What is the best way to have a hysterectomy?
Once it has been determined you need a hysterectomy, you should have the least invasive hysterectomy available to you. The simplest and quickest recovery is a vaginal hysterectomy. There are no abdominal incisions and the pain is minimal. Next easiest recovery is with the da Vinci robot or laparoscopic hysterectomy. Small incisions are placed on the abdomen to give access to the uterus. The longest recovery is with a abdominal hysterectomy (large abdominal incision). This route may be necessary for a very large uterus or cases complicated by scar tissue and endometriosis. Remember no incision or small incision equals less pain.
Should I have my cervix removed during my hysterectomy?
Traditionally the cervix has been removed to avoid risk of cervical cancer in the future. This risk is minimal. Proponents of leaving the cervix argue it helps with sexual function and pelvic support. I am not convinced this is true. Most patients that do not have the cervix removed, have less post op pain and return to normal function sooner. I perform either and let the patient choose.
Should I have my ovaries removed?
This is not a simple decision. In the past we recommended removal of the ovaries at the time of hysterectomy for all patients over the age of 45 to reduce the risk of ovarian cancer. Current research suggests the ovaries continue to produce significant levels of testosterone in the menopause, and this may reduce the risk of heart disease. In this study, patients who had the ovaries removed died at a younger age than those with the ovaries in place. Currently, in patients without a significant family history of ovarian cancer or personal history of endometriosis or pelvic pain I recommend not removing the ovaries.
What about hormones?
This is the most controversial topic I deal with daily. The short answer is that I recommend hormones to most patients. For most the benefits and improvement in the quality of life far outweigh the potential increase in breast cancer. Since the WHI study in 1997, women have been unnecessarily apprehensive about taking hormones.
Compounded hormones vs. pharmaceutical hormones?
Either. I think it is more important that you take the hormones that you are most comfortable taking. Both are safe and cost about the same. I do think the use of compounded hormones requires more testing to prove effectiveness and achieve balance. We offer both, along with hormone testing as needed.
What is saliva testing?
Saliva testing is used to test levels of cortisol, DHEA, estrogen, testosterone, and progesterone. Saliva testing measures these hormones at the cell level, not what is circulating in the blood. Some feel that saliva levels more accurately represent the effectiveness of hormone therapy. We use saliva testing for achieving hormone balance and the workup of fatigue. See ZRT Labs for more information.
What is estrogen dominance?
As women age, their ovarian hormone production drops. The decrease in production is not balanced. When the decrease in progesterone is greater than the decrease in estrogen, a state of estrogen dominance occurs. Symptoms of this condition include cycles that are irregular and heavy, breast tenderness, bloating, low sex drive, fatigue, and PMS. Symptoms can usually be improved with low dose progesterone cream.
What is food sensitivity?
The inability to tolerate certain foods, also known as sensitivity or intolerance, induces chronic activation of the innate immune system and gives rise to inflammatory processes in the body. This inflammation has been linked to countless chronic conditions, including: digestive disorders, migraines, obesity, chronic fatigue, ADD, aching joints, skin disorders, arthritis and many more. A common food allergen is gluten. Gluten is a protein found in many grains. Other foods can cause a similar response of inflammation by the body. See gluten free and food allergy testing.
How does food sensitivity differ from classic food allergies?
True food allergies refer to a reaction to foods that involve the immune system. The reaction can be so acute that massive amounts of the chemical histamine can be produced which leads to anaphylaxis. Sometimes it may simply cause hives, skin rashes, and other non-life-threatening reactions. However, this is a potentially fatal condition because it causes the throat and esophagus to swell, cutting off air from the lungs.
What are ovarian cysts?
Each month the ovaries form multiple follicles of which one or two will enlarge and release an egg. These follicles can be as large as 3 inches and can cause pain and swelling. Many patients and physicians will refer to these follicles as “cysts.” Remember most “cysts” are a normal part of a women’s menstrual cycle and will resolve on their own. Abnormal cysts do form on the ovaries. If they do not resolve on their own, surgery may be needed to remove the abnormality. The best way to prevent cysts is to use the birth control pill or the Nuva Ring. Using an IUD will not prevent cysts from developing.
What are my options for getting my tubes tied?
When you are sure, a tubal ligation is a great form of birth control. There are two ways to have your tubes tied: laparoscopic and trans cervical. Laparoscopic tubal ligation is performed in an operating room with complete anesthesia. A camera is placed through the abdomen and small permanent clips are placed across the tubes. Most patients are sore for 1-2 weeks. This tubal ligation is effective immediately. A trans cervical tubal ligation is performed in the office with light sedation. There are no incisions and the recovery is minimal. The negative is that the procedure is not effective for 3 months. A dye test is required to verify the tubes are blocked. Both forms are very effective.
What are uterine fibroids?
Uterine fibroids are usually non cancerous growths that occur on or in the uterus. They can be a cause of excessive bleeding, painful periods, or painful sex. Fibroids can also be a cause of infertility. Fibroids will continue to grow until menopause, at which time they may shrink. In general if the fibroids are not causing a problem, they can be watched. Excessive or rapid growth may warrant removal. Surgical options for removal include myomectomy (removal of the fibroids) or hysterectomy. Either procedure can be performed using the da Vinci robot to minimize your discomfort and recovery. http://www.davincisurgery.com/gynecology Other treatments include uterine artery embolization. This is a procedure where the vessels feeding the fibroids are blocked. The procedure is long, has significant x-ray exposure and has a low success rate. Complications can be significant.
What is an endometrial ablation?
Endometrial ablation is a procedure performed for excessive bleeding. The purpose of the procedure is to destroy the endometrial lining of the uterus. This is the layer that grows and sheds each month. Reducing this layer will decrease the amount bleeding. We use several different methods to perform the endometrial ablation.
How effective is an endometrial ablation?
Fifty percent of the patients that have an ablation will experience no further bleeding. Another 45% will have reduced periods. Five percent will continue to have heavy bleeding.
Does insurance cover endometrial ablations?
Yes. Insurance coverage is excellent, especially if the procedure can be performed in the office.
What else do I need to know about an endometrial ablation?
An ablation is not birth control. Some form of permanent birth control is needed (tubal ligation or vasectomy). An ablation can only be done when pregnancy is no longer desired.