Overview
This natural biological process is the permanent end of fertility. Menopause is the time when the ovaries stop producing hormones at the levels needed to allow sexual reproduction. It typically occurs around age 51.
Perimenopause
Perimenopause is a term used to describe the period leading up to menopause. During this time, a woman’s body begins the transition to permanent infertility. Perimenopause typically lasts from one to three years. It ends at menopause. During perimenopause, a woman’s hormone levels may fluctuate. Periods may become irregular, and fertility levels decrease. A woman may experience changes in sexual function and desire. She may experience hot flashes, sleep problems, mood changes, headaches and urinary issues. A woman may experience changing cholesterol levels and a loss of bone density. Her breasts may become less full, her hair may thin, and her amount of abdominal fat may increase.
Menopause
As perimenopause progresses, a woman’s periods gradually cease. One year after her final menstrual period, a woman is said to have reached menopause. At this point, she is no longer fertile. A woman who has her uterus removed but retains at least one functioning ovary will still experience menopause. In this situation, menopause can be identified by a measure of the level of hormones in the blood.
Episiotomy
Overview
This incision enlarges the vagina to help with the delivery of a baby. Episiotomy can be helpful when the mother is at risk of vaginal tearing. It can be used for delivery of a large baby, to speed up a delivery, or for a breech delivery (when the baby is being delivered buttocks first). It can also create space for forceps or a vacuum device.
Anesthesia
Because an episiotomy is performed during a vaginal delivery, the woman may already have been given an epidural or other anesthesia. If needed, an injection is also given to numb the area.
The Incision
The incision is usually performed just as the baby’s head reaches the entrance of the vagina. The physician typically makes one of two types of incisions. A midline incision is made from the bottom of the vagina and into the perineum (the tissue between the vagina and anus). A medio-lateral episiotomy is an angled incision that starts near the bottom of the vagina.
After Delivery
After the baby and placenta have been delivered, the physician cleans and carefully closes the episiotomy with sutures. The body will absorb the sutures as the incision heals. The patient will typically heal within four to six weeks.
Overview
The simple, in-office screening procedure is used to identify the presence of abnormal cells on the cervix (the opening of the uterus). The Pap test can be used to detect precancerous cells and cervical cancer. It takes only a few minutes to perform.
The Procedure
In preparation for the procedure, the patient is positioned and a speculum is inserted into the vagina to expose the cervix. The physician carefully inserts a specialized collection device into the vagina. Many types of collection devices are available, including swabs, brushes, and spatulas. The physician collects a cell sample from the exterior of the cervix and from the entrance of the cervical endometrial canal. This is usually painless for most women, but in some cases it can be uncomfortable.
End of Procedure
When the procedure is complete, the speculum is removed and the patient is allowed to go home. The cell samples are sent to a lab for microscopic analysis. The physician will follow up with lab results.
Lab Results
The Pap smear will return with either a negative or a positive result. A negative result (also called a normal Pap) means that cells were successfully gathered but no abnormal cells were seen. A positive result (also called an abnormal Pap) means that abnormal cells were found. A positive result does not necessarily mean that the patient has cancer – the test may have detected atypical or suspicious cells that are not cancerous, but in some cases these cells may become cancerous if not treated. Sometimes, the Pap may also show evidence of an infection such as yeast, bacterial vaginosis, or human papilloma virus (HPV).
After a Positive Result
If a patient receives a positive result, the physician may repeat the test to rule out a false positive. If the second test confirms the positive result, the physician will recommend further testing and possibly treatment based on a combination of the patient’s history and test results. The recommendations may include more frequent Pap tests or a colposcopy (a visual examination of the cervix performed with a lighted, magnifying viewing instrument called a colposcope). The physician may also take a tissue biopsy from the cervix or the end
Hormone Replacement Therapy (HRT)
Overview
This treatment involves using synthetic or natural hormones to replace the hormones a woman’s body no longer makes after menopause. Hormones can be given through pills, skin creams or gels, or through patches placed on the skin. Hormones can also be delivered through vaginal creams, rings and tablets.
Effects of Menopause on the Body
The hormones estrogen and progesterone regulate the thickening of the uterine lining that is part of a woman’s monthly ovulation cycle. At menopause, the ovaries produce lower levels of these hormones. When hormone levels drop, women can experience hot flashes, loss of sex drive, sleeplessness, fatigue, and mood swings. They may have vaginal dryness, night sweats and itchy skin.
Osteoporosis After Menopause
Estrogen also plays a role in calcium absorption. Calcium is essential for keeping bones strong. After menopause, lower levels of estrogen make it difficult for a woman to absorb enough calcium. This raises a woman’s risk of developing osteoporosis, a weakening of the bones. Osteoporosis increases a woman’s risk for bone fractures.
Benefits of Hormone Replacement
Hormone replacement therapy can counteract the loss of natural hormones and reduce the symptoms of menopause. The decision regarding hormone use will depend on a woman’s symptoms, health history and family history. A physician can tailor an individual therapy plan for each patient.
Epidural For Childbirth
Overview
This procedure is an injection of anesthetic through the lower back. This injection numbs the lower abdomen, blocking the pain of childbirth. A patient who has been given an epidural will remain awake and alert. The patient will still have the ability to push to deliver the baby.
Preparation
In preparation for the procedure, the patient lies on her side or sits to expose her lower back. The skin is cleansed with an antiseptic solution. A local anesthetic is injected to numb the tissue around the epidural injection site.
Positioning the Needle
The physician guides a larger needle through the numbed tissue and into the epidural space. The needle is not pushed through the dura (the sac that surrounds the nerve roots). The needle is positioned just outside this sac. If a catheter is needed, it is pushed through the needle.
Injecting the Anaesthesia
When the needle or catheter is in position, the physician slowly injects the anaesthetic mixture. The anaesthetic bathes the nerves in the area. The pain-numbing sensation typically begins working within twenty minutes.
End of Procedure
When the injection is complete, the physician removes the needle. The numbness will typically last for a few hours after the injection. If a catheter is used, it will be left in place so that more anaesthetic can be injected as needed. The catheter will be removed when the patient no longer requires anaesthesia.
What Is Colposcopy?
Colposcopy is a procedure that uses an instrument with a magnifying lens and a light, called a colposcope, to examine the cervix (opening to the uterus) and vagina for abnormalities. The colposcope magnifies the image many times, thus allowing the health care provider to see the tissues on the cervix and vaginal walls more clearly. In some cases, a cervical biopsy, a small sample of tissue, may be taken for further examination in the lab.
Before The Procedure
- Your health care provider will explain the procedure to you and offer you the opportunity to ask any questions that you might have about the procedure.
- You may be asked to sign a consent form that gives your permission to do the procedure. Read the form carefully and ask questions if something is not clear.
- Generally, no prior preparation, such as fasting or sedation, is required. If a biopsy is performed and requires regional or general anesthesia, you may need to fast for a certain number of hours before the procedure, generally after midnight.
- If you are pregnant or suspect that you are pregnant, you should notify your health care provider.
- Notify your health care provider if you are sensitive to or are allergic to any medications, latex, tape, iodine, and anesthetic agents (local and general).
- Notify your health care provider of all medications (prescribed and over-the-counter) and herbal supplements that you are taking.
- Notify your health care provider if you have a history of bleeding disorders or if you are taking any anticoagulant (blood-thinning) medications, aspirin, or other medications that affect blood clotting. It may be necessary for you to stop these medications prior to the procedure.
- You should not use tampons, vaginal creams or medications, douche, or have sexual relations for 24 hours before the test.
- Your health care provider may recommend that you take a pain reliever 30 minutes before the procedure, or you may be given a sedative before the anesthesia is started. If sedation is given, you will need someone to drive you home afterwards.
- You may want to bring a sanitary napkin to wear home after the procedure.
- Based on your medical condition, your health care provider may request other specific preparation.
During The Procedure
A colposcopy may be performed in your health care provider’s office, on an outpatient basis, or as part of your stay in a hospital. Procedures may vary depending on your condition and your health care provider’s practices.
Generally, a colposcopy follows this process:
- You will be asked to undress completely or from the waist down and put on a hospital gown.
- You will be instructed to empty your bladder prior to the procedure.
- You will lie on an examination table, with your feet and legs supported as for a pelvic examination.
- Your health care provider will insert an instrument called a speculum into your vagina to spread the walls of the vagina apart to expose the cervix.
- The colposcope, which is like a microscope with a light on the end, will be placed at the opening of your vagina. The colposcope does not enter your vagina.
- Your health care provider will look through the colposcope to locate any problem areas on the cervix or in the vagina. Photographs with the colposcope or sketches of any areas may be made for your health care record.
- Your cervix may be cleansed and soaked with a vinegar solution, also called an acetic acid solution. This solution helps make the abnormal tissues turn white and become more visible. You may feel a mild burning sensation. An iodine solution may be used to coat the cervix, called the Schiller test.
- Your health care provider may take a small tissue sample called a biopsy. When this is done, the area is numbed, but you may feel a slight pinch or cramp as the tissue is removed.
- Cells from the inside of the cervical canal may be sampled with a special instrument called an endocervical curette. This may also cause some cramping.
- Bleeding from the biopsy site may be treated with a paste-like topical medication or with a pressure dressing.
- The tissue will be sent to a lab for examination.
After The Procedure
After a colposcopy procedure, you may rest for a few minutes before going home.
If you have a colposcopy with a biopsy, the recovery process will vary, depending on the type of biopsy performed and the type of anaesthesia (if any) used.
If you received regional or general anaesthesia, you will be taken to the recovery room for observation. Once your blood pressure, pulse, and breathing are stable and you are alert, you will be taken to your hospital room or discharged to your home. If this procedure was performed on an outpatient basis, you should plan to have another person drive you home.
You may want to wear a sanitary pad for bleeding. If a biopsy was performed, it is normal to have some mild cramping, spotting, and dark or black-coloured discharge for several days. The dark discharge is from the medication applied to your cervix to control bleeding.
If a biopsy was performed, you may be instructed not to douche, use tampons, or have intercourse for one week after the procedure, or for a period of time recommended by your health care provider.
You may also have other restrictions on your activity, including no strenuous activity or heavy lifting.
You may resume your normal diet unless your health care provider advises you differently.
Take a pain reliever for cramping or soreness as directed by your health care provider. Aspirin or certain other pain medications may increase the chance of bleeding. Be sure to take only recommended medications.
Your health care provider will advise you on when to return for further treatment or care. Generally, women who have had a cervical biopsy will need more frequent Pap tests.
Notify your health care provider if you have any of the following:
- Bleeding
- Foul-smelling drainage from your vagina
- Fever and/or chills
- Severe pelvic (lower abdominal) pain
Your health care provider may give you additional or alternate instructions after the procedure, depending on your particular situation.
Dilation And Curettage (D and C)
Overview
In this outpatient procedure, a small tool called a curette is used to remove tissue from inside the uterus. Dilation and curettage is often used to obtain a biopsy in cases of heavy menstruation or postmenopausal bleeding or to clear tissue that may be left after a miscarriage or delivery. The procedure usually takes about 15 to 30 minutes.
Preparation
In preparation for the procedure, the patient is positioned and anaesthesia is administered. A speculum is inserted into the vagina to expose the cervix. The physician carefully dilates the opening of the cervix to allow access to the uterus.
Removing Tissue
The physician inserts a curette into the uterus and presses it against the uterine wall. With gentle scraping motions, the physician uses the curette to carefully remove tissue from the lining of the uterus.
End of Procedure and Aftercare
When the procedure is complete, the instruments are removed, and the patient is allowed to go home. The physician will provide aftercare instructions and will follow up with any lab results from tissue samples.