endometriosis, hysterectomy, OB GYN, Uncategorized

Not Everyone with Endometriosis Should Get a Hysterectomy Like Lena Dunham

The internet is aflame with people suffering from endometriosis wondering if they should be getting a hysterectomy after Lena Dunham revealed she had one at the age of 31.

Best wishes to Lena Dunham in her future health, it sounds like she has been through so much the past few years. I would not presume to know all the details behind her medical condition. She is quoted regarding her recent health battles here , and she has an article coming out in Vogue in March detailing her personal experience.

However, it is important for people to understand that not everyone with endometriosis or chronic pelvic pain should get a hysterectomy- in fact, the overwhelming majority should not. The truth of the matter is that it’s the ovaries that cause the problem with endometriosis and therefore you cannot be cured from endometriosis if the ovaries remain. A hysterectomy means simply taking out the uterus (typically with cervix too) but leaving the ovaries behind.

The simple fact is that endometriosis pain is tied to the estrogen provided by the ovaries. Therefore, even if the uterus is removed, the pain may continue if even just one ovary remains.

So, why don’t we just take out the ovaries too?

It’s complicated. You need the ovaries for more than just the obvious ability to produce an egg to allow for the ability to get pregnant and conceive a child. While the sole purpose of the uterus is for childbearing, the ovaries involve much, much more.

The estrogen produced by ovaries is protective to our bones and cardiovascular health as well, amongst many other things. Taking out the ovaries prematurely would cause an instant menopause in a woman in her 20’s or 30’s which has serious ramifications on long term health.

This is the reason why many physicians are reluctant to do such a major surgery as hysterectomy and/or removing of the ovaries in a woman in her 30’s. Your reproductive choices are absolutely your right. However, it is important to understand that simply removing a uterus will not cure a patient of endometriosis. Knowing this fact, it makes little sense to go through a major surgery to remove an organ which is not directly causing endometriosis.

Endometriosis implants can be found throughout the abdominal cavity. During surgical procedures, I’ve personally seen implants on bowel (intestines), pelvic sidewall, bladder, and even in the skin of the abdominal wall. Therefore, you can see how taking out the uterus may relive some pain, but it is not a cure.

Is there ever a time for removing both the uterus and ovaries in someone at a young age with debilitating pain from endometriosis? The answer is yes, rarely.

This is only after a multitude of other less risky and effective measures have been attempted and failed. It is exceedingly rare that a patient would not benefit from other methods of suppressing estrogen for short periods of time. Therefore, the case where a hysterectomy is needed for endometriosis alone is very rare and should never be a first treatment for endometriosis.

A hysterectomy alone may be considered for other reasons such as excessive bleeding not responding to less invasive treatments, large fibroids, uterine abnormalities, and even cancer. We may never know all the reasons behind Lena Dunham’s decision to have her uterus removed- that is between her and her doctor. However, given the fact the ovaries remain tells me it’s about more than endometriosis.

So, to any patients suffering with endometriosis, please know there is always more to t story and discuss all options with your doctor.

This article should not be taken as medical advice, but each patient should explore options with their own physician regarding treatment options for this painful and sometimes debilitating condition called endometriosis (there are many!).

 

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OB GYN, Parenting

8 Things Your Doctor Wants You to Know About Your Miscarriage

Miscarriage is one of the hardest (and most common) challenges women face. If you have not had a miscarriage yourself, you most certainly have a best friend, sister, or daughter who has. There are many myths floating around the internet, however there are a few important truths everyone should know about miscarriage.

1. You aren’t alone. Miscarriage is common and occurs more frequently than you might think. Often, a miscarriage occurs before a woman even knows she is pregnant. If you include these cases in statistics, up to 50% all pregnancies end in miscarriage. However, the number is closer to 15-20% for recognized pregnancies.

2.  Most miscarriages occur in the first trimester, but they can also happen later too. Luckily this is rare after 13 weeks. It is often more traumatic emotionally and physically in later trimesters. Women who experience late second trimester or 3rd trimester fetal losses (the term used when occurs later in pregnancy) will have physiologic responses from their bodies that think they just had a child. Their breasts may engorge with milk, a painful reminder of what was lost.

3.  It’s not your fault.

4.  It’s not your fault. Bears repeating. Also, its okay to grieve an early pregnancy loss. You likely had hopes, expectations, and dreams already wrapped up around this pregnancy. It may take a while to recover.

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5. Up to 80% of pregnancy tissue from first trimester miscarriage is chromosomally abnormal- meaning that there was a genetic problem with the developing baby.

6. There has been debate over the amount of time you should wait after a miscarriage before trying again, but newer research shows that in most cases you can start trying again with the next cycle. Although, 3 months is a commonly quoted and may give you more time to heal physically and emotionally.

7. The fact that you got pregnant is a good sign that you will be able to get pregnant again.

8. You have 3 options when a miscarriage occurs- make sure you discuss all 3 with your doctor to determine the best course of option for you.

Expectant: this means waiting for your body to complete the miscarriage on its own. It may include moments of severe cramping and bleeding. The timing can be unpredictable, but you may be able to avoid a procedure if this is important to you. However, if the bleeding is severe you may still need medical intervention.

Medication: If you haven’t started bleeding yet, a pill can help your body to start the process once miscarriage is confirmed. This gives you a measure of control over when the process will start. It is successful in most cases, but sometimes you may still ultimately need a procedure if everything does not pass on its own.

Surgical: The procedure is called Dilation and Curettage “D & C”. This is a minor procedure to remove the contents of the uterus (failed pregnancy). Some women prefer this option as bleeding and cramping time is limited after the procedure. The process is over sooner and may cause less interruption for women who may need to be back at work, or have other children at home dependent on their care. There are risks with any surgical procedure, and although minor, must also be considered.

Since many people wait to tell family and friends about a new pregnancy until safely out of the first trimester, it can be a lonely experience if you go through a miscarriage without the support of your loved ones. In recent years, women have become more vocal about miscarriage and this has helped women feel less alone when it occurs. Don’t be afraid to reach out to others during this time. Be sure to discuss any concerns with your doctor and don’t lose hope about what the future may bring.