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| On this page, Dr. Wilson will answer frequently asked questions. The page will be updated frequently. If you have a question that you would like addressed on this page, please call the office and leave a message for Dr. Wilson or email us at
DrDWilsonOBGYN@aol.com.
 I have very heavy bleeding each month. It is so severe that I have to take a day off of work just so I can be home to change tampons and pads. My doctor says that my uterus is normal according to the ultrasound. He prescribed birth control pills but they really don't help and I feel lousy on them. What are my options? |
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| You have a number of options. The first thing to try is birth control pills. In many instances just that regulation of hormones will control the bleeding. After a few months you can stop them, and frequently your cycles will be normal again.
Your second option, if you are not planning any more pregnancies, is endometrial ablation. This is a short outpatient procedure in which the uterine lining is burned off using an instrument that is introduced into the uterus for a few minutes and heated. It is a very safe procedure and 56% of women will never bleed again after the procedure. Of the other 44%, the vast majority will have much lighter periods. Your third option is hysterectomy. For the woman with a normal uterus who is simply bleeding heavily for no identifiable reason, a laparoscopic hysterectomy is ideal. The average operating time in a patient with a normal sized uterus is less than an hour, and she can expect to go home the next day and be back to normal functioning in a week. |
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| I am 60 years old, I have had 5 children, and over the past few years I feel a bulging in my vagina when I am on my feet for long periods of time. Sometimes when I take a shower I can feel something coming out. Can anything be done about this? | ||
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| Many women who have had vaginal deliveries experience "pelvic relaxation." The uterus can descend into the vagina and can, in extreme cases, even begin to come out. Along with this, women often have hernias in the vaginal connective tissue. A cystocele is a hernia between the vagina and the bladder and a rectocele is a hernia between the vagina and the rectum.
If a woman would prefer to avoid surgery, a pessary can be placed in the vagina to support the uterus and decrease the hernia size. Pessaries are generally made of silicone and need to be removed, cleaned, and replaced periodically. Many women are satisfied with pessaries and use them for years. Surgery is another option, and if the relaxation is severe, this is the option that most women choose. The uterus can be removed laparoscopically and the top of the vagina can be suspended using permanent suture. The cystocele and rectocele are then repaired through the vagina. Women who have been suffering with pelvic relaxation for many years are thrilled with the results. Often they find that in addition to eliminating the bulging, back pain is cured and bowel movements are much easier. |
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| I have fibroids in my uterus. My doctor says that I need to have a hysterectomy because they are growing and my periods are getting heavier. She says that I cannot have a vaginal hysterectomy because the uterus is too big. Am I a candidate for a laparoscopic hysterectomy? | ||
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| Yes. Even women with large fibroids are candidates for laparoscopic hysterectomy. If the fibroids are extremely large, they can be shrunk medically before the procedure. Most of the time, however, this is unnecessary. Many of the patients we perform laparoscopic hysterectomies on have previously been told that they need abdominal hysterectomies. The best way to find out if you are a candidate is to make an appointment for a consultation. Remember to bring a copy of your ultrasound report. | ||
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| I am interested in a supracervical hysterectomy because I have read that it is better to leave my cervix in order to preserve sexual function. My doctor tells me that I could get cervical cancer, but I have only had one abnormal pap smear 5 years ago and the repeat pap was normal. What are my actual chances of getting cervical cancer? | ||
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| Your chances of developing cervical cancer are extremely small, and certainly not enough to justify taking out a cervix if you want to leave it in. My philosophy is that we as surgeons need to have a good reason to remove any tissue we take out of the body. If there is nothing wrong with your cervix, it should stay. We don't really know if sexual function is better with the cervix in, but it seems that way. Also, unless you are already suffering with uterine prolapse, the strong tissue surrounding the cervix helps to support the pelvic floor. | ||
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| I am sick of bleeding and cramping every month and my doctor says that I need a better reason than that to have a hysterectomy. Nothing I take relieves the pain unless I take narcotics, and then I can't function. My uterus is only slightly enlarged according to the ultrasound. I am frustrated. Why can't I have a hysterectomy? I don't want to have children, in fact, I have had my tubes tied. | ||
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| You probably have adenomyosis, a disease in which the glands that normally line the uterus grow into the muscle. Typically, women with adenomyosis have bad cramps, and nothing relieves the pain. They may also bleed, but the worst symptom is pain. On ultrasound, the uterus is usually only slightly enlarged. Hysterectomy is the only real cure for this disease, and a laparoscopic hysterectomy is the perfect procedure for a woman with adenomyosis. | ||
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| I have had a hysterectomy years ago, and I chose to leave my ovaries. Now I have an ovarian cyst that will not go away. My doctor told me that since I have had surgery before, I cannot have the ovary out laparoscopically. Is that true? He says that I might have adhesions and it could be cancer, and laparoscopy is unsafe. | ||
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| Laparoscopy is less safe if you have had prior abdominal surgery of any kind. However, you are most definitely a candidate. We take steps to protect you from injury, including something called an "open laparoscopy." Normally, the first entry into the abdomen is "blind." When we suspect adhesions, we will make the first incision layer by layer while watching for bowel that could be stuck under the place that we are cutting. This is not absolute protection, but so far I have never had an injury if I do it this way. It still ends up being a tiny incision, by the way.
If we suspect that the ovarian cyst may be cancer, we use an "endocatch bag" which allows us to remove the ovary laparoscopically without spilling the contents. This protects you from spreading malignant cells in your abdomen. |
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| I have a demanding job and cannot take weeks off from work, but I am told by my doctor that I need a hysterectomy. How quickly can I return to work after a laparoscopic hysterectomy? | ||
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| Most women return to work within a week to 10 days. It is rare to require more time off, unless you have a complication. | ||
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| I am very confused about hormones lately. The media seems to say that hormones cause cancer and blood clots. Is this true? | ||
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| The reason the media has covered the hormone issue so intensely lately is that the Womens Health Initiative Study was prematurely halted due to an increased risk of breast cancer in the group of women taking estrogen along with progesterone, in the form of premarin (an estrogen derived from pregnant mare's urine), and provera, a synthetic progesterone. It is of note that the arm of the study which includes women taking estrogen alone is still continuing. This recent development leaves many of us confused, doctors included. First, let me say that this study changes nothing about estrogen itself. We have known for years that estrogen causes blood to clot more easily, but aside from that, no other risks have been absolutely proven. We think that estrogen may increase the risk of breast cancer, but the studies are not completely clear. We also know that estrogen has many positive effects on the body, including the reduction or elimination of hot flushes, night sweats, insomnia, mood swings, and vaginal dryness. It improves memory, prevents bone loss, and prevents wrinkles. It even prevents dental problems!
The combination of estrogen and progesterone seems to be more risky for the breasts.A woman needs progesterone in addition to estrogen if she has a uterus. Without the progesterone, uterine cancer could develop. If a woman has had a hysterectomy, no progesterone is needed. So what is a woman to do? Avoiding the estrogen and progesterone used in this study is probably a good first step. Many women are stopping their hormones completely, and that is reasonable. We have other drugs to prevent bone loss and hot flushes. Until we gather more evidence, however, we cannot say with certainty what a woman should do. At this point, if a woman is taking estrogen primarily to prevent bone loss but has very few symptoms otherwise, I suggest that she stop her hormones. If she has a strong family history of breast cancer, she should consider stopping. Otherwise, it is a very individual decision. |
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| Does estrogen replacement therapy prevent alzheimers disease? My mother had alziemers disease and I am terrified that I will develop the disease also. | ||
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| A recent study in the Journal of the American Medical Association reports that while taking estrogen replacement therapy after alzeimers disease has struck is not helpful, women who take estrogen for the first ten years after menopause can cut their risk for developing the disease in half. A womans risk of alzeimers disease is much higher than a man's risk, and estrogen therapy lowers a woman's risk to approximately that of a man. | ||