Author Archives: Dr. Kelly Roy, MD

About Dr. Kelly Roy, MD

Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS Dr. Kelly Roy is a specialist in surgical gynecology and advanced laparoscopy (and hysteroscopy). She is a long-time resident of Arizona and obtained her Bachelor of Science degree in Biomedical Engineering at Arizona State University before finishing her Doctorate of Medicine at the University of Arizona in 1997. Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001. Well known for her teaching and surgical ability, she is on the faculty at the residency program at both Banner University Medical Center and Saint Joseph’s Hospital in central Phoenix and is a Clinical Assistant Professor of Medicine at the University of Arizona College of Medicine, Phoenix Campus. Dr. Roy has taught advanced surgical techniques to medical students, residents, fellows and colleagues for over 15 years. Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today. Read More About Dr. Kelly Roy, MD | WebMD Profile | Health.USNews.com Profile

What Is Infertility? And Other Infertility FAQ’s Answered

This entry was posted in Ask An Expert, Health FAQs and tagged Infertility on July 14, 2021 by Dr. Kelly Roy, MD.

Infertility is a widespread condition; millions of people experience it every day. In fact, in the United States alone, 6 percent of women between the ages of 15 and 44 experience infertility. This number doubles if you consider women who can get pregnant but are unable to carry the child to term. Understanding what infertility is and how it is treated is essential for any person or couple struggling to get pregnant.

Infertile Couples Have Trouble Getting Pregnant

Infertility happens when a person or couple has difficulty getting pregnant after having regular, unprotected sex over an extended period, typically a year, without the use of birth control or other measures to prevent pregnancy. The time frame applies to women 15 to 35 years of age. Women 35 or older may naturally have a harder time conceiving and may be treated for infertility after a shorter time, usually around six months.

Infertility also refers to women who become pregnant but are unable to carry a healthy baby to term. An example of this would be a woman who experiences multiple miscarriages.

Infertility FAQs

Below are some frequently asked questions that people have about infertility causes, symptoms and treatments.

What Causes Infertility?

Infertility may be caused by one or many underlying issues. No one solution will guarantee a pregnancy. It usually takes patience and thorough investigative work to find solutions to the problem.

To get pregnant, four major processes need to happen. When something disrupts one of these four processes, it can cause difficulty or prevent the conception of a child.

The steps are:

A woman’s ovaries must produce eggs in her reproductive system for pregnancy. If the ovaries are not producing healthy eggs, it can lead to infertility.
A woman’s eggs must be fertilized by sperm from a male for pregnancy to happen. If there are not enough sperm or sperm healthy enough to reach the eggs, infertility may happen.
There is a passageway in a woman’s body that must provide a clear path for sperm to travel through to make its way to the eggs. Additionally, eggs must be able to travel to the uterus. If anything is blocking these pathways, it can cause infertility.
After an egg is fertilized, it must attach itself to the wall of the uterus. If this does not properly happen, infertility may result.

What Role Does Ovulation Play in Infertility?

Regular periods usually reflect ovulation. Ovulation happens when a healthy egg is sent to the fallopian tubes from the uterus, which is necessary for pregnancy. However, sometimes ovulation doesn’t happen with menstruation, and this is referred to as a disruption of ovarian function. Ovarian functions that are disrupted are the most common causes of infertility.

A woman who does not ovulate during her menstrual cycle has a condition known as anovulation.

This may be caused by:

Diminished ovarian reserve. This is a condition that happens when a woman has fewer eggs in her body than she should for her age.
Functional hypothalamic amenorrhea. This condition happens when unhealthy weight loss or an obsession with exercise affects the ovulation processes. This condition may happen when a person is dealing with an eating disorder.
Polycystic ovary syndrome. This is a condition that may be caused by too much testosterone in a woman’s body.
Issues with the hypothalamus and pituitary glands. These parts of the brain produce hormones that are associated with ovulation. When these hormones are not at the levels they should be or are out of balance, it can cause many problems in the ovulation process.

Is Infertility Caused Solely by a Woman’s Body?

A common myth is that women are solely responsible for infertility. The truth is, men are often part of, or the sole cause of, infertility. Many people are surprised to learn that in 35 percent of cases or more, men are part of the cause of infertility. In just under 10 percent of cases, it is solely caused by the male.

How Can a Man Contribute to Infertility?

There are many common reasons a man may contribute to infertility.

These reasons include:

Being overweight
Excessive or frequent alcohol use
Smoking
Testosterone resulting from medicine
Illegal testosterone use to build muscles

Genetic factors
Certain medications
Exposing testicles to frequent heat
Exposure to radiation
Diabetes

When Should a Couple Consult a Professional Health Care Provider?

A person or couple should consult a healthcare provider after a year of regular, unprotected intercourse without becoming pregnant. However, if a woman is over 35, it is harder to get pregnant, and therefore, she should seek help sooner. The time frame is generally six months after not becoming pregnant. Failure to become pregnant can cause depression, anxiety, and guilt.

Are There any Reasons Someone Should Consult a Doctor Earlier Than a Year?

If you are not over the age of 35 and are having trouble conceiving, there are circumstances where you may want to consult a professional before a year of being unable to conceive.

If you are a woman, you may consult a doctor earlier if you:

Have experienced multiple miscarriages
Experience severe pain during your period
Experience frequent pain during sexual intercourse
Have been diagnosed with a sexually transmitted infection (STI) in the past

Suspect you have an STI
Have acne or excessive body hair
Have been diagnosed with pelvic inflammatory disease

If you are a male, you may consult a doctor earlier than a year, if you:

Have dealt with infertility with other sexual partners
Have a sperm analysis that is abnormal
Experienced testicular trauma in the past

Have had or are being treated by chemotherapy
Have been diagnosed with an STI in the past
Suspect you have contracted an STI

How Is Someone Tested for Infertility?

Many tests can be done to identify the causes of infertility. Tests utilizing x-rays, ultrasound, and a process called hysterosalpingography all help doctors spot things in the reproductive system that may be causing trouble. Investigating a woman’s ovulation cycle is another tool to identify causes. Males will likely have their sperm tested to determine their health and quality of it.

Is Infertility Permanent?

Infertility does not mean the condition is permanent or that there is no solution. Many people become pregnant and go on to carry and deliver healthy children after being diagnosed as infertile.

Can Living a Less-Stressful Life Cure Infertility?

It is a common myth that most infertility can be cured simply by living a less stressful life. The truth is that the intense emotions that accompany infertility might be the cause of stress and not the other way around. While there may be some truth that stress can affect sperm and the production of healthy eggs, the idea that infertility can be treated by stress reduction alone is an unhelpful one. It often intensifies feelings of guilt and self-blame that people dealing with infertility may already be feeling.

How Does a Healthcare Professional Treat Infertility?

Because there are many different causes of infertility, every situation is unique. Some infertility treatments include surgery, medication, or a mixture of both.

A treatment called intrauterine insemination (IUI), more commonly known as artificial insemination, is often used. IUI is considered primarily for cases where the male may be the cause and cases where the cause is hard to pinpoint.

I’ve Heard About Assisted Reproductive Technology. What Is It?

Assisted reproductive technology (ART) refers to many different treatments. The ART most commonly known to the public is in-vitro fertilization. However, ART refers to any treatment of infertility where a woman’s eggs are dealt with outside her body. ART usually involves removing a healthy egg from a woman’s body in a laboratory setting and combining that egg with healthy sperm. Once the egg has been successfully fertilized, it can be returned to the woman’s body. In some cases, a couple elects to have another woman carry the baby, whereas the fertilized egg would be inserted into that woman’s uterus.

Can I Treat Infertility on My Own?

If you and a partner have gone over a year while engaging in a healthy sex life and have not become pregnant, it is likely time to consult a professional. It is estimated that 85 percent of couples become pregnant within the first year of trying, so the numbers suggest that after this amount of time, it may be time to investigate the situation further as medical intervention is likely needed.

Is It Possible to Be Infertile After I’ve Had a Child?

Many people do not realize that they can still deal with and need infertility treatment even after having a healthy child. This can happen because the factors that cause infertility can show up later in life, or there may be underlying causes that weren’t present during the first pregnancy.

Arizona Gynecology Consultants Treat Infertility

If you are experiencing infertility and want treatment from experts with the latest medical knowledge and technologies, contact Arizona Gynecology Consultants today. Our programs investigate your specific fertility needs and provide individualized treatments for anyone dealing with infertility. We’re here to help answer any additional questions you have about your personal symptoms nod possible treatments. Reach out to discuss your options. We’re here for you.

Dr. Kelly Roy, MD

Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS

Dr. Kelly Roy is a specialist in surgical gynecology and advanced laparoscopy (and hysteroscopy). She is a long-time resident of Arizona and obtained her Bachelor of Science degree in Biomedical Engineering at Arizona State University before finishing her Doctorate of Medicine at the University of Arizona in 1997.

Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.

Well known for her teaching and surgical ability, she is on the faculty at the residency program at both Banner University Medical Center and Saint Joseph’s Hospital in central Phoenix and is a Clinical Assistant Professor of Medicine at the University of Arizona College of Medicine, Phoenix Campus. Dr. Roy has taught advanced surgical techniques to medical students, residents, fellows and colleagues for over 15 years.

Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.

www.azgyn.com/

Is It Normal to Feel Tired All of the Time?

This entry was posted in Ask An Expert and tagged fatigue on June 23, 2021 by Dr. Kelly Roy, MD.

Feeling exhausted and drained of energy is unfortunately quite common for a multitude of people across the country. Because of this, many of them don’t acknowledge that being excessively tired is a problem.

Being overly fatigued can be caused by many different aspects of your health and lifestyle. Because of the large number of factors that can cause fatigue, it is important to acknowledge what could possibly be playing a role in making you feel so tired, as sometimes it can be related to health issues. Being exhausted does not have to be part of your daily life.

Here are some things to keep in mind when you’re feeling a little too tired.

What Is Fatigue?

Fatigue can be described as the feeling of being not only tired but completely drained of energy, too. Fatigue is consistent exhaustion that just does not seem to go away, even sometimes when you get enough sleep. This excessive tiredness can be caused by a variety of different elements in your life. And for women, there are even more reasons you may be feeling excessively fatigued that can be directly related to health issues such as hormone or thyroid problems. Because fatigue can be caused by so many different factors in your life, it is important to try and find the root of your problem to try and treat it as effectively as possible.

7 Possible Reasons You Might Feel Tired All of the Time

1. Your Diet

Your diet plays an immense role in the amount of energy you feel you have throughout the day. Making sure you eat enough is crucial to ensure your body gets the boost it needs to get through the day. Eating breakfast also plays a big role, as that is the first meal of the day where you are breaking your fast from sleeping that night, to give your body more energy. You should also be making sure that you are getting enough healthy, whole foods that supply your body with nutrients. All foods should be eaten in moderation, but it is crucial to include some healthy, wholesome foods.

2. Nutrient Deficiencies

Speaking of your diet, there are also other issues that may be causing your fatigue. Many women especially find that they lack the certain vitamins and nutrients they need to maintain energy and hormone levels correctly. Because of this, it’s important to talk to your doctor and understand what nutritional areas you may be lacking in. Taking vitamins and supplements is a small change that may have a big impact on your energy and life overall.

3. Stress

Stress can impact your body and overall health in more ways than one. Consistent stress has the capability of not only negatively affecting your sleep, but your mental and physical health, too. Chronic stress is known to cause anything from muscle tension and headaches to intense fatigue. Learning to identify when your stress levels may be too high and understanding how to cope with them and hopefully lower them is a big step into the process of getting rid of fatigue.

4. Lack of Sleep or Sleeping Disorder

Of course, a lack of sleep plays a big part in feeling tired the next day. The problem is, when you continually do not get enough sleep, your body cannot function the way it should with regular sleep. This causes fatigue as your body literally slows down in order to keep working properly.

If you constantly find yourself unable to fall asleep or stay asleep, you might have a sleeping disorder. Talking to your doctor to see if you may be experiencing a sleep disorder such as insomnia can help you take the next steps towards curing your chronic fatigue.

5. Thyroid Issues

The thyroid helps regulate a lot of different functions of your body. When your thyroid is working incorrectly, for example, if it is underactive, factors such as your metabolism and sleep schedule can be heavily impacted. Many people with an underactive thyroid deal with chronic fatigue, weakened metabolisms, and even hair loss. Thyroid issues are often genetic, making it important to be sure you get yours looked at by a professional.

6. Depression and Anxiety

Depression and anxiety both can affect your energy levels immensely. Depression almost always coincides with a lack of energy and motivation and is actually one of the most common causes of excessive fatigue across the country. Because depression can also affect your mood, many people find themselves with a complete lack of energy and little motivation to do anything, almost making them feel more slowed down and tired.

Anxiety can cause similar issues. For some people, anxiety can cause a lack of sleep, with the inability to calm down. Many people with anxiety deal with racing thoughts, worry, nervousness, or the feeling of impending doom around the time they may need to go to sleep. Because of how heavily both anxiety and depression can affect your energy levels and life overall, it’s important to talk to a doctor to see what you can do to help.

7. Medications You’re Taking

The medications you take may actually have a larger impact on your sleep and energy levels than you might think. Making sure that you not only remember to take your medicine each day but ensuring that you are taking it at the right time can make a big difference. Many medications such as antidepressants are SSRIs, which are meant to be taken in the morning. If someone who is on an SSRI takes their medication at night, they will most likely experience a short burst of energy, racing thoughts, or the inability to fall or stay asleep due to the medication kicking in.

How Do I Boost My Energy?

Do you find yourself wondering why you constantly feel tired or why your energy is so low? While there are a multitude of factors that can go into causing your fatigue, there are also a lot of natural ways that you can combat it. Make sure you stay away from substances like sugary, caffeinated energy drinks that will ultimately make you feel worse.

Here are a few ways to naturally boost your energy:

1 .Taking Supplements and Vitamins

Because so many people deal with vitamin deficiencies for so long without realizing, oftentimes when their body becomes regulated with the correct levels of vitamins and nutrients, energy levels start to boost themselves.

There are also some natural supplements, both by themselves or combined as suggested by healthcare providers, that can help give you energy. Supplements such as B12 and Ashwagandha can help naturally increase your body’s energy levels. Taking the vitamins your body needs while also supplementing with other natural ingredients may help get your energy levels where they need to be.

2. Eating Enough and Eating Whole Foods

As diet culture still reigns supreme through most media nowadays, it is important to remember how crucial it is to make sure you are eating enough. Your body uses food as energy, it’s as simple as that. When you don’t eat enough, your body does not have enough energy to serve you the way it should. When you eat enough, and on top of that, eat healthier, whole foods, your energy levels should naturally begin to shift.

3. Move More

It may seem counterintuitive at first, but it’s been found that people who are more active and move more regularly in their day-to-day lives also deal with less fatigue and get better sleep. Sedimentary lifestyles often leave you feeling fatigued, yet sometimes full of energy at the same time, often leading to bad sleep patterns.

And as people age and lifestyles change, many find that they are just not moving enough anymore. Being active helps to not only use excess energy (if you have any), as well as help you be able to get a more full, deep rest at night. Being active also helps release natural chemicals in your brain such as serotonin and dopamine, giving you a natural energy boost.

4. Managing Stress

Stress is an energy drainer. Those who find themselves consistently dealing with high levels of stress in their life may also find that they are immensely fatigued as a result. Not only does stress drain your energy levels, but it also keeps you from getting the rest you need. Many people that deal with stress have racing thoughts and trouble stopping these thoughts. Because of this, they often have issues falling and staying asleep, as their brain can’t ever shut off for long enough to recoup.

5. Get Some Sleep/Take a Nap

While it might not be quite that simple for everyone, sometimes the best way you can give yourself a natural energy boost is by getting some quality sleep. Most people do not get the right amount of sleep they actually need each night, resulting in a constant state of fatigue that they can’t seem to find their way out of. Whether you start trying to go to sleep an hour earlier or you talk to your doctor about finding a medicine that might be able to help, making sure you get enough sleep needs to be made a priority in your life.

Should I Be Worried About Being Tired All of the Time?

While being tired isn’t necessarily the biggest issue you might have right now, if you are dealing with consistent, intense fatigue, you should talk to your doctor. Unfortunately, chronic fatigue can be related to a variety of different health issues. Consulting your doctor, describing your problems, and trying to find the source of the problem is the smartest thing you can do so that you both can work to accurately treat it and hopefully transform your energy levels.

Taking Care of Your Health

Here at Arizona Gynecology Consultants, we prioritize your health. There are a variety of factors that go into your overall health and well-being, sometimes making it complicated to keep up with. We work to ensure that you are provided with top quality, professional services by experienced providers so that you can achieve your best health.

If you’re feeling excessively tired or fatigued, contact us today to schedule a consultation so we can help you identify and address any underlying issues. You don’t have to suffer through it!

Dr. Kelly Roy, MD

Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS

Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.

Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.

www.azgyn.com/

What You Need to Know About the Sonata Fibroid Treatment

This entry was posted in Procedures and tagged Fibroid Treatment on June 9, 2021 by Dr. Kelly Roy, MD.

Most people are likely to agree: After receiving a diagnosis of any kind, it’s a relief to learn that the treatment is minimally invasive or non-surgical. It’s even better when the condition doesn’t require treatment, of any kind. Much of the time, that’s exactly the case for uterine fibroids. If small enough, the fibroid likely won’t cause any symptoms, and won’t need to be treated. In some instances, fibroids may need to be treated with medication.

However, this isn’t always the case for larger, more severe uterine fibroids. In some instances, these fibroids may be large enough to impair fertility — they may also cause more intense and uncomfortable symptoms, such as excessive menstrual bleeding. This is the point at which a fibroid would typically need to be surgically removed.

Historically, uterine fibroids have been removed using procedures such as hysterectomies and myomectomies. Surgeries such as these can have a substantial impact on the patient’s life, moving forward. For example, although receiving a hysterectomy (the complete removal of the uterus) will ensure that fibroids do not grow back, it will result in the person being unable to have children. The decision to receive a hysterectomy can be a difficult one to make.

More recently, non-surgical solutions to uterine fibroids have been developing — this includes the Sonata® fibroid treatment.

What Are Uterine Fibroids?

Uterine fibroids are growths on the uterus. They’re non-cancerous, and very rarely develop into uterine cancer. Fibroids typically develop during childbearing years.

The size of a fibroid varies quite significantly, depending on the individual. At their smallest, fibroids can be as tiny as seedlings — so small that they may not even be visible to the human eye. However, if they grow larger and more severe, fibroids can become significant masses, which are able to enlarge and even distort the uterus.

The number of fibroids someone possesses can also vary from person to person. It’s possible to develop just a single uterine fibroid. It’s also possible to develop multiple fibroids. In some especially extreme instances where a person has large or numerous fibroids, the uterus can enlarge to the point where it comes into contact with the rib cage, even adding weight to the person’s body. (However, this isn’t a common scenario.)

Many women will develop uterine fibroids at some point in their lives, leading up to menopause. As a whole, the condition is quite common. Since fibroids often don’t lead to symptoms, many women with fibroids will remain entirely unaware. Still, it is possible for fibroids to be discovered during a prenatal ultrasound or a pelvic exam. In these symptom-free fibroid cases, the individual will likely not require treatment, of any kind.

In instances where fibroids do lead to symptoms, here’s a clearer idea of what to look out for:

Menstrual bleeding that’s heavy and lasts longer than a week
Pain or pressure in the pelvic region
Frequent urination and difficulties emptying the bladder
Pain in the legs or back
Constipation
Painful sex
Fertility issues

If you begin to notice any conjunction of these symptoms, then be sure to consult your doctor.

What Is the Sonata® Treatment?

The Sonata® Treatment is a minimally invasive option for treating symptomatic uterine fibroids. It has been approved by the U.S. Food and Drug Administration (FDA), making it a viable and effective option for fibroid treatment in the United States. It was developed by Gynesonics, a women’s health care company that focuses its efforts on developing transcervical technologies that are incision-free and minimally invasive. These technologies are intended to be uterus-preserving and can be used for the purpose of diagnosis and treatment of women’s health conditions.

The treatment is fully incision-free and begins with the use of an intrauterine ultrasound device. Using this device, a medical professional is able to find and target individual uterine fibroids. Upon discovery, radiofrequency energy is sent to the fibroid being targeted, leading to a reduction in size, as well as less severe symptoms in the patient.

In many ways, the Sonata® system is a breakthrough method of treating symptomatic uterine fibroids. Thanks to the treatment, instances of hysterectomies and myomectomies can be reduced, and the uterus can be preserved. Additionally, the Sonata® treatment is versatile, being capable of treating various types, sizes, and locations of uterine fibroids.

According to clinical studies, the Sonata® system has been shown to reduce fibroid systems. Within three months of the treatment, close to 90 percent of women saw a significant reduction in menstrual bleeding. Within a year, this number rose to around 95 percent of women. Further, following their treatment using the Sonata® system, over half of the patients had returned to their regular activities by the next day. This is a far different scenario than if the patient had received a hysterectomy or a myomectomy instead.

How Does the Sonata® Treatment Work?

The Sonata® treatment can be used to treat uterine fibroids of different sizes and types, as well as fibroids found at different locations in the uterus. No incisions will need to be made. The Sonata® procedure is often performed while the patient is under anesthesia. The fibroid specialist will begin by inserting the intrauterine ultrasound device — it will be inserted into the uterus via the vagina.

Using this ultrasound device, the specialist will be able to begin locating the uterine fibroids. Once the fibroids have been accurately pinpointed, the radiofrequency energy will be introduced directly to the growth. This begins the process of a gradual shrinking of the fibroid, which will continue over time. This also leads to the eventual reduction of (or relief from) symptoms associated with uterine fibroids.

Given the nature of the treatment, the uterus is not harmed in the process. Unlike with a hysterectomy, the uterus is fully preserved and has the potential to heal. The Sonata® treatment is also an outpatient procedure, rarely taking more than one hour for a specialist to complete.

What Are the Benefits of Using Sonata® for the Treatment of Women With Uterine Fibroids?

Unsurprisingly, the Sonata® system offers a large variety of benefits, compared to other treatments women may receive for symptomatic uterine fibroids. Here’s an overview of those benefits:

Given that the Sonata® system is capable of targeting and treating a variety of fibroid locations and types, it is a uniquely versatile method of treatment. If you’re currently experiencing symptoms as a result of uterine fibroids, there’s a good chance you’ll be able to qualify for the Sonata® treatment. You won’t have to worry about your fibroids being “severe enough” to warrant treatment using the Sonata® system — if you’re experiencing symptoms of any degree, this could be an option to suit you. Consider having a conversation with your doctor, if you’re unsure.
Unlike many of the existing treatments for symptomatic uterine fibroids, the Sonata® system requires no incisions or surgical interventions. It is also possible for the procedure to be performed without general anesthesia, based on your preferences or your specialist’s. Due to the lack of surgical intervention, you should expect a far shorter recovery time compared to if you received a hysterectomy or a myomectomy. Also, unlike these more invasive procedures, the uterus is preserved. This can be a huge long-term benefit for many women. Receiving fibroid treatment via the Sonata® system will not damage your ability to have children in the future.
Due to the minimally invasive nature of the treatment, there is no scarring associated with the Sonata® system.
There’s not just a shorter recovery time for those who receive the Sonata® treatment, but in addition, there will be a far shorter hospital stay to account for as well. Plus, in many cases, women who’ve received the Sonata® system treatment have been able to return to their usual daily routine by the very next day.

Is the Sonata® Treatment Covered by Insurance?

As is the case for most new medical treatments, insurance coverage can vary from provider to provider. After having a conversation with your doctor and establishing that the Sonata® system is a viable treatment for you, your specialist can work with your insurance and check for coverage.

Fortunately, health insurance coverage for the Sonata® treatment is expanding. Just within the first six months of 2020, over 50 million new individuals became eligible for the Sonata® system, should they ever require it.

Clinicians like Dr. Bradley Hurst — the current Director of Assisted Reproduction at Atrium Health’s Carolinas Medical Center — are putting in the effort to improve the availability of the Sonata® system, by helping to expand insurance coverage for the procedure. For example, Dr. Hurst has put in substantial effort to improve access within the Charlotte, North Carolina area.

Fortunately for fibroid patients, many health care professionals see the value of medical innovation — not just Dr. Hurst, although he is certainly a great example. These specialists and professionals are collaborating with commercial payers, hoping to expand the public’s access to the groundbreaking Sonata® treatment.

Medical directors of commercial insurance companies will determine whether certain treatments are safe, necessary, and effective enough, in order to warrant insurance coverage. They will also look at the cost-utility of that treatment, based on the disease state. Since medical policies are reviewed annually (at a minimum), there is a good chance that coverage for the Sonata® system will only continue to expand, given the effectiveness of the treatment. This is wonderful news for individuals searching for a non-invasive, uterus-preserving fibroid treatment, within their budget.

In the short time it’s been available to the public, the Sonata® treatment has made a clear impact on how symptomatic uterine fibroids are approached and treated. With the development of the treatment, it’s become increasingly obvious that surgical intervention, such as with a hysterectomy or a myomectomy, isn’t always necessary to eliminate symptoms.

Sonata® Treatments at Arizona Gynecology Consultants

At Arizona Gynecology Consultants, we’re proponents of medical interventions that improve lives. We also provide consulting services for gynecological surgeries, including the Sonata® treatment. You can always expect our team of dedicated healthcare professionals to treat your situation with the utmost compassion and respect. We bring high-quality health care services to the Phoenix metropolitan area, at several convenient locations.

Do you have any questions about the Sonata® treatment? Interested in learning more about our other gynecology services?

Dr. Kelly Roy, MD

Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS

Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.

Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.

www.azgyn.com/

What You Need to Know About Urinary Incontinence

This entry was posted in Health FAQs and tagged Clinical Treatment, Signs And Symptoms on May 27, 2021 by Dr. Kelly Roy, MD.

Let’s face it; some medical concerns are a bit harder to share than others. One concern that is often pushed under the rug is urinary incontinence. This complication can impact both men and women, and the possible triggers for this issue are numerous. What is most soothing is the fact that it can often be completely treatable or at the very least manageable.

What is urinary incontinence?

Simply put, it is the leaking of any urine that you are unable to control. It is hard to gather specific statistics because of an assumed level of reserve due to embarrassment; this can impact your medical situation and your emotional, psychological, and social life. It ultimately keeps a person from thoroughly enjoying their life. Millions of Americans are affected by this issue, so there is no reason to feel shame or embarrassment. The faster an individual finds an excellent treatment plan, the sooner they can return to regular life.

Understanding Risk for Incontinence

When it comes to the risk of developing urinary incontinence, the chances vary drastically. Some symptoms of UI can point to larger issues that may need to be seriously addressed, while others may be milder and more temporary. The good news is that for most, these risks can be resolved quickly, leading to an only temporary risk of developing urinary incontinence. Risks can include:

Pregnancy, the form of delivery, and number of children.
Post-menopause or instances where you may have a drop in your estrogen levels.
Prostate issues, especially for men.
Poor health, such as diabetes, stroke, high blood pressure, or obesity.

What Are the Symptoms of UI?

The truth is that these symptoms can vary depending on the type of UI you may have. The basic concept is that there is a miscommunication between your brain and your bladder. Your bladder stores the urine, and the muscles in your lower pelvis are responsible for holding tight. When ready, your brain sends a signal to the bladder, the muscles contract, and urine is forced through the urethra. When it comes to dealing with urinary incontinence, it can impact a variety of these steps. There are four most common types of urinary incontinence.

Stress Urinary Incontinence (SUI)

This result is from weak pelvic muscles. It is the stress caused by physical pressure versus mental stress. It is one of the most common instances of UI. The common symptoms include small amounts of urine escaping while exercising, walking, bending, lifting, sneezing, and coughing. These symptoms can range from mild, moderate to severe. How is UI treated? For this type, there is no medical specific treatment. Lifestyle changes may help, as well as utilizing Kegel exercises to strengthen your pelvic walls. With today’s advancement in technology, all you need is a small device and a smartphone to conveniently exercise your pelvic walls. This condition is usually caused by pregnancy or childbirth, menopause, hysterectomy, age, or obesity.

Overactive Bladder (OAB)

This is another common form of UI. This is also known as the “urgency” incontinence. Your body essentially gives you a little warning when it comes to needing to urinate. You could suddenly feel an urge due to shifting position, hearing running water, or even during sex.

What are the symptoms of UI?

In this case, your bladder tells you it needs to empty, even when it isn’t full. You can’t control or ignore the symptoms of this form of a UI. It can hit unexpectedly, leaving your life and daily activities interrupted, often without a moment’s notice. This impacts at least 30% of men and 40% of women in the U.S. alone. This can be caused by cystitis, which is an inflammation of the lining of the bladder. It can also be caused neurologically through multiple sclerosis, stroke, and Parkinson’s. An enlarged prostate can also cause it.

Mixed SUI and OAB

This sounds exactly how it is. You’re impacted in part by both the most common issues of UI. You may “leak” a bit at times unexpectedly, following a good sneeze or even a laugh. You may also feel the sudden, undeniable urge to pee without a moment’s notice.

Overflow Incontinence

This is where your body makes more urine than it can hold, or your bladder may be full but for whatever reason can’t empty. This is rare in women and is most often found in men with prostate problems. This is typically created through a blockage or obstruction caused by an enlarged prostate, a tumor pressing onto the bladder, urinary stones, or constipation.

Total Incontinence

While less likely, certain individuals may have to deal with this form of UI. It can be caused by various factors, including anatomical defects from birth, a spinal cord injury that impacted the communication between the brain and the bladder, or a fistula. A fistula is a tube or channel that develops between the bladder and a nearby area, usually the vagina.

General Symptoms of Incontinence

The good news is that not all these symptoms are long-term. Many are short-term and potentially treatable. There are some general symptoms, including vaginal infections, irritations, medication use, constipation, general mobility, and UTI (urinary tract infection) that are often common causes.

Temporary Symptoms of Incontinence

Sometimes, all fingers can point toward your diet when it comes to issues with UI. Different foods, drinks, and medicines can all affect your urinary continence. Drinks such as alcohol, caffeine, and carbonated drinks can impact your body differently. This also includes artificial sweeteners, spicy foods, sugar, acid, even chocolate!

Potential Complications of UI

Dealing with a UI can impact many different facets of your life. You may also develop skin problems. This could include sores, rashes, and infections caused by the skin being wet or damp most of the time. This can lead to complications with any wound healing and can promote fungal infections. Prolapse is rare but still a risk to consider, especially if your UI goes untreated. This is when a part of the vagina, bladder, or urethra falls into the entrance of the vagina, typically due to an extremely weak pelvis wall. In an instance such as this, surgical intervention will be necessary.

When Should I See a Doctor?

The short answer is the sooner, the better! If you notice an increase in frequency that can’t be easily explained, such as a dramatic increase in water intake, it may be a sign of a larger concern. This especially becomes a concern when it starts to impact the overall quality of your life. If you find yourself restricting activities such as going out for dinner, having drinks with friends, enjoying outdoor adventures or sports, this is no good!

You shouldn’t have to limit your social interactions due to urinary concerns. Your quality of life should be your number one priority. There is no reason to suffer in silence, especially because there are numerous remedies to many different UI issues. You’ll also want to consider your age. The speed at which you may make it to and from the bathroom can vary with age, weight, and other mobility factors. You’ll want to be aware of additional risks of falling and other injuries when trying to race against a sometimes unpredictable clock. There is also the risk that your UI is a sign of a much larger issue. You’ll want to handle these issues early on before they lead to more serious complications down the line.

Urinary Incontinence Diagnosis

Wondering how UI is diagnosed? Many different methods can be used to determine if you have a UI and what form you may be experiencing. These methods vary, so it is best to try to explain your situation as well as possible to your medical professional. This may help put the focus on what is most likely impacting you.

Bladder Diary

This may seem a bit silly at first, but it can help pinpoint precisely what form of UI you may be dealing with. You’ll want to keep track of how much you drink to start. You may want to specially note if your intake has suddenly increased or decreased for whatever reason. You’ll also want to keep track of when urination occurs, as well as if you experienced any incontinence throughout the day. Even the smallest leak can interrupt your day, so keeping track of the small nuances can make a huge difference.

Physical Exam

Your doctor may not necessarily ask you about your bladder health. The largest stigma with UI is the feeling of embarrassment, but if you don’t share with your doctor, they will not be able to help you. When getting your physical exam, be sure to share your concerns with your doctor. Millions of Americans struggle with UI issues, so there is no reason to be shy. Upon your physical exam, your doctor can check for the strength of your vaginal walls, or for men, any risk of having an enlarged prostate.

Urinalysis

This will help determine if you have any signs of infection or abnormalities.

Blood

Simple blood work can rule out many potential issues, especially when it comes to kidney function, which can impact your urinary health.

Postvoid Residual (PVR) Measurements

This test can help determine how much urine is left in the bladder after urination. For those who suffer from an overactive bladder or one that tends to overflow, this could finally lead you and your medical professional in the right direction for treatment.

Pelvic Ultrasound

If a typical physical examination doesn’t provide enough information, a pelvic ultrasound may be the next best step. This creates an image of your pelvic area that can help pinpoint any abnormalities or inconsistencies that may not have been initially discovered.

Stress Test

This form of testing can include testing your body’s ability to react to sudden pressure.

Urodynamic

This test determines how much pressure your bladder and urethra can withstand.

Cystogram

This x-ray focuses explicitly on the bladder to check for any abnormalities or concerns that wouldn’t be found in a typical exam.

Treatments for Urinary Incontinence

How is UI treated? There are many different methods when it comes to treating UI. Many of these treatments will vary depending on the severity of your condition. These treatments can range from at-home activities to surgical intervention. Some of the most common forms of treatment include:

Bladder Training

This can involve a few different types of exercises. Most commonly, they are:

Delay-control urge—This is feeling the need to urinate but training your body to wait, even if it is only for short periods at first.
Double voiding—This is the process of urinating, waiting, and then urinating again.
Toilet timetable—Sometimes routine is key. This bladder training is structured so that you create specific times in which to use the bathroom, for example, every two hours. This makes a predictable routine for your body to follow.

Medications

Medicine is rarely used alone. It is often paired with other techniques or exercises to improve UI symptoms. Medicines often prescribed include:

Anticholinergics—This is a medicine that can be used to calm an overactive bladder.
Topical estrogen—This helps reinforce the tissues in the urethra and vaginal areas. It can also help to lessen symptoms caused by UI.
Imipramine—A tricyclic Dealing with complications in such an intimate part of your body can lead to depression, anxiety, and a desire to pull away from certain social interactions. It is important to allow your medical professional in so that they can try to alleviate some of these issues.

You May Have Urinary Incontinence, But So What?

Millions of Americans deal with some form of UI every day. This number is hard to measure due to the feeling of embarrassment that stops many from sharing their experience. The truth of the matter is that many people deal with various forms this condition may present itself in. Whether you feel you go to the bathroom too much, too little, or just too unexpectedly, there are various exercises and treatments that could help alleviate your symptoms. What matters most is your ability to be open and honest with your health care professional. You may feel you are alone, but in fact, you are with a great majority of people who experience similar issues. Break the silence and give yourself the opportunity to truly live life to its fullest. You should never feel chained to the restroom.

Life is too short to let UI stop you from living each day to the max.

Editor’s Note: This article was originally published August 7, 2017 and was updated May 27, 2021.

Dr. Kelly Roy, MD

Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS

Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.

Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.

www.azgyn.com/

What Is Menopause?

This entry was posted in Health FAQs and tagged estrogen therapy, Holistic, hormone therapy, menopause on April 5, 2021 by Dr. Kelly Roy, MD.

Menopause is a gradual biological process that eventually leads to the cessation of menstrual periods. Once a woman becomes menopausal, ovarian functions cease, and she will no longer be able to have children. Signs of menopause may vary among different women, especially regarding menstruation changes; a doctor will diagnose a woman with menopause after she has gone a full 12 months without experiencing a menstrual period. Going through menopause can be an incredibly emotional experience, and the loss of the ability to have children can be devastating, especially for a woman who has never had children and who experienced menopause earlier than usual. However, several effective treatments are available to help manage menopause symptoms, from simple adjustments to lifestyle changes to hormone therapy.

Menopause Age

Excluding external causes, menopause typically results from the natural decline of a woman’s reproductive hormones as she ages. Menopause generally occurs in the early 50s, but some women can experience it as young as the 30s or as old as the 60s. In most cases, as a female nears her late 30s, her ovaries will make lower amounts of the hormones progesterone and estrogen, the two primary hormones responsible for regulating menstruation and for releasing eggs during ovulation, and fertility declines. After reaching her 40s, she will experience irregular periods that become shorter or longer, lighter or heavier, and occur more or less frequently. Then, usually around the age of 51, her ovaries will stop releasing eggs, and she will no longer experience periods.

Signs of Menopause

Menopause generally includes three stages, perimenopause, menopause, and post-menopause.

First Stage: Perimenopause

Perimenopause can last for quite a long time and generally entails symptoms that prepare the woman’s body for menopause. Perimenopause lasts for about four to five years or until menopause occurs, which is when the ovaries stop releasing eggs altogether.

During the years between the onset of perimenopause and menopause itself, women generally experience:

Low estrogen levels
Irregular periods
Worsened premenstrual symptoms
Mood changes
Headaches
Slowed metabolism and weight gain
Vaginal dryness
Breast tenderness
Loss of fullness in breasts

Dry skin and hair loss
Hot flashes, accompanied by sweating or a flushed face
Chills
Decreased sexual interest
Fatigue, sleep problems, and night sweats
Aches and pains in joints and muscles
Urinary incontinence

Skipping periods during this stage is expected and common. Sometimes, a woman may skip a menstrual period one month only to experience it the following month or skip several months in a row and then return to a monthly cycle for a few months. Menstrual periods during perimenopause occur on shorter cycles, meaning they come closer together.

Second Stage: Menopause

The full onset of menopause refers to the cessation of menstrual cycles for one full year. During this time, women may experience a wide range of possible effects, and may develop other medical conditions as a result. For example, some women develop osteoporosis or heart disease during menopause. Doctors can provide customized treatment to individual patients to address their unique symptoms.

A frequently asked question by women close to menopause age is: Can you get pregnant during menopause? The answer is yes; even though periods are irregular, it is still possible to become pregnant. If you have experienced a skipped period but are unsure if you have entered menopause, you should take a pregnancy test.

Final Stage: Post-Menopause

The term “postmenopausal” simply refers to women who have already reached menopause. Every woman will experience menopause and the postmenopausal stage differently.

Hormonal imbalances can lead to the appearance of more body hair in some women, as testosterone production continues while estrogen production diminishes. Some women experience weight fluctuations and changes in skin texture.

External Causes of Menopause

Although every woman will inevitably experience menopause due to declining hormones, some women experience it at earlier ages due to external influences. Some medical conditions and diseases may require surgeries that cause menopause to begin very soon thereafter. Women who experience menopause in this manner often report more significant symptoms than women who experience menopause naturally.

Oophorectomy

Some women will experience menopause early due to problems with the ovaries. If a woman develops ovarian cysts or ovarian cancer, her doctor may recommend surgical removal of the ovaries, which will then spur the onset of menopausal symptoms. Typical menopause entails a full year of cessation of ovarian function, so surgical removal of the ovaries will lead to menopause. Symptoms may be severe because these hormonal changes occur abruptly instead of increasing gradually over several years as they would under normal circumstances.

Hysterectomy

A hysterectomy is a surgical procedure that removes a woman’s uterus; it may be performed due to fibroids, cancer, endometriosis, pelvic inflammatory disease, or uterine prolapse. A hysterectomy can involve the removal of the ovaries and can include the removal of the cervix, uterus, fallopian tubes, and the top portion of the vagina. Only removing the ovaries will induce immediate menopause, but a hysterectomy without removal of the ovaries can still cause women to experience menopausal symptoms such as hot flashes after surgery. These symptoms are typically only temporary and become less severe as the patient recovers.

Chemotherapy and Radiation Therapy

Women who develop some forms of cancer and undergo radiation treatment and chemotherapy may also experience menopause sooner than expected. Cancer therapies can induce menopause symptoms during or shortly after receiving treatment, but some women do not report experiencing such symptoms for quite a long time after completing cancer treatment. The impact on menstruation and fertility may not be permanent, so it is recommended to continue using birth control methods. Depending on the cancer and the treatments’ location, an ovulating woman can experience menopause due to interference from these treatments. Radiation therapy should only affect ovarian function if the radiation is directly targeted to the ovaries, while radiation targeted to the other parts of the body does not affect menopause.

Primary Ovarian Insufficiency

About 1 percent of all women experience premature ovarian failure—or ovarian failure before 40. This occurs when the ovaries fail to produce normal amounts of reproductive hormones, referred to as primary ovarian insufficiency. Doctors cannot predict when this will occur and do not know for certain why it happens; many researchers suspect genetic links and autoimmune diseases as contributing factors. In these cases, hormone therapy is recommended to protect the brain, heart, and skeletal system, at least until the woman reaches the natural menopause age.

Medical Complications

The loss of estrogen that results during menopause is associated with various health problems that increase in prevalence as women age, including decreased skin elasticity, reduced muscle strength and tone, a higher risk of developing Alzheimer’s disease, and vision problems such as cataracts and macular degeneration. The following medical complications are most common in postmenopausal women: cardiovascular disease, osteoporosis, urinary issues, sexual dysfunction, and weight gain.

Cardiovascular Disease

Cardiovascular disease is the number one leading cause of death among women, and the decline in estrogen women experience during menopause directly correlates with an increased risk of cardiovascular disease. Estrogen has a protective influence on the artery wall’s inner layer by helping the blood vessels stay flexible, so they can relax and expand when necessary to accommodate blood flow. Along with the reduced estrogen, other changes occur later in life that can affect postmenopausal women’s heart health, including increases in blood pressure, bad cholesterol, and triglycerides, a certain form of fat in the blood. Eating a healthy diet full of nutritious foods, keeping a regular exercise routine, and maintaining a normal weight is essential for reducing cardiovascular disease risk during menopause.

Osteoporosis

Osteoporosis is a progressive medical condition that causes bones to weaken and become brittle, increasing their vulnerability to fractures. Women comprise 80% of osteoporosis patients and are four times as likely to develop this disease as men due to thinner, lighter bones and longer life expectancy. Along with its function in the reproductive system, estrogen supports the strength and density of bone mass by inhibiting the process of bone resorption. Throughout the first few years of menopause, decreased estrogen levels cause women to rapidly lose bone density, heightening the risk of developing this condition. Postmenopausal women suffering from osteoporosis are particularly susceptible to fractures in the wrists, hips, and spine.

Urinary Issues

The loss of elasticity in the vagina tissues and urethra may lead to several urinary system issues. Typically, this includes the sudden, frequent, strong need to urinate, followed by incontinence. Incontinence occurs in two types, urge incontinence and stress incontinence. Urge incontinence is losing urine after experiencing this sudden need to urinate. In contrast, stress incontinence involves losing urine due to laughing, coughing, sneezing, lifting, or other motions that place stress on the bladder. Additionally, urinary tract infections may occur more frequently. Treatment of incontinence includes Kegel exercises that strengthen the pelvic floor, topical estrogen applied to the vagina, and hormone therapy.

Sexual Dysfunction

A combination of vaginal dryness due to reduced moisture production and loss of elasticity in vaginal tissue may result in discomfort, pain, and slight bleeding during intercourse. These adverse side effects make it difficult for many postmenopausal women to become aroused as easily as they did in the past, causing a significant loss in libido or even a total lack of sex drive. Lower estrogen also causes less blood to flow to the vulva, clitoris, and vagina, and these decreased sensations may also reduce the libido. Water-based lubricants and moisturizers can alleviate vaginal dryness in many cases, but when this isn’t enough, local vaginal estrogen treatment can be recommended in the form of a vaginal tablet, cream, or ring.

Weight Gain

Due to the hormonal changes that occur, many women gain weight quickly during menopause, especially in the abdomen. Simultaneously, as a woman ages, she loses muscle mass while gaining fat, slowing down her metabolism. This makes it more challenging to maintain a healthy weight, even with the same eating and exercise habits maintained before the onset of menopause. Genetic factors can also increase vulnerability to postmenopausal weight gain. Excess weight, particularly in the abdomen, heightens the risk of developing cardiovascular disease, breathing problems, Type 2 diabetes, and several forms of cancer, such as colon, breast, and endometrial cancers. Combating this weight gain requires exercise, healthy eating habits, limiting sugary foods, and avoiding alcohol.

What Is Menopause: Diagnosis

Menopause symptoms are typically sufficient to alert most women that they have begun the menopausal transition. However, if you are experiencing irregular periods, hot flashes, or other signs of low estrogen, it is always a good idea to contact your primary care physician to discuss your situation. In some circumstances, your doctor may recommend blood screenings to measure your levels of follicle-stimulating hormone (FSH) and estrogen (estradiol). As menopause occurs, FSH levels increase, and estrogen levels decrease. Because hypothyroidism can produce symptoms similar to those experienced during menopause, you may also undergo a thyroid-stimulating hormone (TSH) screening to rule this out as the cause of your symptoms.

Menopause Treatment Options

Although some external factors can cause menopause early, naturally occurring menopause is a fact for every woman. While menopause is not a medical condition and does not require treatment, it can still produce negative symptoms for some women. In fact, numerous studies of postmenopausal women conducted around the world found that hot flashes after menopause continue to occur for years, sometimes affecting women even 20 years after the initial onset of menopause. With these symptoms occurring so frequently and potentially lasting for decades, many women seek treatment options to manage their symptoms.

Based on your medical history and menopause symptoms, your doctor may suggest estrogen therapy to make up for lost natural estrogen production and relieve hot flashes. Typically, estrogen is provided at the lowest dose and within the shortest time frame that will provide effective symptom relief. Women who experience vaginal dryness, unwanted hair growth, and hot flashes can find relief with hormone therapy. However, doctors are often hesitant to prescribe these options unless necessary, due to their links to increased risk of stroke, heart disease and breast cancer. Estrogen and progestin can increase these risks, and estrogen-based hormone therapy can lead to the development of endometrial cancer.

To provide relief of menopause symptoms without the risks of hormone therapy, doctors can prescribe different medications to handle hot flashes, mood swings, cramps and other issues. When taken in low doses, antidepressants called selective serotonin reuptake inhibitors (SSRIs) may help women who cannot take estrogen for health reasons or women who are experiencing a mood disorder while undergoing menopause. Seizure medication Gabapentin and high blood pressure medication Clonidine can alleviate hot flashes. Doctors may also recommend medications that help prevent or treat osteoporosis and Vitamin D supplements to strengthen the bones.

Finding the Right Solution for You

Every woman experiences menopause differently, and it’s vital for every woman to know the best options for handling the potentially unpleasant side effects of the different stages of menopause. At Arizona Gynecology Consultants, our expert team of health care professionals has comprehensive knowledge in all aspects of women’s health care and can guide you through this challenging time with dedication and compassion. We provide the highest quality of health care services at several locations in the Phoenix metropolitan area, each with experienced menopause specialists who help patients manage their symptoms during every stage of menopause.

If you have questions about menopause, contact us for more information about resources in your area.

Related Reading: How Long Does Menopause Last on Average?

*Editor’s Note: This article was originally published August 9, 2017 and has been updated April 4, 2021.

Dr. Kelly Roy, MD

Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS

Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.

Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.

www.azgyn.com/

Your Guide to Vaginal Reconstruction Surgery

This entry was posted in Procedures and tagged Vaginal Reconstruction on January 21, 2021 by Dr. Kelly Roy, MD.

There is no single thing on Earth that is more personal to us than our bodies, and no single part of us that is more private than, well, our private parts.

Perhaps that’s why the topic of vaginal reconstruction is so rarely discussed, even while certain types of vaginal surgeries have risen by 9% over the past year. However, due to researchers and surgeons’ efforts worldwide—including right here at Arizona Gynecology Consultants—there is a wider range of effective, minimally invasive, and therapeutic vaginal surgeries than ever before.

Together, these procedures are known as vaginal reconstructive surgeries.

What Is Vaginal Reconstruction?

Vaginal reconstruction, also known as vaginal rejuvenation, refers to surgeries performed on the vagina, urethra, and labia. In most cases, surgeons either operate to reverse defects or repair damage to these tissues. As a group, vaginal reconstructive surgeries aim to restore this complex system of organs and tissues’ original function and return the patient to a sexually and physically complete life.

As many as 40% of women report sexual and other vaginal concerns, and vaginal reconstruction can address many sources. Reconstruction can address vaginal pain and incontinence and restore the sexual or reproductive function or even this crucial area’s sensitivity. In some cases, vaginal reconstruction could even improve the appearance or size of one of these areas.

Who Can Benefit from Vaginal Reconstruction?

Many women of reproductive or post-reproductive age can see benefits from vaginal rejuvenation surgeries, but the primary group of candidates is those women who have experienced surgical alteration, injury, or defect of the vaginal region. This group can include:

Women living with a congenital disability that altered the structure and function of the vaginal walls
Women who have experienced severe physical trauma to the vaginal region—most often the result of rape and assault, or accident
Women who have experienced vaginal wall prolapse, a condition where the walls of the vagina herniate and interfere with other organs and structures, including the bladder, urethra, and more
Women who have undergone extensive surgery or radiation to treat cancers of the uterus, ovaries, cervix, vagina, vulva, or bladder

Although surgeons and other vaginal health care providers certainly recognize the importance of the appearance of your most intimate areas, improving appearance is typically a secondary consideration to improving your overall vaginal health. However, otherwise-healthy women who have experienced issues with vaginal function and sexual responsiveness may also benefit from vaginal rejuvenation, including:

Women who have experienced traumatic or multiple childbirths, leading to diminished sensation
Women experiencing inelasticity of the internal, contoured vaginal tissues
Women who regularly experience painful sexual intercourse, or pain and soreness with exercise
Women who wish to improve the overall appearance of the external labia or vulva due to changes caused by aging, injury, or congenital issues

Types of Vaginal Rejuvenation Surgeries

Just as the reason’s women seek vaginal reconstruction or rejuvenation can vary, the surgeries themselves can vary as well. We want to note, as well, that every patient is different, and the reasons women seek vaginal reconstruction surgery are very likely to differ. Among the most common types of vaginal rejuvenation surgeries are:

Vaginoplasty, overall reconstruction of the internal structure of the vagina
Labiaplasty, reshaping of the external labia and surrounding tissue
Vulvoplasty, reshaping of the external vulva and surrounding tissue

Depending on the initial reasons for surgery and the type of procedure chosen, there are multiple results vaginal reconstruction surgeries can produce; it is also important to note that most vaginal surgeries are not performed solely to improve appearance. However, we’ve found that many women experience reduced pain and restoration of function and a sense of well-being, and increased self-confidence after vaginal reconstruction surgery. Desired results can include:

Tightening the walls of the vagina to restore it to its condition before childbirth, surgery, or aging (also known as virgin tightening surgery)
Improving sensitivity and reducing pain during intercourse or exercise
Reducing urinary incontinence and vaginal prolapse
Improving self-confidence and self-esteem following a perceived improvement in vaginal sensation or pain, as well as labial or vulvar appearance

How You Can Prepare for Vaginal Reconstruction Surgery

In general, vaginal rejuvenation procedures are minimally invasive and use innovative equipment designed to help you experience reduced pain and blood loss, quicker recovery, and minimal scarring. However, as vaginal reconstruction (and any minimally invasive surgery) is still a surgery, you’ll need to follow the recommendations of your medical team to achieve the best possible result.

Depending on the specific combination of vaginal rejuvenation procedures you’ve scheduled, your medical history, and the advice of your physician, preparation for vaginal reconstruction can vary. In many cases, you’ll be asked to maintain a liquid diet for 24 hours before your surgery and limit liquids after midnight the night before the procedure. Some providers also require a bowel prep to clear your bowels before surgery. In addition, if you regularly take blood-thinning medications or over-the-counter nonsteroidal anti-inflammatory drugs, you’ll likely need to discontinue their use before surgery to reduce your chances of excessive bleeding during your surgery.

Overall, these recommendations are general to any surgery, and your vaginal reconstruction surgeon may have special recommendations unique to you. It is crucial to discuss any surgery preparations with your physician before your procedure.

How Does Vaginal Reconstruction Happen?

As the types of vaginal issues leading to the need for vaginal rejuvenation vary, so, too, do the surgical techniques used to correct them. The specific procedure used during your reconstruction depends on the damage, injury, or other issues you’ve encountered and can range from a fairly simple process to a complex procedure involving multiple techniques. However, as mentioned, special care is taken to ensure that the vaginal rejuvenation procedures performed remain minimally invasive.

Surgeons at Arizona Gynecology Consultants utilize world-class vaginal rejuvenation surgical techniques performed at the world’s best medical institutions. In addition, these surgeons are specially trained to perform these techniques and handle the specialized equipment necessary for their completion. As a result, surgical outcomes are nearly always positive.

How Do You Recover from Vaginal Reconstruction?

Immediately after your vaginal reconstruction surgery, you’ll be taken to the post-surgery recovery room for monitoring. At this time, you will likely receive medications for any nausea or pain experienced. Once you’ve recovered sufficiently, you will be encouraged to move and walk as much as possible to improve blood flow—this encourages proper healing as well as prevents blood clots from forming in your legs and other extremities.

Most patients only require a few days to recover from vaginal reconstruction, depending on the specific procedures. However, with all vaginal rejuvenations, most physicians recommend abstaining from sexual intercourse for six weeks or so. After this time, a few risks persist, as they do with any surgical procedure—however, the risk of these incidences is minimal:

Adverse reactions to anesthesia
Scarring
Infection of the surgical site
Loss of sensation

Also, while some vaginal rejuvenations are performed to increase sexual response, the degree to which sensation is restored varies. Some women experience minimal restoration of sensation, and some achieve optimal sensation. Meanwhile, a few women may experience oversensitivity, which can cause pain and detract from sexual pleasure.

Is Vaginal Reconstruction for You?

As with any surgical procedure, it is essential to consult with your gynecologist to determine if vaginal reconstruction is right for you. Arizona Gynecology Consultants’ board-certified group of gynecologists and women’s health providers can assess your unique condition and help you explore the surgical and other options available to you.

Contact our office today to request an appointment.

Dr. Kelly Roy, MD

Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS

Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.

Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.

www.azgyn.com/

Your Guide to Pre-Surgical Weight Loss

This entry was posted in Fitness and Nutrition on July 17, 2020 by Dr. Kelly Roy, MD.

Ever wonder why it’s so hard to lose weight?

Anyone who has ever tried knows that weight loss is difficult. According to the Centers for Disease Control and Prevention, around half (49%) of U.S. adults reported trying to lose weight between 2013 and 2016. On average, 20% of overweight adults are successful in long-term weight loss (defined as losing 10% of body weight and maintaining for at least one year).

If these numbers are discouraging, it can be helpful to understand why it’s so difficult to achieve and maintain weight loss—and how an evidence-based approach can help you sustain results over the long term. The use of such methods is recommended if you are considering an intervention like gastric bypass.

Look here to find the answer to “how long does menopause last?”

The Psychological and Physiological Battlegrounds of Weight Loss

Some people fall into the trap of oversimplifying weight loss as “calories in, calories out.” Still others study popular books advertising fad diets such as Paleo and low carb. The truth is that weight loss is a multifaceted issue, a battle that an individual must fight on two different battlegrounds: the physiological and the psychological.

Many weight-loss experts use the Kubler-Ross model to explain the weight loss journey. You likely have heard of this process when describing grief or contending with an incurable illness, but it provides a helpful lens for how individuals perceive losing weight (and why it is so tricky).

Denial

In the denial stage, an individual readily makes excuses for their weight. For example, “shirts from stores always run small,” or “I may have a belly, but that doesn’t mean that I am overweight.” In this stage, an individual has yet to confront the issue that weight is a problem.

Anger

Here, an individual has confronted the fact that their weight is a problem—and that causes issues. “It’s not fair that I have to watch everything that I eat.” Or, “why can my friend eat everything and look like that?”

Bargaining

Here, an individual starts thinking about incremental changes that can aid in the weight loss journey. “Maybe I should just eat more fruits and vegetables.” Or, “Perhaps if I swap out olive oil for butter, I will lose some weight.” Deep down, however, you know that cutting calories will be the key to achieving weight loss.

Depression

The depression stage doesn’t refer to the clinical sense, but this is when a light bulb goes off, and the individual understands the depth of the problem and the need to resolve it. “How did I let myself get this far? Will I ever be able to stop it?”

Acceptance

In the final step, an individual realizes that they need to lose weight and resolves to create a long-term plan to address it. You accept that weight loss is essential, and you believe it is something you can achieve.

Getting Started on Your Weight Loss Journey

If you have made it this far, you have likely made it through the five stages and are ready to make a sustainable lifestyle change. The next step is understanding the right way to lose weight and keep it off. Though blogs and bookstore shelves will all claim to hold the secret to weight loss, the best approaches are based on rigorous scientific evidence and medicine. Medically supervised weight loss programs provide a solid foundation for weight loss that makes it more likely to sustain the results over the long term – and weight loss is often a prerequisite before electing to undergo surgery.

Pre-Surgical Weight Loss Programs

Pre-surgery weight loss plans have two aims (1) to instill healthy habits that will persist after surgery; and (2) to reduce the amount of fat around your vital organs, which reduces the risk of surgical complications. After surgery, your provider will also give you diet guidelines that come in weekly phases. The intent of pre- and post-surgery diet plans are to help you meet the requirements for surgery, promote healthy, sustainable habits, and reduce the risk of complications associated with excess weight and hormone imbalance.

Why Is It Important To Lose Weight Before Surgery?

It is important to lose some weight before surgery because it helps reduce the amount of fat in your abdomen and around your organs, which may allow for less invasive procedures such as laparoscopy in place of open surgery. Laparoscopic options are less invasive and involve shorter recovery times so that you can resume your regular activities sooner.

Losing weight before surgery also encourages you to rethink your dietary habits. Excess weight, particularly in women, has been linked to increased risk of certain cancers, heart disease, diabetes, hypertension, stroke, and arthritis. Conditions such as these not only affect life expectancy but also quality and level of enjoyment. Women who carry excess weight can struggle with infertility, depression, self-image issues, and social isolation. Following a presurgical weight loss plan can not only reduce the risk of surgical complications but improve quality of life long thereafter.

Your health care provider will develop your exact goals and plans. You may begin as soon as you qualify for the procedure. Adherence to pre-surgical diet plans is essential, as your procedure could be delayed or canceled if some weight loss does not occur.

Example Pre-Surgical Guidelines

Your health care provider will create a tailored pre-surgical plan. General guidelines include:

Elimination or drastic reduction of foods that are high in carbohydrates, such as potatoes, pasta, desserts, bread, and other bread products.
Reduction or elimination of foods that are high in saturated fats, such as fried foods and fatty meats.
Elimination of sugary drinks such as juice and soda.
Learning and exercising portion control.
Elimination of binge-eating behaviors.
Avoidance of alcohol, cigarettes, and recreational drugs.
Supplementation with a daily vitamin.
Protein supplements such as powders and shakes.

What Will My Pre-Surgery Diet Look Like?

Pre-operative diets vary but usually consist of high-protein, low-calorie foods such as protein shakes. Protein helps protect your muscle tissue and can encourage your body to burn fat instead of muscle for energy. Protein is also essential for speeding recovery post-surgery.

As you approach your surgery date, your health care provider will switch you over to a mostly liquid or only liquid diet. In some cases, you may be able to continue eating bland solids such as fish, watered-down oatmeal, and soft-boiled eggs.

In the final days before surgery, your team will give your instructions about fluid and food intake. In some cases, your team may want you to drink carbohydrate-based fluids up to 2 hours before your surgery. In others, you may be asked to eliminate fluids 12 hours before surgery.

Women and Weight Loss: Special Considerations

Say you and a male friend, partner, or workout buddy choose to lose weight together. Though you may both faithfully count calories and dedicate yourself to the process, you may find that he loses weight earlier. It can be frustrating, but women often struggle to lose weight because of their genetic makeup. Several factors may be at play, such as:

Metabolism. Women tend to have more fat and less muscle mass compared to men. This affects your basal metabolic rate, or the number of calories your body burns at rest. The more muscle you have, the more calories you will burn, even when you’re not exercising. For this reason, weight loss programs often encourage adding strength training in addition to healthy eating habits.
After-effects of pregnancy. A woman gains weight, including fat reserves, during pregnancy. Moms often have difficulty prioritizing healthy eating and exercising when caring for young children. The Centers for Disease Control and Prevention estimates that nearly half of U.S. women gain too much weight during pregnancy, making it that much harder to shed.
Menopause. It is also common for women to gain weight during menopause as their hormones diminish and metabolism slows. During this stage, weight tends to concentrate in the abdomen.
PCOS. Between 5 and 10% of American women struggle with polycystic ovarian syndrome (PCOS), which leads to hormonal imbalances that can make losing weight more difficult. PCOS also has ties to menstrual irregularity and infertility.

Effective weight loss in women relies on a combination of factors, such as hormone balance, an understanding of the factors contributing to weight gain, and the development of plans that are both realistic and achievable. Medically supervised weight loss programs have been linked to long term positive outcomes and clinically significant weight loss.

A health care provider who specializes in women’s health can help you navigate other important considerations surrounding presurgical weight loss and reproductive health, such as:

Contraceptive use. Women who are obese can experience irregular periods as well as uncomfortable symptoms arising from comorbid conditions such as PCOS. As they lose weight, many women find that their fertility and menstrual cycles normalize. Women wishing to avoid pregnancy should speak with their health care provider about contraceptive use pre- and post-surgery.
Pregnancy. If you wish to become pregnant following a weight loss program or surgery, it is essential to talk to your health care provider about nutritional supplementation and meeting the needs of your growing baby.
Osteoporosis. Women are already at a heightened risk of osteoporosis, and a growing body of evidence suggests that obesity can compound this risk. Your healthcare provider should talk to you about the importance of monitoring bone density and discuss supplementation to reduce your risk.

If you are considering medical weight loss or interventions such as surgery, it is essential to team with a specialist with a background in women’s health. A women’s and reproductive health practitioner can help you navigate the challenges and special considerations that come with being a woman of reproductive age. If you’ve ever thought “I need to find a gynecologist near me” then look no further.

Our Medical Weight Loss Team

The team at Arizona Gynecology Associates is ready to help you tackle your weight loss journey. Julia Cyr, DNP, heads up our medical weight loss team. Julia has long held a passion for delivering compassionate health care to women through all stages of life. In addition to medical weight loss, she also specializes in contraception management, nutrition, and hormone replacement. This makes her uniquely qualified to help women navigate the challenges of weight loss, both pre- and post-surgery.

At Arizona Gynecology Associates, we understand that weight loss is a battle that women fight on both psychological and physiological fronts. We strive to help our patients understand the underlying causes surrounding their weight, from habits that can lead to unhealthy eating to other conditions such as metabolic disorders or PCOS. We help you, as an individual with unique circumstances, overcome your challenges, and kickstart your healthier life.

We are committed to helping you achieve and sustain significant weight loss! For more information about our weight loss services, please contact us today. Kick your frustration to the curb and make healthy lifestyle changes that last.

Dr. Kelly Roy, MD

Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS

Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.

Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.

www.azgyn.com/

What Is Endometriosis?

This entry was posted in Health FAQs and tagged Gynecological Surgery, Minimally Invasive Surgery, Signs And Symptoms on April 12, 2020 by Dr. Kelly Roy, MD.

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?

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.

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.

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.

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.

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.

Dr. Kelly Roy, MD

Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS

Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.

Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.

www.azgyn.com/

Adenomyosis: Symptoms, Causes and Risk Factors

This entry was posted in Health FAQs and tagged Adenomyosis, Endometriosis, Uterine Bleeding on August 14, 2019 by Dr. Kelly Roy, MD.

We’ve all heard about endometriosis, a condition in which the uterine lining (endometrium) develops outside the uterus and grows on other organs within the abdomen, including the ovaries. There is another condition that can take place with the endometrium, known as uterine adenomyosis. This condition affects women, mostly in child-bearing years, and can be quite painful. Although most women have never heard about it, near 20 percent of them are affected by it.

History and Definition of Adenomyosis

Whereas it was described as early as 1860, adenomyosis was not properly diagnosed or named until the early part of the 20th century. In 1908, Thomas Cullen investigated its causes and named it, determining it was not an inflammation of the uterus, because it did not present any signs.

Not until 1972 did a proper definition come about, made by Dr. Charles C Bird, MD. At that time, adenomysis was described a “benign invasion of endometrium into the myometrium, producing a diffusely enlarged uterus which microscopically exhibits ectopic non-neoplastic, endometrial glands and stroma, surrounded by the hypertrophic and hyperplastic myometrium”.

What Is Adenomyosis?

Adenomyosis is a condition in which the endometrium, instead of growing out into the uterus, grows into the uterine wall (myometrium). Each time the lining (endometrium) is stimulated, during the menstrual cycle, the trapped lining in the myometrium is also stimulated and can make menstrual cramps and pain worse. This can disrupt the quality of life for the women who have to deal with it. And because adenomyosis symptoms vary due to he flux of estrogen levels going up and down, the menstrual cycle brings more discomfort than usual.

The condition can either be generalized adenomyosis, spread out over a large area of the uterine wall, or localized a small area or spot, also known as adenomyoma. The area that is affected by adenomyosis is called the endometrial-myometrial junction, where the endometrium and myometrium meet. It is the disruption of this junction – adenomyosis – that is considered a contributing factor in the failure of eggs to settle and stay in the uterus, thus preventing women from becoming pregnant.

Symptoms and Treatment

In spite of it being a benign condition, adenomyosis symptoms run the gamut and include:

Painful periods (dysmenorrhea)
Heavy periods (menorrhagia)
Bloody discharge or spotting between periods (metrorrhagia)
Bloating during pre-menstruation
Pain during or after sex (dyspareunia)
Chronic pelvic pain
Tender uterus and larger than normal in size

Women may also suffer from depression, irritability and reduced fertility or infertility. However, when women go into menopause and their estrogen levels drop, so do the symptoms of adenomyosis.

Drugs and Hormones

Adenomyosis treatments vary with the severity of the symptoms that present themselves. If the symptoms are mild enough, doctors can treat them with anti-inflammatory drugs and hormonal treatments. Usually they include contraceptive pills and IUDs. Certain surgeries can be performed that will treat the condition as well.

Uterine Artery Embolization

This procedure is usually used for uterine fibroids, but if the adenomyosis is just a small area or spots, this surgery could take care of it. The blood supply to the affected area is cut off and the adenomyosis shrinks. A 2007 study showed that after three to five years, the symptomatic pain was reduced by half and the success of the procedure was about 60 percent. This minimally invasive procedure leaves no scars.

Endometrial Ablation

Considered as a last resort procedure, endometrial ablation is conducted when other options have failed to relieve the symptoms. Because it destroys the endometrium, this is a permanent solution, like a hysterectomy and will only be done if the woman no longer wishes to become pregnant. It does, however, relieve the symptoms of adenomyosis, and the woman either has no more periods or has reduced bleeding. This may not work if the endometrium has infiltrated too far into the myometrium (uterine muscle wall).

MRI Surgery

MRI guided focused ultrasound surgery (MRgFUS) uses an MRI in real time to monitor focused high-intensity waves that create heat and destroy the targeted tissue. This is an early stage, non-invasive procedure that requires an overnight stay in a hospital or surgicenter setting. Because the uterus remains, this procedure allows a woman to still have children. The side effects are few and the prognosis is good, but it is not recommended for a woman who also has endometriosis.

Hysterectomy

Hysterectomy is the only treatment that will eliminate all adenomyosis symptoms effectively and permanently. Hysterectomies have been the treatment for years, but are only done in severe cases of the condition and if the woman no longer wants to get pregnant. To prevent early menopause, the ovaries may be left in, if they are not affected by endometriosis, which can be a co-occurring condition.

Risk Factors and Causes

Middle-aged women who already have had children (the more children, the greater the risk) or who have had uterine surgery, such as a cesarean, or an inflammation after childbirth are more at risk for adenomyosis, however it can affect any woman before menopause. But a root cause has still not been found.

One of the risks of having adenomyosis is anemia from the blood loss each month. Anemia is a condition caused by an iron deficiency. This means the body cannot make enough red blood cells to carry oxygen to the various parts of the body. Dizziness, fatigue, and irritability ensue and can lead to depression and anxiety.

Adenomyosis Diagnosis

In the past, the only way to diagnose adenomyosis was postoperatively and it had never been fully characterized nor any epidemiological studies made, mostly due to the fact that surgical removal was also the only way to get rid of the symptoms. Adenomyosis was severely understudied and understood until recently, when better diagnostic tools became available. However, doctors have done extensive studies in recent years and have discovered much from the information.

A 2008 study determined that adenomyosis was just a variant and not a disease on its own. The symptoms that are associated with this condition, are also symptomatic of endometriosis and uterine fibroids, thus the recommendation for a hysterectomy to get rid of all the symptoms has continued to be the best solution.

A paper written in 2010 cited several studies on adenomyosis, one of which was done in Italy in 2009, that concluded women who had had induced abortions, dysmenorrhea or chronic pelvic pain were more likely to have adenomyosis. A different study corroborated that dysmenorrhea and chronic pelvic pain were symptomatic of adenomyosis, adding depression as another factor. A third study determined that women who are diagnosed with adenomyosis most likely also have endometriosis.

Biopsy

One of the preoperative diagnostic tools used are biopsies, using keyhole surgery or laparoscopy in order to take a tissue sample. With the addition of a camera, it has been easier to get a sample, but still no guarantee to get the “right” sample, because adenomyosis doesn’t always present itself readily, like endometriosis. As in the past, several samples would have to be taken to get a good diagnosis. The best way is through the vagina, however that may damage the uterus and may make it more difficult to have children in the future, and going through the abdomen is still only good for endometriosis diagnoses.

Better Methods

With the advent of MRI’s, diagnoses have been easier to make. With the MRI, the endometrium and myometrium are clearly defined and the endometrial-myometrial junction is also clearly distinguishable. The thickening of the affected area of the uterine wall is now also considered confirmation of adenomyosis. An adenomyosis ultrasound or more specifically, a Transvaginal ultrasound (TVU) is another way to diagnose possible adenomyosis. TVU is able to identify myometrial cysts but most importantly, disparities of myometrial texture and composition, which signal the presence of adenomyosis.

Medical Care for Adenomyosis

Adenomyosis is one of two endometrium-related conditions that are fairly common to have. It can cause painful and heavy periods, as well as chronic pelvic pain, bloating and an enlarged, tender uterus. The causes are mostly unknown, however women who have had uterine surgery or trauma, are more at risk than others. Diagnosis can be done more accurately nowadays with MRIs and TVUs, although the best way to get rid of all symptoms, especially if they are extremely painful and risk quality of life, is getting a hysterectomy.

That may not be the best answer for someone with only minor symptoms or who wishes to still have children. There are less invasive and permanent treatments, such as hormonal treatment or minor surgery to excise the involved portion of the uterus.

If you have any of the symptoms and suspect you may have adenomyosis, it’s best to check with your doctor as soon as possible. Following a pelvic exam, he or she may schedule you for an MRI or TVU to get a better look.

Arizona Gynecology Consultants is located in the Phoenix and Mesa metropolitan areas. We provide expert and individualized health and medical services for women of every age, treating each patient as a unique person. Our team specializes in all aspects of women’s health and we are dedicated to practicing excellence in women’s care.

SCHEDULE A CONSULTATION TO SEE IF ADENOMYOSIS IS THE ROOT CAUSE OF YOUR DISCOMFORT.

Dr. Kelly Roy, MD

Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS

Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.

Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.

www.azgyn.com/

Low Estrogen: What It Means and What Symptoms to Look For

This entry was posted in Health FAQs and tagged Premenopause, Reproductive Health, Signs And Symptoms on July 1, 2019 by Dr. Kelly Roy, MD.

Estrogen plays a significant role in a woman’s life. Estrogen contributes to reproductive health as well as regulating aging. Most women understand that estrogen levels usually decrease during perimenopause or menopause, a sign that they are leaving the childbearing years behind.

Sometimes, it can happen early, such as when a woman over-exercises on a regular basis (exercise addiction), or she suffers from an eating disorder like anorexia, and her body can no longer maintain estrogen levels.

Decreasing estrogen levels, although considered a normal part of menopause, may cause adverse effects to a woman’s body and her health.

Estrogen in the Body

Estrogen is most notably responsible for the sexual development of girls during puberty. These levels of estrogen fluctuate throughout a woman’s lifetime up until menopause, when low levels of estrogen completely prevent menstruation and ovulation.

Estrogen also regulates:

Changes in breast tissue during adolescence and pregnancy
Menstrual cycles
Body weight, by helping control metabolism
Development and growth of healthy bone tissue
Healthy cardiovascular activity

With so many effects on various parts of the body, it is important that estrogen levels maintain a healthy standard. Low estrogen levels can be a sign of age, but seriously low levels can have lasting negative effects.

Causes for Concern

Any condition that impairs the ovaries can reduce estrogen production. The most common risk factor for women is age. As women age, perimenopause and menopause cause the body to produce less estrogen. Estrogen levels can also decrease for various other reasons, including:

Premature ovarian failure
Congenital conditions: Turner syndrome
Thyroid disorders
Excessive exercise
Being severely under or overweight
Chemotherapy
Low functioning pituitary gland

Other unique cases can include excessive exercising and eating disorders such as anorexia. If a woman is more than 15 percent underweight, the body can no longer maintain normal estrogen levels. In order to maintain healthy levels of estrogen, a woman should maintain a healthy diet, lifestyle, and weight.

Effects and Symptoms

As women approach the age of 40, they may wonder what symptoms to look for that herald decreasing levels of estrogen. Estrogen depletion can bring on a combination of hormonal and biochemical fluctuations that can lead to changes in the brain and nervous system.

Irregular Periods

Estrogen is the critical hormone in regulating a woman’s period and menstrual cycle. Low estrogen levels can cause irregular periods, including shorter or longer periods, light or heavier flow, spotting, or missed periods altogether.

Infertility

Low estrogen directly affects ovulation. Without estrogen, ovulation will not occur making it difficult to become pregnant. This is considered infertility.

Hot Flashes and Night Sweats

The most common symptoms and probably the least liked, hot flashes and night sweats can go on for a long time: 7 to 11 years. They are caused by the hypothalamus which controls body temperature. When estrogen levels start going down, the hypothalamus can no longer regulate body temperature and even the slightest change can cause hot flashes or night sweats to bring the temperature down, or chills to bring it back up.

Insomnia and Fatigue

Estrogen produces serotonin, a neurotransmitter in the brain that triggers melatonin, a hormone that helps a person sleep. Once a woman goes into menopause, the depleted estrogen levels produce less serotonin and by extension, less melatonin. With the night sweats that interrupt sleep, fatigue and insomnia become the new normal.

Mood Swings

Hormonal imbalances, that often make teenagers moody and difficult, are back during menopause, making women grumpy. Add lack of sleep and it can get worse. Mood swings – laughing, crying, anger and upset – at the drop of a hat – are all part of the package.

Depression and Difficulty Focusing

Serotonin also affects mood and social behavior, as well as memory, sexual desire and function. With lowered serotonin levels, depression, not just mood swings, can occur and it becomes more difficult to recover from it. Memory lapses and trouble focusing or concentrating are two more symptoms of low estrogen and serotonin levels. Some experts believe that they put women at a greater risk for Alzheimer’s and dementia.

Physical Symptoms of Low Estrogen

The brain and nervous system are not the only parts of a woman that are affected by menopause and lowered estrogen levels. Of course, the reproductive system’s ability decreases with age as ovary function and estrogen levels go down. But the skin, heart, bones and urinary systems are also affected.

Dry Everything and Low Sexual Desire

Dry skin, dry eyes and a dry vagina are more signs of menopause and low estrogen levels. These can be allayed with moisturizing fluids, such as lotion, eye drops and lubricant (in that order). Unfortunately, reduced sexual desire comes from decreased estrogen and serotonin levels. Menopause also makes the vaginal walls thinner and they lose elasticity, coupled with vaginal dryness, sex can be painful.

The skin loses its moisture-holding abilities as well as its elasticity, leading to dryness, itching, and an increase in wrinkling and sagging. Also, it becomes more susceptible to injury, such as bruising, due to thinning of the skin and it doesn’t heal as quickly. Researchers are beginning to study the lack of estrogen as a possible connection to melanoma, a serious type of skin cancer.

The Heart Connection

As women get older, they become more vulnerable to cardiovascular issues, such as heart attacks, strokes, or other heart-related problems. Hypertension, or high blood pressure is the biggest cardiovascular risk for women in and after menopause. Normally estrogen increases levels of nitric oxide, which is a very powerful dilator of blood vessels, and dilated blood vessels are conducive to healthy blood pressure.

Lowered estrogen levels make hypertension an increasingly bigger factor in women.

Though this may not start until just before perimenopause, it can quickly increase until about age 60, when the new level of blood pressure stabilizes to a new norm.

The Beautiful Bones

After the age of 30, new bone production cannot keep up with bone loss and once menopause hits and estrogen levels decrease, women have an increased risk for low bone mineral density, osteopenia and osteoporosis. This bone density loss can lead to weakening of the bones and an increased risk for fractures and other injuries.

The Urinary System

No laughing matter, incontinence is one of the signs of decreased estrogen levels. Just as with the vaginal walls, the reduced levels of estrogen cause the urethra walls to thin, dry and lose elasticity. This causes the incontinence when coughing, laughing, sneezing or lifting heavy objects. It also leads to feeling the need for frequent urination and an increased risk for developing UTIs.

Weight Gain

Estrogen plays a significant role in weight management and how the body stores fat. During perimenopause and menopause low estrogen contributes to weight gain. Specifically women store more fat in their thighs and hips, which can change during menopause. Eating a healthy diet and exercising regularly can help combat weight gain with low estrogen levels.

Diagnosis and Treatment for Low Estrogen

If any of the above-noted symptoms appear, the first step is to get a physical exam by a trusted physician who can review your medical history and symptoms. It may be necessary to do a blood test to check hormone levels. The doctor may also recommend additional tests to rule out other conditions that might be causing symptoms similar to low estrogen.

Synthetic Hormone Treatment

Hormone Replacement Therapy or HRT is sometimes recommended for women who do not have high blood pressure or other cardiovascular problems. There are various types of HRTs available, including one that combines estrogen with progesterone, a hormone that maintains pregnancy. There are side effects that need to be considered, but these can be discussed with a doctor, to determine which HRT is best.

Sometimes all that is needed are serotonin-boosting antidepressants for those women who end up suffering from depression more than the other symptoms.

Estrogen Therapy

Estrogen therapy is recommended by a doctor or medical expert. In some cases, small amounts of estrogen can be used to combat those who have had small changes in their estrogen levels, such as women who have had their ovaries removed. In other instances, estrogen therapy may be used to treat certain symptoms of perimenopause and menopause.

Natural Treatments

Natural remedies include natural food and soy supplements, maintaining a healthy weight and, in some cases, decreasing the intensity or frequency of exercise. Soy or soybean isoflavones are, at best, an alternative treatment for HRT, and at worst, a controversial treatment with increased risk for breast cancer. It’s best to speak to your doctor or healthcare professional before adding this or any supplement to your diet.

Exercise and eating foods rich in calcium and adding vitamin D supplements during and after menopause is a good way to maintain and increase bone density. Low-fat milk, cheese and dairy products, green leafy vegetables like broccoli, cabbage and okra, as well as soybeans and soy products such as tofu, are great for getting the extra calcium needed. It is important to remember that exercise must also be sufficient, but not excessive. Too much exercise and too little body fat can further decrease levels of estrogen.

Estrogen Overview

Reduced estrogen levels can cause many problems for women, including an increased risk of serious conditions, including heart disease, osteoporosis (softening of bone tissue), and obesity. However there are ways to lessen the symptoms and the impact of lower estrogen levels to a woman’s overall wellbeing, including her physical, emotional, and sexual health.

The sooner a woman can be screened for low estrogen levels, the better chance she has at combatting the negative effects listed above. AZGYN’s Gynecology Services and Minimally Invasive Procedures can be the solution for many women. They provide an assortment of general health practices and specialized services by expert staff and surgeons.

If you are a woman and suspect you have low estrogen levels, contact us for help today.

Dr. Kelly Roy, MD

Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS

Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.

Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.