Gynecologic Conditions

Your first visit will consist of a private consultation with Dr. Miller.  This will give you and the doctor an opportunity to become acquainted with each other.  If you are having fertility problem, it is beneficial for you to bring your partner to this appointment so that a complete history can be obtained.  Dr. Miller will then determine what testing is most appropriate for you.  If you have already undergone testing, it is helpful for you to bring a copy of your records for the doctor to review during this visit.

As a Reproductive Endocrinologist physician, Dr. Miller evaluates and treats women with a variety of problems.  This includes:

  • Amenorrhea
    • no menstrual period for 3 months or longer
    • the most common reason is pregnancy
    • evaluation for a hormonal imbalance including thyroid dysfunction, hyperprolactinemia, PCOS and ovarian dysfunction is recommended
  • Ectopic pregnancy
    • an abnormal pregnancy located outside the uterine cavity
    • treatment is optimal if identified early
    • medical therapy is preferred over surgery to minimize the risk of long-term complications
  • Endometriosis
    • endometrial glands and stroma located outside of the uterus
    • may cause painful periods or pelvic pain
    • affects 3-10% of reproductive age women
    • may cause infertility due to scarring of the fallopian tubes, decreasing egg quantity or egg quality or impaired implantation
  • Hirsuitism
    • excess hair growth on the chin, sideburns, upper lip, chest and back
    • may be caused by a hormonal imbalance such as PCOS
    • treatment will help prevent additional hair growth
  • Infertility
    • No viable pregnancy achieved after one year of unprotected sex
    • No viable pregnancy achieved after six months of unprotected sex if there are other risk factors (e.g., female 35 years or older, diagnosis of endometriosis or PCOS)
    • affects 1 out of 6 couples
  • Menstrual disorders/ abnormal uterine bleeding
    • may be due to a hormonal imbalance, intrauterine growth or infection
    • treatment option depends on whether a woman desires to conceive
  • Ovulatory dysfunction
    • Hyperprolactinemia, excess prolactin hormone, may impair or prevent a woman from ovulating
    • Hyper- or hypothyroidism, too much or too little thyroid hormone, may affect a woman’s ability to ovulate also
  • Polycystic ovarian syndrome (PCOS)
    • a syndrome in which a woman has at least two of the following:
      • few, irregular menstrual periods
      • excess hair growth, acne or high levels of androgens in the blood
      • polycystic ovaries on ultrasound exam
    • affects 10% of women and has a genetic component
    • women with PCOS may need assistance to conceive because they are not ovulating regularly
  • Premature ovarian insufficiency
    • ovaries that are not functioning
    • symptoms include hot flashes and irregular, infrequent menstrual periods
    • affects 1% of women

Premature Ovarian Insufficiency handout

  • Recurrent pregnancy loss
    • two or more miscarriages is abnormal and should be evaluated
    • testing for a possible etiology is recommended although over 50% of couples do not find an explanation
    • treatment is available and chances for a successful full-term pregnancy are >60%
    • close surveillance with early pregnancy tests & then weekly ultrasound exams during the first trimester is offered

Recurrent Pregnancy Loss handout

  • Uterine adhesions
    • scar tissue inside the uterus may cause infertility or recurrent pregnancy loss
    • women typically complain that their menstrual periods have changed and become very light
  • Uterine anomalies
    • bicornuate or unicornuate uterus and intrauterine septum are examples
    • may be suspected after performing a hysterosalpingogram (HSG) & then confirmed with a pelvic MRI
  • Uterine myomas
    • commonly known as fibroids, these harmless growths can cause irregular or heavy bleeding and infertility
    • evaluation with ultrasound exam helps to define the size and location
    • treatment can help restore menstrual cycles & improve fertility
  • Uterine polyps
    • benign growths that can cause infertility, early miscarriage or heavy menstrual periods
    • can be identified by hysterosalpingogram or sonohysterogram
    • treatment is recommended to maximize fertility