Posts Tagged ‘Hysterectomy’
The Women’s Specialists of Plano, a group of gynecologists in Plano, Texas, were used as resources for this article.
Many women suffer from abnormal menstrual periods. For many, a very heavy menstruation is the primary symptom. An average of 90% of women will complain of lengthy or heavy periods at least once in their adolescent years. But when heavy and lengthy periods become a monthly occurrence for a longer period of time than what is deemed normal, a medical procedure might be necessary to cure the problem. For women who experience on-going, very heavy menstrual periods and who are finished having children, one option to consider is endometrial ablation.
Endometrial ablation is one treatment for heavy periods and is the removal of the uterine lining called the endometrium. Endometrial ablation will not be performed for the removal of cancerous tissue and is not a successful cancer treatment. Endometrial ablation is performed to cure abnormally heavy menstruation, and should only be performed when other non-surgical procedures have failed, and the patient does not desire to become pregnant in the future.
Before the endometrial ablation procedure is performed a biopsy of the endometrium will be performed to ensure that the uterus is free of cancer. Once the biopsy is found to be cancer-free an examination will be performed to ensure that polyps or an infection are not the causes of the heavy bleeding. If all tests come back clear then your doctor may choose to move forward with the endometrial ablation procedure. The best candidates for an endometrial ablation for the treatment of heavy periods usually meet the following criteria:
- A woman who suffers from heavy menstrual bleeding monthly
- A woman who wishes to cease menstruation but wants to avoid hysterectomy
- A woman who is finished bearing children
- A woman whom is clear of genital infection
- A woman who does not have polyps or any other malformation of the uterus
- A woman who has not been diagnosed with cancer
- A woman who has attempted non-surgical therapies to no avail
To begin the ablation, a woman’s cervix is dilated so that instruments can be inserted through the cavity. The instrument used depends upon the type of ablation you and your doctor have chosen. The different types of ablation can be performed by laser beam, electricity, freezing, heating, or microwave energy. The type of procedure depends upon a number of things including but not limited to:
- The preference and experience of the surgeon
- The presence of fibroids
- The size and shape of the uterus
- Whether or not pretreatment medication was given
- The type of anesthesia chosen by the patient and surgeon
The type of procedure most commonly chosen by experienced gynecologists is the FDA approved NovaSure. NovaSure is a minimally invasive and extremely effective endometrial ablation procedure with up to 90% of patients claiming significantly lighter periods after the procedure. NovaSure can usually be performed in office in a few minutes and has been known to cause the patient very little pain. During the NovaSure procedure a woman will come in to the office during her cycle. She will receive a general anesthesia in the cervix prior to the procedure. The cervix will then be dilated and a small wand will be inserted into the cervix. A mesh device will expand from the wand into the uterus fitting the uterine cavity precisely. Then a carefully measured radio frequency is delivered through the mesh for 90 seconds deteriorating the endometrium. The device and the mesh are then removed from the uterus.
The procedure typically lasts about 5-10 minutes and most women are able to return to their daily activities after 24 hours. Some cramping and discharge is associated with the procedure but is normal and should not cause alarm. It is necessary to sustain from sexual intercourse and to avoid tampon usage for several weeks after the procedure or until your doctor has cleared you to do so.
NovaSure is not performed on women who hope to conceive in the future, not because it is not possible, but because it is unsafe for both the mother and the child. Once you return to normal sexual activity after NovaSure it is important that you use some type of contraceptive, you and your doctor should discuss this and decide which contraceptive would be right for you.
Some side effects may follow after the procedure is performed. These symptoms do not occur in every case and should not cause alarm. The truth is that 90% of women who receive this surgery are very pleased with the outcome, and claim to have suffered from very minimal side effects.
If you are suffering from heavy menstrual bleeding, talk to your doctor today and rid yourself of this heavy burden. Treatment for heavy periods by way of endometrial ablation has changed the lives of many women. Talk to your doctor today and get more information on the endometrial ablation procedure that might be best for your situation and learn if NovaSure for heavy periods is your answer.
According to the Women’s Specialists of Plano, a group of gynecologists in the Plano, Texas area, if you are a woman that has delivered multiple children, has experienced a difficult childbirth delivery, or if you have gone through menopause, you may experience the unwanted and frustrating symptoms associated with a cystocele. Pelvic floor dysfunction is a common disorder among both males and females, but even more commonly found in females because of the pelvic and vaginal pressure associated with the above scenarios.
A cystocele (also referred to as a prolapsed bladder) is a pelvic organ prolapse that is explained as the result of a drooping bladder. This condition most commonly affects women between the ages of 50-60. There are many reasons why a woman may experience a prolapsed bladder. A woman’s bladder can droop and cause a cystocele after pushing to deliver children, years of straining to have bowel movements, or heavy lifting over an extended period of time. Another common cause of a cystocele is a previous hysterectomy. Many gynecologists state that when women go through menopause, estrogen begins to naturally decrease within the female body. Estrogen regulates the strength of the muscles around the vagina. When Estrogen is no longer produced these muscles loosen and can lead to a prolapsed bladder.
Many women will have a cystocele and not show symptoms, while others will deal with a variety of unwanted symptoms. Symptoms of a cystocele include:
- Pressure in the vaginal area
- A feeling of fullness in the pelvic region
- Discomfort in the pelvic area when you cough, bend, jump, lift, etc.
- Urinary incontinence ranging from mile to severe
- Bladder infections
- Pain or urinary leakage during sexual intercourse
All of these symptoms will vary depending on the stage and type of cystocele that is presented at diagnosis. There are three types of cystoceles that are classified by their severity.
They are classified as follows:
Grade 1 Cystocele
A grade 1 cystocele will show milder symptoms initially but may worsen if not treated. During this phase the bladder droops just slightly into the vagina causing discomfort and urine leakage. The treatment for this type of cystocele may be rest and recovery, and avoiding heavy lifting or straining which may cause the problem to worsen. Daily exercises of the vaginal muscles through Kegel movements is also recommended.
Grade 2 Cystocele
A grade 2 cystocele is a bit more severe. During this phase the bladder droops until it can be seen through the opening of the vagina causing the complete obstruction of the vagina. This type of cystocele causes major discomfort and severe urinary incontinence. The treatment for this type of cystocele is usually some form of cystocele repair surgery but the cystocele may also be treated with a pessary device.
Grade 3 Cystocele
A grade 3 cystocele is the most severe of cystoceles. This is the diagnosis when the bladder droops low enough to bulge completely out of the vagina. Symptoms are similar to those of a grade 2 cystocele—but worse. Treatment for this type of bladder prolapse is cystocele repair surgery to move the bladder back into its proper place.
Treatment of grade 2 and grade 3 cystoceles are A.) The placement of a pessary device or B.) A cystocele repair surgery to place the bladder back into its place and keep it there.
A Pessary Device is a device that it placed against the uterus inside the vagina to hold the bladder in place. They are made of many types of materials in several different sizes. You and your OBGYN will discuss which is right for you, how to remove and replace it, and the proper procedures for cleaning it. A pessary must be removed on a regular basis to avoid infection or any other complications. Many women are fitted for a pessary device and yield very positive results.
Some women will require cystocele repair surgery for the treatment of their cystocele. In this repair surgery sutures are used to reattach the fascia thus giving enough support to allow the bladder to remain in place. Patients receiving this surgery should be prepared to stay in the hospital for several days and take 4-6 weeks to fully recover. This surgery is very successful in replacing the bladder thus eliminating the cystocele. The surgery can be performed through open and laparoscopic techniques depending on the grade and severity of the defect. The percentage of recurring cystoceles is very small after a cystocele repair surgery.
If you are suffering from discomfort and urinary leakage or incontinence do not assume it could be the result of age, you need to see your doctor. In the early stages, cystocele treatments are minimally invasive and maximally effective. Contact the Plano, Texas group of OBGYNs from the Women’s Specialists of Plano and learn more about cystocele out treatment options and cystocele repair surgery today.
Menopause Symptoms and Treatments | Hormone Replacement Therapy | Estrogen Replacement Therapy | Plano, Texas
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 and Dennis Eisenberg —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.
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:
The gynecologists and patients of the Women’s Specialists of Plano contributed to this article.Visit them on the web at www.obgynplano.com.
Dr. Murray Fox, a Plano gynecologist, and Dr. Daryl Greebon, a Plano OBGYN, of Women’s Specialists of Plano have joined the Faith in Practice medical mission team currently in Guatemala. Dr. Fox and Dr. Greebon are medical mission veterans and find the experience incredibly rewarding. Dr. Murray Fox and Dr. Daryl Greebon will volunteer their surgical expertise to poor Guatemalan women in need of gynecologic surgery. The surgeries they perform will include removal of uterine fibroids, hysterectomy and vaginal reconstruction.
Faith in Practice’s mission is to improve the physical, spiritual, and economic conditions of Guatemalan’s poor through short-term surgical, medical and dental mission trips and health-related educational programs
The large FIP team of surgeons, anesthesiologists, nurses, administrators, clergy, translators, oral surgeons, dental hygienists, and a photojournalist will travel to Reutealeahu, Guatemala from February 26, 2010 through March 7, 2010. The team will provide short-term surgical, medical and dental care. Prior to the mission, the team gathers all the supplies that will be required for performing surgery and post-operative care. Each team member typically brings 2 trunks of medical supplies. In total, 86 trunks arrived in Guatemala for this mission.
At the beginning of the trip, the FIP team will assess all surgery candidates and prepare a surgical schedule. The remainder of the week will be spent in surgery and providing after care.
To follow Dr. Fox and Dr. Greebon while they are on their medical mission, a Facebook Fan Page has been set up, Faith In Practice-Greebon Team 244.
The physicians at Women’s Specialists of Plano, 972-379-2416, are among the more experienced gynecologic robotic surgeons in the Plano, Texas area. Several of the doctors at Women’s Specialists underwent additional training on the da Vinci robotic surgery system and have since performed hundreds of minimally invasive robot-assisted procedures such hysterectomy and mymoectomy.
Medpage Today, an online medical news site, published an article titled, “Robotic Surgery Benefits Seen for Hysterectomy.” The article highlights recent findings that robot-assisted hysterectomy may in fact be a safer surgical option for patients with a large uterus and underlying medical conditions. Historically, robotic surgery was seen as optimal for a patient with an average sized uterus and normal pathology. Patients with a large uterus and more complex pathology were seen as better candidates for a traditional hysterectomy.
A recent review of five community practices through the country found robotic surgery, specifically robot-assisted hysterectomy, can produce favorable outcomes for more complex cases. It was shown that robotic surgery could be associated with fewer complications and less blood loss compared to traditional open-abdomen hysterectomy.
The da Vinci robotic surgery allows 3D images of the pelvis and mirrors the precise hand and wrist movements of the surgeon while eliminating the possibility of slight hand tremors.
If you are interested in learning more about robot-assisted hysterectomy, please contact Women’s Specialists of Plano in Plano, Texas. Their modern office is conveniently located near the Medical Center of Plano. You can schedule an appointment by calling 972-379-2416 or by visiting their online appointment center.
Article source: Medpage Today
Jules Monier, MD of Women’s Specialists of Plano was interviewed for the below article originally published in Articlesbase on September 2.
Endometrial Ablation: The Simple Way to End Heavy Periods (Menorrhagia) Without a Hysterectomy
Author: Kristy Theis
If you are a woman who dreads her monthly menstrual cycle because of a relentless, long and heavy flow, you are not alone. In fact, more than 1 in 5 women experience a persistent and abnormal menstrual flow every month, a condition known as menorrhagia.
Is My Period Normal?
Each month, as a woman’s body prepares itself for a possible pregnancy, the hormone levels estrogen and progesterone rise thus thickening the uterine lining in order to protect the egg released by the ovaries. If fertilization does not occur, a woman will shed this lining which will be visible as blood indicating the start of her period.
As the time nears for a woman to have her period, those suffering from menorrhagia will dread the days leading to the very first sign of blood that will eventually appear. A normal period is usually marked with less than 10 tablespoons of blood lost and a manageable flow for up to 4-7 days. When a woman has a consistently long and heavy period every month—severe enough to cause nausea, fatigue, moodiness, or a complete interruption of daily life, it might be time to check into a menorrhagia treatment in order to resolve the problem.
Curing Heavy Periods
Endometrial ablation is one such menorrhagia treatment procedure that can radically improve the symptoms associated with a prolonged and unrelenting menstrual flow. During the procedure, the endometrial lining is removed either by using freezing temperatures or a heated fluid. The removal of the lining, in essence, prevents the flow of blood to occur.
According to Dr. Jules Monier, a Gynecologist in Plano, Texas, “Endometrial ablation has been around in some form for more than 20 years. The procedure has been perfected and now an unprecedented number of women can enjoy normal menstrual cycles with a much lighter flow accompied by the usual, mild symptoms associated with having an average period.”
The NovaSure® method, an approved endometrial ablation procedure designed specifically as a menorrhagia treatment option over more drastic procedures such as a hysterectomy, uses radio frequency energy to permanently remove the lining of the uterus, which reduces, or eliminates, future bleeding. The procedure, which is carried out under local anesthesia, usually takes under an hour to complete and is typically performed either in the office on an out-patient basis or in a hospital as a day surgery procedure.
Dr. Jules Monier performs the procedure in his Plano, Texas office on a routine basis and consistently receives satisfactory feedback from the patients who have opted to have the treatment. “More than half of my patients experience a total absence of a period after the procedure is performed. Most others see a significant improvement in their menstrual flow and the symptoms that follow. I like to refer to the procedure as it’s like having a hysterectomy without having a hysterectomy.”
For the women that have visited this Plano, Texas office and the thousands of others who have undergone the NovaSure® procedure, 97% say they would recommend the treatment to their friends.
Who is the right candidate for this procedure?
Although the chances for pregnancy reduce greatly after the NovaSure® endometrial ablation procedure has been performed, it is still possible to become pregnant. Any woman who has completed child-bearing or who is menopausal can be a candidate for the treatment. Prior to performing the NovaSure® method, your gynecologist will do a sonogram and in some cases, an endometrial biopsy to ensure there is not another underlying condition present. Light cramping and bleeding may occur in the days or weeks following the procedure but will then disappear allowing the majority of women to enjoy either a normal or an absent menstrual flow.
To learn more about what may be causing you to have a consistently heavy period and to look at the treatments that are available, such as the NovaSure® method, be sure to discuss all of your options with your gynecologist.
About the Author:
Dr. Jules Monier was interviewed for this article and has been practicing gynecology in the Plano, Texas area for 25 years. He is currently in practice with Women’s Specialists of Plano. http://www.obgynplano.com/
Kristy Theis is a Plano, Texas-based communications freelance writer specializing in b2b, consumer and vertical trade copy suitable for both print and Internet. She has over 14 years experience in the fields of marketing, PR and copywriting and currently serves as the content editor for emedicalmedia.com.
Facts About Urinary Incontinence and Uterine Prolapse – The Solution
Author: Dr Daryl Greebon
In part one of this discussion, we discussed disorders referred to as pelvic floor disorders, or as disorders of pelvic support. These disorders include urinary stress incontinence (urinary leakage), uterine prolapse (dropped uterus), cystocele (dropped bladder), rectocele (bulging of the back wall of the vagina), enterocele (A form of internal hernia), and vaginal vault prolapse (dropped vagina after hysterectomy). We discussed some of the causes and the symptoms associated with pelvic floor disorders. In this portion of the discussion, I would like to discuss the potential solutions to these problems.
For the most part, the treatment of all of these disorders is surgical. When uterine prolapse or urinary incontinence symptoms are mild, surgery is to be avoided if possible and conservative measures such as avoiding heavy lifting, managing fluid intake, and using stool softeners can help mitigate the symptoms and delay the need for surgery. Unfortunately, the physical stresses and activities of life almost always cause progression of these problems, so that most women who have these disorders eventually need surgery. For elderly women who are not sexually active and not good surgical candidates because of other medical problems, the use of a pessary (a plastic or rubber device that fits into the vagina to hold the uterus and bladder in better position) can be used. However these are not adequate for anyone who is sexually active, or has moderate physical activity.
We will now discuss the various procedures necessary to correct pelvic organ prolapse. Because there are often multiple problems (uterine prolapse, cystocele, rectocele) more than one procedure is often required.
Hysterectomy – When there is uterine prolapse (dropped uterus), usually a vaginal hysterectomy is required. The tubes and ovaries can be removed vaginally as well for those postmenopausal women who need to have the ovaries out. Occasionally, vaginal repairs listed below may be done in association with and abdominal hysterectomy, or a daVinci robotic hysterectomy.
Tension Free Vaginal Tape
TVT – Tension Free Vaginal Tape. This is a procedure to repair the bladder neck. This does not take care of significant bulging of the vagina, but is all about control of urinary incontinence. Needles are passed either behind the pubic bone, or around the lateral pelvic bones and into the space between vaginal wall and bladder. A 1 cm. wide mesh tape is threaded through the needle and the needle is pulled out . In this way, the vaginal tape is anchored in place and lays without tension beneath the urethra so that when the woman coughs or sneezes the urethra is compressed against the mesh and the resulting fibrous tissue that is laid down around the mesh. This compression prevents urinary incontinence.
Anterior repair – (also medically known and anterior colporraphy). This is a repair of the anterior or front wall of the vagina beneath the bladder. This is done to correct the extensive bulging of a large cystocele. An incision is made in the vaginal wall, the vaginal tissue is then separated from the underlying bladder. In the older type of anterior repair, suture is used to pick up some bladder wall on one side, then on the other, and when this suture is tied, it pulls the tissue together and lifts and supports the bladder. Unfortunately, when women have weak connective tissue to begin with, the tissue which is used for support is often not as strong as we might like, and therefore, with conventional old-style anterior repairs, the failure rate is higher. To avoid this problem, newer procedures have been developed which use a mesh material, like a loose weave thin cloth, which can be placed beneath the bladder to provide support. In today’s world, these surgeries are often done with kits, which provide conveniently shaped pieces of mesh with “arms” of mesh material that can be passed thru tissue with a needle much like the TVT described above. The arms help anchor the mesh is place long term, and seem to give better long-term results. The primary problem with placing mesh material in the vagina is the possibility of erosion such that the vaginal tissues do not heal completely over the mesh graft, or the possibility of pain with intercourse if this mesh is used in women prior to menopause.
Posterior repair – (posterior colporrhaphy) This procedure is a repair of the back wall of the vagina over the rectum. The description of this procedure would be identical to the description above of an anterior repair. The vaginal wall is opened, the vaginal tissues are dissected off of the underlying rectum, and then either sutures are placed to obliterate the defect and provide support, or mesh materials are used as described above to provide better long-term support.
Vaginal Vault Suspension
Vaginal vault suspension – This is a procedure to lift or elevate the vaginal vault (top of the vagina after hysterectomy). Some doctors try to accomplish this simply by doing a good anterior and posterior repair. If there is significant vault prolapse, I do not believe that this is adequate to prevent recurrence. There are however, additional procedures that can be done, some vaginally and some abdominally to support the top of the vagina when necessary. Sometimes the top of the vagina is anchored with sutures to the sacrospinous ligament, or high up on the uterosacral ligament. These are both strong structures which can give a better chance of long-term support, and both of these can be done vaginally. Each procedure has its relative strengths and weaknesses.
Traditionally the “gold standard” procedure for repair of vaginal vault prolapse is the Abdominal Sacrocolpopexy. This requires an abdominal incision, and the 4 – 6 week recovery attendant with an abdominal incision. This procedure uses a 3cm. piece of mesh material sewn to the top of the vagina with multiple stiches. The other end of the mesh is attached to the sacrum internally. Fortunately, today this procedure can usually, though not always be done as a daVinci robotic sacrocolpopexy. Using robotic surgery, it is possible to attach mesh both to the top of the vagina, and to the sacrum using laparoscopic techniques. This means less pain, quicker recovery, and easier return to work than the traditional open operation, and still gives the “gold standard” result.
Discuss Your Options with Your Doctor
There obviously are nuances about when these procedures should be applied and in what combination. Results with many of these procedures are directly dependent on the surgeon’s skill and experience. For instance, a talented and experienced surgeon can usually do a vaginal hysterectomy in 30-45 minutes and do vaginal hysterectomy with anterior repair and posterior repair and TVT in about 2 hours, whereas an inexperienced or less expert surgeon can take 2.5 to 3 hours for vaginal hysterectomy alone. While the time one takes to do a surgery is not a direct measure of quality, long operating times often suggest that the surgeon was either struggling or uncomfortable doing the case. The message is to make sure as much as possible that your surgeon knows and has considered all of the surgical choices available to you, and that he/she is choosing the best surgery for you, and that he/she is skilled at performing these operations.
I hope that this two part discussion has been helpful in understanding the problems of pelvic Relaxation or pelvic support disorders, and it is my sincere hope that this information serves you well if you or a loved one are having problems in these areas or are contemplating surgery in the near future.
About the Author:
Dr Daryl Greebon is a board certified OBGYN with Women’s Specialists of Plano. Dr Greebon is a member of the Baylor Regional Medical Center at Plano medical staff. Daryl Greebon, M.D., gynecologist, graduated from the University of Texas Southwestern Medical School. He went on to serve his internship and residency at the University of Pittsburgh Medical Center. http://www.obgynplano.com/womens-doctors-physicians/dr-daryl-greebon-md/
Facts About Urinary Incontinence And Uterine Prolapse – The Problem
Author: Dr Daryl Greebon
There are many forces that work on the pelvic floor in women. Lifting, laughing, coughing, sneezing, and having babies all have the effect of exerting downward pressure on the floor of the pelvis and in some women this leads to symptomatic problems such as urinary incontinence. These disorders are referred to as pelvic floor disorders, or as disorders of pelvic support. These disorders include urinary stress incontinence (urinary leakage), prolapsed uterus (dropped uterus), cystocele (dropped bladder), rectocele (bulging of the back wall of the vagina), enterocele (a form of internal hernia), and vaginal vault prolapse (dropped vagina after hysterectomy).
The common thread in all of these conditions is a loss of support of the uterus, bladder, or vaginal walls. While the forces listed above can cause problems, some women may do heavy work and have two or three babies and not have too much trouble, and others may not do particularly heavy work and have only one baby and still have a problem, so there is clearly more to this story than just the external forces. I believe that some women, or some families inherit a tendency to have weakness in the connective tissues that provide pelvic support. It is this weakness that allows these problems to occur.
It is therefore, no surprise that if a woman has generalized weakness of the pelvic floor, these problems are seldom isolated to one organ. While this is not always true, if a woman has urinary incontinence the odds are pretty high that she will have other issues as well, such as uterine prolapse or rectocele. Furthermore, since these organs are in close proximity, a problem in one may aggravate problems in others, so that a prolapsed uterus (dropped uterus) may over time make a cystocele (dropped bladder) get worse. This is one reason that in some cases if the bladder is repaired, but the uterus is not removed, recurrence of urinary incontinence is more likely. It is important when evaluating these problems for surgical correction that the entire pelvis is evaluated and that all problems are corrected at the same time. Every gynecologist, particularly early in his or her career has done a hysterectomy and repair of bladder, only to have the patient return six months or a year later with a newly developed rectocele because after the repair the forces of pressure were directed in a different place causing the new problem to develop. This could be avoided by choosing the best group of procedures at the start.
Let’s talk for a few moments about the various conditions. First, is a dropped uterus (uterine prolapse). While this can occur at almost any age (the earliest I have seen was a 21 year old nurse), it is more common in the 40’s and 50’s and beyond, after having had children and often after menopause. Uterine prolapse sometimes causes no symptoms until it is quite severe, but can cause pressure and discomfort. If the uterus is enlarged for any reason it is even more likely to cause pressure symptoms as it drops lower. This pressure may be felt in the lower abdomen, in the rectal area, on the bladder, or on the lower vagina. In extreme cases, the uterus can protrude completely outside of the vagina such that the vagina is almost turned inside out.
Second, a dropped bladder (cystocele, or bladder prolapse) can sometimes be subtle. There are two versions of this, one is when the neck of the bladder is dropped or weakened. The bladder neck is the important urinary control element, so when the bladder neck is dropped urinary stress incontinence develops. Urinary Stress Incontinence is a leakage of urine that occurs with coughing, sneezing, lifting or laughing. This is usually a small volume of leakage, maybe just a few drops, but can occur repeatedly throughout the day and can be a major problem. Most women would recognize this since mild versions may be a bit of leakage that occurs with running or sneezing.
There are other kinds of urinary incontinence which are not necessarily caused by a cystocele and which would not necessarily respond to surgical correction, so it is important to have preoperative assessment to decide if urinary stress incontinence is really the problem. The second sort of bladder problem is prolapse or weakness of the upper part of the bladder so that the bladder bulges into the vagina to a large extent. This can cause urinary retention and an increased risk of urinary tract infection. Sometimes this “pouch effect” can prevent urinary leakage, but if the mistake is made to fix the bulging bladder but not support well the neck of the bladder, having surgery might actually create urinary incontinence that a woman did not have before her surgery.
Third, a rectocele is a bulging of the back wall of the vagina over the rectum. This can be quite large at times, and can cause constipation, pelvic pressure, and in some cases a woman may have to place a finger in the vagina and press down to initiate a bowel movement. Different specialties may look at this problem differently. Some colorectal surgeons view this primarily as a bulging of the rectum and will offer a transrectal repair of this problem. Gynecologists on the other hand tend to view this as a defect of support, and it is my belief that any procedure that does not in some way provide better support of the back wall of the vagina is doomed to failure. I had a case in which a young gynecologist correctly diagnosed a rectocele, but his plan of action was to refer the patient to his friend the colorectal surgeon. The surgeon performed a transrectal repair. Immediately after the surgery the patient was concerned that the “bulge” for which she had originally gone in was still present. After six weeks of being told that this was swelling she asked the colorectal surgeon about it only to be told, ”Oh, that is a vaginal problem, you need to see your gynecologist for that”. She chose another doctor.
Fourth, an enterocele is much like an internal hernia in which the abdominal contents try to push their way down between the vagina and the rectum. This is fairly common with large rectoceles, but it is important for the surgeon to recognize this problem, know what it is, and repair it appropriately. Enteroceles are sometimes difficult to diagnose with certainty before surgery and tend to present like and act like a rectocele.
Last, is vaginal vault prolapse. This occurs after a hysterectomy in women who have severe disorders of pelvic support. The normal anchors that hold the vagina in place after a hysterectomy do not hold and the top of the vagina comes down and often protrudes at the vaginal opening. This is often accompanied by pressure and discomfort. It is important in the initial evaluation to be sure what is coming down, is it the bladder, the top of the vagina, or the rectum. This distinction is important because the appropriate repairs might be significantly different.
This concludes our discussion of Urinary Incontinence and Uterine Prolapse – The Problem. Please continue your study of these problems with “Facts About Urinary Incontinence and Uterine Prolapse – The Solution”. Part II continues our discussion of Pelvic Floor Disorders and Disorders of Pelvic Support focusing on the surgical correction of these problems.
About the Author:
Dr. Daryl Greebon is a board certified OBGYN with Women’s Specialists of Plano. Dr. Greebon is a member of the Baylor Regional Medical Center at Plano medical staff. Daryl Greebon, M.D., gynecologist, graduated from the University of Texas Southwestern Medical School. He went on to serve his internship and residency at the University of Pittsburgh Medical Center. http://www.obgynplano.com/womens-doctors-physicians/dr-daryl-greebon-md/
Understanding Uterine Fibroids
Author: Dr Daryl Greebon
Understanding Uterine Fibroids
Many women experience these non-cancerous tumors, which can require hysterectomies
A lot of women wonder just exactly what uterine fibroids are. They’re usually non-cancerous tumors that develop within the uterus, and 15-20 percent of women in their reproductive years and 30-40 percent of women older than 30 may suffer from uterine fibroids.
Why should women know about fibroids?
Uterine fibroids are the most prevalent pelvic tumor, but the cause of uterine fibroid tumors is unknown. Not all women with fibroids experience symptoms; however some women ache and have significant menstrual bleeding. In addition, fibroids can place pressure on the bladder, triggering frequent urination.
Fibroids may grow as a single growth or in groups. Fibroids vary in size from very small to eight inches in diameter. The growth of a fibroid typically depends on the hormone estrogen. Once a woman develops a fibroid, the fibroid usually continues to grow throughout her menstruation years.
Women who do not experience symptoms associated with their fibroids may not require treatment. Fibroids may even shrink after menopause, but if heavy bleeding or pain occurs, a hysterectomy may be required. Uterine fibroids are the main reason hysterectomies are performed.
What is a hysterectomy?
A hysterectomy involves surgically removing the uterus, and sometimes the cervix and/or ovaries and fallopian tubes are also removed.
According to the Centers for Disease Control and Prevention, after cesarean section, hysterectomy is the second most frequently performed major surgical procedure for women of reproductive age in the United States. Approximately 600,000 hysterectomies are performed annually in the U.S., and an estimated 20 million U.S. women have had a hysterectomy.
Although some women are wary of having surgery to relieve symptoms because of the down time they may experience, new technology is available that enables the removal of uterine fibroids and hysterectomies to be performed less invasively, leading to shorter hospital stays. For hysterectomies that may be difficult to perform as a vaginal procedure and would otherwise require an abdominal hysterectomy, the “da Vinci® Surgical System” offers an alternative.
This new robotic technology offers numerous potential benefits over traditional surgery, including less pain and scarring, less risk of infection, and faster recovery. It also may decrease the risk of blood loss that can occur during a hysterectomy. This new technology is available to Collin County and other area residents at Baylor Regional Medical Center at Plano, located near President George Bush Turnpike and Preston Road.
About the Author:
A member of the Baylor Regional Medical Center at Plano medical staff, Daryl Greebon, M.D., gynecologist, graduated from the University of Texas Southwestern Medical School. He went on to serve his internship and residency at the University of Pittsburgh Medical Center. Dr. Greebon is a board certified OBGYN practicing with Women’s Specialists of Plano. www.obgynplano.com