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Conditions We Treat

Abnormal Uterine Bleeding

Abnormal bleeding between cycles or heavy menstrual bleeding can be caused by a variety of functional or structural gynecologic conditions. These can range from simply failure of ovulation to fibroids, polyps, hyperplasia (overgrowth of the uterine lining) and even uterine cancer, among many other causes.

Besides the inconvenience and the detrimental effects on a woman’s lifestyle, abnormal bleeding can lead to anemia (low blood count) secondary to blood loss, which is usually associated with fatigue and weakness, and in severe cases, shortness of breath, dizziness and loss of consciousness.

Abnormal bleeding can be treated medically or through minimally-invasive surgical options, depending on the cause.

Medical or hormonal therapy involves oral or injectable hormones, as well as the hormone-containing intrauterine device (IUD).

Definitive treatment for women not desiring future fertility is through hysterectomy. However, several other minimally-invasive options are offered for women desiring to retain their uterus.

Endometrial ablation, hysteroscopic or laparoscopic myomectomy (removal of fibroids), and Uterine Fibroid Embolization are among the conservative options.


Uterine Fibroids

Fibroids are common, almost universally benign tumors of the uterus that may grow and cause uterine enlargement with significant pressure symptoms (such as urinary urgency, frequency or retention or bowel complaints), heavy bleeding, pain or occasionally infertility or recurrent pregnancy loss when the uterine cavity is distorted.

Symptomatic fibroids can be treated conservatively through laparoscopic or hysteroscopic myomectomy or Uterine Fibroid Embolization. Definitive treatment is through hysterectomy.

A vaginal or laparoscopic hysterectomy is feasible in most cases, regardless of the size of the uterus.


Endometriosis

Endometriosis is a condition where the cells that normally line the cavity of the uterus are located in other pelvic organs such as the ovaries, the lining of the pelvic cavity, the bowel, bladder or ureters. These endometrial cells that normally form the monthly menstrual cycle are still hormonally responsive and cause cyclic bleeding in the pelvic cavity. Consequently, this may lead to pelvic pain at the time of menses, pain with intercourse, infertility and occasionally pain with urination or bowel movements when these organs are involved.

Endometriosis is found in up to 10% of women, 50-80% of patients with chronic pelvic pain and 40-50% of patients with Infertility. Treatment can be through medical (hormonal) therapy or surgical excision. Laparoscopic excision of endometriosis is indicated when medical therapy fails and when the disease results in infertility, since hormonal treatment also interferes with fertility.

Laparoscopic treatment of endometriosis can be either conservative (in women desiring to preserve fertility) or definitive (by removing the uterus, tubes and ovaries when indicated).


Chronic Pelvic Pain

Chronic pelvic pain is pain lasting six months or more that is severe enough to affect a woman’s lifestyle and daily activities.

Pain may occur daily, can be worse with menstrual cycle and may be worsened by intercourse.

Chronic pelvic pain can be caused by a multitude of conditions including endometriosis, adenomyosis, fibroids, ovarian cysts, adhesions, interstitial cystitis, irritable bowel syndrome and pelvic floor disorders, among others.

Our physicians are well-trained to manage women with chronic pelvic pain. Through a detailed history and physical examination, your doctor will plan the diagnostic approach and recommend the appropriate treatment options.

We adopt an active, multi-disciplinary approach to the diagnosis and treatment of pelvic pain, utilizing laparoscopy, hysteroscopy, cystoscopy, pelvic floor physical therapy, medical and surgical treatment, and referral to our colleagues in Urology, Gastroenterology, Psychology and Chronic Pain Management as indicated.


Prolapse

Pregnancy, prior vaginal delivery, age, and menopausal status can affect the natural support of the pelvic floor muscles and ligaments, hence leading to pelvic organ prolapse.

Prolapse can affect different parts of the vagina, the cervix or the uterus and can vary in degree and severity.

Prolapse can be treated conservatively with a pessary that is inserted in the vagina to provide some support when surgery is not desired or is risky.

Definitive treatment of prolapse is through surgical correction of the pelvic support. Our physicians are trained to treat prolapse in a minimally-invasive fashion, by the vaginal approach or through laparoscopic sacrocolpopexy, laparoscopic uterosacral vaginal vault suspension, sacrospinous ligament fixation, and/or paravaginal defect repair.


Ovarian Cysts or Masses

Ovarian Cysts can be functional or physiologic, that generally resolve spontaneously when followed with pelvic ultrasound.

Persistent Ovarian Cysts or masses can range from benign conditions such as Dermoid Cysts, Endometriomas and benign tumors, to ovarian cancer.

Benign ovarian cysts can be treated conservatively through Laparoscopic Ovarian Cystectomy (removal of the cyst with preservation of the ovary) or definitively through Oophorectomy (removal of the ovary). Our physicians are capable of removing the ovaries through a single tiny incision at the umbilicus in most cases (SILS).

Ovarian cancer generally requires a bigger incision and requires a staging procedure performed by our Gynecologic Oncology Colleagues.


Adenomyosis

Adenomyosis is a condition where the glands lining the endometrial cavity escape into the muscle wall of the uterus, hence causing cyclic pelvic pain, excessive menstrual bleeding and cramping, and frequently painful intercourse. Childbirth, cesarean delivery and any uterine procedure increase your risk of adenomyosis. Treatment options range from hormonal treatment to definitive management through hysterectomy for women who have completed childbearing.


Mullerian Anomalies

These are congenital abnormalities of the female pelvic organs, leading to malformations of the uterus, cervix, vagina, tubes or ovaries. Some of the Mullerian anomalies are amenable to surgical repair through laparoscopic surgery.


Urinary Incontinence


Adhesions

Adhesions or scar tissue results from a variety of tissue insults, such as prior abdominal or pelvic surgery, pelvic inflammatory disease or endometriosis. Adhesions can involve the bowel, bladder, uterus, tubes, ovaries and ureters and can lead to chronic pelvic pain, infertility, bowel obstruction and other complications. Symptomatic adhesions are best freed up laparoscopically through small incisions, which provides excellent visualization and precision to restore the normal pelvic anatomy.


Ectopic Pregnancy

When the fertilized egg is implanted outside the uterine cavity, this is referred to as ectopic pregnancy. Ectopic pregnancy is a serious condition and does not lead to a viable pregnancy. If ectopic pregnancy is not treated promptly, it can lead to rupture, intra-abdominal bleeding, shock and death. Treatment of ectopic pregnancy ranges from medical treatment with chemotherapy to laparoscopic management, either with preservation or excision of the affected fallopian tube.