Developments of new surgical techniques and advances in surgical equipment allow us to perform more and more surgical procedures using laparoscopy and hysteroscopy. These novel procedures have revolutionized the approach to the majority of gynecological disorders. We can now perform the majority of surgeries without the need for large incisions into the abdominal wall and therefore, most often, patients can go home on the day of surgery and recover to full activity in approximately two weeks after surgery.
Our physicians have extensive experience in these procedures and are considered the best in their field.
These minimally invasive techniques offer many alternatives to hysterectomy for many women suffering from:
- Uterine fibroids
- Severe endometriosis
- Chronic pelvic pain
- Painful menstrual cycles (dysmenorrhea)
- Uterine thickening (adenomyosis)
Advanced laparoscopic procedures performed at Yale Reproductive Endocrinology include:
- Laser excision of endometriosis
- Laser and harmonic scalpel used in treatment of pelvic and abdominal adhesions, myomectomies
- Supra-cervical and total laparoscopic hysterectomies
- Removal of the ovaries
- Removal of ovarian cysts with preservation of the ovaries
- Laparoscopic treatment of pelvic pain including presacral neurectomies and uterosacral nerve ablations.
Advanced hysteroscopic procedures include, among others:
- Endometrial ablation
- Resections of fibroids
- Resections of intrauterine adhesions
- Removal of polyps
- Corrections of tubal obstructions
- Evaluations of fallopian tubes (falloposcopy)
Monday, March 30, 2009
Pregnancy Loss
What is pregnancy loss?
Pregnancy loss is the death of an unborn baby at any time during pregnancy. It is estimated that pregnancy loss occurs in over half of all early pregnancies. Most of these occur so early that the mother does not even know she is pregnant. Although 15 to 20 percent of diagnosed pregnancies are lost in the first or second trimesters of pregnancy, nearly all occur during the first trimester. Only about 1 percent of diagnosed pregnancies are lost after 16 weeks.
Pregnancy loss includes:
Blighted ovum - pregnancy loss before 8 weeks in which the egg is fertilized but never develops into an embryo.
Miscarriage - early pregnancy loss, also called spontaneous abortion
Ectopic pregnancy - the development of the fetus outside the uterus, in a fallopian tube, cervical canal, or the pelvic or abdominal cavity
Molar pregnancy - an abnormal development of placental and fetal tissues, occurring in about one out of 1,000 to one out of 1,500 pregnancies
Stillbirth - when the fetus dies before birth.
What causes pregnancy loss?
The vast majority of pregnancy losses are due to genetic or chromosomal abnormalities. However, other factors can also play a role in pregnancy loss. These include, but are not limited to, the following:
- Abnormal embryo development
- Hormone problems in the mother including low levels of progesterone or abnormal thyroid function
- Diabetes in the mother (especially in women who have poorly controlled blood glucose levels)
- Abnormalities of the uterus including scar tissue inside the uterus, abnormal formation or shape of the uterus, or myomas (fibroid tumors)
- Incompetent cervix - the opening to the uterus cannot stay closed during pregnancy.
- Infection (including organisms such as cytomegalovirus (CMV), mycoplasma, chlamydia, and ureaplasma, as well as listeriosis and toxoplasmosis)
- Antifetal antibodies - the mother's immune system recognizes the fetus as a foreign body and rejects it.
- Autoimmune diseases (conditions such as lupus erythematosus in which the body makes antibodies against one's own normal body chemicals; other autoimmune problems include antiphospholipid antibody syndrome)
- Cigarette smoking (there is an association with pregnancy loss and cigarette smoking)
- Exposure to toxic substances and chemicals such as anticancer drugs (studies are conflicting about the relationship of substances such as anesthetic gases, alcohol, and caffeine to pregnancy loss; exposure to video display terminals, or computer screens, has not been shown to be related to pregnancy loss)
Some women have recurrent problems in which pregnancy loss occurs over and over, usually three or more times. It is often difficult to find a cause for recurrent losses and couples may need additional testing for genetic or chromosomal problems.
Fortunately, most pregnancy losses are usually isolated events. A woman with a spontaneous early pregnancy loss has an 80 to 90 percent chance of a normal pregnancy the next time she conceives.
Why is pregnancy loss a concern?
Some pregnancy losses do not cause any problems, while others may be very serious and life threatening for the mother, if untreated. However, the most difficult part for most families is the emotional stress of the loss itself.
The loss of a baby at any time in pregnancy can be emotionally and physically difficult for the mother and other members of the family. For some families, the timing of the loss in the pregnancy may make the experience more or less difficult. For example, an early loss, before the mother even knew she was pregnant may not be as stressful as a loss later in pregnancy, after feeling fetal movement or seeing the fetus on ultrasound examination. However, parents may have strong feelings and sadness whenever a loss occurs.
Parents often experience a grief reaction to a loss, including feelings of the following:
* Shock, numbness, denial, and confusion
* Anger, guilt, searching and yearning
* Disorientation, depression, withdrawal, lack of energy
* Reorganization, resolution
These are normal responses to loss and may take months and sometimes years to work through. Experience with grieving families has found the following to be helpful:
* Seeing or holding (this is especially important in later pregnancy losses and with babies who die with a birth defect)
* Remembrances (including a lock of hair, hand or footprint, photographs, naming of the baby)
* Counseling (with a professional who is experienced in bereavement counseling)
* Memorial or funeral service
What are the symptoms of pregnancy loss?
Vaginal bleeding is the most common symptom of pregnancy loss. In later pregnancy, a woman with a stillborn may no longer feel fetal movements. However, each type of loss has specific symptoms. Also, each woman may exhibit different symptoms or the symptoms may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
How is pregnancy loss diagnosed?
In addition to a complete medical history and physical examination, diagnosis of pregnancy loss is usually based on laboratory tests, with reported symptoms aiding in the diagnosis. Tests used to diagnose pregnancy loss may include:
* Pregnancy blood tests for the hormone human chorionic gonadotrophin (hCG)
* Ultrasound - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs.
Treatment for pregnancy loss:
Specific treatment for pregnancy loss will be determined by your physician based on:
* Your pregnancy, overall health, and medical history
* Gestational age of the fetus
* Your tolerance for specific medications, procedures, or therapies
* The type of pregnancy loss
* Your opinion or preference
Once pregnancy loss occurs, the uterus must be emptied of all the fetal tissues to prevent further complications. Counseling and support of the family is important. Your physician can help you find resources and support organizations that can help after pregnancy loss.
Pregnancy loss is the death of an unborn baby at any time during pregnancy. It is estimated that pregnancy loss occurs in over half of all early pregnancies. Most of these occur so early that the mother does not even know she is pregnant. Although 15 to 20 percent of diagnosed pregnancies are lost in the first or second trimesters of pregnancy, nearly all occur during the first trimester. Only about 1 percent of diagnosed pregnancies are lost after 16 weeks.
Pregnancy loss includes:
Blighted ovum - pregnancy loss before 8 weeks in which the egg is fertilized but never develops into an embryo.
Miscarriage - early pregnancy loss, also called spontaneous abortion
Ectopic pregnancy - the development of the fetus outside the uterus, in a fallopian tube, cervical canal, or the pelvic or abdominal cavity
Molar pregnancy - an abnormal development of placental and fetal tissues, occurring in about one out of 1,000 to one out of 1,500 pregnancies
Stillbirth - when the fetus dies before birth.
What causes pregnancy loss?
The vast majority of pregnancy losses are due to genetic or chromosomal abnormalities. However, other factors can also play a role in pregnancy loss. These include, but are not limited to, the following:
- Abnormal embryo development
- Hormone problems in the mother including low levels of progesterone or abnormal thyroid function
- Diabetes in the mother (especially in women who have poorly controlled blood glucose levels)
- Abnormalities of the uterus including scar tissue inside the uterus, abnormal formation or shape of the uterus, or myomas (fibroid tumors)
- Incompetent cervix - the opening to the uterus cannot stay closed during pregnancy.
- Infection (including organisms such as cytomegalovirus (CMV), mycoplasma, chlamydia, and ureaplasma, as well as listeriosis and toxoplasmosis)
- Antifetal antibodies - the mother's immune system recognizes the fetus as a foreign body and rejects it.
- Autoimmune diseases (conditions such as lupus erythematosus in which the body makes antibodies against one's own normal body chemicals; other autoimmune problems include antiphospholipid antibody syndrome)
- Cigarette smoking (there is an association with pregnancy loss and cigarette smoking)
- Exposure to toxic substances and chemicals such as anticancer drugs (studies are conflicting about the relationship of substances such as anesthetic gases, alcohol, and caffeine to pregnancy loss; exposure to video display terminals, or computer screens, has not been shown to be related to pregnancy loss)
Some women have recurrent problems in which pregnancy loss occurs over and over, usually three or more times. It is often difficult to find a cause for recurrent losses and couples may need additional testing for genetic or chromosomal problems.
Fortunately, most pregnancy losses are usually isolated events. A woman with a spontaneous early pregnancy loss has an 80 to 90 percent chance of a normal pregnancy the next time she conceives.
Why is pregnancy loss a concern?
Some pregnancy losses do not cause any problems, while others may be very serious and life threatening for the mother, if untreated. However, the most difficult part for most families is the emotional stress of the loss itself.
The loss of a baby at any time in pregnancy can be emotionally and physically difficult for the mother and other members of the family. For some families, the timing of the loss in the pregnancy may make the experience more or less difficult. For example, an early loss, before the mother even knew she was pregnant may not be as stressful as a loss later in pregnancy, after feeling fetal movement or seeing the fetus on ultrasound examination. However, parents may have strong feelings and sadness whenever a loss occurs.
Parents often experience a grief reaction to a loss, including feelings of the following:
* Shock, numbness, denial, and confusion
* Anger, guilt, searching and yearning
* Disorientation, depression, withdrawal, lack of energy
* Reorganization, resolution
These are normal responses to loss and may take months and sometimes years to work through. Experience with grieving families has found the following to be helpful:
* Seeing or holding (this is especially important in later pregnancy losses and with babies who die with a birth defect)
* Remembrances (including a lock of hair, hand or footprint, photographs, naming of the baby)
* Counseling (with a professional who is experienced in bereavement counseling)
* Memorial or funeral service
What are the symptoms of pregnancy loss?
Vaginal bleeding is the most common symptom of pregnancy loss. In later pregnancy, a woman with a stillborn may no longer feel fetal movements. However, each type of loss has specific symptoms. Also, each woman may exhibit different symptoms or the symptoms may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
How is pregnancy loss diagnosed?
In addition to a complete medical history and physical examination, diagnosis of pregnancy loss is usually based on laboratory tests, with reported symptoms aiding in the diagnosis. Tests used to diagnose pregnancy loss may include:
* Pregnancy blood tests for the hormone human chorionic gonadotrophin (hCG)
* Ultrasound - a diagnostic imaging technique which uses high-frequency sound waves and a computer to create images of blood vessels, tissues, and organs.
Treatment for pregnancy loss:
Specific treatment for pregnancy loss will be determined by your physician based on:
* Your pregnancy, overall health, and medical history
* Gestational age of the fetus
* Your tolerance for specific medications, procedures, or therapies
* The type of pregnancy loss
* Your opinion or preference
Once pregnancy loss occurs, the uterus must be emptied of all the fetal tissues to prevent further complications. Counseling and support of the family is important. Your physician can help you find resources and support organizations that can help after pregnancy loss.
Endometriosis
Check out the Yale Program for Endometriosis Facebook Page:
http://www.facebook.com/pages/Yale-Program-for-Endometriosis/55776207899?ref=ts
Pelvic Pain
What is pelvic pain?
Pelvic pain is a common complaint among women. Its nature and intensity may fluctuate, and its cause is often obscure. In some cases, no disease is evident. Pelvic pain can be categorized as either acute, meaning the pain is sudden and severe, or chronic, lasting over a period of months or longer. Pelvic pain may originate in genital or extragenital organs in and around the pelvis, or it may be psychological, which can make pain feel worse or actually cause a sensation of pain, when no physical problem is present.
What causes pelvic pain?
Pelvic pain may have multiple causes, including:
- Inflammation or direct irritation of nerves caused by acute or chronic trauma, fibrosis, pressure, or intraperitoneal inflammation
- Muscular contractions or cramps of both smooth and skeletal muscles
- Psychogenic factors, which can cause or aggravate pain
Some of the more common sources of acute pelvic pain, or pain that occurs very suddenly, may include:
- Ectopic pregnancy - a pregnancy that occurs outside the uterus
- Pelvic inflammatory disease (PID) - an infection of the reproductive organs
- Twisted or ruptured ovarian cyst
- Miscarriage or threatened miscarriage
- Urinary tract infection
- Appendicitis
- Ruptured fallopian tube
Some of the conditions which can lead to chronic pelvic pain, pain that may last for several months or longer, may include:
- Menstrual cramps
- Endometriosis
- Uterine fibroids - abnormal growths on or in the uterine wall
- Adhesions - scar tissue between the internal organs in the pelvic cavity
- Endometrial polyps - protrusions attached by a small stem in the uterine cavity
- Cancers of the reproductive tract
This long-term and often unrelenting pain may cause a woman's defenses to break down, resulting in emotional and behavioral changes. This occurrence is often termed "chronic pelvic pain syndrome."
What are the different types of pelvic pain?
The following are examples of the different types of pelvic pain most commonly described by women, and their possible cause or origin. Always consult your physician for a diagnosis.
Localized Pain - may be due to an inflammation
Colicky Pain - may be caused by spasm in a soft organ, such as the intestine, ureter, or appendix
Sudden onset of Pain - may be caused by a temporary deficiency of blood supply due to an obstruction in the circulation of blood
Slowly-developing Pain
may be due to inflammation of the appendix or an intestinal obstruction
Pain involving the Entire Abdomen
may suggest an accumulation of blood, pus, or intestinal contents
Pain aggravated by movement or during examination
may be a result of irritation in the lining of the abdominal cavity
How is pelvic pain diagnosed?
Diagnostic procedures and tests will be performed in order to determine the cause of the pelvic pain. In addition, your physician may ask you questions regarding the pain such as:
- When and where does the pain occur?
- How long does the pain last?
- Is the pain related to your menstrual cycle, urination, and/or sexual activity?
- What does the pain feels like (i.e., sharp, dull, etc.)?
- Under what circumstances did the pain begin?
- How suddenly did the pain begin?
Additional information about the timing of the pain and the presence of other symptoms related to activities such as eating, sleeping, sexual activity, and movement can also help the physician in determining a diagnosis.
Diagnostic tests for pelvic pain:
In addition to a complete medical history and physical and pelvic examination, diagnostic procedures for pelvic pain may include:
- Blood tests
- Pregnancy test
- Urinalysis
- Culture of cells from the cervix
- Ultrasound - a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs.
- Computed tomography (CT) - a non-invasive procedure that takes cross-sectional images of the internal organs; to detect any abnormalities that may not show up on an ordinary x-ray.
- Magnetic resonance imaging (MRI) - a non-invasive procedure that produces a two-dimensional view of an internal organ or structure.
- Laparoscopy - a minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic area, the physician can determine the locations, extent, and size of the endometrial growths.
- X-ray - electromagnetic energy used to produce images of bones and internal organs onto film.
Treatment for pelvic pain:
Specific treatment for pelvic pain will be determined by your physician based on:
- Your overall health and medical history
- Extent of condition
- Cause of the condition
- Your tolerance for specific medications, procedures or therapies
- Expectations for the course of the condition
- Your opinion or preference
Treatment may include:
- Antibiotic medications
- Anti-inflammatory and/or pain medications
- Relaxation exercises
- Oral contraceptives (ovulation inhibitors)
- Surgery
- Physical therapy
If a physical cause cannot be found, pelvic pain may be diagnosed as a psychological defense or coping mechanism for some type of trauma. In some cases, psychotherapy is recommended. In other cases, physicians may recommend a multi-disciplinary treatment utilizing a number of different approaches including nutritional modifications, environmental changes, physical therapy, and pain management.
Pelvic pain is a common complaint among women. Its nature and intensity may fluctuate, and its cause is often obscure. In some cases, no disease is evident. Pelvic pain can be categorized as either acute, meaning the pain is sudden and severe, or chronic, lasting over a period of months or longer. Pelvic pain may originate in genital or extragenital organs in and around the pelvis, or it may be psychological, which can make pain feel worse or actually cause a sensation of pain, when no physical problem is present.
What causes pelvic pain?
Pelvic pain may have multiple causes, including:
- Inflammation or direct irritation of nerves caused by acute or chronic trauma, fibrosis, pressure, or intraperitoneal inflammation
- Muscular contractions or cramps of both smooth and skeletal muscles
- Psychogenic factors, which can cause or aggravate pain
Some of the more common sources of acute pelvic pain, or pain that occurs very suddenly, may include:
- Ectopic pregnancy - a pregnancy that occurs outside the uterus
- Pelvic inflammatory disease (PID) - an infection of the reproductive organs
- Twisted or ruptured ovarian cyst
- Miscarriage or threatened miscarriage
- Urinary tract infection
- Appendicitis
- Ruptured fallopian tube
Some of the conditions which can lead to chronic pelvic pain, pain that may last for several months or longer, may include:
- Menstrual cramps
- Endometriosis
- Uterine fibroids - abnormal growths on or in the uterine wall
- Adhesions - scar tissue between the internal organs in the pelvic cavity
- Endometrial polyps - protrusions attached by a small stem in the uterine cavity
- Cancers of the reproductive tract
This long-term and often unrelenting pain may cause a woman's defenses to break down, resulting in emotional and behavioral changes. This occurrence is often termed "chronic pelvic pain syndrome."
What are the different types of pelvic pain?
The following are examples of the different types of pelvic pain most commonly described by women, and their possible cause or origin. Always consult your physician for a diagnosis.
Localized Pain - may be due to an inflammation
Colicky Pain - may be caused by spasm in a soft organ, such as the intestine, ureter, or appendix
Sudden onset of Pain - may be caused by a temporary deficiency of blood supply due to an obstruction in the circulation of blood
Slowly-developing Pain
may be due to inflammation of the appendix or an intestinal obstruction
Pain involving the Entire Abdomen
may suggest an accumulation of blood, pus, or intestinal contents
Pain aggravated by movement or during examination
may be a result of irritation in the lining of the abdominal cavity
How is pelvic pain diagnosed?
Diagnostic procedures and tests will be performed in order to determine the cause of the pelvic pain. In addition, your physician may ask you questions regarding the pain such as:
- When and where does the pain occur?
- How long does the pain last?
- Is the pain related to your menstrual cycle, urination, and/or sexual activity?
- What does the pain feels like (i.e., sharp, dull, etc.)?
- Under what circumstances did the pain begin?
- How suddenly did the pain begin?
Additional information about the timing of the pain and the presence of other symptoms related to activities such as eating, sleeping, sexual activity, and movement can also help the physician in determining a diagnosis.
Diagnostic tests for pelvic pain:
In addition to a complete medical history and physical and pelvic examination, diagnostic procedures for pelvic pain may include:
- Blood tests
- Pregnancy test
- Urinalysis
- Culture of cells from the cervix
- Ultrasound - a diagnostic imaging technique which uses high-frequency sound waves to create an image of the internal organs.
- Computed tomography (CT) - a non-invasive procedure that takes cross-sectional images of the internal organs; to detect any abnormalities that may not show up on an ordinary x-ray.
- Magnetic resonance imaging (MRI) - a non-invasive procedure that produces a two-dimensional view of an internal organ or structure.
- Laparoscopy - a minor surgical procedure in which a laparoscope, a thin tube with a lens and a light, is inserted into an incision in the abdominal wall. Using the laparoscope to see into the pelvic area, the physician can determine the locations, extent, and size of the endometrial growths.
- X-ray - electromagnetic energy used to produce images of bones and internal organs onto film.
Treatment for pelvic pain:
Specific treatment for pelvic pain will be determined by your physician based on:
- Your overall health and medical history
- Extent of condition
- Cause of the condition
- Your tolerance for specific medications, procedures or therapies
- Expectations for the course of the condition
- Your opinion or preference
Treatment may include:
- Antibiotic medications
- Anti-inflammatory and/or pain medications
- Relaxation exercises
- Oral contraceptives (ovulation inhibitors)
- Surgery
- Physical therapy
If a physical cause cannot be found, pelvic pain may be diagnosed as a psychological defense or coping mechanism for some type of trauma. In some cases, psychotherapy is recommended. In other cases, physicians may recommend a multi-disciplinary treatment utilizing a number of different approaches including nutritional modifications, environmental changes, physical therapy, and pain management.
Fibroids
Fibroids are the most frequently seen tumors of the female reproductive system. Fibroids, also known as uterine myomas, leiomyomas, or fibromas, are firm, compact tumors that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus. It is estimated that between 20 to 30 percent of women of reproductive age have fibroids, although not all are diagnosed. Some estimates state that up to 75 percent of women will develop fibroids sometime during their childbearing years, although only about one-third of these fibroids are large enough to be detected by a physician during a physical examination.
What are fibroids?
Fibroids are the most frequently seen tumors of the female reproductive system. Fibroids, also known as uterine myomas, leiomyomas, or fibromas, are firm, compact tumors that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus. It is estimated that between 20 to 50 percent of women of reproductive age have fibroids, although not all are diagnosed. Some estimates state that up to 30 to 77 percent of women will develop fibroids sometime during their childbearing years, although only about one-third of these fibroids are large enough to be detected by a physician during a physical examination.
In more than 99 percent of fibroid cases, the tumors are benign (non-cancerous). These tumors are not associated with cancer and do not increase a woman's risk for uterine cancer. They may range in size, from the size of a pea to the size of a softball or small grapefruit.
What causes fibroid tumors?
While it is not clearly known what causes fibroids, it is believed that each tumor develops from an aberrant muscle cell in the uterus, which multiplies rapidly because of the influence of estrogen.
Who is at risk for fibroid tumors?
Women who are approaching menopause are at the greatest risk for fibroids because of their long exposure to high levels of estrogen. Women who are obese and of African-American heritage also seem to be at an increased risk, although the reasons for this are not clearly understood.
Research has also shown that some factors may protect a woman from developing fibroids. Some studies, of small numbers of women, have indicated that women who have had two liveborn children have one-half the risk of developing uterine fibroids compared to women who have had no children. Scientists are not sure whether having children actually protected women from fibroids or whether fibroids were a factor in infertility in women who had no children. The National Institute of Child Health and Human Development is conducting further research on this topic and other factors that may affect the diagnosis and treatment of fibroids.
What are the symptoms of fibroids?
Some women who have fibroids have no symptoms, or have only mild symptoms, while other women have more severe, disruptive symptoms. The following are the most common symptoms for uterine fibroids, however, each individual may experience symptoms differently.
Symptoms of uterine fibroids may include:
- Heavy or prolonged menstrual periods
- Abnormal bleeding between menstrual periods
- Pelvic pain (caused as the tumor presses on pelvic organs)
- Frequent urination
- Low back pain
- Pain during intercourse
- A firm mass, often located near the middle of the pelvis, which can be felt by the physician
In some cases, the heavy or prolonged menstrual periods, or the abnormal bleeding between periods, can lead to iron-deficiency anemia, which also requires treatment.
How are fibroids diagnosed?
Fibroids are most often found during a routine pelvic examination. This, along with an abdominal examination, may indicate a firm, irregular pelvic mass to the physician. In addition to a complete medical history and physical and pelvic and/or abdominal examination, diagnostic procedures for uterine fibroids may include:
X-ray - electromagnetic energy used to produce images of bones and internal organs onto film
Transvaginal ultrasound (also called ultrasonography) - an ultrasound test using a small instrument, called a transducer, that is placed in the vagina
Magnetic resonance imaging (MRI) - a non-invasive procedure that produces a two-dimensional view of an internal organ or structure
Hysterosalpingography - x-ray examination of the uterus and fallopian tubes that uses dye and is often performed to rule out tubal obstruction
Hysteroscopy - visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina
Endometrial biopsy - a procedure in which a sample of tissue is obtained through a tube which is inserted into the uterus
Blood test - to check for iron-deficiency anemia if heavy bleeding is caused by the tumor.
Treatment for fibroids:
Since most fibroids stop growing or may even shrink as a woman approaches menopause, the physician may simply suggest "watchful waiting." With this approach, the physician monitors the woman's symptoms carefully to ensure that there are no significant changes or developments and that the fibroids are not growing.
In women whose fibroids are large or are causing significant symptoms, treatment may be necessary. Treatment will be determined by your physician(s) based on:
- Your overall health and medical history
- Extent of the disease
- Your tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
- Your desire for pregnancy
In general, treatment for fibroids may include:
Hysterectomy
Hysterectomies involve the surgical removal of the entire uterus. Fibroids remain the number one reason for hysterectomies in the United States.
Conservative Surgical Therapy
Conservative surgical therapy uses a procedure called a myomectomy. With this approach, physicians will remove the fibroids, but leave the uterus intact to enable a future pregnancy.
Gonadotropin-releasing Hormone Agonists (GnRH agonists)
This approach lowers levels of estrogen and triggers a "medical menopause." Sometimes GnRH agonists are used to shrink the fibroid, making surgical treatment easier.
Anti-hormonal Agents
Certain drugs oppose estrogen (such as progestin and Danazol), and appear effective in treating fibroids. Anti-progestins, which block the action of progesterone, are also sometimes used.
Uterine Artery Embolization
Also called uterine fibroid embolization, uterine artery embolization (UAE) is a newer minimally-invasive (without a large abdominal incision) technique. The arteries supplying blood to the fibroids are identified, then embolized (blocked off). The embolization cuts off the blood supply to the fibroids, thus shrinking them. Physicians continue to evaluate the long-term implications of this procedure on fertility and regrowth of the fibroid tissue.
Anti-inflammatory Painkillers
This type of drug is often effective for women who experience occasional pelvic pain or discomfort.
Irregular Uterine Bleeding
Every year approximately 180,000 women in the United States undergo hysterectomies for treatment of abnormal uterine bleeding. And many more women with this condition forego hysterectomies and either suffer silently or rely on relatively ineffective hormonal treatment. But Yale Reproductive Endocrinology has expertise with a number of alternative outpatient or office-based surgical procedures that offer relief, including endometrial cryoablation and thermal ablation.
Hormonal Imbalance
Hormonal imbalance may be caused by abnormalities in the secretion of estrogen, progesterone, as well as androgens. Depending on the type of abnormality, patients may experience a wide array of symptoms, including hot flushes, vaginal dryness, depression, abnormal vaginal bleeding, and excessive hair growth. Our practice offers a wide array of tests depending on patients' needs and state-of-the-art treatment.
Ovulatory Disorders
Ovulatory disorders are common in reproductive age women and constitute the most common cause of menstrual abnormalities. In addition to causing discomfort due to irregular bleeding, ovulatory disorders are also common causes of infertility.
Ovulatory disorders may result from problems in the ovary as well as abnormalities in the pituitary gland and hypothalamus in the brain. Another common cause of ovulatory dysfunction associated with hirsutism is polycystic ovary syndrome.
Yale Reproductive Endocrinology offers state-of-the-art approaches for the diagnosis of underlying causes of ovulatory disorders as well as their treatment. Experts at Yale Reproductive Endocrinology are recognized nationally and internationally for their scientific contributions in the pathogenesis, diagnosis and treatment of ovulatory disorders and authored many peer reviewed articles.
Ovulatory disorders may result from problems in the ovary as well as abnormalities in the pituitary gland and hypothalamus in the brain. Another common cause of ovulatory dysfunction associated with hirsutism is polycystic ovary syndrome.
Yale Reproductive Endocrinology offers state-of-the-art approaches for the diagnosis of underlying causes of ovulatory disorders as well as their treatment. Experts at Yale Reproductive Endocrinology are recognized nationally and internationally for their scientific contributions in the pathogenesis, diagnosis and treatment of ovulatory disorders and authored many peer reviewed articles.
Hypoandrogenism and Excessive Hairiness (Hirsutism)
What is excessive hairiness?
Excessive hairiness, also known as hirsutism, is characterized by abnormal hair growth on areas of skin that are not normally hairy. Although the condition can affect both men and women, it usually only presents a problem to women.
What causes excessive hairiness?
Excessive hairiness tends to run in families, especially in families of Mediterranean descent. The excessive hairiness in children and women may be caused by pituitary or adrenal glands disorders. In addition, women may develop excessive hairiness after menopause. Anabolic steroids or corticosteroids, and certain medications, also may cause excessive hairiness.
How is excessive hairiness diagnosed?
Although diagnosis of excessive hairiness can be diagnosed with a medical history and physical examination, finding the underlying cause for the condition may include blood tests, if an endocrine disorder is suspected.
Treatment for excessive hairiness:
Specific treatment for excessive hairiness will be determined by your physician based on:
- Your age, overall health, and medical history
- Extent of the condition
- Cause of the condition
- Your tolerance for specific medications, procedures, and therapies
- Expectation for the course of the condition
- Your opinion or preference
Treatment may include:
- Removing the hair by shaving, plucking, waxing, depilatories, electrolysis, bleaching, or laser surgery
- Medication (to control any underlying endocrine disorder)
Excessive hairiness, also known as hirsutism, is characterized by abnormal hair growth on areas of skin that are not normally hairy. Although the condition can affect both men and women, it usually only presents a problem to women.
What causes excessive hairiness?
Excessive hairiness tends to run in families, especially in families of Mediterranean descent. The excessive hairiness in children and women may be caused by pituitary or adrenal glands disorders. In addition, women may develop excessive hairiness after menopause. Anabolic steroids or corticosteroids, and certain medications, also may cause excessive hairiness.
How is excessive hairiness diagnosed?
Although diagnosis of excessive hairiness can be diagnosed with a medical history and physical examination, finding the underlying cause for the condition may include blood tests, if an endocrine disorder is suspected.
Treatment for excessive hairiness:
Specific treatment for excessive hairiness will be determined by your physician based on:
- Your age, overall health, and medical history
- Extent of the condition
- Cause of the condition
- Your tolerance for specific medications, procedures, and therapies
- Expectation for the course of the condition
- Your opinion or preference
Treatment may include:
- Removing the hair by shaving, plucking, waxing, depilatories, electrolysis, bleaching, or laser surgery
- Medication (to control any underlying endocrine disorder)
Acne
Hyperandrogenism is the detection of excess androgen (a masculine steroid hormone). The most common clinical presentation of hyperandrogenism in reproductive-aged women is acne or hirsutism.
Acne
What is acne?
Acne is a disorder of the hair follicles and sebaceous glands. With acne, the sebaceous glands are clogged, which leads to pimples and cysts.
Acne is very common - nearly 17 million people in the US are affected by this condition. Acne most often begins in puberty. During puberty, the male sex hormones (androgens) increase in both boys and girls, causing the sebaceous glands to become more active - resulting in increased production of sebum.
How does acne develop?
The sebaceous glands produce oil (sebum) which normally travels via hair follicles to the skin surface. However, skin cells can plug the follicles, blocking the oil coming from the sebaceous glands. When follicles become plugged, skin bacteria (called Propionibacterium acnes, or P. acnes) inside the follicles, cause inflammation. (The basic acne lesion is called a comedo.)
Acne progresses in the following manner:
1. Microcomedo: blockage of the hair follicle, which is too small to see
2. Blackheads:(a semisolid, black plug): blockage of the hair follicle in which the plug can be seen
3. Whiteheads (a semisolid, white plug): blockage of the hair follicle in which the plug cannot be seen
4. Infection and irritation cause pustules (pimples or zits) to form.
Eventually, the plugged follicle bursts, spilling oil, skin cells, and the bacteria onto the skin surface. In turn, the skin becomes irritated and pimples or lesions begin to develop.
Acne can be superficial (pimples without abscesses) or deep (when the inflamed pimples push down into the skin, causing pus-filled cysts that rupture and result in larger abscesses).
What causes acne?
Rising hormone levels during puberty may cause acne. In addition, acne is often inherited. Other causes of acne may include the following:
- Hormone level changes during the menstrual cycle in women
- Certain drugs (such as corticosteroids, lithium, and barbiturates)
- Oil and grease from the scalp, mineral or cooking oil, and certain cosmetics may worsen acne
- Bacteria inside pimples
Acne can be aggravated by squeezing the pimples or by scrubbing the skin too hard.
What are the symptoms of acne?
Acne can occur anywhere on the body. However, acne most often appears in areas where there is a high concentration of sebaceous glands, including the following:
- Face
- Chest
- Upper back
- Shoulders
- Neck
The following are the most common symptoms of acne. However, each child may experience symptoms differently.
Symptoms may include:
- Blackheads
- Whiteheads
- Pus-filled lesions that may be painful
- Nodules (solid, raised bumps)
The symptoms of acne may resemble other skin conditions. Always consult your child's physician for a diagnosis.
Treatment of acne:
Specific treatment will be determined by your child's physician based on:
- Your child's age, overall health, and medical history
- Severity of the acne
- Your child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the condition
- Your opinion or preference
The goal of acne treatment is to minimize scarring and improve appearance. Treatment for acne will include topical or systemic drug therapy. Depending upon the severity of acne, topical medications (medications applied to the skin) or systemic medications (medications taken orally) may be prescribed by your child's physician. In some cases, a combination of both topical and systemic medications may be recommended.
Topical medications to treat acne:
Topical medications are often prescribed to treat acne. Topical medication can be in the form of a cream, gel, lotion, or solution. Examples include:
Benzoyl Peroxide
Kills the bacteria (P. acnes)
Antibiotics
Helps stop or slow down the growth of P. acnes and reduces inflammation
Tretinoin, Adapalene
Stops the development of new acne lesions (comedones) and encourages cell turnover, unplugging pimples
Systemic medications to treat acne:
Systemic antibiotics are often prescribed to treat moderate to severe acne, and may include the following:
- Doxycycline
- Minocycline
- Tetracycline
- Treatment for severe, cystic, or inflammatory acne:
Isotretinoin (Accutane®), an oral drug, may be prescribed for individuals with severe, cystic, or inflammatory acne to prevent extensive scarring. Isotretinoin reduces the size of the sebaceous glands that produce the skin oil, increases skin cell shedding, and affects the hair follicles, thereby reducing the development of acne lesions. Isotretinoin can clear acne in 90 percent of patients. However, the drug has major unwanted side effects, including psychiatric side effects. It is very important to discuss this prescription medication with your child's physician.
Pituitary/Hypothalamic Failure
The anterior (front) lobe of the pituitary gland makes up 80 percent of the gland's weight. It releases a variety of hormones that affect growth, physical and sexual development, and other endocrine glands. Oversecretion or undersecretion of certain hormones by the anterior lobe of the pituitary gland will cause other endocrine glands to over- or underproduce certain hormones, as well.
What is hypopituitarism?
Hypopituitarism, also called an underactive pituitary gland, is a condition that affects the anterior (front) lobe of the pituitary gland - usually resulting in a partial or complete loss of functioning of that lobe. The resulting symptoms depend on which hormones are no longer being produced by the gland. Because the pituitary gland affects the other endocrine organs, effects of hypopituitarism may be gradual, or sudden and dramatic.
What causes hypopituitarism?
Hypopituitarism, in children, is often caused by a benign (non-cancerous) pituitary tumor, an injury, or an infection. However, often no exact cause can be determined.
What are the symptoms of hypopituitarism?
Symptoms vary depending on what hormones are insufficiently produced by the pituitary gland. The following are common symptoms associated with reduced production of certain hormones:
Insufficient Gonadotropins Production (Luteinizing Hormone and Follicle-Stimulating Hormone)
In premenopausal women, this leads to absent menstrual cycles, infertility, vaginal dryness, and loss of some female characteristics. In men, this deficiency leads to impotence, shriveling of testes, decreased sperm production, infertility, and loss of some male characteristics.
Insufficient Growth Hormone Production
This usually produces no symptoms in adults. In children, this deficiency can lead to stunted growth and dwarfism.
Insufficient Thyroid-Stimulating Hormone Production
This usually leads to an underactive thyroid and may cause confusion, cold intolerance, weight gain, constipation, and dry skin.
Insufficient Corticotrophic Production
This rare deficiency leads to an underactive adrenal gland, resulting in low blood pressure, a low blood sugar level, fatigue, and a low tolerance for stress.
Insufficient Prolactin Production
This rare deficiency may cause an inability to produce breast milk after childbirth in some women.
The symptoms of hypopituitarism may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
How is hypopituitarism diagnosed?
The symptoms of several underactive glands may help your child's physician diagnose hypopituitarism. In addition to a complete medical history and physical examination, diagnostic procedures for hypopituitarism may include:
Computed Tomography Scan (Also Called a CT or CAT Scan)
A diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
Magnetic Resonance Imaging (MRI)
A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Blood Tests
To measure hormone levels.
Bone X-rays of the Hand
To determine bone age.
Treatment for hypopituitarism:
Specific treatment for hypopituitarism will be determined by your child's physician based on:
- Your child's age, overall health, and medical history
- Extent of the disease
- Your child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
Treatment of hypopituitarism depends on its cause. The goal of treatment is to restore the pituitary gland to normal function, producing normal levels of hormones. Treatment may include specific hormone replacement therapy, surgical tumor removal, and/or radiation therapy.
What is hypopituitarism?
Hypopituitarism, also called an underactive pituitary gland, is a condition that affects the anterior (front) lobe of the pituitary gland - usually resulting in a partial or complete loss of functioning of that lobe. The resulting symptoms depend on which hormones are no longer being produced by the gland. Because the pituitary gland affects the other endocrine organs, effects of hypopituitarism may be gradual, or sudden and dramatic.
What causes hypopituitarism?
Hypopituitarism, in children, is often caused by a benign (non-cancerous) pituitary tumor, an injury, or an infection. However, often no exact cause can be determined.
What are the symptoms of hypopituitarism?
Symptoms vary depending on what hormones are insufficiently produced by the pituitary gland. The following are common symptoms associated with reduced production of certain hormones:
Insufficient Gonadotropins Production (Luteinizing Hormone and Follicle-Stimulating Hormone)
In premenopausal women, this leads to absent menstrual cycles, infertility, vaginal dryness, and loss of some female characteristics. In men, this deficiency leads to impotence, shriveling of testes, decreased sperm production, infertility, and loss of some male characteristics.
Insufficient Growth Hormone Production
This usually produces no symptoms in adults. In children, this deficiency can lead to stunted growth and dwarfism.
Insufficient Thyroid-Stimulating Hormone Production
This usually leads to an underactive thyroid and may cause confusion, cold intolerance, weight gain, constipation, and dry skin.
Insufficient Corticotrophic Production
This rare deficiency leads to an underactive adrenal gland, resulting in low blood pressure, a low blood sugar level, fatigue, and a low tolerance for stress.
Insufficient Prolactin Production
This rare deficiency may cause an inability to produce breast milk after childbirth in some women.
The symptoms of hypopituitarism may resemble other conditions or medical problems. Always consult your physician for a diagnosis.
How is hypopituitarism diagnosed?
The symptoms of several underactive glands may help your child's physician diagnose hypopituitarism. In addition to a complete medical history and physical examination, diagnostic procedures for hypopituitarism may include:
Computed Tomography Scan (Also Called a CT or CAT Scan)
A diagnostic imaging procedure that uses a combination of x-rays and computer technology to produce cross-sectional images (often called slices), both horizontally and vertically, of the body. A CT scan shows detailed images of any part of the body, including the bones, muscles, fat, and organs. CT scans are more detailed than general x-rays.
Magnetic Resonance Imaging (MRI)
A diagnostic procedure that uses a combination of large magnets, radiofrequencies, and a computer to produce detailed images of organs and structures within the body.
Blood Tests
To measure hormone levels.
Bone X-rays of the Hand
To determine bone age.
Treatment for hypopituitarism:
Specific treatment for hypopituitarism will be determined by your child's physician based on:
- Your child's age, overall health, and medical history
- Extent of the disease
- Your child's tolerance for specific medications, procedures, or therapies
- Expectations for the course of the disease
- Your opinion or preference
Treatment of hypopituitarism depends on its cause. The goal of treatment is to restore the pituitary gland to normal function, producing normal levels of hormones. Treatment may include specific hormone replacement therapy, surgical tumor removal, and/or radiation therapy.
Hyperprolactinemia
Hyperprolactinemia is a hypothalamic-pituitary condition of elevated serum prolactin in non-pregnant women. Hyperprolactinemia may affect menstrual cycle and ovulation. It may also cause infertility and loss of libido. On occasions hyperprolactinemia may be caused by a small tumor in the pituitary and may damage the surrounding organs such as the optic nerves. Therefore, the timely diagnosis and treatment of hyperprolactinemia is quite important. Our practice collaborates with Medical Endocrinology Pituitary Program and Neurosurgery together offering state-of-the-art testing and treatments for hyperprolactinemia.
Polycystic Ovarian Syndrome
Polycystic Ovarian Syndrome (PCOS) is the most common endocrine disorder affecting young women. This condition is associated with infertility, absent or irregular menstrual cycle and increased activity of testosterone (“male hormone”). Most women with PCOS have also other hormonal and metabolic problems such as elevated level of insulin and cholesterol. In the long term, women with this condition are at increased risk of cardiovascular diseases and diabetes. Our center offers extensive state-of-the-art testing and treatments of PCOS. We are also developing new therapies designed to treat symptoms and to protect from long-term consequences of this disorder.
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