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Ask The Expert |
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This month's topics |
| Question from Pamela: |
| How common are dermoids? Do all dermoids need to be removed? Am I at a greater risk for ovarian cancer? |
| Answer from Dr. Toub: |
| Dermoids are fairly common, and are the most common benign germ cell tumor of the ovary during pregnancy. It is hard to come by the exact incidence in the general population, but they are most common in women under 40. In general, they should always be removed. Dermoids do not increase your risk of ovarian cancer, and are benign (non-cancerous) tumors by definition. |
| Question from Panther: |
| Ever since I had my hysterectomy done I have been having increasing pain in my ovaries and lower abdomen. Also intercourse was increasingly painful. He has prescribed Keflex and wants to go from there. |
| Answer from Dr. Toub: |
| I would defer to your doctor in this case. There are many possibilities for pain after hysterectomy or any major abdominal surgery, and the evaluation is best left up to your personal gynecologist. |
| Question from Vicki: |
| What causes dysplasia? Is there anything you can do to prevent it? |
| Answer from Dr. Toub: |
| Cervical dysplasia, that are precancerous cells, are generally caused by the human papillomavirus. Smoking also increases one's risk. The only ways to prevent transmission of HPV are 100% compliance with the use of condoms and avoidance of smoking. Fortunately, dysplasia is readily diagnosable with Pap smears and treatment results are generally excellent when diagnosed early. |
| Question from Laura: |
| I need a cystocele and rectocele. Also I have a prolapse uterus and need a hysterectomy. I trust my Dr., but I'm still a little scared, does a hysterectomy sound like the way to go with all the above problems? |
| Answer from Dr. Toub: |
| That would depend on the degree of prolapse, the relative risks of surgery in a given patient, etc. You may need to have another discussion with your doctor so that you are comfortable with the decision to proceed. |
| Question from Lewis: |
| I had a partial hysterectomy after the surgery. My doctor had a biopsy on the removal of the fibroid. It was return saying there was no fibroid. I had an ultrasound it showed a 3cm fibroid. How could this be possible? My ovaries tube and cervix wasn't removed. I'm still having pain. What should I do concerning this matter? |
| Answer from Dr. Toub: |
| It would be inappropriate to comment on specific details of your medical care, as this is not the purpose of this forum. You should have a detailed discussion with your doctor about this matter, in order to have a better understanding of the situation. |
| Question from Marcy: |
| It is common to take out the ovaries as well as the uterus when there are fibroids involved? |
| Answer from Dr. Toub: |
| That would depend upon the age of the patient, the presence or absence of associated ovarian abnormalities, and the desire of the patient. Regardless of the indications for benign hysterectomy, it is an option to remove the ovaries in a woman who is near the age of menopause, since the lifetime risk of ovarian cancer is 1.4%, and this form of cancer is unfortunately often diagnosed at an advanced stage. In my view, this option should be presented to a Peri menopausal patient (typically age 45 or older, although this cutoff varies from doctor to doctor), but the decision should always be that of the patient. |
| Question from Sallie: |
| A&P repair is vaginal reconstruction surgery. If procedure was done abdomen would the vaginal wall have to be cut or trimmed and removed? |
| Answer from Dr. Toub: |
| Generally, an AP repair is a vaginal procedure. In some cases, it has been done laparoscopically through the abdominal cavity, and as far as I know it does not involve trimming the vaginal mucosa (lining), although I cannot say for certain as some practitioners may combine the laparoscopic approach with a modification of the vaginal repair procedure. |
| Question from Sallie: |
| In a forum letter, I read where rectoceles can cause app. 50% of patients' problems with dyspareunia. Is that true? How could the repair cause this problem? If that happened is it still possible to have pelvis to pelvis intercourse. |
| Answer from Dr. Toub: |
| I am not aware that rectoceles are the cause for half of all cases of painful intercourse, and in my experience an untreated rectocele does not generally result in dyspareunia. Repairing a rectocele can, on occasion, cause some degree of dyspareunia, but this should be uncommon. If it did occur, it would relate to post-surgical inflammation and scarring. In general, it should be very possible to have intercourse after a rectocele repair so long as everything has healed (usually after a few weeks or so). |
| Question from Dream: |
| My menstrual cycle very dark color (some clotting) that is progressing more and more. I've been taking Orthro-Tricyclen for two years now. Normally my period is exactly to the day, which is why I am concerned. I also am having some lower pelvic pressure that is spontaneous. |
| Answer from Dr. Toub: |
| Is the problem the quality of the blood or the timing of the period (or both?). The first thing to do is contact your doctor and consider a pregnancy test. Assuming you are not pregnant, your gynecologist should be able to evaluate what is going on. But the critical thing at this point is to rule out pregnancy, since abnormal uterine bleeding may be a sign of a tubal pregnancy that can be life threatening if untreated. |
| Question from Tania: |
| I have a prolapsed uterus Stage 1-2, rectocele and cystocele. This is affecting my ability to do normal things. My options are to have with sutures to hold the uterus and bladder then have a hysterectomy after my second child or Burch Technique. Either way I will have a rectocele and cystocele done. Could you tell me the advantages and disadvantages to these options? |
| Answer from Dr. Toub: |
| Unless you have co-existing uterine prolapse, it is not necessary to do a hysterectomy in order to repair a cystorectocele. The specific options need to be discussed with your doctor. The Burch procedure is not an appropriate operation for a cystocele, although it is an excellent procedure for stress urinary incontinence. Again, you need to have a detailed discussion with your doctor about the indications, risks and benefits of any proposed surgery. |
| Question from Kim: |
| I had a hysterectomy last week and stop breastfeeding that day. A week later my breasts are very sore but not engorgement pain. They left one ovary. Do you have information on breast pain after hysterectomy and breastfeeding? |
| Answer from Dr. Toub: |
| I'm assuming that you had a hysterectomy associated with delivery. My suspicion is that your symptoms are not related to the hysterectomy so much as to breastfeeding itself. A lactation specialist affiliated with your hospital can provide you with individualized advice and instruction. |
| Question from Joe: |
| I have tried to find the answer to this question by visiting nearly a hundred web sites on fibroids. Can a fibroid tumor (about 16-week size uterus) cause rectal bleeding or hemorrhoids? It is causing a lot of pressure and is to the point where it is painful all the time on the left side. |
| Answer from Dr. Toub: |
| Uterine fibroids do not cause hemorrhoids or rectal bleeding in general. While the cause of hemorrhoids is not entirely clear, it probably does relate to increases in rectal straining pressure. A very large fibroid theoretically, over time, might increase the risk of hemorrhoids (just as a developing pregnancy can), but I have never seen this happen nor have I ever heard of this. At the very least, the fibroid would not be the first thing on my list as a cause of rectal bleeding, and this should be evaluated by a gastroenterologist or primary care physician to rule out the more common reasons for rectal bleeding. |
| Question from Olivia: |
| I am 28 years old I had my cervix and uterus removed at age 26. I have PCOS and I want to know am I too young for a total hysterectomy? What are the pros and the cons? |
| Answer from Dr. Toub: |
| If you had your cervix and uterus removed already, then you have had a total hysterectomy by definition. Regardless, polycystic ovarian syndrome is not an accepted indication for a hysterectomy in and of itself. You should consult your doctor to clear up any confusion on this issue. |
| Question from Teresa: |
| What is an endometrial ablation? What is involved in this procedure and how is it done? |
| Answer from Dr. Toub: |
| An endometrial ablation is an outpatient procedure in which the uterine lining is essentially destroyed or removed. This is an alternative for women who otherwise have an indication for hysterectomy, but is not an appropriate procedure for women who desire future fertility. There are many ways to do an ablation-in an operating room setting it is done under hysteroscopic guidance the uterine lining is either destroyed through an electric cautery ball, or else removed in thin strips. Ablation may also be done in an office setting (although not under direct hysteroscopic visualization) with a variety of new devices that act to destroy the lining. You should consult with your gynecologist to get additional information and determine if such a procedure is or is not indicated in your personal situation. |
| Question from Suzy: |
| I have been placed on Premarin .625 mg, which is causing abdominal pain as well as migraines but has done nothing for the hot flashes and night sweats. What should I do: continue taking or consider another method of hormone replacement. |
| Answer from Dr. Toub: |
| You should consult your doctor as to the potential source of your pain. Hormone replacement therapy should not cause abdominal pain and generally should not cause migraines in most cases. Depending on your age, you may require a higher dosage of estrogen to relieve symptoms. If you still have your uterus, you should also be taking progesterone concurrently. |
| Question from Raj: |
| 1. What are the new advances in non-surgical treatment of fibroid uterus? 2. What are the advances in the management of PIH? |
| Answer from Dr. Toub: |
| The best answers to both are fairly long and out of the scope of this forum. In a nutshell, the most significant recent non-surgical treatment of fibroids probably is uterine artery embolization, although in my opinion it remains to be proven in large-scale trials. As far as pregnancy-induced hypertension, there are few significant major advances, although we know a bit more about what things do not cause PIH. |
| Question from Mootown: |
| I am going to have hysteroscopic endometrial ablation done soon. Where does the blood go to if I don't have another period? Will I still go through a menopause? And also, I have a problem due to an imbalance of hormones, so will this problem. Will I still need to take something for my hormonal imbalance? |
| Answer from Dr. Toub: |
| If an ablation produces total amenorrhea (lack of periods), then there is no uterine lining to be shed at all. In most cases, however, menstrual periods still occur, but are usually less heavy. The menstrual blood goes out the cervix as before, since all that is being attempted is removing or destroying the uterine lining itself. You would still experience a menopause later on, and as ablation has no effect on hormone levels, this is a separate issue itself. However, if your abnormal uterine bleeding is due to a hormonal cause, it may be simpler and safer to try to correct this first with hormonal manipulation. You should certainly speak with your doctor to make certain you fully understand the proposed procedure and all alternatives beforehand. |
| Question from Saugestad: |
| How many LEEPs do I or should I have before I have a hysterectomy? |
| Answer from Dr. Toub: |
| Unless there is a bona fide indication for hysterectomy, simply having several LEEPS is not generally considered an indication for this major operation. In some cases, if high-grade dysplasia persists despite multiple attempts at conservative therapy, that would be a judgement call and require individualized management. In the majority of cases, however, conservative treatment of cervical dysplasia, be it with LEEP or laser generally is curative, with the remainder treatable through cone biopsies. Unless there is microinvasive cancer or worse, most women should not require hysterectomy for pre invasive disease of the cervix. The exceptions are those occasional patients who have a genuine premorbid fear of cancer for whom anything less than a hysterectomy will provoke severe anxiety. However most women would find the thought of a hysterectomy much more anxiety provoking than conservative management of dysplasia! |
| DISCLAIMER: The Expert Section is not the place to include lengthy medical histories Any long Questions or urgent matters should be placed on the Women's Health Forum.The above represents material for educational and discussion purposes only. The material provided should NOT be used for diagnosing or treating any health problem or condition. It is NOT a substitute for consultation with and advice from qualified healthcare providers. If you have or suspect you have a health problem, consult a qualified healthcare provider. The author and any other party involved in the preparation or dissemination of the material presented are not responsible for any errors or omissions in the material provided above, or any results obtained from the use of such material. |
