Fibroids

Fibroids are growths of the uterus. They arise from the muscle of the uterus and are sometimes called leiomyomas or myomas. They can cause the uterus to become larger, bulkier and irregularly shaped. Fibroids are not cancerous nor do they become cancerous. However, sometimes it is difficult to tell if a mass in the uterus is a fibroid or a rare form of cancer called uterine sarcoma. 

Fibroids are very common. It is estimated that 80% of women will have fibroids in their lifetime, although not everyone will be symptomatic. Symptoms of fibroids include heavy or prolonged menstrual bleeding, pelvic pain or pressure or issues with pregnancy and infertility. Symptoms often depend on the size and location of the fibroids. 

Large fibroids can sometimes be felt on physical examination, however pelvic ultrasounds are often used to confirm the presences and location of a fibroid. Fibroids do not need to be treated unless they are causing bothersome symptoms. Treatment options include medication or surgery. 

If you have fibroids and have bothersome symptoms, talk with your provider about which treatment option would be best for you.

Abnormal Uterine Bleeding

Regular menstruation (period) occurs every 24-38 days, lasts for up to 8 days without any bleeding in between cycles. Abnormal uterine bleeding (AUB) is a term which refers to deviation from a regular menstruation.

You can have abnormalities in frequency. You can be bleeding too often (i.e. having a period less than 24 days apart) or too infrequent (i.e. having a period more than 38 days apart). You can have amenorrhea, which is when you do not get a period at all. Primary amenorrhea describes a condition where a woman never gets a period after the time she was supposed to start puberty. Secondary amenorrhea describes a condition where a woman was previously having a regular period for at least six months but then stops. Some women may also experience intermenstrual bleeding (i.e. bleeding in between periods).

You can have abnormalities in quantity. You can be bleeding too heavy (i.e. bleeding more than 1 pad an hour for a minimum of 2 hours straight). Heavy menstrual bleeding may lead to other issues such as anemia. You can also have very light bleeding (i.e. only spotting). Typically having a light period is not an issue unless it is an indication of cervical stenosis or scaring in the uterus. 

There can be many reasons why a woman can experience abnormal uterine bleeding and it can occur in any stage of life, however; some causes of abnormal bleeding are more common in a particular season of life. Abnormal uterine bleeding can have structural causes such as fibroids, endometrial polyps, adenomyosis, or neoplasia. There can also be non structural causes to abnormal uterine bleeding such as ovulatory dysfunction, infections, disorders in blood clotting, and medications.  You may need a physical exam, laboratory testing, imaging (i.e. ultrasound), and possibly a biopsy of your uterus to determine the cause of your abnormal bleeding. If you are experiencing abnormal uterine bleeding we recommend that you follow up with your provider for evaluation.

Genetic Cancer Screening

Genes are the instruction manual that tells our cells how to produce certain proteins and build different structures in our cells and in our body.  All cancers are caused by harmful changes in a person’s genes. These changes are known as mutations or “variants”. These mutations can cause cells to become abnormal and overgrow leading to cancer.

Most mutations occur by chance and others are thought to be caused by lifestyle, environmental factors, and/or infections such as the HPV viruses. 

However, some cancers are due to gene mutations that are passed down through our family (from parent to child) and lead to what is called hereditary cancer. Hereditary cancers tend to affect multiple people in a family with the same type of cancer or other cancers linked to that specific gene mutation. Family members may develop more than one type of cancer and it can occur at a younger than average age. Two well known genetic mutations are the BRCA 1 and BRCA 2 gene mutations that lead to an increased risk of breast and ovarian cancer. 

Discuss genetic cancer screening with your provider if you have a strong family history of cancer or take the hereditary cancer assessment and follow up with your provider if you qualify for genetic cancer screening. 




Sexually Transmitted Infections

Sexually transmitted infections (STIs) are viruses and bacteria that are contracted during sexual contact and have the potential to cause disease in the body.   This can include vaginal, anal, and oral sex, as well as skin-to-skin contact. Some STIs are curable with antibiotics and while others are not, they can be managed with proper medical care.

Gonorrhea, chlamydia, and trichomonas are examples of bacterial STIs that can be found in the cervix and vagina. They can cause changes in vaginal discharge, abnormal bleeding, pelvic pain, and burning with urination. Sometimes, women don’t have any symptoms, which is why it is important to consider screening tests if you are sexually active even with no symptoms. These infections can be treated with antibiotics, and your partner will need to be treated as well, to prevent continuously passing the infection back and forth. If left untreated, these infections can cause pelvic inflammatory disease which can result in loss of fertility. Screening/testing for these bacteria can be done with a urine sample or a vaginal swab.

Other infections are from viruses that can be detected in blood work, a skin culture, or a cervical pap smear. Examples of sexually transmitted infections that are viral include human immunodeficiency virus (HIV), hepatitis B and C, human papillomavirus,, and herpes simplex virus. 

Using condoms consistently, and correctly, are the best way to protect yourself against STIs. Consider getting vaccinated against hepatitis B and HPV.

Get tested promptly if you are having symptoms or consider routine screening even if you are asymptomatic. 

You can learn more about STIs and STDs here: https://www.cdc.gov/std/healthcomm/fact_sheets.htm

Please talk to your provider if you think you may have an STI or have been exposed to an STI. 

Menopause

Menopause is the time in a woman’s life when she naturally stops having menstrual periods. A woman is in menopause once she goes 12 months or more without having a period. The average age of menopause is 51.4 years old. “Perimenopause” defines the years prior to menopause and can be characterized by irregular menstrual cycles, hot flashes, night sweats, sleep disturbances, and changes to your vaginal and urinary tract. Due to the lack of estrogen, women are at higher risk for osteoporosis and cardiovascular disease after reaching menopause. 

MENSTRUAL CYCLE CHANGES

During your childbearing years, monthly changes in two hormones–estrogen and progesterone–control your menstrual cycle. Beginning in your 30’s and 40’s, the ovaries make less estrogen. A common sign of perimenopause is a change in your menstrual cycle. Cycles may become longer or shorter. They may space out (skip periods). They may become lighter or heavier. Although changes to your menstrual cycle are normal in the perimenopause years, you should still report them to your provider. Abnormal bleeding may be a sign of a problem. Let your provider know if you are experiencing anything of the following

  • Bleeding in between periods
  • Bleeding after sex
  • Spotting at any time in the menstrual cycle
  • Bleeding that is heavier or lasts for more days than usual
  • Any bleeding after menopause 

HOT FLASHES AND NIGHT SWEATS

Hot flashes are a common symptom of perimenopause. They are described as sudden feelings of heat that rush to the upper body and face. The skin can become red and flush with sweat. They may last for a few seconds to several minutes or hours. They are not harmful but can become disruptive and interfere with daily activities. When hot flashes occur at night these are called night sweats and can cause sleep disturbances. 

VAGINAL AND URINARY TRACT CHANGES

The vaginal lining gets thinner, dryer, and less elastic as estrogen levels decrease during menopause. Vaginal atrophy is the term used to describe this condition and it can lead to painful intercourse and more frequent vaginal and urinary tract infections. 

Menopause is a natural event, but the symptoms can be very bothersome and even disruptive to daily life. Please speak to your provider for more information and to receive advice on lifestyle modifications, medications, and treatments that can help cope with this time of transition. 







Endometriosis

Endometriosis is a condition in which the cells that make up the lining of the uterus (the endometrium) are found outside the lining of the uterus. It is very common occurring in 1 in 10 women of reproductive age. 

Many women with endometriosis have little to no symptoms. Others have severe pain which interferes with their daily life. Endometriosis is also a major cause of infertility -40 % of infertility may be due to endometriosis.

Endometriosis is usually diagnosed in women in their 30’s but can occur at any age. It can be more common if a patient has a family history of endometriosis. Pregnancy can help with endometriosis symptoms. The symptoms almost always go away with menopause.

The most common symptoms of endometriosis is chronic pelvic pain. The pain is often worse just before and during the menstrual period. Dysmenorrhea is pain that occurs with menstruation. In a woman with endometriosis the dysmenorrhea gets worse over time. Women may also have deep pain with intercourse. They can also have bowel and urine related symptoms. Heavy menstrual periods can also be a symptom.

Endometriosis is often diagnosed by symptoms. Your provider may also order an ultrasound. The only sure way to make a diagnosis is by surgery. The surgery would be a laparoscopy which is done under anesthesia in the hospital. It may also be a way to treat the endometriosis by burning any obvious signs of the disease. 

There are several treatments that work for endometriosis. Birth control pills are a good option as well as a Mirena IUD. There are several other medications such as Lupron and Orlissa which tricks your body into being menopausal. As discussed before, laparoscopy is a good way to make a diagnosis and treat the endometriosis. This will often give a women temporary relief. The surgery is also combined with medications to keep the symptoms from coming back. In about 40-80% of women the symptoms return after a laparoscopy. In severe cases when nothing will help the pain a hysterectomy may be needed. 

Endometriosis is a chronic condition. Many women have symptoms that come and go until menopause. There are many treatments available to give a woman relief. 

Please talk to your provider if you think you may have endometriosis or have any questions.

 

Patient Reviews

Wonderful bedside manner, and very prompt to see me. I arrived late because the Google Maps took me to the wrong address. I was still seen right away. All of the employees and other patients I passed looked happy. Very pleased with this experience!
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Excellent and caring as always!
9/09/2021


Dr. Nancy Hafner listened to what I had to say, responded positively to my questions & addressed my concerns. She expressed empathy, and care & did not at any point rush thru any aspect of the exam. She explained what she was doing and why – which brought a degree of comfort to me. Because she was very attentive & had a positive demeanor, she is now my new favorite MD. The patience she exhibited was the best I have received perhaps -ever. A delightful person with a wealth of experience. No wonder she is booked solid months in advance. There are several other MDs I know that could learn a thing or two from her. Bravo Dr. Nancy Hafner!!!
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Dr. Hafner is the best, I recommend her often to anyone who will listen!
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8/16/21

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