What is a hysterectomy?

A hysterectomy is a surgery to remove the uterus. Hysterectomies are performed for a variety of gynecologic conditions such as uterine fibroids, heavy periods, endometriosis, chronic pelvic pain, uterine prolapse, and gynecologic cancer.

A hysterectomy is a surgery to remove the uterus. When the entire uterus is removed, this is called a total hysterectomy. If the entire uterus, tubes, and ovaries are removed this is called a total hysterectomy with bilateral salpingo-oophorectomy. Sometimes the uterus is removed, but the cervix is left behind. This surgical technique is called a supracervical hysterectomy.

During hysterectomies, Obgyns often recommend fallopian tube removal (bilateral salpingectomy) to reduce ovarian cancer risk. Some women will also need the removal of the ovaries (oophorectomy). Hormonal changes only occur when the ovaries are removed.

Gynecologists perform hysterectomies through a variety of techniques. The size of the uterus, surgeon experience, the patient’s body type, and the prior surgical history help determine the proper surgical approach. Techniques include:

1. Vaginal hysterectomy
2. Abdominal hysterectomy
3. Laparoscopic hysterectomy (total or supracervical)
4. Laparoscopic-assisted vaginal hysterectomy
5. Robotic hysterectomy

What are the advantages of laparoscopic supracervical hysterectomy?

Many patients who need a hysterectomy are concerned about a long recovery and missing time off work. A laparoscopic supracervical hysterectomy is an excellent option for hysterectomy candidates who do not have any cervix problems.

The cervix is the opening of the uterus at the back of the vagina. Some women are not candidates for supracervical hysterectomy due to a history of cervical dysplasia, HPV, or abnormal pap smears.

This minimally invasive technique allows faster recovery, reduced pain, and shorter hospital stay. Patients benefit from small incisions, a short hospital stay, and a quicker return to work, exercise, and everyday activities.

During laparoscopic surgery, the surgeon places a camera through the umbilicus (belly button). This technique allows the surgeon to use small instruments to perform the surgery and monitor the surgical field through these tiny incisions.

How long will I be in the hospital?

Surgeons perform a laparoscopic supracervical hysterectomy as an outpatient procedure or inpatient surgery with an overnight stay. Various factors, such as the patient’s underlying health status, surgical complexity, and physician preference, help determine the surgical plan.

Most laparoscopic supracervical hysterectomy patients can leave the hospital much faster after a traditional abdominal hysterectomy.

Can my family visit me?

A trusted family member should drive you to and from the hospital or ambulatory surgery center for a laparoscopic supracervical hysterectomy. Families are welcome to stay with you before and after surgery. Hospital visitor policies for overnight stays vary from region to region due to the Covid-19 pandemic.

Does my procedure require an anesthetic?

A laparoscopic supracervical hysterectomy requires general anesthesia. An anesthesiologist will temporarily put the patient to sleep so they will feel no pain during surgery. The surgeon may also inject a local anesthetic into the incisions to decrease postoperative pain.

What’s the procedure when I check-in?

Most surgeries will involve a preoperative visit with your surgeon to go over the procedure’s risks and benefits in detail. Your surgeon answers questions regarding your upcoming surgery. The surgical consent form is reviewed, signed, or updated with any changes.

Because any hysterectomy will eliminate the possibility of child-bearing, your doctor will ask questions to make sure you are confident you will not want children in the future.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

After arrival at the hospital or Ambulatory Surgery Center, the staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. You will meet the nursing team who will provide care during your stay. Your nurse will place an IV at this time.

The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens on the day of surgery?

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV to help you go to sleep.

The OR nursing team will cover your body with sterile drapes and prep the abdomen for surgical sterility. The team then performs a “surgical time-out.” The head nurse will read a surgical safety checklist aloud, requiring all surgical team members to be present and attentive.

The gynecologic surgeon will insert a speculum into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina.

Once the speculum is in place and the cervix visualized, the surgeon inserts a device called a uterine manipulator into the cavity of the uterus. This step facilitates the surgeon’s ability to safely operate and avoid injury to surrounding tissue such as the bladder, rectum, intestines, and ureter.

The surgeon will mark the surgical sites with a small marking pin and insert a small camera through an incision in the belly button. Air inflates and distends the abdomen to allow visualization of the pelvis. My preference is to insert a specialized instrument called Gel point mini by Applied Medical. This type of port will enable me to use one incision to perform the procedure.

The surgical team positions the laparoscopic camera to show the pelvic anatomy. We pass small instruments through the additional ports.

Many surgeons recommend complete removal of the fallopian tubes (bilateral salpingectomy) at the time of surgery as this technique reduces the risk of ovarian cancer.

The fallopian tubes are located and grasped with one instrument. Using the other hand, the surgeon clamps and cuts the fallopian tubes from the adjacent anatomy.

The surgeon travels down the sides of the uterus, freeing it from the connecting tissues. The round ligament and uterine/ovarian ligaments are clamped, cauterized, and then cut. At each step, the surgeon will take precautions to control and avoid bleeding.

Critical anatomy lies towards to lower end of the uterus. The surgeon will separate the bladder from the lower uterine segment to allow visualization of the cervix and avoid bladder injury.

The surgeon will focus careful attention on the uterine arteries, the main blood supply to the uterus. These two blood vessels travel over the ureters, which are the tubes connecting the kidney to the bladder.

At this point, we can separate the uterus from the cervix for removal. There are various techniques, but I prefer to use a product called the bipolar Lina Loop.

The surgeon lassos the loop over the uterus and positions it at the uterus and the cervical junction. We perform a safety check to make sure no other anatomy is in contact with the loop. Then the uterus is amputated from the cervix.

The uterus is now free but still needs to be removed. We place the uterus into a surgical bag for tissue retrieval.

The surgeon examines all of the surgical sites for bleeding. When safe, the Obgyn removes the uterus safely located inside the bag through the umbilical (belly button) incision. We removal the operative ports and sew the surgical incisions closed.

Once the procedure is complete, the surgical team completes a post-procedure review. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to wake the patient up for transfer to the recovery room.

How long will I be in the operating room?

Once the patient enters the operating room, a series of safety steps must occur. This process takes about 20 minutes.

The operative time for laparoscopic supracervical hysterectomy varies. The surgeon’s experience, surgical technique, patient body type, uterine size, and previous surgeries are all factors. For example, a small uterus is a much easier surgery than a large, fibroid uterus.

In general, the patient should expect 1–2 hours of total operative time.

When can I go home?

Postoperative recovery time will vary from person to person. Some surgeons will recommend an outpatient procedure, while others prefer an overnight stay. The patients underlying health status, surgical complexity, and physician preference are all factors.

To be able to go home, each patient must meet specific discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. The recovery room team will control postoperative nausea, vomiting, and pain and monitor for postoperative bleeding.

The nursing team will go over discharge instructions, and confirm postoperative pain management plans.

AFTERCARE AND RECOVERY QUESTIONS

What is the usual recovery time?

Most women should be able to return to normal daily activities within a few weeks of surgery. The nursing team will help patients walk and move around a few hours after surgery to reduce blood clots’ risk, improve lung function, and expedite bowel function return.

Most patients will require pain medication like NSAIDs and narcotics for a time. Many experience discomfort in the right shoulder due to air irritating the nerves of the diaphragm.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are safe to use.

What aftercare is required?

You should speak with your physician regarding the resumption of exercise and sexual activity. Most can return to basic activities in one to two weeks. Sexual activity is typically restricted for 6–8 weeks to allow complete healing.

Your doctor will schedule a postoperative examination 1–2 weeks after the procedure to evaluate the incisions.

Danger Signals to look out for after the procedure

You should call your doctor if you experience heavy vaginal bleeding, fevers, severe nausea or vomiting, worsening abdominal pain, or the inability to pass gas.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over 24 hours, call your physician. After any surgery, contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas

What preparations should I make for aftercare at home?

Laparoscopic procedures require very little postoperative care. Keep the incisions clean and dry. Patients should avoid sexual activity until cleared by their doctor. One may resume a normal diet the day of surgery and begin light exercise the day after the procedure or when you feel ready.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Still have questions?

Read through any existing comments in the section below and if you still need information on this procedure please do leave your questions in the comments section.

The post Preparing for: Laparoscopic Supracervical Hysterectomy appeared first on Medika Life.

A hysterectomy is a surgery to remove theuterus. Hysterectomies are performed for a variety of gynecologic conditions such as uterine fibroids, heavy periods, endometriosis, chronic pelvic pain, uterine prolapse and gynecologic cancer. 

During a hysterectomy, the uterus is removed. Obgyns often recommend fallopian tube removal (bilateral salpingectomy) to reduce the risk of ovarian cancer. Some women will also need the removal of the ovaries (oophorectomy). Hormonal changes only occur when the ovaries are removed.

Gynecologists perform hysterectomies through a variety of techniques. The size of the uterus, surgeon experience, the patient’s body type, and the prior surgical history help determine the proper surgical approach. Techniques include:

1. Vaginal hysterectomy
2. Abdominal hysterectomy 
3. Laparoscopic hysterectomy 
4. Laparoscopic-assisted vaginal hysterectomy 
5. Robotic hysterectomy robotic

What are the advantages of robotic hysterectomy?

Contrary to the name, robots do not perform the surgery. A human gynecologic surgeon attaches a surgical system to intraabdominal ports. While sitting at a surgical console, the surgeon controls the robotic arms while monitoring the surgical field in a 3D view..

Through 4–5 small incisions, the surgeon detaches the uterus from the surrounding tissues. Robotic surgery is a minimally invasive surgery that allows for faster recovery, reduced pain, and shorter hospital stay.

The American College of Obgyn acknowledges this type of hysterectomy’s growing popularity but recommends robotic hysterectomy be reserved for more complex cases that can not be safely completed through other minimally invasive techniques.

Experienced robotic surgeons prefer the precise control of the surgical arms allowing complex cases to be completed in a minimally invasive fashion. Patients benefit from small incisions, a short hospital stay, and a faster return to work, exercise, and everyday activities.

How long will I be in the hospital?

Surgeons perform robotic hysterectomies as an outpatient procedure or as an inpatient surgery with an overnight stay. Various factors, such as the patient’s underlying health status, surgical complexity, and physician preference, help determine the surgical plan.

Most robotic hysterectomy patients are able to leave the hospital much faster after a traditional abdominal hysterectomy. 

Can family visit me?

A trusted family member should drive you to and from the hospital or ambulatory surgery center for a robotic hysterectomy. Families are welcome to stay with you before and after surgery. Hospital visitor policies for overnight stays vary from region to region due to the Covid-19 pandemic.

Does my procedure require an anesthetic?

Laparoscopic robotic surgery requires general anesthesia meaning patients will be temporarily put to sleep. The surgeon may also inject a local anesthetic into the incisions to decrease postoperative pain.

What’s the procedure when I check-in?

Most surgeries will involve a preoperative visit with your surgeon to go over the procedure’s risks and benefits in detail. Your surgeon answers questions regarding your upcoming surgery. The surgical consent form is reviewed, signed, or updated with any changes.

Because robotic hysterectomies will eliminate the possibility of child-bearing, your doctor will ask questions to make sure you are confident you will not want children in the future.

In most settings, patients will receive a preoperative phone call by a nurse or medical assistant one to two days before surgery. If any blood work or preoperative testing is required, it will be scheduled and confirmed.

After arrival at the hospital or Ambulatory Surgery Center, the staff will guide you to the preoperative holding area to change into a surgical gown and store your valuables. You will meet the nursing team who will provide care during your stay. An IV will be placed at this time.

The anesthesia team will come to interview you and answer questions. Typically your surgeon will also come and review any last-minute questions.

What happens in the operating room?

After the preoperative evaluation, the team will guide you to the operating or procedure room. You will move from the mobile bed to the operating table. Once you are positioned comfortably and safely, the anesthesiologist will give you medication through your IV to help you go to sleep.

The OR nursing team will cover your body with sterile drapes and prep the abdomen for surgical sterility. The team then performs a “surgical time-out.” A surgical safety checklist is read aloud, requiring all surgical team members to be present and attentive.

The gynecologic surgeon will insert a speculum into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina.

Once the speculum is in place and the cervix visualized, the surgeon inserts a device called a uterine manipulator into the cavity of the uterus. This step facilitates the surgeon’s ability to safely operate and avoid injury to surrounding tissue such as the bladder, rectum, intestines, and ureter.

The surgeon will mark the surgical sites with a small marking pin. A small camera is inserted through an incision into the belly button. Air inflates and distends the abdomen to allow visualization of the pelvis. Three or four secondary ports are placed to allow the robotic arms to function. 

The robot is then positioned over the body and attached to the ports. The laparoscopic camera is positioned to show the pelvic anatomy. Small instruments are passed through the additional ports. Scissors are attached to one robotic arm and a grasping device in the other. This allows the surgeon to operate with both hands. 

The surgeon then moves away from the patient to the surgical consult to control the robot. 

As the surgeon takes her seat, she adjusts the camera and robotic arms’ position to begin the surgery.

Many surgeons recommend complete removal of the fallopian tubes (bilateral salpingectomy) at the time of surgery as this technique reduces the risk of ovarian cancer.

The fallopian tubes are located and grasped with one instrument. Using the other hand, the surgeon clamps and cuts the tubes from the adjacent anatomy.

The surgeon travels down the sides of the uterus freeing it from the connecting tissues. The round ligament and utero-ovarian ligaments are clamped, cauterized and then cut. At each step, the surgeon will take precautions to control and avoid bleeding. 

Towards to lower end of the uterus lies important anatomy. The surgeon will separate the bladder from the lower uterine segment to allow visualization of the cervix. 

The surgeon will focus attention on the uterine arteries. These two blood vessels are the main blood supply to the uterus and travel over the ureters, which are the tubes connecting the kidney to the bladder. 

Once the uterine arteries are controlled, the surgeon can safely separate the uterus from the vagina. 

The surgeon makes a circular incision just below the cervix freeing the uterus. The uterus is delivered through the vagina and sent to the pathologist to analyze the tissue. 

The surgeon then sews the edges of the vagina closed to form the vaginal cuff. 

The surgeon examines all of the surgical sites for bleeding. When safe, the Obgyn removes the operative ports and sews the surgical incisions closed. 

Once the procedure is complete, the surgical team completes a post-procedure review. All instruments and equipment are counted and verified. When finished, the anesthesiologist will begin to wake the patient up for transfer to the recovery room.

How long will I be in the operating room?

Once the patient enters the operating room, a series of safety steps must occur. This process takes about 20 minutes.

The operative time for robotic hysterectomy varies. The surgeon’s experience, surgical technique, patient body type, uterine size, and patient’s previous surgeries are all factors.

In general, patient should expect 1–2 hours of total operative time.

When can I go home?

Postoperative recovery time will vary from person to person. Some surgeons will recommend an outpatient procedure while others prefer an overnight stay. The patients underlying health status, surgical complexity and physician preference are all factors. 

To be able to go home, each patient must meet specific discharge criteria. The patient’s vital signs must be stable. The patient must be alert, oriented, and able to walk with assistance. Postoperative nausea, vomiting, and pain must be controlled as well as confirmation of no postoperative bleeding.

The nursing team will go over discharge instructions, and the plan for postoperative pain management options will be confirmed.

What is the usual recovery time

Most women should be able to return to normal daily activities within a few weeks of surgery. The nursing team will help patients walk and move around a few hours after surgery to reduce blood clots’ risk, improve lung function, and expedite bowel function return.

Most patients will require pain medication like NSAIDs and narcotics for a time. Many experience discomfort in the right shoulder due to air irritating the nerves of the diaphragm.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are safe to use.

What aftercare is required?

You should speak with your physician regarding the resumption of exercise and sexual activity. Most can return to basic activities in one to two weeks. Sexual activity is typically restricted for 6–8 weeks to allow the vaginal cuff to heal.

Your doctor will schedule a postoperative examination 1–2 weeks after the procedure to evaluate the incisions.

Danger Signals to look out for after the procedure

You should call your doctor if you experience heavy vaginal bleeding, fevers, severe nausea or vomiting, worsening abdominal pain, or the inability to pass gas.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over 24 hours, call your physician. After any surgery, contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge
• Abdominal pain not controlled by pain medication
• Inability to pass gas

What preparations should I make for aftercare at home?

Robotic procedures require very little postoperative care. Keep the incisions clean and dry. Sexual activity should be avoided until cleared by your doctor. One may resume a normal diet the day of surgery and begin light exercise the day after the procedure or when you feel ready.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Still have questions?

Read through any existing comments in the section below and if you still need information on this procedure please do leave your questions in the comments section.

The post Preparing for: Robotic Hysterectomy appeared first on Medika Life.

An endometrial biopsy is a simple office-based procedure where a doctor removes a small amount of tissue from inside the uterine cavity. This tissue is called the endometrium. To find out if any abnormal cells are present, the doctor must sample the endometrial tissue to be tested and evaluated under a microscope.

An endometrial biopsy is used to diagnose or rule out endometrial cancer or precancerous changes in the tissue called endometrial hyperplasia.

Women with postmenopausal bleeding, heavy periods, irregular periods, or abnormal findings on a sonogram may be candidates for this procedure. Most often, an endometrial biopsy is performed as part of the evaluation of abnormal uterine bleeding, but it also is used in cases of infertility.

What does this procedure involve?

The gynecologist inserts a thin, flexible tube called a pipelle into the uterine cavity through the cervix’s opening called the cervical os. Using negative pressure, the doctor pulls a small amount of endometrial tissue into the pipelle for sampling. The procedure takes only a few minutes and causes mild cramps.

Where is an endometrial biopsy procedure performed?

Gynecologists perform endometrial biopsy procedures in an office setting.

Can my family visit me?

Endometrial biopsies are performed in a medical office setting. The vast majority of patients will be able to drive themselves to and from the procedure. Some may prefer a trusted family member to bring them. 

Does my procedure require an anesthetic?

Anesthesia is not typically required for an endometrial biopsy procedure. Some physicians spray a topical anesthetic directly onto the cervix. Occasionally, gynecologists provide local anesthesia via a paracervical anesthetic.

A paracervical block is an anesthetic technique done by a gynecologist to numb the uterus. Medication is injected into the cervical tissue to reduce pain during surgery.

Some gynecologists recommend oral medication to reduce anxiety

What’s the procedure when I check in?

Most procedures will involve a preoperative visit with your surgeon. The risks and benefits of the procedure will be discussed in detail and questions regarding your procedure are discussed.

The consent form is reviewed, signed, or updated with any changes.

Because an endometrial biopsy is performed in an office setting, the experience will feel like a normal office visit. After checking in, you will be taken to a procedure room. The medical assistant will prepare the room and provide a gown or leg coverings. When all is prepared, your surgeon will come and review any last-minute questions.

What happens in the procedure room?

Your surgeon will help position your legs into the stirrups. A speculum is placed into the vagina to allow visualization of the cervix, the opening of your uterus located at the back of the vagina.

Once the speculum is in position to allow visualization of the cervix, the procedure will attempt to pass a small pipelle through the cervix into the endometrial cavity. If the cervical os (opening) is too narrow, then the doctor will attach an instrument called a Tenaculum to the top of the cervix to stabilize the uterus. Then, they will use a small tool to dilate the cervix wide enough for the pipelle to enter. 

Once the pipelle is safely inside the uterus a small amount of endometrial tissue is pulled into the tube for sampling. 

These cells are sent to a pathologist for evaluation. 

After the biopsy, the speculum is removed and the procedure is complete. Some patients will experience mild bleeding, spotting or a brown, coffee-ground vaginal discharge over the next few days.

How long will I be in the procedure?

Once the patient enters the procedure room a series of safety steps must occur.

An endometrial biopsy procedure takes approximately 2–5 minutes. This includes the surgical time as well as accounting for positioning, the speculum insertion, a paracervical block anesthetic, and removal of the instruments

When can I go home?

After an office-based endometrial biopsy procedure, patients may go home after getting dressed as long as you are feeling normal.

Post-procedure recovery time will vary from person to person.

Endometrial biopsy procedures require a minimal amount of recovery. Patients may leave as soon as the procedure is complete.

AFTERCARE AND RECOVERY QUESTIONS

What is the usual recovery time

You should be able to resume all work and household activities on the same day as your procedure. You should expect to feel a little vaginal soreness for 2–3 days. Mild uterine cramping is also common.

• Some patients will require mild pain medication like NSAIDs.
• It is wise to wear a sanitary pad for a few days as you may experience vaginal spotting or dark vaginal discharge.
• You will be instructed to abide by pelvic rest for approximately 1–2 days. This includes no douching, no sex, and no tampons.
• You should call your doctor if you experience heavy vaginal bleeding, fevers, or worsening abdominal pain.

What aftercare is required?

Most women should be able to return to normal daily activities the same day. You should speak with your physician regarding the resumption of sexual activity. Typically, the recommendation is to avoid vaginal intercourse for 1–2 days.

You should not use tampons for 1–2 days after the procedure to reduce the potential risk of infection.

Light bleeding, spotting, and brown or black discharge is common and expected. Sanitary napkins are advised.

Your doctor will schedule a postoperative examination to review the pathology report findings. If any abnormalities are found on the biopsy, your doctor will discuss the next steps

Danger Signals to look out for after the procedure

After an endometrial biopsy procedure, we expect light spotting and vaginal discharge.

If you experience heavy bleeding, abdominal or pelvic pain, a fever, or pain that increases over time beyond 24 hours, call your physician. After any surgery contact your physician if you meet any of the following criteria:

• Pain not controlled with prescribed medication
• Fever > 101
• Nausea and vomiting
• Calf or leg pain
• Shortness of breath
• Heavy vaginal bleeding
• Foul-smelling vaginal discharge

What should I pack at home?

Nothing special is required after an endometrial biopsy procedure. A supply of sanitary napkins will help keep your clothing clean.

What information should I provide to my doctors and nurses?

It is very important to provide your doctor with an updated list of all medications, vitamins, and dietary supplements prior to surgery. All medication and food allergies should be reviewed. Share any lab work, radiologic procedures, or other medical tests done by other healthcare providers with your surgeon prior to your procedure.

Still have questions?

Read through any existing comments in the section below and if you still need information on this procedure please do leave your questions in the comments section.

The post Preparing for an Endometrial Biopsy appeared first on Medika Life.

Every woman suffering from the effects of uterine fibroids deserves to know all of her options. Removing fibroids is not always the answer. While Obgyn physicians are comfortable discussing surgical treatment options, many doctors do not discuss all the alternatives.

Uterine fibroid embolization can be an excellent choice for the many women with fibroids who want to avoid surgery and keep their uterus. This minimally invasive alternative effectively treats fibroid with minimal downtime and recovery. 

Uterine fibroids are one of the most common gynecological conditions with many available treatment options. Educating yourself is a key step to allow you and your doctor to make a joint decision together on the best approach.

I want to keep my uterus. What are my options?

What are uterine fibroids?

Uterine fibroids are benign noncancerous tumors affecting women. Fibroids, also called leiomyomas, are groups of cells that form into a ball of muscle in the walls of the uterus. Up to 80% of women will develop one or more uterine fibroids during their lifetime.

Uterine fibroids behave in strange ways. They may grow slowly or quickly, or they may simply stay the same size throughout a woman’s life. Some women will develop more fibroids while others will not.

Many women are unaware they have fibroids, while others suffer unbearable symptoms. Heavy menstrual periods, pelvic pain, cramping, frequent urination, constipation, painful intercourse, and back pain are common complaints. 

Hysterectomy and myomectomy are not your only option to treat fibroids. 

Women with fibroids who want to avoid surgery and keep their uterus need to know about uterine fibroid embolization. UFE is an important option, but your Gynecologist may not mention it. 

What is a uterine fibroid embolization?

Uterine Fibroid Embolization (UFE) is a minimally invasive procedure to shrink or destroy uterine fibroids. Although fibroids are a common gynecologic condition, this procedure is not done by a gynecologist. 

Instead, this safe and highly effective non-surgical treatment is performed by an interventional radiologist.

To perform a UFE, the doctor inserts a small catheter into an artery in the arm or leg. The doctor injects a substance called IV contrast to project the blood supply onto a video screen via X-ray technology. 

The thin, flexible catheter is then advanced to the location of the fibroid. Small particles called polyvinyl alcohol are pushed through the catheter to block the blood flow to the fibroid. 

Starved of their blood supply, the fibroids shrink and die. 

UFE advantages

UFE has several advantages over hysterectomy and myomectomy.  

1. General anesthesia is not required.
2. No surgical incisions are needed. 
3. There is no blood loss. 
4. Treats adenomyosis. 
5. All fibroids may be treated at the same time. 
6. Minimal downtime and recovery. 
7. Can treat a fibroid of any size. 
8. A viable option for those with a medical condition prohibiting major surgery.

Disadvantages of UFE include:

1. Fertility effects. The long term effects on fertility are not completely understood. While some studies show an increase in fertility, others studies show negative effects. UFE is not typically recommended for women who would like to get pregnant in the future. 
2. Fibroids are not removed. While UFE shrinks and treats the tumors, it does not remove them from the body. 
3. Infection. The risk of infection is quite low but there is a possibility of delayed infection during the first postsurgical year. 
4. The potential need for retreatment. 
5. Not recommended for all types of fibroids. 

All procedures have risks

The risks of UFE is low but include:

1. Infection. The infection risk is low but is a serious, potentially life-threatening complication of UFE. In rare cases, hysterectomy is needed to treat an infected uterus. 
2. Premature menopause. 
3. Amenorrhea. Some women experience a loss of menstrual cycles after UFE. 
4. Pelvic pain. Pain and cramping are rare, but in some cases may persist for the first few months after the procedure. 

Why didn’t my Gynecologist mention UFE? 

Not all gynecologists discuss UFE as an option for uterine fibroids. Some doctors are not aware of UFE. Many have had little to no clinical experience with the procedure. Other Obgyns may have had a negative experience with interventional radiology referrals in the past. 

UFE is a highly specialized procedure and some geographic areas may not have access to a local Interventional radiologist. 

In my experience, I have found UFE to be a safe and effective option for women with fibroids. I am not trained to perform the procedure so I had to educate myself on the risks, benefits, and tremendous value UFE offers. 

Our practice refers patients to Dr. Suzanne Slonim at the Fibroid Institute of Dallas.

The post UFE: Treating Uterine Fibroids without Losing Your Uterus appeared first on Medika Life.

Structure

The ovaries are covered on the outside by a layer of simple cuboidal epithelium called germinal (ovarian) epithelium. This is actually the visceral peritoneum that envelops the ovaries. Underneath this layer is a dense connective tissue capsule, the tunica albuginea. The substance of the ovaries is distinctly divided into an outer cortex and an inner medulla. The cortex appears more dense and granular due to the presence of numerous ovarian follicles in various stages of development. Each of the follicles contains an oocyte, a female germ cell. The medulla is a loose connective tissue with abundant blood vessels, lymphatic vessels, and nerve fibers.

Oogenesis

Female sex cells, or gametes, develop in the ovaries by a form of meiosis called oogenesis. The sequence of events in oogenesis is similar to the sequence in spermatogenesis, but the timing and final result are different. Early in fetal development, primitive germ cells in the ovaries differentiate into oogonia. These divide rapidly to form thousands of cells, still called oogonia, which have a full complement of 46 (23 pairs) chromosomes. Oogonia then enter a growth phase, enlarge, and become primary oocytes. The diploid (46 chromosomes) primary oocytes replicate their DNA and begin the first meiotic division, but the process stops in prophase and the cells remain in this suspended state until puberty.

Many of the primary oocytes degenerate before birth, but even with this decline, the two ovaries together contain approximately 700,000 oocytes at birth. This is the lifetime supply, and no more will develop. This is quite different than the male in which spermatogonia and primary spermatocytes continue to be produced throughout the reproductive lifetime. By puberty the number of primary oocytes has further declined to about 400,000.

Beginning at puberty, under the influence of follicle-stimulating hormone, several primary oocytes start to grow again each month. One of the primary oocytes seems to outgrow the others and it resumes meiosis I. The other cells degenerate. The large cell undergoes an unequal division so that nearly all the cytoplasm, organelles, and half the chromosomes go to one cell, which becomes a secondary oocyte. The remaining half of the chromosomes go to a smaller cell called the first polar body. The secondary oocyte begins the second meiotic division, but the process stops in metaphase. At this point ovulation occurs. If fertilization occurs, meiosis II continues. Again this is an unequal division with all of the cytoplasm going to the ovum, which has 23 single-stranded chromosome. The smaller cell from this division is a second polar body.

The first polar body also usually divides in meiosis I to produce two even smaller polar bodies. If fertilization does not occur, the second meiotic division is never completed and the secondary oocyte degenerates. Here again there are obvious differences between the male and female. In spermatogenesis, four functional sperm develop from each primary spermatocyte. In oogenesis, only one functional fertilizable cell develops from a primary oocyte. The other three cells are polar bodies and they degenerate.

Ovarian Follicle Development

An ovarian follicle consists of a developing oocyte surrounded by one or more layers of cells called follicular cells. At the same time that the oocyte is progressing through meiosis, corresponding changes are taking place in the follicular cells. Primordial follicles, which consist of a primary oocyte surrounded by a single layer of flattened cells, develop in the fetus and are the stage that is present in the ovaries at birth and throughout childhood.

Beginning at puberty, follicle-stimulating hormone stimulates changes in the primordial follicles. The follicular cells become cuboidal, the primary oocyte enlarges, and it is now a primary follicle. The follicles continue to grow under the influence of follicle-stimulating hormone, and the follicular cells proliferate to form several layers of granulose cells around the primary oocyte. Most of these primary follicles degenerate along with the primary oocytes within them, but usually one continues to develop each month. The granulosa cells start secreting estrogen and a cavity, or antrum, forms within the follicle. When the antrum starts to develop, the follicle becomes a secondary follicle. The granulose cells also secrete a glycoprotein substance that forms a clear membrane, the zona pellucida, around the oocyte. After about 10 days of growth the follicle is a mature vesicular (graafian) follicle, which forms a “blister” on the surface of the ovary and contains a secondary oocyte ready for ovulation.

Ovulation

Ovulation, prompted by luteinizing hormone from the anterior pituitary, occurs when the mature follicle at the surface of the ovary ruptures and releases the secondary oocyte into the peritoneal cavity. The ovulated secondary oocyte, ready for fertilization is still surrounded by the zona pellucida and a few layers of cells called the corona radiata. If it is not fertilized, the secondary oocyte degenerates in a couple of days. If a sperm passes through the corona radiata and zona pellucida and enters the cytoplasm of the secondary oocyte, the second meiotic division resumes to form a polar body and a mature ovum

After ovulation and in response to luteinizing hormone, the portion of the follicle that remains in the ovary enlarges and is transformed into a corpus luteum. The corpus luteum is a glandular structure that secretes progesterone and some estrogen. Its fate depends on whether fertilization occurs. If fertilization does not take place, the corpus luteum remains functional for about 10 days; then it begins to degenerate into a corpus albicans, which is primarily scar tissue, and its hormone output ceases. If fertilization occurs, the corpus luteum persists and continues its hormone functions until the placenta develops sufficiently to secrete the necessary hormones. Again, the corpus luteum ultimately degenerates into corpus albicans, but it remains functional for a longer period of time.

The post The Ovaries appeared first on Medika Life.

Anatomical Structure

The uterus is a thick-walled muscular organ capable of expansion to accommodate a growing fetus. It is connected distally to the vagina, and laterally to the uterine tubes.

The uterus has three parts;

• Fundus – top of the uterus, above the entry point of the uterine tubes.
• Body – usual site for implantation of the blastocyst.
• Cervix – lower part of uterus linking it with the vagina. This part is structurally and functionally different to the rest of the uterus.

The Cervix

The cervix is the lower portion of the uterus, an organ of the female reproductive tract. It connects the vagina with the main body of the uterus, acting as a gateway between them.

The cervix is composed of two regions; the ectocervix and the endocervical canal. The ectocervix is the portion of the cervix that projects into the vagina. It is lined by stratified squamous non-keratinized epithelium. The opening in the ectocervix, the external os, marks the transition from the ectocervix to the endocervical canal.

The endocervical canal (or endocervix) is the more proximal, and ‘inner’ part of the cervix. It is lined by a mucus-secreting simple columnar epithelium. The endocervical canal ends, and the uterine cavity begins, at a narrowing called the internal os.

Functions of the cervix

The cervix performs two main functions:

• It facilitates the passage of sperm into the uterine cavity. This is achieved via dilation of the external and internal os.
• Maintains sterility of the upper female reproductive tract. The cervix, and all structures superior to it, are sterile. This ultimately protects the uterine cavity and the upper genital tract by preventing bacterial invasion. This environment is maintained by the frequent shedding of the endometrium, thick cervical mucus and a narrow external os.

Histological Structure

The fundus and body of the uterus are composed of three tissue layers;

• Peritoneum – a double layered membrane, continuous with the abdominal peritoneum. Also known as the perimetrium.
• Myometrium – thick smooth muscle layer. Cells of this layer undergo hypertrophy and hyperplasia during pregnancy in preparation to expel the fetus at birth.
• Endometrium – inner mucous membrane lining the uterus. It can be further subdivided into 2 parts:
  • Deep stratum basalis: Changes little throughout the menstrual cycle and is not shed at menstruation.
  • Superficial stratum functionalis: Proliferates in response to oestrogens, and becomes secretory in response to progesterone. It is shed during menstruation and regenerates from cells in the stratum basalis layer.

Ligaments

The tone of the pelvic floor provides the primary support for the uterus. Some ligaments provide further support, securing the uterus in place.

They are:

• Broad Ligament: This is a double layer of peritoneum attaching the sides of the uterus to the pelvis. It acts as a mesentery for the uterus and contributes to maintaining it in position.
• Round Ligament: A remnant of the gubernaculum extending from the uterine horns to the labia majora via the inguinal canal. It functions to maintain the anteverted position of the uterus.
• Ovarian Ligament: Joins the ovaries to the uterus.
• Cardinal Ligament: Located at the base of the broad ligament, the cardinal ligament extends from the cervix to the lateral pelvic walls. It contains the uterine artery and vein in addition to providing support to the uterus.
• Uterosacral Ligament: Extends from the cervix to the sacrum. It provides support to the uterus.

Vascular Supply and Lymphatics

The blood supply to the uterus is via the uterine artery. Venous drainage is via a plexus in the broad ligament that drains into the uterine veins.

Lymphatic drainage of the uterus is via the iliac, sacral, aortic and inguinal lymph nodes.

The post The Uterus appeared first on Medika Life.

Endometriosis happens when tissue similar to the lining of the uterus grows outside of the uterus where it does not belong. It causes painful periods and affects more than 11% of American women. It is especially common among women age 25–35, and may impact ones ability to get pregnant. Several different treatment options can help manage the symptoms, improve your life, reduce pain, and improve your chances of getting pregnant.

What is endometriosis?

Endometriosis, sometimes called “endo,” is a common gynecologic health problem. It gets its name from the word endometrium, the tissue present in the lining of the uterus or womb. For women with endometriosis, this tissue begins growing outside of the uterus and on other areas in the body where it doesn’t belong.

Most often, endometriosis is found on the:

• Ovaries
• Fallopian tubes
• Tissues that hold the uterus in place
• The outer surface of the uterus

Endometriosis implants may also be found in the vagina, cervix, vulva, bowel, bladder, or rectum. Rarely, endometriosis appears in other parts of the body, such as the lungs, brain, and skin.

What are the symptoms of endometriosis?

Symptoms of endometriosis can include:

• Pain. Pelvic pain and painful periods are the most common symptoms. Women with endometriosis may have many different kinds of pain. These include:
• Very painful menstrual cramps (dysmenorrhea). The pain may get worse over time.
• Chronic (long-term) pain in the lower back and pelvis.
• Pain during or after sex (dyspareunia). Most endometriosis patients describe a “deep” pain distinctly different from discomfort at the entrance to the vagina during penetration.
• Bleeding or spotting between menstrual periods (metrorrhagia). Abnormal uterine bleeding has many causes and should be evaluated by your doctor.
• Infertility, or not being able to get pregnant.
• Stomach (digestive) problems. These include diarrhea, constipation, bloating, or nausea, especially during menstrual periods.

Why does endometriosis cause pain and health problems?

Endometriosis growths are benign (not cancerous), but they can still cause troublesome problems.

Remember, endometriosis implants occur when tissue similar to the lining of the uterus begins to grow outside of your uterus where it doesn’t belong. Endometriosis growths may swell and bleed in the same way the lining inside of the uterus does every month during menstrual cycles. This process causes swelling, pain, and scar tissue because the tissue grows and bleeds in an area where it cannot easily get out of your body.

The endometriosis implants may also continue to expand causing problems such as:

• Blocking the fallopian tubes.
• Benign ovarian tumors (endometriomas)
• Inflammation (swelling)
• Forming scar tissue and adhesions (a type of tissue that can bind your organs together).
• Problems in your intestines and bladder

How common is endometriosis?

Endometriosis is a common health problem for women affecting approximately 11% of women, or more than 6 ½ million women in the United States, have endometriosis. The exact number is unknown as many women who have endometriosis suffer no symptoms at all. Obgyns often discover endometriosis during routine surgeries such as tubal ligations.

Who gets endometriosis?

Endometriosis can happen to any woman who has menstrual periods, but it is more common in women 25-35 years old. Occasionally, we find endometriosis in young girls before they begin having periods which is called premenarcheal endometriosis.

You might be more likely to get endometriosis if you have:

• Never had children
• Menstrual periods that last more than seven days
• Short menstrual cycles (27 days or fewer)
• A family member (mother, aunt, sister) with endometriosis
• A health problem that blocks the normal flow of menstrual blood from your body during your period

What causes endometriosis?

No one knows for sure what causes this disease. Researchers are studying possible causes:

• Problems with the menstrual period flow. Retrograde menstrual flow is the most likely cause of endometriosis. Some of the tissue shed during the period flows through the fallopian tube into other areas of the body, such as the pelvis.
• Genetic factors. Because endometriosis runs in families, it may be inherited in the genes.
• Immune system problems. A faulty immune system may fail to find and destroy endometrial tissue growing outside of the uterus. Immune system disorders and certain cancers are more common in women with endometriosis.
• Hormones. The hormones estrogen and progesterone promote endometriosis. Research is looking at whether endometriosis is a problem with the body’s hormone system.
• Surgery. During surgery to the abdominal area, such as a Cesarean (C-section) or hysterectomy, endometrial tissue could be picked up and moved by mistake. For instance, endometrial tissue has been found in abdominal scars.

How can I prevent endometriosis?

You can’t prevent endometriosis. But you can reduce your chances of developing it by lowering the levels of the hormone estrogen in your body. Estrogen helps to thicken the lining of your uterus during your menstrual cycle.

To keep lower estrogen levels in your body, you can:

• Talk to your doctor about hormonal birth control methods, such as pills, patches or rings with lower doses of estrogen.
• Exercise regularly (more than 4 hours a week). This will also help you keep a low percentage of body fat. Regular exercise and a lower amount of body fat help decrease the amount of estrogen circulating through the body.
• Avoid large amounts of alcohol. Alcohol raises estrogen levels. No more than one drink per day is recommended for women who choose to drink alcohol.
• Avoid large amount of drinks with caffeine. Studies show that drinking more than one caffeinated drink a day, especially sodas and green tea, can raise estrogen levels.

How is endometriosis diagnosed?

If you have symptoms of endometriosis, talk with your doctor. The doctor will talk to you about your symptoms and do or prescribe one or more of the following to find out if you have endometriosis:

• Pelvic exam. During a pelvic exam, your doctor will feel for large cysts or scars behind your uterus. Smaller areas of endometriosis are harder to feel.
• Imaging test. Your doctor may do an ultrasound to check for ovarian cysts from endometriosis. An ultrasound uses sound waves to create pictures of your reproductive organs. 
• Magnetic resonance imaging (MRI) is another common imaging test that can take a picture of the inside of your body.
• Medicine. If your doctor does not find signs of an ovarian cyst during an ultrasound, he or she may prescribe medicine:
  • Hormonal birth control can help lessen pelvic pain during your period.
  • Gonadotropin-releasing hormone (GnRH) agonists block the menstrual cycle and lower the amount of estrogen your body makes. GnRH agonists also may help pelvic pain.
• If your pain gets better with hormonal medicine, you probably have endometriosis. But, these medicines work only as long as you take them. Once you stop taking them, your pain may come back.
• Laparoscopy. Laparoscopy is a type of surgery that doctors can use to look inside your pelvic area to see endometriosis tissue. Surgery is the only way to be sure you have endometriosis. Sometimes doctors can diagnose endometriosis just by seeing the growths. Other times, they need to take a small sample of tissue and study it under a microscope to confirm this.

How is endometriosis treated?

There is no cure for endometriosis, but treatments are available for the symptoms and problems it causes. Talk to your doctor about your treatment options.

Medicine

If you are not trying to get pregnant, hormonal birth control is generally the first step in treatment. This may include:

• Extended-cycle (you have only a few periods a year) or continuous cycle (you have no periods) birth control. These types of hormonal birth control are available in the pill or the shot and help stop bleeding and reduce or eliminate pain.
• Intrauterine device (IUD) to help reduce pain and bleeding. The hormonal IUD protects against pregnancy for up to 7 years. But the hormonal IUD may not help your pain and bleeding due to endometriosis for that long.

Hormonal treatment works only as long as it is taken and is best for women who do not have severe pain or symptoms.

Elagorix (brand named Orilissa) is a new medication indicated for endometriosis. It works by interacting with the hormones LH (luteinizing hormone) and FSH (follicle-stimulating hormone) to reduce the amount of circulating Estrogen. This medication is highly effective at reducing moderate to severe pain associated with endometriosis

If you are trying to get pregnant, your doctor may prescribe a gonadotropin-releasing hormone (GnRH) agonist. This medicine stops the body from making the hormones responsible for ovulation, the menstrual cycle, and the growth of endometriosis. This treatment causes a temporary menopause, but it also helps control the growth of endometriosis. Once you stop taking the medicine, your menstrual cycle returns, but you may have a better chance of getting pregnant.

Surgery

Surgery is usually chosen for severe symptoms, when hormones are not providing relief or if you are having fertility problems. During the operation, the surgeon can locate any areas of endometriosis and may burn, destroy, or remove the endometriosis implants. The surgeon may also test to see if the fallopian tubes are open (chromotubation). After surgery, hormone treatment is often restarted unless you are trying to get pregnant.

Other treatments you can try, alone or with any of the treatments listed above, include:

• Pain medicine. For mild symptoms, your doctor may suggest taking over-the-counter medicines for pain. These include ibuprofen (Advil and Motrin) or naproxen (Aleve).
• Complementary and alternative medicine (CAM) therapies. Some women report relief from pain with therapies such as acupuncture, chiropractic care, herbs like a cinnamon twig or licorice root, or supplements, such as thiamine (vitamin B1), magnesium, or omega-3 fatty acids.

Does endometriosis go away after menopause?

For some women, the painful symptoms of endometriosis improve after menopause. As the body stops making the hormone estrogen, the growths shrink slowly. However, some women who take menopausal hormone therapy may still have symptoms of endometriosis.

If you are having symptoms of endometriosis after menopause, talk to your doctor about treatment options.

Can I get pregnant if I have endometriosis?

Yes. Many women with endometriosis get pregnant. But, you may find it harder to get pregnant. Researchers think endometriosis may affect as many as one in every two women with infertility.

No one knows exactly how endometriosis might cause infertility. Some possible reasons include:

• Patches of endometriosis block off or change the shape of the pelvis and reproductive organs. This can make it harder for the sperm to find the egg.
• The immune system, which normally helps defend the body against disease, attacks the embryo.
• The endometrium (the layer of the uterine lining where implantation happens) does not develop as it should.

If you have endometriosis and are having trouble getting pregnant, talk to your doctor. He or she can recommend treatments, such as surgery to remove the endometrial growths.

What other health conditions are linked to endometriosis?

Research shows a link between endometriosis and other health problems in women and their families. Some of these include:

• Allergies, asthma, and chemical sensitivities
• Autoimmune diseases, in which the body’s system that fights illness attacks itself instead. These can include multiple sclerosis, lupus, and some types of hypothyroidism.
• Chronic fatigue syndrome and fibromyalgia
• Certain cancers, such as ovarian and breast cancer

External Resources

For more information about endometriosis, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:

• Eunice Kennedy Shriver National Institute of Child Health and Human Development (NICHD), NIH, HHS
  Phone Number: 800-370-2943
• American College of Obstetricians and Gynecologists (ACOG)
  Phone Number: 800-673-8444
• Endometriosis Association
  Phone Number: 414-355-2200
• Endometriosis Foundation of America
  Phone Number: 646-854-3337
• Endometriosis Research Center
  Phone Number: 800-239-7280

The post How Endometriosis Causes Painful Periods and Affects Fertility appeared first on Medika Life.

Menstruation is a woman’s monthly bleeding, often called your “period.” When you menstruate, your body discards the monthly buildup of the lining of your uterus (womb). Menstrual blood and tissue flow from your uterus through the small opening in your cervix and pass out of your body through your vagina.

During the monthly menstrual cycle, the uterus lining builds up to prepare for pregnancy. If you do not get pregnant, estrogen and progesterone hormone levels begin falling. Very low levels of estrogen and progesterone tell your body to begin menstruation.

What is the menstrual cycle?

The menstrual cycle is the monthly hormonal cycle a female’s body goes through to prepare for pregnancy. Your menstrual cycle is counted from the first day of your period up to the first day of your next period. Your hormone levels (estrogen and progesterone) usually change throughout the menstrual cycle and can cause menstrual symptoms.

How long is a typical menstrual cycle?

The typical menstrual cycle is 28 days long, but each woman is different.² Also, a woman’s menstrual cycle length might be different from month-to-month. Your periods are still “regular” if they usually come every 24 to 38 days.³ This means that the time from the first day of your last period up to the start of your next period is at least 24 days but not more than 38 days.

Some women’s periods are so regular that they can predict the day and time that their periods will start. Other women are regular but can only predict the start of their period within a few days. 

What is ovulation?

Ovulation is when the ovary releases an egg so it can be fertilized by a sperm in order to make a baby. A woman is most likely to get pregnant if she has sex without birth control in the three days before and up to the day of ovulation (since the sperm are already in place and ready to fertilize the egg as soon as it is released). A man’s sperm can live for 3 to 5 days in a woman’s reproductive organs, but a woman’s egg lives for just 12 to 24 hours after ovulation.

Each woman’s cycle length may be different, and the time between ovulation and when the next period starts can be anywhere from one week (7 days) to more than 2 weeks (19 days). Use this ovulation calculator as an aid to determining your ovulation dates .

At different times in a woman’s life, ovulation may or may not happen:

• Women who are pregnant do not ovulate.
• Women who are breastfeeding may or may not ovulate. Women who are breastfeeding should talk to their doctor about birth control methods if they do not want to get pregnant.
• During perimenopause, the transition to menopause, you may not ovulate every month.
• After menopause you do not ovulate.
   

How do I know if I’m ovulating?

A few days before you ovulate, your vaginal mucus or discharge changes and becomes more slippery and clear. This type of mucus helps sperm move up into your uterus and into the fallopian tubes where it can fertilize an egg. Some women feel minor cramping on one side of their pelvic area when they ovulate. Some women have other signs of ovulation.

Luteinizing hormone (LH) is a hormone released by your brain that tells the ovary to release an egg (called ovulation). LH levels begin to surge upward about 36 hours before ovulation, so some women and their doctors test for LH levels. LH levels peak about 12 hours before ovulation.¹ Women who are tracking ovulation to become pregnant will notice a slight rise in their basal temperature (your temperature after sleeping before you get out of bed) around ovulation. 

How does my menstrual cycle change as I get older?

Your cycles may change in different ways as you get older. Often, periods are heavier when you are younger (in your teens) and usually get lighter in your 20s and 30s. This is normal.

• For a few years after your first period, menstrual cycles longer than 38 days are common. Girls usually get more regular cycles within three years of starting their periods. If longer or irregular cycles last beyond that, see your doctor or nurse to rule out a health problem, such as polycystic ovary syndrome (PCOS).
• In your 20s and 30s, your cycles are usually regular and can last anywhere from 24 to 38 days.
• In your 40s, as your body starts the transition to menopause, your cycles might become irregular. Your menstrual periods might stop for a month or a few months and then start again. They also might be shorter or last longer than usual, or be lighter or heavier than normal.

Talk to your doctor or nurse if you have menstrual cycles that are longer than 38 days or shorter than 24 days, or if you are worried about your menstrual cycle.

Why should I keep track of my menstrual cycle?

If your periods are regular, tracking them will help you know when you ovulate, when you are most likely to get pregnant, and when to expect your next period to start.

If your periods are not regular, tracking them can help you share any problems with your doctor or nurse.

If you have period pain or bleeding that causes you to miss school or work, tracking these period symptoms will help you and your doctor or nurse find treatments that work for you. Severe pain or bleeding that causes you to miss regular activities is not normal and can be treated.

How can I keep track of my menstrual cycle?

You can keep track of your menstrual cycle by marking the day you start your period on a calendar. After a few months, you can begin to see if your periods are regular or if your cycles are different each month.

You may want to track:

• Premenstrual syndrome (PMS) symptoms: Did you have cramping, headaches, moodiness, forgetfulness, bloating, or breast tenderness?
• When your bleeding begins: Was it earlier or later than expected?
• How heavy the bleeding was on your heaviest days: Was the bleeding heavier or lighter than usual? How many pads or tampons did you use?
• Period symptoms: Did you have pain or bleeding on any days that caused you to miss work or school?
• How many days your period lasted: Was your period shorter or longer than the month before?

You can also download apps (sometimes for free) for your phone to track your periods. Some include features to track your PMS symptoms, energy and activity levels, and more.

When does a girl usually get her first period?

The average age for a girl in the United States to get her first period is 12.This does not mean that all girls start at the same age.

A girl may start her period anytime between 8 and 15. The first period normally starts about two years after breasts first start to develop and pubic hair begins to grow. The age at which a girl’s mother started her period can help predict when a girl may start her period.

A girl should see her doctor if:

• She starts her period before age 8.
• She has not had her first period by age 15.
• She has not had her first period within three years of breast growth.

How long does a woman usually have periods?

On average, women get a period for about 40 years of their life. Most women have regular periods until perimenopause, the time when your body begins the change to menopause. Perimenopause, or transition to menopause, may take a few years. During this time, your period may not come regularly. Menopause happens when you have not had a period for 12 months in a row. For most women, this happens between the ages of 45 and 55. The average age of menopause in the United States is 52.

Periods also stop during pregnancy and may not come back right away if you breastfeed.

But if you don’t have a period for 90 days (three months), and you are not pregnant or breastfeeding, talk to your doctor or nurse. Your doctor will check for pregnancy or a health problem that can cause periods to stop or become irregular.

What is a normal amount of bleeding during my period?

The average woman loses about two to three tablespoons of blood during her period. Your periods may be lighter or heavier than the average amount. What is normal for you may not be the same for someone else. Also, the flow may be lighter or heavier from month to month.

Your periods may also change as you get older. Some women have heavy bleeding during perimenopause, the transition to menopause. Symptoms of heavy menstrual bleeding may include:

• Bleeding through one or more pads or tampons every one to two hours
• Passing blood clots larger than the size of quarters
• Bleeding that often lasts longer than eight days

How often should I change my pad, tampon, menstrual cup, sponge, or period panties?

Follow the instructions that came with your period product. Try to change or rinse your feminine hygiene product before it becomes soaked through or full.

• Most women change their pads every few hours.
• A tampon should not be worn for more than 8 hours because of the risk of toxic shock syndrome (TSS)
• Menstrual cups and sponges may only need to be rinsed once or twice a day.
• Period panties (underwear with washable menstrual pads sewn in) can usually last about a day, depending on the style and your flow.

Use a product appropriate in size and absorbency for your menstrual bleeding. The amount of menstrual blood usually changes during a period. Some women use different products on different days of their period, depending on how heavy or light the bleeding is.  

What is toxic shock syndrome?

Toxic shock syndrome (TSS) is a rare but sometimes deadly condition caused by bacteria that make toxins or poisons. In 1980, 63 women died from TSS. A certain brand of super absorbency tampons was said to be the cause. These tampons were taken off the market.

Today, most cases of TSS are not caused by using tampons. But, you could be at risk for TSS if you use more absorbent tampons than you need for your bleeding or if you do not change your tampon often enough (at least every four to eight hours). Menstrual cups, cervical caps, sponges, or diaphragms (anything inserted into your vagina) may also increase your risk for TSS if they are left in place for too long (usually 24 hours). Remove sponges within 30 hours and cervical caps within 48 hours.

If you have any symptoms of TSS, take out the tampon, menstrual cup, sponge, or diaphragm, and call 911 or go to the hospital right away.

Symptoms of TSS include:

• Sudden high fever
• Muscle aches
• Vomiting
• Nausea
• Diarrhea
• Rash
• Kidney or other organ failure

How does the menstrual cycle affect other health problems?

The changing hormone levels throughout the menstrual cycle can also affect other health problems:

• Depression and anxiety disorders. These conditions often overlap with premenstrual syndrome (PMS). Depression and anxiety symptoms are similar to PMS and may get worse before or during your period.
• Asthma. Your asthma symptoms may be worse during some parts of your cycle.
• Irritable bowel syndrome (IBS). IBS causes cramping, bloating, and gas. Your IBS symptoms may get worse right before your period.
• Bladder pain syndrome. Women with bladder pain syndrome are more likely to have painful cramps during PMS.

The post Menstruation explained. Everything You Need to Know About the Menstrual Cycle appeared first on Medika Life.

Uterine fibroids are benign noncancerous tumors affecting women. Fibroids, also called leiomyomas, are made of muscle cells forming into balls and bumps that grow in the uterus. Up to 80% of women will develop one or more uterine fibroid during their lifetime.¹ 

Many women are unaware they have fibroids. Doctors accidentally discover fibroids during a routine pelvic or pregnancy ultrasound.

Uterine fibroids behave in strange ways. They may grow slowly or quickly, or they may simply stay the same size throughout a woman’s life. Some women will develop more fibroids while other women will not. 

Why do we get uterine fibroids?

We do not know exactly why some women get fibroids, and others do not. Genetics and family history play a role. Having a family member with fibroid increases the risk. Fibroids are most common in African-American women affecting up to 50%. Two female hormones, Estrogen and Progesterone, affect fibroids. Fibroids tend to shrink when the production of these hormones stops after menopause. 

What are the symptoms of uterine fibroids?

Not all women will have symptoms. The size and location of the fibroids in the uterus impact the potential for life-disrupting symptoms as fibroids increase blood flow to the uterus. Fibroids can also impact fertility and the risk of miscarriage. Most fibroids do not cause problems in pregnancy but do increase the risk of preterm labor and fetal growth concerns. 

Size matters with fibroids. Large ones can lead to what we call bulk symptoms. These include:

1. Painful intercourse
2. Pressure or abdominal fullness
3. Increased abdominal size 
4. Frequent urination
5. Constipation
6. Low back pain

The location of the fibroid inside of the uterus plays a role as well. Fibroids increase blood flow to the uterus. These symptoms include:

1. Heavy periods (menorrhagia)
2. Painful periods and cramping (dysmenorrhea)
3. Bleeding after sex (postcoital bleeding)

Types of fibroids

1. Intramural These fibroids are located within the muscular walls of the uterus and typically can cause heavy bleeding, painful intercourse, or pressure symptoms.
2. Submucosal These dangle inside the uterine cavity, typically cause heavy bleeding, irregular bleeding, or bleeding after intercourse. 
3. Subserosal This type of fibroid grows on the outer wall of the uterus. Heavy periods, pelvic pain and bulk or pressure symptoms are common

How are fibroid’s diagnosed?

1. Pelvic exam: A healthcare provider can often diagnose uterine fibroids by feeling the size and shape of the uterus during a pelvic exam. Typically, a confirmation test will then be ordered
2. Ultrasound: Alos called a sonogram, this is a low-cost tool using sound waves to generate an image of the uterus to find, locate and measure the fibroids
3. Magnetic resonance imaging (MRI): MRI is the most accurate imaging tool to identify the size, number, and location of uterine fibroids. An MRI can often help distinguish between benign fibroids and a rare malignant tumor called a leiomyosarcoma.
4. Computerized tomography: CT scan is an alternative to MRI and ultrasound for the analysis of fibroids. 
5. Hysteroscopy: A simple procedure where a doctor uses a small camera to evaluate the inside of the uterine cavity. 
6. Saline infused sonogram: Also called a sonohysterogram, is a special type of ultrasound. A doctor fills the uterus with a small amount of fluid to separate the top of the uterus from the bottom. This technique allows better visualization of the inside of the uterus. 

How are fibroids treated?

1. Hysterectomy: The removal of the uterus. Approximately 40% of hysterectomies in the United States are performed because of fibroids.² While a hysterectomy is the most definitive treatment for fibroids, it also is the most invasive. 
2. Myomectomy: A surgical procedure to remove individual fibroids while preserving the uterus. The size and location of the fibroids in the uterus determine the type of myomectomy. Options include an abdominal, laparoscopic, robotic, and hysteroscopic myomectomy. Myomectomies provide highly effective relief for fibroid symptoms. The original fibroids do not grow back, but new fibroid may develop. 
3. Uterine fibroid embolization: A highly effective option for women who wish to preserve their uterus and avoid surgery. An interventional radiologist performs this procedure through an IV without surgery. Occluding agents are placed into the blood vessel supplying each fibroid. This process starves the fibroid of blood, causing it to shrink. 
4. Radiofrequency fibroid ablation: The Acessa procedure is a minimally invasive, outpatient treatment for fibroids of all types and sizes and in all locations within the uterine wall. This laparoscopic surgery is performed through small incisions using a camera, an ultrasound probe, and the Acessa electrode tip. Heat is used to destroy fibroid tissue causing the fibroid to shrink over time.
5. Endometrial ablation: A short, outpatient surgical procedure to treat abnormal uterine bleeding without the need for incisions. The process destroys the endometrial lining, the tissue responsible for menstrual bleeding. This low-risk option has a 95% patient satisfaction rate and requires minimal patient downtime. Endometrial ablation does not treat or shrink fibroid s but is an effective option to control the associated bleeding. 
6. MRI guided Focused ultrasound: This newer treatment treats fibroids through high-intensity ultrasound. Under MRI guidance, focused ultrasound waves pass through the skin to destroy the fibroids. 

Treatment with Medication

1. Gonadotropin-releasing hormone agonists: GnRH medications are often used preoperatively to temporarily reduce the size of fibroids before surgery. GnRH medications can help decrease blood loss, operative time, recovery time, and sometimes allow a minimally invasive type of hysterectomy. 
2. Progesterone IUD: These thin the endometrial lining. They do not directly treat uterine fibroids but effectively reduce menstrual bleeding.
3. Oral contraceptives: OCPS reduce menstrual bleeding. They do not treat fibroids but are often used to reduce symptoms in women who seek temporary relief.
4. Tranexamic acid: Antifibrinolytic therapy is an effective treatment to reduce the bleeding from uterine fibroids and menorrhagia. This treatment does not directly affect the size of uterine fibroids.
5. Pain medication: Nonsteroidal anti-inflammatory drugs reduce pain and blood loss from fibroids.
6. Selective progesterone receptor modulators: SPRMs such as Ulipristal acetate are newer medications that directly affect the Progesterone receptors. Progesterone is required for cellular proliferation and fibroid growth. This medication is currently FDA for endometriosis, but early clinical trials show promise in bleeding control and fibroid shrinkage. 
7. Oriahnn™ is a combination product containing elagolix, estradiol, and a type of progesterone called norethindrone acetate. Elagolix is a gonadotropin-releasing hormone antagonist. This term means it suppresses the ovarian sex hormones estrogen and progesterone, both of which stimulate fibroid growth

1. Wallach EE, Vlahos NF. Uterine myomas: an overview of development, clinical features, and management. Obstet Gynecol. 2004;104(2):393–406.
2. 3. Whiteman MK, Hillis SD, Jamieson DJ, et al. Inpatient hysterectomy surveillance in the United States, 2000–2004. Am J Obstet Gynecol. 2008;198(1):34.e1–34.e7.

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