Women’s Health

Updated September 16, 2026

Our gynecology service covers the ordinary and the complicated: annual examinations, contraception including IUD placement, cervical screening and colposcopy, pregnancy planning and preconception care, and the conditions that bring most women in — bleeding that is too heavy or too unpredictable, pain, fibroids, and the long transition through menopause.

Heavy and irregular bleeding

Heavy menstrual bleeding is one of the most normalised symptoms in medicine. Women describe changing protection hourly, planning their clothing around their cycle, and being exhausted for a week each month, and are told this is within the range of normal. Frequently it is not.

Two tests are skipped more often than any others. The first is ferritin: iron deficiency without anemia is extremely common in women with heavy periods and produces the fatigue, breathlessness on stairs and poor concentration that get attributed to a busy life. A normal hemoglobin does not exclude it. The second is a bleeding-disorder screen: von Willebrand disease affects roughly one per cent of the population, presents in adolescence as heavy periods, and is typically diagnosed decades late if at all. A woman who has bled heavily since her first period, bruises easily, or bled unusually after dental work or childbirth should be screened rather than reassured.

Beyond that the evaluation looks for structural causes — fibroids, polyps, adenomyosis — with ultrasound, and for endometrial pathology with a biopsy where age or risk factors warrant it. Treatment ranges from the hormonal IUD, which is genuinely first-line and often overlooked, through tranexamic acid and hormonal options, to hysteroscopic removal of polyps or submucosal fibroids and ablation.

Fibroids — the decision that depends too much on who you see

Fibroids are common and most need no treatment at all. When they do, the option a woman is offered still depends heavily on which specialist she saw first: a surgeon offers surgery, an interventional radiologist offers embolization. That is not a conspiracy, it is the structure of medicine, and it is exactly the problem a multi-specialty group is positioned to solve.

Here a woman can hear the case for each from the people who perform them. Doing nothing is a legitimate option for fibroids that are not causing symptoms. Medical management can control bleeding. Hysteroscopic resection handles fibroids inside the cavity. Myomectomy preserves the uterus and is preferred where future fertility matters. Uterine fibroid embolization avoids surgery and general anesthesia and suits many women well, with a recognised trade-off around future pregnancy that should be discussed rather than glossed. Hysterectomy is definitive and is the right answer for some women and a considerable over-treatment for others.

Pelvic pain and endometriosis

Pelvic pain is under-investigated and over-dismissed. Endometriosis still takes years to diagnose on average, and the delay is largely a listening problem rather than a technology one. Our approach treats several contributors as real and treatable in their own right: pelvic floor dysfunction, which responds to pelvic floor physical therapy rather than to analgesia; bladder pain syndrome; and pelvic congestion from venous insufficiency, which our vascular service can image and treat. Chronic pelvic pain frequently has more than one cause at once, which is why treating only the most obvious one so often fails.

PCOS

Polycystic ovary syndrome is best understood as a metabolic condition with ovarian manifestations rather than an ovarian condition with metabolic side effects. That framing changes what gets treated: insulin resistance and weight are central, not incidental, and the long-term concerns are diabetes, cardiovascular risk and endometrial protection, alongside the immediate issues of irregular cycles, acne, hair growth and fertility. Our weight management and internal medicine services are part of managing it properly.

Menopause

Menopause is where the gap between the evidence and what women have been told is widest. The Women's Health Initiative was reported in a way that frightened a generation of women and their physicians away from hormone therapy, and the more careful reading that followed — about the age at which therapy is started, the difference between transdermal and oral estrogen, and what the absolute rather than relative risks actually are — never reached the same audience.

We discuss it properly, including what hormone therapy does and does not do, who should not take it, and the non-hormonal options for women who cannot or prefer not to. Perimenopause gets its own attention because it is the phase women are most often told is not happening yet. Local estrogen for genitourinary symptoms is a separate and much lower-risk decision that is frequently conflated with systemic therapy, to many women's detriment.

Who provides it

Gynecology is provided by Dr. Tamara Guichard, Dr. Julia Raber, Dr. Hina Ahmad and Dr. Deirdre Johnson Gundy, with Elisha Grace Gomez, PA-C, Jenny Ye, WHNP, Sarah Weld, NP and Stephanie Nguyen, FNP-BC.