Screening & Tests- 03

1- Your 20s and 30s: Jumpstart Healthy Living

2- Medical Tests in Your 20s and 30s
3- Your 40s and 50s: Managing Health Changes
4- Exams for Women Over 40

5- Health Checklist for Women Over 40
6- Your 60s and Up: Healthy Body, Sharp Mind
7- Testosterone and Estrogen Levels in Women
8- Estrogen Test

9- Progesterone Test
10- Breast Biopsy
11- What to Expect From an Ob-Gyn Visit
12- Hysteroscopy

13- Pelvic Exam
14- Pap Smear
15- What If My Pap Test Results Are Abnormal?
16- Vaginal Wet Mount
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9- Progesterone Test

What is a Progesterone Test?

A progesterone test is a blood test. It can help your doctor check on ovulation or possible fertility problems, make sure everything is OK if you’re already pregnant, or help find out why you have abnormal bleeding from your uterus.

Your doctor may call it a “serum progesterone” test. By itself, it’s not enough to diagnose any particular problem. But it could help, along with other tests.

What Is Progesterone?

Progesterone is a hormone, which is something your body makes to help it work. Hormones help manage many things your body does, including getting pregnant.

Progesterone helps control your period and prepares your body to get pregnant, after you ovulate.

If you do get pregnant, additional amounts of progesterone are created, which, among other effects, helps prepare your breasts to eventually make milk.

If you don’t get pregnant, the level of progesterone in your body drops. This, then, helps trigger the beginning of your period.

What Happens in the Test?

You don’t need to do anything to prepare. But it will help if you take note of when your last menstrual period started and ended -- or, if you’re pregnant, how far along you are.

The test itself is simple. Your doctor, physician’s assistant, or another health care professional will insert a needle in a vein in one of your arms and take a bit of blood for testing in a lab.

Test Results

Your results may be one of these:

Progesterone levels don’t fluctuate regularly. If the test shows that your progesterone levels don’t rise and fall on a monthly basis, as they should, then you may not be ovulating or having regular periods. This could make it harder to get pregnant.

Progesterone levels not increasing: If you are in the early stages of pregnancy but progesterone levels haven’t risen, as expected, this could signal problems, such as a chance of having a miscarriage. Your doctor would need more than this test result to find that out, though.

High levels of progesterone: If you’re not pregnant, but the test shows increased amounts of progesterone, such results are sometimes linked to:

• Ovarian cysts
• Rare form of ovarian cancer
• Glands producing too much progesterone
• Adrenal cancer

Low levels of progesterone: If the test shows a lower than normal level of progesterone, it could be due to:

• Toxemia -- a condition that can happen late in your pregnancy that could be serious if not treated
• Ovaries not working normally
• You’re not menstruating
• Miscarriage

Other tests

If your doctor has you take a progesterone test, it’s possible that you might also get:

• Other blood tests to check on your ability to get pregnant
• An ultrasound to measure the thickness of the lining of your uterus
• A specific blood test, if you’re already pregnant, to figure out if there are problems with the pregnancy.

10- Breast Biopsy

Breast Biopsy

Test Overview

A breast biopsy removes a sample of breast tissue that is looked at under a microscope to check for breast cancer. A breast biopsy is usually done to check a lump found during a breast examination or a suspicious area found on a mammogram, ultrasound, or magnetic resonance imaging (MRI).

There are several ways to do a breast biopsy. The sample of breast tissue will be looked at under a microscope to check for cancer cells.

• Fine-needle aspiration biopsy. Your doctor inserts a thin needle into a lump and removes a sample of cells or fluid.
• Core needle biopsy. Your doctor inserts a needle with a special tip and removes a sample of breast tissue about the size of a grain of rice.
• Vacuum-assisted core biopsy. This is done with a probe that uses a gentle vacuum to remove a small sample of breast tissue. The single small cut doesn't require stitches and leaves a very small scar.
• Open (surgical) biopsy. Your doctor will make a small cut in the skinand breast tissue to remove part or all of a lump. This may be done as a first step to check a lump or if a needle biopsy doesn't provide enough information.

If needed, your doctor may use ultrasound or MRI to guide the biopsy needle. Or your doctor may use a computer to locate the exact spot for the biopsy sample from mammograms that have been taken from two angles (stereotactic needle biopsy). A fine wire, clip, or marker also may be used to mark the site.

Why It Is Done

A breast biopsy checks to see if a breast lump or a suspicious area seen on a mammogram is cancerous (malignant) or noncancerous (benign). Testing a biopsy sample is the only reliable way to find out if cancer cells are present.

How To Prepare

Tell your doctor if you:

• Are taking any medicines or supplements (such as vitamins or herbal remedies).
• Are allergic to any medicines, including anesthetics.
• Are allergic to latex.
• Have any bleeding problems or take blood thinners, such as warfarin (Coumadin) or clopidogrel (Plavix).
• Are or might be pregnant.

You will be asked to sign a consent form that says you understand the risks of the test and agree to have it done.

Talk to your doctor about any concerns you have regarding the need for the biopsy, its risks, how it will be done, or what the results will mean. To help you understand the importance of the biopsy, fill out the medical test information form(What is a PDF document?).

If you take a blood thinner, you will probably need to stop taking it for a week before the biopsy.

If a breast biopsy is to be done under local anesthesia, you do not need to do anything else to prepare for the biopsy.

If the biopsy is to be done under general anesthesia, follow the instructions exactly about when to stop eating and drinking, or your surgery may be canceled. If your doctor has instructed you to take your medicines on the day of surgery, do so using only a sip of water. An intravenous line (IV) will be put in your arm, and a sedative medicine will be given about an hour before the biopsy. Arrange for someone to drive you home if you will be having general anesthesia or are going to be given a sedative.

Other tests, such as blood tests, may be done before your breast biopsy.

How It Is Done

Fine-needle aspiration biopsy

A fine-needle aspiration biopsy may be done by an internist, family medicine doctor, radiologist, or a general surgeon. The biopsy may be done in your doctor's office, a clinic, or the hospital.

You will take off your clothing above the waist. A paper or cloth gown will cover your shoulders. The biopsy will be done while you sit or lie on an examination table. Your hands may be at your sides or raised above your head (depending on which position makes it easiest to find the lump).

Your doctor numbs your skin with a shot of numbing medicine where the biopsy needle will be inserted. Once the area is numb, a needle is put through your skin into your breast tissue. Ultrasound may be used to guide the placement of the needle during the biopsy. If the lump is a cyst, the needle will take out fluid. If the lump is solid, the needle will take a sample of tissue. The biopsy sample is sent to a lab to be looked at under a microscope. You must lie still while the biopsy is done.

The needle is then removed. Pressure is put on the needle site to stop any bleeding. A bandage is put on. A fine-needle aspiration biopsy takes about 5 to 15 minutes.

Core needle biopsy

A core needle biopsy may be done by an internist, family medicine doctor, radiologist, or general surgeon. The biopsy may be done in your doctor's office, a clinic, or the hospital.

You will take off your clothing above the waist. A paper or cloth gown will cover your shoulders. The biopsy will be done while you sit or lie on an examination table. Your hands may be at your sides or raised above your head (depending on which position makes it easiest to find the lump).

Your doctor numbs your skin with a shot of numbing medicine where the biopsy needle will be inserted. Once the area is numb, a small cut is made in your skin. A needle with a special tip is put into the breast tissue. The doctor will take 3 to 12 samples to get the most accurate results.

The needle is removed. Pressure is put on the needle site to stop any bleeding. A bandage is put on. This may be repeated several times to make sure enough tissue samples were collected.

A core needle biopsy takes about 15 minutes.

Stereotactic biopsy

A stereotactic biopsy is done by a radiologist. The biopsy is done in a radiology department.

You will take off your clothing above the waist. A paper or cloth gown will cover your shoulders. You will lie on your stomach on a special table that has a hole for your breast to hang through. A mammogram or MRI is used to find the exact site for the biopsy.

Your doctor numbs your skin with a shot of numbing medicine where the biopsy needle will be inserted. Once the area is numb, a small cut is made in the skin. With a special X-ray to guide the needle, it is put into the suspicious area. Usually, more than one sample is taken through the same cut. You must lie still while the biopsy is done.

The small cut made for the needle does not usually need stitches. Pressure is put on the needle site to stop any bleeding. A bandage is put on. A small metal marker (clip) is usually placed in the area where the biopsy sample was taken. This is done to locate the exact spot where the tissue sample was taken.

The metal marker will stay in your breast if you do not have cancer. You will not be able to feel it, and it will not set off metal detectors. You can still have an MRI safely. When you have mammograms in the future, the radiologist will be able to see the metal marker.

This type of breast biopsy takes about 60 minutes. But most of this time is needed for the mammogram or MRI and finding the area for the biopsy.

Vacuum-assisted biopsy

A vacuum-assisted biopsy is done by a radiologist or a surgeon. This method may be used for a core needle biopsy or a stereotactic biopsy. The biopsy may be done while you sit or lie on an examination table. Or you will lie on your stomach on a special table that has an opening for your breast. A mammogram, ultrasound, or MRI is used to find the exact site for the biopsy.

Your doctor numbs your breast with a shot of local anesthetic. Once the area is numb, a small cut is made in your skin. A hollow probe with a special tip is put into the breast. Tissue is gently vacuumed into the probe. With this type of biopsy, the doctor can take more than one sample without removing the probe.

After the probe is removed, pressure is put on the site to stop any bleeding. The small cut does not need stitches and leaves only a small scar.

A vacuum-assisted core biopsy takes less than an hour.

Open biopsy

An open biopsy is done by a general surgeon, gynecologist, or family medicine doctor. The biopsy may be done in a surgery clinic or the hospital.

You will need to take off all or most of your clothes above the waist. You will be given a gown to use during the biopsy. The biopsy will be done while you sit or lie on an examination table. Your hands may be at your sides or raised above your head (depending on which position makes it easiest to find the lump).

An open biopsy can be done using local or general anesthesia. If local anesthesia is used, you may also be given a sedative.

If you have general anesthesia, an intravenous (IV) line will be put in your arm to give you medication. You will not be awake during the biopsy.

After the breast is numb (or you are unconscious), your doctor makes a cut through the skin and into the breast tissue to the lump. If a small wire was placed using mammogram to mark the biopsy site, your doctor will take a biopsy from the area at the tip of the wire.

Stitches are used to close the skin, and a bandage is put on. You will be taken to a recovery room until you are fully awake. You can usually return to your normal activities the next day.

An open biopsy takes about 60 minutes.

How It Feels

You will feel only a quick sting from the needle if you have a local anesthetic to numb the biopsy area. You may feel some pressure when the biopsy needle is put in. After a fine-needle aspiration biopsy, core needle biopsy, or stereotactic biopsy, the site may be tender for 2 to 3 days. You may also have some bruising, swelling, or slight bleeding. You can use an ice pack or take an over-the-counter pain medicine (not aspirin) to help relieve swelling and mild pain.

For 24 hours after the biopsy, do not do any heavy lifting or other activities that stretch or pull the muscles of your chest.

If you have general anesthesia for an open breast biopsy, you will not be awake during the biopsy. After you wake up, the area may be numb from a local anesthetic that was put in the biopsy site. You will also feel sleepy for several hours.

For 1 to 2 days after an open biopsy, you may feel tired. You may also have a mild sore throat if a tube was used to help you breathe during the biopsy. Using throat lozenges and gargling with warm salt water may help with the sore throat.

After an open biopsy, your breast may feel tender, firm, swollen, and bruised. You can use an ice pack or take an over-the-counter pain medicine (not aspirin) to help relieve swelling and mild pain. The tenderness should go away in about a week, and the bruising fades within 2 weeks. But the firmness and swelling may last for 6 to 8 weeks. You should wear a bra or sports bra for support for 2 to 3 days after the biopsy. Do not do any heavy lifting or other activities that stretch or pull the muscles of your chest.

Risks

The possible risks from a breast biopsy include:

• An infection at the biopsy site. An infection can be treated with antibiotics.
• Bleeding from the biopsy site.
• Not getting a sample of the abnormal tissue.
• Dizziness and fainting.

Call your doctor immediately if:

• Your pain lasts longer than a week.
• You have redness, a lot of swelling, bleeding, or pus from the biopsy site.
• You have a fever.

Core needle and stereotactic breast biopsies may leave a small round scar. Open biopsies leave a small straight line scar. The scar fades over time. A fine-needle biopsy usually does not leave a scar.

Results

A breast biopsy removes a sample of breast tissue that is looked at under a microscope for breast cancer.

What Affects the Test

A needle biopsy takes tissue from a small area, so there is a chance that a cancer may be missed.

What To Think About

Most breast lumps are not cancer. But the chance of having a cancerous breast lump is higher after menopause than before menopause.

Some lumpiness of breast tissue is normal. The fibrous tissue in the breast often feels lumpy or bumpy, especially before your menstrual period. This lumpiness (fibrocystic change) is so common in women that doctors now think it is a normal change. These changes usually go away after menopause, but they also may be found in women who are taking hormone therapy following menopause.

Related Information

• Lymph Node Biopsy

References

Other Works Consulted

• Chernecky CC, Berger BJ (2008). Laboratory Tests and Diagnostic Procedures, 5th ed. St. Louis: Saunders.
• Fischbach FT, Dunning MB III, eds. (2009). Manual of Laboratory and Diagnostic Tests, 8th ed. Philadelphia: Lippincott Williams and Wilkins.

Credits

ByHealthwise Staff
Primary Medical ReviewerSarah Marshall, MD - Family Medicine
Specialist Medical ReviewerC. Dale Mercer, MD, FRCSC, FACS - General Surgery

11- What to Expect From an Ob-Gyn Visit

What to Expect From an Ob-Gyn Visit

A gynecologist is a doctor who specializes in women's reproductive health. Obstetricians care for women during their pregnancy and just after the baby is born. They also deliver babies. An ob-gyn is trained to do all of these things.

Your ob-gyn will deal with some of the most important health issues in your life, including birth control, childbirth, and menopause. An ob-gyn can also screen for cancer, treat infections, and perform surgery for pelvic organ or urinary tract problems.

Because ob-gyns deal with such personal and sensitive health issues, the thought of seeing one, especially for the first time, may be troubling to some women. You might be nervous or embarrassed at having a doctor see the most private parts of your body. Or you may be reluctant to discuss your most intimate issues with an ob-gyn.

To take the dread out of your annual appointments, here are some tips on finding an ob-gyn you feel comfortable with and a preview of what to expect at your checkups.

Finding an Ob-Gyn You Trust

You wouldn't want to trust just anyone with the most sensitive parts of your body. That's why you need to think carefully about your choice of an ob-gyn.

Don't just randomly pull a doctor's name off your health insurance list. Get a referral from a friend, family member, or your primary care provider. Usually, your primary care provider can manage most screening procedures and will have a good referral resource if a specialist is needed.

As you're making a decision, consider whether you would prefer a male or female gynecologist. Some women are more comfortable going to a woman because they will have to undress completely during the exam.

Meet with the ob-gyn before making a decision. Ask about his or her medical experience, certification, and attitude about important reproductive issues, like birth control.

Your questions might include:

• Do you accept my health insurance?
• At which hospital do you have admitting privileges?
• What are your office hours?
• If you are not available when I need to see you, who will cover for you?

Make sure you're completely comfortable before becoming a patient.

What to Expect During Ob-Gyn Visits

When should you start seeing an ob-gyn? The American Congress of Obstetricians and Gynecologists (ACOG) recommends that girls have their first ob-gyn visit when they're 13 to 15 years old or they become sexually active, whichever comes first. The first visit for teens may just include a talk with the doctor and no exam.

Try to avoid having sex or douching within 24 hours of your appointment. Sexual activity could irritate the tissue of the vagina and affect your Pap test results.

Your appointment will usually start with a general health check. The nurse will weigh you and take your blood pressure. You may have blood and urine tests done, too.

Then it's time for the physical exam. The nurse will take you into the exam room and ask you to undress completely. You will be given a gown that opens to the front, and a sheet to cover your lap.

Your ob-gyn will probably start by asking you some general questions about your personal and family health history. A nurse or other health professional might stay in the room with you and the ob-gyn for the pelvic exam.

The doctor will first examine the outside of your vagina, which includes the vulva area and vaginal opening, for abnormalities. The doctor will then examine your reproductive organs from the inside. While your knees are bent and your feet are in stirrups to keep them apart, the gynecologist will use a speculum -- a device that holds the vagina open -- to view the inside of your vagina and cervix (the opening to your uterus). You might feel some pressure during this exam, but it shouldn't be painful. Your ob-gyn will also examine the walls of the vagina and cervix.

A Pap test is often done during the pelvic exam. Your ob-gyn will remove a sample of cells from your cervix using a small brush. Those cells will be sent to a lab and checked for cervical cancer and other abnormalities.

If you are sexually active, the doctor might also test you for sexually transmitted diseases (STDs) like gonorrhea, chlamydia, syphilis, and HIV. To test for STDs, the ob-gyn will take a swab of tissue during the pelvic exam and/or check blood tests.

Then, the ob-gyn will do an internal bimanual exam by placing one or two gloved fingers in your vagina and the other hand on top of the lower part of your abdomen, to feel your cervix, uterus, fallopian tubes, and ovaries from outside your body. Your doctor may also, if it's needed, do a rectovaginal exam. This will involve the ob-gyn placing a gloved finger in your rectum.

Your ob-gyn should also do a breast exam to check for any lumps or other abnormalities.

Talking to Your Ob-Gyn

Use your annual ob-gyn appointment as an opportunity to ask questions. Even if your questions seem intimate or embarrassing, you can be sure that your doctor has heard them before. It's OK to ask about your periods, sex, or whatever you want to know about your reproductive health.

Your ob-gyn should also ask you a lot of questions. These questions might get very personal, but your doctor needs to know the answers to care for you properly. Questions can deal with:

• Your period and any problems with it, such as missed or heavy periods
• Vaginal discharge
• Whether you're sexually active and how active you are
• The number of sexual partners, both that you have now and have had in the past
• Sexual issues or problems
• Any sexually transmitted diseases (STDs) you've had or think you might have
• Birth control methods
• Vaccine history

Remember that your ob-gyn is your partner in reproductive health. Carry on that partnership by making and keeping your annual appointments. In between visits, let your doctor know if you have any new problems.

12- Hysteroscopy

What Is a Hysteroscopy?

If you’re having heavy menstrual periods and severe cramping, or your doctor needs to know more about your reproductive health, she may recommend you have a hysteroscopy. The procedure can give her an up-close look at your cervix and uterus and help her learn what’s causing problems.

Why Would I Need the Procedure?

During a hysteroscopy, your doctor inserts a hysteroscope -- a thin tube with light on the end -- into your vagina. She’ll be able to see into your cervix and inside your uterus. If she finds anything abnormal, she can take a sample for later testing.

Among the most common reasons for a hysteroscopy are periods that are longer or heavier than normal, or bleeding between periods.

You might also need the procedure in these situations:

• Your Pap test results are abnormal.
• You’ve been bleeding after menopause.
• There are fibroids, polyps, or scarring on your uterus.
• You’ve had more than one miscarriage or problems getting pregnant.
• Your doctor needs a small tissue sample (biopsy) of the lining of your uterus.
• You’re having a sterilization procedure as a permanent form of birth control.
• Your IUD has come out of place.

How is It Done?

A hysteroscopy can either be in a hospital or at your doctor’s office. You can be either awake or under general anesthesia during the procedure. If you’re awake, your doctor will give you medicine to help you relax. She’ll also use medication or tools called dilators to help open your cervix.

She’ll likely use a tool called a speculum to keep your vagina open. If you’ve ever had a Pap smear, your doctor has probably used one during that procedure, too.

Next, she’ll gently insert the hysteroscope through the cervix into your uterus. Then she’ll push gas or a liquid-like saline through the hysteroscope into your uterus to expand it. This will give her a clear view of its lining and the opening of your fallopian tubes through the hysteroscope.

After the Procedure

You’ll probably be able to go home soon after. But if you received local or general anesthetic, you’ll need someone to drive you.

For a few days after the procedure, you may have some mild cramping or bleeding. You might also have gas that can last for about 24 hours. Your doctor may give you medicine to help with any pain.

You’ll have to avoid sex for at least 2 weeks after the procedure. Before you’re sent home, your doctor will tell you more about how to take care of yourself after surgery.

What Are the Risks?

Just like any medical procedure, you could have some complications from a hysteroscopy, including:

• Problems from the anesthesia
• Infection
• Tearing or damage to your cervix, though this is rare
• Problems with gas or fluid from the uterus
• Damage to nearby organs like the bladder, bowel, or ovaries
• Pelvic inflammatory disease

If you experience symptoms like a fever, severe abdominal pain, or heavy bleeding after the procedure, call your doctor immediately or go to the emergency room.