Tag Archives: Gynecological Surgery

Endometriosis

What Is Endometriosis?

Endometriosis is a uterine condition that affects as many as 1 in every 10 women during their childbearing years, or about 175 million women worldwide. Women with endometriosis experience a wide range of symptoms, and it’s crucial to understand this condition’s effects on a woman’s body and identify its existence as soon as possible.

Left unchecked, endometriosis can cause chronic, daily, and even debilitating pain for women and girls who experience it. Prolonged, unidentified endometriosis can even cause infertility; in fact, about 30 to 40 percent of women with endometriosis will experience infertility because of the condition. In addition, some of the symptoms of endometriosis can masquerade as other, common uterine and hormone-related conditions, lengthening the time to diagnosis and increasing infertility risks.

For that reason, early identification and treatment is crucial. Some women with endometriosis can manage the symptoms with simple treatments like hormone therapy or birth control, while others may require surgery. Building a wealth of knowledge about the condition can help you identify it, seek treatment, and make more informed decisions regarding the treatment process.

How Does Endometriosis Occur?

Endometriosis Diagram

As you may have suspected, endometriosis involves the uterus as well as potentially other reproductive organs within the woman’s body. The endometrium is the tissue that lines the walls of the uterus, and endometriosis is a condition that affects these tissues. During a normal menstrual cycle, the endometrium builds up in anticipation of pregnancy, where it is needed to help sustain a growing embryo or fetus; when pregnancy does not occur, the endometrium breaks down and is shed via menstruation.

A woman with endometriosis will start accumulating endometrial tissue outside the uterus, usually inside the abdominal cavity. Unfortunately, the tissues outside the uterus still respond to the menstrual cycle the same as the tissues inside the uterus. Once a period begins, these tissues will break apart and bleed. While the endometrium tissues inside the uterus can exit through the cervix, the tissues outside the uterus have nowhere to go.

How Does Endometriosis Affect Women?

The endometrium tissues that dissolve and bleed in the abdominal cavity will aggravate the other tissues around the uterus and cause inflammation, swelling and severe cramping pains. Doctors refer to the tissues scarred by endometrial tissues as nodules, implants, growths or lesions. This scarred, misplaced tissue is what causes the pain or discomfort common to endometriosis and can lead to the infertility so common to the condition. However, the exact symptoms experienced often depend on the location of the endometrium outside the uterus.

Most commonly, endometriosis affects:

  • Ovaries
  • Fallopian tubes
  • Ligaments supporting the uterus
  • The area between the uterus and the rectum
  • The outside of the uterus
  • The lining of the pelvic cavity

In rare cases, endometrium tissues can accumulate in the intestines, anus, bladder, cervix, vagina or vulva, including previous abdominal surgery scars. In extremely rare cases, doctors have located endometrial tissues in patients’ thighs, arms and lungs.

Endometriosis is a progressive condition that may not manifest noticeable symptoms until many years after menstrual periods begin. Each cycle causes more endometrium accumulation. Over the years, the endometrium implants grow and affect more tissues. Menopause generally causes the symptoms of endometriosis to subside and the implants to deteriorate.

What Causes Endometriosis?

While researchers have made many discoveries regarding what happens to the tissues affected by endometriosis, the exact endometriosis causes remain unknown. Currently, the only endometriosis cases that can be linked to a definitive cause are those where direct transplantation – the transferal of endometrial tissue onto the abdominal wall after a caesarean section or other uterine surgery – has occurred.

Popular, evidence-based theories include:

  • Travel theories, in which researchers posit that endometrial tissues may travel via the blood and lymphatic systems and implant elsewhere in the body.
  • Reverse menstruation, in which some menstrual tissue reverses direction within the fallopian tubes and into the abdomen, where it implants.
  • Transformation, in which researchers suggest that other types of cells in any location may transform spontaneously into endometrial cells.

While research is ongoing, in an attempt to determine the root cause of endometriosis, researchers agree there may be a genetic component as well. Some women, due to genetic family history, may be predisposed to endometriosis.

Endometriosis Symptoms

Signs and Symptoms of Endometriosis

As mentioned earlier, identifying endometriosis symptoms early can allow for earlier treatment of the condition, perhaps reducing the chances women will experience infertility as a result. The early symptoms of endometriosis typically include more significant:

  • Menstrual cramping
  • Abdominal pain
  • Lower back pain
  • Pain or discomfort during sexual intercourse
  • Pain or discomfort during urination and bowel movements
  • Heavier periods
  • Clotting during periods
  • Spotting during periods
  • Irregular periods
  • Fatigue and disrupted sleep
  • Depression

If endometriosis is allowed to progress, symptoms can spread beyond the reproductive system itself and into the other abdominal systems it affects. Endometrium implants can cause irritation that can progress into infections, abscesses or areas of the body that are tender to the touch. If endometriosis affects the tissues of the intestines or bladder, it can cause urinary or intestinal pains as well.

Endometriosis and PCOS Fertility

Although endometriosis is a fairly well-known and well-documented condition that causes infertility, it’s often confused with another common reproductive disorder known as polycystic ovary syndrome, or PCOS. Both conditions can cause infertility but distinguishing between the two is important, since treatment regimens differ. So, what is PCOS and how is it different?

Simply put, while endometriosis involves the transferal and growth of the endometrium outside of the uterus, PCOS involves the ovaries. With PCOS, the ovaries don’t ovulate as they should, causing egg follicles to become stuck inside. While, on the surface, endometriosis and PCOS can feel like depression, “period pain” or “abdominal pain”, their primary symptoms and the method of diagnosis differ greatly.

Diagnosing Endometriosis Cases

A doctor will need to review a patient’s entire gynecological history to properly diagnose endometriosis. The doctor must also perform a full physical examination and a pelvic examination. In some cases where doctors have reason to believe endometrial tissue may have spread to other, specific areas within the pelvis, doctors may perform an ultrasound, CT scan or MRI to provide images of the organs in question.

Endometriosis Symptoms

However, a positive diagnosis is only confirmed with a laparoscopic procedure. During this procedure, the patient is typically subject to general anesthesia, and the abdomen inflated with air via a small needle; this allows the doctor to have a better view of all components of the abdominal cavity. Then, the doctor will insert a lighted laparoscopic surgical instrument through a small abdominal incision to view the internal organs and locate endometrial implants. Overall, the procedure takes approximately 30 to 45 minutes.

Based on the findings during the laparoscopy, the doctor will be able to confirm the presence of endometriosis. However, doctors rarely eliminate the possibility of endometriosis, since endometrial growths may be tiny, or hidden by other tissues. Next, the doctor will rate the severity of the endometriosis present.

Determining Endometriosis Severity

The American Society of Reproductive Medicine has established a classification system for endometriosis, which is as follows:

  • Stage 1 – Minimal presence of endometriosis
  • Stage 2 – Mild presence of endometriosis
  • Stage 3 – Moderate presence of endometriosis
  • Stage 4 – Severe presence of endometriosis

To determine which stage each case of endometriosis falls under, doctors must first consider a number of factors, including:

  • The amount of tissue accumulation
  • The location of those tissues
  • The amount of scar tissue involved
  • The spread of the scar tissue within the abdominal cavity
  • Whether pelvic structures like the pelvic cavity or the pelvic floor are involved
  • Fallopian tube blockage
  • The presence of pelvic adhesions
  • The severity of the patient’s symptoms

Small, isolated endometrial implants are usually considered mild endometriosis, while more significant lesions would be moderate to severe endometriosis. More severe cases of endometriosis will also create more scar tissue, potentially involving the structural components of the pelvis, causing blockage of the Fallopian tubes and other organs.

Treatment Options for Endometriosis

Women diagnosed with endometriosis have a number of treatment options available, based on many factors such as overall health, the severity of the condition, tolerance for certain treatments, and the expected outcome of treatment. Endometriosis treatment may include:

  • Rest and relaxation. Avoiding stress, heat therapy, taking warm baths, and other relaxation techniques can help relieve minor symptoms of endometriosis and dyspareunia.
  • Diet changes. For minor cases, doctors may suggest a diet for endometriosis and fertility. Typically, this includes avoiding caffeine, alcohol, red meat and processed foods, as well as increasing consumption of fruits, vegetables, Omega 3s and soy.
  • OTC medications. Doctors suggest simple pain medications such as ibuprofen for mild cases of endometriosis or other over the counter treatments like CBD endometriosis pain relievers.
  • Hormone therapy. Hormone treatment is very effective for small, isolated endometrial implants. Oral contraceptives that contain estrogen and progestin or synthetic progestin pills can provide relief in some cases.
  • Hormone blocking. Other women may require more robust treatments with synthetic pituitary blockers or gonadotropin-releasing hormone agonists. These medications block hormones from the pituitary gland that contribute to the menstrual cycle. While these monthly injections are effective for some women, they also cause bone mineral loss.

Female hormone therapy

For women who want to become pregnant after treatment of endometriosis, the first three options are often considered the most conducive to a healthy pregnancy in the future. Some women opt for temporary hormone suppression therapy, so they can attempt to conceive afterward. For other patients, hormone suppressants can be an effective solution with the added benefit of preventing pregnancy, if desired. Still others require surgery to treat the cause of endometriosis pain.

Surgical Options

Some women with severe endometriosis will require surgery for relief. In these cases, surgeons will try to remove as much of the endometrium implants as possible without risking damage to the surrounding tissues. Primarily, endometriosis surgery is limited to three distinct options:

  • Laparoscopy. Some surgeons opt for laparoscopic laser removal, which begins with the same process used to diagnose endometriosis. Once endometrial tissue is found, the surgeon will cauterize and vaporize sections of endometrial tissue. Laparoscopic procedures are minimally invasive and have shorter recovery times than typical abdominal surgeries.
  • Laparotomy. For advanced cases, more drastic surgical options may be the only solution. A laparotomy uses a much larger incision into the abdominal cavity to expose more of the interior to the surgeon. Then, a similar procedure is used to excise the endometrial tissue. With a larger incision comes a more extended recovery period post-surgery.
  • Hysterectomy. For the most severe or advanced cases, a hysterectomy may be required to stop the symptoms of endometriosis. During this procedure, a surgeon removes the uterus altogether, either laparoscopically, through a large incision, or even through the vagina. In some cases, the ovaries are removed as well to inhibit tissue growth. After hysterectomy, future pregnancy is not possible.

Endometriosis Surgery

While conservative surgery is a safe and effective way to treat endometriosis, it’s important to treat as early as possible. In fact, as many as 40% of advanced endometriosis patients experience symptoms within five years as the result of tissue regrowth. More drastic surgeries such as hysterectomy with ovary removal do a better job of eliminating existing tissue and the hormone swings that cause it to grow, but regrowth and infertility is still possible. Thus, it’s vital for any woman considering any level of surgery to discuss the issue at length with her doctor.

Take Control of Your Uterine Health with Endometriosis Specialists in Arizona

Keeping close tabs on your menstrual cycles and uterine health are important at any age. Every endometriosis case is different, but your case can be manageable with early detection, symptom management and careful screening. The providers who work with Arizona Gynecology Consultants can handle any aspect of gynecological care, so contact us today if you would like more information about endometriosis or treatment options.

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.

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 diagnoses 2 to 3 times as often as other women, 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, 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.

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, 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.

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.

What Are Ovarian Cysts - Arizona Gynecology Consultants

What Are Ovarian Cysts?

A cyst in any part of the body can be a sign of cancer or other negative health conditions, and this applies to ovarian cysts as well. While some women develop benign ovarian cysts that are not cancerous, these cysts can still cause several uncomfortable symptoms.

Cancerous cysts in the ovaries can quickly develop into more dangerous types of cancer, and ovarian cyst screenings are an important preventive measure against this.

Types of Ovarian Cysts

The ovaries are two small organs located on either side of the uterus. The ovaries house a woman’s eggs and release them periodically during the menstrual cycle.

The hormones created in the ovaries regulate menstruation and ovulation – the cycle of released eggs moving from the ovaries through the fallopian tubes. If a sperm cell fertilizes the egg, it results in pregnancy, and the fertilized egg will implant on the uterine wall and develop into a fetus.

If egg fertilization does not occur, the woman will flush it from her body during menstruation. A cyst is a sac filled with fluid, and ovarian cysts can form inside or outside the ovaries.

Functional Cysts

Follicles in the ovaries help eggs mature and then release them at the proper time. Functional cysts form when an ovarian follicle fails to dissolve after releasing a matured egg or fails to release a matured egg.

Polycystic Ovaries

Polycystic ovary syndrome (PCOS) is a condition that affects the way eggs develop in the ovaries. Clusters of cysts form when these follicles fail to open at the appropriate time.

Endometriomas

Endometriosis is a medical condition that affects the uterine walls. Tissue from the lining of the uterus grows improperly, causing severe menstrual cramps and other symptoms. In some cases, these tissues can accumulate in other parts of the body, including the ovaries.

When endometriosis causes endometriomas to form on the ovaries, this can impact fertility and cause extreme pain.

Cystadenomas

These are fluid-filled cysts that form on the surface of the ovaries.

Dermoid Cysts

These cysts contain cells similar to the ones found in other parts of the body such as the hair, teeth and nails.

What Are Ovarian Cysts: The Symptoms

Some women develop ovarian cysts and do not notice any adverse symptoms for quite a long time. However, screenings are very important, because some types of ovarian tumors share similar traits with ovarian cysts.

While noncancerous, benign tumors may pose no threat and are often easily removable with surgery, malignant cancerous tumors can spread cancer to other areas of the body and require immediate attention. It is, unfortunately, common for ovarian cancer to spread before detection.

Some of the most common symptoms of ovarian tumors and cysts include:

  • Pain during sexual intercourse
  • Abnormally painful menstrual cramps
  • Weight gain
  • Loss of appetite, coupled with nausea and possibly vomiting
  • Throbbing aches in the lower back
  • Increased frequency of urination
  • Difficulty urinating
  • Abdominal pain and bloating

Women who experience these symptoms should see a doctor immediately for a screening. Most ovarian cysts and tumors are detectable during a routine pelvic exam, and a gynecologist will likely refer the patient to additional screenings after detecting a suspicious lump or other sign of a cyst or tumor.

Follow-up procedures may include:

  • Ultrasounds
  • Laparoscopy
  • Hormone level tests
  • Other imaging tests
  • CA-125 screening

CA-125 is a protein in the blood, and CA-125 levels tend to be much higher in women with ovarian cancer.

Screening and Treatment

Regular health screenings are crucial to early cancer detection and to manage the unpleasant, noticeable symptoms some ovarian cysts can cause. Older women and postmenopausal women are more likely to develop ovarian cancer and therefore require more frequent screenings. It’s important to remember that many types of benign ovarian cysts will dissipate over time without any negative symptoms. Other women will require different solutions if cysts do not go away on their own.

When a doctor identifies a benign cyst, he or she may recommend regular checkups every few months to monitor the cyst. If the cyst progresses into dangerous territory, the doctor may prescribe treatment or recommend surgery. If a cyst grows, causes significant pain or doesn’t go away on its own, a doctor may recommend a laparotomy or laparoscopy procedure to remove the cyst.

A laparotomy involves a large incision in the abdomen, whereas a laparoscopy is a less-invasive procedure performed with a flexible lighted instrument and camera apparatus. Laparoscopy is preferred due to the easier recovery and lower risk during surgery, but larger cysts and ovarian tumors will likely require laparotomy.

Regular Checkups Are Important

Most women discover their ovarian cysts and tumors during routine gynecological exams. These exams are very important for female health, and women should have the utmost confidence in the doctors who treat them.

At Arizona Gynecology Consultants, we understand how important regular gynecological screenings are for women, and we work with an extensive network of trusted providers and health care professionals to provide the best standard of care possible. Get in touch with us if you have questions about ovarian cysts, screenings or other issues related to your gynecological health.