Jan
7
The causes of abnormal uterine bleeding (prolonged or excessive bleeding, as well as bleeding between periods) vary and commonly includes endometrial polyps or fibroids. Endometrial polyps are growths extending from the lining of the inside cavity of the uterus. Polyps can also cause spotting in menopause and in rare cases become cancerous, usually in women over the age of 50. Uterine fibroids (also called myomas or leiomyomas) arise from the muscular wall of the uterus. They vary in size, number, and location. It is estimated that 25% to 50% of women between ages 30 and 50 have fibroids. Fibroids are not typically associated with an increased risk of uterine cancer and almost never develop into cancer. Only fibroids that cause symptoms need to be treated.
You don’t have to let abnormal bleeding interfere with your daily activities. While there is no medication to treat polyps and fibroids, there are procedures to remove them. If there are numerous fibroids, large ones, or they are located in the middle or outer portion of the wall of the uterus then either myomectomy (removal of just the fibroids), or hysterectomy (removal of the uterus) is necessary.
However, if these growths project into the uterine cavity then they may be removed with a hysteroscope (the insertion of a small scope through the cervical opening into the uterine cavity). Dilation & Curettage (commonly known as a D&C) has been shown to miss removal of lesions. Hysteroscopy is the preferred method as it allows visualization and targeted removal: via grasper for small polyps, hot-wire cutting resection loop or morcellation for fibroids. Hysteroscopic Morcellation uses an instrument inserted through the hysteroscope that rapidly shaves away growths. Since the system does not use heat it minimizes damage to the inner lining of the uterus, which helps preserve the chances of pregnancy in the future. This device also shortens operative time and enhances safety.
Hysteroscopic procedures are performed on an outpatient basis. If you have completed your family then your doctor may give you the option of also having an Endometrial Ablation to further reduce or eliminate your menstrual bleeding. Your doctor will provide specific details regarding postoperative care, but most women return to their regular activities the following day.
At Women’s Health Specialists we are proud that we continue to lead in advancing minimally invasive surgical techniques for women of the San Francisco Bay Area.
PS: Check out Hysteroscopic Morcellation Videos & Brochures
Wishing You Good Health,
Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com
Dec
11
Ambulance chasing lawyers have found a new victims’ rights to champion. Not so fast…
The organs in your pelvic cavity—uterus, vagina, bladder and rectum—are held in place by a web of muscles and ligaments that act like a hammock. When these tissues become weakened or damaged (typically during childbirth, and/or after hysterectomy), one or more of the pelvic organs fall (prolapse) into the vagina. As a result, the organs may press against the vaginal wall and produce a hernia-like bulge causing discomfort, limiting sexual and physical activity, or impair bladder or bowel function.
Pelvic organ prolapse (POP) currently affects 1 in 11 women and Stress Urinary Incontinence (SUI)—urine leakage with coughing, exercise etc.—1 in 6. Just as prolene mesh has replaced plication groin hernia repairs so has it revolutionized the urethral sling for SUI over 15 years ago and is similarly changing POP repairs.
While urethral mesh slings have rare complications and have become the gold standard, using larger pieces of mesh for POP corrective surgery has been controversial with setbacks. The good news is significant evolution has occurred over the past decade with lighter weight prolene mesh that has lowered the risk of exposure to less than 10% (which does require an outpatient, small revision of the mesh that fortunately doesn’t affect restored support). Contrast this with a 30 40% failure rate of non grafted cystocele (bladder prolapse) repairs, where these women require complete reoperation in a scarred field ripe for complications. After all these women have poor pelvic ligaments that tore during childbirth creating these vaginal hernias. Hence, improved success (better than 90%) and longevity of a mesh-augmented repair for women with moderate to severe prolapse becomes a compelling choice.
We have been approached by numerous concerned patients who have been misled by these alarming ads that the FDA recalled mesh products. This is not true. The FDA now requires surgeons to communicate about the risks to their patients contemplating POP surgery—with and without mesh augmentation; We have been doing so since we began using grafts years ago. The FDA has a list of 13 questions that patients should ask their doctor including their experience performing these complex procedures. It’s only fair that women suffering with prolpase recieve balanced information so they can make an educated decision about surgery, or alternaitives such as a pessary. It’s unfair to have medicine dictated by greedy lawyers influencing these women into tolerating prolapse and its impact on bowel, bladder, and sexual function.
Wishing You Good Health,
Women’s Health Specialists
2299 Mowry Avenue, Suite #3C
Fremont, CA 94538
510.796.7057
www.WomensHealthFremont.com
PS: Our web site WomensHealthFremont.com has many educational resources including videos to help educate you on SUI, prolapse, and other pelvic health issues
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Nov
12
So you want birth control pills and have a medical illness. Is it OK?
Filed Under Women's Health News
Most contraindications to oral contraceptives (OC) are due to the estrogen component in the pill. Clearly, there are women for whom OCs should not be prescribed. These include women who have a history of migraines with aura due to the increased risk of stroke. Women with uncontrolled high blood pressure or smokers older than age 35 should not be prescribed OCs because of increased heart disease risk. Caution should be used when initiating combined OCs in women who already have elevated blood pressure.
OCs are contraindicated in several other groups of women. These include diabetics with end-organ damage (Kidney, eye, vascular); a personal history of breast cancer or estrogen-dependent tumor; active liver disease; a history of blood clots in veins. Women with mild high cholesterol who do not have other cardiovascular risk factors can be prescribed OCs if their low-density lipoprotein cholesterol is less than 160. Combined OCs are also contraindicated in breast-feeding women who are within 6 weeks of delivery (Progesterone only pill OK).
Potential side effects of OCs should be discussed with patients considering OC use. The most common side effects include nausea, headaches, breast tenderness, and breakthrough bleeding which often resolve in first few months. A more serious, but uncommon side effect of OC use is a small increase in the risk of venous blood clots compared to women who do not use OCs; this risk may be higher in obese women. This increase is much lower than the risk blood clots associated with pregnancy.
Unplanned pregnancy in women with medical illnesses like those described above can be disastrous for both mother and child. Other contraceptives may be better suited for these women. Nevertheless, contraception, while not perfect nor risk free, allows time to optimize medical conditions so as to reduce impact on pregnancy or avoid it altogether if that is what a woman desires.
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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