Minimally Invasive Surgery: Smaller Incisions, Smarter Questions

The phrase minimally invasive can sound like the entire decision has already been made. It has not. The diagnosis, treatment goal, alternatives, fertility plans, anesthesia, recovery, and the surgeon's recommended approach all deserve a clear conversation before the operating room.

Dr. Joseph Leveno provides gynecologic surgery in Plano, including laparoscopy, hysteroscopy, endometrial ablation, and hysterectomy for appropriately selected patients.

What Does Minimally Invasive Actually Describe?

It describes the surgical approach, not the importance of the procedure. Laparoscopy generally uses small abdominal incisions and a camera to view or operate within the pelvis. Hysteroscopy uses a thin instrument passed through the vagina and cervix to view or treat the inside of the uterus.

These approaches can reduce the need for a large abdominal incision in selected cases, but every procedure still carries risks and requires preparation and recovery.

Which Conditions May Be Treated This Way?

Minimally invasive techniques may be considered for fibroids, ovarian cysts, endometriosis, abnormal bleeding, uterine polyps, adhesions, sterilization, or hysterectomy, among other indications. The same diagnosis does not lead every patient to the same operation.

Size, location, prior surgery, overall health, pregnancy goals, imaging findings, and the reason for treatment all influence what is feasible and appropriate.

What Should You Ask at the Consultation?

Bring a written list. A surgical conversation contains too much information to rely on memory alone.

• What is the exact diagnosis and goal of the recommended procedure?
• What nonsurgical or alternative surgical options are reasonable?
• How could the procedure affect fertility, periods, or hormone function?
• What recovery restrictions, warning signs, and follow-up should I expect?

Also ask whether tissue will be sent to pathology, what anesthesia is planned, and what circumstances could change the surgical approach.

How Are Laparoscopy and Hysteroscopy Different?

Laparoscopy views the abdominal and pelvic cavity through small incisions. It may be used to diagnose or treat conditions involving the ovaries, fallopian tubes, outside of the uterus, or other pelvic structures.

Hysteroscopy enters through the cervix without an abdominal incision and focuses on the uterine cavity. It may be used to evaluate or remove certain polyps, fibroids, scar tissue, or other causes of abnormal bleeding.

Does a Smaller Incision Mean an Easy Recovery?

Not necessarily. Recovery depends on the exact procedure, length of surgery, anesthesia, medical history, complications, and the physical demands of home and work. A hysterectomy performed through a minimally invasive approach is still major surgery.

Before scheduling, ask about driving, lifting, exercise, work, bathing, sex, bleeding, pain control, and help needed at home. Planning realistically is more useful than choosing the most optimistic recovery story online.

The Best Choice Begins With the Diagnosis

Surgery should solve a defined problem or answer an important clinical question. If the diagnosis remains uncertain, ask what additional evaluation is needed and how the result would change treatment.

"Minimally invasive surgery is a valuable option, but the approach still has to fit the diagnosis and the patient," says Dr. Leveno. "The consultation is where we connect those details and discuss alternatives."

Preparation also includes the practical details that are easy to underestimate. Ask which medicines and supplements may need adjustment, when to stop eating or drinking, whether someone must drive you home, and how much help you may need during the first several days. Do not change prescription medicine without instructions from the surgical team and the clinician who manages it.

Before consenting, repeat the plan back in your own words. Confirm the intended procedure, possible additional procedures, and what findings could cause the plan to change. If a term is unfamiliar, ask for plain language. Understanding the decision is part of informed consent, not an interruption to it.

Frequently Asked Questions

Is minimally invasive surgery always outpatient?

No. Some procedures are outpatient, while others require observation or a hospital stay. The plan depends on the procedure and the patient's health.

Will laparoscopy preserve fertility?

That depends on the condition and procedure. Ask specifically how the recommended surgery may affect the uterus, ovaries, fallopian tubes, and future pregnancy.

Can abnormal bleeding be treated without surgery?

Often, yes. Medication or hormonal options may be appropriate depending on the cause. Evaluation should come before choosing among medical and procedural treatments.

To discuss your diagnosis and surgical options, contact Dr. Leveno's Plano office and schedule a consultation.

Pap Test, Pelvic Exam, and STI Screening Walk Into an OBGYN Office

They may happen during the same appointment, but they are not interchangeable. A Pap test screens cervical cells, a pelvic exam evaluates pelvic anatomy, and STI screening looks for specific infections. Having one does not mean that all three occurred.

Dr. Joseph Leveno provides preventive and sexual health services through individualized well-woman visits in Plano.

What Does a Pap Test Screen For?

A Pap test collects cells from the cervix to look for abnormal changes that may lead to cervical cancer. Cervical cancer screening may use a Pap test, a high-risk HPV test, or both, depending on age, history, and current guidelines.

Screening is intended for people without symptoms and generally occurs at intervals longer than one year. A previous abnormal result, immune condition, history of cervical disease, or other factor may change the schedule.

What Happens During a Pelvic Exam?

A pelvic exam may include looking at the external genital area, using a speculum to view the vagina and cervix, and examining pelvic organs with gloved hands. Which components are appropriate depends on symptoms, history, pregnancy, and shared decision-making.

A pelvic exam can help evaluate pain, bleeding, discharge, a pelvic mass, or other concerns. It does not by itself test for cervical cell changes or every sexually transmitted infection.

How Is STI Screening Different?

STI testing looks for particular infections and may use urine, blood, or swabs from the vagina, cervix, throat, or rectum depending on exposure and the infection being considered. Many infections can be present without symptoms.

Recommendations vary by age, pregnancy, sexual history, anatomy, new or multiple partners, a partner's diagnosis, and other risk factors. The useful conversation is specific and confidential, not based on assumptions about appearance or relationship status.

What Should You Ask Before the Visit Ends?

Clear language prevents a great deal of confusion. Ask exactly what was performed and when results should arrive.

• Was cervical cancer screening due and which test was used?
• Was a pelvic exam performed, and was anything unusual found?
• Which STI tests were ordered and which infections were not included?
• How and when will results be delivered, and what follow-up is needed?

Do not assume that a request to “test for everything” has one universal meaning. There is no single test that screens for every STI.

Can You Need an Annual Visit Without an Annual Pap?

Yes. A routine OBGYN visit can address contraception, periods, pelvic symptoms, breast health, pregnancy planning, menopause, sexual health, medication review, and age-appropriate preventive care even when cervical screening is not due.

Updated 2026 ACOG guidance includes several cervical screening options depending on age and circumstances. Patients should follow the interval recommended for their own history rather than requesting a yearly test simply because it was once routine.

Specific Questions Lead to Better Care

You do not need to know the correct test name before arriving. Tell your clinician what you are concerned about, whether you have symptoms, and what exposures or changes may be relevant.

"A patient should leave knowing what we tested, what we did not test, and what happens next," says Dr. Leveno. "Those are straightforward questions and they are always appropriate to ask."

If privacy is a concern, ask how results will appear in the portal, on billing documents, or in notifications. You can also request time to speak without a partner or family member in the room. Clear communication about confidentiality can make it easier to share the information needed to select appropriate tests.

Remember that timing matters. Some infections are not detectable immediately after an exposure, and a negative result may not answer every question if testing occurred too early. Ask whether repeat testing is recommended.

Frequently Asked Questions

Does a Pap test detect sexually transmitted infections?

No. A Pap test is used for cervical cancer screening. STI testing is separate, although samples may sometimes be collected during the same visit.

Do I need a pelvic exam every year?

The need depends on symptoms, history, pregnancy, and shared decision-making. Your clinician can explain which parts of the visit are recommended and why.

Can I request STI screening without symptoms?

Yes. Many STIs can be asymptomatic. Tell your clinician about your age, pregnancy status, partners, exposures, and concerns so the appropriate tests can be selected.

If you are unsure which screening is due, contact Dr. Leveno's Plano office to schedule a confidential well-woman visit.

Ovarian Cyst or Ovulation Pain? Your Body Deserves Context

One-sided pelvic pain invites quick internet conclusions. It must be ovulation. It must be a cyst. It must be the first alarming result on a search page. In reality, timing and symptoms provide clues, but they rarely provide a complete diagnosis on their own.

Dr. Joseph Leveno evaluates pelvic pain and ovarian cyst concerns as part of personalized gynecologic care in Plano.

What Does Ovulation Pain Usually Feel Like?

Some patients notice brief discomfort on one side of the lower abdomen around the middle of a menstrual cycle. It may feel like an ache, pressure, or sharper twinge and may alternate sides in different cycles.

Cycle timing can support the possibility of ovulation pain, but it does not rule out another cause. Pain that is severe, persistent, increasingly frequent, or accompanied by other symptoms deserves evaluation.

What Is an Ovarian Cyst?

An ovarian cyst is a fluid-filled or partly solid sac that develops on or within an ovary. Many cysts form as part of the normal menstrual cycle, cause no symptoms, and resolve without treatment.

Other cysts may persist, grow, bleed, rupture, or cause the ovary to twist. The ultrasound appearance, size, symptoms, age, and whether a patient has gone through menopause all help determine what happens next.

Which Details Help Explain Pelvic Pain?

A simple symptom log can give the visit a much better starting point. Record the pattern without trying to label the diagnosis.

• Where the pain occurs, when it began, and whether it comes and goes
• Relationship to periods, ovulation, sex, exercise, urination, or bowel movements
• Associated bleeding, discharge, bloating, nausea, fever, or dizziness
• Pregnancy possibility, contraception, prior cysts, and previous pelvic surgery

Pelvic pain can come from reproductive organs, the urinary tract, the digestive system, muscles, or nerves. Context helps narrow the possibilities.

When Is One-Sided Pain an Emergency?

Sudden severe pelvic or abdominal pain, particularly with nausea, vomiting, weakness, dizziness, fainting, shoulder pain, fever, or possible pregnancy, needs urgent evaluation. Ovarian torsion, a ruptured or bleeding cyst, ectopic pregnancy, and other emergencies cannot be safely sorted out through a routine online message.

Call emergency services or go to an emergency department for severe or life-threatening symptoms. If you are uncertain about a new symptom that is not severe, contact your clinician promptly for guidance.

How Are Ovarian Cysts Evaluated?

The evaluation may include a pregnancy test, pelvic examination, ultrasound, blood work, or other testing based on the situation. Not every cyst requires the same follow-up, and not every case of pelvic pain will show a cyst.

When a cyst appears likely to be benign and symptoms are manageable, repeat imaging may be recommended to confirm that it resolves or remains stable. Surgery may be considered for selected cysts based on symptoms, size, appearance, persistence, or concern for complications.

Your Pain Does Not Need a Perfect Label

Patients sometimes delay because discomfort is intermittent or difficult to describe. A symptom can still be medically relevant even when it is not present every minute.

"The useful question is not whether a patient can name the cause before she arrives," says Dr. Leveno. "It is what the pain is doing, how it has changed, and whether the evaluation points to something that needs treatment."

While waiting for a nonurgent appointment, avoid repeatedly pressing on the painful area to test it. Keep a brief record of timing and associated symptoms instead. If the pattern changes, pain becomes severe, or pregnancy becomes possible, update the office rather than assuming the original appointment timing is still appropriate.

Frequently Asked Questions

Can an ovarian cyst resolve without treatment?

Yes. Many functional cysts resolve on their own. Follow-up depends on symptoms, ultrasound features, size, age, and medical history.

Can a cyst cause irregular bleeding?

Some cysts may be associated with cycle changes or bleeding, but abnormal bleeding has many possible causes. An evaluation helps determine whether the two are connected.

How can I tell whether pain is ovulation or a cyst?

You often cannot confirm the cause from symptoms alone. Timing may offer a clue, while examination and ultrasound may be needed when symptoms persist or are concerning.

For persistent, recurring, or unexplained pelvic pain, contact Dr. Leveno's Plano office. Seek urgent care immediately for sudden severe pain or other emergency symptoms.

Fibroids Are the Roommates Nobody Invited

They can take up space, create a surprising amount of disruption, and behave very differently from one person to the next. Uterine fibroids are common, noncancerous growths, but the word common does not describe how much they may affect an individual patient's life.

Dr. Joseph Leveno evaluates fibroid symptoms and provides individualized gynecologic treatment in Plano based on the size and location of fibroids, symptom severity, health history, and pregnancy goals.

What Are Uterine Fibroids?

Fibroids develop from the muscle of the uterus. They may grow within the uterine wall, project into the uterine cavity, or extend toward the outside of the uterus. A patient may have one fibroid or several, and their sizes can vary considerably.

They are not the same as uterine cancer, and many fibroids never cause symptoms. Finding one on an ultrasound does not automatically mean treatment is required.

Which Symptoms Can Fibroids Cause?

Location often matters as much as size. A fibroid that changes the uterine cavity may contribute to bleeding, while another may create pressure because of where it sits.

• Heavy, prolonged, painful, or more frequent menstrual bleeding
• Pelvic pressure, fullness, abdominal enlargement, or lower back discomfort
• Frequent urination, constipation, or discomfort during sex
• Fertility or pregnancy concerns in some circumstances

Those symptoms can also have other causes, so the goal is not to identify fibroids from a checklist. It is to give your clinician a clear picture of what has changed.

How Are Fibroids Evaluated?

Evaluation begins with symptoms, menstrual history, prior pregnancies, family history, medications, and reproductive plans. A pelvic examination and ultrasound may help identify the number, size, and position of fibroids.

Additional imaging or hysteroscopy may be useful in selected situations, particularly when bleeding is prominent or a fibroid may involve the uterine cavity. Blood work may also be recommended if heavy bleeding could have caused anemia.

Does Every Fibroid Need Treatment?

No. Fibroids that are small, stable, and not causing meaningful symptoms may only need observation. Treatment becomes a more useful discussion when bleeding causes anemia, pain or pressure affects daily life, fertility is involved, or symptoms are worsening.

The decision is about the patient, not simply the ultrasound measurement. Two people with similarly sized fibroids may reasonably choose very different plans.

What Treatment Options Might Be Discussed?

Medication or hormonal treatment may help manage bleeding or pain for some patients. Procedures can include hysteroscopic treatment for selected fibroids inside the uterine cavity, minimally invasive surgery, myomectomy, or hysterectomy depending on the situation.

Future pregnancy plans are especially important. Some treatments preserve the uterus while others end the ability to carry a pregnancy. Ask what the recommendation is intended to improve, which alternatives exist, and how each option may affect fertility and recovery.

When Should You Stop Calling It Normal?

If periods repeatedly cause missed work, nighttime changes, leaks, severe pain, or symptoms of anemia, the disruption is worth evaluating. The same is true for persistent pelvic pressure, urinary changes, or a noticeably enlarging abdomen.

"A fibroid does not need treatment simply because it exists, but symptoms should not be dismissed simply because fibroids are common," says Dr. Leveno. "We decide what to do by looking at the whole clinical picture."

If you have earlier ultrasound reports, operative notes, or records from fertility treatment, bring them when possible. Comparing current findings with prior measurements can help show whether a fibroid has changed. A list of treatments already tried, how long you used them, and what happened is equally useful when discussing the next step.

Frequently Asked Questions

Can fibroids go away on their own?

Fibroids often shrink after menopause as hormone levels change, but the course is not identical for every patient. Symptoms and growth before menopause should still be evaluated appropriately.

Can fibroids affect fertility?

Some fibroids can affect fertility or pregnancy depending on their location, size, and relationship to the uterine cavity. Many patients with fibroids become pregnant without difficulty.

Is a hysterectomy the only definitive option?

Hysterectomy removes the uterus and prevents fibroids from returning, but it is not the only treatment. Medication, monitoring, and uterus-preserving procedures may be appropriate depending on symptoms and goals.

If bleeding, pressure, or pain may be related to fibroids, contact Dr. Leveno's Plano office to schedule a gynecologic evaluation.

Perimenopause Is Having a Main-Character Moment

Perimenopause has finally entered everyday conversation, which is helpful until every headache, missed period, and bad night's sleep gets assigned to it automatically. The transition can affect much more than cycle timing, but not every new symptom should be explained away by hormones.

Dr. Joseph Leveno provides individualized menopause and perimenopause care in Plano, including evaluation of symptoms and discussion of appropriate treatment options.

What Is Perimenopause?

Perimenopause is the transition leading to menopause, when ovarian hormone production and menstrual patterns begin to change. It often starts in the forties, although timing and duration vary considerably.

Menopause is reached after twelve consecutive months without a menstrual period when another cause is not responsible. Until then, pregnancy may still be possible, even when cycles have become unpredictable.

Which Changes Are Common?

The most recognizable signs are cycle changes and hot flashes, but the experience is not identical from one person to the next. Some patients have a few manageable symptoms while others find that sleep, concentration, mood, or sexual health is significantly affected.

• Periods that become less predictable, closer together, farther apart, or different in flow
• Hot flashes, night sweats, sleep disruption, or temperature sensitivity
• Vaginal dryness, discomfort during sex, or urinary changes
• Mood changes, headaches, or difficulty concentrating

Track what is new and how it affects ordinary life. The pattern is often more useful than trying to grade every symptom on a perfect scale.

When Does Bleeding Need Evaluation?

Cycle irregularity can occur during perimenopause, but very heavy bleeding, bleeding between periods, bleeding after sex, or bleeding that becomes prolonged should be discussed. Any bleeding after menopause also requires evaluation.

Other conditions, including fibroids, polyps, thyroid disorders, pregnancy, medication effects, and changes in the uterine lining, can overlap with the transition. An evaluation helps avoid assigning every change to age alone.

Do You Need a Hormone Test?

Not always. Hormone levels can fluctuate substantially during perimenopause, so a single laboratory value may not provide the simple answer patients expect. Age, menstrual history, symptoms, medical history, and examination often provide more useful context.

Testing may still be appropriate when the timing is unusual, the diagnosis is uncertain, or another condition needs to be considered. The decision should answer a clinical question rather than simply produce a number.

What Treatment Options Are Available?

Treatment depends on the symptoms that matter most, their severity, and the patient's health history. Practical changes, nonhormonal medication, localized vaginal treatment, contraception, or systemic hormone therapy may be considered.

Hormone therapy can be effective for certain symptoms but is not appropriate for everyone. The type, dose, route, need for progestogen, and individual risks should be reviewed with a qualified clinician.

You Do Not Have to Earn Relief

Symptoms do not need to become unbearable before they count. If sleep disruption is affecting work, hot flashes are limiting daily life, or vaginal symptoms are affecting comfort and relationships, bring them up.

"Perimenopause is common, but the treatment plan should never feel generic," says Dr. Leveno. "We look at the symptoms, the patient's medical history, and what she wants to improve."

Prepare for the visit by noting the date of your last period, recent cycle lengths, bleeding changes, contraception, prior gynecologic procedures, and any family history of breast, ovarian, uterine, or colon cancer. Bring an updated list of medicines and supplements, including products used for sleep or hot flashes.

It is also useful to decide which symptom you most want to improve first. Better sleep, fewer hot flashes, more predictable bleeding, or less vaginal discomfort may call for different starting points. A focused priority can make a broad transition feel much more manageable.

Frequently Asked Questions

Can I become pregnant during perimenopause?

Yes. Ovulation can still occur even when periods are irregular. Discuss contraception if pregnancy is not desired and pregnancy planning if it is.

Is every irregular period caused by perimenopause?

No. Pregnancy, thyroid conditions, fibroids, medication effects, and other causes can alter bleeding. New or concerning changes deserve evaluation.

Is hormone therapy the only treatment?

No. Options include practical strategies, nonhormonal medicines, localized treatments, and hormone therapy when appropriate. The best choice depends on symptoms and health history.

If cycle changes, sleep disruption, hot flashes, or vaginal symptoms are affecting your life, contact Dr. Leveno's Plano office to discuss personalized perimenopause care.