There are many reasons why a woman may choose to have, or need a hysterectomy. A hysterectomy is the removal, or partial removal of the uterus. The uterus is the large, hollow, female organ that resides in the female pelvis between the bladder and the rectum. It is where a fetus grows once an egg has been fertilized.

Hysterectomy statistics include:

• 10% of Hysterectomies are performed because of (due to) cancer
• 30% of Hysterectomies are performed because of (due to) Fibroid Tumors
• 20% of Hysterectomies are performed to eliminate pain caused by Endometriosis
• 16% of Hysterectomies are performed to repair a prolapsed Uterus.
• The remaining 24% of Hysterectomies are performed for reasons such as recurrence of pain and heavy bleeding, severe infection, and post delivery trauma.

Regardless of the reason a woman might be receiving a hysterectomy it is still a big decision, which accompanies an understandable amount of stress. Today, the complications following a hysterectomy can be lessened with new tools, techniques and medical technologies.  The gynecologists at the Women’s Specialists of Plano use a system called the da Vinci robotic surgery which makes the entire surgery and recovery process a lot simpler than it once was.

The robotics hysterectomy da Vinci system is a highly technical system of small, precise, electronic tools that robotically assist a physician in surgically removing the reproductive organs without causing major incisions or long recovery periods. The list of pros for a robotics hysterectomy includes:

• Less pain
• Fewer complications
• Less blood loss
• Shorter hospital stay
• Low risk of wound infection
• Quicker recovery and return to normal activities

What is robotic surgery? It’s a fairly simple process. The da Vinci robotic surgery allows doctors to see the organs through a microscope via a 3d screen without the need to make large incisions. The robotic arms of the da Vinci allows precise movement and act as the surgeon’s hands eliminating unsteadiness. The surgery leaves the patient with just a couple of very tiny incisions that usually do not require sutures.

OBGYN’s are constantly asked “What is robotic surgery and how will it benefit me?” from patients. Two Women’s Specialists of Plano recipients of robotics hysterectomy recently provided the following feedback regarding their recent procedures:

According to Patricia, “After battling breast cancer and going through numerous surgeries, the last thing I wanted to do was go under the knife again. But when my OBGYN found a benign tumor on my ovary, he recommended a hysterectomy. The first thing that came to my mind was that I would be left in a considerable amount of pain because of a huge incision and out of work for six to eight weeks. After looking at my specific situation, we decided on the robotic hysterectomy method. The surgery was fast and I was in recovery within a very short period of time. I barely had to take any painkillers and I had no complications whatsoever. My scars are barely visible.  Even after one week, I felt good enough to go back to work, but still stayed home because of my doctor’s advice. I would recommend the robotic hysterectomy to anyone considering a hysterectomy.”

Sharon, another patient who underwent a hysterectomy via da Vinci robotic surgery, shares a similar experience.

“After several years of experiencing inconsistent, crampy, long periods—coupled with abnormal and inconclusive pap smears, I was ready for a hysterectomy. My doctor recommended the robotic hysterectomy technique and after doing my own research on the technology, I knew it was for me. Not only was the surgery a breeze, but the post-op recovery was trouble-free and brought with it minimal pain and scarring. Technology is a beautiful thing and it has allowed this surgery to become easier and the result as if it has never happened.”

The benefits of the robotic hysterectomy have been documented by thousands of patients and doctors.  Because the procedure is highly technical, it requires a skilled, trained surgeon.  While not all patients are candidates for this procedure, more and more are and are turning towards the method because of the benefits it brings.

According to the doctors that make up the Women’s Specialists of Plano, “The skillfulness of the robotic tools and the dexterity of the 3D technology allows for the effectiveness of traditional open hysterectomy surgery and brings it to the minimally-invasive setting.”

Any woman considering or being faced with a hysterectomy, should discuss all of the options with their OBGYN. The robotic hysterectomy is one such consideration to be discussed.

The Women’s Specialists of Plano (972.379.2416, http://obgynplano.com) specializes in pelvic floor dysfunction and vaginal prolapse. When Jean, a 74-year old resident of Plano, Texas, began having unusual and at times frightening symptoms during bowel movements, she decided to make an appointment with the Women’s Specialists of Plano.  “What should have been an everyday normal bodily function for anyone, created stress and anxiety for me because every time I attempted to take a bowel movement, I felt as if my internal organs were coming out—and in most cases, they were,” said Jean.

Jean’s OBGYN, Dr. Murray Fox, diagnosed her condition as pelvic floor dysfunction, or in her case, a vaginal prolapse. It is a common disorder seen by the entire group of doctors at WSOP including Drs. Jules Monier, Dennis Eisenberg, Daryl Greebon and Jon Ricks.

Pelvic floor dysfunction is a condition in which the muscles that uphold the reproductive and digestive organs of a female weaken, and fail to work properly. The immediate result of this muscle failure is “falling of the female organs”, or, a sensation of pelvic pressure or an actual falling of the organs dropping through the vagina. Difficulty passing stools and urinary incontinence are the most common immediate symptoms eventually causing pain, and even more alarming symptoms such as what Jean was experiencing.  With the insertion of a vaginal pessary, Jean’s symptoms went away and she was able to resume life as normal.

During the early stages of pelvic floor dysfunction, it may be possible to re-strengthen the pelvic muscles through physical therapy and repair the damage before the dysfunction progresses. But due to the nature of the symptoms, it is commonly missed at an early stage, and the dysfunction becomes much worse.

When pelvic floor dysfunction is not treated properly or immediately it can cause problems of much larger proportions such as:

• Cystocele-The protrusion of the bladder into, and at times through the vagina.
• Rectocele-The protrusion of the rectum into, and at times through the vagina.
• Enterocele-The protrusion of the bowel into, and at times through the vagina.
• Urethrocele-The protrusion of the urethra into, and at times through the vagina.
• Vaginal Prolapse-The protrusion of the top of the vagina into the lower portion of the vagina completely inverting it. (This is most common in post-hysterectomy patients.)

Statistics suggest that 40% of women between 60-80 years of age will experience some degree of pelvic floor dysfunction or vaginal prolapse. At this age the dysfunction is the resort of multiple things including age, gravity, number of children, constipation, childbirth etc. However, it is important to note that 1 of every 3 women of 25 and up will suffer from the dysfunction as well. The most common causes being pregnancy, obesity, vaginal delivery, and menopause.

If you begin to notice symptoms that lead you to believe that you may be suffering from any degree of pelvic floor dysfunction, consult with your physician as soon as possible. Pelvic floor dysfunction is diagnosed through a series of testing. Your doctor will begin their testing with a careful study of your medical history, symptoms, and physically or emotionally traumatic experiences that could be contributing to the physical and emotional pain of this disorder. Specific tests will be administered to determine which muscles are not properly performing their job.

Pelvic floor dysfunction may be treated with specialized physical therapy known as biofeedback if the dysfunction is found at an early stage. With biofeedback, a person may be able to strengthen the pelvic floor muscles and remind the body to perform these tasks as it should. Approximately 75% of individuals with pelvic floor dysfunction experience significant improvement with biofeedback.

Many times, pelvic floor dysfunction patients and those suffering from vaginal prolapse will need corrective surgery.  Using a vaginal pessary or a mesh device is often effective for curing the problem. A vaginal pessary can be inserted into the vagina to support the prolapsed organs. Meshes to secure organs into place are also commonly used. Using sutures, a mesh is used to help keep the bladder, uterus or other pelvic organs secure.  Using a pessary or a mesh will commonly alleviate symptoms.

If you are experiencing unusual symptoms that you believe may be associated with pelvic floor dysfunction, consult with your doctor and learn about the treatment options that are available to help you with your specific situation.

The stage of life between a young woman’s fertility, and the menopause of a woman’s later years is called peri-menopause. Peri-menopause begins in a woman’s late 30s to early 40s and can last 3-15 years.  According to Drs. Fox, Greebon, Monier, Eisenberg and Ricks, Plano, TX gynecologists that make up the Women’s Specialists of Plano (972.379.2416), “This number is different for every woman, but one fact that remains the same is that during this phase, undesirable effects will take place to a woman’s body.”

Peri-Menopausal Bleeding

Peri-menopause is onset by the fluctuations of the female hormones estrogen and progesterone. These normal hormone changes are the result of the ongoing decrease of eggs inside a woman’s ovaries.  As these eggs decrease, there is no more cyclic estrogen and progesterone production. The symptoms a woman will experience during due to these biological changes most often reflect peri-menopause. The most obvious sign that a woman may be in peri-menopause is the change in her menstrual cycle. It is important to highlight what a normal period looks like for most women:

• The start of one period to the start of the next should be at least 21 days
• Periods should last less than 10 days
• There is no spotting in between periods
• Periods should be no further apart than 90 days

Because all women’s cycles are unique, peri-menopausal bleeding changes will be unique to each woman. Some women notice a very heavy period one-month, followed by the absence of a period the next month. Others may experience more frequent periods that appear less than the average 28-32 days apart. Some woman may only spot during their period for several months, while others notice heavier bleeding throughout. Only you will know if your cycle has changed. The sporadic distribution of estrogen and progesterone is to blame for menopausal bleeding changes and is inevitable.

The natural hormonal imbalance that takes place inside of a woman’s body may cause other undesirable symptoms. Some of the symptoms of peri-menopause include:

• Hot flashes
• Sleep problems (which affects 75% of all peri-menopausal women)
• Mood changes
• Vaginal dryness
• Bladder problems
• Decreased fertility
• Increase in bad cholesterol
• Loss of bone mass
• Weight gain

Other common symptoms of peri-menopause include bouts of depression; it is also very common for a woman in these years to suffer from a loss in libido and decreased sexual arousal.

The Transition from Peri-Menopause to Menopause

Every woman is born with a certain amount of eggs. She will not produce anymore throughout her life. As a woman ages, so do the ovaries which is where the eggs reside. During pre-menopause the fluctuation of hormones within a woman’s body begin to make it difficult for the eggs to reach the point of ovulation, causing the above mentioned symptoms for a peri-menopausal woman. As it becomes increasingly difficult for an egg to reach ovulation, ovulation begins to cease. After an egg is no longer able to reach ovulation at all, ovulation ceases completely and so does a woman’s cycle. It is at this time that a woman’s transition from peri-menopause to menopause is complete.

It is important to remember that peri-menopause is the stage before menopause and does not mean that you have crossed over the bridge. A woman in peri-menopause has a decreased likelihood of getting pregnant, but it is still possible. A woman is not considered menopausal until she has been without a cycle for a full 12 months. If you are peri-menopausal and aspire to have a child, talk to your doctor about your options.

Peri-menopause shows itself differently in every woman. Some may find it alarmingly obvious that their body is changing, while others may soar through peri-menopause into menopause without ever noticing a single hot flash. However it is important to note that if you are noticing that the symptoms of peri-menopause are beginning to affect parts of your daily life you need to speak with your doctor. He or she will discuss your options with you and help you to find comfort during this transition.

There are several approaches to easing the transition from peri-menopause to menopause; only your doctor will be able to decide what option is best for you. Some methods that women have found helpful to help minimize the symptoms of peri-menopause include:

• Low dose birth control, for the relief of hot flashes and the changes associated with menopausal bleeding.
• Exercise, which is good for your health and known to help a woman receive better rest.
• Vaginal lubricants and sex therapy, to help recover the loss of libido.
• A diet full of calcium, to help protect against the loss of bone mass.
• Anti-depressants, to help control the mood swings and bouts of depression.

The Women’s Specialists of Plano in Plano, Texas include Dr. Murray Fox, Dr. Daryl Greebon, Dr. Jules Monier, Dr. Dennis Eisenberg, and Dr. Jon Ricks.  They offer adolescent gynecology, obstetrics and treat women even past the menopausal years. As a woman’s body goes through the myriad of changes from teenage to menopause, it’s important to have a trusted resource to answer questions and receive regular well checks. Peri-menopause, while it can be a troublesome condition for many women, is treatable on some levels.  Contact your physician today to learn more.

An estimated 17 million women in the U.S. will cope with female bladder problems and urinary incontinence each year. According to the Women’s Specialists of Plano, TX, (972.379.2416, http://obgynplano.com), a large majority of these women do not discuss the symptoms associated with their incontinence with their family doctors and in many cases, the condition is left untreated.

Urinary incontinence is the medical term used to describe the loss of urine control. It can happen when you cough, sneeze, exercise or do any other type of activity that may put stress on the bladder. Urinary incontinence can exist where a woman might experience episodes of a slight dribble of urine, to the inability to hold urine all together; it can also be temporary or permanent depending on the underlying cause. While it is not a serious health concern, it can lead to anxiety, stress and embarrassment for sufferers.

Causes of Female Urinary Incontinence

Female urinary incontinence is usually caused by weakened or damaged pelvic muscles that prevent the urethra from closing tight enough to hold urine in the bladder. Many women will experience incontinence after giving childbirth where exceptional strain is put on the pelvic region. For many, this condition will go away, while for others, it will continue to worsen before female incontinence treatment is sought. Other causes of female urinary incontinence include:

• Childbirth
• The aging process
• Traumatic injury
• Weight gain
• Smoking
• Neurological disorders (spinal cord/head injuries)
• Infections (urinary tract, bladder infections, etc.)
• Certain diseases (such as Multiple Sclerosis)
• Medications, prescription drugs

Types of Female Urinary Incontinence

Drs. Daryl Greebon, Jules Monier, Murray Fox, Dennis Eisenberg and Jon Ricks are Plano, Texas gynecologists that make up the Women’s Specialists of Plano. They offer female incontinence treatment and see various types of female urinary incontinence from patients that enter their office doors.

There are five basic types of urinary incontinence. Stress incontinence occurs when you leak urine during a physical activity such as lifting, jumping, exercising, sneezing and coughing. It is typically a result of both hypermobility (which occurs when the urethra and bladder neck shift from their normal positions) and an Intrinsic Sphincter Deficiency, which occurs when the urethral sphincter is unable to close tightly enough to hold urine in the bladder during physical exertion.

Urge incontinence is described as over-activity of the detrusor muscle, which is the smooth muscle that surrounds the bladder. It typically relaxes to allow the bladder to fill, then contracts to squeeze out urine when a woman goes to the toilet. During urge incontinence, the bladder will contract frequently creating an overwhelming need to urinate even if you just went. This condition is often referred to as “overactive bladder” and makes it difficult to hold your urine long enough to reach a toilet.

Other forms of female urinary incontinence include overflow incontinence where the bladder never completely empties causing urine to leak, and functional incontinence where a physical limitation or immobility may exist making it impossible for a person to reach the toilet in time.

Female Incontinence Treatment

There are solutions for female urinary incontinence and female bladder problems that have been proven to bring them a sense of normalcy. Every woman should discuss their symptoms with their physician so that the correct solution can be found.  For mild incontinence, Kegal exercises are usually effective; behavior therapies and small lifestyle changes such as decreasing the amount of fluids taken in or scheduling bladder elimination can also help.

For women who experience moderate incontinence, medications, protective undergarments and bulking injections such as collagen may be used. Some women find that their female bladder problems go away with the use of a pessary device. A pessary device is a stiff ring that is inserted into the vagina where it places pressure against the wall of the vagina and urethra. This pressure helps control leakage because it repositions the urethra.

For many women, surgery becomes the answer in order to get their incontinence under control. Retropubic suspensions are used to treat hypermobility. These suspensions elevate and restore the bladder neck and urethra back to their natural anatomical positions.  This procedure is often referred to as the Burch procedure.

A variety of slings are also available to help restore normal bladder function. Slings can be inserted via a minimally-invasive surgical technique to help support the bladder and urethra. Some slings use self-fixating anchors while others use sutures.  All are used to provide relief of the sensations and symptoms associated with urinary incontinence and most provide good results.

If you suffer from incontinence, make an appointment with your gynecologist to talk about your symptoms and options for a permanent solution so that your quality of life can be restored and the stress and anxiety from female urinary incontinence eliminated.

Dallas, Plano, TX (http://obgynplano.com) – There is a reason why the popular “Got Milk?” advertising campaign hits home for so many people. The models in the ads look healthy, vibrant and strong. If these ads are insinuating that a glass of milk each day makes you strong and healthy, and helps keep weak bones at bay, then pour me a double.

While a lack of calcium (read information regarding calcium intake recommendations) is one cause of weak bones that can lead to osteoporosis, there are many others that lead to this common, debilitating disease. Osteoporosis is a skeletal condition that causes bones to become weaker, less dense and more brittle. It is often referred to as the “bone thinning” disease and affects 25 million people each year with approximately 80% of these being women.

Though symptoms may not appear until later on in adulthood, the bone thinning process actually begins in women around age 30 as this is when estrogen starts to decrease naturally within the body. By age 65, 80% of women will have some form of bone density loss. The disease alone is responsible for hundreds of thousands of fractures seen in area emergency rooms across the U.S. and accounts for billions of dollars in medical care. Even more alarming, in older adults, a hip fracture due to osteoporosis has very limited recovery prognosis and many will require constant care in helping with daily activities. In addition, many die of the complications during the recovery process.  This is the whole rationale for treating osteopenia and osteoporosis: prevent fracture.

So what do you need to know about osteoporosis?  The physicians at the Women’s Specialists of Plano provide bone density test screening daily to local Dallas area women and were helpful in addressing this very question.

Those at Risk

There are many risk factors as to why a woman might develop osteoporosis including a family history of brittle bones, fair complexion, poor nutrition, smoking, low weight, alcoholism, a long-term low calcium intake and an estrogen deficiency.  In addition, there are many medical conditions associated with this disease such as multiple sclerosis, anemia, rheumatoid arthritis, eating disorders, pulmonary disease and many, many others. Certain long-term prescription drug use also affects bone loss.  Research has concluded that Caucasian women are at most risk over Hispanic, Asian African American and Indian. For the most part, anyone could be at risk for developing osteoporosis.

Osteoporosis Prevention:  What can You do?

At a young age, even in the teen years, women can begin a life of healthy choices that will help delay bone loss for a long time. Most women will not even think about getting a bone density test until long after their teen years. Until then, one should avoid cigarettes and alcohol and focus on a healthy lifestyle, eating a healthy diet rich in protein, vegetables, calcium and vitamin D (both will help strengthen bones.) Exercise and strength training is also very important. Women should educate themselves on the foods that help to prevent this disease as well as the medications that can lead to brittle bones.   Unfortunately, there are some risk factors that cannot be changed including age, menopause, gender, family history and other medical problems.

Millions of women will live with osteoporosis. It is important to have bone screen tests yearly and to discuss treatment options with your doctor. Photo courtesy of Horia Varian, Flickr, Creative Commons

Living with Osteoporosis

Women should discuss bone loss and osteoporosis during their next visit for their well woman care. Bone density tests and a dual density bone densitometer can (often) determine how much bone loss has occurred.  This is important to know so that an appropriate plan for the treatment for osteoporosis can be provided.  The key to managing osteoporosis is to prevent more bone loss from occurring through healthy eating, exercise, and overall healthy lifestyle habits. Preventing injuries and falls becomes crucial for those living with this disease; this can be done by closely monitoring how you walk and where you step, wearing a brace when needed, and being aware of your surroundings at home where falls might occur. When osteoporosis becomes painful, causes fractures, etc., physical therapy, pain relievers and electrical nerve stimulation can be recommended treatment for osteoporosis to offer comfort. In addition, new drugs on the market today can offer exceptional treatment solutions for many women.  Bisphosphonates, forteo, reclast and prolia are examples of the drugs that are being prescribed to thousands of women.

Although osteoporosis is something that every woman is at risk for developing, the lifestyle changes mentioned in this article are proactive modifications that can be made in order to onset the delay of symptoms. Please discuss your concerns with your doctor today and create a plan to keep your bones healthy and strong.

See other articles from obgynplano on the subject of osteoporosis.

January 4, 2011 (http://obgynplano.com)–It is the New Year. Do you know when your next mammogram screening will be?  The skilled OBGYN physicians that make up the Women’s Specialists of Plano (972.379.2416) offer the following information for those who are new to the mammogram process as well as for those who have general questions and/or concerns.

What are the National Cancer Institute’s (NCI) Recommendations for Screening Mammograms?

According to the National Cancer Institute, “Women age 40 and older should have mammograms every 1 to 2 years.
 Women who are at higher than average risk of breast cancer should talk with their health care providers about whether to have mammograms before age 40 and how often to have them.”

What is a Mammogram?

A mammogram is used to check for breast cancer in the breast. It is an x-ray image and will show if there is any sign (such as a tumor, mass, lump in the breast, etc.) of cancer as well as if the breast tissue appears normal. A mammogram can be done digitally or via film. This common mammogram procedure is also referred to as a screening mammogram where several images are taken of each breast.  The x-ray images help physicians screen for breast cancer when lumps cannot be felt externally.

When a mammogram is ordered because a woman has felt a specific lump in the breast during a routine breast examination, or because she has another symptom, then it is referred to as a diagnostic mammogram. This mammogram is helpful in order to rule out cancer; oftentimes these lumps are benign cysts or tiny deposits of calcium. A diagnostic mammogram takes longer to perform than a screening test because more images and x-rays are needed and they are typically taken at a variety of angles.  Diagnostic mammograms are also used on women where screening becomes more challenging; such as in the instance where breast implants are in place.

What are the Benefits of Screening Mammograms?

Most women will have their first screening mammogram around age 40; at this young age, early detection of breast cancer can often be seen with screening mammography alone.  For women who have a history of breast cancer in their family, or who have a history of cysts and benign lumps, and for those who have had breast augmentation, a diagnostic mammogram may be ordered from start.

Is there a Downside to a Screening Mammogram?

A screening mammogram does not necessarily mean that cancer will be found.  These mammograms can detect cancerous tumors that often cannot be felt by touch (such as a lump in the breast), but in 20% of the cases, screening mammograms will miss breast cancers that are present.

False-Negative Results vs. False-Positive Results—What Does This Mean?

False-negative mammogram results occur when cancer exists within the breast at the time of screening, but it is not caught during the screening mammogram. False-negative results occur in younger women more so than older women because younger women have higher breast density—which is the primary cause of a false-negative result.  On the other hand, older women will have more fatty tissue in the breast.  High-density breast tissue, as well as tumors, will show up as white on the x-ray, whereas fatty tissue is dark making it easier to detect a true cancer cell.

False-positive mammogram results occur when a physician or radiologist concludes that a mammogram is abnormal, even though no cancer exists.  To conclude a false-positive mammogram, further analysis will need to occur to rule out cancer. This is done usually with a diagnostic mammogram, an ultrasound or a biopsy.

Can the X-Ray Imaging from Mammograms Cause Cancer?

This is a concern for many women. Although repeated exposure to x-rays can be harmful, mammograms require just a very small dose of radiation. Exposure is low and the benefits of receiving a mammogram completely outweigh the risks of this exposure. It is very important that woman alert their health care provider if there is any possibility they are pregnant as this could be dangerous for the unborn fetus.

What is Digital Mammography?

Advances in technology have produced digital mammograms, in which the images taken are computerized and shown on a screen, rather than recorded on film using an x-ray cassette.  This allows faster and more accurate stereotactic biopsy, and reduces the patient’s discomfort, requiring her to remain still for a shorter period of time.  Digital mammography is still in its infancy, but some studies have shown that women with denser breasts, post-menopausal women, and women under the age of forty may benefit from digital mammograms.  Otherwise, the digital images are said to be “comparable” at this stage with traditional film images.

What are the Risks for Developing Breast Cancer?

According to the National Cancer Institute, women who exhibit the following traits are at an increased risk for developing breast cancer:

• Age—as a woman ages, her chances for developing breast cancer increase
• A personal history of breast cancer
• A family history of breast cancer
• Hereditary genes (For example, BRCA1, BRCA2, and others)
• High breast density
• Reproductive and menstrual history—Women who had their first menstrual period before age 12 or who went through menopause after age 55 are at an increased risk of developing breast cancer. Women who had their first full-term pregnancy after age 30 or who have never had a full-term pregnancy are also at increased risk of breast cancer.
• Long-term use of hormone replacement therapy—(those who have combined estrogen and progestin hormone therapy for more than 5 years).
• Exposure to radiation
• Excessive use of alcohol
• A heavy body weight/obesity
• Lack of exercise

The Women’s Specialists of Plano offers mammogram, sonogram, biopsy and 3D-imaging services in office.  Schedule your mammogram today by calling 972-379-2416 or visit our online appointment center.

According to the Women’s Specialists of Plano (www.obgynplano.com 972.379.2416) (Plano, TX), women have more options than ever before concerning hysterectomy treatment.  In the current year, 1 in 600,000 women will undergo a hysterectomy. For some, it will be a necessary procedure in order to cure a life-threatening condition such as cancer, severe infections or uncontrollable bleeding. For others, it will be an option to help ease the symptoms of certain conditions such as fibroids, endometriosis, pelvic pain or uterine prolapse.  When a hysterectomy seems like the right choice, it helps to know the facts and the alternatives that are available so that you can make the right choice for you and for your situation.

What is a hysterectomy?

The uterus is the pair shaped, hollow organ that resides in the pelvis and is what holds a baby during pregnancy.  When a woman has a hysterectomy either all or a part of the uterus is removed. Depending on the reason for the hysterectomy, a woman may have either a complete or total hysterectomy where both the uterus and the cervix are removed, a partial hysterectomy (sometimes called a supracervical hysterectomy) where the upper portion of the uterus is removed but the cervix remains, or a radial hysterectomy where the entire uterus, cervix and a portion of the vagina are removed.    In the majority of cases, a woman will choose to undergo a total hysterectomy.

How are Hysterectomies Performed?

Traditional hysterectomy surgical procedures are still divided into abdominal and vaginal.  Most women can be candidates for all three; but depending on the size of the uterus, tumor, condition, etc., one may be a better option than the other.  Below, is a breakdown of the types of hysterectomies-each are considered traditional hysterectomy procedures:

• Laparoscopic: Using this method, 3 to 4 tiny incisions are made into the abdomen through which a slim, lighted, telescope instrument called a laparoscope, along with small surgical instruments, are inserted. These tools will essentially work to remove the uterus.  This method usually requires a couple of days or less in the hospital and recovery can take up to 4 weeks.

• Vaginal: This hysterectomy method is not visible to the naked eyes.  It uses a small incision inside the vagina to remove the uterus and other organs (if needed) and typically requires 1-2 days in the hospital and up to a 4-week recovery period.

• Abdominal (also known as Open): This hysterectomy method is the most invasive of all hysterectomies.  It requires either a vertical or horizontal incision just above the pubic bone to remove the uterus and cervix (and in some cases, other surrounding organs). This particular hysterectomy will require a longer hospital stay and is performed under general anesthesia with a recovery period up to 6 weeks.

What About the Robotic Hysterectomy?

da Vinci robotic surgery is revolutionizing the way certain procedures are performed, including a hysterectomy. Using the robotic technique, hysterectomies are being document to be more effective, easier to perform, offer a quicker recovery and are dramatically less invasive than a traditional surgical hysterectomy.

Using small incisions and then inserting miniature medical instruments and a 3D camera into the patient, the surgeon is able to maneuver the tools and seamlessly translate the movement of the fingers, wrist and hand from a separate nearby console.  All of these real-time movements are performed under a magnified, high-resolution, 3D image of the uterus.  While not all gynecological practices and groups offer this technology, the Women’s Specialists of Plano have for many years.  They feel that the investment, training, and practice that it takes to fully understand and become skilled at robotic surgery is worth it.

While robotic surgery seems like the best option for women who are candidates, one drawback is the availability of the technology.  “The da Vinci robotic surgical technique is truly the only available gynecological technology that can provide surgeons with the innate control, range of motion, fine tissue handling and 3D visualization that is characteristic of open surgery—but producing vastly different recovery times. Unfortunately, this technique takes practice, hands on experience, time to master and a nice size investment; thus, it is not offered by all gynecological groups,” says Dr. Jon Ricks.

What Experienced Physicians Have To Say:  Robotic Surgery vs. Traditional Surgery

In a recent roundtable discussion led by the Women’s Specialists of Plano, recovery is the major difference between a robotic hysterectomy vs. traditional surgery.  During this discussion, all five of the doctors that make up this highly specialized group of gynecologists discussed the types of hysterectomies and the differences. In general the recovery from a robotic hysterectomy is the same as a traditional hysterectomy, just faster.  They divide recovery into three phases:

• How fast a patient comes out of the anesthesia
• How soon a patient gains back strength
• How soon a patient gains stamina

According to Dr. Murray Fox, “With a traditional hysterectomy, the first two recovery phases take 18 to 24 hours each.  The third takes 3 – 6 weeks; with robotic surgery the first two take 6 to 18 hours and the third, just 7 – 14 days.”

Dr. Dennis Eisenberg can usually see the differences almost immediately after the surgery is performed and the patient has returned back for their post-op visit. “Side effects post-op for all types of hysterectomies will be similar, but with the robotic hysterectomy, they are smaller and minimalized.  My patients will often commend the fact that they had less pain and were quicker to return to normal function than their friends who have undergone traditional surgery.”

Dr. Daryl Greebon and Julies Monier also agree that the robotic surgery might not be for everyone, but that for those who are candidates, it is generally the more preferred option, “As far as effectiveness, each type of hysterectomy works well. Some are better in certain situations.  For instance, we have found that heavier women actually do better with the robotic technique because we can see better.  However, this particularly type of woman presents more problems for anesthesia with the robot, so she needs to be in reasonably good health to have this procedure.”

Regarding da Vinci robotic surgery vs. traditional surgery, they continue to say, “Scarring can occur with any surgery but scarring has proven to be much less noticeable with robotic which is a significant advantage since intraabdominal scarring can lead to complications with future surgeries, or cause problems such as bowel obstruction.”

While the da Vinci robotic hysterectomy technology has certainly taken the medical profession by storm, it will take time before it appears in the offices of most physicians. Training and consistent use are two key ingredients that will make the adoption a success. The Women’s Specialists of Plano in Plano, TX feel the training, price tag and commitment are not only justified, but also invaluable in terms of what they can offer their patients.  It is also up to each patient, in cooperation with their surgeon, to determine whether a robotic surgery vs. traditional surgery is in their best interest.

Every woman will go through menopause and will experience different symptoms. There is help that can be offered to treat these symptoms. Talk to your gynecologist today.

When I interviewed some of the physicians at the Women’s Specialist of Plano, Texas (http://obgynplano.com, 972.379.2416) for a women’s health feature on the topic of menopause, I assumed they would tell me the obvious: that menopause is simply a phase all women go through that causes unwanted symptoms and an end to all menstrual periods.

I was right, they did. But I also learned a lot more during my discussion with Drs. Murray Fox, Daryl Greebon, Jules Monier, Dennis Eisenburg and Jon Ricks—all skilled and experienced gynecologists with WSOP—that really made me think differently about the “change of life.”

Menopause symptoms and treatments are different for every woman and there is a range of options for each specific case.  As a 37-year old female, I thought I still had a long time until I had to deal with the side effects of menopause. I distinctly remember my mom going through it at age 50 when she had a serious hot flash during the middle of my engagement party.

The truth—is that what I saw in her, were symptoms she had been dealing with for several years.

What Is Menopause?

Every woman is born with a certain number of eggs. These eggs are stored in the ovaries and it is in the ovaries that the hormones estrogen and progesterone are produced, which regulate ovulation and menstruation. Menopause occurs when the ovaries no longer produce an egg every month and menstruation stops. Natural menopause is a normal condition that occurs in all women between the ages of 40-58. Natural, meaning that menopause occurs without the side effects of any medical treatment such as a hysterectomy or chemotherapy. All women will experience some of the same symptoms from menopause as they age, but all will experience one common characteristic: their reproductive period will come to an end.

While the end to a menstrual cycle is a welcomed part of menopause, there are a number of unwelcome symptoms associated with this change. They include: irregular periods, missed periods, fatigue, mood swings and irritability, insomnia, depression, headaches, muscle aches and pains, bone loss (osteoporosis), incontinence and changes in sex drive (libido) as well as a decrease in vaginal lubrication.  In additions, many women will experience hot flashes and night sweats. Fortunately, many of the symptoms associated with menopause are temporary and will eventually disappear once menopause ends.

Help for Menopause

For women who choose to discuss menopause symptoms and treatments with their physicians, it is reassuring to know that there are many natural and home remedy steps one can take to help decrease and prevent some of the symptoms such as exercise, yoga, eating a healthy diet and getting plenty of rest.  Many women learn how to cool a hot flash by learning what triggers them. This helps them limit when hot flashes will occur and control them when they start.

For women that need additional help during menopause, there are medications that can be taken to help minimize the symptoms such as antidepressants, bone loss medications, Clonidine (a high blood pressure medication that helps ease hot flashes), vaginal estrogen creams and Progestin pills which help with irregular periods before menopause occurs.

Hormal Replacment Therapy:  Is It Right For You?

The onset of menopausal symptoms occur when the body stops producing estrogens. There are three types of estrogen produced in the human body and all three of these occur in balanced proportions, and although they are closely related, each has its own special function:

• Estradiol is the primary estrogen hormone and in nature it comprises 80% of the estrogen a woman’s body makes.
• Estrone is the least prevalent of the normal estrogens in women.  It increases significantly during pregnancy, but is a bit weaker than estradiol in its effect.
• Estriol is the third natural estrogen, and is also less potent in estrogen effect than estradiol.

Menopause symptoms and treatments will vary for each woman. For many women, hormone replacement therapy is used in the post-menopausal patient to minimize symptoms caused by the lack of a predictable estrogen-progesterone production. While hormone replacement is not for everyone, it has made a difference in millions of women’s lives. Patients are generally divided into two groups: those with a uterus and those without.  Patients without a uterus are usually treated with estrogen alone (estrogen replacement therapy – ERT); while those with a uterus are treated with estrogen and progesterone (hormone replacement therapy – HRT).

Likewise, hormone medications are also divided into groups: natural (made from soy, yam or other roots), bio-identical (compounded by a pharmacy) and synthetic (manufactured by pharmaceutical companies). In a woman who still has her uterus, ANY form of estrogen can stimulate the uterine lining and cause bleeding issues and the risk of endometrial cancer. The key in preventing this problem when estrogen replacement therapy is needed is to use progesterone with it in an adequate amount to protect the endometrium. For women who do not have a uterus, the endometrium is gone, and there is no need for progesterone, which can make estrogen therapy easier whether it is a cream, pill, or patch.

HRT and ERT:  Pill or Cream?

Is it better to take a pill, or use topical therapy?  This too has been debated for years.  Not all people respond equally well to the same product, so one woman may find it easier in her routine of life to take a pill.  Another may not react well with the pill, or may have trouble remembering to take a pill regularly and may be a better candidate for the patch, vaginal ring or for estrogen cream.  Each method works the same and it is important for a woman to find the best match for her and for her current lifestyle.

Hormone Replacement Therapy and Breast Cancer

The link between estrogen and breast cancer has been a highly discussed topic over the last decade.  According to Dr. Murray Fox, “Much of the data that has been reported in the media regarding the link between estrogen and breast cancer has been vastly misrepresented.  The media touts that 30% or 40% of women develop breast cancer while taking estrogen.  Those numbers are distorted. In recent tests that included several groups of 10,000 women, out of those who had no hormone treatment, 28 developed breast cancer; those with hormone treatment resulted in 36 women who developed breast cancer.  In a similar group of women who took estrogen alone, without any progesterone (because they had had hysterectomies), there were 7 fewer cases of breast cancer, suggesting that it is not primarily estrogen that causes the problem, but is the combination of estrogen and progesterone.”

Dr. Daryl Greebon agrees, “It is important for women to understand that estrogen poses greater risks for other medical issues than cancer. The primary risk of estrogen is blood clots (phlebitis); this can include blood clots in the leg, pulmonary embolus, or stroke. These risks exist with any estrogen replacement therapy whether oral or topical, and whether compounded or not.”

Dr. Jules Monier and the other physicians at the Women’s Specialist in Plano, Texas recommend their patients who are on estrogen replacement therapy use the lowest dose of estrogen possible for the shortest time possible, preferably no more than 5 years.  “However, quality of life is an important consideration, and as with all medical treatments one must weigh the benefits and the risks. For women who have incapacitating symptoms it may be worth the risks to have a better life style, this is an individual choice, “ says Dr. Monier.

Menopause symptoms and treatments and the best solution to handle the “change of life” can be a complex issue for many women. Each woman should discuss the options that are available with their doctor. The choice of using HRT or ERT should be made based on a balance of risks and benefits.  While there are risks to consider, for those women who suffer severely from menopausal symptoms, hormone replacement therapy and estrogen replacement therapy can make a major difference in their life.

About the writer:  Kristy Theis is the content editor for EmedicalMedia.  The physicians that make up the Women’s Specialists of Plano, Texas were interviewed for this article.

According to the National Cancer Institute, more than 43,000 cases of uterine cancer (also referred to as endometrial cancer) will be diagnosed this year. The Women’s Specialists of Plano (972.379.2416) offers uterine cancer treatment in Plano, TX. They recently compiled the following Q & A on this serious form of cancer. Early screening is important in order to prevent uterine cancer from starting or spreading.

What is the Uterus?

The uterus is the hollow, pear-shaped organ that resides in the pelvic region of a female.  The uterus is a part of the reproductive system and is the place where a baby grows during pregnancy.  The uterus holds the cervix, which is the lower, narrow area of the uterus, and the fallopian tubes that extend from both sides of the organ.  The uterus contains two layers of tissue: the inner layer is known as the endometrium; the outer layer is called the myometrium. It is within this lining that a woman’s body prepares itself for menstruation as the walls within the uterus are lined and thickened with blood and then released monthly through the vagina.

What Conditions Can Exist in the Uterus?

Fibroids (benign tumors), endometriosis (endometrial tissue that grows inside the body, outside of the uterus) and endometrial hyperplasia (an increase of cells in the lining of the uterus) are all benign conditions that can affect the uterus. Another condition that can exist within the uterus is Adenomysis—in which the endometrium exists in the muscle of the uterus. Endometrial polyps can also exist in the uterus and is another source of abnormal bleeding. These conditions should be monitored and treatment for each condition is available.

What is Uterine Cancer?

Uterine cancer is a type of cancer that affects the uterus; it most often occurs when abnormal or cancerous cells begin to develop and multiply in the endometrium lining of the uterus.  When cancer occurs within the lining of the uterus, it is known as endometrial cancer.  Endometrial cancer is the most common type of uterine cancer. If the cancer develops in the tissue and muscles that make up the uterus, the cancer is known as a sarcoma.  Sarcomas are the most rare of uterine cancers.

What Causes Uterine Cancer?

The exact cause of uterine cancer is not known; however, studies have shown that there are some risk factors:

• Age.  Uterine cancer, endometrial cancer and sarcomas of the uterus most often affect women over the age of 50
• Obesity.   Obese women have higher levels of estrogen in their bodies because the body makes some of its estrogen naturally in fatty tissues.  Higher levels of estrogen create a higher risk for uterine cancer.
• Untreated Conditions.  Certain uterine conditions, if left untreated, could increase the chances of a woman getting uterine cancer. Chronically irregular periods, especially going more than three months between periods will increase the risk.
• Race.  White woman are more likely to get uterine cancer than African-American women.
• Diabetes and hypertension.
• Certain hormone-related therapies. Women who are on estrogen replacement therapy and unbalanced hormonal therapy should be monitored closely. These specific therapies, as well as “natural” therapies such as estrogen cream, if not balanced by progesterone, can increase the risk of uterine cancer.
• Starting menstruation early (before age 12)
• Never being pregnant

What are the Symptoms of Uterine Cancer?

It is important to note that the majority of diagnosed uterine cancers (including endometrial cancer and sarcomas) occur near or after menopause.  Abnormal and ongoing vaginal bleeding is typically the first symptom of uterine cancer. Other symptoms may include heavy discharge, painful urination, and pain in the pelvic area or pain during intercourse.

How is Uterine Cancer Diagnosed?

If a woman has unusual symptoms, a pelvic exam, pap test or biopsy may be administered. Once uterine cancer is in fact diagnosed, your doctor will work to determine the stage.

What are the Stages of Uterine Cancer?

In most cases, a hysterectomy is the first step and the most reliable way to stage uterine cancer. It allows the surgeon and the pathologist the opportunity to look closely at where the cancer has invaded and spread.  Staging uterine cancer occurs in 4 ways:

• Stage 1:  The cancer is isolated in the uterus and has not spread to the cervix
• Stage 2:  The cancer has spread to the cervix
• Stage 3: The cancer has spread outside the uterus; however it has not spread outside of the pelvic region. Lymph nodes in and around the pelvic may or may not contain cancer cells.
• Stage 4:  The cancer has spread to other organs in the body

What Treatment Options are Available for Uterine Cancer?

Most women who have been diagnosed with uterine cancer will have surgery.  A hysterectomy (removal of the uterus) is generally the first course of treatment; during this procedure the ovaries are typically removed as well. During the hysterectomy, lymph nodes will most likely also be removed so that tests can be administered to see if and where the cancer has spread. Depending on the stage of the cancer, radiation therapy, chemotherapy and/or hormonal therapy will be recommended.

What is the Prognosis for Uterine Cancer?  Can it be Prevented?

Prognosis is first related to the depth of cancer invasion into the myometrium—the less the invasion, the better the prognosis.  The cervix and surrounding tissues are then screened and tested for cancer. If uterine cancer is found early, the prognosis is excellent.  The 1-year survival rate is about 92% if the cancer has not spread.  That number does drop significantly if the cancer has spread to nearby organs. Women should have annual and routine physical examinations including pelvic exams, Pap smears and blood work. If you are experiencing any abnormal bleeding, pain in the pelvic area, bleeding lasting longer than a full week and bleeding that occurs every 21 days or more, please consult with your doctor.

The doctors that make up the Women’s Specialists of Plano offer uterine cancer treatment in Plano, TX.  Visit them on the web at www.obgynplano.com

The article below was written by Kristy Theis, Medical Content Editor for eMedical Media in Dallas, TX.  It was featured on Hubpages May 12, 2010 and written on behalf of the Women’s Specialists of Plano.

“I Have Uterine Fibroids.  Should I be concerned?”

The doctors that make up the Women’s Specialists of Plano (972.379.2416) see their fair share of uterine fibroids weekly at their North Texas OBGYN office. Uterine fibroid tumors are one of the most common gynecological conditions affecting American women today—in fact, this year alone, almost 1 in 4 will be diagnosed with these benign uterine tumors.  While the majority of uterine fibroid tumors are non-cancerous, there is the incidence of malignancy (cancer) in about 1 in 10,000—making fibroids a worrisome diagnosis for thousands of women.

Not too long ago, most American women were sent down the road of having a hysterectomy when diagnosed with uterine fibroids.  I recently interviewed a group of Plano, Texas-based gynecologists—as well as some of their patients—and was pleasantly surprised to learn that there are in fact several options for patients suffering from uterine fibroids.

Fibroids are tumors that develop in the uterus, most often, affecting women over the age of 30 and still in childbearing years. They can be very small, exist as one or in groupings, can be slow or fast growing, and for many, symptoms will be almost non-existent. For many women, on-going and at times continuous cramping, bloating, constipation, heavy bleeding and a feeling of pressure and pain in the uterus can exist.  For women with a personal or family history of cancer, knowing that these tumors exist within the uterus can be troublesome making the treatment of uterine cysts a very important decision for them.

When I met with Patricia, a patient of Dr. Murray Fox, a physician with the Women’s Specialists of Plano practice, she described symptoms that sounded more like a pregnancy than a uterine fibroid.  Her non-cancerous uterine tumors presented themselves years earlier and over time began to grow until the end result was a cantaloupe size tumor.  With a growth so large, she decided to have a full hysterectomy because once the tumor was removed, much of her uterus would have to be removed with it. Since Patricia was past her child-bearing years, a hysterectomy was an acceptable route to take.

According to Dr. Jules Monier, a gynecologist with Women’s Specialists, most women will be diagnosed in the earlier stages through routine pelvic exams.

“We are able to diagnose uterine fibroids early on in most cases and monitor them with each patient.  During this time, conservative treatment of uterine cysts can be provided.  It’s important for women to be cognitive of their symptoms and pay attention to what their body is telling them so that a more aggressive treatment option can be considered if necessary.  No woman should be expected to endure the harsher symptoms that can come along with uterine fibroids.”

The exact causes of fibroid tumors are unknown. The Women’s Specialists of Plano experts agree that treatment of uterine cysts is not necessary with uterine fibroids unless at least one of the following conditions are occurring:

• The uterine fibroid is greater in size than a 12-week pregnancy
• The uterine fibroid(s) is growing
• The uterine fibroid(s) is causing bleeding
• The uterine fibroid(s) is causing pain
• The uterine fibroid(s) is associated with pregnancy loss

Treatment options available today are vastly different than years ago.  “Before our patients have to consider a hysterectomy for their uterine fibroids, they do have other treatment options, that in most cases, are successful.  Uterine artery embolization and myomectomy procedures are highly effective treatment options and are generally recommended before a hysterectomy,” Says Dr. Daryl Greebon, a Plano, Texas-based OBGYN.

During a uterine artery embolization procedure, physicians use an x-ray camera to inject small particles through a catheter directly aimed at the fibroid. These particles block the arteries that provide blood flow and essentially cause the fibroids to shrink.

A myomectomy is a surgical procedure where the fibroid tumors are surgically removed.  This procedure can be done with an open incision or using a more minimally-invasive technique such as the robotic myomectomy. The robotic method reduces the side effects of the surgery and overall recovery.  A myomectomy, in general, is considered one of the only surgical treatment options that preserve fertility.

In the procedures mentioned above, a large majority of women experience relief with their symptoms.

Robin is another patient of Women’s Specialists I interviewed and one who had a dramatically different outcome than my earlier subject.  She also battled uterine fibroid tumors since she was in her late 20’s and because she still desired to have children, she opted to have a robotic myomectomy. Dr. Dennis Eisenberg performed the surgery robotically and today, she remains symptom free from her fibroid tumors.  Although the risk of them returning does exist; she has not had any real significant growths or reoccurrences.

Dr. Murray Fox explains, “Uterine fibroid tumors can affect the quality of life.  I have had young women who are afraid to go to their places of business for fear they will soak through their clothes due to heavy bleeding caused by fibroids, and others who have experienced weight gain in the abdominal area because of fast growing and oversized tumors. The question I go over with my patients first is should the fibroid tumors be treated?  If the answer is yes, we discuss how.”

It is extremely important to talk to your gynecologist, get all of the facts revolving around your specific uterine fibroid tumors and review all of your options to help you decide the best outcome for your particular situation, future desires and current lifestyle.

About the writer:

Kristy Theis is the Medical Content Editor for eMedical Media and is a Dallas-based freelance communications writer.

The gynecologists and patients of the Women’s Specialists of Plano contributed to this article.Visit them on the web at www.obgynplano.com.