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Endometriosis, a common gynecological disease, affects one in 10 women in the U.S., and is diagnosed in up to half of women who experience infertility . Due to its nonspecific symptoms, endometriosis often goes undetected for years. Many individuals attribute their chronic pelvic pain to menstrual cramps rather than recognizing it as a symptom of endometriosis. Additionally, some may remain unaware of their condition due to silent symptoms. It can take up to a decade for some patients to receive a proper diagnosis. Normally, the uterine lining (endometrium) grows along the interior walls of the uterus, providing a cushioned and receptive environment for embryo implantation during pregnancy. However, in endometriosis, the endometrium grows outside the uterus, commonly on the exterior of the uterus, ovaries, fallopian tubes, bladder, intestines, or other pelvic structures. This displacement frequently leads to chronic pelvic pain and may cause secondary symptoms, such as irritability, difficulty sleeping , anxiety , depression , or low self-esteem. Over time, endometriosis induces inflammation, bleeding, and scar tissue formation within the pelvic cavity, regardless of whether the patient experiences pelvic pain. The presence of scar tissue can hinder fertility. Early diagnosis of endometriosis, before the formation of scar tissue, can help preserve fertility. A delayed diagnosis may pose challenges for conception, even with assisted reproductive procedures like in vitro fertilization (IVF) . To confirm endometriosis, clinicians biopsy a small sample of uterine tissue and examine it under a microscope for signs of the condition. For patients diagnosed with endometriosis, the news may bring emotional relief after years of pelvic pain without a clear cause. Our providers offer treatments to alleviate chronic pain and related physical and emotional symptoms, and assess whether endometriosis has contributed to infertility. Treatment options for endometriosis include medications and/or surgical procedures, such as excision surgery, to relieve pain, remove scar tissue, and improve organ function. These treatments may also prevent a recurrence. In cases of endometriosis-related infertility, clinicians may recommend IVF or other assisted reproductive therapies to enhance pregnancy chances. Many patients with endometriosis benefit from therapy alongside medical treatments. Additionally, we conduct various research projects, offering patients access to medication and testing at no cost. Throughout the infertility journey, our counselors support patients with endometriosis, explaining different assisted reproductive technologies and helping patients understand their options fully.

The Sexuality, Intimacy, and Menopause Program is one of the only clinics of its kind in the country. By combining both medical and psychological interventions, it is designed to help women who experience sexual dysfunction after cancer. Sexual dysfunction after cancer is common; however, sexual side effects often go untreated after having successfully treated a patient’s cancer. Our doctors look to manage not only the physical issues, but also any psychological concerns that may arise. Founded by Elena Ratner, MD, MBA, associate professor of Obstetrics, Gynecology & Reproductive Sciences and co-chief for the Section of Gynecologic Oncology, and Mary Jane Minkin, MD, clinical professor of Obstetrics, Gynecology & Reproductive Sciences, the clinic began nearly a decade ago. Psychologist Dwain Fehon, PsyD, associate professor of Psychiatry and chief psychologist of Psychiatric Services at Yale New Haven Hospital, is a vital member of the team. He and his staff provide essential emotional care that helps improve our patients’ relationships and personal health. Many women have concerns related to intimacy and menopause because of cancer surgery or treatment. Our specialists consult with patients to address the difficult physical and emotional aspects of cancer care and treatment, and create a personalized care plan for each patient. We have developed a unique focus on menopause management for cancer survivors and “previvors”—healthy women who have their breasts or ovaries removed because of a genetic risk of developing cancer. What types of patients do we see? Women who experience: Changes in sexual function as a result of chemotherapy, radiation, or surgery for cancer Menopause symptoms as a side effect of cancer treatment Early menopause or sexual changes after surgery for cancer risk reduction What we provide: Menopause symptom management Resources for cancer survivors on maintaining sexual health Access to complementary and supportive services Access to individual and couples counseling What to expect from an appointment: Our team will first discuss each patient’s medical and cancer history, as well as what type of treatment they have had. They will be asked about symptoms of menopause and sexual problems, such as hot flashes, night sweats, changes in sexual desire, painful intercourse, vaginal dryness, or changes in mood or sleep patterns. Depending on their symptoms, patients may have a gynecologic exam. The team will then discuss options for symptom management and improving their sexual health. They will also have the opportunity to talk about emotional and relationship issues affecting their life. Women are welcome to bring their partners to the appointment.

The focus of the team of clinicians who form the Gynecologic Oncology Program at Smilow Cancer Hospital is to provide comprehensive and compassionate care for women with gynecologic cancers. Women diagnosed with vulvar, vaginal, cervical, uterine, fallopian tube, or ovarian cancers are provided with exceptional care from Yale’s experienced team of gynecologic oncologists at the hospital’s dedicated Women’s Center. In addition, the team also treats soft tissue tumors of the pelvis, gestational trophoblastic disease, as well as women with precancerous changes that have been identified in the vulva, vagina, and cervix, including dysplasia and carcinoma in situ, or premalignant changes of the endometrium, including adenomatous hyperplasia. The physicians of the Gynecologic Oncology Program offer a wide spectrum of advanced strategies for the diagnosis and treatment of gynecologic cancers, including colposcopy evaluation, conformal radiotherapy, and novel, targeted chemotherapies. The multidisciplinary program has experts from the obstetrics, gynecology, and reproductive sciences; radiation oncology; radiology and biomedical imaging; genetics; pathology; pharmacy; and social work. A dedicated patient coordinator facilitates patient appointments and communication, coordinates services, and supports each patient and their family. Surgery for previously untreated gynecologic cancer Surgical treatment of cancer is the most common option for previously untreated cancers. These operations include radical hysterectomies for cervical cancer, cytoreductive surgery for ovarian cancer, radical vulvectomies for vulvar cancer and total abdominal hysterectomies, bilateral salpingo-oophorectomies, and lymphadenectomies for the staging and treatment of endometrial cancers. Conventional laparoscopic and robotic surgery is available to women in need of surgery for uterine cancer, as well as for removal of the uterus, tubes, and ovaries. Prophylactic surgery, including hysterectomy, bilateral salpingo-oophorectomy, or bilateral salpingectomy with ovarian conservation, is also available to women looking to prevent ovarian cancer occurrence. Preservation of fertility in women with gynecologic cancers whenever possible is always a priority. We perform radical trachelectomies in women with early-stage cervical cancer who desire fertility preservation. For women with early-stage, low-grade endometrial cancers, hormonal therapy is prescribed. Chemotherapy Management The Gynecologic Oncology Program provides a full spectrum of chemotherapeutic agents used in the management of ovarian cancer, fallopian tube cancer, uterine cancer, mesenchymal tumors of the uterus, cervical cancer, vaginal cancer, and vulvar cancer. These chemotherapeutic agents may be used either for primary treatment or treatment of recurrent disease. Neoadjuvant chemotherapy, i.e., chemotherapy prescribed before surgical treatment, is often used for women with advanced ovarian cancer to reduce the s

The Prenatal Genetic Diagnostic Program provides expert genetic screening, testing, and counseling for parents. Our tests and services includefirst-trimester screening, chorionic villus sampling (CVS), amniocentesis, fetal blood sampling (FBS), and many others. After diagnosis, we provide counseling and connect patients to appropriate support networks to help parents adjust to and prepare for their child's special needs. In addition to pioneering the development of CVS and FBS, Yale has the most experienced team for these procedures in New England. Between 11 and 12 weeks after a woman's last menstrual period, she can instantly learn the baby's risk for Down syndrome and other abnormalities with our safe, noninvasive first-trimester risk assessment. Our team of specially-certified physicians, sonographers, and genetic counselors will provide patients with accurate information as quickly as technology allows. The procedure is simple: Patients provide a blood sample at least one week before their scheduled appointment, then visit us between weeks 11 and 14 of their pregnancy. Our comprehensive prenatal testing and genetic counseling services include: First and second trimester screenings Targeted ultrasound (formerly known as Level II ultrasound). We are equipped to perform targeted vaginal ultrasounds at an early gestational age, and provide diagnostic information early in a woman's pregnancy. Antenatal testing services. These services include nonstress testing, biophysical profiles, fetal versions, and PG gel insertions to help ensure fetal well-being throughout pregnancy. Fetal echocardiography. The Yale Fetal Cardiovascular Center is the most experienced diagnostic and treatment program of its kind in New England and provides the full range of prenatal surgical care. Prenatal ultrasound testing is typically performed during the second trimester to diagnose cardiac conditions in an unborn baby. Chorionic villus sampling (CVS). This is usually performed between the 10th and 12th weeks of pregnancy and involves the removal of a small sample of the placenta from the uterus. Amniocentesis. This is usually performed during the 15thweek of pregnancy or later, the procedure removes a sample of amniotic fluid from the uterus for evaluation. Fetal blood sampling. Fetal bloodis collected directly from the umbilical cord orfetus to test for signs of anemia and otherblooddisorders. Fetal tissue biopsy. This is typically performed between the 17thand 20thweeks of pregnancy, for patients who carry an abnormal gene for a severe skin disease to find out whether or not their fetus is similarly affected. Fetal karyotyping. This involving the collection of chorionic villi, amniotic fluid, or fetalblood to obtain and analyze chromosomes for abnormalities. Biochemical testing Fluorescence in situ hybridization (FISH) analysis. This involves laboratory testing to detect chromosomal abnormalities and other genetic mutations in a patient

Established in 1990, the Ovarian Cancer Early Detection Program provides women with new methods for the prevention, early detection, and treatment of gynecologic cancers. The direct connection between the research lab and patient care makes ours the leading center for women’s reproductive cancer research and treatment. The ovary is the fifth most common site for cancer to develop in American women. However, it is the fourth leading cause of cancer deaths in American women. There are more deaths from ovarian cancer than from cervical and uterine cancers combined. The program aims to identify ovarian cancer in its early stages when it is highly curable. We are committed to providing a comprehensive approach to treating reproductive cancers. Our multidisciplinary team is composed of physicians, scientists, nurses, genetic counselors, geneticists, and other medical staff. The Ovarian Cancer Early Detection Program was established in order to identify: Screening tests that are the most appropriate for detecting early ovarian cancer The frequency with which these tests should be employed How frequently these tests are normally performed We offer the following specialized services for women: Risk assessments, including genetic counseling and physical examinations The latest surgical interventions and postoperative treatment New diagnostic imaging and ultrasound technologies Opportunities for women with normal physical and ultrasound examination results and also for women with ovarian cancer to participate in approved clinical trials to develop new treatments Our approach to ovarian and other gynecological cancers is rooted in a program called Discovery to Cure, a broad initiative launched by Yale to combat all reproductive cancers. The program combines the cutting-edge research we do in the lab with a multidisciplinary team approach to patient care and the latest early detection methods.

Cancer Screening strategies are used to identify cancers at their earliest stage, before the onset of signs and symptoms, when the disease is most easily treated or cured. Cancer Prevention strategies are used to minimize the risk of cancer occurring. The Smilow Screening & Prevention Program brings together doctors and researchers at Smilow Cancer Hospital and Yale Cancer Center who are focused on merging the best science with the best cancer prevention and screening programs. Our goal is to provide patients in Connecticut with the tools they need to stay healthy. Screening Our Program offers many different screening tests for cancer of many types. Cancer screening tests are for patients who do not have symptoms. The goal of these tests is to find cancer as early as possible, and before any symptoms appear. Some, but not all, cancer screening tests detect potential problems and allow the doctor to remove the suspicious tissue at the time of the screening. This is important as it means that patients are less likely to develop cancer later in life. Sometimes the screening test results in a finding that requires more follow-up testing. Cancer screening offers the most protection when it is done on a regular basis as recommended by physicians. Patients should consult with their primary care physicians to determine which tests they recommend based on factors including gender, age, family history, and possibly race or ethnicity. Prevention Our program offers information to help patients make choices that can maintain their health and potentially reduce their risk of cancer. It is usually not possible to know why one person develops cancer and another does not. Healthy choices help all people--whether they have a family history of cancer or not--reduce their risk of developing cancer and many other chronic diseases. Avoiding smoking or chewing tobacco, choosing a diet that is rich in fruits and vegetables, exercising regularly, avoiding sitting for long periods, limiting alcohol, protecting skin and eyes from the sun and tanning beds are all key elements of healthy living. Following physician advice on regular cancer screening is also critical to long-term health. Types of cancer screening Click on the links below for more information on these specific cancer screening tests at Smilow Cancer Hospital: Lung Cancer Colorectal Cancer Breast Cancer Prostate Cancer Cervical Cancer Skin Cancer Head & Neck Cancer

Providing patient-centered, compassionate gynecologic care is our priority. Our diverse team of gynecologists offers consultative and treatment services for a comprehensive range of gynecologic conditions. Our clinical expertise in prevention, screening, and diagnosis of gynecologic cancers, prevention and treatment of gynecologic infections, fibroid management, management of endometriosis and pelvic pain, contraceptive services, and gynecologic care for patients with HIV are just a few examples of areas in which we are proud to be making a difference in our community. We offer state-of-the-art approaches to individualize the care of women with complex gynecologic conditions, including those that are precancerous, require minimally invasive surgery, or other advanced medical or surgical treatments. We care for patients of all ages across the entire community, including those who are underserved. We offer expertise in treating a variety of conditions including: Abnormal pap smears Abnormal uterine bleeding Chronic pelvic pain Complex surgical histories Endometriosis Fibroids Menopausal symptoms Ovarian cysts Pelvic infections Precancerous changes in the vulva, vagina, cervix (dysplasia), or uterus (hyperplasia) Sexual dysfunction Additionally, we provide the following specialty services: Minimally Invasive Gynecologic Surgery (MIGS) . We offer an array of advanced laparoscopic, robotic, vaginal, and hysteroscopic surgical techniques to manage benign and precancerous gynecologic conditions. Office-based procedures. We offer several in-office procedures including colposcopy and LEEP, contraceptive implant and IUD insertion and removal, diagnostic hysteroscopy, endometrial and vulval biopsies, and trigger point injections in a safe, comfortable, and convenient setting. Transgender care. We offer surgical consultation for women transitioning to men. Pre-invasive gynecology care. We provide multidisciplinary evaluation and management of abnormal pap tests and precancerous conditions of the uterus, cervix, vagina, and vulva using the most up-to-date practice guidelines, in collaboration with gynecologic pathologists. Chronic Pelvic Pain. We provide a comprehensive, patient-centered approach to pelvic pain. We work with a multidisciplinary team (colorectal, urology, interventional radiology, social work, physical therapy, and vascular surgery) to address pelvic pain, which often has multiple causes. We are committed to working closely with local practices, community-based health centers, and colleagues in other medical specialties to ensure coordination of timely and appropriate gynecologic care for our patients. Our multidisciplinary approach includes partnership with primary care, other surgical specialties, pathology, radiology, social work and care coordination. We are committed to serving the community and providing access to care. Our collaborative care model includes working with the Connecticut Veterans Administration Health Care System, Corn

Working out of Yale New Haven Hospital and Smilow Cancer Hospital, the Gynecologic Pathology program is a fundamental component in the prevention, diagnosis, and treatment of diseases of the female genital organs. Our pathologists are subspecialty-trained and highly experienced, with a passion for patient care. The program emphasizes diagnostic tissue evaluation, oncological biomarker identification, and clinical applications, as well as understanding the pathogenesis of various gynecological cancers. We encounter a high volume of complex, neoplastic gynecologic surgical specimens from the Yale Gynecologic Oncology Service and biopsy specimens from many outpatient clinics in the greater New Haven area. Beyond routine tissue diagnosis, team members actively participate in the real-time decision-making process for patient management, including daily intraoperative consultation, weekly gynecologic tumor conferences, and many ongoing cancer clinical trial programs. We have a national and international reputation as experts in the diagnosis of gestational trophoblastic diseases (complete and partial hydatidiform moles, gestational trophoblastic tumors) and endometrial cancer. We are among the few institutions to offer molecular genotyping as part of the routine diagnostic algorithm for molar pregnancies. Our services include examination of the following: Ovarian cancer, endometrium, and cervix Infertility, placental evaluation, endometrial hyperplasia, dysfunctional uterine bleeding, cervical Pap smear, sexually transmitted diseases, cervical dysplasia