The pain becomes worse and worse with time and eventually no longer restricted to menses. Pain can appear randomly, with bowel movement, intercourse, cause frequent urination, bloatedness and many other symptoms. The usual age of diagnosis is late 20’s when the pain gets intolerable or if a couple has difficulty getting pregnant. The major issues reported are pain and infertility. Women with strong family history of endometriosis are at higher risk for the disease. Puberty hormones stimulate the growth of the endometriosis and menopausal hormone withdrawal marks the end of endometriosis. Endometriosis have been found in girls as young as 8 year of age. 

DIAGNOSIS

Diagnosis of endometriosis is surgical. Diagnosis is performed through a small umbilical incision of 5mm by inserting a camera called a laparoscope inside the abdomen. This operation is usually recommended once a patient reports unbearable progressive menstrual pains, or unexplained fertility. Other times finding of a blood filled ovarian cyst also called endometrioma prompts a surgical evaluation and leads to diagnosis. Endometriosis is staged based on the spread of the disease identified during surgery. Severity of symptoms do not correlate with the extent of the disease.  

RELATED: Endometriosis Treatment in Los Angeles

TREATMENT

Treatment options are surgical and hormonal suppression. During a diagnostic laparoscopy endometriosis lesions can be eliminated using excision or lasers. Treatment can also be in the form of hormonal suppression such as birth control pills. Many women who are unable or unwilling to use birth control pills may use bio-identical hormones to suppress the growth of the endometriosis and control pain. The ideal treatment is a combination of the surgical and hormonal suppression. Surgically the extent of the disease can be determined and the visible lesions can be excised which reduces pains and improve fertility. Hormonal suppression is also used to reduce the disease progression or recurrence.

Early diagnosis and treatment is crucial since endometriosis expands with time. In my practice women diagnosed early usually have the best outcome. Do not ignore persistent signs and symptoms. If you suspect endometriosis in yourself or a friend and would like to be evaluated please give us a call or pay us a visit in Glendale or West Los Angeles.

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These are the most common questions I am asked from women transitioning through perimenopause or in menopause. Women concerned about changes they see in themselves, friends, or family seek ways to either make it easier or prevent unwanted changes associated with reduced hormones.

Changes that are most reported are hot flushes, fatigue, insomnia, vaginal dryness, mood changes, mental fogginess, decreased libido, and weight gain in the mid abdomen. Long term, hair loss, loss of skin elasticity, decreased muscle tone, and reduced metabolism also occurs.

Reduced hormones during perimenopause and menopause increase the risk of heart attack by 10 fold, causes gradual weakness in the bones or osteoporosis, and worsen vaginal prolapse and urinary control problems.

The controversies surrounding the safety of hormone therapy that has raged for the past 30 years now is settled by several major studies. These studies show hormone therapy as a significant part of women’s health in perimenopause and menopause.

RELATED: Menopause Care in Los Angeles

Studies also show that starting hormones in perimenopause or very quickly after menopause has the least risk and the greatest benefit. These benefits last as long as the hormones are used. We have also found that hormone customization is the best way to approach hormone replacement. We are all different and are affected differently as we go through the change of life. Evaluating a woman’s symptoms and testing guide the type of hormones her body needs and close follow up allows for adjusting the dosage for complete resolution of symptoms.

In my practice we use bioidentical hormones. These hormones are sourced from soy and yam and compounded to resemble the hormones naturally produced by a woman’s body. I feel that this similarity in hormone structure to natural hormones allow better acceptability and efficacy and minimize side effects. Also using creams to deliver the hormones through the skin has shown to eliminate the risk of deep venous blood clots, stroke, and heart attacks, a major concern with other delivery methods. The goal of hormone replacement is to maximize benefit and minimize risk.

RELATED: Are you experiencing perimenopause symptoms?

Most women are good candidates for hormone replacement therapy with promise of better health and quality of life. If you are on hormone therapy and looking for better results, or thinking about starting, we are happy to see you. Please call us with questions or make an appointment for a consultation.

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Follicles

Follicles are cysts ovaries make on a monthly basis as they prepare to ovulate or release an egg. These cysts are normal and non-cancerous. However, at times they may cause pain. Sometimes during intercourse one of these cysts or follicles, as we call them, pop and release either blood or fluid into the abdomen causing pain. The pain can be so severe that it may be confused with appendicitis. Follicles are easily diagnosed with ultrasound and usually with pain management resolve on their own.

Polycystics Ovarian Syndrome or PCOS

Polycystic ovarian syndrome or PCOS is when ovaries make too much male hormone or androgens. Elevated androgen levels disrupt the delicate ovulation cycle and result in menstrual irregularities. Three criteria are required for PCOS diagnosis; elevated androgen levels, polycystic appearing ovaries on ultrasound, and irregular menstruations. Typically, women with PCOS complain of increased acne, increased facial and body hair, male pattern baldness, weight gain, and in long term are at increased risk for infertility, diabetes, uterine and breast cancer, and heart disease. Treatment is usually through suppressing the excess androgen production and usually is very successful. I enjoy taking care of patients with PCOS and fertility issues. Treatment can be challenging, but usually very successful and rewarding.

RELATED:  What is Polycystic Ovarian Syndrome or (PCOS)?

Endometriomas

Endometriomas are formed by endometriosis implants on the ovary. Endometriosis is displacement of endometrial glands from inside the uterus to the internal pelvic cavity and organs.  Once these glands land on the ovary and are stimulated during each menstrual cycle by the estrogen from the ovaries, they grow and produce bloody ovarian cysts. We call these endometriomas. This condition typically causes pain prior to menses and gets progressively worse with age. In severe cases patients visit emergency rooms frequently for pain management. Also, many women with chronic pelvic pain suffer from endometriosis. Endometriosis may also scar internal reproductive organs causing fertility problems. Endometrioma can be seen on ultrasound however endometriosis can only be diagnosed by evaluation of the internal abdominal cavity using a special surgical instrument called laparoscope. This operation is done through a small umbilical incision under general anesthesia. Because of my expertise in laparoscopic surgery endometriosis treatment has become a large part of my practice.

Dermoids

Dermoids, are primarily diagnosed in young women and originate from undifferentiated cells in the ovary. After puberty these cells multiply and become hair, skin, bone, and other tissue within the ovary. Dermoid cysts are surgically removed once they grow and cause pain, usually through laparoscopy.

RELATED: Can Endometriosis Become Cancer?

Borderline and Cancerous Cysts

Borderline and cancerous cysts of the ovary are rapidly growing and sometimes invasive tumors that are difficult to diagnose in early stages. The rate of ovarian cancer is 1/3200 women and it is more common after menopause. Women with a history of breast and ovarian cancer are at increased risk. Genetic testing in women with a strong family history is recommended to determine their risk level. In women determined to be at high risk of cancer close observation and prophylactic surgery has been helpful in preventing the occurrence of cancer. No method of screening for early diagnosis of ovarian cancer in the general population has been identified.

Ovarian cysts are common and varied. Early diagnosis and treatment are crucial in avoiding medical issues in later years. A complete medical history, pelvic exam, pelvic ultrasound, and blood test are all simple first steps. So, visit your gynecologist.

Schedule an appointment with Dr Michael Tahery at the Glendale office or the West Los Angeles office to find out more about ovarian cysts and the treatment options available.

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How many couples do you know trying to get pregnant and have difficulty? Or have “fertility anxiety”?

On any given day in my practice, I am faced with the seemingly straight forward, yet complex question from women at various stages of their lives; “can I get pregnant?”. Women in their twenties and nervous about their health; those in their thirties worried about the metaphorical clock ticking away; and women in their forties optimistically seeking guidance. Some may have tried a few cycles naturally to get pregnant and others may not be ready yet.

Fertility is big news because the rate of infertility is increasing in both men and women. Several factors are implicated and the most common are environment, age, genetics, and medical conditions.

Diet and environmental toxins are very concerning topic. Pesticides, hormones added to foods, chemicals in the air we breathe and water we drink may play an important role. It effects the health of the female ovaries and the eggs they produce; it also effects the number and quality of sperm in men.

Advanced maternal age is another big factor. As ovaries age, the produced eggs are harder to fertilize. The number of eggs also decrease with age. The rate of attrition increases after 30, speeds up after 35 and at 40 very few eggs are left. If you are from a family with children born to mothers in their forties, your chance of having children later in life also increases. Genetics is an important factor and is much harder to analyze. Testing can determine your approximate egg count and quality and many of the factors that impede fertility.

Medical conditions that may not play a significant role in the fertility of a young adult can become serious factors as the person ages. Fibroids and endometriosis are two common examples. These conditions worsen with age and cause damage to reproductive organs. Hormonal imbalance such as polycystic ovarian syndrome, disrupt ovulation cycles and make eggs weaker. Simple office evaluation can diagnose many of these medical conditions.

Some of the fertility anxiety experienced by women may be justified and many are not, and most are easily treated. Discuss any concerns with a gynecologist. There are many ways your fertility can be evaluated. Simple, tried and true instructions can increase your odds of pregnancy, such as treating your body better with a balanced diet, exercise, and getting your checkup at least annually. In my practice, at times, simple solutions and early detection have made tremendous improvements in a couples fertility.

Oddly enough, anxiety about fertility has shown to reduce the chances of pregnancy. So, relax. Seek the help of a gynecologist.

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Frequently, I hear a variation of this sentence from mothers very soon after childbirth. Too frequently, if you ask me.

It is the symptom of our fastpaced life. We have no time to waste on recovery. We hear, “Be strong. Get back to work. All mothers do it.” Work, family, child, and pretty much anyone else comes first. No matter what a mother has gone through mentally, emotionally, and physically, they are expected to bounce back, quickly. Having gone through an amazing bodily transformation, while supporting another human life; to delivery, which is a nature’s wonder that never seizes to amaze me after all these years. To postpartum, trying to heal and go back to the baseline as soon as possible, the “new normal”.

We have picked 6 weeks randomly, to be the general time a mother can spend in recovery after a delivery, without consideration for a mother’s new responsibilities of the baby. At 6 weeks she is juggling the baby, plus their normal responsibilities; it may be a full-time job, housework, and/or caring for another family member in need. Also, without any consideration for emotional, or physical needs that may have come about as a result of a complicated road to pregnancy, pregnancy itself, and delivery.

In other comparable economies in Europe, the median maternity leave is 87 weeks. Most countries also allow paternity leave. Obviously, the importance of bonding and maternal recovery is of significant importance in these countries.

Having said all this, slow down, delegate some of your responsibility and give yourself time to recover mentally, physically, and emotionally. Visit your obstetrician more often during pregnancy and after delivery. Ask questions and complain about things that do not seem right and bother you. Get re-assurance, treatment, or consult from other specialists if necessary. There is a solution for most things that does not seem right. Some quick and some may take some time.

You might “feel great” but take your time and be your own advocate. Long term, you will be happy you did. A problem passed over today may become a chronic issue you will have to deal with for many years to come.

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Traditional surgical treatment involves excision of the hemorrhoids that can be very painful with a long recovery time. Using radiofrequency and electrocautery, we are able to treat a large number of hemorrhoids, under local anesthesia, as an out-patient procedure.

An office evaluation of the anal area is necessary to qualify for this treatment and rule out other causes of pain and discomfort such as anal fissures, tumors, infection, abscess, polyps or cancer. Once hemorrhoids are identified, in most cases local treatment involving emollients and steroids are sufficient to relieve the pain. However, if the hemorrhoids are recurrent, treatment using these outpatient techniques are employed.

Treatment requires a duration of less than 15 minutes. Local anesthesia is used. With no down time, in most cases, the patient may return to his or her normal activities subsequent to the procedure. Multiple treatments may be necessary to allow for complete resolution of the hemorrhoids.

For patients that qualify for this treatment, this may be a solution much more tolerable than the traditional excisional treatment.

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Adenomyosis occurs when the lining of the uterus penetrates the muscle of the uterus and causes the uterus to act as a sponge. As a woman gets closer to having her period, the uterus becomes full of blood and congested and when the period starts, the bleeding pours out of the endometrial lining and the uterus, as if a sponge is being squeezed. The congestion causes fullness and pressure in the lower abdomen and once the bleeding starts, the large amount of blood trying to exit the uterus causes cramping and pressure that can be very severe.

RELATED: 4 Reasons You Might Be Experiencing Irregular Periods

How is the diagnosis made?

An ultrasound examination in the office can easily identify the many causes of pain and bleeding. We use transvaginal or trans-abdominal ultrasound as needed and with the advanced technology in our ultrasound system, we can use 3D options to further evaluate the uterus and the ovaries. We also utilize Doppler to evaluate the blood flow.

In situations when the problem is hormonal or due to an enlarged uterus as a result of adenomyosis, identified treatment is usually hormonal. We use natural progesterone creams or pills, low-dose hormonal birth control, or hormonal IUD as the first line of therapy. The hormone progesterone in these treatments helps decrease the congestion of the uterus and is usually extremely effective in resolving pain and heavy bleeding. Minimally invasive surgical options such as uterine artery embolization and endometrial ablation are also very effective in treating the more severe cases which do not respond well to conservative measures.

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The changes in a woman’s body that eventually result in the symptoms mentioned above start long before the actual symptoms present themselves, which is why physicians should be watchful during yearly exams for any early signs. Also, women going through these hormonal changes should be aware of changes in their body and report any symptoms to their physicians.

There are several treatment options and each needs to be personalized based on the current level of discomfort and need. However, prevention is always the best policy.

Early hormonal replacement can prevent these changes from occurring. In our office, we prefer natural hormone therapy as it offers minimal adverse effects and maximal benefits to the affected area. We synthesize the hormones naturally and therefore have control over the dosage and ensure that the chemical structure is similar to the ones naturally produced in a woman’s body.

Non-hormonal options are also available for few patients that do not qualify for hormone therapy. This type of medication increases lubrication and reduce symptoms associated with menopause during use.

Evaluation of the bladder can help your doctor determine the exact nature of the urinary problem that may have gotten worse after menopause. Many options are then available to address these issues before they turn into major problems.

Kegel exercise, modification of diet and fluid intake and weight loss help strengthen the pelvic muscles and improve the function of the genital and urinary organs, keeping you healthy and improve the quality of life during this next stage of life.

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The effects of PMS can be disruptive, and cumulatively can take a negative toll on anyone’s mind and body, not to mention those around you or in contact with you on a daily basis including family and friends. I recently treated a 26-year-old patient who for one week prior to her menstruation could not leave the house. Another patient in her 40’s was so bloated she could not put her pants on before her menstrual cycle. Other times, I have received calls from husbands about the change in the mood of their spouse around the time of their periods.

RELATED: 4 Common Reasons You Might Be Experiencing Irregular Periods

The treatment we offer is in most cases very successful. A combination of special low calorie and low salt diet eliminates much of the bloating. Exercise, especially swimming also tends to mobilize much of the fluid collection in the extremities. Short duration of diuretics can also be used to relieve symptoms that do not respond to diet and exercise. For other symptoms, we try to use natural products to balance the bodies hormonal balance. Every patient is different and the range of unwanted PMS symptoms varies from patient to patient. With an individualized plan of care, we can properly address your symptoms to alleviate your monthly struggle and become as comfortable as possible with your menstrual cycle. In this day and age, there are mobile applications to monitor your menstrual cycle not only to remind you of your time of the month or how many days on average are in your cycle, but also to document and take note of your symptoms, cravings and feelings. If you are able to routinely keep track of certain things that are consistently appearing prior to and during your cycle, we can better address your needs and provide some relief to the symptoms that come and seem to stay too long.

We are happy to report that we have been able to successfully treat our patients and keep many husbands happy!

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A weight loss program based on gradual changes in eating habits and regular exercise is an effective way to correct weight gain and restore health.

Our diet program is based on sound medical advice. It does not sacrifice your health for weight loss. We take into consideration your lifestyle, cultural diet, exercise, daily habits and work habits. We add to that your hormonal environment and metabolism. All this under the supervision of a physician.

Our goal is a lifestyle change that leads to weight loss and healthy, vigorous living.

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