Uterine Causes

 

Fibroids

                              Uterine Fibroids courtesy: Gloecknerd/CC/wiki

Definition of Fibroids:

Fibroids are abnormal growths in the uterus. Fibroids are not cancer growths.

For many women fibroids cause no symptoms and are often found incidentally. For others fibroids, depending on their size and location in the uterus, can cause various signs and symptoms.

Cause:

It is still not very clear what causes fibroids although research is slowly advancing its knowledge on this diseases etiology. It is known that female hormones do influence fibroid development and growth. Both estrogen and progesterone both seem to be involved.

Signs and Symptoms:

1. No Symptoms: many women have no symptoms of fibroids and their fibroids are found during a pelvic exam, ultrasound, MRI, CT Scan, or during surgery.

2.Vaginal Bleeding: Vaginal bleeding is a common symptom.

  • The bleeding occurs during times other than a woman’s menstrual flow (period).
  • Irregular Menstrual Flow:
  • Increase in menstrual flow
  • Increase in duration of menstrual flow
  • Increase in menstrual spotting before or after menstrual flow.


3. Pain: Anemia

  • Increase in menstrual pain
  • Back pain
  • Pain during intercourse
  • Abdominal pain


4. Infertility

5. Miscarriages

6. Lower abdominal bloating

7. Urinary or bowel movement irregularity & discomfort

Diagnosing Fibroids:

  • Ultrasound
  • HSG - Hysterosalpingogram
  • SIS - Saline Infusion Sonogram (sonohysterogram)
  • MRI - Magnetic Resonance Imaging
  • CT Scan - Computed Tomography Scan
  • Hysteroscopy
  • Laparoscopy


Medical Treatment:

  • Oral Contraceptive Pills
  • Other contraceptive methods using hormones
  • GnRH Agonists


Surgical Treatment:

Hysterectomy: is a surgical procedure where the Uterus is removed.

  • Vaginal Hysterectomy: The uterus is removed through the vagina.
  • Abdominal Hysterectomy: The uterus is removed through an abdominal incision.
  • Laparoscopic Hysterectomy: The Uterus is removed using “Key Hole” surgery.


Myomectomy: is a surgical procedure where the fibroids are removed.

  • Hysteroscopic Myomectomy: used for fibroids inside the uterine cavity.
  • Laparoscopic Myomectomy: “Key Hole” surgery.
  • Myomectomy via Laparotomy: fibroids are removed through an abdominal incision


Endometrial Ablation: using heat or electrocautery to destroy the lining of the uterus.

Uterine Artery Embolization: is a procedure where the arteries that supply the uterus with blood are embolized (blocked). This procedure decreases blood flow to the fibroids allowing them to shrink.

Magnetic Resonance Imaging-Guided Ultrasound Surgery: Ultrasound waves are used to destroy the fibroids. This technique is non-surgical; although preliminary studies are promising long term outcomes are still being studied.

If you are experiencing fertility problems and have been told or suspect that you have fibroids call today to schedule an appointment to help you diagnose your problem and select the most appropriate therapy for your condition. An individualized treatment protocol based on each patients signs, symptoms, fibroid size and location will produce better outcomes.

If you have been told that you need a hysterectomy (complete removal of the uterus) and still desire to have children in the future please call for a second opinion. It is rare that Hysterectomy is the only solution.

Asherman Syndrome



               Asherman Syndrome on HSG. courtesy: Floranerolia/cc/wiki

Asherman syndrome Definition:

Is a condition caused by adhesions (scar tissue) in the uterine cavity. The scar tissue is a due to trauma to the uterine cavity.

Causes of Asherman Syndrome:

Any condition that causes trauma to the uterine cavity may cause Asherman syndrome

1. Endometritis post-partum
2. Retained Products of Conception post-partum
3. Surgical Trauma:

        1. Curettage
        2. Cesarean Section
        3. Myomectomy (abdominal or hysteroscopic)
        4. Uterine Artery Embolization
        5. Uterine cavity ablation
        6. Infections:

            1. Tuberculosis
            2. Schistosomiasis


Symptoms of Asherman Syndrome:

  • Hypomenorrhea: light menstrual flow
  • Dysmenorrhea: painful menstrual flow
  • Recurrent Pregnancy loss
  • Infertility
  • Amenorrhea: no menstrual flow


Diagnosis of Asherman Syndrome:

  • Patient history that is suspicious for the condition. (symptoms + history of trauma to cavity)
  • Ultrasound
  • Saline infusion sonogram
  • Hysterosalpingogram
  • Hysteroscopy (gold standard)


Treatment of Asherman Syndrome:

The most effective treatment method is surgical followed by hormonal therapy. During a hysteroscopy the adhesions (scar tissue) is visualized and excised. After the adhesions are removed typically a physical barrier is placed in the uterine cavity to prevent new scar tissue from forming. This is most often done by placing a balloon catheter in the cavity as it heals. The patient is then given high doses of estrogen therapy in an attempt to create a new endometrial lining in place of the adhesions.

Estrogen therapy is typically given for 4 weeks. The catheter typically remains in the cavity for about one week. The physician may place the patient on antibiotics and anti-inflammatory medications to prevent infection and cramping.

Post Treatment of Asherman Syndrome:

A post treatment evaluation is typically recommended. Hysteroscopy, SIS, or HSG may be ordered. The patient is also evaluated on her menstrual flow. Post treatment evaluation is essential as recurrence of this condition is common.

Pregnancy and Asherman Syndrome:

After successful treatment of this condition pregnancy rates are still low, as low as 25% by some studies. The severity of the disease is a predictor of pregnancy outcomes.

Risks associated with Asherman Syndrome and pregnancy:

  • Post-partum hemorrhage: heavy bleeding after delivery
  • Placenta Previa: Low lying placenta that may block the normal passage of a fetus during labor. (often requiring cesarean section)
  • Placenta Accreta: a placenta that embeds deep into the uterus and is not amenable to delivery after child birth. Often treated surgically if associated with post-partum hemorrhage.
  • Preterm labor.


American Reproductive Centers:

Drs. Mazin Abdullah and Maher Abdallah have extensive training in the treatment of Asherman Syndrome and have performed countless hysteroscopic surgeries encompassing many patients, disease states and have even treated international patients with Asherman Syndrome (Tuberculosis etiology).  If you are a patient that thinks you have this condition feel free to contact us to schedule an appointment.  If you are a physician that has a patient with severe Asherman Syndrome and would like assistance during the surgery or would like to refer her to our clinic for treatment please call our office at 949-309-3330 and ask to speak with one of our physicians.

 

Cervical Stenosis



                                Cervical Canal During Hysteroscopy

Cervical Stenosis Definition:

Cervical stenosis is a condition in which the cervical canal is narrow or in severe cases completely obstructed.


Causes:

  • Cervical Conization: a procedure used to remove a portion of the cervix when cancer / pre-cancer is diagnosed.  It is a testing and often curative procedure.
  • Cryotherapy
  • Cervical Cerclage: a procedure where sutures are used to close the cervix to reduce the risk of preterm delivery.
  • Any surgery involving the cervix including ablation.
  • Recurrent Vaginal Infections.


Symptoms:

  • Worsening dysmenorrhea (painful periods)
  • Light menstrual flow
  • Long duration of menstrual flow
  • Amenorrhea (no menstrual flow seen): is rare, but when the cervix is completely blocked no menstrual flow is visualized.


Treatment & Diagnosis:

Diagnosis: is often made by the history of the patient followed by uterine sounding and dilation (mechanically opening the cervical canal with dilators).  An ultrasound can also be helpful in determining the diagnosis.  With severe cervical blockage the ultrasound often reveals Hematometra (blood collecting in the uterus).

Treatment: often cervical dilation alone is adequate.  In severe cases a catheter is often left in the cervix for 1-2 weeks.  The catheter prevents re-closure of the cervix and ensures that blood in the uterus can drain.