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Fibroids and Endometriosis
Discussion in 'All Categories' started by Dale - Dec 26th, 2011 7:50 am.
Dear Doctor,

I would like to have your opinion on possible treatment for my wife, age 34, who is otherwise healthy, except occasional small brownish vaginal discharge. Tests on her liver, kidney, thyroid functions, chest x-ray and upper abdominal ultrasound are all normal.

Since she could not get pregnant after six months of our marriage, on transvaginal ultrasound she is found to have multiple (at least three) uterine fibroids, with the largest being approximately 3cm x 4cm. MRI shows similar findings, plus possible chocolate cysts on both ovaries.

Based on these information, I would like to know:

1. What is the best treatment approach for her now? Our goal is to have a child.

2. Would she be benefited if a laparoscopic myomectomy is performed to remove the fibroids?

3. If she is found to have endometriosis during laparoscopic myomectomy, should it be operated on at the same time?

4. Can you give me an estimate on medically related costs (doctors fees, tests, surgery, anesthesiologist, etc) for a laparoscopic myomectomy without insurance coverage?

Thank you very much for your help.


re: Fibroids and Endometriosis by Dr JS Chauhan - Dec 27th, 2011 12:26 am
Dr JS Chauhan
Dr JS Chauhan
Dear Dale

You did not mention which type of fibroid it is:

Uterine Fibroids are classified based on their whereabouts inside the uterus. There are three primary kinds of fibroid tumors:

Subserosal fibroids develop in the outer portion of the uterus and continue to grow outward. These fibroids typically do not affect a ladies menstrual flow, or cause excessive menstrual bleeding, but could cause pain due to their size and the added pressure on other organs.

Intramural fibroid tumors are the most typical and develop in the uterine wall and expand. These fibroids may cause the uterus to appear larger in size which can be mistaken for putting on weight or pregnancy. Associated symptoms include heavy menstrual bleeding, pelvic and lower back pain, frequent urination and pressure.

The other kind of fibroid tumor is submucosal, the least common of the three. These fibroids develop inside the uterine cavity and may cause excessive menstrual bleeding along with prolonged menstrual cycles.

A woman may have one or all of these types of fibroids. It is common for a lady to have multiple fibroid tumors also it may be difficult to understand which fibroid is causing your symptoms. Because fibroid tumors are a diffuse disease of the uterus, you will find usually more fibroids present than could be detected due to their small size. A woman who has only one visible fibroid needs to think that you will find multiple uterine fibroids present when discussing therapy. Uterine fibroids can also be referred to as myoma, leiomyoma, leiomyomata, and fibromyoma.

The fibroid which is outside the uterine cavity is not the cause of infertility.

Endometriosis is the real cause of infirtility for your wife. Many theories have been proposed to describe why it's tougher for women with endometriosis to conceive. However, up to now, none have been proven. It's possible there are several causes and that different causes are relevant in different women. Some of the theories include:

pelvic adhesions inhibit the movement from the egg on the fallopian tube. eggs are of poor quality
chemicals made by the endometriosis inhibit the movement of the egg down the fallopian tube
inflammation within the pelvis caused by endometriosis energizes the manufacture of cells that attack the sperm and shorten their life time eggs aren't released from the ovaries each month (also called anovulation, which may also exist in women without endometriosis).

We can perform both the surgery for your wife but you should first come with all the report and consult with us to find out the way we should treat your wife.

With regards

M.K. Gupta
re: Fibroids and Endometriosis by sad - Apr 20th, 2012 7:31 pm
would anyone be wliilng to take this challenge?I have a cultural assessment assignment in my health course. I thought that the internet would be a very diverse place for me to find the right candidate for this information. I know that there are a lot of questions, however they are all needed in order to get a good assessment of the right individual. Please take this challenge. I am looking forward to reading the answers from someone from a different culture than myself. I am a 39 year old mother of 1 son who has been married to a wonderful man for the past 10 years. I am a caucasian american, catholic. Here are the questions to the assignment. Please answer each question for all. Thank you so very much:Brief history of the cultural group with which you identify.where were you born?With what cultural group(s) do you affiliate?To what degree do you identify with the cultural group?Where have you lived(country,city) and when (during what years)? if a recent relocation to the US, include prevalent diseases in country of origin.What are your attitudes, values and beliefs about birth, health, illness, health care providers?How do you view work, leisure, education?How do you perceive change?How does your cultural group regard expression of emotion and feelings, spirituality, and religious beliefs?How are dying, death and grieving expressed in a culturally appropriate manner?How is modesty expressed by men and women?Are there culturally defined expectations about male-female relationships, including the health care relationship?Do you have any restrictions related to sexuality, exposure of body parts, certain types of surgery (e.g., amputation, vasectomy, hysterectomy)?Are there any restrictions against discussion of dead relatives or fears related to the unknown?To what cause(s) do you attribute illness and disease (e.g., divine wrath, imbalance in hot/cold or yin/yang, punishment for moral transgressions,hex, soul loss)?What so you believe promotes health (e.g., eating certain foods, wearing amulets to bring good luck, exercise, prayer, rituals to ancestors, saints or intermediate deities)?Do you rely on cultural healers (e.g.,curandero, shaman, spiritualist, priest, minister, monk)?Who determines when you are sick and you are healthy?Who determines the type of healer and treatment that should be sought?In what types of cultural health practices do you engage (e.g., use of herbal remedies, potion, message, wearing of talismans or charms to discourage evil spirits, health rituals, incantations, prayers)?What is appropriate sick role behavior?Who determines what symptoms constitute disease/illness?Who decides when you are no longer sick?Who cares for you at home?How does your cultural group view mental disorders?Are there differences in acceptable behaviors for physical versus psychological illness?What is the meaning of food and eating to you?With who do you usually eat?What types of food are eaten?What do you define as food?What do you believe composes a healthy versus an unhealthy diet?Do religious beliefs and practices influence your diet (e.g., amount, type, preparation or delineation of acceptable food combinations, such as kosher diets)?Do you abstain from certain foods at regular intervals, on specific dates determined by the religious calendar, or at other times?If your religion mandates or encourages fasting, what does the term fast mean (e.g., refraining from certain types or quantities of foods, eating only during certain times of the day)?For what period of time are you expected to fast?Who composes your social network (family, peers, and cultural healers)?What are the roles of various family members during health and illness?What impact does economic status have on lifestyle, place of residence, living conditions, ability to obtain health care, discharge planning?What is your highest educational level obtained?What learning style is most comfortable/familiar?Do you prefer to learn through written materials, oral explanation or demonstration?What have you learned from this assignment about yourself?How would you expect or want to be treated by health care personnel.Is there a specific thing that you would expect the health care personnel to know about your culture when taking care of you?To anyone who has excepted this challenge, thank you very much. I know that it is a lot and I would have split the questions up in the site, however, all the questions need to be answered by the same individual and given the anonymity of the subject, I could not be sure that the same person would be answering the questions. Thank you so very much if you have taken this challenge .You have helped me greatly and I hope that when I am doing my paper on your culture that I will do it justice.
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