Integrative medicine means evaluating and treating the whole person, not just a symptom or a disease, in order to achieve optimal health based on individuals’ goals and preferences. This process begins with a comprehensive well-woman exam. During this exam, we will review your complete medical, surgical, social, and family history. You will have a thorough physical exam of the breast, abdomen, and pelvis, have a pap test done at the appropriate interval, as well as routine STD testing and bloodwork when indicated. Your mammogram, colonoscopy, and bone scans may also be ordered at this time. It is also an important opportunity for us to evaluate your emotional well-being and define your fitness goals.

Abnormal bleeding can happen for numerous reasons. You may experience irregular spotting, periods which come more than once a month or skip months, or excessively heavy bleeding. In evaluating bleeding problems, Dr. Soffer considers possible anatomical issues like fibroids, polyps, and endometrial overgrowth, as well as biochemical problems like hormonal imbalances. She will perform a complete evaluation including history and physical examination, ordering laboratory studies and/or imaging. She will then review all possible treatment options to address the underlying issue.

Fibroids are growths within the uterine muscle which are extremely common and usually cause no symptoms. However, if they grow into the uterine lining, they can cause very heavy bleeding which can require medical or surgical management to control. In rare cases, fibroids can grow to be large enough to cause pressure or pain symptoms which may require intervention, as well.

The inner lining of the uterus is called the endometrium. This lining thickens all month in response to hormones during your menstrual cycle, and at the end of the cycle (if you don’t get pregnant) the drop in your hormones signals the lining to shed so the uterus can build a new lining the next cycle (in case you get pregnant that month). This is a typical menstrual cycle, and the uterus is structured to handle this process of tissue growth and shedding with minor to moderate discomfort (see dysmenorrhea). 

Endometriosis is a problem where there is endometrial tissue outside of the uterus, usually in the abdominal cavity on the ovary, bladder, bowel, or abdominal wall. This is a problem because nowhere in the body, outside the uterus, is equipped to handle this kind of tissue growth and shedding. The intense inflammation from this process causes intense pain in the abdomen just before and during periods.

Similarly, adenomyosis is a problem where the endometrial lining migrates into the uterine muscle wall, where it’s not supposed to be. This can also cause excessive menstrual pain and bleeding.

Both endometriosis and adenomyosis can be difficult to diagnose and effectively treat.

Dysmenorrhea refers to painful, crampy periods, and may also coincide with other symptoms such as pain radiating into the back or legs, nausea, vomiting, and diarrhea. Since these symptoms overlap with numerous other medical issues, Dr. Soffer is careful to evaluate patients with these symptoms for other possible causes. Once a full workup has been done, Dr. Soffer will discuss in detail the best treatment options for each patient, depending on their medical history, exam, and preferences.

Premenstrual Syndrome usually occurs in the few days before your period due to sudden hormonal fluctuations. Symptoms can include mood swings, irritability, sleep disturbances, acne, bloating, joint pain, breast tenderness, diarrhea, fatigue, and weakness. Treatments can include hormonal management, mood stabilizers, herbal therapies, anti-inflammatory medications, meditation, acupuncture, and other remedies aimed at alleviating each patient’s specific symptoms.

The transition into menopause is rarely seamless for any woman. Symptoms can vary widely, range from mild to severe, and can last from months to years. Most women develop abnormal bleeding patterns in their mid to late 40s as they approach menopause, and then eventually stop menstruating completely. The physical symptoms can range from hot flashes and night sweats to changes in hair, skin, vision, and metabolism. Most women will experience mood swings, a decrease in their sex drive and some may develop pain with intercourse if vaginal dryness becomes a significant issue. Some report difficulty sleeping or concentrating. There are also other health considerations such as increasing risk for cancer, cardiovascular disease, and osteoporosis. Dr. Soffer begins the process of evaluating the whole person, identifying risk factors, and addressing them early so that her patients are prepared, symptoms are minimized, and all options considered as women transition through this dramatic life change.

Many symptoms that women suffer in menopause are side effects from the changing hormonal milieu that occurs during this transition. Using hormonal supplements to stabilize these hormonal fluctuations can be one effective way of helping to control many of these symptoms. There can be significant risks to this therapy, however, including possibilities for blood clots, heart attacks, strokes, and breast cancer. While these are serious risks for many women which may preclude using this therapy, the risks vary widely depending on medical history, family history, and individual patient goals. Dr. Soffer spends a tremendous amount of time with her patients reviewing the data on these questions, risks specific to each individual patient, and reviewing alternative options if HRT is deemed too risky to use for menopausal symptom management.

In the modern era, it is nearly a universal truth that women struggle to maintain a healthy weight. This often stems for a multitude of factors, including:

Fast-paced lifestyles which can preclude time for healthy cooking; 

The expense of healthier fruits and vegetables (as compared to junk food);

The under-emphasis in our culture on emotional well-being, which leads many people to self-treat depression and anxiety with food;

The lack of training in healthy eating options during childhood;

The complexity of our lives, caring for children, partners, parents, communities, often precluding focus on self;

Certain medical conditions, like thyroid disorders, PCOS, disabilities, autoimmune diseases;

Certain medications, like steroids and high-dose hormones;

The list goes on and on….

Dr. Soffer understands that to be able to maintain a healthy weight, the barriers to that must first be identified, and managed. Only then does a patient truly have the potential for weight loss and maintaining her goal weight. Dr. Soffer utilizes numerous methods to help her patients with this, including medical evaluations for underlying disorders which may be contributing; dietary counseling and meals plans (complete with shopping lists); exercise plans, meditation, and behavioral therapy. Dr. Soffer rarely, if ever, utilizes medications to promote weight loss due to the inherent cardiovascular risks often associated with these medications. As always, she will have detailed discussions with her patients to define what will be the best methods to help them achieve their goals.

Pap tests are the main method for cervical cancer screening. A speculum exam is done to collect cells from inside the cervix to evaluate for precancerous changes. If abnormalities are found, Dr. Soffer will review different options with you, depending on the result and your personal risk factors. You may require a colposcopy for further evaluation to magnify the cervix for visually-guided biopsies of abnormal-appearing tissue.

There are many birth control options to choose from, including: condoms, pills, patches, nuvarings, injections, intrauterine devices (IUDs), Nexplanon (an implant under your skin), vasectomy, and tubal ligation. In choosing your method, it is important to consider your medical history, physical and pelvic examination, as well as your plans for future childbearing. Dr. Soffer will review each option in detail and help you choose the one which is right for you.

Ovarian cysts are extremely common and often have no symptoms. In some cases, if they grow large or rupture, they can cause significant pain and may require medical or surgical intervention. In some cases, a patient can have significant abdominal pain that is attributed to a cyst found incidentally on imaging, but this is actually incorrect as the pain is being caused by something else. Rarely, a dangerous type of cyst can develop on the ovary which can be cancerous. Because ovarian cysts can have numerous different causes, implications, and treatments, it is important to have routine exams and a physician you trust to thoroughly evaluate the situation.

Vaginal discharge is usually a normal, way for the vagina to retain moisture and a healthy pH balance. Sometimes, however, excessive, itchy and/or stinky discharge may be a sign of an infection like bacterial vaginosis, yeast, trichomonas, gonorrhea, chlamydia, or other microbes. Occasionally,                                           or ureaplasma may cause urinary or pain symptoms. Dr. Soffer is able to reliably evaluate for and treat such vagina infections. 

The vulva is the external aspect of female genitalia which includes the labia, clitoris, urethral meatus, and the vaginal opening. Numerous issues can occur on the vulva. Mostly commonly, yeast infections can cause itching and scratching of the skin. Many people, however, will be told they have recurrent yeast infections to explain their itching symptoms, when in fact there may be any number of skin disorders that can cause intractable itching, like lichen sclerosus, lichen planus, lichen simplex chronicus, and many more. Rarely, skin or vulvar cancers can cause these symptoms, as well. Dr. Soffer specializes in diagnosing and treating vulvar disorders, having extensive experience with many of these rare conditions. She tests for infections, autoimmune disorders, as well as skin disorders to evaluate vulvar symptoms. Additionally, she is skilled in surgical treatment of vulvar lesions.

PCOS is defined as irregular periods due to elevated androgens (testosterone-like hormones). Their high testosterone levels can cause lower voice, excessive hair growth, cystic acne, mood swings, and irritability. The hormonal imbalance can cause ovulation to be disrupted and reduce fertility. Patients with PCOS can also be at risk for several metabolic problems, as well, including diabetes, high blood pressure, high cholesterol, and excessive weight gain. Dr. Soffer evaluates all the various components involved with PCOS, and discusses with each patient, in detail, their individual risks and treatment options. 

      This diagnosis can be very confusing for patients, many of who assume they must have a mass on their ovary because of the term “polycystic ovaries.” Unfortunately, the name is misleading as it does not refer to a fluid-filled sac on the ovary. The name actually refers to the tendency for PCOS patients to have their eggs line up right in a row along the periphery of the ovary in a ‘string of pearls’ formation. Radiologists will often refer to eggs within the ovary as ‘cysts’ on a radiology report, but it is not the same as having a mass.

UTIs can be very common for some women. Though they are often simple infections that can be treated with a routine dose of antibiotics with low likelihood of recurrence, in some women they can be a more serious situation. If the infections recur more than 3 times a year, there may be an anatomical problem with the urinary tract itself. Dr. Soffer can help begin the process of evaluation for this, and refer to appropriate specialists, if necessary, when other issues are identified.

About 4 in 10 women have problems with sex at some point during their lives. There can be many reasons for this. Hormonal fluctuations, particularly as women approach menopause, may reduce interest in intercouse. Additionally, these hormone shifts, along with certain medications, cancer treatments, and illnesses, can cause tissue changes in the reproductive tract which may make intercourse unpleasant or painful. Emotional distress, depression, and anxiety can also harm a woman's ability to enjoy a healthy sexual relationship with her partner. Dr. Soffer is adept at evaluating both the psychosocial and physiological aspects which may contribute to diminished sexual health and counsels patients extensively on available treatment options.