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Endometriosis

Navigating Endometriosis: Symptoms, Diagnosis, and Treatment Options

As women, it is never easy to hear that our physical health is compromised, especially when it comes to our reproductive system. For those who have been diagnosed with endometriosis, uncertainty about what comes next can feel overwhelming. Whether you’ve been diagnosed with endometriosis or you know someone who has, accurate information is key. The more informed you are on the topic, the more supported you will feel. In fact, understanding the causes, symptoms, and treatment options can provide you with a clear path forward.

What Is Endometriosis?

Endometriosis Diagram

Endometriosis is a disorder in which tissue very much like the tissue that creates the lining of your uterus, known as the endometrium, develops in areas other than the uterus. Tissue growth can occur in areas it should not, including reproductive organs like the fallopian tubes and ovaries, as well as other pelvic tissue. Though uncommon, this tissue can even be found in areas outside the pelvic organs.

During endometriosis, the endometrial-like tissue takes on the functions and characteristics of your true endometrial tissue. As a result, the tissue will thicken, break down, and bleed during the menstrual cycle. The problem this presents is that there is no way for the tissue to exit your body. Normal pelvic tissue surrounding this foreign, trapped tissue can get inflamed and create scar tissue. Adhesions, which are bands of fibrous tissue, can develop and cause endometrial tissue that develops on organs to stick together. In addition, if tissue grows on the ovaries, cysts can form called endometriomas. Women with endometriosis can also experience severe pain during their menstrual cycle and could develop fertility issues.

Women with endometriosis may not notice the condition for some time, especially if they are prone to painful menstrual cramps or other discomforts. Eventually, however, most women do notice a significant difference in the severity of their menstrual pain, usually leading to a visit to their gynecologist. The good news is that once endometriosis is diagnosed, there are effective treatments available.

Endometriosis: Symptoms and Causes

Endometriosis Symptoms
Unfortunately, many women hesitate to explore medical concerns until they start to impact daily life, especially as they pertain to the reproductive system. A primary reason endometriosis so often goes undiagnosed is due to a delay in reaching out for healthcare. Fortunately, regular visits with your gynecologist can help you feel more comfortable opening up to your doctor and seeking treatment for any minor or major concerns.

If you’re concerned about a potential issue with your reproductive health, knowing the symptoms and causes of endometriosis can help you make the decision to seek treatment, understand the condition, and explore your treatment options.

Symptoms

There are a variety of symptoms associated with endometriosis, the most common of which is pelvic pain that heightens during the menstrual cycle. The pain can be worse than usual and can also increase over time.

Other symptoms to look for include:

  • Excessive Bleeding – Occasional heavy menstrual periods could occur, as well as bleeding between periods.
  • Painful Periods – Also known as dysmenorrhea, pelvic pain and cramping could begin days before a menstrual cycle and continue to last for as long as 1-2 weeks. In addition to pelvic pain, you may also experience abdominal pain and lower back pain.
  • Urinary and Bowel Pain – If you experience unusual pain while urinating or having a bowel movement, especially during a menstrual period, this could be an indicator of endometriosis.
  • Pain with intercourse – A common symptom of endometriosis is pain during or after sex.
  • Infertility – Endometriosis-related infertility is often detected when a woman seeks infertility treatment.
  • Additional Symptoms – Endometriosis can also cause fatigue, nausea, constipation, bloating, or diarrhea.

It is beneficial to look for these additional symptoms beyond pelvic pain because while pelvic pain is often the reason many women discover their diagnosis, this symptom presents itself differently from case to case. Some women have mild endometriosis and experience severe pain, while others have advanced endometriosis with little to no pain. Everyone has a different pain tolerance, and the way endometriosis affects you can be drastically different compared to someone else.

Causes

There is still some uncertainty when it comes to the exact cause of endometriosis, and researchers have not identified a single cause that can trigger the condition. However, while the root cause is still uncertain, scientists have developed several theories.

Some possible explanations for endometriosis include:

  • Transformation of peritoneal cells. Also known as “induction theory,” experts believe that hormones or immune factors may support the transformation of peritoneal cells into endometrial-like cells.
  • Retrograde menstruation. In some cases, menstrual blood with endometrial tissue may continue on into the abdominal cavity via the fallopian tubes instead of being eliminated from the body. The cells may stick to the internal cavity walls and the associated organs, and with nowhere to go, this tissue could continue to build layers, thicken, and cause pain.
  • Transformation of embryonic cells. Estrogen and other hormones can transform embryonic cells into endometrial-type cells during puberty, which can then implant into the abdominal cavity.
  • Endometrial cell transport. Endometrial cells are transported to other parts of the body through blood vessels or tissue fluid and may wind up in the abdominal cavity.
  • Surgical scar implantation. Endometrial cells may attach to a surgical incision, especially after surgeries involving the pelvic organs.
  • Immune system issues. Immune disorders could also cause endometriosis. The body may be unable to identify and eliminate endometrial tissue developing in places it should not.
  • Genetics. Family history may also play a role in your likelihood of developing this condition. Women who have a close relative with this condition are more prone to having it themselves.

What Are the Four Stages of Endometriosis?

Endometriosis Symptoms

If you or a loved one have recently received an endometriosis diagnosis, it is important to understand the four stages of endometriosis: minimal, mild, moderate, and severe. Understanding these stages can help you understand what to expect as you and your physician discuss treatment. There are a variety of factors used to determine the stage, including the location, number, size, and depth of the endometrial implants. It is beneficial to keep in mind that the pain you may experience during your menstrual cycle does not determine your endometriosis stage.

Stage One: Minimal

When a person is diagnosed with stage one or minimal endometriosis, the lesions caused by endometriosis are small, and the implants are shallow. Individuals with stage one may experience inflammation in the area.

Stage Two: Mild

Individuals with stage two endometriosis have mild lesions and endometrial tissue is implanted fairly shallow. This stage is considered mild endometriosis.

Stage Three: Moderate

Individuals who are in the moderate stage may have more lesions than seen in the previous stages. The endometriosis implants are typically deeper within both the pelvic lining and the ovaries.

Stage Four: Severe

Individuals in this stage likely have deep implants on both the ovaries and the pelvic lining. In many cases, there are lesions that could extend to the fallopian tubes and portions of the bowel region. There could also be cysts on one or both of the ovaries due to repetitive cycles of the endometriosis cells thickening, shedding, and becoming trapped.

The Diagnosis Process

Endometriosis can have similar symptoms to other conditions, including ovarian cysts, pelvic inflammatory disease, and even irritable bowel syndrome. This can prolong diagnosis and often requires a variety of tests to ensure accuracy. These delays can be significant; it can take some cases 4 to 11 years for a diagnosis from the onset of symptoms. Ongoing research and support are needed to ensure this timeframe can be significantly reduced so that accurate diagnosis can be given and the right treatment implemented. It can be frustrating, but patience and open communication with your healthcare team can help minimize the delay in proper diagnosis.

Things that are likely to occur during the diagnosis process include:

  • A detailed medical history. Your doctor will likely explore any personal or family history of endometriosis, as there is an increased risk of developing endometriosis if a close family member also has the condition. Your doctor will complete a general health assessment to ensure your signs and symptoms aren’t connected to a different long-term disorder.
  • A physical exam. Your doctor will complete a detailed pelvic examination to search for cysts or scars behind the uterus. A speculum and light will be used to see inside the vagina and cervix, helping the doctor determine the severity of your condition, as well as possibly rule out other conditions that may share other symptoms.
  • Ultrasound imaging. A transvaginal or abdominal ultrasound can be used to provide clear images of your reproductive organs. An ultrasound helps identify cysts and lesions.
  • Laparoscopic imaging. This is a minor surgical procedure that provides an opportunity to directly view endometriosis. Once a person is diagnosed with this condition, the same procedure can be used to remove the tissue.

Treatment Options

Female hormone therapy

The main goal of endometriosis treatment is to alleviate pain and help you learn to cope with the physical and emotional challenges that can be associated with this condition. Which treatment is best for you will depend on your age, the severity of your symptoms, the severity of the condition itself, and any plans for future pregnancies. There are medications, alternative therapies, and surgeries that can be considered.

Medications

Medications can help you control the symptoms of endometriosis.

Hormonal options and medications include:

  • Birth Control – Hormonal suppression can help reduce the symptoms associated with this condition, which can include using estrogen and progesterone birth control options such as oral birth control pills, patches, Nexplanon, IUD, a vaginal ring, or the birth control shot. These medications can help you experience less painful periods.
  • GnRH Medications – Gonadotropin-releasing hormone medications stop the hormones associated with your menstrual cycle. This essentially puts your reproductive system on hold to help relieve pain.
  • Danazol – Also known as Danocrine, this medication stops the production of hormones that cause a period. Individuals on this medication may have an occasional menstrual period, or they may stop entirely.

It is important to note that these medications are not recommended for those who are trying to get pregnant. In addition, if the medication is stopped in an attempt to become pregnant, endometriosis symptoms can come back. Your medical professional will discuss the details of these options with you. For pain relief, doctors commonly prescribe over-the-counter pain relief and non-steroidal anti-inflammatory drugs (NSAIDs) like acetaminophen and ibuprofen.

Surgery

Endometriosis Surgery

Surgery can be an effective way to help relieve endometriosis pain and improve your ability to become pregnant. There are always risks associated with any form of surgery, so it is beneficial to discuss this treatment option with your provider. Endometriosis is a chronic disease, so surgery is not often the final solution. Symptoms may return within a few years, or they may not.

Surgical treatments include:

  • Laparoscopy – This procedure can be used to diagnose and treat endometriosis. A surgeon makes a small cut into the abdomen and inserts a thin tube-like tool called a laparoscope into your body, which uses a high-definition camera to identify lesions so they can be accurately removed through the tube.
  • Hysterectomy – In severe cases, removing the uterus may be suggested due to scar tissue and the extent of endometriosis in the pelvic area.

Alternative Therapies

Not everyone wants to turn to medications or surgery to experience relief. Some patients may experience symptom relief through holistic treatments and delay surgical procedures for a time.

These treatments may include:

  • Acupuncture
  • Herbal medication
  • Dietary changes
  • Pelvic floor muscle therapy
  • Heat therapy

Endometriosis FAQs

Whether you have just received an endometriosis diagnosis or believe you may be experiencing symptoms of endometriosis, the answers to these common questions could shed some light on what to expect.

Can I Get Pregnant if I Have Endometriosis?

Endometriosis can make it more difficult to become pregnant, but pregnancy is not impossible. Your chances of becoming pregnant largely depend on the severity of your condition, as well as your treatment options. It may be recommended to try to conceive sooner than later, as this condition often worsens over time.

What Are the Risk Factors Associated with Endometriosis?

Common risk factors include a family history of endometriosis, when you started having your period, the length of your menstrual cycle, and any defects in your uterus or fallopian tubes. Having a close family member with the condition or menstruating before the age of 11 can increase your chances of developing endometriosis. Long menstrual cycles and uterine or fallopian tube defects can increase the chances that excess tissue will develop in the abdominal cavity.

Can Endometriosis Go Away on its Own?

Yes, in some cases. Lesions can get smaller, and you may only have a few of them. Menopause can also help alleviate or eliminate endometriosis since the body no longer produces estrogen. However, for most, this condition needs ongoing treatment to relieve pain and prevent the condition from worsening.

Let Us Support You

Endometriosis awareness can help individuals and their families better prepare and face this diagnosis. Currently, it can take years for an accurate endometriosis diagnosis, which can mean years of pain and discomfort that can only worsen over time. At Arizona Gynecology Consultants, women’s health is our top priority. We continue to strive for advancements in the diagnosis and treatment of this condition. View our Arizona gynecology services and book an appointment.

Editor’s Note: This article was originally published April 12, 2020 and was updated October 2, 2023.

References :

  1. Agarwal, S. K., Chapron, C., Giudice, L. C., Laufer, M. R., Leyland, N., Missmer, S. A., Singh, S. S., & Taylor, H. S. (2019). Clinical diagnosis of endometriosis: A call to action. American Journal of Obstetrics and Gynecology, 220(4), 354.e1–354.e12. https://doi.org/10.1016/j.ajog.2018.12.039
  2. ?Mayo Clinic. (2018, July 24). Endometriosis – Symptoms and Causes. Mayo Clinic; Mayo Clinic. https://www.mayoclinic.org/diseases-conditions/endometriosis/symptoms-causes/syc-20354656
  3. Wadood, A. (2019, July 2). Endometriosis. Healthline; Healthline Media. https://www.healthline.com/health/endometriosis
  4. ?What are the symptoms of endometriosis? (n.d.). Https://Www.nichd.nih.gov/. https://www.nichd.nih.gov/health/topics/endometri/conditioninfo/symptoms
  5. ?Heitmann, R. J., Langan, K. L., Huang, R. R., Chow, G. E., & Burney, R. O. (2014). Premenstrual spotting of ?2 days is strongly associated with histologically confirmed endometriosis in women with infertility. American Journal of Obstetrics and Gynecology, 211(4), 358.e1–358.e6. https://doi.org/10.1016/j.ajog.2014.04.041
  6. ?Surrey, E. S., Soliman, A. M., Johnson, S. J., Davis, M., Castelli-Haley, J., & Snabes, M. C. (2018). Risk of Developing Comorbidities Among Women with Endometriosis: A Retrospective Matched Cohort Study. Journal of Women’s Health, 27(9), 1114–1123. https://doi.org/10.1089/jwh.2017.6432
When Should an Ovarian Cyst Be Surgically Removed?

Should an Ovarian Cyst Be Surgically Removed?

Regardless of its size or level of severity, discovering an ovarian cyst can be a stressful and confusing experience for any woman—especially if the cyst is causing you severe discomfort in your day-to-day life. However, the way a cyst is treated or even if it needs to be treated varies from situation to situation.

Ovarian cysts are relatively common (occurring in between 8% and 18% of women) [1]Ross, E.K. (2013). Incidental Ovarian Cysts: When to Reassure, When to Reassess, When to Refer. Cleveland Clinic Journal of Medicine; 80(8): 503–514. Retrieved from 2013 article., both pre- and post-menopausal. However, most of these cysts are benign, meaning that they’re non-cancerous. [2]Abduljabbar, H. S., Bukhari, Y. A., Al Hachim, E. G., Alshour, G. S., Amer, A. A., Shaikhoon, M. M., & Khojah, M. I. (2015). Review of 244 cases of ovarian cysts. Saudi medical journal, 36(7), … Continue reading In rare circumstances, though, it’s also possible for a cyst to become cancerous or to cause severe complications for the patient. Whenever a twisted ovary or rupture occurs, this can be extremely painful, and the patient must receive immediate medical care.

With so many possibilities, you might be unsure how to proceed after the discovery of an ovarian cyst. To start, take any recommendations by your doctor into serious consideration. They’ll be able to give you a clearer idea of your cyst’s condition and whether treatment is necessary.

When Should an Ovarian Cyst Be Surgically Removed?

Fortunately, in the case of most ovarian cysts, surgery isn’t a necessary treatment. [3]Imperial College London. (2019, February 5). Ovarian cysts should be ‘watched’ rather than removed, study suggests. ScienceDaily. Retrieved February 20, 2022 from … Continue reading The majority of these types of cysts can resolve on their own, often without symptoms or complications. However, there are a few situations where ovarian cyst removal may be the best course of action. For example, suppose the cyst is on the larger side, is actively growing, is non-functional, causes pain, or continues throughout more than two menstrual cycles. In that case, your gynecologist might suggest surgical removal.

In some cases, a cyst can be removed using a procedure known as an ovarian cystectomy. However, the ovary itself won’t be removed during this procedure. There are other times when removing the entire ovary may be the safest path to take. When just the affected ovary is removed, and the other remains intact, this is known as an oophorectomy.

Though rare, some cystic mass may be cancerous. [4]Jayson, Elise C Kohn, Henry C Kitchener, Jonathan A Ledermann, Ovarian cancer, The Lancet,Volume 384, Issue 9951,2014,Pages 1376-1388,ISSN 0140-6736,https://doi.org/10.1016/S0140-6736(13)62146-7. You can expect to be referred to a gynecologic cancer specialist in these instances. The surgical treatment needed in these cases can differ. However, you may need to receive a total hysterectomy. In other words, the ovaries, uterus, and fallopian tubes will all need to be removed. Other cancerous cysts are best treated with radiation or chemotherapy.

If the ovarian cyst develops after the start of menopause, your gynecologist will likely recommend surgical removal.

Functional Cysts Vs. Non-functional Ovarian Cysts

The distinction between functional and non-functional ovarian cysts is important to keep in mind, as it can dramatically influence the best course of treatment.

Functional Cysts (Follicular and Corpus Luteum)

Functional cysts come in two forms: follicular cysts and corpus luteum cysts. Both of these ovarian cysts form during someone’s menstrual cycle.

A follicular cyst may develop when an egg can’t be released from the follicular sac (where an egg grows). More often than not, follicular cysts will resolve on their own in no more than two menstrual cycles.

If the follicular sac releases an egg, but there’s a buildup of fluid, this is a corpus luteum cyst. Although these ovarian cysts often resolve on their own, they can be more painful than a typical follicular cyst. It’s even possible that they will result in bleeding.

As a whole, functional cysts are a benign type of growth. If the functional cyst is small and not causing any symptoms or pain, treatment likely won’t be needed. However, your gynecologist may prescribe birth control bills when menstrual problems or pain are involved, as this can stop new cysts from forming.

Periodic ultrasound studies can be used to monitor the cyst to ensure that it resolves on its own.

Non-Functional Cysts (Dermoid, Cystadenoma, Endometrioma, & Malignant)

When a woman develops a non-functional ovarian cyst, it isn’t a result of releasing an egg or her menstrual cycle. Although most non-functional cysts are non-cancerous, that isn’t always the case.[5]M A Pascual, L Hereter, F Tresserra, O Carreras, A Ubeda, S Dexeus, Transvaginal sonographic appearance of functional ovarian cysts., Human Reproduction, Volume 12, Issue 6, Jun 1997, Pages … Continue reading

Non-functional ovarian cysts also come with several potential complications, including a twisted ovary or rupture. Other times, the non-functional ovarian cyst may be large enough that this alone causes the patient pain or discomfort.

There are four types of non-functional ovarian cysts, and those are:

  • Dermoid
  • Cystadenoma
  • Endometrioma
  • Malignant

Non-Functional Ovarian Cysts

Dermoid cysts are typically benign, although they can rupture or twist the ovary. [6]Mobeen S, Apostol R. Ovarian Cyst. [Updated 2021 Jun 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: … Continue reading They’re also present from the patient’s birth rather than developing later in life. These cysts are composed of hair, skin, muscle, or organ tissue.

Cystadenomas are large cysts that develop on the outside of the ovaries. Despite their size and the discomfort they can cause, they are typically benign. Similarly, endometriomas are usually benign cysts, although they develop due to an excess of uterine lining tissue.

As a woman ages, her cysts may become cancerous or malignant. This is a rare situation, but a “watch and wait” strategy is the best way to catch the problem early. When a patient experiences persistent ovarian cysts (especially after menopause), her doctor must perform routine ultrasound screenings to check for tumors or signs of cancer.

How Big Does an Ovarian Cyst Have to Be to Get It Removed?

Most ovarian cysts are relatively small, often with little to no symptoms or pain. However, if one of these cysts grows to a larger size, this can cause complications and necessitate surgical removal. Surgery often isn’t necessary until an ovarian cyst has grown to 50 to 60 millimeters in size or approximately 2 to 2.4 inches.

Still, these measurements aren’t a rigid guide to when a cyst should be removed. For example, for a simple benign cyst, your doctor might prefer not to surgically remove it until it’s larger than 4 inches. On the opposite hand, if an ovarian cyst is cancerous, it will need to be removed even if it’s of a much smaller size.

Ovarian Cyst Removal Side Effects and Risks

Like any surgical procedure, there are potential risks or side effects to having an ovarian cyst surgically removed. [7]Henes, M., Engler, T., Taran, F. A., Brucker, S., Rall, K., Janz, B., & Lawrenz, B. (2018). Ovarian cyst removal influences ovarian reserve dependent on histology, size and type of operation. … Continue reading

Some of the most common risks of ovarian cyst removal surgery are that:

  • It may not control the pain, despite removal.
  • The ovarian cysts return (after cystectomy).
  • An infection develops.
  • Scar tissue builds up at the surgical site—on the fallopian tubes, ovaries, or in the patient’s pelvis.
  • Damage is done to the bladder or bowel.

Ovarian Cyst Removal Recovery Time

The anticipated recovery time after ovarian cyst removal surgery depends on whether the patient had a laparoscopy or a laparotomy.

Laparoscopy involves a small incision and has a shorter recovery time. Usually, the patient can return to their day-to-day activities within a day. They should avoid strenuous exercise or activity for around a week, though.

If there’s any suspicion of cancer, a laparoscopy won’t be the most appropriate surgical option. So instead, some patients will have a laparotomy performed. This procedure gives an improved view of the female pelvic organs and abdominal muscles, involving a larger incision in the abdomen.

After receiving a laparotomy, the patient could remain in the hospital for approximately two to four days. It will also take around four to six weeks to return to their usual activities.

The Cost of Ovarian Cyst Removal Surgery

Like recovery time, the cost of ovarian cyst removal depends on the type of surgery the patient has received. In addition, whether or not the patient has health insurance coverage is also essential in determining cost.

If the patient has health insurance, the cost of their surgery usually consists of a copay and coinsurance rate of between 10% and 50% (sometimes more). However, if the cyst removal surgery is medically necessary, health insurance providers will generally cover it.

Alternatively, if the patient doesn’t have health insurance, it will typically cost between $7,000 and $15,000 to have ovarian cysts surgically removed. Depending on the patient’s location and the hospital used, the cost can vary.

Although some hospitals may charge as little as $6,500 for surgery, the figure can be several thousand dollars higher with a doctor’s fee.

If you’re an uninsured or cash-paying patient, many care providers will offer a discount of up to 30% (or more).

How Well Does Ovarian Cyst Removal Surgery Work?

How Well Does Ovarian Cyst Removal Surgery Work? 

 

If the patient receives an oophorectomy, the current cysts have been removed—so, there won’t be any risk of new ovarian cysts developing in the future.

However, a cystectomy preserves the ovary (and the patient’s fertility if this is a concern). This means that new cysts can develop in the future, whether they form on the same ovary or the opposite one.

Your doctor may prescribe birth control pills to reduce the chances of new ovarian cysts developing. [8]Grimes DA, Jones LB, Lopez LM, Schulz KF. Oral contraceptives for functional ovarian cysts. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD006134. DOI: … Continue reading

Ovarian Cyst Treatment & Removal by Arizona Gynecology Consultants

At Arizona Gynecology Consultants, we are a team of experienced gynecology professionals in the Phoenix and Mesa areas. If you’re currently struggling with ovarian cysts, we offer both general care and minimally invasive surgical procedures.

We treat many women’s health conditions, including primary care, menopause, abnormal bleeding, pelvic pain, hormone replacement, and more. AZGYN even offers several no-incision medical treatments, including for abnormal uterine bleeding or uterine fibroid treatments.

* Editor’s Note: This article was originally published Jun, 2017 and has been updated Feb, 2022.

References

References
↑1 Ross, E.K. (2013). Incidental Ovarian Cysts: When to Reassure, When to Reassess, When to Refer. Cleveland Clinic Journal of Medicine; 80(8): 503–514. Retrieved from 2013 article.
↑2 Abduljabbar, H. S., Bukhari, Y. A., Al Hachim, E. G., Alshour, G. S., Amer, A. A., Shaikhoon, M. M., & Khojah, M. I. (2015). Review of 244 cases of ovarian cysts. Saudi medical journal, 36(7), 834–838. https://doi.org/10.15537/smj.2015.7.11690
↑3 Imperial College London. (2019, February 5). Ovarian cysts should be ‘watched’ rather than removed, study suggests. ScienceDaily. Retrieved February 20, 2022 from www.sciencedaily.com/releases/2019/02/190205185156.htm
↑4 Jayson, Elise C Kohn, Henry C Kitchener, Jonathan A Ledermann, Ovarian cancer, The Lancet,Volume 384, Issue 9951,2014,Pages 1376-1388,ISSN 0140-6736,https://doi.org/10.1016/S0140-6736(13)62146-7.
↑5 M A Pascual, L Hereter, F Tresserra, O Carreras, A Ubeda, S Dexeus, Transvaginal sonographic appearance of functional ovarian cysts., Human Reproduction, Volume 12, Issue 6, Jun 1997, Pages 1246–1249, https://doi.org/10.1093/humrep/12.6.1246
↑6 Mobeen S, Apostol R. Ovarian Cyst. [Updated 2021 Jun 10]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2022 Jan-. Available from: https://www.ncbi.nlm.nih.gov/books/NBK560541/
↑7 Henes, M., Engler, T., Taran, F. A., Brucker, S., Rall, K., Janz, B., & Lawrenz, B. (2018). Ovarian cyst removal influences ovarian reserve dependent on histology, size and type of operation. Women’s health (London, England), 14, 1745506518778992. https://doi.org/10.1177/1745506518778992
↑8 Grimes DA, Jones LB, Lopez LM, Schulz KF. Oral contraceptives for functional ovarian cysts. Cochrane Database of Systematic Reviews 2011, Issue 9. Art. No.: CD006134. DOI: 10.1002/14651858.CD006134.pub4. Accessed 21 February 2022.
Endometrial Ablation Surgery: Frequently Asked Questions and Resources for Women

Endometrial Ablation Surgery: Frequently Asked Questions and Resources for Women

This entry was posted in Health FAQs and tagged on by .

What is Endometrial Ablation?

Endometrial ablation is a surgical procedure to destroy the lining of the uterus (endometrium). Ablation is used to treat abnormal uterine bleeding, premenstrual syndrome, and painful periods. This form of treatment is not a first-line therapy, and is usually reserved as a solution when other methods have not brought satisfactory results.

Why Do I Need Endometrial Ablation surgery?

Endometrial ablation may be used as a treatment option for women who have abnormal uterine bleeding, premenstrual syndrome, and painful periods. It should only be reserved as an option when other methods of controlling bleeding, cramps and treating premenstrual syndrome have not been successful.

This procedure may be recommended if you have heavy or long periods, or abnormal bleeding that negative affects your daily life and activities, or causes anemia (low blood count).

What are the Risks and Side Effects of Endometrial Ablation?

Endometrial ablation is a common and relatively safe procedure for women. There is very little recovery time with endometrial ablation, and between 70-80% of women treated with ablation surgery are satisfied with the results of the operation. With any minimally invasive procedure, like endometrial ablation, there is a risk of complications. Though the risk of complications are low, common complications may include:

Possible Post-Operative Complications from Endometrial Ablation

  • Pregnancy After Endometrial Ablation
  • Pain-Related Obstructed Menses
  • Failure to Control Menses
  • Risk from Pre-Existing Conditions
  • Infection

In the past, intra-operative procedures had a higher risk of post-operative complications, but with new technology and a better understanding of expectations, today’s ablation procedures have many fewer complications – of-which, the risk of post-operative infection is the most serious.

Who Should Not Have Endometrial Ablation Surgery?

Endometrial ablation is not an option for every woman, and there are many things to consider before having this procedure. Endometrial ablation may not be recommended if you have the following:

  • A current infections (vaginal or cervical)
  • Pelvic inflammatory diseases
  • Current condition, or a history of cancer of the reproductive organs (endometrial, cervical, or uterine cancers)
  • If you were recently pregnant (within the past 6-12 months)
  • Weakness of the uterine muscle wall
  • If you currently have an IUD, Intra-uterine Device
  • If you have had a C-Section (either classic incision or vertical)
  • If you have uterine abnormalities that increase the risk of the procedure (narrow cervix or large uterus).

Will Endometrial Ablation Surgery Stop Me from Having my Period?

While the main goal of the surgery is to minimize or lessen the bleeding from menstruation, 10% of those women that have ablation surgery stop having their period. 70% of women that undergo endometrial ablation have significantly reduced bleeding. It is important to note that endometrial ablation is not used to stop you from having your period completely, but 10% of patients see this result.

Can I Get Pregnant After Endometrial Ablation?

Just as endometrial ablation is not used as a treatment to completely stop you from having your period altogether, endometrial ablation is not used as a form of contraception. This procedure is not meant for sterilization, rather it can cause infertility issues in women and is not recommended for those women who plan on having children in the future.

The risk of pregnancy complications – including increased risk of miscarriage – is much higher in women who have had endometrial ablation. Even though it is unlikely that you can become pregnant after endometrial ablation surgery, it is possible. It is important to remember that a woman who has had endometrial ablation still has her reproductive organs – it is just the lining of the uterus that has been affected.

Female Reproductive System Infographic

How Long Does it Take to Recovery after Endometrial Ablation Surgery?

Recovery time after endometrial ablation surgery is minimal, and you should be able to return to your normal routine in 3 days, in most cases. Allow for up to 2 weeks to recover fully physically, and to return to exercise and physical tasks.

The type of anesthesia used during the procedure will determine how quickly you recover immediately after the surgery, and if anesthesia was used, driving is not recommended for at least 2 days after the surgery.

Types of Endometrial Ablation Surgeries

There are several ways a gynecology surgical consultant may choose to perform an endometrial ablation, including:

Electrosurgery for Endometrial Ablation

Also called electrocautery, electrosurgery for endometrial ablation uses an electric wire loop or a roller ball. The instrument cauterizes the lining of the uterus, destroying the tissue.

Cryoablation Surgery for Endometrial Ablation

Similar to electrosurgery, an instrument or a probe is chilled to a temperature low enough to freeze and destroy tissue of the lining of the uterus.

Free Flowing Hot Fluid Endometrial Ablation

Also called fluid or hydrothermal ablation, this is a procedure where heated fluid is pumped into the uterus to destroy its lining.

Heated Balloon Endometrial Ablation

Very similar to the free flowing hot fluid procedure, the heated balloon procedure utilizes heated fluid within a balloon that is delivered to the uterus via a catheter.

Microwave Endometrial Ablation (MEA)

With MEA endometrial ablation, microwaves are used to destroy the lining of the uterus. Microwaves are delivered via an instrument/probe.

Radiofrequency Endometrial Ablation

Very similar to (MEA), Radiofrequency ablation utilizes radio waves to destroy the lining of the uterus.

Considerations before Endometrial Ablation

Even though endometrial ablation is safe and minimally invasive, it is still a surgical procedure. Therefore, you should consider the following before having endometrial ablation surgery:

  • Be sure that you have met with your gynecology surgical consultant and you understand the procedure fully, including risks and special considerations.
  • You will be asked to fast for at least 8 hours before testing procedures.
  • If you are pregnant or considering getting pregnant, be sure to tell this to your doctor.
  • Be sure your doctor knows any existing allergies that you have – including allergies to medications, latex, tape or adhesives, and local/general anesthesia allergies.
  • Let your doctor know if you are taking any blood thinning drugs or have a bleeding disorder. Blood thinners and medications that can prevent blood clotting may need to be discontinued before the operation.
  • Your doctor may prescribe medications as a pre-treatment before the operation.

Do You Have Questions or Concerns About Endometrial Ablation?
Call or contact us to speak with our gynecological surgery consultants (602) 358-8588

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What is a Hysterectomy?

What is a Hysterectomy?

A hysterectomy is uterus removal surgery. There are many reasons that a uterus must be removed, but in all cases, the woman’s health calls for such a procedure.

Reasons For A Hysterectomy

A woman’s reproductive system goes through three major hormonal changes during her lifetime. Puberty, pregnancy, and menopause all cause dramatic hormone shifts that can cause complications with the uterus, ovaries, or fallopian tubes.

Uterine Fibrosis

Uterine fibrosis is the development of benign lumps that grow in the uterus. These lumps are not cancerous but cause pain, bleeding, cramping, painful sex, and the urge to urinate. A hysterectomy will remove these lumps and the uterus, relieving the symptoms and guaranteeing they do not come back.

Cancer

Cancer of the uterus, cervix, or ovaries can call for the removal of all or some of these organs. The procedure must happen before cancer spreads.

Uterine Prolapse

Prolapse is when the uterus slides from its normal position into the vaginal canal. Prolapse can cause the collapse of other structures, such as the vagina and rectum. Removal of the uterus will maintain the structures of other pelvic organs.

Endometriosis

Endometriosis is when uterine tissue develops outside the uterus. It often causes extreme pain, heavy periods, and infertility. Endometriosis makes certain hysterectomy procedures more difficult.

Abnormal Vaginal Bleeding

If the uterus cannot maintain the uterine lining, a woman can experience bleeding not connected to menstruation.

Chronic Pelvic Pain

A uterus that is not performing correctly can cause severe pain in the pelvis.

Adenomyosis

Adenomyosis is the thickening of the uterus, which causes pain and makes it unfit for a fetus.

Types Of Hysterectomy

There are several different hysterectomy types; the procedure may not refer just to the removal of the uterus but to the removal of any combination of the reproductive organs.

Supracervical/Subtotal Hysterectomy

Removal of the upper part of the uterus takes place but the cervix remains. Some OB/GYNs will recommend this if they are uncomfortable or untrained in the removal of the cervix. See the advantages and disadvantages of leaving the cervix intact below.

Partial Hysterectomy

A partial hysterectomy is the removal of the uterus and the cervix. The ovaries and fallopian tubes remain intact.

Radical Hysterectomy

The uterus, cervix, and upper portion of the vagina are removed. Radical hysterectomies usually take place when cancer is present. No other hysterectomy removes any part of the vaginal canal.

Oophorectomy

Oophorectomy is the removal of the ovaries. This can take place with or without the removal of the uterus, especially in cases of ovarian cancer. One or both ovaries can be removed.

Salpingectomy

The removal of the fallopian tubes is a salpingectomy. The fallopian tubes connect the ovaries to the uterus. When a woman gets her “tubes tied,” the fallopian tubes are severed and tied to prevent pregnancy. One or both fallopian tubes can be removed.

Total Hysterectomy and Bilateral Salpingectomy-Oophorectomy

This is the term for the procedure in which the uterus, cervix, both ovaries, and both fallopian tubes are removed. It is also called a total hysterectomy. This occurs in the case of progressed cancer.

Reproductive Anatomy

In order to fully understand the effects of the different types of hysterectomies, one must understand the purpose of the various reproductive organs and the effects of their removal. Some organs produce hormones and removing them will spur changes in the body.

Uterus

The uterus, or womb, is the organ that houses the fetus during pregnancy. It does not produce hormones, but removing the uterus makes the body unable to become pregnant. Once the uterus is removed, there will no menstruation as there is no uterus to shed its uterine lining.

Ovaries

The ovaries house and release the eggs, or ovum. The ovaries also produce estrogen and other hormones that a woman uses post-puberty, during pregnancy, and in perimenopause. Menopause is the process of the ovaries no longer producing these hormones. The removal of the ovaries will prompt menopause, and women will experience hot flashes, mood swings, and the other symptoms that go along with this change. If only one ovary is removed, a woman will not experience this until she is at the age of menopause. Women who have already completed menopause will not go through it again at the removal of the ovaries. A woman can no longer become pregnant when her ovaries are removed. Pregnancy is still possible if only one ovary has been removed.

Fallopian Tubes

The fallopian tubes are the tubes between the ovaries and the uterus that houses the egg while it waits for fertilization. The removal of the fallopian tubes will not affect hormones but will prevent a woman from becoming pregnant.

Cervix

The cervix is the opening between the uterus and the vaginal canal. During pregnancy, the cervix prevents the fetus from moving outside of the uterus and dilates during birth to let the baby out. The cervix does not produce hormones. The removal of the cervix does not affect vaginal lubrication, cause prolapse, lessen sexual satisfaction, or guarantee a safer hysterectomy procedure. A cervix that has not been removed with the uterus during a hysterectomy can cause vaginal bleeding, a higher potential for cancer developing, and thus the need for more pap smears. The cervix may need to be removed to prevent the risk of cancer.

Methods For Hysterectomy Surgeries

An OB/GYN can use one of several different methods when performing a hysterectomy. Each has its all own advantages and disadvantages. Ask for information about which procedure is best for your situation.

Vaginal Hysterectomy

A vaginal hysterectomy is a procedure in which the uterus and other organs are removed through the vaginal canal.

Advantages

There are no incisions with a vaginal hysterectomy, making it the least-invasive form of hysterectomy, and the recovery is very quick as a result. It is especially effective in correcting prolapse. A vaginal hysterectomy is also cost-effective.

Disadvantages

A vaginal hysterectomy requires room in the vaginal canal to remove the uterus, as a result, it is not the best option for women who have not give birth vaginally. Larger uteri masses are more difficult to remove as well. There is a larger risk of bleeding due to an injury of the uterine or ovarian arteries and high risk of complications with patients who have had a cesarean section or previous pelvic surgery because the surgeon will have difficulty seeing other issues or complications in the area.

Laparoscopic Hysterectomy

A laparoscopic hysterectomy requires three to five small incisions in the abdomen. The procedure is then completed using long tools to remove the uterus or other organs.

Advantages

Laparoscopic surgery offers a faster recovery time. The patient is out of the hospital the next day and can go back to work two weeks later. It is safe to use if patients have undergone other pelvic procedures, such as a cesarean section, in the past. It is generally a better option for those who have large uterine masses to be removed or who are not candidates for vaginal hysterectomies. The OB/GYN completing the procedure has full access and visibility, lowering the risks of complications.

Disadvantages

There is a risk of injury to other organs, such as the bladder, and possible conversion to an open hysterectomy due to extreme endometriosis. It is less readily available because specialized training is required to complete the procedure safely.

Open Abdominal Hysterectomy

Open abdominal hysterectomies are still the most common procedures that take place. This is due to lack of training for laparoscopic hysterectomies.

Advantages

An open hysterectomy surgery allows for removal of any size masses.

Disadvantages

A large, 6- to 12-inch incision is made across the abdomen. This causes severe pain and 6 to 8 weeks of recovery. There are also higher hysterectomy complication rates, due to the invasive nature of the procedure.

What Are Congenital Uterine Anomalies - Arizona Gynecology Consultants

What Are Uterine Anomalies?

A congenital uterine anomaly is a uterus malformation that occurs during embryonic development. In the earliest stages of the life cycle, a woman’s uterus forms in two separate halves that grow together over time. Any small missteps in this development cycle can lead to a misshapen or malformed uterus, creating uterine problems later in life.

Congenital uterine anomalies happen to less than 5 percent of women. However, about 25 percent of women who miscarried have some sort of congenital uterine anomaly. Congenital uterine anomalies mostly occur due to random variations during embryonic development, but some uterine anomalies can result from in-utero exposure to certain substances.

For example, baby girls exposed to diethylstilbestrol (synthetic estrogen) are more prone to develop congenital uterine anomalies than others. Doctors often used this medication between 1938 and 1971 to help prevent miscarriages and premature births. Today, there are no known risk factors proven to increase the potential of developing a congenital uterine anomaly.

Types of Congenital Uterine Anomalies

Ultrasound is one of the most-used methods for diagnosing the type of uterine anomaly present in a patient. Doctors will use ultrasound imaging to determine how the patient’s uterus developed and what type of complications the anomaly may present later in life. Different anomalies will produce different effects and lead to varying long-term health complications.

Septate Uterus

One of the most common types of uterine anomalies, a septate uterus, describes a uterus with a normal uterine surface, but with two endometrial cavities. This anomaly occurs when the two halves of the uterus only partially combine during fetal development.

Bicornuate Uterus

The other most common uterine anomaly is a bicornuate uterus. Like the septate uterus, a bicornuate uterus has two endometrial cavities and one external uterine surface. However, a bicornuate uterus has an indented and abnormal uterine surface.

Arcuate Uterus

This uterine anomaly describes a uterus with a 1 cm or smaller indentation in the endometrial cavity.

Unicornuate Uterus

A unicornuate uterus develops only on one side. During fetal development, a baby girl’s uterus develops in two halves that gradually combine to form a single uterus. This anomaly occurs when only one half develops.

Didelphys Uterus

This uterine anomaly describes when the two halves of a developing uterus never combine, resulting in two separately developed halves.

Müllerian Anomalies

This congenital disorder affects about 4 percent of females and occurs during fetal development. This condition results from a malformation of the process of developing Müllerian ducts in the female reproductive system.

These conditions are more than just uterine anomalies, and kidneys often suffer as a result. A woman with a Müllerian anomaly may be missing a kidney, leading to additional medical complications later in life.

Symptoms of Uterine Anomalies

One common thread shared by all the different possible uterine anomalies is that most are asymptomatic. Some women may experience increased pain and discomfort during menstrual cycles, but for the most part, these anomalies do not create significant symptoms on their own.

However, the resulting symptoms often interfere with pregnancy and contribute to lost pregnancies and infertility. Many women do not discover they have a uterine anomaly until they undergo screening for infertility or miscarriage.

After one or more miscarriages, a woman may decide to have a screening to determine the cause, and this is the point when doctors diagnose most uterine anomalies. Women who do experience negative symptoms typically report inconsistent periods or no periods, but the most commonly reported symptoms relate to pregnancy.

Identifying Uterine Anomalies

Doctors use ultrasound imaging to determine which type of uterine anomaly a patient has, and treatment can include many options. Uterine anomaly surgery is a viable option for some women, as it may help restore uterine function and allow for a healthy pregnancy.

However, some anomalies are more difficult to treat, often leading to more significant medical complications. Doctors may also use hysterosalpingograms or MRI procedures to help diagnose uterine anomalies.

Treating Uterine Anomalies

Most uterine anomalies will not require treatment, but treatment generally involves surgery for uterine anomalies. After a positive diagnosis for a uterine anomaly, a women’s surgery specialist will advise the patient about her options.

Most corrective surgery is minimally invasive with little risk, but physicians will recommend surgery only if the uterine anomaly:

  • Prevents pregnancy
  • Results in miscarriage
  • Causes significant pain

Women who have a septate or bicornuate uterus may have the septum wall between the two endometrial cavities removed to restore healthy uterine function. In the case of a unicornuate uterus, the surgeon may remove the undeveloped portion of the uterus, and the patient could possibly have a viable pregnancy using the intact portion. Women at greater risk for premature delivery may require a cervical cerclage to prevent premature cervical dilation.

Is Surgery Right for Me?

Physicians only recommend surgery for a uterine anomaly if the condition prevents pregnancy or prevents the woman from maintaining a pregnancy to full term. In some cases, uterine anomalies can prevent a placenta from attaching correctly, resulting in a miscarriage.

Here are some vital facts to know about uterine anomalies an pregnancy:

  • A woman with a septate uterus has a 25 to 47 percent chance of experiencing a miscarriage.
  • A woman with a bicornuate uterus will have a higher risk of going into preterm labor.
  • Someone with a unicornuate uterus will have about a 37 percent chance of experiencing a miscarriage, and about a 17 percent chance of preterm labor.

Other medical issues, including cervical insufficiency and uterine fibroids, can also interfere with pregnancy and full-term delivery. It’s up to the individual to decide whether her anomaly warrants surgical intervention.

Ultimately, a uterine anomaly may result in only a slightly higher risk of miscarriage for a small malformation, but more significant uterine anomalies can make pregnancy or maintaining a pregnancy to full term impossible. Women should consult their physicians if they have trouble conceiving or experience a sudden onset of symptoms that could indicate a uterine anomaly.

Learn More About Infertility Problems and Testing

What Women Should Know About Minimally Invasive Surgery - AZ Gyn

What Women Should Know About Minimally Invasive Surgery

For women who are in need of gynecological surgery, the idea of “going under the knife” or “getting cut open” (especially “down there”) can be enough to scare off even the bravest and most confident of us.

But thanks to advances in surgical procedures, women today have many minimally invasive surgical options. In fact, it’s never been safer to get the surgery you need.

What Is Minimally Invasive Surgery?

To understand what minimally invasive surgery is, let’s look at what it’s not.

Traditional, or “open,” surgery involves making an abdominal incision large enough for the surgeon to see the area well and navigate the site with surgical tools. Although surgeons do their best to make the surgical incision as small as possible, there are practical limitations with this type of surgery.

Minimally invasive surgery (MIS), meanwhile, utilizes modern advances in technology that allow a surgeon to perform procedures using very small incisions, or in some cases, no incision at all.

Types of Minimally Invasive Surgery

Any type of surgery that isn’t open surgery and that involves minimal incisions can be considered minimally invasive surgery. However, there are two main types that we will explore here. Both use technology inserted through small incisions or natural orifices to perform the operation. Which one is used depends on the specific protocol of a particular surgery.

Endoscopic Surgery

Benefits of Minimally Invasive Surgery Bulleted List - Arizona Gynecology Consultants

Endoscopic surgery involves making small incisions – often less than an inch each – and inserting a small tube equipped with a tiny camera, and other tubes with microsurgery tools as appropriate. The tube can also be inserted through a natural orifice, such as the mouth or cervix, depending on the location to be operated on and the type of surgery.

The camera allows the surgeon to see an enlarged view of the surgical area for clear viewing. The small surgical tools give the surgeon the ability to make very precise cuts and sutures.

Other terms you might hear used for this type of surgery include:

  • Laparoscopy
  • Hysteroscopy
  • Keyhole surgery

Robotic-Assisted Surgery

Like with endoscopic surgery, microscopic cameras and tools are inserted through small incisions. However, during robotic-assisted surgery, the surgeon operates from a console with controllers and a high-definition screen. When the surgeon makes a movement with the controllers, the computer makes the movement more precise.

Robotic-assisted surgery is appropriate for delicate surgeries that benefit from the computer’s ability to perform movements that are more precise than what the human hand is capable of.

With both types of MIS, the surgeon is still very much in control of the operation, regardless of the technology used.

Like all surgeries, minimally invasive surgeries require a professional surgery center and well-trained medical staff with experience performing these types of procedures. Anesthesia needs vary; your doctor will discuss your options with you.

Benefits of Minimally Invasive Surgery

MIS is generally considered safer and more effective than traditional open surgery. Benefits include:

  • Smaller incisions
  • Lower risk of infection
  • Reduced blood loss
  • Less pain
  • Minimized scarring
  • Shorter hospital stay
  • Faster recovery time

The smaller incision means less healing time for the patient, and it reduces the chance of infection. This, in turn, leads to a shorter hospital stay and reduced expenses for the patient.

Professional women, in particular, enjoy the benefit of being able to rehabilitate to full capacity as quickly as possible, while still taking enough time for a full recovery after surgery.

How to Know If Minimally Invasive Surgery Is Right for You

Gynecological conditions that improve after minimally invasive surgery include:

  • Uterine fibroids
  • Endometriosis
  • Ovarian cysts
  • Pelvic organ prolapse
  • Cervical incompetence
  • Abnormal uterine bleeding
  • Pelvic pain

Minimally Invasive Gynecological Surgery in Phoenix, Arizona

Our experienced surgeons at Arizona Gynecology Consultants are well-practiced in advanced surgery techniques like minimally invasive surgery. Dr. Kelly Roy is our in-house specialist in gynecology and advanced endoscopy.

If you’ve been putting off a surgery or aren’t sure if your situation warrants surgery, make an appointment today to meet with one of our gynecological specialists. We have offices in multiple locations in the Phoenix area.

Whatever your surgical or reproductive needs, we’ll help you feel safe and well-cared for when you join the Arizona Gynecology Consultants family!

What Are Uterine Fibroids - Arizona Gynecology Consultants

What Are Uterine Fibroids?

Uterine fibroids are small, benign tumors that grow in the uterus. They are made of the same type of cells found in the walls and connective tissues of the uterus.

In some cases, they embed in the walls of the uterus, but some fibroids will project from the outer surface of the uterus into the abdominal cavity. Others can cluster inside the uterus and project into the interior space of the uterus. [1]Farris, M., Bastianelli, C., Rosato, E., Brosens, I., & Benagiano, G. (2019). Uterine fibroids: an update on current and emerging medical treatment options. Therapeutics and Clinical Risk … Continue reading

The cause of uterine fibroids is not known, but some women are at higher risk of developing them than others. Black women receive uterine fibroid diagnosis 2 to 3 times as often as other women, [2]Stewart, E. A., Nicholson, W. K., Bradley, L., & Borah, B. J. (2013). The burden of uterine fibroids for African-American women: results of a national survey. Journal of Women’s Health, … Continue reading and uterine fibroids only rarely appear in young women who have not started menstruating.

Uterine fibroids will stop growing and dissolve over time after menopause.

What Does My Uterine Fibroid Diagnosis Mean?

Uterine fibroid diagnoses are incredibly common, [3]Zimmermann, A., Bernuit, D., Gerlinger, C. et al. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Women’s Health 12, 6 … Continue reading and about 70 to 80 percent of women will receive a uterine fibroid diagnosis before age 50. If your doctor recently diagnosed you as having uterine fibroids, don’t be alarmed: Uterine fibroids are not cancerous, and the worst symptoms they cause are manageable. While this condition can cause some unpleasant symptoms, many women with uterine fibroids do not have any symptoms at all, and the condition is not medically threatening.

Possible Symptoms of Uterine Fibroids

Most uterine fibroids do not cause any noticeable symptoms. If a doctor discovers uterine fibroids that are asymptomatic during a routine gynecological exam, he or she will likely suggest a wait-and-see approach for monitoring the fibroids in the future. The doctor may wish to confirm the uterine fibroid diagnosis with imaging scans like an ultrasound or pelvic MRI.

Women who experience negative symptoms from uterine fibroids typically report painful or excessive bleeding during periods, or bleeding between periods. Uterine fibroids may also cause abdominal swelling or a feeling of fullness. [4]Viva, W., Juhi, D., Kristin, A. et al. Massive uterine fibroid: a diagnostic dilemma: a case report and review of the literature. J Med Case Reports 15, 344 (2021). … Continue reading

If fibroids compress the bladder, the woman may experience a frequent need to urinate or may have difficulty urinating. Uterine fibroids can also cause lower back pain and pain during sexual intercourse.

Excessive bleeding during periods is a common issue, and some women develop anemia from the blood loss and can suffer other medical complications as well. If these symptoms are severe enough, the woman’s doctor may recommend one of several possible treatment options.

What Are Uterine Fibroids: Treatment Options

A doctor will only treat a case of uterine fibroids if they are causing the patient significant discomfort. The type of symptoms the patient displays, and the severity of those symptoms, typically determines the best course of treatment.

Women who experience only mild pelvic pain may benefit from over-the-counter anti-inflammatory and painkiller medications like ibuprofen. If the pain is too severe for these drugs to handle, the woman’s doctor can prescribe a stronger medication.

Hormone Treatment

While doctors have yet to pinpoint the causes of uterine fibroids, they do believe that uterine fibroids have an easier time developing in an estrogen-rich system. Some doctors may wish to treat uterine fibroids with hormonal medication to limit estrogen production, but it’s important that women understand the effects of hormonal medications.

While a birth control pill may contain hormones that reduce excessive bleeding and decrease a woman’s pain during menstruation, birth control pills that contain estrogen can cause uterine fibroids to grow. This treatment would effectively only manage the symptoms while making the cause of those symptoms worse.

Uterine Fibroids and Pregnancy

Some women may wonder if uterine fibroids interfere with pregnancy. Since estrogen encourages fibroid growth, [5]Borahay, M. A., Asoglu, M. R., Mas, A., Adam, S., Kilic, G. S., & Al-Hendy, A. (2017). Estrogen Receptors and Signaling in Fibroids: Role in Pathobiology and Therapeutic Implications. … Continue reading a woman’s existing uterine fibroids may enlarge during the first trimester when estrogen levels are highest. However, the tumors will later shrink after birth.

Surgical Options

Advanced cases of uterine fibroids that cause significant pain and discomfort may require surgery. The two types of surgery that can solve a uterine fibroid problem are:

  • Hysterectomy
  • Myomectomy

If a woman undergoes a hysterectomy during her childbearing years, she will no longer be able to have children. Some women may not wish to have children, or any more children, and find this acceptable if it stops the unpleasant symptoms of the fibroids.

Women who wish to remove their uterine fibroids but still want to be able to bear children may opt for a myomectomy instead. A myomectomy procedure removes the uterine fibroid tumors while leaving the uterus intact.

Doctors perform myomectomies in three different ways:

  • Laparotomy: The doctor enters the uterus through a small incision in the abdomen to remove the uterine fibroids.
  • Laparoscopic myomectomy: The doctor uses a small, thin telescopic instrument through a small incision in the navel to reach the uterine fibroids.
  • Hysteroscopic myomectomy: A procedure which involves inserting a hysteroscope through the cervix to extract the uterine fibroids through the vaginal opening.

Finally, if a woman does not wish to undergo surgery and wants to keep her fertility intact, she can opt for a fibroid embolization procedure. This is a minimally invasive outpatient procedure during which an interventional radiologist shrinks the uterine fibroids by cutting off their blood supply. The patient will often be able to go home the same day as the procedure after a short recovery period.

Know Your Options

Uterine fibroids can be unpleasant and cause a host of problematic symptoms, so women should always refer to their gynecologists for their recommendations for treatment and handling symptoms. Arizona Gynecology Consultants works with a large network of trusted medical providers, so reach out to us if you have questions about managing your uterine fibroids.

References

References
↑1 Farris, M., Bastianelli, C., Rosato, E., Brosens, I., & Benagiano, G. (2019). Uterine fibroids: an update on current and emerging medical treatment options. Therapeutics and Clinical Risk Management, 15, 157–178. https://doi.org/10.2147/TCRM.S147318
↑2 Stewart, E. A., Nicholson, W. K., Bradley, L., & Borah, B. J. (2013). The burden of uterine fibroids for African-American women: results of a national survey. Journal of Women’s Health, 22(10), 807–816. https://doi.org/10.1089/jwh.2013.4334
↑3 Zimmermann, A., Bernuit, D., Gerlinger, C. et al. Prevalence, symptoms and management of uterine fibroids: an international internet-based survey of 21,746 women. BMC Women’s Health 12, 6 (2012). https://doi.org/10.1186/1472-6874-12-6
↑4 Viva, W., Juhi, D., Kristin, A. et al. Massive uterine fibroid: a diagnostic dilemma: a case report and review of the literature. J Med Case Reports 15, 344 (2021). https://doi.org/10.1186/s13256-021-02959-3
↑5 Borahay, M. A., Asoglu, M. R., Mas, A., Adam, S., Kilic, G. S., & Al-Hendy, A. (2017). Estrogen Receptors and Signaling in Fibroids: Role in Pathobiology and Therapeutic Implications. Reproductive Sciences (Thousand Oaks, Calif.), 24(9), 1235–1244. https://doi.org/10.1177/1933719116678686
What are the Types of Birth Control - Arizona Gynecology Consultants

What Are the Different Types of Birth Control?

Birth control is a major decision for every woman. Choosing the right birth control option isn’t always about contraception, either; some women use different types of birth control to manage the symptoms of gynecological conditions such as endometriosis, ovarian cysts and abnormal uterine bleeding issues.

Birth Control Preferences by State

If you’re considering starting birth control, changing the type of birth control you use, or making other decisions about birth control, it’s important to know your options and speak at length with your doctor about your concerns with any of those options.

Types of Birth Control

Birth control exists in both preventive and situational forms. Some women with hormone irregularities benefit from hormone-based birth control options while other prefer intrauterine devices (IUDs) that have a less hormonal impact. Other women prefer permanent birth control methods.

Before starting any type of birth control, make sure you fully understand the intended effects and potential risks.

Hormonal Birth Control

Hormonal medications in pill form are how millions of American women manage their family planning and control any uterine conditions. It’s easily the most popular form of birth control,

Hormonal birth control exists in pill form as well as dermal patches, injections and implants. Some intrauterine devices also qualify as hormonal birth control, because they release different hormones into the bloodstream.

It’s vital to consider the potential side effects of these options, however. Some women prefer alternatives to hormonal medications due to their effects on mood, cognition and sleep.

Intrauterine Devices

IUDs provide an effective alternative to hormonal medications. It’s important to remember, however, that some IUDs still contain hormones. Non-hormonal IUDs physically obstruct the fertilization process and last anywhere from five to 10 years. Some women elect to have IUDs with low doses of hormones to manage severe menstrual cramping.

Some patients experience complications with IUDs due to anatomical difficulties, incompatibility with materials, and other factors. If you have an IUD implanted, it’s crucial to follow your doctor’s directions and call immediately if you believe the IUD has dislodged from its proper position.

Barrier Contraceptives

As the name suggests, this method of birth control involves placing a barrier between the uterus and a partner’s sperm cells. One of the most common forms of barrier birth control is condom use, but it’s important to remember that condoms are not foolproof.

Condoms can break or degrade, and it’s important to always check a condom for expiration date and package integrity first. If a condom’s package is open, damaged, punctured or torn, discard it and use a new one. If a condom breaks during intercourse, it’s best to stop and have your partner put on a new one before continuing.

Other forms of barrier birth control devices include diaphragms and vaginal sponges. These methods are not surefire methods for preventing pregnancy and require reapplication or reinsertion every time you have sex.

A diaphragm is essentially a reverse condom that fits inside the vagina and holds to the cervix with a ring. The outer layer protrudes from the vagina and the partner enters inside the diaphragm, which then catches the partner’s sperm cells.

Vaginal sponges, on the other hand, effectively soak up the partner’s sperm cells for disposal.

Fertility Awareness

Some couples do not use traditional birth control methods for personal or religious reasons. These couples can often successfully manage their family planning by keeping close tabs on the woman’s menstruation and ovulation schedule. During times when the woman is most fertile, the couple can simply abstain from sex or use barrier contraceptives.

Sterilization

Some women and couples do not wish to ever have children. In these cases, permanent methods of birth control work very well. Sterilization involves either a vasectomy for men or a tubal ligation for women.

A vasectomy is an outpatient procedure that is minimally invasive, reversible and entails very mild discomfort and easy recovery. Tubal ligation is a more invasive and permanent option, so couples should discuss these options at length to decide what would work best for them.

Managing Your Birth Control

Unless you plan to rely solely on barrier birth control methods or fertility awareness, you need to know the various effects any type of birth control will have on you and your body. Hormonal birth control medications and devices can sometimes complicate preexisting medical conditions or conflict with certain aspects of your lifestyle. For example, birth control may not be as effective for a smoker as it would be for a non-smoker.

Women who are pregnant or breastfeeding should not use birth control until a doctor advises that it is safe to do so. The hormones in most birth control options can cause serious fetal harm or other complications with pregnancy.

Women who have had different types of cancer, undergone certain medical procedures or who have serious health problems (such as heart disease, blood clots, diabetes or high blood pressure) need to be careful with birth control as well.

The staff at Arizona Gynecology Consultants is always available to answer patients’ questions and address all concerns about birth control. Starting or changing birth control isn’t an easy thing to do, and our providers aim to provide holistic care that treats the whole person. Learn more about the different birth control options by contacting Arizona Gynecology Consultants today.