Reproductive Endocrinology and Gynecology
Drs. Matera, Moomjy and Brown provide individualized gynecologic care to women of all ages, including those who require expert evaluation of gynecologic or endocrinologic disorders, as well as women seeking to maintain optimal health throughout the reproductive years and beyond. In addition to consultations and gynecologic examinations, services offered at Madison Women's Health & Fertility include onsite pelvic and transvaginal sonography, DEXA for bone density assessment, and hormonal testing, all in the comfort and privacy of our office.
Conditions we specialize in treating include:
- PCOS (polycystic ovary syndrome)
- Perimenopause and menopause
- Irregular or absent menstruation
- Uterine fibroids
- Endometrial polyps
Gynecologic and Reproductive Endocrine Services:
- Preventative gynecological care
- Preconception counseling
- Contraception counseling and services
- Pelvic transvaginal sonogram
- Saline infusion sonohysterography (SIS)
- Bone density testing (DEXA)
- Endocrine testing
- Gynecologic surgery
PCOS (polycystic ovary syndrome): PCOS is a common condition which generally is associated with irregular menstruation, symptoms associated with excess androgens (male hormones) and a polycystic appearance to the ovaries by sonography. Symptoms associated with excess androgens may include hirsutism (unwanted hair growth), acne, and alopecia (thinning hair). Many women with PCOS tend to easily gain weight or are obese, and PCOS is often associated with insulin resistance and an increased risk of diabetes. A combination of genetic and environmental factors contribute to cause or exacerbate PCOS. We offer a variety of medical treatments for women with PCOS and related conditions; medications such as Glucophage (metformin), birth control pills, and spironolactone may be used individually or in combination depending on a particular woman's needs. We also offer counseling to encourage women to make lifestyle changes that can help them stay healthy throughout their lives and better control their symptoms through proper diet and exercise. Another goal is to help our PCOS patients plan ahead when future pregnancy is desired by tailoring their treatments to maximize future fertility.
Perimenopause and menopause: Menopause is a natural process, not a disease, and many women stop menstruating uneventfully. But many others experience troubling symptoms associated with the hormonal roller coaster ride that may occur during the transition through menopause. Perimenopause starts with the onset of menstrual irregularity and/or other menopausal symptoms, and ends with the official onset of menopause one year following a woman's final menstrual period. We have expertise helping you manage symptoms that often afflict women during perimenopause and menopause, including abnormal bleeding, hot flashes, mood changes, vaginal dryness, urinary urgency and frequency, and decreased libido. Whether or not you are bothered by any of these symptoms the menopausal transition is an appropriate time for you and your physician to assess your overall health, nutritional status, and risk factors for conditions such as osteoporosis and breast cancer. Our philosophy is to individualize treatment for each of our patients, and we offer a full spectrum of hormonal as well as non-hormonal therapies, including vitamins, minerals, weight bearing and aerobic exercise, nutritional counseling, and prescription medications, such as bisphosphanates for women with osteoporosis, when indicated. We can help you understand the intricacies of the often confusing and conflicting research findings on menopausal hormone therapy so that together we can weigh the risks and benefits of hormonal treatments as they pertain to your own health and quality of life. Not all women need menopausal hormone therapy, but if you do decide to try hormonal therapy we will help you select the regimen best tailored to your needs. We commonly prescribe estradiol, the form of estrogen produced by your ovaries prior to menopause. Estradiol can either be given in one of a variety of vaginal preparations, or it can be given systemically, either via a transdermal preparation such as a patch, gel, or spray, or by mouth. Progesterone is prescribed along with estrogen (unless a woman has undergone hysterectomy) and also can be given in various naturally occurring or synthetic forms either by mouth or via other routes. Some women, particularly those experiencing low libido, may also benefit from androgen replacement, typically using a transdermal testosterone gel.
Irregular or absent menstruation: The most common cause of absent menstruation (amenorrhea) is pregnancy, but many women fail to menstruate regularly because of hormonal disorders, ovarian dysfunction, various medical problems, or other conditions involving the reproductive system. Whether or not you are planning to become pregnant in the near or distant future, it is important to evaluate absent or infrequent menstruation (oligomenorrhea) to maintain optimal health. For example, some women do not menstruate because they do not produce enough estrogen. These women are at increased risk for osteoporosis, and in rare cases they may have tumors of the pituitary gland or other potentially serious medical conditions that are disrupting normal ovulatory function. Other women with irregular periods, such as women with PCOS, do produce normal amounts of estrogen, but because they do not regularly produce progesterone they may be at increased risk for precancer or cancer of the endometrium (uterine lining). Women experiencing amenorrhea or oligomenorrhea are initially evaluated with a comprehensive medical history and physical examination. We pay special attention to potential complicating factors such as stress, nutrition, and other symptoms or physical findings that may be clues to the underlying disorder. After evaluation of appropriate hormonal testing, other laboratory testing, and imaging studies, we will discuss our findings with you and help you to determine which treatment options are best suited to your needs.
Uterine fibroids: Fibroids (also known as myomata or leiomyomata) are extremely common, benign (noncancerous) tumors of the uterine musculature (myometrium). Not every woman with fibroids requires treatment. Women with fibroids experiencing symptoms such as infertility, abnormal bleeding, pelvic pain or pressure need to be properly evaluated to determine if their symptoms are actually being caused by the fibroids or by other gynecologic conditions. Our physicians all have surgical expertise in removal of fibroids (myomectomy), both via an abdominal approach (laparotomy) or using a minimally invasive approach such as hysteroscopy (using a telescopic instrument inserted vaginally through the cervix into the uterus). As fertility specialists we have the knowledge and experience to extensively counsel women regarding the merits of both surgical treatments (myomectomy, hysterectomy) and nonsurgical alternatives including uterine fibroid embolization, MR - guided focused ultrasound , hormonal treatments, and expectant management (watchful waiting).
Endometrial polyps: Endometrial polyps are growths within the uterine lining that may cause abnormal bleeding and contribute to infertility. While tiny polyps often disappear without treatment, larger polyps are more likely to persist and require treatment. Masses that are identified as polyps are usually benign, but rarely may be cancerous or precancerous. Polyps are usually diagnosed by sonogram. A finding of irregular thickening of the lining of the uterus may suggest the presence of polyps, which then are best visualized by SIS, a procedure that involves instillation of saline into the uterus while undergoing transvaginal sonogram. Endometrial polyps may be removed via hysteroscopy.
Endometriosis:Endometriosis is a common gynecologic condition that is often associated with pelvic pain and infertility. We provide comprehensive medical and surgical care for women with endometriosis. For women with endometriosis experiencing infertility, we perform an expeditious infertility evaluation so that appropriate treatment can be instituted in a timely fashion. Depending on a woman's age, severity of endometriosis, symptoms, and coexisting factors that may reduce fertility, we can help you to plan a course of treatment most appropriate for your needs. Older women, those with severe disease, and those with tubal disease or male factor in addition to endometriosis will likely be offered treatment with in vitro fertilization (IVF). Other women may be treated with fertility medications and IUI or with laparoscopic surgery to increase the odds of pregnancy.
For other women with endometriosis, symptom control and preservation of future fertility may be a priority. Medications such as birth control pills are often effective, but some women may require stronger medications, such as leuprolide acetate or danazol, or conservative surgical treatment to relieve their symptoms. Some women may want to consider oocyte cryopreservation (egg freezing) if they don't have immediate plans to conceive. For women with endometriosis contemplating pregnancy in the near future we will discuss addressing other factors such as decreased ovarian reserve, male factor, or tubal disease that may reduce the odds of pregnancy, so that appropriate treatment can be instituted in a timely fashion if necessary.
Gynecologic and Reproductive Endocrine Services:
Preventative gynecological care: An important part of our practice at Madison Women's Health & Fertility is helping women of all ages - from the teen years through the 80s and 90s - stay healthy. We emphasize measures to maintain overall good health as well as gynecologic health for all our patients, and address factors that may affect future fertility in younger women, along with age- related health issues for women approaching menopause or in the postmenopausal years. Routine gynecological care includes a thorough history and physical as well as discussion of lifestyle measures to promote optimal health. We review your family history to help determine your risk for developing particular diseases and advise appropriate screenings. We offer vaccinations, including Gardasil (Human Papilloma Virus), flu, hepatitis B, shingles, varicella and rubella. Services we offer include Pap and HPV testing to screen for cervical cancer, breast cancer screening through breast examination and referral for mammography and other breast imaging studies when indicated, transvaginal pelvic ultrasound, genetic testing, contraceptive counseling, onsite bone density testing to screen for osteoporosis, screening for sexually transmitted diseases, and hormonal and other laboratory testing. We also work with our patients to help coordinate their care with their other medical specialists.
Preconception counseling: Planning prior to pregnancy can help you maximize the chance for a healthy pregnancy. Our physicians will help you address all your concerns in advance so that once you are pregnant there will be fewer unanticipated issues to address. Preconception counseling includes an assessment of your overall health and nutritional status. Women who may be overweight or underweight can learn how addressing these issues may not only help them conceive more easily, but also help reduce the risks of many pregnancy complications that affect mother or baby. Discussion of prescription and over the counter medication use can help women determine whether any changes in medication use need to be made prior to pregnancy. By performing genetic screening tests in advance of pregnancy women found to be at increased risk for having a baby with a genetic disease will have the option of performing Preimplantation Genetic Diagnosis (PGD), which helps ensure that the fetus will not be affected with that disease. For parents who may decline PGD, the benefit of genetic screening is that women found to be pregnant with an affected child can receive appropriate obstetrical care, including consultation with neonatologists and other pediatric specialists who can plan in advance for the specialized care the baby may need starting at the time of delivery, helping assure the best possible outcome for the child.
Contraception counseling and services: Our physicians are experienced with all hormonal and non-hormonal, temporary and permanent methods of contraception. We will counsel you about each method's benefits and risks so we can provide you with the method that best suits your health needs and personal preferences. We help you choose the method that is best for you now, taking into consideration both your current needs and possible future desires.
Pelvic transvaginal sonogram: Based on your symptoms and the findings on pelvic examination a sonogram may be recommended to visualize the uterus and ovaries to determine if there is any cause for concern. All our physicians have expertise in performing sonograms, which can be performed at the time of your visit. Images of the uterus and ovaries are usually best obtained using the transvaginal ultrasound probe, but in some cases better images are obtained using an ultrasound probe placed on the abdomen, rather than in the vagina.
Saline infusion sonohysterography (SIS): SIS (also known as SHG) is a type of sonogram that may be recommended to further assess the endometrial (uterine) cavity. By gently injecting saline (salt water) into the endometrial cavity enhanced images are obtained that can clearly demonstrate abnormalities of the uterine cavity such as polyps or submucous fibroids.
See Fact Sheet
Bone density testing (DEXA): Many postmenopausal women, as well as women with other endocrinologic disorders, are at risk for osteoporosis. Women with osteoporosis are at increased risk for fractures which can be disabling and even life threatening. Our physicians address risk factors for osteoporosis with all our gynecological patients, and offer onsite assessment of bone density for women found to be at risk. Our DEXA allows assessment for osteoporosis of the spine, hip and wrist, and serial assessments can be done here on the same machine to most accurately assess changes over time. For our patients found to have osteopenia (low bone density) we provide counseling on measures that can help prevent the development of osteoporosis, including exercise, Vitamin D and calcium supplementation, and sometimes pharmacologic treatment. Women found to have osteoporosis are more likely to need pharmacologic treatment along with lifestyle changes to help reduce the risk of fracture.
Endocrine testing: Madison Women's Health & Fertility's endocrine laboratory performs daily hormonal assays enabling our physicians to readily assess our patients for hormonal imbalances, and to precisely monitor women receiving hormonal treatment. Hormonal testing includes pregnancy testing as well as measurements of other hormones including estradiol, progesterone, LH, FSH, prolactin, and TSH. Our lab is certified compliant by CLIA (Centers for Medicare & Medicaid Services Clinical Laboratory Improvement Amendments).
Gynecologic surgery: Improved diagnostic techniques often allow us to avoid surgery, but for those patients who may benefit from surgical treatment our physicians have the knowledge and expertise to help you decide whether to undergo surgery and which surgical procedure is most appropriate. When possible, we perform our surgeries using minimally invasive techniques, such as laparoscopy and hysteroscopy, although some surgeries, such as multiple myomectomy, may be more effectively done by laparotomy (making an incision through the skin). Particularly for women in the reproductive years we generally emphasize preservation of reproductive organs – removing cysts, polyps, or fibroids rather than ovaries or uteri, although in some instances removal of the uterus and/or the ovaries may be the desired approach and outcome. All options will be discussed with you in detail, elaborating the pros and cons. If cancer is detected or highly suspected we will provide you with a referral to a specialist in gynecological oncology, and women with problems such as incontinence may be referred to a specialist in urogynecology or a urologist specializing in female urologic problems.
Our physicians have admitting and surgical privileges at their respective hospitals:
Dr. Matera – Columbia campus of New York – Presbyterian Hospital
Dr. Moomjy – Cornell campus of New York – Presbyterian Hospital
Dr. Brown – NYU Langone Medical Center – Tisch Hospital
Hysteroscopy: The hysteroscope is a long slender optical instrument that is inserted through the cervix to allow the surgeon to directly visualize the inside of the uterine cavity. The hysteroscope is attached to a light source and a video monitor to allow optimal visualization. Hysteroscopy is used to definitively diagnose abnormalities within the uterus. Surgical instruments can be placed through an operative hysteroscope to perform surgeries to allow removal of endometrial polyps or uterine fibroids, to treat intrauterine adhesions (scar tissue), also known as Asherman's syndrome, or to resect a uterine septum (a wall of tissue dividing the uterus in two).
Laparoscopy: The laparoscope is an optical instrument that allows the surgeon to visualize the inside of the abdomen and pelvis through a small, approximately 1 cm incision usually made through the navel. Several smaller incisions are usually made in the lower abdomen, typically below the bikini line, to allow placement of any other instruments needed to perform laparoscopic surgery. Like the hysteroscope, the laparoscope is attached to a light source and a video monitor to allow optimal visualization. Surgeries including ovarian cystectomy, laser vaporization or fulgaration of endometriosis, lysis of adhesions (removal of scar tissue), reconstruction of the fallopian tubes, and removal of the fallopian tube or ovary are routinely performed via laparoscopy. The benefits of the laparoscopic approach include smaller incisions, less scar tissue formation and a more rapid full recovery. Women undergoing laparoscopy usually go home on the same day as their surgery and are able to resume normal activities soon after surgery, usually within 1-2 weeks.
Dilatation and Curettage (D&C): This procedure involves dilating the cervix in order to remove tissue from the endometrial cavity. In cases of early miscarriage, a suction D&C may be indicated to remove pregnancy tissue for genetic and pathological testing. For non-pregnant women undergoing D&C an instrument is used to scrape the endometrial lining from the uterine cavity. D&C's are often performed along with hysteroscopy to fully sample the endometrial cavity.
Laparotomy: Laparotomy is surgery through an incision in the abdomen, as would be done for a cesarean section. Many surgeries that were traditionally performed by laparotomy are now successfully accomplished laparoscopically. However some surgeries, such as removal of multiple fibroids from the uterus (myomectomy), may still be better performed via laparotomy. This approach allows the surgeon to palpate the uterus directly to detect even deep, small fibroids, and to carefully reconstruct the uterus to ensure that it is strong enough to carry a pregnancy.
Endometrial Biopsy (EMB): Endometrial biopsy is indicated to evaluate women with postmenopausal bleeding or abnormal bleeding during the menstrual cycle. EMB is a procedure performed in the office to remove a small amount of tissue from the uterine lining so that it can be evaluated by the pathologist. A slim, flexible instrument is passed through the cervix into the uterine cavity to obtain the biopsy specimen. Though many women undergo this quick, simple procedure with only minimal discomfort, we recommend a painkiller such as ibuprofen be taken before the procedure to minimize cramping.