Patient Services
- Annual Gynecologic Healthcare
- Menopausal Medicine and Hormone Replacement
- Infertility Diagnosis and Treatment
- Cervical Cancer Vaccine
- Contraception Counseling and Management
- Other Conditions
Our goal is to provide high quality gynecology services in a comfortable and efficient office setting. Our facility has state-of-the-art equipment, and we provide our patients with cutting-edge diagnostic tools and treatment options.
Hunter Women's Clinic has gone paperless. We are now using Electronic Medical Records! This technology means that all of your records are created and stored electronically. You records are available to our doctors whether they are in the office or not. All data is accessed securely and is HIPPA compliant.
In addition to the information provided below, The American College of Obstetrics and Gynecology (ACOG) website also contains many links to helpful women's health information.
Annual Gynecologic Healthcare
Background
The annual gynecologic exam is one of the most commonly scheduled physician office visits. A woman should schedule her first gynecology exam no later than age 21, or at any age when there is a need for counseling regarding contraception or sexuality. This routine screening exam consists of a complete history taking and physician exam. The exam encompasses women's general health issues and cancer screening for the Breast, Cervix, Uterus, and Ovaries.
Our Services
At Hunter Women's Clinic, many topics are covered during a comprehensive annual exam including contraception, preconceptual conunseling, sexual dysfunction and STD counseling. The Pap smear is only one component of the exam and is used to screen for cervical cancer. Cervical Cancer is caused by a sexually transmitted virus called the Human Papilloma Virus (HPV). In 2006 the Food and Drug Administration (FDA) approved the use of the Gardasil vaccine. Gardasil can prevent the transmission of HPV, and is the first vaccine ever produced which can actually prevent cancer. The HPV vaccine is recommended for girls and young women from ages 9 to 26 and boys. In this age group, it is most effective when given prior to first sexual activity. It is considered a routine adolescent vaccination.
Menopausal Medicine and Hormone Replacement
Background
Over the last decade Hormone replacement has been one of the most dynamic, exciting, and controversial areas of medicine. Several large scale randomized studies including the HERS trial and WHI (Womenen's Health Initiative) have greatly expanded our knowledge of the benefits and long term effects of hormone replacement therapy. The initial finding from the WHI indicated that there were some previously unrecognized rare side effects. Unfortunately, the national popular media misrepresented the overall safety of hormone therapy based on these uncommon complications. Consequently many physicians abandoned the use of hormone therapy in their practices, and many women were left to suffer through menopause without any effective treatment.
Symptoms of the menopausal transition may include the following:
- Menstrual irregularity
- Mood changes, mood swings, and irritablity
- Hot flashes
- Night sweats
- Vaginal dryness
- Urinary incontinence
- Bone loss
- Changes in sexual function and loss of sex drive
Dozens of sub-analyses of the WHI data have subsequently been performed, and have demonstrated that in most circumstances, hormone replacement is safe and effective with minimal or no risk of major complications. Also many physicians and their patients are now seeking alternatives to traditional hormone replacement therapy including natural supplements and bio-identical hormone therapy. Although there are limited data regarding the safety and efficacy of these new treatment options, they represent a very promising and active area of research.
Our Services
Dr. Hunter is a strong advocate for women's health education and autonomy. At Hunter Women's Clinic, we provide comprehensive counseling and education on the most up-to-date information in menopausal medicine and hormone therapy.
We offer all of the following:
- Hormone testing
- Traditional hormone therapy
- Bio-identical hormone treatment
- Natural alternatives
- Other medical therapies
Additionally we offer evaluation and treatment for osteoporosis, breast disease, thyroid and adrenal dysfunction. We provide screening for breast cancer, colon cancer, malignancy of the female reproductive tract, cardiovascular health, and endocrine disorders.
Understanding and anticipating the mental and physical changes that accompany the menopausal transition can make a big difference, and we are confident that our treatment therapies can make the transition much easier.
Infertility Diagnosis and Treatment
Background
Infertility is defined as an inability to conceive after a year of sexual intercourse without any form of contraception. It is a condition that affects nearly 15% of all people at some point in their lives. There are many causes of infertility, and most can be diagnosed and treated. However the woman's age is the most important factor in determining a couple's probability for a successful pregnancy after age 35, and evaluation should not be delayed for a year. Most treatment options involve simple office procedures, X-ray, bloodwork, and oral medications. Occasionally an outpatient surgical procedure is required. The most effective treatment for infertility is In Vitro Fertilization (IVF). However only 3% of infertility patients require this advanced reproductive technology. A referral to a reproductive endocrinologist is required for these procedures. Reproductive Endocrinologists have special expertise in this area because they have three years of fellowship training after completing four years of obstetrics and gynecology residency. However, most infertile patients can be helped with less involved treatment.
Our Services
Dr. Hunter provides a complete basic work-up
for infertility in the female patient. A comprehensive
history and physician exam identifies risk factors for infertility
including male factor, tubal factor, infectious, endometriosis,
diminished ovarian reserve, anovulation, uterine factor, and
progesterone deficits. Most of the time an initial work-up will
consist of an X-ray test, blood work, and a semen analysis.
Factors that may affect sperm quality include:
- Varicocele
- Smoking
- Veneral disease
- Drug use
- Excessive exposure to heat (chronic hot-tub exposure)
Factors affecting female infertility include:
- Age greater than 35 years old
- Exposure to radiation
- Venereal disease
- Smoking
- Prior abdominal surgery (particulary for ectopic pregnancy or endometriosis)
- Uterine fibroids
Endometriosis is a particularly challenging disease which can result in severe pain and infertility (especially prior to the start of monthly menstruation). Although many medical treatment options are available, surgical intervention is sometimes necessary especially when infertility is a concern. Surgery is extremely challenging because the endometrial implants often invade into vital pelvic organs including peritoneum, ureters, bladder, rectum, bowel, fallopian tubes, ovaries, and pelvic nerves and vessels. The surgical dissection must be extremely meticulous so that all of the endometriosis can be removed without injuring any of these vital structures. In contrast, many women who have had surgery for endometriosis only have a diagnostic biopsy, rather than a true surgical resection of disease which usually does NOT result in improvement in pain or infertility. Dr. Hunter has training in fertility preserving, minimally invasive surgery for endometriosis. She performs complete peritoneal endometriosis resection which occasionally involves resection of endometriosis of the bladder, bowel, and appendix. She can also evaluate the integrity and function of the uterine tubes. Dr. Hunter performs Laparoscopic fibroid removal (Myomectomy), microsurgery to fix damaged tubes and tubal ligation reversal.
Contraception Counseling and Management
Background
There are more contraceptive options available today than ever before. Choosing a method that is right for you can be difficult. Many factors may affect your decision including: duration of contraception desired, cost, expected compliance, ease of use, reliability, and side-effects.
Below is a list of the currently available methods:
Hormonal Contraception:
- Oral Contraceptive Pills: Once daily oral medication
- Contraceptive Patch: Once weekly transdermal patch
- Contraceptive Vaginal Ring: Once monthly vaginal ring
- Depo Provera Injection: Every 3 month Intramuscular injection
- Progesterone Intrauterine Device: Placed in the uterine cavity by the physician in the office. Effective up to 5 years
- Implanted Progesterone Rod: Placed subcutaneously in the medial arm by the physician in the office. Effective up to 3 year
- Emergency Contraceptive Pills (Plan B, etc.): Short 1-2 day course of pills to prevent pregnancy from condom failure, etc.
Non-hormonal Contraception
- Condoms: Placed prior to each episode of sexual activity. Condoms provide protection against sexually transmitted diseases.
- Other Spermicides and Barrier Methods: Vaginal contraceptive gel, female condom
- Copper Intrauterine Device: Placed in the uterine cavity by the physician in the office. Effective up to 10 years
- Laparoscopic Tubal Ligation; Uterine tubes are permanently blocked by the physician in the operating room.
- Laparoscopic Bilateral Tubal Removal may decrease chances of cancer in the future.
- Natural family planning
- Partner Vasectomy
Our Service
Hunter Women's Clinic offers many contraception therapy options. During your visit Dr. Hunter will evaluate your needs and provide individualized counseling and education. We will ensure that the method that you choose is the best method for you.
Cervical Cancer Vaccine
Background
In 2006 the Food and Drug Administration (FDA) approved the use of the Gardasil vaccine in women. Gardasil can prevent the transmission of HPV, and is the first vaccine ever produced which can actually prevent cancer. The HPV vaccine is recommended for girls and young women from ages 9 to 26 and boys. In this age group, it is most effective when given prior to first sexual activity. It is considered a routine adolescent vaccination.
Our Services
The Gardasil® vaccine is now available via prescription at your preferred pharmacy.
Other Common Gynecologic Conditions
Listed below are a number of common gynecologic symptoms and likely differential diagnoses. Definitions and additional information about these and many other gynecologic conditions can be found at the American College of Obstetrics and Gynecology (ACOG) website.
Genital itching (Pruritis) -- Vaginal and Vulvar yeast infections (Candidiasis), Lichen Sclerosis and other vulvar skin conditions, Vaginal and vulvar infections and Sexually transmitted diseases, Vulvar Cancer
Vaginal discharge (Leukorrhea) -- bacterial vaginosis, sexually transmitted disease, normal discharge, foreign body (retained tampon, pessary, vaginal NuvaRing)
Skipped or Absent periods (Oligomenorrhea or Amenorrhea) -- pregnancy, polycystic ovarian syndrome (PCOS), stress, weight gain/loss, thyroid disease, prolactin disorders
Excessive Hair Growth (Hirsutism)-- polycystic ovarian syndrome, medications, ovarian tumor, menopause, supplement use
Pelvic pain or painful menses (Dysmenorrhea)-- PID, endometriosis, uterine fibroids, ovarian cysts, adenomyosis, irritable bowel syndrome, interstitial cystitis, urinary infection
Heavy menses (Menorrhagia) -- dysfuctional uterine bleeding, polyps, uterine fibroids, hereditary bleeding disorders, medications, pregnancy
Sexual Pain (Dyspareunia) -- vaginal dryness (urogenital atrophy), vulvar vestibulitis, lichen sclerosis, sexually transmitted disease, Bartholina's cyst
Ovarian Cyst -- functional cyst, benign persistent cyst, dermoid cyst, ovarian neoplasm, paratubal cyst
Breast Pain (Mastalgia)-- caffeine use, stress, hormonal changes, fibrocystic disease, fibroadenoma, breast cyst, breast neoplasm, ligament pain
Vaginal Mass -- Bartholina's cyst, prolapsed uterus, prolpased bladder (cystocele), prolapsed rectum (rectocele), hemorrhoid, cervical polyp, vaginal cancer
Menstrual Migraines
Premenstrual Syndrome (PMS) and Premenstrual Dysphoric Disorder (PMDD)
Sexually Transmitted Disease Screening
Decreased sexual desire (Decreased Libido)