The Nexplanon® implant is a small, flexible rod placed just beneath the skin of the upper arm during a quick in-office procedure. It releases a low, steady dose of progesterone to prevent pregnancy by suppressing ovulation. Nexplanon is more than 99% effective and provides continuous pregnancy prevention for up to 5 years.

Regular cervical cancer screenings with a PAP smear and/or HPV testing are an essential part of preventive women's healthcare, helping to detect cervical cell changes before they become more serious. Our providers perform cervical cancer screenings with PAP and HPV (Human Papillomavirus) testing in accordance with current guidelines and will discuss your results to help you stay proactive about your health. If your PAP or HPV tests return abnormal, we may recommend proceeding with a colposcopy, which is a microscopic exam of the cervix to take a more detailed look and possibly collect biopsies.  We can do this procedure in the comfort of our office.

Visit the American Society for Colposcopy and Cervical Pathology website for excellent patient resources and information on PAP testing and colposcopy.

Visit the CDC website for information on HPV.

There are a variety of short-term hormonal contraceptive methods that we can help you navigate to fit your preferences and routine, including:

• Birth control pills (numerous brands and formulations including ultra low dose and progesterone only; let us help you find the right one!)
• Birth control patch
• Vaginal ring (Nuvaring®)
• Birth control injection (Depo-Provera®)

If you are having trouble getting pregnant and would like compassionate care in a comfortable, friendly setting, please come see us at Cary OB/GYN. Our physicians are able to provide an infertility work-up, including hormone and lab testing, pelvic ultrasonography, and guidance on next steps after taking a careful history and assessing for potential causes of female and male infertility. For patients who qualify, we also offer oral ovulation induction to help you reach your goals faster, as well as expedited referrals to local Reproductive Endocrinologists with whom we work closely to care for our patients.

An intrauterine device (IUD) is a small T-shaped device that is placed through the cervix inside the uterus to provide long-term, reversible pregnancy prevention. IUDs are more than 99% effective and require little to no maintenance after placement. If your family planning goals change, your provider can remove your IUD at any time.

We offer both hormonal and non-hormonal IUD options, including:

• Hormonal IUDs (Mirena®, Kyleena®, Liletta®, and Skyla®) release a small amount of the hormone progesterone to thicken cervical mucus to prevent sperm from entering and to thin the uterine lining. Depending on the device, hormonal IUDs provide effective pregnancy prevention for up to 3 to 8 years.  Hormonal IUDs are also FDA-approved for the treatment of abnormal uterine bleeding due to the added benefit of thinning the uterine lining to effectively decrease menstrual flow or, in some cases, end the flow completely.
• Copper IUD (ParaGard®) is a hormone-free option that uses copper to prevent sperm from fertilizing an egg. ParaGard can remain in place for up to 12 years and may also be used as emergency contraception when inserted within the appropriate timeframe.  If you are interested in having a Copper IUD placed for emergency contraception, please contact our office immediately.

We are pleased to offer in-office surgical options to improve the patient experience and reduce costs compared with traditional hospital surgery. Hysteroscopy refers to the use of a small camera that is inserted into the uterus through the cervix with no incisions, so that we may visualize inside the uterus.  This can be an important step in treating abnormal uterine bleeding, sampling inside the uterus, and visualizing the openings of the fallopian tubes.  In-office hysteroscopy can also remove uterine fibroids and endometrial polyps, which are common growths of extra endometrial tissue inside the uterus.

We are pleased to offer Hormone Replacement Therapy (HRT) and personalized care for your transition into perimenopause and menopause. We offer a range of options and will discuss the risks and benefits in detail after taking a careful history of your symptoms and treatment goals. 

While all of our physicians can prescribe HRT, we are pleased to offer appointments with Drs. Rodrigo and Wyckoff, who are both certified by the North American Menopause Society as Menopause Society Certified Practitioners. This special designation is for physicians who further their education in this area and pass an additional board exam. We are very proud of Drs. Rodrigo and Wyckoff and their commitment to excellence in treating menopause.

When a hysterectomy is the best treatment option, minimally invasive techniques can offer smaller incisions, less pain, and a faster recovery than traditional surgery. Our experienced surgeons provide personalized care and utilize advanced surgical approaches whenever appropriate to help you achieve the best possible outcome.

Drs. Piper and Rodrigo are certified minimally invasive surgeons who operate with the DaVinci robotic system at WakeMed Cary and can offer same-day discharge after hysterectomy, with small incisions for quicker healing and less postoperative pain.

Learn more about the DaVinci robotic system.

Does birth control not feel like the right choice for you right now? We are here to support you in your decisions for your body and your life and have the common goal to help you understand your options and ensure you are in control of your reproductive goals. You can schedule a visit with us to discuss Natural Family Planning (NFP) methods, which is a way to track ovulation to avoid unplanned pregnancy. 

We may discuss these options with you:

• Cervical mucus or basal body temperature monitoring
• Ovulation prediction strips that test for Luteinizing Hormone
• Use of phone apps such as Natural Cycles for additional accuracy and tracking
• Wearable personal biometric monitors

We are pleased to offer Nitrous Oxide as a pain-relief option for all office procedures. Nitrous oxide (NO3), or laughing gas, is an inhaled gas mixture of nitrous oxide and oxygen used for fast-acting, short-term pain relief. 

In addition to the copper IUD, there are other non-hormonal options for birth control. Understanding the effectiveness of these options is important when making an informed decision. 

• Intravaginal gel (Phexx®); we are happy to provide a prescription 
• Spermicide
• Diaphragm or Cervical Cap

Laparoscopy is a minimally invasive surgical technique that is used to diagnose and treat a variety of gynecologic conditions through small incisions. Compared to traditional open surgery, laparoscopic procedures result in less pain, smaller scars, shorter hospital stays, and faster recovery times. Our experienced surgeons utilize advanced laparoscopic techniques whenever appropriate to provide safe, effective care.

A few examples of conditions that can be treated with pelvic laparoscopy by our surgeons include:

• Endometriosis
• Ovarian cysts
• Fallopian tube blockages or cysts
• Uterine fibroids
• Sterilization procedure with removal of fallopian tubes

We are pleased to offer expert pelvic floor physical therapy in the comfort of our office.  Pelvic floor physical therapy offers numerous health benefits and helps treat a variety of gynecologic and obstetric-related problems. 

Benefits include:

• Improved bladder and bowel control
• Pelvic pain relief
• Supporting pregnancy and postpartum recovery
• Treatment and prevention of pelvic organ prolapse
• Core stability and posture improvement
• Relief from painful intercourse

Pelvic pain can be related to your menstrual cycle or happen any time of the month and can have many causes that are important to discuss and explore. Whether your symptoms are acute or chronic, our experienced providers will take a careful history, offer testing to determine the underlying cause, and recommend treatment options to relieve your discomfort and improve your quality of life.

Pelvic pain may occur regularly, like with your monthly periods, or as an uncomfortable sensation that comes and goes or happens on random days. In any case, because pelvic pain can be a sign of a serious issue and can affect your ability to enjoy life, it’s important to determine the cause and to hear about personalized treatment options. Some of these causes may include:

• Menstrual cramping (dysmenorrhea)
• Pelvic floor dysfunction
• Endometriosis
• Adenomyosis
• Uterine fibroids
• Ovarian cysts
• Urinary tract or bladder infection
• Pelvic inflammatory disease
• Ectopic pregnancy
• Gastrointestinal issues such as Diverticulitis or Crohn’s Disease
• Chronic pain syndromes such as fibromyalgia or centralized pain syndrome

Sexually transmitted infection (STI, formerly STD) testing is an important part of maintaining your reproductive and overall health. At Cary OB/GYN, we understand that discussing sexual health can feel sensitive, and our compassionate providers are committed to creating a comfortable, confidential, and judgment-free environment where you can receive the care you need.

During your visit, your provider will review your medical history, discuss your sexual health, and recommend the most appropriate screening based on your age, symptoms, lifestyle, and risk factors. Depending on your individual needs, testing may include a pelvic exam with swab collection, Pap smear, blood testing, or urine testing. We also offer self-swabbing.

Most test results are available within 1-2 days. If additional evaluation or treatment is needed, our team will contact you promptly to review your results, answer your questions, and develop your treatment plan and any needed follow-up.

Whether you are experiencing symptoms, have concerns about a recent exposure, or simply want routine screening as part of your preventive care, we're here to provide the compassionate, confidential care you deserve.

We are also able to offer permanent surgical sterilization, which involves a laparoscopic procedure at the hospital to remove the fallopian tubes.  This is called a bilateral salpingectomy, which has the added benefit of a lifetime reduction in risk for ovarian cancer. Visit the ACOG website to learn more about bilateral salpingectomy and come see us to discuss if this may be right for you.

Uterine fibroids are common benign growths of the muscle tissue of the uterus that can grow inside the uterine lining, the walls of the uterus, or attach to the outside of the uterus. Uterine fibroids may cause heavy menstrual bleeding, intense cramping, pelvic pain, pelvic heaviness or pressure, and even issues with urination or bowel movements.

At Cary OB/GYN, we offer a comprehensive range of uterine fibroid treatment options, supported by a team of advanced minimally invasive surgeons. Determining the location and size of the fibroids is important when selecting the right treatment plan. Examples of treatment options include hormonal therapies, in-office surgery with myomectomy, hysterectomy, or uterine artery embolization.  We provide comprehensive in-office ultrasonography with experienced technicians to show details of your fibroids and support your decision-making.

Drs. Piper and Rodrigo are certified minimally invasive surgeons who operate with the DaVinci robotic system at WakeMed Cary and can offer same-day discharge after hysterectomy, with small incisions for quicker healing and less postoperative pain.

Learn more about the DaVinci robotic system.

The annual women’s wellness exam is an important part of your preventative healthcare and is covered once a year by your insurance. The goals of this exam are to ensure the health of your female reproductive organs, discuss your family planning goals, perform cervical cancer screening with PAP and/or HPV testing, order age-appropriate preventative screening such as Mammograms or Colonoscopies, and to discuss your overall health goals and identify any issues before they become problems. Examples include screening for abnormal uterine bleeding, irregular periods, pelvic pain, vaginitis symptoms, and urinary or bowel dysfunction. If we identify any issues, we may order diagnostic testing, place referrals, or recommend a follow-up visit.

• Polyendocrine Metabolic Syndrome (formerly PCOS)

• Endometriosis

• Urinary incontinence

• Pelvic Organ Prolapse

• Pelvic floor dysfunction- we also offer in-office Pelvic Floor Physical Therapy

• Painful Intercourse

• HPV Vaccination (Gardasil®)

• Vaginitis and vaginal infections

• Adolescent Health

• Ovarian Cysts

• Preconception Counseling

• Fertility testing