Jul
12
Every type of contraception is safer than the condition it is preventing… pregnancy. Ironically many people believe the contrary. So this is a great starting point for contraceptive counseling.
Recently there has been an onslaught of TV commercials, produced by lawyers, soliciting patients who utilize birth control pills containing the progestin drospirenone: Yasmin®, Yaz®, and the generic Ocella®. The solicitation requests patients who have had side effects to contact these lawyers so they so that they may be compensated. These pills have been targeted as they are the most popular branded oral contraceptives in America.
While there is a small risk of blood clots with these birth control pills, it is no different than other ones containing different types of progestins (FDA statement). This risk of blood clots has been estimated at approximately 16 per 100,000 birth control pill users per year, which is far less than the rate of 1 in 1000 pregnancies. Nevertheless, the risk of serious cardiovascular side effects (e.g. blood clots, strokes) in pill users who smoke is significantly increased. Advancing age compounds this effect. Consequently, the pill should not be recommended for smokers 35 years of age and over.
While we don’t want to promote one birth control pill over another, drospirenone is a unique progestin, and pills containing it also reduce acne and pre-menstrual dysphoric disorder (PMDD or more commonly referred to as PMS). So let’s help educate women to not be misinformed by these predatory TV commercials, perhaps prematurely discontinuing their pill and risking an unplanned pregnancy.
Wishing you good health,
Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com
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Jun
8
Hysterectomy, the removal of only the uterus, remains one of the most frequently performed surgical procedures in the United States; more than 600,000 operations are completed each year. Most patients undergoing hysterectomy, (approximately 90%) do so for benign conditions (eg. Fibroids). The surgical approach used to perform the procedure has evolved significantly and indeed continues to evolve. Minimally invasive procedures include vaginal and all types of laparoscopic hysterectomy. Despite these trends, many gynecologists in the United States persist at performing hysterectomy via a large abdominal incision (66%), whereas in many other countries minimally invasive hysterectomy predominates.
Clinical and economic evidence clearly demonstrates that compared with open abdominal hysterectomy; minimally invasive hysterectomy is associated with less pain, shorter hospitalizations, fewer complications, and a more rapid return to normal activities.
While the robotic assistant has been beneficial in other surgical specialties, it has limited adoption in benign gynecologic surgery where it enables conversion of an open procedure to a laparoscopic one. Consequently, the benefits of minimally invasive surgery are similar. While that is a good development for patient care, the reality is it takes an additional 45 minutes under anesthesia to set up the robot, costs the patient thousands of dollars in fees, and ironically does not eliminate an assistant surgeon. Despite the compelling marketing hype, there really are no additional benefits.
Perhaps because they have not been given options, patients have been surprisingly less demanding in requesting minimally invasive hysterectomy and acquiesce to their gynecologist’s preference, which may be limited to an open procedure. The gynecologic surgeons at Women’s Health Specialists were among the first (over 16 years ago) to perform laparoscopic hysterectomy in the San Francisco Bay Area. Honestly it would be fun to use the robot, but we can’t with good conscious when we can accomplish a laparoscopic hysterectomy without one. We need your assistance in educating women, friends and family, that when conservative measures have failed and a hysterectomy is indicated they need to persevere to find competent surgeons who offer a choice of minimally invasive procedures.
Wishing you good health,
Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com
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Apr
20
Traditionally gynecologists have been trained to recommend preventative removal of a woman’s ovaries (oophorectomy) if she is older than 45 when she undergoes a hysterectomy (removal of the uterus) for benign disease. It has been recommended to prevent ovarian cancer and avert the potential for other ovarian problems, like cysts, that might require future surgery.
There is general agreement in the medical community that women who have a breast cancer (BRCA) gene mutation or strong family history of ovarian or breast cancer benefit from removal of ovaries reducing subsequent cancer risk to these organs. However, for the general population recent data reveals that only 2.8% require reoperation after ovarian conservation. In addition, studies indicate that less than 1% of women who retain their ovaries at the time of hysterectomy develop ovarian cancer. Therefore, the rationale of performing oophorectomy to avoid future surgery appears to be unfounded.
Hazards associated with removal of both ovaries include:
- Increased risk of death from heart attacks, all cancers (except ovarian), and all causes
- Increased risk of osteoporosis and hip fractures
- Accelerated decline in sex drive due to loss of testosterone
- Oophorectomy performed before the onset of menopause is associated with an increased risk of parkinsonism, dementia, anxiety, and depression
Ovarian conservation appears to maximize survival among healthy women 40 to 65 years old who undergo hysterectomy for benign disease. Among healthy women hysterectomized before the ages of 55, calculations suggest that 8.6% more would be alive at age 80 if their ovaries were left in situ rather than removed.
Consequently, we practice a cautious approach to oophorectomy at the time of hysterectomy and emphasize the benefits of ovarian conservation as part of our discussion with women preparing for pelvic surgery. Increasingly these operations can be accomplished through minimally invasive approaches, resulting in less pain and a shorter recovery.
Wishing you good health,
Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com
Share this newsletter with those you care about… sisters, mothers, friends
