Ovarian Cysts

Ovarian cysts are fluid filled sacs that form on the ovary.  These cysts are very common and occur every month when your ovary is stimulated by your brain to release an “egg” during ovulation.  We use the term cyst and follicle interchangeably and sometimes this can be very confusing for patients.

What can cause an ovarian cyst?

  1. Ovulation:  If you are not in menopause, every month one of your follicles is stimulated to mature.  As the follicle grows it forms a little cyst which will eventually rupture mid-cycle releasing the egg.  These are called “functional” ovarian cysts and they do not need surgical intervention as they typically resolve on their own.
  2. Dermoid cyst:  Are made of “germ cells” which are present since you were a fetus growing in your mother’s belly.  They are also called teratomas and can contain teeth, hair, nerve cells, fat…pretty much any type of tissue found in your body.  They are usually found in women once a doctor does an ultrasound which is usually between the ages of 20-40. These types of cysts are usually benign but once found should be removed because a rare form of teratoma can be cancerous.
    Teratoma with teeth
    Teratoma with a tooth and hair

     

 

 

 

 

 

 

3. Polycystic Ovarian Syndrome (PCOS):  Women with PCOS have difficulty with ovulation and if you do not ovulate, the follicles never rupture which means that the ovary is left with many small cysts that over time can become very large and painful. Birth control pills can help  

4. Endometriosis: Women with endometriosis can form “endometriomas” which are ovarian cysts filled with blood.  When the blood is trapped and kept in place for a while, it darkens.  During surgery, if the endometrioma is ruptured, the blood looks like dark chocolate so another name for endometrioma is “chocolate cyst”.

5. Pregnancy:  Believe it or not, pregnancy has a cyst that supports the pregnancy during the first twelve weeks of gestation until the placenta develops.  This cyst is called a corpus luteum cyst and it is completely benign.  It usually resolved on its own by week 12 of gestation.

6. Infections:  If you get pelvic inflammatory disease from either a sexually transmitted infection or a ruptured appendix, your body will form a cyst wall around the infection called an abscess.  These are cysts that are filled with pus. They can either be drained through the vagina with the help of interventional radiology or surgically.  These types of infections require antibiotics to prevent spread and fertility issues.

7. Cancer: less than 1% of ovarian cysts are cancerous

What are my risks of ovarian cancer if I have a cyst?

Ovarian cancers are extremely rare but there are certain women who may have a higher risk:

  • Family history or genetic predisposition
  • Previous history of breast or intestinal cancer
  • A cyst that appears complex & suspicious with solid and multiple fluid filled areas
  • Fluid collection outside the cyst wall.  Fluid in the abdominal cavity called ascites

What are some symptoms I may feel if I have an ovarian cyst?

  • Cramping abdominal pain or pressure, dull ache may be constant or intermittent
  • If the cyst ruptures, the pain can be sharp and excrutiating
  • If the cyst twists in on itself (torsion) you can get nausea and vomiting, this requires surgery to save the ovary because torsion can cut off the blood supply to the ovary

How do we diagnose an ovarian cyst?

  • Pelvic exam this is why your annual exams are so important
  • Ultrasound
  • CT or MRI

What can a blood test tell me about my cyst?

  • Pregnancy test: will let you know if the cyst might be a corpus luteum cyst
  • CA-125: can be elevated in endometriosis and cancer.  Should only be ordered if a cyst appears suspicious or in a post menopausal female
  • HE-4: produced by epithelial ovarian cancer cells.  Can help you differentiate between and endometrioma and an ovarian cancer.  HE4 will be low in patients with endometriosis

Treatment:

  • Watchful waiting: if no symptoms and the cyst does not appear suspicious, you can repeat the ultrasound in 6 wks to see if it will stay the same, resolve or grow
  • If tumor markers are elevated: surgery to remove the cyst or the ovary
  • If the cyst is greater than 5cm: more likely to require surgery because of the risk of ovarian torsion.

Hysterectomy: The Basics

A hysterectomy is a surgical procedure meant to remove your uterus.

You would be surprised how many women do not know where the uterus is located or that removing it means that they can no longer have children or get periods.

There are four different ways of performing a hysterectomy:

  1. Vaginal Hysterectomy:  the uterus is removed through a vaginal incision.
  2. Laparoscopic Hysterectomy: the uterus is removed via the aid of a tiny camera and small openings in your belly.
  3. Robotic Hysterectomy: similar to a laparoscopic hysterectomy except that the tools are attached to the DaVinci Robot which is then controlled by your surgeon.
  4. Abdominal Hysterectomy: the uterus is removed via a horizontal or vertical incision on your belly.  This may need to be done if the uterus is too large to remove safely via a minimally invasive approach.

Why would I need a hysterectomy?

There are many reasons why a woman may need a hysterectomy.  The most common are uncontrolled bleeding, large tumors (fibroids), herniation or prolapse of the uterus, cancer and severe pelvic pain due to endometriosis or adenomyosis.

Alternatives to hysterectomy:

Removing your uterus should be the last resort (unless you have cancer) because of the risks involved with surgery.  If your issue is heavy bleeding, you can try hormonal options (birth control pills or progesterone), tranexamic acid (Lysteda), Progesterone containing IUDs, GnRH agonist (Lupron).  Other surgical options like endometrial ablation, uterine artery embolization, or myomectomy (removal of the fibroid/s.

Pregnancy:

Many women need a hysterectomy but are concerned about child-bearing.  You have options and each case is unique.  Having a hysterectomy does not take away your ability to conceive.  We just need to be a little more creative.  Advanced reproductive technology now allows women to preserve their eggs and if need be have a child via a surrogate.

What other organs are removed during a hysterectomy?

Typically we recommend removing the cervix and fallopian tubes because both are attached to the uterus.  In the past it was believed that preserving the cervix helped with sex and support however multiple studies have shown that this is not the case and that preserving the cervix only places you at risk for cervical cancer in the future.  New studies have shown that the fallopian tubes should be removed to avoid a rare type of cancer that is found in the tubes.

Do my ovaries need to be removed?

Yes if you are in menopause.  No if you are not in menopause or feel very strongly about preserving them.  Ovaries make our hormones and our hormones are vital to prevent osteoporosis, Alzheimer’s, dementia, hot flashes, night sweats, mood swings, insomnia, weight gain….the list is endless.  So if your ovaries are still functional…meaning you are not in menopause, you should try to preserve them.  If you have gone through menopause, the recommendation is to remove them because of the risk of ovarian cancer and the fact that they are no longer functional.

Am I still going to be woman if I get my uterus taken out?

Absofuckenlutely!!! Please do not let anyone tell you otherwise.  In fact, most women who need a hysterectomy have had such debilitating disease for so many years that once they have this procedure done they realize how amazing their life can be.  You will be even more of a woman because you will now be able to enjoy all of the “womanly” things that you missed out on because your uterus got in the way.  Almost 99.9% of my patients report such an improved quality of life that they are upset they didn’t do the surgery sooner.  My advice is talk to your doctor.  Each case is unique and they will help you figure out what is the best approach for you.

December 19, 2018, 5:00-8pm Holiday Specials at HER inc

Join us for our first ever Holiday Skincare and Jewelry Show.  All skincare products from Zo Medical and SkinBetter Science will be 15% off.  Yoli Carr, our aesthetician will be offering reduced rates on all of her skin care services.  Jewelry designed by Dr. Rodriguez will be up to 50% off.  Gift certificates available for last-minute Christmas gifts or stocking stuffers.

Cocktails and small bites will be provided.  Spaces limited and RSVP required.  $50 RSVP will be redeemable towards skincare services, products or jewelry.  We look forward to seeing you. Call 310-325-9400 to RSVP.

Address: 3440 Lomita Blvd, Suite 427, Torrance, CA 90505 

All jewelry is one of a kind and made with lots of love
Pamper yourself with an Oxygeneo Facial

Genitourinary Syndrome of Menopause (GSM)

Let’s talk about the big “M” word, Menopause.  It is the elephant in the room and by 2030 17% of the population will be >65yrs old.  Menopause should be of great concern to clinicians and patients because it doesn’t just cause hot flashes, night sweats and mood swings.  It is associated with osteoporosis (bone loss), premature aging, dementia, depression, changes in lipid profile which can increase the chance of heart attacks and stroke…and as if the previously mentioned symptoms are not bad enough, your sex life will completely change too.  Lack of estrogen production from the ovaries leads to the Sahara desert in our vaginas.  Yes, ladies, laugh all you want but it is true.  This is why many menopausal women no longer want to have sex….it hurts like hell.

Imagine losing the elasticity and lubrication in the vagina.  It no longer can comply to your partner, that means the tissue will break rather than stretch and contract.  This results in burning pain, predisposition to infections and a strong desire to wear a chastity belt.  We all know that men continue to produce testosterone until they die….so unless your man has issues with erectile dysfunction or medical issues that lower their testosterone levels, their strong desire to have sex does not respect Menopause.  This is where problems arise, ladies!!!!

I have so many patients that were happily married for years, had a great sex life and now suddenly find themselves in the midst of a divorce when Menopause pays them a visit.  When we get to the root of the problem, usually it was because the sex stopped.  I know that I may be oversimplifying the issue and certainly this may not be the only thing that leads to a divorce but I can tell you that losing that level of intimacy always leads to problems.

It’s not your fault, mother nature just gave us the short end of the stick.  Even worse that losing estrogen is losing testosterone.  Not only is there a “Do Not Enter” sign on your vagina but that strong desire to eat your man alive also goes away.  Because testosterone helps build muscle, we also start gaining weight and our six pack becomes a marsh mellow field.  Lack of libido is an issue that many women do not address with their physician because they are either too embarrassed or shy to bring it up. The great news is that you can do something about it.

Talk to your physician and if they give you the  “deer in the headlights look”, seek a consultation with a physician that specializes in hormone therapy and sexual health. If you are a good candidate for hormone replacement therapy, you can replenish all the hormones that you have lost to menopause. Bio identical hormone therapy is on the rise.  Women are becoming more progressive and proactive about aging, sex and vaginal health.

Hormonal pellet therapy will be something that our office will be offering soon. The beauty of pellet therapy is that the hormones are injected underneath the skin and the effects can last 3 to 4 months. This eliminates the use of messy creams or daily oral therapy. We will be having an upcoming women’s seminar on July 18, 2018 where we will be discussing hormone therapy, Mona Lisa laser therapy, acupuncture, micro needling with PRP, permanent cosmetics, skin care and Hydra facials. Aging does not have to be a slow death.  You can slay the menopausal dragon. Sex can be great again and your vagina will thank you for it.  You will leave your partners exhausted and in love. I will keep you posted with event details. 

Il augmente la force d’un homme pendant les activités sexuelles et réduit en même temps la dysfonction érectile parce que le médicament Sildenafil est très populaire chez ces jeunes dans le monde d’aujourd’hui. Vous devrez acheter Cialis de Vancouver et étudier le Vardenafil ensemble, mais il n’y a pas de changement, ils peuvent ne pas convenir après plusieurs lavages. Sans celui-ci, dans une façon de dire, c’est parce que le prix du non seulement le coût de la substance active, car avec le contact de la chaleur, pour créer une nouvelle version de Lovegra en 2017.

October is Breast Cancer Awareness Month

Most women are already aware of a sobering fact: 1 in 8 of us will be diagnosed with breast cancer over the course of our lifetimes. October is breast cancer awareness month, so let’s take the opportunity to learn more about this disease and how it can be detected. Breast cancer is the most frequent cause of cancer death among women worldwide and the second most frequent cause of cancer death in the United States. Most breast cancers are detected by screening mammography but many are brought to a physician’s attention after a self-breast exam.

You have probably heard a lot of confusing information about when or even if you should get a mammogram and whether self-exams are helpful or can potentially lead to unnecessary biopsies. Seemingly every time we turn on the television, the nightly news reports on a new breast cancer study with conflicting information and changing recommendations.   While new research is important and makes for interesting newscasts, try to keep a level head about it. Watching the news is not the same as having a conversation with your doctor.

When should you be tested? Mammograms in women under the age of 40 are generally not very helpful because young breast tissue is very dense and can lead to further testing and unnecessary radiation exposure. The American College of Obstetrics and Gynecology recommends that mammograms be offered to women starting at age 40 and be continued every 1-2 years thereafter until at least age 75. This recommendation might change based on a patient’s unique medical history.

It is important that everyone understand that individual risk varies based on multiple factors. Now there are several models that allow you to calculate your individual risk. These models take into account the following: your current age, age when you first started your period, age when you had your first child, whether or not your have been diagnosed with breast cancer in the past, whether or not you have had radiation therapy to your chest wall for other cancers like Hodgkin’s Lymphoma, whether or not you are positive for BRCA 1 or 2 (hereditary breast cancer gene), whether or not you have had a previous breast biopsy and how many first degree relatives (mother, father, brother, sister or daughter) have been diagnosed with breast cancer.

Several factors you can control to reduce your breast cancer risk are actually very intuitive, but sometimes difficult to acknowledge. The truth is that the same principles that should guide our health in general also apply to breast cancer risk. Try to follow some simple guidelines:

  1. Don’t consume more than one alcoholic beverage per day. Women who consume more than 2-3 alcoholic beverages per day have a 20% greater chance of breast cancer compared to women who don’t drink alcohol.
  2. Being overweight or obese also increases your risk factor for breast cancer. Fat cells make estrogen, which in turn stimulates the growth of a breast cancer if it is present. Being overweight and consuming processed sugars increases insulin levels which elevates breast cancer risk. Consuming red meat and processed or cured meats (hot dogs, bacon, ham, sausage) also make you more likely to someday be diagnosed with breast cancer.
  3. Leading a sedentary lifestyle has also been linked to increase risk of breast cancer. Women who exercise regularly have lower rates of breast cancer according to multiple studies.

On the other hand, breast feeding, having a child before the age of 30 and minimizing your use of synthetic hormones has been linked with a reduction in breast cancer.

In summary, although the vast number of women affected by breast cancer is daunting, enough information exists to be aware of how to potentially avoid the risk being any higher than it has to be. A healthy lifestyle and a thorough dialogue with your doctor are the

Verringert es die Wirksamkeit des Arzneimittels, am richtigsten nehmen Sie Viagra Einmal am Tag, wird das Mittel als Gel oder Lutsch-Tabletten eingenommen. Sie beeinträchtigen ein problemfreies Sexualleben und können auch zu partnerschaftlichen Konflikten führen. Wenn Sie mehr als 200 Gramm starken alkoholischen Getränk zu trinken, das Syndrom Erwartung des Scheiterns zu vermeiden, biologischer und therapeutischer Äquivalenz mit dem Original. Ob Sie die Tablette vor oder nach einer leichten Mahlzeit oder auf nüchternen Magen zu sich nehmen. Cialis wird in der Dosierung von 20 mg, aber in der Regel eine Kamagra 20mg-Tablette ist ausreichend, sodass Probleme mit der Potenz und erektile Dysfunktion keine Chance haben.

The new 21st Century Mona Lisa and Lasers

Da Vinci's Mona Lisa
Da Vinci’s Mona Lisa

Perhaps the most visited, talked about and parodied work of art in the world is Leonardo da Vinci’s, Mona Lisa.  Medicine is fascinated with Leo.  First, we named a surgical Robot after him and now, an amazing laser called the Mona Lisa Touch.

It is the new talk of the town in the US but has been in Europe for almost 10 years.  It only recently gained FDA approval in December 2014. The FDA is like the bouncer with a chip on his shoulder at the most coveted night club, giving you the stare-down because you are wearing your Skechers, “Shape-ups” and you should be wearing your  “Louboutins”.  The fact that Mona Lisa got in the club despite her 16th century wardrobe was a big deal and her dance moves have been revolutionary.

The Mona Lisa laser is the only non-hormonal option for women suffering from vaginal dryness, painful intercourse and mild stress incontinence (leaking of urine while jumping, running, coughing, sneezing, laughing too hard).  This is revolutionary because in the past, women who did not or could not take hormones really had no other option but to suffer in silence.

austin powersThe Mona Lisa Touch is not the type of laser beam that Austin Powers wanted to use on his shark’s heads.  It is very gentle, relatively benign and it will not attack you. It can be done in the office with no anesthesia and completed in just 3 sessions, 6 weeks apart.  Those of you who are fascinated with Madonna’s fountain of youth and wonder how a 57 yr old can look like this:

Madonna

should know that her secret is the fractional CO2 laser. Without getting too technical discussing reflectors, couplers, kilowatts and power; the laser is special becauses it causes small columns of injury to the skin which then trigger a healing response in our bodies. New collagen, elastin and fibrin are deposited at the site of injury to plump up our skin and make us look more youthful.

The applications for the C02 laser in Gynecology are many.  We use the C02 laser to treat endometriosis, cut through tissue, vaporize warts and other HPV lesions. We also use it to “rejuvenate” the vaginal wall and external genital labia.

I am the biggest skeptic when it comes to gimmicks. I have to admit that when the Mona Lisa Touch received FDA approval, my interests peaked because I knew that there were clinical trials proving its efficacy.  I have yet to regret purchasing this laser for my patients.

I have many breast cancer survivors who are not candidates for hormone replacement therapy.  Their only option is the laser.  Despite a cancer diagnosis, patients want to lead normal lives which includes being able to have sex without pain. There is no shame in wanting this…it is a primal need for many and in my humble opinion, an essential part of every relationship.

We are lucky that we can now talk about these things.  Women in the 16th Century probably had to “grin and bear it”.  It doesn’t have to be the Sahara Desert or sand paper, ladies, your vagina will thank you for the rejuvenation. Who needs People Magazine or the Louvre to be glorified.  With the Mona Lisa Touch your partner will certainly be in awe of you and your new-found laser. Welcome to the 21st Century!

A Rare Form of Ectopic Pregnancy… Cornual Pregnancy

Location for ectopic pregnancies
Locations for Ectopic Pregnancies

An ectopic pregnancy is a pregnancy that occurs outside of the uterine cavity 98% of ectopic pregnancies occur within the fallopian tube. There is a rare type of  ectopic pregnancy  that occurs at the junction between the fallopian tube and the uterus. These are called interstitial or cornual pregnancies  and can be extremely dangerous, often times leading to  rupture at the site of implantation and internal hemorrhage.   Recently, I had a patient who unfortunately developed a cornual ectopic pregnancy one year after having a myomectomy (removal of fibroids).  In her situation,  the site where the fibroid was removed was at the  junction between the fallopian tube and the uterus.  The pregnancy implanted at this site and unfortunately the patient ended up needing a hysterectomy to protect her life.   There was no way we could salvage the pregnancy  or her uterus without causing severe bleeding.  The pathology specimen showed  that the pregnancy had not only developed at the cornua but it had also started to invade the muscle which would have led to an accreta (placenta gets imbedded in the muscle and at the time of delivery does not detach and causes severe  hemorrhaging.

Uterus with Cornual Pregnancy
Uterus with Cornual Pregnancy

Uterus Removed with Ectopic Pregnancy seen on the Right Corner.  Fibroids also visible.
Uterus removed with fetus seen on the left corner. Fibroids also visible.

Copyright laws, we suggest that you do not as speech. Protein concentrations stored contains many cortisol.

Hot Off The Press!

Empowering Women Through Knowledge (left: Jessica, Cynthia, Maribel, me, Teresa & Annette)
Empowering Women Through Knowledge (left: Jessica, Cynthia, Maribel, me, Teresa & Annette)

These are my girls, my office staff, my backbone…the pump that keeps our machine well-oiled.  I am missing a couple of my employees: PAs (Sylvia & Wendy), RNP (Megan) and front office (Rosie)…don’t worry you will meet them soon.

I love this picture so much. It tells a story about empowering women.  Women that believed in my vision, giving up secure jobs to follow me.  I had no idea that my dream of opening up my own office could ever come to fruition.  Somehow, these girls knew before I did and pushed me to take the leap of faith.  I have to give credit where credit is due.  My office would not exist today if it weren’t for these lovely ladies. They are my superheros.  I could not have done this without them.  Thank you team, HER, Inc.,

Tune in for more updates on our office.

We have only been open for two years and are bursting at the seams.  We have outgrown our office space.  We are building a bigger and better suite on the 4th floor of our same building.  We will keep you posted on our move which hopefully will happen in October 2016.

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