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Obstetrics, Gynecology & Reproductive Sciences Archive Questions

Below are Dr. Morozov’s answers to Obstetrics, Gynecology & Reproductive Sciences questions
received through the Ask the Expert feature.

This content is provided for informational purposes only, and is not intended
to be a substitute for individual medical advice in diagnosing or treating a
health problem. Please consult with your physician about your specific health
care concerns.

Now displaying records 1 to 15 of 31.

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Q : 1

Can primary dysmenorrhea progress to secondary dysmenorrhea as one ages? I was diagnosed with dysmenorrhea at age 14 since an ultrasound and pelvic exams were normal. Now at age 27, my cycles are just as painful with new symptoms suggestive of endometriosis including not being able to conconcieve for past two years. Would a pelvic laparoscopy be ideal?

It is a very complex question and discussion. In short - yes, laparoscopy with possible diagnosis of endometriosis is a an appropriate option at this point.

Q : 2

Can tubal litigation effect the menstrual cycle?

Yes, it is possible.

Q : 3

Do you specialize in endometriosis surgery?

Endometriosis and treatment of pelvic pain are my areas of interest.

Q : 4

I am 58 and would like hysteroscpy for diagnostics. Do you do it under general anesthesia?

We do perform diagnostic hysteroscopy under general anesthesia, although you have to have a reason for the procedure (just because you want is not a good medical justification).

Q : 5

I have been looking into tubal ligation, but can't find any real answers about age requirement. I do not have children and I do not wish to have any, but I'm 24 and I've heard that you have to be 25.

Most surgeons will not perform permanent sterilization on a woman who is 24 or 25 years old with no children.

Q : 6

How long is the recovery for a hysterectomy performed robotically?

Most patients only need two weeks to recover from this procedure.

Q : 7

Is there a benefit to having a total hysterectomy done robotically vs. laparoscopically?

The robot is just another tool in the laparoscopic armament of instrumentation. Overall, skilled laparoscopic surgeons should be able to do it either straight stick laparoscopically or robotically.

Q : 8

I was diagnosed with fibroids in 2008. I decided no to have surgery because there was no pain or bleeding. Now, the fibroid has grown from 13cm in 2008 to 21cm. Do I need surgery?

I would definitely suggest removing this given the size of the fibroid. Another concern, although extremely rare, would be that such rapid growth could suggest leiomyosarcoma.

Q : 9

I have had endometriosis pain (and every other symptom) for the past 7 months and had it "cleaned out" last February, which didn't work. So now I'm getting a hysterectomy and was wondering what are the odds of the pain and other symptoms subsiding if I left my ovaries in. Or would I have a better chance of this procedure making me feel better if I had them removed as well?

If your pain is truly because of endometriosis - you will have better success with ovaries taken out. However, even a hysterectomy can not guarantee chronic pain relief. Be sure to find a surgeon who specializes in endometriosis treatment.

Q : 10

I have fibroids and a weak cervix which has resulted in me having several miscarriages. I had the big surgery to remove the fibroids, but they have since grown back. Do u think it's best for me to get the robotic surgery?

This depends on number fibroids and their location. Robotic surgery is usually good for a myomectomy and results have been encouraging. You should discuss your options in great detail with a robotic surgeon before making your decision.

Q : 11

I have a large, fast-growing fibroid that my doctor is recommending a total hysterectomy for. She is concerned about the size (about 8x10x8cm from ultrasound) and that my uterus is much larger than last year and other "shadowy" areas noted on the ultrasound. Due to the size of the fibroid, she feels that for robotic surgery to be effective, I would have to be under anesthesia for a very long time. I didn't really want to have a traditional hysterectomy, but her reasoning sounds logical. What are your thoughts?

You could have a myomectomy - time under anesthesia depends on the skills of the surgeon and available instruments. The concern for leiomyosarcoma with the "fast-growing" fibroid is always a thought. If you decide on hysterectomy, you should find a surgeon who can do it in a minimally invasive way, robot or not. Your recovery time will be short and you, overall, will feel much better than with the open hysterectomy.

Q : 12

In 2007 I had a laporoscopy and was diagnosed with excessive endometriosis. I was told by my gynecologist that all was removed. Another surgery in 2008 revealed dense adhesions. After being on many drugs to stop ovulating, I am still in a lot of pain. Can Seprafilm help with relieving pain caused by adhesions?

The use of Seprafilm, or any anti-adhesive agents for that matter, is highly controversial. Adhesions should not cause pain with periods, but rather produce a constant pelvic/abdominal pain. In the cases where adhesions are thought to be the cause of pain, adhesiolysis (removing them surgically) is indicated. The best way to ensure the good recovery prognosis is the use of meticulous hemostasis and fine surgical techniques. It sounds that you need to have another laparoscopy with a skilled surgeon trained to recognize and treat endometriosis.

Q : 13

I had operative hysteroscopy to remove a uterine fibroid. Eighty percent was removed, but due to the deep penetration into the lateral wall and concerns regarding damage to the area, further resection was not performed. Can the remaining part grow, or is it likely to stay the same size?

The remaining section of the fibroid has the potential to grow. I think your doctor was wise not to try to remove it all because it could have caused damage to your blood vessels. Just because the fibroid has the potential to grow, doesn't mean it will. You should be monitored closely.

Q : 14

I have a number of fibroids the largest being appproximately 5cm in size. I am 49 years old and I don't want a hysterectomy like my doctor has suggested or take the Lupron Depot shot. I wanted to have the uterine fibroid emboliation (UFE) procedure but my doctor says I am not a candidate. I really do not want to have a hysterectomy and I don't want to be out of commission for weeks due to a surgery. Are there any other options?

Usually, an Interventional Radiologist (not a gynecologist) determines if you are candidate for UFE. If you have a laparoscopic hysterectomy, your recovery time will be 1-2 weeks max. Most patients have pain for at least a week or two after UFE and require an overnight admission to the hospital for pain control. I am gynecologist, so I am biased, but I have seen too many patients coming to see me after UFE asking for surgery. The anatomy is heavily distorted after UFE with bowel "stuck" to the dead tissue of the uterus. If you are determined to proceed with embolization, you would need to talk to IR physician.

Q : 15

If i were a candidate for the Da Vinci robotic procedure to remove fibroids only, what are the chances that the tumors will return? Is there a percetage rate?

Yes. It depends an your age and hormonal status, as well as the sizes and number of fibroids you have.

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