Uterine Fibroids: Seek Treatment as Soon as Symptoms Begin

You may be surprised to learn that 8 in 10 women will develop uterine fibroids by the age of 50.  Uterine fibroids are common, non-cancerous growths of the uterine muscle consisting of smooth muscle cells and connective tissue. A woman may have one fibroid or groups of several fibroids, and they can range in size from less than 1 inch to more than 8 inches across. For some women, fibroids will go undetected and not cause any symptoms or trouble. But at least 25 percent of women with fibroids will experience a broad range of symptoms from mild to very severe, and will require treatment.

Here are key findings from a survey published in the American Journal of Obstetrics and Gynecology and the Journal of Women’s Health:

  • Women with fibroid symptoms often wait many years before seeking treatment or diagnosis from a health care provider.
  • African American women are disproportionately affected by fibroids, have more severe symptoms, wait even longer to seek a diagnosis, and have a greater need for information.
  • Most women reported fears associated with their fibroids, including being afraid that they will grow (79 percent), as well as fears regarding relationships, sexual function, body image, loss of control, and hopelessness.
  • Two-thirds (66 percent) of women were concerned about missed days from work due to their symptoms, and 24 percent of employed respondents felt that their symptoms prevented them from reaching their career potential.
  • Women strongly prefer treatment options that are not invasive and can protect fertility.

Women experiencing fibroid symptoms have many treatment options available to them. Speak to a health care provider as soon as possible about symptoms. Fibroid symptoms include:

  • heavy, prolonged or erratic menstrual bleeding
  • menstrual pain or cramping
  • passing blood clots
  • bloating
  • abdominal enlargement
  • constipation
  • urinary frequency or difficulty urinating
  • infertility
  • painful intercourse
  • chronic watery discharge
  • Fatigue

A delay in diagnosis can limit the effectiveness of treatment options available (due to unnecessary growth of fibroids, for example). The earlier one gets a diagnosis of fibroids, the more treatment options available, enabling one to choose a treatment based on health, lifestyle and professional needs, and family preferences.

Treatment options include:

  • Watchful waiting - recommended when fibroids are not currently causing any symptoms.
  • Hormonal therapy - involves the use of birth control pills or other hormones to shrink fibroids or control fibroid related bleeding.
  • Non-hormonal therapies - includes a class of drugs called “antifibrinolytics” recently adopted in the United States to decrease heavy bleeding.
  • Focused ultrasound - a newer, noninvasive, no-incision technology that uses waves of ultrasound energy to heat and destroy fibroid tissue.
  • Uterine fibroid embolization (UFE) - involves surgery to block the uterine artery with small particles to decrease blood supply to fibroids.
  • Myomectomy procedures – can be either hysteroscopic, laparoscopic, abdominal, or robotic – involve surgical removal of fibroids from the uterus.
  • Hysterectomy (including laparoscopic, vaginal, abdominal or robotic) involves removing the uterus entirely, eliminating any possibility of fibroid recurrence.

If you suspect you have fibroids, make an appointment with one of our doctors and begin learning about treatment options. The closer you are to the onset of your symptoms, the more likely it is that you will have a range of treatment options available to you for symptom relief and better quality of


The Skinny on Eating for Two

Most women are aware that diet affects a baby's development in utero, but many pregnant women still make eating errors--mainly because they don't know any better. Even women who try to eat nutritious foods get caught up in the idea that pregnancy is the time for indulgence. After all, haven't we heard that moms-to-be are "eating for two" our whole lives? Unfortunately, this dangerous myth can not only make it harder to lose the excess weight after delivery, but it also puts one at increased risk for gestational diabetes and high blood pressure. The myth of “eating for two" endures partly because it kind of makes sense, but mainly because it is so appealing. Here's the truth:

  • During your first trimester, you don't need any additional calories.
  • In the second trimester, you need 340 more calories/day.
  • In the third, you need 450 more calories/day.
  • The U.S. Department of Agriculture recommends that pregnant women consume 71 grams of protein per day.
  • The number of extra calories you require is small compared with the amount of extra nutrients recommended, so get your additional calories from high-nutrient foods: fruits, vegetables, nuts, beans, legumes, low-fat dairy products, and lean meats. All of these give you lots of nutritional bang for your calorie buck.

While some women take in too many calories, others consume too few because they are terrified of gaining weight and scared it won't come off afterward, so they restrict their diets. This is a big mistake. For example, if you don't get 1,000 milligrams of calcium daily, the baby's skeleton will be built with calcium leached from your bones.

Don't deprive yourself of necessary nutrients during pregnancy, as your fetus will not get what it needs for healthy growth and development. If you are obese, consult a dietitian who specializes in pregnancy nutrition to determine the proper prenatal diet for you.

Here are some tips for maximizing nutrition during pregnancy:

  • Eat a variety of foods to meet your daily needs for protein, calories, carbohydrates, healthy fats, and key vitamins and minerals during pregnancy.
  • Try to minimize "extra" foods that have calories but few nutrients – sugary beverages, fried foods, foods with extra fat and sugar. Instead, choose meals and snacks that pack the most nutrition per calorie. Adding a few nutrition-packed snacks – like yogurt, nuts, a hard-boiled egg, some fresh fruits or vegetables – to your daily intake is a great way to get the healthy calories your baby needs.
  • Choose foods that are as close to their natural state as possible. Pick whole-grain bread or brown rice over refined white bread or white rice, and fresh fruits or frozen unsweetened fruit over canned fruits in sugar syrup, for example.
  • Eat fats, oils, and sweets sparingly. Be sure to choose healthy fats like those found in avocados, nuts, and olive oil.

If you have any diet or nutrition questions during your pregnancy, be sure to address them with your doctor at your next appointment. We are here to help!


Exercising while Pregnant

Society often depicts pregnancy as a time of binge eating and unrestrained weight gain, but practicing healthy habits during these nine months is not only possible, but highly recommended. Of course, with a baby on board, your exercise regimen will change from what you are used to.

The American College of Obstetricians and Gynecologists and the National Institutes of Health (NIH) say almost all women can and should be physically active during pregnancy, recommending that pregnant women get about 30 minutes of moderate exercise most days of the week. The NIH reports that exercising during pregnancy helps reduce pregnancy discomfort, lowers the risks of gestational diabetes, improves sleep, improves mood, helps with an easier labor, and helps provide a faster recovery after delivery.

Here are some tips to keep in mind when it comes to exercising through pregnancy:

  • Research has shown that the mothers of infants who exercise generally have more desirable/healthy body composition. In other words, if you keep up an exercise routine throughout pregnancy, you will have an easier time going back to your pre-pregnancy weight once the baby arrives.
  • Stay well hydrated while exercising; stop exercising if you feel exhausted or overheated or if you feel dizzy.
  • Keep the weather in mind, and if it’s hot outside, avoid exercising in the heat, so you don’t become overheated.
  • For many active women, there is no reason to dramatically cut back on exercise during pregnancy. Most women can maintain the program and routine that they are accustomed to doing.
  • Listen to the body, and it will guide you. If you’ve never exercised, then you should take it easy on starting a plan, but if you’re an avid exerciser or athlete, keep pushing on with some minor modifications.

If you have any questions or concerns about exercise and how to have the healthiest pregnancy, talk to any of our doctors at your next appointment. All women and all pregnancies are different. We can help you figure out the best options for your unique situation.

Pregnancy-induced Hypertension AKA Preeclampsia

Preeclampsia is a condition that may occur during pregnancy, especially in the third trimester, when a woman is having a baby for the first time or the first time with a new partner. This condition can be hard to detect, and can lead to serious complications for the mother or her baby.

If you are pregnant it is important to know the warning signs of preeclampsia. Unfortunately, women are frequently not aware of which symptoms can be signs of potential danger. According to the Preeclampsia Foundation, these symptoms, many of which may be mistaken for normal pregnancy aches and pains, are what to look out for:

  • No symptoms. Some women have elevated blood pressure but have no clues to know it is present. You can’t usually feel that your blood pressure is up.
  • High blood pressure.  It’s usually 140/90 or greater, and can be an early indicator that preeclampsia is developing.
  • Protein in your urine. In preeclampsia your kidneys don’t work properly and protein normally protected by the kidneys leaks out into urine.
  • Swelling. Some swelling in pregnancy is normal, but when you notice that your swelling is excessive, such as around your face or your hands, this can be a sign of trouble.
  • Sudden weight gain. Weight gain of several pounds in just a few days can indicate that your blood vessels are allowing extra fluid to leak into your body’s tissues. Sometimes having extra salt in your diet makes this worse. Drinking more water can make it better.
  • Nausea or vomiting. This is significant when it comes on quickly, especially in the last 3 months of pregnancy. Most “morning sickness” goes away after the first trimester of pregnancy.
  • Abdominal or shoulder pain. This pain is usually found in your upper right quadrant of the abdomen where the liver is located.  It can be a sign of the HELLP syndrome, which is a severe form of preeclampsia with anemia, damage to the liver, and increased bleeding. Sometimes the pain can be felt in your back.
  • Headaches.  Dull or severe, throbbing headaches that don’t go away can be due to high blood pressure.
  • Change in vision.  Vision changes are among the most serious signs of preeclampsia. There can be blurred or double vision, flashing lights or spots. This indicates danger to you and your baby. If you have this, you should seek medical care right away.
  • Hyperreflexia, racing pulse, mental confusion, anxiety, shortness of breath, sense of impending doom. These symptoms may indicate a worsening of preeclampsia and that delivery may be needed soon, even if the baby is premature.

Sometimes preeclampsia may get worse in the 1-2 weeks after delivery. While we often hear that birth is the cure for preeclampsia, in some cases the symptoms may get worse when the patient is at home with her new baby. She may have headaches, swelling, and other changes that show her blood pressure has become worse instead of better. If you are experiencing any of the above symptoms after you have delivered, you must contact your physician about it so that your status can be evaluated and appropriate treatment can be given.

Prenatal care at our practice always includes watching closely for this potentially deadly condition. Talk to your doctor at your next appointment if you have any questions or concerns about preeclampsia or any other pregnancy-related conditions.

Robotic Surgery for Gynecological Problems

The field of robotic surgery has developed rapidly, and its use for gynecologic conditions has grown exponentially. What does this mean for a patient? Do you imagine an independent machine, maybe looking like C3PO from Star Wars or something? Well, the robot does look futuristic, but it is completely controlled by your surgeon, giving him or her more dexterity than the human hand and wrist. Here's what you can really expect if you're a candidate for this cutting edge technology. 

The current robotic surgical system consists of 3 components:   

  • A surgeon's console
  • A patient-side cart with four robotic arms 
  • A high-definition three-dimensional (3D) vision system.  

During robotic surgery, the primary surgeon sits at the console, using finger graspers to control the instruments. Foot pedals and a clutch are used for camera control, activation of energy sources, focusing, and switching the robotic arm. Four to five trocars are used, including one through which a 12-mm or 8-mm three-dimensional endoscope is placed. Instruments are passed through three to four ports, three of which can be controlled by the robotic arms. One additional arm, not controlled by the robot, may be placed as an “assistant” port. Assistant surgical team members pass robotic instruments and sutures through these ports for use by the primary surgeon. These ports also provide suction, irrigation, and countertraction. Instruments for suturing, clamping, endosurgery are also a part of this. The console provides three-dimensional imaging with improved depth perception, and the surgeon has autonomous control of the camera and instruments. Finally, the robotic arm, with its wristed joint and six degrees of freedom, allows for greater dexterity than unassisted surgery and decreases normal hand tremors. 

Robotics have also been found to give an edge in more complex surgeries. The conversion rate to open surgery is lesser with robotic assistance when compared to laparoscopy. For myomectomy surgery, endo wrist movement of robotic instrument allows better and precise suturing than conventional straight stick laparoscopy. The robotic platform is a logical step forward to laparoscopy and has become popular among gynecological surgeons world over. 

If you've been told you need gynecological surgery, our doctors have experience and expertise. Contact us for a consultation. 

Laparoscopy Basics and Benefits

Many surgical procedures that used to be performed through larger abdominal incisions are now performed laparoscopically. With quicker recovery time, very small scars, and excellent outcomes, laparoscopy can have you back to your normal activities within a few weeks compared to the months sometimes needed to recover from open surgery.

In laparoscopic surgery, an instrument called a laparoscope is inserted into the pelvic and abdominal cavities to diagnose and treat gynecologic disorders. Carbon dioxide gas is introduced to provide visualization of the internal organs. A camera is attached to guide the surgeon and to document the findings with photographs.

Laparoscopy has many uses, including the diagnosis and treatment of chronic pelvic pain, endometriosis, fibroid tumors, infertility, and ovarian cysts. 

Some laparoscopic procedures include: 

  • Gynecologic cancer staging
  • Hysterectomy (removal of the uterus with or without the cervix)
  • Myomectomy (removal of fibroids)
  • Sterilization (tubal ligation)
  • Tubal reanastomosis

Benefits of laparoscopy include: 

  • Less pain after laparoscopic surgery than with open abdominal surgery. Open abdominal surgeries require longer hospital stays, larger incisions, and a longer recovery period than laparoscopic surgery.
  • Faster recovery time
  • Less risk of infection
  • Less blood loss
  • Sometimes done in an outpatient setting, so you won’t have to spend the night in the hospital
  • Smaller incisions mean less scarring and faster healing time

Because laparoscopic surgery eliminates the need for large abdominal incisions, the recovery time is extremely fast. Even with hysterectomy procedures, most women are back to normal activities within a few weeks.

Not all gynecologic conditions can be treated with laparoscopy. Very large tumors or masses may need open surgery. Extensive endometriosis can also be very difficult to treat laparoscopically because of associated adhesions (scar tissue), which can involve the adjacent bowel, bladder, ureters, etc. Adhesions cannot be diagnosed with sonography or CT scans, so an operation may start with the laparoscope and end with an open procedure, if extensive adhesive disease is present.

It is important to choose a surgeon who has experience in advanced laparoscopy to properly evaluate you for this type of procedure. Doctors Strebel, Grolle, and Perez have the experience you can rely on when you need gynecological surgery in the Las Vegas area.

Hysterectomy Surgery Options and What's Best For You

Many benign (non-cancerous) conditions can affect a woman’s reproductive system. Common benign conditions including fibroids, endometriosis, adenomyosis, and pelvic prolapse, among others, can cause many different symptoms or no symptoms at all. Some of the more common symptoms may include: pelvic pain, heavy bleeding, irregular periods, fatigue, unusual bloating, pain during intercourse, and infertility. If your symptoms are severe, your doctor may suggest medicine, lifestyle changes, or surgery. Surgical options will depend on your exact condition, symptoms, and overall health.

If appropriate, your doctor may recommend a hysterectomy. There are different ways to perform a hysterectomy, and you should discuss all options with your doctor. 

Hysterectomy methods include: 

  • Vaginal Hysterectomy
    • A vaginal hysterectomy is done through a cut in your vagina. The surgeon operates through this incision and closes it with stitches.
  • Abdominal Hysterectomy
    • During an abdominal hysterectomy (open surgery), your uterus is removed through a large open incision. The incision must be large enough for your surgeon’s hands to fit inside your body and see your organs. 
  • Laparoscopy
    • aparoscopic surgery is minimally invasive. With traditional laparoscopy, your surgeon operates through a few small incisions using long instruments and a tiny camera to guide doctors during surgery. 

Doctors Strebel, Grolle, and Perez can also offer an even less invasive method of hysterectomy done with the da Vinci surgical robot.

  • Single-Site/Single Incision: Your uterus can also be removed through a small incision in your belly button using single-incision traditional laparoscopy or da Vinci® Single-Site® Surgery. 
    • With da Vinci Single-Site Surgery, doctors remove your uterus and possibly your ovaries and fallopian tubes through your belly button using state-of-the-art instruments.
    • Patients who choose da Vinci Single-Site Surgery experience virtually scar-free results.

Da Vinci Single-Site Hysterectomy offers the following potential benefits:

  • Low blood loss
  • Low rate of converting to traditional laparoscopy and open surgery
  • Low rate of complications
  • Short hospital stay
  • Small incision for virtually scar-free results

If hysterectomy has been suggested as a treatment for you, talk to Doctors Strebel, Grolle, or Perez about your options at your next appointment. They can help you choose the best type of surgery for you.

Tips for a Healthy Vagina this Summer

Summer brings with it many things we all enjoy — warmer weather, vacations, pool time. Unfortunately, it also is the season when more women see their doctors regarding yeast, urinary tract, and bacterial infections. Follow this advice for helping to avoid these common but uncomfortable problems and for what to do should you happen to get any type of vaginitis (vaginal inflammation):

  • Wear loose-fitting clothing and underwear that has a cotton crotch.
  • Don’t sit around in a wet bathing suit or clothing.
  • Urinate frequently (try not to “hold it”) and always after sexual intercourse.
  • Stay away from douches and vaginal sprays.
  • Don’t use scented tampons or other perfumed products on or in the vagina.
  • Keep your immune system up (this is as simple as taking daily vitamins or drinking a glass of orange juice every morning).

If you have symptoms of a vaginal infection such as pain, burning during urination, itching, and abnormal discharge:

  • Call your doctor, even if you think you may have a simple yeast infection
  • Drink plenty of fluids
  • Begin treatment as soon as possible

Many women often mistakenly think they have a yeast infection and treat themselves; when, in fact, they have a similar vaginal infection that will not respond to self-treatment with over-the-counter yeast medications. A study by the American Social Health Association found that 70% of women self-treated vaginal infections before calling a health care provider. Most often, they incorrectly thought they had a yeast infection when, in fact, it was bacterial vaginosis or another condition.

The important thing is not to guess, but to recognize the symptoms if you develop a vaginal infection. If you have any concerns, see Dr. Strebel or Dr. Grolle for precise testing and to get the most appropriate and effective treatment right away. Waiting too long to see a doctor or not properly treating an infection can result in even worse infections that can send you to the hospital and impact fertility, so it is absolutely necessary to treat your symptoms as soon as they appear. Keep in mind that the quicker you clear up any infections, the quicker you can get back in the pool and enjoy your summer.