What is endometriosis?

More than 5 million women in the U.S. struggle with a chronic health condition that can not only be painful, but also potentially affect their ability to get pregnant. This health condition is endometriosis.

March is National Endometriosis Awareness Month, and an important time to learn how to manage endometriosis, especially for women trying to conceive.

“Endometriosis occurs when tissue that normally lines the inside of the uterus – the endometrium – grows in places such as the ovaries, fallopian tubes and tissues that hold the uterus in place,” said Joseph Garza, M.D., chief fertility officer of the Advanced Fertility Center, a sister company of the Institute for Women’s Health.

Even though this tissue is outside the uterus, it follows a similar menstrual cycle as the uterine lining: a monthly build up, breakdown and shedding. While a menstrual cycle sheds the uterine lining during a woman’s period, the tissue shed from the endometrium has no way to leave the body.

“This can cause internal bleeding and inflammation, and possibly form scar tissue that can impair a woman’s ability to conceive,” Dr. Garza said. “It’s also a very painful condition to manage monthly.”

Endometriosis can influence infertility in other ways than scar tissue formation. The inflammation that occurs can affect the pelvis and fallopian tubes, and the tissue can also change the internal environment of a woman’s eggs so much that it alters their quality.

“We frequently see fertility patients suffering from endometriosis,” Dr. Garza said. “Fortunately, the condition is treatable.”

Medication can reduce endometrium inflammation and pain, but if a case is severe enough, surgery to remove the tissue may be necessary. In this instance, a laparoscopy is performed on the patient, which is a minimally invasive outpatient surgery. Hormone therapy has also proven to be effective in some cases.

So how do you know if you have endometriosis?

“If you have severe and consistent pelvic pain during your periods, it’s best to talk to your doctor about a management plan that’s right for you,” Dr. Garza advised. “While the relationship between endometriosis and infertility continues to be debated, you should always be proactive about managing your personal health and wellness.”

To learn more about endometriosis or to schedule an appointment with an Institute for Women’s Health OB/GYN, call 210.349.6626

This Article Originally Appeared on https://www.ifwh.org/en/what-is-endometriosis/

Better outcomes for hysterectomies performed with robotic surgery

The decision to have a hysterectomy is a personal and often emotional choice many women make. Fortunately, there are several options that can help make both the surgery itself and the recovery process minimally disruptive to women’s lives. One of those options is a robotic, or da Vinci®, surgery.

“A hysterectomy, which is a surgery that removes a woman’s uterus, can lead to complications that can be minimized by robotic surgery,” said Victor Casiano, M.D., an obstetrician-gynecologist at the Institute for Women’s Health, San Antonio. “Recent studies have shown better clinical outcomes for benign hysterectomies for women who opted not to undergo conventional abdominal, vaginal and laparoscopic hysterectomies.”

The da Vinci Surgical System is designed to help surgeons perform minimally invasive surgeries. Rather than performing a traditional operation, the surgeon uses the robotic surgery system to gain magnified views via specialized instrumentation including a miniaturized surgical camera and other instruments. This allows for precise dissection and reconstruction during complex internal surgeries, which in turn reduces recovery times and risk of complications for the patient. Robotic surgeries are performed while the patient is under general anesthesia, and incisions are tiny – usually only three or four incisions are made near the belly button

“Depending on the patient’s specific circumstances, robotic surgeries can be most beneficial,” Dr. Casiano said. “I’ve seen, first-hand, the outcomes of complex cases performed with the da Vinci Surgical System as opposed to traditional methods of surgery. Typically, the more delicate procedures require assistance with robotic surgery.”

Patients who undergo robotic-assisted hysterectomies share a variety of risky co-factors: advanced age, obesity and larger uteruses than what is typical. Other reasons a doctor may recommend robotic surgery include uterine conditions such as endometriosis, chronic pelvic pain and both cancerous and non-cancerous tumors.

“Recent studies show that women who undergo hysterectomies assisted with robotic surgery experience significantly lower reoperation rates and hospital readmissions than women who underwent traditional surgeries,” Dr. Casiano said. “Any type of surgery has the potential to be disruptive to a patient’s life, so our goal is to get them back to their normal routine as quickly as possible.”

If you’re considering a hysterectomy, talk to your OB/GYN about whether or not you may be a candidate for robotic surgery. They can further explain the risks and benefits specific to you.

Victor Casiano, M.D., is an obstetrician-gynecologist with the Institute for Women’s Health, San Antonio. To schedule an appointment with Dr. Casiano, please call 210.226.9705.

This Article Originally Appeared on https://www.ifwh.org/en/better-outcomes-for-hysterectomies-performed-with-robotic-surgery/

A day in the life of an OBGYN

OB/GYN, shorthand for obstetrician/gynecologist, refers to two medical specialties. Although obstetrics, the branch of medicine focused on delivering babies, might be the oldest medical art, most obstetricians also practice gynecology since exclusively delivering babies would not typically provide much business. The profession requires diverse daily duties and it offers OB/GYNs opportunities to provide various types of surgical procedures and practice preventive medicine.

The Institute for Women’s Health is the largest and best OB/GYN practice in San Antonio, Texas. They are committed to offering exceptional women’s healthcare, from obstetrics and gynecology to fertility and more. They have more than 30 physicians who specialize in all areas of OB/GYN care, including menopause management and fertility treatment. They currently have eight clinics conveniently located throughout San Antonio. It is their mission to take a team approach to providing women of all ages with compassionate care in an inviting, comfortable and patient-centric environment.

The lifestyle and job description of an OB/GYN practitioner consists of:

Keeping Women Healthy

One of the first priorities for an OB/GYN practitioner is their patients. Overall, an OB/GYN provides medical and surgical care to women. Obstetrics involves taking care of women before and during pregnancy and at childbirth, as well as their fetuses and newborn babies, and performing procedures such as cesarean sections. Duties related to gynecology include diagnosing and treating disorders of the female reproductive system. They can diagnose conditions such as infection, endometriosis, and ovarian and breast cancers. OB/GYNs sometimes provide primary care. They also continually take courses to update their skills. Due to the nature of their practice, OB/GYNs are frequently on call, and their hours can be quite long, as they may have to help women through labors lasting longer than 24 hours. On average, OB/GYNs work 58 hours a week, according to the Association of American Medical Colleges. Everything that OB/GYNs do on a daily basis is all meant to improve their patient’s well-being. Caring about their patient’s health is one thing, but to gain their trust and create effective communication is important as well. OB/GYNs have the ability to make the “being pregnant” experience for their patients easier to cope with since it is probably the most challenging phase a woman can face in her lifetime. Without the help of OB/GYNs, one can only imagine how difficult it would be for women to maintain their health.

Multitude of Duties

OB/GYNs place a priority on encouraging patients to maintain healthy lifestyles. The Institute for Women’s Health does a good job having their OB/GYNs provide care and comfort to all their patients. In general, OB/GYNs provide information about exercise, nutrition and planning pregnancies. They also warn of the dangers of smoking tobacco and drinking alcohol excessively. After examining patients, they order the appropriate tests to nail down a diagnosis. Then they explain the test results, provide treatment options and monitor the patient's progress. Of course, OB/GYNs only recommend their patients to maintain their health because they want what is best for them. OB/GYNs, with further education, can subspecialize in fields such as critical care medicine, female pelvic medicine and reconstructive surgery, gynecologic oncology, and reproductive endocrinology and infertility. When required, they refer patients to other specialists and consult with other health care providers when necessary.

Other Positions

If they are in private practice, OB/GYNs require business and administrative skills, such as bookkeeping, marketing and personnel matters, as do those who work in administrative capacities in hospitals or who run community health programs. OB/GYNs running hospital or community health programs may also need to be familiar with the public policy and governmental regulations concerning their hospital or community programs. Some OB/GYNs go on to teach in medical schools. In medical schools and for private corporations, they can also perform research on diseases and their treatments and write articles for medical and scientific journals.

Becoming Qualified

Aspiring OB-GYNs graduate from medical school and complete 4 years of a hospital residency program. These programs provides training in areas such as preconceptional health, pregnancy, postpartum care, genetic counseling, women's overall health, management of hormonal disorders, and surgery to treat pelvic organ and urinary tract problems. All doctors must be licensed in the state in which they work. State licensing requirements vary.

A Good Outlook

The Bureau of Labor Statistics expects that, for physicians and surgeons overall, employment will grow 24 percent between 2010 and 2020, faster than the average for all occupations, with growth best for specialties that treat conditions affecting aging baby boomers. The I Have a Plan Iowa website notes that OB-GYNs will be in demand as female baby boomers increasingly reach menopause. According to the BLS, in 2012, obstetricians and gynecologists made mean annual salaries of $216,760.

The Complications for Pregnant Women

Through stories from friends and informational packets from doctors, women are aware of many risks associated pregnancy. Flu-like symptoms, vomiting, preeclampsia, maternal bleeding, and preterm labor are often discussed. Our bodies are incredible, complicated things, however, and sometimes serious issues fly under the radar during all the chaos of caring for a brand new baby.

Unfortunately, the vast majority of women who develop diabetes during pregnancy are not screened for diabetes again within one year after giving birth. There are many cases where gestational diabetes resolves after pregnancy. On the other hand, there are some cases where women will develop type 2 diabetes. The American College of Obstetricians and Gynecologists recommend that women with gestational diabetes have their blood sugar levels checked at least six to 12 weeks after giving birth.

It’s not uncommon for women who have a history of gestational diabetes have a higher risk of developing diabetes. The risk level is at its highest within 10 years of having gestational diabetes. Researchers have used commercial insurance claims to study more than 440,000 women who gave birth at least once between 2000 and 2012. Not to mention, there were 32,252 women who had gestational diabetes in that same time frame.

Gestational diabetes often has no symptoms and can only be diagnosed at a routine screening. Hyperglycemia, which is known as high blood glucose (blood sugar), can cause thirst, dry mouth, frequent urination, fatigue, recurrent infections, and blurred visions. Unfortunately, many may write off these symptoms as normal when, in actuality, they are serious warning signs. In cases of untreated gestational diabetes, there is a high possibility that the placenta may break away from the wall of the uterus (placenta abruption), causing vaginal bleeding and abdominal pain.

The hormones such as estrogen, progesterone, and human placental lactogen (HPL) that are produced during pregnancy can make the body insulin-resistant. This allows extra glucose and nutrients to be passed to the fetus. There are a few women who are either unable to produce enough insulin during pregnancy, or the body’s cells are more resistant to insulin, which can result in gestational diabetes.

Having a BMI above 30, a previous baby that was large for its gestational age, gestational diabetes in a previous pregnancy, a family history of diabetes, or being of South-Asian, Afro-Caribbean, or Middle Eastern descent can increase the risk of developing gestational diabetes.

The condition often arises in the third trimester and disappears once the baby is born. Controlling gestational diabetes requires for women to diet and exercise. It occasionally requires medication and if left untreated, it can increase the chances of birth complications.

Surprisingly, within one year after giving birth, only 25 percent of women had received blood sugar screening. How could so many women with diabetes be left out of receiving treatment for such a long time? Who’s responsible for causing this kind of situation? These kinds of questions raise concern for the pregnant women community. While many women are willing to accept the pregnancy risks they are aware of, potential mothers deserve to know the full picture of what long-term changes their bodies might undergo as a result of said pregnancy.

Thankfully, there are some signs of improvement in this area. Recommended screening at six to 12 week postpartum increased from two percent of women in 2001 to seven percent in 2011. . In addition, oral glucose tolerance tests were performed in 36 percent of women in Western states within 12 weeks of giving birth. Imagine that statistic compared to 19 percent of women in the Northeast and 18 percent in the South. Interestingly, Asian women were more likely than white women to receive blood sugar screening while they were pregnant

Women who visited either an endocrinologist or a nutritionist-diabetes educator after giving birth were more than likely to be screened for diabetes. Currently, it appears that women need to reach out to doctors for follow-up tests. Whether or not scheduling follow-up appointment is responsibility of the new mother or her medical health professional is debatable and varies from clinic to clinic. However, the point remains that women who have gestational diabetes and are not screened postpartum may continue to develop elevated blood sugar. Worst case scenario, the women can become pregnant again and have overt diabetes. Entering a pregnancy with overt diabetes poses greater risks to the fetus and the pregnancy.

In addition to screening after giving birth, usually at the six to 12-week postpartum follow-up appointment, women with gestational diabetes should receive ongoing blood sugar screening every one to three years.

When you have a new baby, it is difficult to keep up with the medical care routine, especially when the obstetrics team changes between pregnancies. Sometimes it isn’t possible to stay with the same OBGYN and many women don’t push their obstetrics teams communicate. This lack of communication between women’s different obstetric teams can cause problems and more stress towards the woman giving birth. Sometimes, it may not be clear as to which doctor is supposed to do the screening or when he/she should plan to do it.

If women catch diabetes or abnormal blood sugar early, there are ways one can try to prevent overt diabetes from occurring. It’s important for women to catch this irregular behavior early in order for their dietary change and exercise to have profound effects.

If you live in San Antonio, Texas, make sure to take the risk of diabetes seriously. A study by the University Health System found that 11.8% of the Bexar County population (137,009 people) are diagnosed with diabetes. They believe approximately 440,468 Texans are undiagnosed. Women in San Antonio need to take the risk of gestational diabetes seriously. The Institute of Women’s Health provides OB/GYN services to women across San Antonio.