Obstetrics & Gynecology Services | Women & Infants Hospital (2023)

What is heavy bleeding?

Heavy menstrual bleeding, or menorrhagia, is prolonged or very heavy menstrual bleeding that could be related to various health conditions, including hormones or diseases. It is a treatable problem.

Causes

When an egg is not fertilized, the lining of the uterine wall begins to deteriorate and break down, which causes bleeding.

Hormones

• Estrogen and progesterone imbalances
• Other hormones

Diseases and other causes

• Bleeding disorders
• Cancer
• Fibroids
• Intrauterine contraceptive devices
• Kidney or liver disease
• Miscarriage or ectopic pregnancy
• Thyroid conditions

Symptoms

If a tampon or pad has to be changed every one or two hours and is soaked through or bleed for longer than a week, a healthcare provider should be sought.

Diagnosis

• Biopsies – Examine tissue
• Blood tests – check for anemia
• Dilation and curettage – scraping and examining the cavity
• Hysteroscopy – cervix can be viewed using an instrument that has been inserted
• Pap test – cells collected from the cervix and examined
• Ultrasound –sounds waves are used to create an image of the uterus

Treatment

• Ablation – a procedure used to deteriorate the uterine lining
• Birth control pills – Stops ovulation
• Iron supplements – treat anemia due to loss of blood
• Hysterectomy – surgery to remove the uterus
• Progesterone hormone treatment
• Prostaglandin inhibitors – nonsteroidal drugs to reduce cramping and reduce bleeding
• Resectioning – uterine lining is removed

What is Polycystic ovarian syndrome?

Polycystic ovarian syndrome is a series of symptoms due to issues with women’s hormones and affects the ovaries. In polycystic ovarian syndrome cysts that can develop on ovaries create a hormone called androgen, which is mostly found in men. Though naturally found in small amounts in women, when the level is too high, it causes issues with a woman’s menstrual cycle and subsequent symptoms.

Women with polycystic ovarian syndrome could develop other serious health concerns, including diabetes, high blood pressure, and uterine cancer.

Risk factors

• Genetic factors, such as if a mother or sister has developed it
• Insulin resistance
• Obesity

Symptoms

• Abnormal or irregular period pf menstrual cycle
• Acne
• Excess bodily hair
• Infertility
• Ovaries develop cysts or are large
• Skin tags or patches of discoloration
• Thinning hair
• Weight gain

Diagnosis

• Blood test
• Ultrasound

Treatment

• Healthy diet
• Medication

Sexually transmitted diseases can most often occur through direct and unprotected sexual contact vaginally, anally, or orally. Commonly, symptoms usually include a combination of the following:

• pain or discomfort during sex or urination
• sores, bumps, or rashes on or around the vagina, anus, buttocks, thighs, or mouth
• unusual discharge or bleeding from the genitals
• itchiness in or around the genital area

These diseases can also be contracted by sharing needles.

Types of STI’s

The most common types are:

Chlamydia – Bacterial infection that causes pain during sex or urination and in the lower abdomen, and colored discharge from the genitals. It can lead to various infections as well as pelvic inflammatory diseases and infertility. Babies born to untreated mothers may develop blindness, eye infections, or pneumonia.

Gonorrhea – Bacterial infection that often does not present symptoms, but those that do include a lighter colored discharge from the genitals, pain during sex or urination, frequent urination, itching around the genitals, and sore throat. It can lead to other infections, infertility, and pelvic inflammatory disease, and it is treated with antibiotics. It can pass from mother to child during childbirth.

Herpes – Officially called the herpes simplex virus, there are two strains of the virus, which commonly are transmitted sexually. It causes cold sore, with are blisters on the genitals or mouth. They heal on their own within a few weeks. It can be passed to a fetus in the womb or to a baby during childbirth, and congenital herpes can be dangerous. There is no cure

Human immunodeficiency virus (HIV) – Immune system becomes damaged or compromised and can lead to contracting other diseases, developing cancer, and possibly to AIDS, a more severe form of the virus if not treated. Symptoms resemble the flu and include aches, chills, fever, headaches, nausea, rashes, sore throat, and swollen lymph nodes. There is no cure yet, but management, starting in the early stages, is effective.

Human papillomavirus, (HPV) – Virus that is passed by skin-to-skin contact, and symptoms usually involve warts on the genitals, mouth, or throat, and certain strains can lead to cancers affecting the cervix, rectum, mouth, and vulva. There is no treatment, but infections are often clear on their own. There are vaccines for the more dangerous strains.

Lice – Small infects similar to head or body lice and live in the public hair. Symptoms include itching, bumps, low-grade fever, fatigue and irritability. They are easy to transmit to others through contact and by sharing clothes, bedding, towels, and touching other objects.

Syphilis – Bacterial infection characterized by a sore with later symptoms including rashes, fatigue, fever, headaches, joint pain, hair loss, or weight loss, and it can lead to a loss of sensory functions, mental illness, heart disease, other infections, and possibly death.

Trichomoniasis – Tiny organism that is hard to detect. A smaller percentage of people develop symptoms, which include genital discharge, itching or burning, painful sex or urination, and frequent urination. It can lead to infections, infertility, and pelvic inflammatory disease, but it is treated with antibiotics.

What is the vulva?

The vulva is the external genital area of women. The outer folds of skin are called the labia majora and the inner folds are called the labia minora.

Services

The Vulvar Clinic at Women & Infants Hospital provides evaluation and treatment of acute, chronic and recurrent conditions.

Folliculitis appears as small, red, and sometimes painful bumps caused by bacteria that infect a hair follicle. It can occur on the labia majora. This can happen because of shaving, waxing, or even friction. Folliculitis often goes away by itself, but avoiding contact or creating more friction helps.

Contact dermatitis

Contact dermatitis is caused by irritation of the skin by items such as soaps, lotion, fabrics, or perfumes. Symptoms can include extreme itching, rawness, stinging, burning, and pain. Treatment involves avoidance of the source of irritation and possibly steroidal medication in severe cases.

Lichen simplex chronicus

Lichen simplex chronicus may be a result of contact dermatitis or other skin disorder that has been present for a long time. Thickened, scaly areas appear on the vulva. It causes intense itching. Treatment may include steroid creams. this purpose.

Lichen sclerosus

Lichen sclerosus is a skin disorder that can cause itching, burning, pain during sex, and tears in the skin. The vulvar skin may appear thin, white, and crinkled, and white bumps may be present with dark purple coloring. Treatment may include steroidal creams.

Llichen planus

Lichen planus is a skin disorder that causes Itching, soreness, burning, and abnormal discharge. There may be white streaks on the vulvar skin, or the entire surface may be white or darkened bumps. Treatment may include creams, prescription drugs, or injections, which may be required long-term.

Vulvar intraepithelial neoplasia

Vulvar intraepithelial neoplasia involves a development of non-cancerous cells that are often caused by human papillomavirus (HPV) infection. Symptoms include itching, burning, or irregular skin that may be bumpy, smooth, or a different color. Treatment may include cream, laser treatment, or surgery. The HPV vaccine can help prevent this condition.

Vulvar cancer

Vulvar cancer can be caused by an infection with HPV. Other forms of cancer that can affect the vulva include melanoma (skin cancer) Symptoms may include itching, burning, inflammation, or pain. Other symptoms of cancer include a lump or sore on the vulva, changes in the skin color, or a bump. Treatment varies depending on the stage of cancer, but surgery is common, while other treatment such as chemotherapy or radiation could also be used in certain circumstances.

Endometriosis occurs when the endometrium, or lining of the uterus, grows outside of the uterus in the pelvis and abdomen.

What is an ovarian cyst?

The ovaries, which are responsible for producing hormones and an egg during a woman’s menstrual cycle. During the normal reproductive cycle, a cyst, or a fluid-filled sac, may develop on an ovary. Most of these cysts are harmless and go away on their own, but some can be harmful.

Most often they are non-cancerous, or benign, but some may be cancerous, or malignant. A cyst can be determined using an ultrasound.

Common types ofbenign cysts include:

• Dermoid- Made from different types of tissue including teeth, hair, fat, or skin. These are more common in younger women and are often painless.
• Endometrioma- When endometriosis grows on the ovary, a cyst called an endometrioma may develop. These may be very painful when a patient is near her menstrual cycle.
• Cystadenoma - Cysts that grow from the outside of the ovary. If these grow large, the woman may feel bloated, pain, or discomfort.

Treatment

Treatment can utilize non-invasive surgical procedures called laparoscopy, which uses a small incision in the umbilical area.

Premenstrual syndrome is a condition in women that results in bloating, headaches, and breast tenderness in the week or so before a menstrual cycle begins. Premenstrual dysphoric disorder is a more serious form that entails anxiety and depression and irritability.

The causes are unknown but could be due to decreased levels of estrogen and progesterone hormones. Other chemicals in the body, including serotonin, also may have a role.

Symptoms

In PMS, symptoms include:

• Bloating
• Body and breast tenderness
• Headaches

In PMDD, symptoms include:

• Anger
• Anxiety
• Depression
• Difficulty concentrating or focusing
• Fatigue
• Food cravings
• Headaches
• Insomnia
• Mood swings
• Suicidal thoughts

Diagnosis

A medical provider will review medical and family histories to help determine the cause of symptoms.

Treatment

• Antidepressant medication
• Birth control pills
• Diet changes
• Exercise
• Pain medications
• Stress management

Uterine fibroids are benign growths in or on the walls of the uterus that often occur in pre-menopause. They rarely cause symptoms, but some symptoms might include heavy menstrual bleeding, pain, constipation, or frequent urination.

The Program in Women’s Oncology treats the full range of gynecologic cancers, including cancer of the cervix, endometrium/uterus, fallopian tube, ovaries, vagina, and vulva.

Kent Hospital >>

2 Dudley Street, Suite 580,
Providence, RI 02905

(401) 274 - 1122, ext.42735

166 Toll Gate Road
Warwick, RI 02886

(401) 739-2000
(401) 732-7842

Pawtucket Location:
21 Division Street
Pawtucket, RI 02860
(401) 727-4800
(401) 921-6924

Hours:
Monday, Tuesday, Wednesday, Friday 8 a.m.- 5 p.m.
Thursday 8 a.m. - 7 p.m.
Saturday 8 a.m. - 12 a.m.

Providence Location:
18 Imperial Place, Suite 2-D
Providence, RI 02903
(401) 727-4800
(401) 921-6924

Hours:
Monday - Friday 8 a.m. - 5 p.m.

East Greenwich Location:
1407 South County Trail, Building 4, Suite 420
East Greenwich, RI 02818

Hours:
Monday - Friday 8 a.m. - 5 p.m.

East Providence Location:
450 Veterans Memorial Parkway
East Providence, RI 02914

Hours:
Monday - Friday 8 a.m. - 5 p.m.

Contact for all locations:
(401) 727-4800
(401) 921-6924

Providers:
Anh-Tai Dang, MD
Charissa Dinobile, MD
Harris Galkin, MD
Jennifer Gassner, MD
Jeffrey Hunter, MD

Midwives:
Jane Bradley, CNM
Fiona Clement, CNM
Jennifer Grande, CNM
Aimee Jakeman, CNM
Maggie Kuch, CNM
Linda Nanni, MS, CNM
Kelly Russell, CNM
Marie Sample, CNM
Deb Shaffer, CNM
Erica Truesdale-Greil, CNM
Julie Vermeulen, CNM
Abigail Wetzel, CNM, FNP

Katherine McCleary, MD
Pawtucket and Lincoln Locations

Mary Beth Sutter, MD
Pawtucket Location

Jennifer Rosenbaum, MD
East Greenwich Location

Nicole Gleyzer, DO
East Greenwich Location

Benjamin Adler, MD
West Warwick Location

Charles Hackett, MD
East Greenwich Location

All Care New England Family Medicine physicians provide gynecological services as well.

A list ofFamily Medicine physicians can be found here.

Providence Location:
235 Plain Street, Suite 401
Providence, RI 02905

Wakefield Location:
49 South County Commons Way
Wakefield, RI 02879

East Greenwich Location:
1050 Main Street
East Greenwich, RI 02818

(401) 421-1710
(401) 861-2164

Hours:
Monday - Friday 8 a.m. - 4:15 p.m.
Closed 12 p.m. - 1 p.m.

Providers:
Kathleen Bowling, MD
Ziad Fersan, MD, FACOG
Caroline Skudlarek, DO
Elizabeth Sullivan, MD
Gary Wharton, MD