Currently there are two ways to treat endometriosis – hormonal therapy and surgery. Depending on the patient’s expectations and the extent of the disease, we may prescribe hormonal therapy, surgery, a combination of surgery and hormonal therapy, or occasionally a just “wait and see” approach.
Approximately 750,000 hysterectomies are performed annually in the United States, with a mortality rate of about 12 per 10,000 operations.1 Costs to consumers and insurers have been estimated at approximately $1.7 billion per year.2 Thus, alternative procedures that are safer and less invasive, preserve the uterus, and cost less are increasingly in demand. In recent years, several such techniques have been introduced.
Laparoscopic myomectomy (LM) is a minimally invasive surgical procedure for the removal of uterine myomas. It was first described in the late 1970s by Semm. Subsequently, equipment has been developed to enhance the procedure. LM requires advanced laparoscopic skill and expertise in suturing and tissue removal. Laparoscopic assisted myomectomy (LAM), a procedure that combines operative laparoscopy and minilaparotomy, was described by Nezhat et al in 1994.
Isolated unilateral torsion of a fallopian tube is an infrequent but significant cause of acute lower abdominal pain in a female of reproductive age. We present a literature review and a case of a 41 yrs old lady who presented with sudden onset right sided lower abdominal pain radiating to right thigh. Clinical examination revealed tenderness in right lower abdomen and tender right adnexal mass was noted on vaginal examination.
A rare case of the inguinal endometriosis was reported with immunohistochemical analysis. A 28-year-old woman had a thumb-sized tumor in the right groin for two years with a gradual increase in size and pain. An operation revealed an elastic hard tumor with an unclear margin and adhesion to the uterine round ligament. The histology showed irregular proliferation of the endometrial glands and stroma.
Intracytoplasmic sperm injection (ICSI) is a component of infertility treatment often employed when conventional in vitro fertilization is unlikely to be successful. Despite good clinical results with ICSI, the procedure is typically associated with degeneration of a significant percentage (approximately 10%) of the treated oocytes. The cause of this degeneration remains unclear. Speculation that damage caused by oocyte compression during the injection procedure may be responsible has led to the development of a novel technique known as laser-assisted ICSI.
Comparison of Human Uterine Cervical Electrical Impedance Measurements Derived Using Two Tetrapolar Probes of Different Sizes
It is usually quite simple to find the cause of abnormal menstrual bleeding, although occasionally the cause may not be found. Since abnormal uterine bleeding can be caused by disorders of the uterus, hormone imbalance (usually not ovulating), and pregnancy, it is helpful to look at each area separately.
Myomectomy is the only surgical treatment of myomas that preserves fertility. The safety of pregnancy after uterine artery embolization has not been established, and pregnancy is impossible after hysterectomy. The average reduction in volume of fibroids after a UAE is 50%, where fibroids that have removed are completely gone.
Uterine fibroid embolization represents a fundamentally new approach to the treatment of fibroids. Embolization is a minimally invasive means of blocking the arteries that supply blood to the fibroids. It is a procedure that uses angiographic techniques (similar to those used in heart catheterization) to place a catheter into the uterine arteries. Small particles are injected into the arteries, which results in the blockage of the arteries feeding the fibroids. This technique is essentially the same as that used to control bleeding that occurs after birth or pelvic fracture, or bleeding caused by malignant tumors.
The most important question to ask is whether or not the fibroids need to be treated at all. The vast majority of fibroids grow as a woman gets older, and tend to shrink after menopause. Obviously, fibroids that are causing significant symptoms need treatment. While it is often easier to treat smaller fibroids than larger ones, many of the small fibroids never will need to be treated. So just because we can treat fibroids while they are small, it doesn't follow that we should treat them. The location of the fibroids plays a strong influence on how to approach them. A gynecologist experienced in the treatment of fibroids can help you determine if they need to be treated.
Menopause is the time in a woman's life when the ovaries stop producing estrogen. Menopause is usually recognized by the cessation of menstrual periods. Other symptoms of menopause include flashes, mood changes, difficulty sleeping, and vaginal dryness. If a woman is not menstruating because she has had a hysterectomy or endometrial ablation, other symptoms of menopause often alert her that menopause is starting.
Fibroids are non-cancerous (benign) growths of the muscle wall of the uterus. They are probably responsible for more unnecessary gynecologic surgery than any other condition. It is a staggering number, but about 600,000 American women have a hysterectomy every year. And about 30% of those hysterectomies, 180,000 in all, are performed because of fibroids. For many years these growths have been surgically removed, often because of fear of the problems they might cause in the future. And, those problems are often overstated. While approximately 30% of all women will have fibroids during their lifetimes, the vast majority of these women will never have symptoms and will never require treatment. And, for the rare patient that does have problems, there are a number of sound and effective options available. Hysterectomy should be the solution of last resort.
Pelvic pain that lasts 6 or more months, and is not associated with the menstrual period, is called chronic pelvic pain (menstrual pain is discussed in chapter 3). Chronic pelvic pain is a fairly common problem. It is estimated that about 20% of the visits to gynecologists are for pelvic pain, and one out of every seven hysterectomies are performed for this reason. Chronic pelvic pain can lead to significant distress and even disability. In recent years, a great deal of effort and research has been focused on helping women with chronic pelvic pain and people suffering from all types of chronic pain. Because of this, we are able to help people diminish the effects of pain.
Throughout history, menstruation has been associated with myth and superstition. Menstrual blood was felt to cure leprosy, warts, birthmarks, gout, worms and epilepsy. It has been used to ward off demons and evil spirits. Menstruating women have been separated from their tribes in order to prevent a bad influence on the crops or the hunt. As recently as 1930, the cause of abnormal menstrual bleeding was felt to be an undue exposure to cold or wet just prior to the beginning of the period.
The terminology used to describe pap smear results has changed over the past few years, leading to confusion about what the results of your pap smear actually mean. Originally, pap smears were divided into 5 "classes" based on what the cells looked like to the pathologist. Class I was normal, while class II cells appeared a little irregular to the pathologist, usually representing bacterial infection. Class III and IV pap smears suggested that dysplastic cells were present, and further testing needed to be done. Class V usually meant cancer.
Chronic pelvic pain (CPP) is often accompanied by poorly defined symptoms and a sense of failure by both doctor and patient.
As our ability to look inside the uterus improves, many women are told they have a common abnormality of the uterine lining, called endometrial polyps. An understanding of these common growths that develop inside the uterine cavity will help patients decide which course of treatment best suits them.
A patient of mine who regularly reads the forum recently asked me about board certification for Ob/Gyn doctors. She explained that there is a lot of confusion about this issue, and that many women's magazines and other media tell women to always seek out the services of an Ob/Gyn who is board certified. So, this looked like a good opportunity to review the board certification process.
Uterine fibroids ( "fibroid tumors";" leiomyoma"; "myomas") are benign, (non-cancerous) growths present in about 30% of women over the age of 30. They are usually detected on pelvic examination, which may reveal the uterus to be enlarged and/or irregular in configuration. The vast majority of cases are absolutely silent and cause no symptoms. The size of a single fibroid may be smaller than a pea, or larger than a melon. In a given patient, there may be a single fibroid, or multiple fibroids of varying size. In the latter situation, the summation of the fibroids of varying sizes will lead to an aggregate size increase.
"Abnormal Uterine Bleeding" or "AUB" is a relatively common condition. Normal menstrual flow produces less than 3 ounces of blood, in a maximum of 7 days. AUB patterns are characterized by flows that are heavier, and/or more prolonged or more frequent than a 21-28 day interval. AUB can cause anemia, embarrassment, or marked inconvenience. It has been said by many so afflicted women-" I have to plan my life around my period".
The last time I had seen Mrs. Martin for a checkup was in the winter of 1995. At that time she weighed nearly 250 pounds. During her visit a year later, to my dismay, she had gained another 40 pounds. That’s a lot of weight for anybody to carry around, and it’s of special concern in a woman who stands just 5’1" in her stocking feet.
Fibroids and Hysterectomies used to go together like Rogers and Hammerstein. Not anymore. If your physician recommends removing your uterus as the most effective treatment for severe fibroids without first considering less invasive therapies, start singing another tune and get a second opinion!
Many gynecologists will remove laparoscopically ovaries/ovarian cysts and treat ectopic pregnancies as well as endometriosis. Hysterectomies, bladder suspension surgeries and pelvic floor repair can also be treated by laparoscopy but these procedures are more advanced and may require additional training.
Hysteroscopy is a form of minimally invasive surgery. The surgeon inserts a tiny telescope (hysteroscope) through the cervix into the uterus. The hysteroscope allows the surgeon to visualize the inside of the uterine cavity on a video monitor. The uterine cavity is then inspected for any abnormality. The surgeon examines the shape of the uterus, the lining of the uterus and looks for any evidence of intrauterine pathology (fibroids or polyps). The surgeon also attempts to visualize the openings to the fallopian tubes (tubal ostia).
