Women’s Health

Gynecology & Menopause

Our Women’s Health team is dedicated to providing exceptional, compassionate women’s healthcare through all stages of life. We provide healthcare for the entire spectrum of women’s health issues from gynecology and preventative care to diagnosis and treatment of common and complex concerns—such as pelvic pain, urinary incontinence, and menopause symptoms.

Call 218-927-5566 to schedule an appointment. No referrals required.

Service Spotlight: Vulvar or Vaginal Pain

Vulvodynia (vul-voe-DIN-e-uh) is chronic pain or discomfort around the opening of your vagina (vulva) for which there’s no identifiable cause and which lasts at least three months. The pain, burning or irritation associated with vulvodynia can make you so uncomfortable that sitting for long periods or having sex becomes unthinkable.

“If you have vulvar or vaginal pain, please seek help. As a gynecologist, I see these conditions frequently. It’s more common than you think and there is no need to be embarrassed. A brief exam can help determine a cause for your pain. Most importantly, I can offer you treatment options to lessen your discomfort and help you get better.” – Dr. Jennifer Tessmer-Tuck, OBGYN specialist

Women’s Health services provided include:

  • Annual well-woman exams
  • Preventive healthcare and counseling
  • Breast exams
  • Family planning and contraception
  • Infertility treatment
  • Gynecology (including surgery)
  • Minimally invasive laparoscopic surgery (including hysterectomies)
  • Menopausal care

Our Women’s Health Providers

Our Women’s Health team consists of two highly skilled OB/GYN gynecologists and surgeons with the Minnesota Center for Obstetrics & Gynecology, as well as a women’s health nurse practitioner and a certified nurse midwife. They provide evidence-based, comprehensive information and treatment options for menopause symptoms with one-stop convenience.

Alisha Lindberg, MD
Jennifer Tessmer-Tuck, MD
Megan Workman, APRN, DNP, CNM
Harlie Metag, APRN, WHNP-BC

Menopause and Women’s Midlife Transitions

Menopause marks the end of a woman’s menstrual cycle and child-bearing years. While it’s a natural transition for women into healthy aging, you may experience a wide range of menopause symptoms that may affect both physical and emotional health. The spectrum of concerns, questions and bothersome perimenopause and menopause symptoms are extremely varied—that’s why we offer personalized care for your midlife transitions.

Common menopause symptoms include:

  • Bleeding
  • Pelvic pain/pressure
  • Vulvar itching/pain
  • Vaginal dryness
  • Sleep disturbances
  • Hot flashes
  • Urinary incontinence
  • Bowel incontinence
  • Libido/arousal/orgasm concerns
  • Painful intercourse
  • Weight gain
  • Mood changes
  • Vulvar abnormalities

InterStim for Incontinence
Riverwood offers the innovative, high-tech InterStim procedure to treat urinary urge incontinence or fecal incontinence. Similar to a pacemaker, an implanted device uses electrical pulses to stimulate the sacral nerves that control the bladder and muscles related to the urinary function.

Frequently Asked Questions

Vulvodynia (vul-voe-DIN-e-uh) is chronic pain or discomfort around the opening of your vagina (vulva) for which there’s no identifiable cause and which lasts at least three months. The pain, burning or irritation associated with vulvodynia can make you so uncomfortable that sitting for long periods or having sex becomes unthinkable.

Vulvodynia may cause different types of pain. This pain is often described as burning, stinging, irritation, and rawness. Other words that may be used include aching, soreness, throbbing, and swelling. Pain may be felt over the entire vulva or only in one place, such as the clitoris. Symptoms can start and stop without warning, or they may occur only when the area is touched. Inserting a tampon, having sex, or wearing snug underwear can be triggers for some women.

“If you have vulvar or vaginal pain, please seek help. As a gynecologist, I see these conditions frequently. It’s more common than you think and there is no need to be embarrassed. A brief exam can help determine a cause for your pain. Most importantly, I can offer you treatment options to lessen your discomfort and help you get better.” – Dr. Jennifer Tessmer-Tuck, OBGYN specialist

Many women have pain in their pelvic region at some point in their lives. Finding the cause of pelvic pain can be a long process. Often, there is more than one reason for the pain and its exact source can be hard to detect. Women who have pelvic pain should consult a doctor, especially if the pain disrupts daily life or gets worse over time.

Pelvic pain can be acute or chronic depending on the cause. Acute (sharp) pain starts over a short time (a few minutes to a few days). Chronic pain can either come and go or be constant. Pelvic pain can result where scar tissue (adhesion) forms. In evaluating the cause of pelvic pain, your doctor may ask you questions about the pain and its effect on your daily life.

All causes of pain should prompt a visit to your doctor. Your medical history will be taken and you will have a physical exam. Some tests also may be done to find the cause. Your doctor may then be able to suggest treatment.

Many women leak small amounts or urine at times. This can occur with certain movements, such as coughing during stress or pregnancy. When leakage of urine becomes frequent or severe enough to become a problem, it’s called urinary incontinence.

There are three types of incontinence, including urge, stress and overflow. The most common type is urge incontinence, which occurs when the muscle wall of the bladder is overactive. Stress incontinence occurs when the pressure inside the bladder is greater than the pressure in the urethra. It causes loss of urine during coughing, laughing, sneezing or physical activity. In overflow incontinence, the bladder does not empty all the way, which causes steady leaking of small amounts of urine.

Drs. Michael and Rachel Cady and Dr. Tessmer-Tuck, obstetrics and gynecology specialists who practice at Riverwood, are among only a few surgeons locally offering a new high-tech solution to help women regain bladder control. They can implant a nerve-stimulating device called InterStim, which stimulates and quiets the nerves of the bladder.

If you’re having urinary incontinence issues, seek medical care right away as there are many effective treatment options.

Menstrual cycles that are longer than 35 days for shorter than 21 days are abnormal. The lack of a period for three to six months (amenorrhea) is also abnormal. Abnormal uterine bleeding can occur at any age. At certain times in a woman’s life it is common for periods to be somewhat irregular. They may not occur on schedule in the first few years after a girl starts to have them (around age 9 to 16 years). The length of the menstrual cycle may change as a woman nears menopause around age 50 years. It also is normal to skip periods or for bleeding to get lighter or heavier at this time.

Abnormal uterine bleeding can have many causes. They include: pregnancy, miscarriage, ectopic pregnancy, adenomyosis, use of some birth control methods such an intrauterine device (IUD) or birth control pills, infection of the uterus or cervix, fibroids, polyps, problems with blood clotting, endometrial hyperplasia, certain types of cancer, and polycystic ovary syndrome. Sometimes, abnormal uterine bleeding is caused by too much or not enough of certain hormones. If can be caused by growths such as polyps or fibroids. Medications such as birth control pills can cause abnormal uterine bleeding.

If you are having abnormal bleeding, see your healthcare provider. Abnormal bleeding can have many causes. Once the cause if found, it often can be treated with success.

Many women begin to experience heavy and/or irregular menstrual bleeding in their 30s and 40s, as they get closer to menopause. There are many treatment options available. They include endometrial ablation, hormone-releasing IUD, hormone therapy, dilation and curettage and hysterectomy (removal of the uterus). Your healthcare provider can help you decide which treatment is right for you.

Uterine fibroids are almost always benign (not cancer) growths in the uterus. They occur in about 20-25% of all women. A normal uterus is the size of a small pear; fibroids can grow as big as pumpkins. About one in four or five women over age 35 has them. Fibroids may cause no symptoms and require no treatment. Getting regular checkups and being alert to warning signs such as changes in menstruation (more bleeding, cramps) or pain in the abdomen or lower back, or pain during sex, will help you be aware of changes that may require treatment.

Treatment options include:

  • Hysteroscopic resection of fibroids: Women who have fibroids growing inside the uterine cavity may need this outpatient procedure to remove the fibroid tumors.
  • Uterine artery embolization: This procedure stops the blood supply to the fibroid, causing it to die and shrink. Women who may want to become pregnant in the future should discuss this procedure with their healthcare provider.
  • Myomectomy: This surgery removes the fibroids. It is often the chosen treatment for women who want to have children, because it usually can preserve fertility.
  • Hysterectomy, a surgery to remove the uterus, is the only permanent solution for fibroids that keeps them from growing back. It may be an option if medicines do not work and other surgeries and procedures are not an option.

A woman with endometriosis may have painful periods, pain in the lower abdomen before and during menstruation, cramps for a week or two before menstruation and during menstruation, pain during or following sexual intercourse, pain with bowel movements, pelvic or low back pain that may occur at any time during the menstrual cycle.

Treatment for endometriosis depends on the extent of the disease, your symptoms and whether you want to have children. It may be treated with medication, surgery or both. If you have symptoms of endometriosis, see your healthcare provider to discuss treatment options.

The use of Hormone Replacement Therapy (HT) should be an individual decision based on a medical evaluation of risk. It’s best to use HT early in the onset of menopause, typically between the ages of 45 to 55, and use it for the shortest period of time. HT helps with menopause symptoms of vaginal dryness, hot flashes, sleep disruption, and it helps promote bone growth. HT comes in several different forms, including pill, vaginal cream or hormone patch.

Insomnia and sleep disruptions from hot flashes are common in women going through menopause. Fluctuating levels of estrogen and progesterone that occur during perimenopause and menopause can cause hot flashes in about 85 percent of American women. If menopause symptoms continually keep you up at night, make an appointment to see your healthcare provider.

Several lifestyle changes can help prevent hot flashes and improve sleep. Get regular aerobic exercise such as brisk walks or working out with a DVD. Limit caffeine—found in coffee, tea and chocolate—which is a stimulant that can take as long as 8 hours to leave your body and trigger hot flashes. Skip having an alcoholic drink before bedtime as it’s another hot flash trigger.

The over-the-counter vaginal lubricants and moisturizers are nonhormonal therapies and temporarily relieve the symptoms of vaginal dryness, itching, and irritation.

Estrogen treatment is considered the most effective treatment for symptomatic vaginal atrophy. One type of estrogen therapy used for postmenopausal symptoms is systemic estrogen. It restores estrogen in the body to treat symptoms, but it affects the whole body because it is absorbed into the blood. Local estrogen therapy is applied directly to the vaginal tissue to alleviate symptoms; it can be given as tablets, pessaries, cream, or a vaginal ring.

Uterine prolapse is the falling or sliding of the uterus from its normal position in the pelvic cavity into the vaginal canal. The uterus is held in position in the pelvis by muscles, special ligaments and other tissue. The uterus drops into the vaginal canal (prolapses) when these muscles and connective tissues weaken.

Uterine prolapse feels like you’re sitting on a small ball. Heavy lifting or coughing could be dangerous. Weight loss is recommended in women with uterine prolapse who are obese.

Most women with mild uterine prolapse do not have bothersome symptoms and don’t need treatment. Vaginal pessaries can be effective for many women with uterine prolapse. Surgery usually provides excellent results; however, some women may require treatment again in the future.

Surgery should not be done until the prolapse symptoms are worse than the risks of having surgery. The specific type of surgery depends on the degree of prolapse, desire for future pregnancies, other medical conditions, desire to retain vaginal function, and a woman’s age and general health. Often, a vaginal hysterectomy is used to correct uterine prolapse.

Human papillomavirus (HPV) is a virus that causes infection by entering cells. HPV infection is the most common sexually transmitted infection in the United States. It can cause genital warts, growths that can appear on the outside or inside of the vagina or on the penis and can spread to nearby skin. Warts can be removed with medication or surgery. At least 13 types of HPV are linked to cancer of the cervix, anus, vagina, penis, mouth, and throat.

A vaccine is available that can prevent infection with HPV. The vaccine protects against the HPV types that are the most common cause of cancer, precancer, and genital warts.

Girls and boys should get the HPV vaccine as a series of shots. Vaccination works best when it is done before a person is sexually active and exposed to HPV, but it still can reduce the risk of getting HPV if given after a person has become sexually active. The ideal age for HPV vaccination is age 11 years or 12 years, but it can be given starting at age 9 years and through age 26 years.

Pelvic inflammatory disease (PID) is an infection of the female reproductive organs. Two sexually transmitted infections (STIs)—gonorrhea and chlamydia—are the main cause of PID. It is a common illness that is diagnosed in more than 1 million women each year in the United States. PID occurs when bacteria move from the vagina and cervix upward into the uterus, ovaries, or fallopian tubes. The bacteria can lead to an abscess in a fallopian tube or ovary. Long-term problems can occur if PID is not treated promptly.

Ovarian cysts are quite common in women during their child-bearing years. Most cysts result from the changes in hormone levels that occur during the menstrual cycle and the production and release of eggs from the ovaries. A woman can develop one cyst or many cysts. Ovarian cysts can vary in size—from as small as a pea to as big as a grapefruit.

Most ovarian cysts are small and do not cause symptoms. Some go away on their own. Some may cause symptoms because of twisting, bleeding and rupture. They may cause a dull ache in the abdomen and pain during sexual intercourse.

Most cysts are benign—not cancerous. A few cysts may turn out to be malignant (cancerous). For this reason, all cysts should be checked by your doctor.

If you have any symptoms, see your doctor. If ovarian cysts are found early, many of the problems caused by them can be treated.