The questions women must ask their OBGYNs about surgery
December 17, 2018 4:35 pm12/17/2018 04:35pm
Too often, the bond established between an OBGYN and the patient can lead to a deficit in treatment options for complex GYN conditions. Without fully understanding their condition, all of the options available, and the benefits and risks associated with doing nothing at all or choosing a treatment plan, these patients depend solely on the advice of their trusted physician. Being equipped with the important questions to ask is essential to ensure you receive appropriate treatment from the right doctor.
COMPLEX GYN CONDITIONS: BRIDGING THE PATIENT INFORMATION GAP
Too often, the bond established between an OBGYN and the patient can lead to a deficit in treatment options for complex GYN conditions like endometriosis, fibroids, and ovarian cysts. In many cases, patients undergo unnecessary open surgery. Without fully understanding their condition, all of the options available, and the benefits and risks associated with doing nothing at all or choosing a treatment plan, these patients depend solely on the advice of their trusted physician. Being equipped with the important questions to ask is essential to ensure you receive appropriate treatment from the right doctor.
The specialists at The Center for Innovative GYN Care (CIGC®) are committed to providing women with the knowledge they need to speak up. It is important for women to get the correct diagnosis early and not to delay treatment. In many cases, OBGYNs are not trained in the advanced surgical techniques necessary to adequately treat complex GYN conditions and often prescribe hormones or pain management in lieu of surgery. In other cases, they advise their patients to watch and wait. In both scenarios, this may only allow GYN conditions to worsen. Questions about conditions and treatments such as endometriosis, fibroids, laparoscopic endometriosis excision, and hysterectomies can be answered with the experts at CIGC.
SEEKING A LAPAROSCOPIC GYN SPECIALIST IS THE BEST WAY TO TREAT ENDOMETRIOSIS
Endometriosis is one of the most misunderstood and misdiagnosed GYN conditions. Fifty percent of women with endometriosis see at least five healthcare professionals before receiving an accurate diagnosis and/or referral. It is estimated that a woman with endometriosis will have to wait seven to nine years for a proper diagnosis of the disease because it is not visible on any type of diagnostic imaging. During that time, the inflammation caused each month can lead to scarring in the pelvic cavity, which can, in turn, lead to infertility, chronic pain, or difficulty going to the bathroom. While initial symptoms can indicate there is a problem, a laparoscopic endometriosis specialist can diagnose and remove endometriotic lesions in the same procedure. If skilled in advanced techniques like bowel and bladder repair, an endometriosis specialist can thoroughly remove all instances of endometriosis in the pelvic cavity to ensure longer relief from pain.
“Over the years, we have seen countless patients who were told their endometriosis pain was just in their head, so that when they come to see us, it’s been years of being under or misdiagnosed,” said Dr. Natalya Danilyants, MD, co-founder of The Center for Innovative GYN Care in Maryland. “Endometriosis can cause a great deal of damage to the reproductive system. If a patient is properly diagnosed early, and treated with laparoscopic excision, the disease and the resulting pain can be managed, while monitoring to minimize the risks of infertility.”
Shelby Steylen had been struggling with menstrual pain since age 12 and eventually agreed to a hysterectomy at age 25. Shelby and her husband both wanted to start a family, but in hopes of relieving her debilitating pain, she underwent a hysterectomy. Shelby was advised the surgery could help the pain, the pain would remain, or the pain could worsen. Just one year after her hysterectomy, the pain had returned, and the endometriosis had fused her uterus to her bowel.
In response to Shelby’s story, Dr. Danilyants explained the importance of finding an endometriosis specialist who can perform a laparoscopic endometriosis excision. A hysterectomy is not a cure for endometriosis. If treated incorrectly, endometriosis can actually get worse. Stage 4 endometriosis — the most severe and complicated form — makes it almost impossible to remove all the tissue. If the tissue isn’t entirely removed, the endometriosis can return worse than before.
“I feel silly for not fighting more,” Shelby said, adding that it can be hard to be confident enough to disagree with your doctor. “If your period is affecting you that much, it isn’t normal. You need to sit down, write down your symptoms, and tell your doctor.”
WHAT TO ASK YOUR SURGEON:
Can you treat endometriosis laparoscopically?
Can you perform endometriosis excision as an outpatient procedure, or will I have to stay overnight in a hospital?
How many endometriosis excision procedures have you performed?
Can you safely remove pelvic adhesions or scar tissue?
Can you safely perform bladder and bowel repairs?
FIBROID TREATMENT IS NOT ONE-SIZE-FITS-ALL
Fibroids, another complex but common GYN condition, affect approximately 80 percent of women by age 50. It is common practice for OBGYNs and primary care physicians to simply watch them and wait for treatment. However, as fibroids can grow extremely fast, waiting to remove a small fibroid can lead to a much more complicated removal procedure down the line – and waiting to remove a large fibroid can result in irreversible damage to the uterus, putting fertility at risk.
Even when a treatment is suggested, oftentimes the solution could be an incorrect fit and even problematic. Treating fibroids with uterine fibroid embolization (UFE) can negatively affect fertility. The goal of the embolization is to block the blood flow either to the fibroid or to the uterus. Women are flocking to this technique, as it is a non-surgical approach, without understanding the potential impact on fertility and the fact that it does not prevent new fibroids from growing.
Before agreeing to a fibroid embolization procedure for large fibroids, women need to know the possible complications that can follow the procedure. Fibroids require blood to grow. Without it, some or all of the tumor will die. With UFE or uterine artery embolization (UAE), plastic particles are injected into the blood vessel to starve the fibroid, resulting in some shrinkage of the tumor. While UFE has been shown to provide short-term benefits in controlling bleeding associated with fibroids, the long-term effects are less positive. The reintervention rate, or additional treatments necessary, was higher than laparoscopic myomectomy. Multiple studies have shown that women have difficulty conceiving after undergoing embolization treatments due to an impaired ovarian reserve, and they have a higher risk of complications during pregnancy including placental abruption, miscarriage, and preterm births.
Fibroids can be removed surgically via either a myomectomy or a hysterectomy. If a patient can maintain fertility, a laparoscopic myomectomy may be possible, but fibroids can return. A hysterectomy is the only cure for fibroids.
OBGYNs are still performing myomectomies and hysterectomies as open surgeries due to lack of laparoscopic training. If performed as a laparoscopic procedure by a specialist, depending on the placement and size of the incisions, the surgery can provide patients with immediate relief and faster recovery than even UFE procedures.
The advanced-trained minimally invasive GYN specialists at CICG developed the LAAMÒ myomectomy for preserving fertility and the DualPortGYN® hysterectomy to remove fibroids. Women with fibroids who are able to get pregnant need to research all treatment options to ensure their future fertility is protected.
“Countless studies have reviewed the aftereffects of embolization treatments for fibroids, and the majority of authorities on women’s reproductive health still caution that embolization is not recommended for women who intend to get pregnant,” said Paul MacKoul, MD. “Laparoscopic myomectomy is the procedure of choice for women with fibroids who want to conceive. Sadly, we see many patients who have had embolization treatments who wanted to be able to have children but were advised by their OBGYN that UFE was a safe option for them. It is common for these women to have either faced difficulty getting pregnant or have had miscarriages after having UFE.”
However, for women past childbearing age, a myomectomy is not recommended due to the risk of future surgical procedures. Fibroids can return, subjecting women to additional myomectomy or hysterectomy down the line; therefore, a hysterectomy should be considered for fibroid removal.
WHAT TO ASK YOUR SURGEON:
How do you perform fibroid removal?
Can you perform a laparoscopic myomectomy or hysterectomy?
How large are the incisions?
Is the myomectomy or hysterectomy an outpatient procedure, or will I have to stay overnight in a hospital?
Can you preserve my uterus for fertility?
How often do you perform a hysterectomy when you plan to perform a myomectomy?
What is the recovery time for a fibroid removal procedure?
NAVIGATING MENOPAUSE SYMPTOMS: HORMONE THERAPY OPTIONS IMPROVE AFTER HYSTERECTOMY
When the time comes to find relief from menopause symptoms, the answers may not always seem clear. There is conflicting information about the risks of hormone replacement therapy (HRT), which can be hard to navigate.
However, in a new comprehensive study, estrogen-only therapy showed no overall increase in breast cancer risk compared to women who had never used HRT. This type of therapy can be safely prescribed to women who no longer have a uterus.
Those using combined HRT, a blend of estrogen and progestogen, had a risk 2.7 times greater than nonusers, significantly higher than previously reported. This is the type of hormone therapy that can be prescribed to women who have not had a hysterectomy. Estrogen-only therapy can negatively affect the uterus and requires progesterone to balance out the effects. If the uterus is still present, estrogen therapy alone can increase the risk of uterine cancer.
The implications for women who have GYN conditions that would benefit from a minimally invasive hysterectomy are now twofold. In addition to treating a condition such as fibroids or adenomyosis, a hysterectomy opens a woman up to a safer form of HRT when she reaches menopause. Hormone therapy can alleviate the often life-altering symptoms of menopause, including hot flashes, night sweats, mood swings, and vaginal atrophy, while reaping the benefits of a decreased risk of colorectal, lung, and breast cancers; coronary heart disease; pulmonary embolism; or stroke.
“For many women, menopause symptoms are incredibly disruptive to their lives so that the benefits of hormone replacement therapy often outweigh the risks, but it is important to understand how we as medical professionals can further advise based on the results of these studies,” said Dr. Paul MacKoul. “These findings make a strong case for the safe use of estrogen therapy after hysterectomy for relief of menopausal symptoms. This is an important factor for older women with fibroids who often believe a myomectomy is a preferable and less invasive procedure than a hysterectomy, which isn’t true.”
“Taking the fear and stigma out of having a hysterectomy is important for medical professionals to work through with patients,” said Dr. Danilyants. “Once a woman is past childbearing, if she is suffering with a GYN condition like large fibroids, a hysterectomy performed with the DualPortGYN technique has exceptional results and will eliminate the need for the higher risk combination hormone therapy once she enters menopause. She can live a healthier, symptom-free life. It’s important to take the patient’s wishes into account when discussing treatment options, but it’s equally important for the patient to have all of the facts. These new findings are an important tool for women to make better choices about their health.”
WHAT TO ASK YOUR SURGEON:
How do you perform a hysterectomy?
How large are the incisions?
Can you perform the hysterectomy as an outpatient procedure or will I have to stay overnight in a hospital?
How long is the recovery?
What are your recommendations for hormone therapy for menopause symptoms?
Diagnosing and treating complex GYN conditions is a complicated matter. And although OBGYNs treat to the best of their ability, it is always important to ask questions and seek a second opinion.
Dr. Paul MacKoul, MD, and Dr. Natalya E. Danilyants are minimally invasive GYN specialists who developed the DualPortGYN and LAAM techniques used at The Center for Innovative GYN Care. These advanced techniques allow women with complex conditions such as large fibroids, extensive endometriosis, adenomyosis, and pelvic adhesions to have outpatient procedures with fast recovery. Book a consultation to learn more about expert treatment of complex GYN conditions.