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.
Approximately 600,000 hysterectomies are performed every year in the United States alone, but only 10% or so for cancer of the uterus, or ovaries and rarely the fallopian tubes. The uterine indications usually are related to problems of bleeding, pain, pelvic tenderness, or a failure of pelvic support that causes uterine prolapse. Much less commonly, ovarian tumors will suggest the need for hysterectomy.
Pelvic adhesions cause many problems for millions of women. From obstructed tubes associated with infertility, to pelvic tenderness, and painful intercourse, to chronic pelvic pain. Curiously, adhesions can be very extensive, yet relatively silent. They may remain silent indefinitely, or long after the causative event, become symptomatic. The causes of adhesions are multiple but basically the tissue irritation that produces the adhesive process arises from an inflammatory event, or from trauma (i.e. post surgical).
"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".
Approaching menopause, the bleeding pattern for many women will perhaps change, with cycles either becoming shorter initially, and then with time the menstrual interval will begin to lengthen, be variable and perhaps some cycles skipped altogether, and then finally the periods stop entirely. A woman is said to be menopausal if more than 6 months have elapsed and she has not had a 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!
Laparoscopy is a form of minimally invasive surgery. The surgeon inserts a tiny telescope (laparascope) though a small incision at the umbilicus (belly-button). The laparoscope allows the surgeon to visualize the pelvic organs on a video monitor. Several additional smaller incisions are made in the abdomen for the surgeon to place specially designed surgical instruments, which help the surgeon carry out the same procedure as in open surgery.
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).
In 2009, it was suggested by researchers from the National Birth Defects Prevention Study that nitrofurans and sulfonamides, antibiotics commonly used for the treatment of urinary tract infections (UTIs), may increase the risk of birth defects when taken during the first trimester.
Questions on Laparoscopy & Hysteroscopy
The Pelvic Pain and Urgency/Frequency (PUF) patient symptom scale is a diagnostic tool used to screen patients with chronic pelvic pain. Developed by C. Lowell Parsons, MD, the PUF self-report questionnaire uses a symptom score (which measures how often a patient experiences problems) as well as a bother score (which notes the degree to which the symptoms bother the patient); the bother and symptom score combine for a total PUF score. The scale takes about 5 minutes to complete. Scores range between 0 and 35, and studies have indicated that a score greater than 12 is indicative of significant symptoms.
