Women’s health care delivery in the United States operates under a fragmented model. Patients move between primary care offices, imaging centers, specialist referrals, and procedural facilities. Each transition introduces delays, duplicated testing, and information gaps that compromise clinical decision-making.
Maya Healthcare Clinic structures care delivery differently.
The clinic consolidates diagnostic evaluation, procedural intervention, and longitudinal management under single clinical oversight. An in-house board-certified gynecologist directs care pathways from initial consultation through surgical treatment and long-term follow-up. On-site ultrasound, endometrial biopsy capability, and hysteroscopic procedures eliminate external referrals for routine gynecologic conditions.
This operational model produces measurable outcomes: reduced time from diagnosis to treatment, decreased referral rates, improved follow-up completion, and continuity of clinical records across decades of patient care.
Risk-Stratified Contraceptive Selection
Contraceptive counseling at Maya Healthcare Clinic follows American College of Obstetricians and Gynecologists (ACOG) medical eligibility criteria. The selection process balances clinical contraindications, reproductive goals, adherence capacity, and patient preference across hormonal, barrier, and long-acting reversible contraceptive (LARC) categories.
Medical history assessment determines contraceptive safety. Providers evaluate hypertension through in-office blood pressure measurement rather than patient report alone. Elevated readings contraindicate estrogen-containing methods due to stroke and cardiac risk. Migraine evaluation uses structured questioning to differentiate neurologic aura from typical headache features.
Specific indicators of aura include:
- Visual phenomena—flashing lights, zigzag patterns, blind spots
- Sensory symptoms—spreading numbness, tingling
- Speech difficulty
- Gradual symptom development over 5 to 60 minutes with complete resolution before headache onset
When providers cannot confidently rule out aura, estrogen is avoided. Progestin-only or nonhormonal methods are offered without delaying contraception for neurologic consultation.
Thromboembolic disease history contraindicates estrogen based on patient report. Thrombophilia laboratory testing is reserved for high-risk cases rather than routine screening.
This approach prioritizes access over universal diagnostic testing while maintaining safety through careful history-taking and blood pressure documentation.
Method-Specific Outcomes and Continuation Patterns
Progestin-only pills require daily administration at consistent times. Hormone levels fluctuate, producing irregular spotting, breakthrough bleeding, or absent menses. Late or missed doses reduce efficacy and increase patient anxiety. Continuation rates reflect adherence challenges.
The contraceptive implant delivers steady progestin over three years. Bleeding unpredictability drives discontinuation. Patients experience frequent, prolonged, or irregular spotting in the first three to six months. Some adapt. Others request early removal despite high efficacy and low maintenance requirements.
Maya Healthcare Clinic implements bleeding management protocols before implant removal. When patients present with persistent irregular bleeding at three to six months, providers rule out pregnancy and infection, then offer short-term interventions:
- NSAIDs for 5 to 7 days
- Combined oral contraceptives or low-dose estrogen (if eligible) for brief courses
- Tranexamic acid for heavier episodes
These treatments interrupt bleeding cycles and improve satisfaction. Removal proceeds only when bleeding remains unacceptable despite pharmacologic management.
Hormonal IUDs show different patterns. Early spotting transitions to lighter menses or amenorrhea over months. Most patients view reduced bleeding as beneficial. Continuation rates are highest with hormonal IUDs, followed by implants, then progestin-only pills.
Abnormal Uterine Bleeding Diagnostic Framework
Evaluation of abnormal uterine bleeding follows a structured sequence designed to separate structural from functional causes. The diagnostic pathway begins with detailed history covering bleeding pattern, pregnancy risk, medications, systemic disease, and bleeding disorders. Physical and pelvic examination follows.
Initial laboratory assessment includes:
- Pregnancy test
- Complete blood count
- Thyroid-stimulating hormone
- Additional hormone panels or coagulation studies when history suggests specific etiologies
Endometrial biopsy is performed for patients over 45, those with risk factors for endometrial pathology, or cases with persistent unexplained bleeding.
Risk factors lowering biopsy threshold in younger patients:
- Obesity
- Polycystic ovary syndrome
- Diabetes
These conditions increase unopposed estrogen exposure. When combined with bleeding lasting several months, occurring frequently, or presenting as heavy flow, biopsy proceeds regardless of age. Early detection of precancerous or cancerous changes depends on lowering diagnostic thresholds in high-risk populations.
Imaging Protocols for Structural Assessment
Transvaginal ultrasound serves as first-line imaging for suspected fibroids or polyps. When ultrasound findings are unclear or intracavitary lesions require better visualization, saline infusion sonohysterography or hysteroscopy follows.
Normal imaging combined with laboratory evidence of hormonal irregularity points toward ovulatory dysfunction or systemic causes. These cases receive medical management rather than surgical intervention.
Treatment Pathways for Submucosal Fibroids
A 3-centimeter submucosal fibroid confirmed by ultrasound in a patient with menorrhagia and fertility goals presents specific treatment considerations. Maya Healthcare Clinic follows a decision tree based on symptom severity and reproductive priorities.
Mild symptoms receive medical management:
- Tranexamic acid
- Hormonal IUD
Severe bleeding or active fertility planning favors hysteroscopic resection. Uterine artery embolization is avoided when pregnancy is desired due to potential impact on uterine blood flow and future pregnancy outcomes.
The in-house gynecologist performs hysteroscopic myomectomy at Maya Healthcare Clinic. Referral occurs only when fertility preservation requires specialized reproductive endocrinology management beyond routine fibroid removal.
Preoperative Anemia Optimization
Hemoglobin below approximately 10 g/dL prompts delay of elective hysteroscopic procedures, particularly when ongoing heavy bleeding continues. Exact thresholds vary based on patient symptoms and comorbidities.
Initial management uses oral iron supplementation (ferrous sulfate with vitamin C for enhanced absorption) when patients are stable and surgery is not urgent. Hematology referral and intravenous iron administration are indicated when:
- Anemia is moderate to severe
- Oral iron is not tolerated
- Absorption is impaired
- Faster correction is required
Patients with significant fibroid-related bleeding or larger, more vascular fibroids may receive short-term hormonal suppression preoperatively. This reduces bleeding, improves hemoglobin levels, and decreases endometrial vascularity. Surgery proceeds more safely after optimization.
Operational Structures Supporting Service Integration
Maya Healthcare Clinic maintains comprehensive gynecologic care through specific operational elements. A board-certified gynecologist provides clinical oversight across all service lines. On-site capabilities include ultrasound, endometrial biopsy, and hysteroscopic procedures.
Shared protocols standardize care pathways. One electronic medical record system maintains patient information across years of treatment. Coordinated scheduling allows evaluation, diagnosis, treatment, and follow-up to occur within the same facility rather than across multiple offices.
Cross-trained staff support procedural care under direct physician supervision. Non-physician personnel maintain competencies in:
- Sterile setup
- Instrument handling
- Patient monitoring
- Specimen processing
- Complication recognition
Clear scope-of-practice boundaries ensure the gynecologist performs all invasive steps. Staff operate within defined roles. Physician privileges at nearby hospitals provide escalation pathways when complications require higher-level care.
This structure produces measurable operational outcomes:
- Reduced external referrals for routine gynecologic conditions
- Decreased time from diagnosis to treatment initiation
- Improved follow-up completion rates
- Higher patient satisfaction compared with fragmented care models
Longitudinal Care Across Reproductive Life Stages
Patients receiving contraceptive counseling, abnormal bleeding evaluation, and procedural intervention at Maya Healthcare Clinic accumulate clinical data that informs later care decisions. When these patients transition through perimenopause to menopause, historical information directly shapes management protocols.
Past contraceptive history reveals estrogen tolerance or contraindications. Documentation of hypertension, migraine with aura, or thromboembolic events determines whether menopausal hormone therapy is safe and which delivery route is appropriate.
Prior abnormal bleeding evaluations, ultrasound findings, fibroid history, and endometrial biopsy results inform decisions about progestin protection and endometrial monitoring intensity during hormone therapy.
History of anemia, heavy menstrual bleeding, or polycystic ovary syndrome guides metabolic screening and bone health assessment during the menopausal transition.
Providers access longitudinal records showing trends across decades rather than isolated snapshots from fragmented care. This continuity produces:
- Safer hormone therapy decisions based on documented tolerance patterns
- Reduced duplicated testing
- Earlier detection of emerging health risks
- More personalized symptom management protocols
Patients presenting with incomplete or fragmented records lack this historical context. Providers must reconstruct medical history through patient recall, request records from multiple facilities, or repeat diagnostic testing. Clinical decision-making proceeds with less certainty.
Evidence-Based Integration as Clinical Framework
Maya Healthcare Clinic structures women’s health delivery around institutional standards, measurable protocols, and consolidated service lines. The model reduces referral requirements, maintains diagnostic and procedural capabilities in-house, and preserves longitudinal clinical records across reproductive life stages.
Contraceptive selection follows ACOG medical eligibility criteria through risk-stratified assessment. Abnormal bleeding evaluation uses structured diagnostic sequences to differentiate structural from functional causes. Procedural management includes preoperative optimization and clear referral criteria.
Operational structures supporting integration include physician oversight, shared protocols, unified medical records, coordinated scheduling, and cross-trained staff with defined scope-of-practice boundaries.
The framework demonstrates that comprehensive women’s health care operates through clinical systems design rather than aspirational patient experience messaging. Measurable outcomes validate the integrated model: reduced external referrals, faster treatment initiation, improved follow-up rates, and clinical continuity that informs decades of care decisions.
Vishnu Upadhyay
Vishnu Maya Upadhyay is the owner and operator of Maya Health Care & Behavioral Health Clinic in Euless, TX, founded in 2013. A highly accomplished Nurse Practitioner, she holds triple board certifications in Family Practice, Women’s Health, and Mental Health. With a career spanning over two decades, she brings extensive clinical expertise and a deep commitment to compassionate, patient-centered care.
– Bachelor of Science in Nursing (BSN) from Raj Kamari Amrit Kaur (RAK) College in New Delhi, India.
– Certified Women’s Health Nurse Practitioner from UT Southwestern.
– Certified Family Nurse Practitioner from Texas Woman’s University.
– Doctor of Nursing Practice (DNP) from Chamberlain University in 2017 with distinction.
– Post-doctorate Mental Health Nurse Practitioner certification (PMHNP-BC) from Brandman University in 2021.
