or other health professional know. You will most likely have a breast exam, but might also have an imaging test like a mammography, ultrasound exam, or MRI, according to the ACOG.

Follow-Up Needed for a Benign Breast Condition

Most conditions don’t increase risk of cancer, but some, like breast lumps, do. If you have a condition that increases risk of cancer, more frequent clinical breast exams and imaging tests over the next 1 -2 years may be recommended based on your age, health risks, and test results, the ACOG said.

Dr. Vaddadi practices in SIMED’s Gainesville and Lake City offices. To review any of these topics, to get tested or examined for breast cancer, or just for general woman’s health issues, schedule an appointment with Dr. Vaddadi by calling 352-331-1000 or requesting an appointment online.

If you show symptoms, need a breast cancer exam, or have not had your annual gynecology visit, you can schedule an appointment with SIMED Women’s Health in Gainesville, Ocala, Lady Lake, Lake City, or Chiefland.

Gainesville: 352-331-1000
Ocala: 352-391-6464
Lake City: 352-331-1000
Chiefland: 352-331-1000
Lady Lake: 352-391-6464

You can also schedule your appointment online. Don’t wait; call or click today.

Don’t forget to follow us on Twitter and Facebook for more content!

View our article on why women in their 20s visit the gynecologist.
View our article on why women in their 30s visit the gynecologist.

 

Reasons Women in their 30s Visit the Gynecologist

Woman standing with a background behind her and information about polycystic ovarian syndrome or PCOD
As part of our women’s health series, we are highlighting common reasons women in their 30s visit the gynecologist. 
We spoke with Dr. Prethi Vaddadi, of SIMED Women’s Health, about why women go to the gynecologist, how their common problems are treated and what to look for in common gynecological issues.

Vaginitis:

Vaginitis is an inflammation of the vagina. As many as one third of all women will experience symptoms of vaginitis during their lives. Vaginitis is most common during the reproductive years.
A change in the balance of the yeast and bacteria that normally live in the vagina or a shift in a woman’s hormone levels can result in vaginitis. Symptoms associated with vaginitis include: change in color, odor or amount of vaginal discharge, itching or irritation, pain during intercourse, spotting or light vaginal bleeding, and/or painful urination.
Factors that can change the normal balance of the vagina include:
1. Use of antibiotics
2. Changes in hormone levels due to pregnancy, breastfeeding, or menopause
3. Douching,
4. Spermicides
5. Sexual intercourse
6. Infection.
To diagnose vaginitis, your health care provider will take a detailed history, examine the area and take a swab of the discharge from your vagina.

Common causes of vaginitis:

1. Yeast infection (candidiasis) 
Yeast infection is a common cause of vaginitis.  The yeast infection is usually caused by a fungus called Candida. It is found in small numbers in the normal vagina. However, when the balance of bacteria and yeast in the vagina is altered, the yeast may overgrow and cause symptoms.  
Symptoms may include
1. Itching and burning of the area outside the vagina called the vulva
2. Red and swollen vagina 
3. White, lumpy, odorless vaginal discharge
Yeast infections can be treated either by placing anti-fungal medication into the vagina or by taking a pill.
2. Bacterial Vaginosis:
Bacterial vaginosis is caused by a shift in the quantity of a particular bacteria normally occurring in the vagina.
Symptoms:
The discharge is usually thin and dark or dull gray, but may have a greenish color. Itching is uncommon, but may be present if there is a lot of discharge. The discharge odor is described as fishy, but may only be noticeable after sexual intercourse.
Treatment:
Several different antibiotics can be used to treat bacterial vaginosis, but the two that are most commonly used are metronidazole and clindamycin. They can be prescribed to be taken by mouth or via insertion into the vagina as a cream or gel.
3. Atrophic Vaginitis:
This condition is not caused by an infection, but may occur any time when female hormone levels are low, such as during breastfeeding and after menopause. 
Symptoms:
Atrophic vaginitis results in vaginal irritation, such as dryness, itching, burning, changes in urination, change in vaginal discharge, and/or painful vaginal intercourse. 
Treatment:
Atrophic vaginitis is treated with estrogen, which can be applied as a vaginal cream, ring, or tablet. A water-soluble lubricant also may be helpful during intercourse.

Sexually Transmitted Infections:

A person with an STI (Sexually transmitted infection) can pass it to others by contact with skin, genitals, mouth, rectum, or body fluids. Anyone who has sexual contact—vaginal, anal, or oral sex—with another person may get an STI. STIs may not cause symptoms. Even if there are no symptoms, your health can be affected.
STIs are caused by bacterial or viral infections. STIs caused by bacteria are treated with antibiotics. Those caused by viruses cannot be cured, but symptoms can be treated.
Common STIs: Chlamydia, Gonorrhea, Genital Herpes, HIV, HPV, Syphilis, Trichomoniasis, Hepatitis B
How can you reduce the risk of getting an STI?
Know your sexual partners and limit their numbers.  The more partners you have or your partners have had, the higher your risk of getting an STI.
Using a latex condom every time you have vaginal, oral, or anal sex decreases the chances of infection. Condoms lubricated with spermicides do not offer protection against STIs, and in fact, frequent use of some spermicides can increase the risk of HIV.
Sexual acts that tear or break the skin carry a higher risk of STIs. Even small cuts that do not bleed let germs pass back and forth. Anal sex poses a high risk because tissue in the rectum tears easily. Body fluids also can carry STIs. Having any unprotected sexual contact with an infected person poses a high risk of getting an STI.
Vaccines are available to greatly reduce the risk of Hepatitis B and HPV infections and should be received by anyone at moderate to high risk. 

Contraception:infographic about contraception for women including injection, oral contraception, implant, IUD

1. Long Acting Contraceptives
Long-acting reversible contraception (LARC) methods include the intrauterine device (IUD) and the birth control implant. Both methods are highly effective in preventing pregnancy, last for several years, and are easy to use. Both are reversible—if you want to become pregnant or if you want to stop using them, you can have them removed at any time.
The IUD and the implant are the most effective forms of reversible birth control available. During the first year of typical use, fewer than 1 in 100 women using an IUD or an implant will become pregnant. This rate is in the same range as that for sterilization.
Over the long term, LARC methods are 20 times more effective than birth control pills, the patch, or the ring.
IUD:
The IUD is a small, T-shaped, plastic device that is inserted into and left inside the uterus. There are two types of IUDs:
1. The hormonal IUD releases progestin. Different brands of hormonal IUDs are approved for use for up to 5 years and for up to 3 years.
2. The copper IUD does not contain hormones. It is approved for use for up to 10 years.
Both types of IUDs work mainly by preventing fertilization of the egg by the sperm. The hormonal IUDs also thicken cervical mucus, which makes it harder for sperm to enter the uterus and fertilize the egg, and keep the lining of the uterus thin, which makes it less likely that a fertilized egg will attach to it.
Implant:
The birth control implant is a single flexible rod about the size of a matchstick that is inserted under the skin in the upper arm. It releases progestin into the body. It protects against pregnancy for up to 3 years.
The progestin in the implant prevents pregnancy mainly by stopping ovulation. In addition, the progestin in the implant thickens cervical mucus, which makes it harder for sperm to enter the uterus and fertilize the egg. Progestin also keeps the lining of the uterus thin, making it less likely that a fertilized egg will attach to it.
2. Combined Birth Control Methods:
Birth control pills, the birth control patch, and the vaginal birth control ring are combined hormonal birth control methods. They contain two hormones: estrogen and progestin.
These hormones prevent pregnancy mainly by stopping ovulation (the release of an egg from one of the ovaries). They also cause other changes in the body that help prevent pregnancy. The mucus in the cervix thickens, making it hard for sperm to enter the uterus. The lining of the uterus thins, making it less likely that a fertilized egg can attach to it.
With perfect use—meaning that the method is used consistently and correctly each time—fewer than 1 woman out of 100 will become pregnant during the first year, according to the American Congress of Obstetricians and Gynecologists.
Vaginal Ring:
The vaginal ring is a flexible, plastic ring that is placed in the upper vagina. It releases estrogen and progestin that are absorbed through the vaginal tissues into the body.
You fold the ring and insert it into the vagina. It stays there for 21 days. You then remove it and wait 7 days before inserting a new ring. During the week the ring is not used, you will have your period. 
3. Progestin only contraception methods:
Progestin is a form of progesterone, a hormone that plays a role in the menstrual cycle and pregnancy. Progestin-only pills and the injection have about the same effectiveness as combination estrogen and progestin pills, rings, and patches.
 

Abnormal Uterine Bleeding:

The normal length of the menstrual cycle is typically between 24 days and 38 days. The vaginal bleeding in a cycle is usually 4 to 6 days, but can last up to 8 days.
Bleeding in any of the following situations is considered abnormal uterine bleeding:
1. Bleeding or spotting between periods
2. Bleeding or spotting after sex
3. Heavy bleeding during your period
4. Menstrual cycles that are longer than 38 days or shorter than 24 days
5. “Irregular” periods in which cycle length varies by more than 7–9 days 
6. Bleeding after menopause.
Some of the causes of abnormal bleeding include: 
1. Problems with ovulation
2. Fibroids and polyps
3. Adenomyosis, a condition in which the endometrium (or inner lining of the uterus) grows into the wall of the uterus
4. Bleeding disorders
5. Problems linked to some birth control methods, such as an intrauterine device (IUD) or birth control pills
6. Miscarriage
7. Ectopic pregnancy (fertilized egg implants outside the uterus)
8. Certain types of cancer, such as cancer of the uterus and cervix.
Abnormal uterine bleeding is diagnosed by obtaining a detailed health history of you and your menstrual cycle. It may be helpful to keep track of your menstrual cycle before your visit. Note the dates, length, and type (light, medium, heavy, or spotting) of your bleeding on a calendar. You also can use a smartphone app designed to track menstrual cycles. Blood tests may be done to rule out other diseases.
Treatment of Abnormal Uterine Bleeding:
Medications often are tried first to treat irregular or heavy menstrual bleeding.
If medication does not reduce your bleeding, a surgical procedure may be needed. There are different types of surgery depending on your condition, your age, and whether you want to have more children.

Abnormal Cervical Screening (Pap Smears):

Cervical cancer screening is used to find abnormal changes in the cells of the cervix that could lead to cancer. The cervix is the portion of your uterus that extends down into the vagina. Screening includes the Pap test and, for some women, testing for a virus called HPV.
The main cause of cervical cancer is infection with HPV. If you have an abnormal cervical cancer screening test result, you may need further testing. 
Treatment:
In general, there are two ways to treat abnormal cervical cells: 1) “excisional” treatment and 2) “ablative” treatment. With excisional treatments, tissue is removed from the cervix and is sent to a laboratory to be studied. The results will determine the severity of abnormal cells.  With ablative treatment, abnormal cervical tissue is destroyed, and there is no tissue to send to a laboratory for study.

Polycystic Ovary Syndrome (PCOS):

Common PCOS signs and symptoms include the following:
• Irregular menstrual periods
• Infertility
• Obesity
• Excess hair growth on the face, chest, abdomen, or upper thighs
• Severe acne or acne that occurs after adolescence and does not respond to usual treatments
• Oily skin
• Patches of thickened, velvety, darkened skin called acanthosis nigricans
• Multiple small fluid-filled sacs in the ovaries
Although the cause of PCOS is not known, it appears that PCOS may be related to many different factors working together. These factors include insulin resistance, increased levels of hormone called androgens, and an irregular menstrual cycle.
PCOS affects all areas of the body, not just the reproductive system. It increases a woman’s risk of serious conditions that may have lifelong consequences.
Treatment:
A variety of treatments are available to address the problems of PCOS. Treatment is tailored to each woman according to symptoms, other health problems, and whether she wants to become pregnant.
Combined hormonal birth control pills can be used for long-term treatment in women with PCOS who do not wish to become pregnant. For overweight women, weight loss alone often regulates the menstrual cycle. Even a loss of 10–15 pounds can be helpful in making menstrual periods more regular. Insulin-sensitizing drugs used to treat diabetes frequently are used in the treatment of PCOS. 

Endometriosis:

Endometriosis is a condition in which the type of tissue that forms the lining of the uterus (the endometrium) is found outside the uterus.
Endometriosis occurs in about one in ten women of reproductive age. It is most often diagnosed in women in their 30s and 40s.
Almost 40% of women with infertility have endometriosis. Inflammation from endometriosis may damage the sperm or egg or interfere with their movement through the fallopian tubes and uterus. In severe cases of endometriosis, the fallopian tubes may be blocked by adhesions or scar tissue.
Symptoms:
The most common symptom of endometriosis is chronic (long-term) pelvic pain, especially just before and during the menstrual period. Pain also may occur during sex. If endometriosis is present on the bowel, pain during bowel movements can occur. If it affects the bladder, you may feel pain during urination. Heavy menstrual bleeding is another symptom of endometriosis. Many women with endometriosis have no symptoms.
Diagnosis:
The only way to tell for sure that you have endometriosis is through a surgical procedure called laparoscopy. Sometimes a small amount of tissue is removed during the procedure. This is called a biopsy.
Treatment:
Treatment for endometriosis depends on the extent of the disease, your symptoms, and whether you want to have children. Endometriosis may be treated with medication, surgery, or both. When pain is the primary problem, medication usually is tried first.

Ovarian Cysts:

An ovarian cyst is a sac or pouch filled with fluid or other tissue that forms in or on an ovary. Ovarian cysts are very common. They can occur during the childbearing years or after menopause. Most ovarian cysts are benign (not cancer) and go away on their own without treatment. Rarely, a cyst may be malignant (cancer).
In most cases, cysts do not cause symptoms. Many are found during a routine pelvic exam or imaging test done for another reason. Some cysts may cause a dull or sharp ache in the abdomen and pain during certain activities. Larger cysts may cause twisting of the ovary. This twisting usually causes pain on one side that comes and goes or can start suddenly. Cysts that bleed or burst also may cause sudden, severe pain.
If your obstetrician–gynecologist (ob-gyn)or other health care professional thinks that you may have a cyst, ultrasound, blood tests and physical exams may be done.
Treatment:
There are several treatment options for cysts. Choosing an option depends on the type of cyst and other factors. Treatment options include watchful waiting and, if the cyst is large or causing symptoms, surgery.
 
Dr. Vaddadi practices in SIMED’s Gainesville and Lake City offices. To review any of these topics or just for general woman’s health issues, schedule an appointment with Dr. Vaddadi by calling 352-331-1000 or requesting an appointment online.
Gainesville: 352-331-1000
Lake City: 352-331-1000
Chiefland: 352-331-1000
Lady Lake: 352-391-6464
You can also schedule your appointment online. Don’t wait; call or click today.
 
Don’t forget to follow us on Twitter and Facebook for more content!
 

Robotic Surgery for Women's Health

Gynecological surgeon Prethi Vaddadi,MD has recently joined the SIMED Women’s Health team and she specializes in robotic surgery.

Facing surgery can be a frightening experience fraught with questions, doubts and uncertainties. However, most surgeries are elective, meaning that you decide if surgery is the best option for you and elect to have the procedure. This decision process often gives you needed time to prepare, which is an important step. Research suggests that women who prepare mentally and physically for surgery have fewer complications, less pain and recover more quickly than those who don't prepare.

- "Preparation for Surgery | HealthyWomen." Ed. Ranit Mishori, 28 Apr. 2011.

Gynecological surgeon Prethi Vaddadi,MD has recently joined the SIMED Women’s Health team and she specializes in robotic surgery. This style of surgery is minimally invasive and represents the new standard in gynecological care for Hysterectomy, uterine fibroids, correction of vaginal prolapse, pelvic reconstructive surgery, reversal of Tubal Ligation, urinary leakage/incontinence procedures, and Endometriosis. Dr. Vaddadi took the time to answer some frequently asked questions about these procedures, and about gynecology in general.

What questions should women be asking their gynecologist?

Women should feel comfortable asking their gynecologist: “How often should I see a gynecologist?” “How often should I get pap smears?” “What are the different options of contraception that are available?” “What STDs am I at risk for and how do we screen for them?” “When do I need to start screening for breast cancer, cervical cancer, and colon cancer?”

What method of gynecological surgery is right for me?

Gynecological surgery ranges from minimally invasive methods to open abdominal procedures. Robotic surgery, Laparoscopic surgery, Vaginal surgery and Ablations are examples of minimally invasive surgeries. Patients who have scar tissues, complex circumstances, large masses, and cancer are typically not candidates for this type of surgery.

The gynecological surgery alternatives are tailored specifically to each patient and their particular symptoms. A thorough evaluation of each patient including the history and a physical is always needed. Once the evaluation has been established, a plan of care is initiated based on each individual patient’s needs.

The goal is to do the least invasive and most conservative therapy to take care of a patient’s problem. This can often be done with a minimally invasive procedure, including the robotic surgeries.

As for patients who are high risk surgical candidates or whose health needs to be optimized prior to definitive surgical management, minimally invasive radiological interventions may also be explored such as uterine artery embolization to control hemorrhage in cases of large uterine fibroids.

What should I expect before, during and after a hysterectomy?

There are multiple ways to perform a hysterectomy including vaginally, laparoscopically, robotically, and abdominally. Determining which route is the best for a patient depends on: size of uterus or mass, previous surgical history, weight, medical comorbidities, and pathology. Before any surgery, the goal is to always optimize a patient’s health in order to ensure safety for the patient to undergo any surgical procedure. This usually includes a visit with a primary care doctor and any other additional work up if needed.

The length of hospital stay ranges from going home the day of surgery to staying overnight in the hospital, to a hospital stay of a few days for some complex cases. If no complications occur, patients who undergo minimally invasive surgery i.e. vaginal, laparoscopic, or robotic surgery, usually are discharged home either the same day or the next day. Pain is usually less and recovery is faster with minimally invasive surgery. Recovery from a hysterectomy can range from 1 week to 6 weeks, with the shorter duration of time to recovery associated more often with the minimally invasive options.

What are the common misconceptions about removing a cervix?

Common misconceptions about removing a cervix at the time of the hysterectomy include sexual function and pelvic support. Dr. Vaddadi states that additional steps are taking to ensure adequate pelvic support at the time of the hysterectomy these steps decrease rates of pelvic organ prolapse. Pelvic support and sexual function are normally NOT affected by removing the cervix. For women who desire to keep their cervix, routine cervical cancer screening is necessary, and an effect of keeping the cervix can be cyclically vaginal bleeding resulting from retained uterine tissue near the cervix.

Will my physical activity need to be limited after a hysterectomy?

Physical activity is usually limited for 6 weeks following surgery to ensure adequate tissue healing. This includes lifting, working out and sexual intercourse.

Will I still need to have annual checkups and pap smears after my hysterectomy?

Yes, annual checkups with a gynecologist are necessary to screen for STDs, management of hormones, screen for breast cancer, and osteoporosis. Annual checkups also are important for management of contraception, menopausal symptoms, and most importantly the overall management of women’s health issues.

The need for surveillance Pap smears following hysterectomy depends on whether the cervix remains or was removed. If the cervix remains Pap smears monitoring is unchanged from women who have their uterus. If a hysterectomy was performed due to cervical dysplasia (a pre cancer condition) or cervical cancer Pap smears will continue for a while. Fortunately women who have had a hysterectomy for non-cancer, and non-dysplasia reasons will be free of the need of future Pap smears.

If I have a hysterectomy, do my ovaries need to be removed?

Ultimately, the decision to remove a patient's ovaries, in the setting of benign disease, is left to the patient. With the understanding that the normal ovary may turn into cancer, disease or pain in the future, patients may decide whether or not to preserve ovarian tissues. Removal of the ovaries results in “surgical menopause.” Which causes an abrupt drop in estrogen hormone levels. The premature loss of estrogen may cause hot flashes, and increased risk of developing osteoporosis, heart disease and stroke.

Occasionally despite surgery to remove an ovary, portions of the ovary can be left behind (called residual ovary syndrome), this may need treatment/surgery in the future. For those patients who have their ovaries removed prior to menopause, hormone replacement therapy is explored to help manage menopausal symptoms. For women with gynecological malignancies, there are usually clear indications to remove the ovaries and Fallopian tubes.

If you are interested in scheduling an appointment with Dr. Prethi Vaddadi to discuss your GYN concerns or any of our SIMED Women’s Health physicians at any of our locations including Gainesville, Ocala, Chiefland, Lady Lake (The Villages), and Lake City; you can contact SIMED Women’s Health or click here to request an appointment online.