Abnormal pap smears and Colposcopy?

Abnormal pap smears are common and may require taking a closer look by a procedure called colposcopy. During a colposcopy the cervix is visualized by the microscope, the colposcope. 
Under magnification, a biopsy of the cervix may be done. This can be mildly uncomfortable. The results from a colposcopy are useful in determining the best way to manage an abnormal pap smear result.

Heavy Menstrual Periods?

Many women begin to experience heavy and/or irregular menstrual bleeding in their 30s and 40s, as they begin to get closer to menopause. Heavy periods are more than just a hassle - they take a physical, social, and emotional toll as well. About 10 million women suffer from heavy menstrual bleeding.

Studies show heavy menstrual bleeding can affect women in a number of ways:


  • Many feel tired and nauseated
  • Many experience bad cramps
  • Many have headaches


  • More than 60% have had to miss social or athletic events
  • About 80% report avoiding sex
  •  33% have been forced to miss work


  • 77% have depression or moodiness
  • 75% feel anxious
  • 57% report a lack of confidence during their period

Heavy periods are not something you have to live with! Today, there are a number of effective treatment options available.  

1. Cooper J, et al. A randomized, multicenter trial of safety and efficacy of the NovaSure system in the treatment of menorrhagia. J Am Assoc Gynecol Laparosc. 2002; 9:418-428. 2.National Women’s Health Resource Center. Survey of women who experience heavy menstrual bleeding. Data on file; 2005.

Endometrial Ablation

Heavy bleeding is most common for women between 40 and 50 years old. Losing too much blood can lead to anemia (low iron in the blood). It can also affect your ability to do daily activities. Endometrial ablation is the destruction of the lining of the uterus to treat heavy periods. 

Endometrial ablation is a short procedure performed as Day surgery. There are no incisions as it is done through the vagina. The most common method of ablation is using electrical energy – the Novasure procedure. This procedure it very quick and has an excellent success rate (30-40% of women have lighter periods following the procedure and 50-60% of women no longer have periods).
An alternative ablation procedure is the Hydro ThermAblator System (HTA) in which hot water is circulated in the uterine cavity to destroy the lining. This procedure can be useful in small uterine cavities or abnormally shaped cavities where Novasure cannot be used.
Endometrial ablation is for those women who no longer wish to have children. Pregnancy is not advised after an ablation. If you think you may be a candidate for endometrial ablation, please make an appointment to discuss this with Dr Alexander.

Advanced Laparoscopic Surgery

In the past, most surgery involving the reproductive organs was done by laparotomy (a surgical procedure in which an incision is made in the abdomen). Now, many of these same procedures can be done through the laparoscope. There are many benefits to laparoscopy - a shorter hospital stay, smaller incisions, and a shorter recovery. 
Laparoscopy can be used to treat endometriosis, ovarian cysts, ectopic pregnancy, adhesions and fibroids. It can also be used to evaluate infertility problems. 

An advanced laparoscopy can be done to remove the uterus (a hysterectomy).

If you think you have any of the above problems that could be treated with laparoscopy please call our office.

Vaginal Prolapse management and surgery

Vaginal prolapse can occur with or without urine incontinence. Management and treatment can vary depending on severity, symptoms and discomfort, and other pathology if any.

Colporrhaphy uses native tissue stiches to repair or strengthen the tissue that supports the vagina. This involves making small cuts to your vagina, reflecting and pushing main organs away and then approximating  your own native tissue. This surgery is usually for women with a stage one or stage two prolapse who have not had other prolapse surgery.

Hysterectomy removes the uterus. This can usually be done through your vagina without cuts to your skin but can also be done with several small cuts across the belly (laparoscopic or ‘keyhole’ hysterectomy) or one long cut across the belly (abdominal hysterectomy). A hysterectomy is usually for women with moderate or severe prolapse. This operation means you can no longer become pregnant.
Surgery using a synthetic graft puts a kind of ‘mesh’ around your pelvic organs to give them permanent support. This surgery is usually for women with a stage three or stage four prolapse or a prolapse that has come back after other prolapse surgery.

Sacrocolpopexy attaches a piece of mesh to your tailbone (sacrum) to give your vagina and/or uterus permanent support. It can be done as keyhole surgery or with one longer cut to your belly (laparotomy). This surgery is usually for women with a stage three or stage four prolapse or who have already had a hysterectomy. It may also be an option for younger women with a prolapsed uterus that don’t want to have a hysterectomy.

Sling procedure Surgery for stress incontinence ( that is when you loose urine when cough, laugh, dance or physical exercise). 

Tension free tape
No stitches are used to attach the tension-free sling, which is made from a strip of synthetic mesh tape. Instead, body tissue holds the sling in place. Eventually scar tissue forms in and around the mesh to keep it from moving. 

Single-incision mini-arc. 
With this approach, your surgeon makes only one small incision in your vagina to perform the procedure. Through this single incision, your surgeon places the sling, there are no other incisions or needle sites needed.

Recovery time for tension-free sling surgery varies. Your doctor may recommend two to four weeks of healing before returning to activities that include heavy lifting or strenuous exercise. It may be up to six weeks before you're able to resume sexual activity.

Using surgical mesh is a safe and effective way to treat stress urinary incontinence. However, complications can occur in some women, short term include voiding difficulties and infection, long term include erosion of the material, and pain.