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Menopause is the time in a woman's life when the ovaries stop producing estrogen. Menopause is usually recognized by the cessation of menstrual periods. Other symptoms of menopause include flashes, mood changes, difficulty sleeping, and vaginal dryness. If a woman is not menstruating because she has had a hysterectomy or endometrial ablation, other symptoms of menopause often alert her that menopause is starting.

Fibroids are non-cancerous (benign) growths of the muscle wall of the uterus. They are probably responsible for more unnecessary gynecologic surgery than any other condition. It is a staggering number, but about 600,000 American women have a hysterectomy every year. And about 30% of those hysterectomies, 180,000 in all, are performed because of fibroids. For many years these growths have been surgically removed, often because of fear of the problems they might cause in the future. And, those problems are often overstated. While approximately 30% of all women will have fibroids during their lifetimes, the vast majority of these women will never have symptoms and will never require treatment. And, for the rare patient that does have problems, there are a number of sound and effective options available. Hysterectomy should be the solution of last resort.

Pelvic pain that lasts 6 or more months, and is not associated with the menstrual period, is called chronic pelvic pain (menstrual pain is discussed in chapter 3). Chronic pelvic pain is a fairly common problem. It is estimated that about 20% of the visits to gynecologists are for pelvic pain, and one out of every seven hysterectomies are performed for this reason. Chronic pelvic pain can lead to significant distress and even disability. In recent years, a great deal of effort and research has been focused on helping women with chronic pelvic pain and people suffering from all types of chronic pain. Because of this, we are able to help people diminish the effects of pain.

In some situations surgery may be recommended by your physician. Although many people around the world walk into hospitals each day to face an operation, very few of us can do it without at least some fear. It is always a step that requires a great deal of thought and consideration since it involves some discomfort, some risk, and some disruption of one's life.

Throughout history, menstruation has been associated with myth and superstition. Menstrual blood was felt to cure leprosy, warts, birthmarks, gout, worms and epilepsy. It has been used to ward off demons and evil spirits. Menstruating women have been separated from their tribes in order to prevent a bad influence on the crops or the hunt. As recently as 1930, the cause of abnormal menstrual bleeding was felt to be an undue exposure to cold or wet just prior to the beginning of the period.

The terminology used to describe pap smear results has changed over the past few years, leading to confusion about what the results of your pap smear actually mean. Originally, pap smears were divided into 5 "classes" based on what the cells looked like to the pathologist. Class I was normal, while class II cells appeared a little irregular to the pathologist, usually representing bacterial infection. Class III and IV pap smears suggested that dysplastic cells were present, and further testing needed to be done. Class V usually meant cancer.

Leaving ovaries intact during hysterectomies for non-cancerous conditions may boost long-term survival rates for women under age 65, according to the results of a new study published in the August issue of Obstetrics and Gynecology.

Over the past decade, a technique has been developed that can reduce or stop your periods without a hysterectomy. This surgery can be done in women who have flooding either with or without fibroid tumors. Dr. Dott was one of the surgeons who introduced this minimally invasive procedure in Atlanta. He has performed this procedure many times and is certified by the Accreditation Council for Gynecological Endoscopy in Advanced Hysteroscopic Surgery. He has taught this procedure in training institutions both in the United States and Russia.

Chronic pelvic pain (CPP) is often accompanied by poorly defined symptoms and a sense of failure by both doctor and patient.

As our ability to look inside the uterus improves, many women are told they have a common abnormality of the uterine lining, called endometrial polyps. An understanding of these common growths that develop inside the uterine cavity will help patients decide which course of treatment best suits them.

Hysteroscopy is a gynecologic procedure that involves placing a small tube with a camera on one end and a light on the other into the uterus to tell if there are problems within the uterine cavity. This procedure has developed over the years to become one of the more common and useful gynecologic tools. The tube, called a hysteroscope (say “hyst-er-oh-scope”), is about as big around as one’s little finger, and is slipped into the uterus after slowly dilating the cervix. Once inside the uterus a gynecologist can diagnose a number of problems and can often treat them during the same procedure.

Laparoscopy, looking inside the abdomen through a tube placed through a small incision, is a procedure commonly used by gynecologists to diagnose and treat a number of medical conditions. Since the early 1900's when rudimentary laparoscopes were used to visualize, but not treat, abdominal diseases, advancements in this technique have led to the ability to perform complex surgical procedures through a few small incisions, rather than the larger incisions used in the past.

A patient of mine who regularly reads the forum recently asked me about board certification for Ob/Gyn doctors. She explained that there is a lot of confusion about this issue, and that many women's magazines and other media tell women to always seek out the services of an Ob/Gyn who is board certified. So, this looked like a good opportunity to review the board certification process.

Uterine fibroids ( "fibroid tumors";" leiomyoma"; "myomas") are benign, (non-cancerous) growths present in about 30% of women over the age of 30. They are usually detected on pelvic examination, which may reveal the uterus to be enlarged and/or irregular in configuration. The vast majority of cases are absolutely silent and cause no symptoms. The size of a single fibroid may be smaller than a pea, or larger than a melon. In a given patient, there may be a single fibroid, or multiple fibroids of varying size. In the latter situation, the summation of the fibroids of varying sizes will lead to an aggregate size increase.

Approximately 600,000 hysterectomies are performed every year in the United States alone, but only 10% or so for cancer of the uterus, or ovaries and rarely the fallopian tubes. The uterine indications usually are related to problems of bleeding, pain, pelvic tenderness, or a failure of pelvic support that causes uterine prolapse. Much less commonly, ovarian tumors will suggest the need for hysterectomy.

Pelvic adhesions cause many problems for millions of women. From obstructed tubes associated with infertility, to pelvic tenderness, and painful intercourse, to chronic pelvic pain. Curiously, adhesions can be very extensive, yet relatively silent. They may remain silent indefinitely, or long after the causative event, become symptomatic. The causes of adhesions are multiple but basically the tissue irritation that produces the adhesive process arises from an inflammatory event, or from trauma (i.e. post surgical).

"Abnormal Uterine Bleeding" or "AUB" is a relatively common condition. Normal menstrual flow produces less than 3 ounces of blood, in a maximum of 7 days. AUB patterns are characterized by flows that are heavier, and/or more prolonged or more frequent than a 21-28 day interval. AUB can cause anemia, embarrassment, or marked inconvenience. It has been said by many so afflicted women-" I have to plan my life around my period".

Approaching menopause, the bleeding pattern for many women will perhaps change, with cycles either becoming shorter initially, and then with time the menstrual interval will begin to lengthen, be variable and perhaps some cycles skipped altogether, and then finally the periods stop entirely. A woman is said to be menopausal if more than 6 months have elapsed and she has not had a period.

The last time I had seen Mrs. Martin for a checkup was in the winter of 1995. At that time she weighed nearly 250 pounds. During her visit a year later, to my dismay, she had gained another 40 pounds. That’s a lot of weight for anybody to carry around, and it’s of special concern in a woman who stands just 5’1" in her stocking feet.

Fibroids and Hysterectomies used to go together like Rogers and Hammerstein. Not anymore. If your physician recommends removing your uterus as the most effective treatment for severe fibroids without first considering less invasive therapies, start singing another tune and get a second opinion!

Laparoscopy is a form of minimally invasive surgery. The surgeon inserts a tiny telescope (laparascope) though a small incision at the umbilicus (belly-button). The laparoscope allows the surgeon to visualize the pelvic organs on a video monitor. Several additional smaller incisions are made in the abdomen for the surgeon to place specially designed surgical instruments, which help the surgeon carry out the same procedure as in open surgery.

Many gynecologists will remove laparoscopically ovaries/ovarian cysts and treat ectopic pregnancies as well as endometriosis. Hysterectomies, bladder suspension surgeries and pelvic floor repair can also be treated by laparoscopy but these procedures are more advanced and may require additional training.

Hysteroscopy is a form of minimally invasive surgery. The surgeon inserts a tiny telescope (hysteroscope) through the cervix into the uterus. The hysteroscope allows the surgeon to visualize the inside of the uterine cavity on a video monitor. The uterine cavity is then inspected for any abnormality. The surgeon examines the shape of the uterus, the lining of the uterus and looks for any evidence of intrauterine pathology (fibroids or polyps). The surgeon also attempts to visualize the openings to the fallopian tubes (tubal ostia).

In 2009, it was suggested by researchers from the National Birth Defects Prevention Study that nitrofurans and sulfonamides, antibiotics commonly used for the treatment of urinary tract infections (UTIs), may increase the risk of birth defects when taken during the first trimester.

Questions on Laparoscopy & Hysteroscopy