Image not available

Classification of endometriosis (rear view). The stage is determined by the severity of the endometriosis. Stage I (minimal) Stage II (mild) with peritoneal implants Stage III (moderate) with peritoneal implants and endo-metriotic cysts (endometriomas) Stage IV (severe) with extensive peritoneal implants, large endometriomas, and dense adhesions (a chocolate cyst is pictured on the right ovary). gesterone eases symptoms. Treatment possibilities include the following. If one of these...

S ex and S exuality

Many women are concerned about how hysterectomy will affect their sexuality and their sex lives. Few women feel comfortable talking with their physician about sexual matters, however, and so these concerns often remain unspoken. We urge women to become informed about this important subject before having surgery. Talk to your doctor, read books, and scout out reliable Internet sites. As we have emphasized throughout this book, women who undergo surgery fully informed tend to be more relaxed and...

Reproductive Options

Often, although hysterectomy is the best treatment available to alleviate many gynecologic conditions, it can be deferred when a woman wishes to bear children. Clearly, if hysterectomy is performed as treatment for a gynecologic malignancy, waiting is not an option. When pelvic pain from endometriosis persists despite previous conservative surgeries, when abnormal bleeding continues even though medical treatments have been tried, when the alternative treatments to hysterectomy are not well...

HRT and Cancer

A woman who has had uterine, cervical, or ovarian cancer or en-dometriosis may have concerns about HRT. Indeed, there is much we do not know about the effects of hormone replacement on different types of cancer. Limited information is available about the use of estrogen therapy after treatment for endometrial or ovarian cancer. Some studies show that estrogen therapy used in conjunction with a progestin seems to be relatively safe in women who have been treated for early-stage en-dometrial...

Endometriosis

From age 22, Beverly endured painful cramping with her menstrual periods. She knew she would have to spend at least a day each month in bed, and she took prescription painkillers for several days. Each year during her pelvic exam her doctor gave her a prescription for pain medicine and scheduled a return visit in one year's time. After several years, Beverly decided to switch doctors. Her new gynecologist suggested doing exploratory surgery to diagnose her problem. At age 30, after...

Uterine Fibroids

R Obviously something was not as it should be. Stephanie was focused on her career as a lawyer in Washington, D.C., as she had been for years, but when she reached her early forties, she could no longer ignore her physical symptoms. She had heavier periods than usual and vaginal bleeding between periods. She was severely constipated and felt pressure on her bladder all the time. She assured herself that the intensity of her work was causing physical symptoms, but finally she had to admit that...

Pelvic Pain Infection and Adhesions

Today's potent antibiotics can cure almost every pelvic infection, and so hysterectomy is rarely recommended as a treatment and usually only in cases of severe infection. Chronic pelvic pain or pelvic adhesions may sometimes be appropriately treated with hysterectomy. Adenomyosis, a condition that is often very painful, is best treated with hysterectomy. This chapter is about these conditions. Chronic pelvic pain is a symptom, not a disease. To determine the best treatment, we need first to...

Anesthesia Anesthesiology Consultation

You may wish to talk to the anesthesiologist who will be involved with your surgery shortly before the operation. Ask your doctor to provide relevant laboratory data and other preoperative information to the anesthesiologist before the time of the assessment so that the anesthe siologist can take this information into account in his or her discussion with you. The anesthesiologist will evaluate your anesthetic risks and discuss your preferences (for example, general or regional anesthetic). The...