Baptist HealthTalk

Inside Women’s Health: Real Talk on Fibroids, Pain & Hysterectomies

• Baptist Health South Florida

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Struggling with heavy periods, pelvic pain, or fibroids? You’re not alone—and you have options.

 In this episode of Baptist HealthTalk, OB/GYN Dr. Ingrid Paredes explains the symptoms, causes and treatments behind some of the most common (and misunderstood) women’s health issues, including endometriosis, fibroids and hysterectomies.

 You’ll get real answers to the questions so many women have but don’t always ask—and walk away with the knowledge to make confident decisions about your care.

 Watch now and take the first step in advocating for your health.


Host:

Neki Mohan, Award-Winning Journalist

 

Guest:

Ingrid Paredes, M.D., Obstetrician/Gynecologist

Don't ever suffer in silence. I feel that a lot of women are suffering in silence. It be menopause, depression, postpartum depression, anemia, pain, painful sex, fibroid, fear of surgery. Don't let the fear takeover. Mm-hmm <affirmative> bring it up. Talk to your doctor, look up your options. Welcome to Baptist Health Talk, a podcast on all things healthcare. Powered by Baptist Health South Florida, your trusted source for healthcare prevention and wellness. I'm your host, Neki Mohan. Welcome back to a new episode of Baptist Health Talk, where we answer your most search questions on trending topics. Today we're diving into a topic that's really personal for me. A hysterectomy. I had one due to fibroids. And let me tell you, I had a lot of questions going in. What are the mechanics of the procedure? What should I expect and what's the recovery time? Well, it turns out I'm not alone. And it's really a common procedure and there are quite a few reasons women get them. So today we're breaking it all down from the reasons women have them to the myths to how the procedure itself has come a long way. We're joined by obstetrician and gynecologists, Dr. Ingrid Peredes thank you so much for being here. Thank you for having me here. Yes, We're gonna get started right into this. Before we dive in, tell us a little bit about your background and uh, what kinds of conditions you work and treat. Perfect. I'll tell you so I am a full-time obstetric and gynecology physician, which means I do obstetrics and I do gynecology. And I would like to um, present the difference because most people don't really quite know. They're like, but do you do deliveries? Well, yeah, that's the obstetric component of a provider. When they do their OB obstetrician, that means that they do deliveries. I do vaginal deliveries, C-sections the world with the babies. I also do gynecology. The gynecology world is maintenance's visit in the office. Well women where you go to get your pap smear, you need blood work, you have a vaginal infection, breast exam, anything related women. And then in that gynecology world is surgical. So there is a gynecologic surgeries that I do. I feel like today's days most of the OB-GYNs are either staying kind of like in OB or going into GYN. And when you do GYN you can either do menopause and just stay as a menopause specialist and not do anything else but menopause or just do office hours and not do surgery or some crazy ones like me. Like I like to do it all. You're busy. So I am very busy, but I like it all because I feel like I would like to meet you see what your problem is, you have abnormal bleeding. I do an ultrasound. I find that you have fibroids and I tell you the different options for management of that fibroids, which is not always surgery, but when surgery is the one who will do that surgery. It's fascinating to be the same person. So you already have that relationship with me or that trust with me. Yes. For me to deliver your baby and then I can also take care of your fibro uterus. Yeah. So you see the The woman full cycle. Yes. Every part of her life. Let's dive into hysterectomy. For those that don't know, what is a hysterectomy and what are the most common reasons a patient would have to get? One Great question. A hysterectomy is removal of the uterus. This can be done several ways. It can be removed from the vagina directly through the already hole that you have vaginal hysterectomy. You can do it laparoscopically. When I say laparoscopically is with a camera, you put a camera in the belly button, the other incisions in the abdomen as well. And then we use devices to then duet all laparoscopically where we put a camera and we see it and then it still comes out from the vagina, but it's not a vaginal hysterectomy. Still laparoscopic hysterectomy. In that same world of laparoscopic, we have robotic, which is still a laparoscopic surgery, but robotics adds that enhanced view of the abdomen. Ergonomically better for us. The surgeons where we can be sitting here moving the arms of a robot and the patient is over there. It's pretty fascinating. When it's straight stick laparoscopy, you're next to the patient, you're standing your neck. When it's robotic, you're looking at a view in the robot in the console sitting down and the patient is over there. So often the patients are like, but is a robot doing the surgery? No, I am doing the surgery but I'm just moving the robotic arms. And then the other method is open hysterectomy, which means you have a phannenstiel incision kind of like a C-section. You get open. You could do it ideally more cosmetically with a phannenstiel incision with a lower incision at the bottom, uhhuh <affirmative>. Or you could do an open down. It all depends how big the fibroid is or or how big the uterus, all that stuff. Wow. In my case it was fibroids and for so many women, that's it. I couldn't believe how many women deal with it. Especially when you start talking about it. Um, talk about fibroids and why they can be so problematic. Okay, so fibroids are benign growth of the uterus. Those growths can be in the most of the uterus in the intracavitary inside the uterus, in the subserosa in the submucosal. So there's different categories of fibroids in general, depending on their location, you could potentially just do a myomectomy, my ectomies, when you just remove the fibroid and then when you leave the uterus behind. So that's an important distinction that I like to mention because if the patient is not done with their uh, fertility, like if they're not done having kids, then you don't wanna remove the uterus. But it is possible to just remove the fibroid and then keep the uterus on. They could get pregnant later on. So it's important to get a history if you're done with kids. It's really more complicated to do a myomectomy rather than doing a hysterectomy. So I often times, if they're done with kids, I do a hysterectomy. And in the hysterectomy you remove the uterus, the fallopian tubes, and the fiber within as well as the cervix. Um, I guess we can go later on into the different type of hysterectomies. And when do you remove the ovaries or no, because that's a very common, um, misunderstanding from the patient. Yeah, absolutely. How do you diagnose fibroids? Good question. Fibroids are diagnosed very easy with an ultrasound. Yeah. For that, have to do the ultrasound. So that's a good question. So what makes me do the ultrasound quite often and the most common presentation is abnormal or heavy uterine bleeding, pelvic pain frequency urinating, depending on where the fibroid is because if the fibroid is located in the anterior wall of the uterus is gonna press on the bladder. And you'll be surprised sometimes that's the only concern and not have had patients present like that. They're just coming in because I'm going to a bathroom at all a lot and I'm not having a UTI. And when I do an ultrasound, they have a, a fibroid that is pressing on the bladder and then causing them to go off then and not necessarily having heavy bleeding, but the most common heavy bleeding, pelvic pain, painful sex, painful defecation just because of anatomically having a mask there E could cause those symptoms. What about Infertility? Good question. It is not the most common presentation, but when you are working up somebody during infertility, you often do an ultrasound and then when you do the ultrasound you can find the fibroid. But I have delivered many patients with fibroids where they had no problem getting pregnant. That's Good to know. Another condition, uh, we talk a lot about is endometriosis. It seemed like so many women go undiagnosed for years. How does that fit into this conversation? I love That question and I'm gonna start by defining endometriosis because many times the patients don't quite know what it is. And the way I explain it is that endometriosis is endometrial tissue, which is that tissue that is supposed to be inside the uterine cavity, travels outside the uterus into the abdominal cavity. And those implants, those endometrial implants can implant in the ovaries, in the fallopian tube, in the intestines, in the liver, and even in the lungs. What happens to this tissue is they respond to the hormones. So every time the patient goes through the menstrual cycle, those cells still respond to the estrogen, which means that those cells will bleed. So if you have those cells bleeding inside the abdomen near the ovary, you basically have internal bleeding. That blood is very irritating and that irritation causes scar tissue to form inside the body, which then causes infertility, chronic pelvic pain, difficulty with your periods or painful periods, painful sex. And that's where it can come. And I can see that patients can present with all those symptoms, but it could either be a fibroid or endometriosis. Fibroid is easily diagnosed with a di with an ultrasound. Endometriosis is not so please don't think that you had an ultrasound and somebody tells you that you have endometriosis because a gold standard for endometriosis is laparoscopic. Doing a biopsy of that implant and sending it unconfirmed, that you have end endometrial cells outside of the uterus. But often we don't take the patients to the OR to do this biopsy to tell them what do we do? We rule out that it's not a fibroid. And once there's no anatomic problems like a fibroid, we give them birth control pills. The birth control pills suppressive ovulation and their pain gets better. So that's how we come more or less with treatment, more or less diagnose a possible endometriosis. Wow, that was a great explanation. Um, let's talk about, um, cancer sometimes that is hysterectomy is a way of part treating gynecological cancers. What should women know about that? That's a very good point because I should mention the distinction as a gynecologist, even though I do gynecologic surgery and I do hysterectomies, I standard of care for my own practice for myself to do an endometrial biopsy. An endometrial biopsy is an in-office procedure hurts a little bit, but I would say it's not as painful as um, many other procedures. So I do it in the office to every patient that I take to the or.'cause I need to make sure that before I take out the uterus, there's no cancer. Mm-hmm <affirmative>. Because if there is cancer there, I shouldn't be the right provider doing this hysterectomy. It should go to a gynecologic oncologist doctor because they will do extra things that I wouldn't necessarily do. Like for example, pelvic lymph node biopsy, pelvic washings, or even once you're in the abdomen and there's evidence of disease, they may need extra surgery. So instead of going on my hands and then later on needing more surgery is better done with a gynecologic oncologist doctor, a gynecology oncologist, a specialty. Yeah. No, that's so important to differentiate. There's so much fear around hysterectomies. Like will it send me an early menopause? Yes. A How will it affect affect how I feel as a woman? Yes. Um, you know, but I was very fortunate. I think most of my providers said, you're gonna be relieved<laugh>. Yes. They were like, You're gonna be relieved. Were you? Yes. Good. Yes. Did you take ovaries? No. Good. No. Can I make that distinction? Yes. Because that's so common that my patients are hesitant. Let's say that we're bypassed the whole diagnosis mm-hmm <affirmative>. And decision of doing it or not, they fear having a hysterectomy or having their life back and be relieved like you are because of the fear of menopause. Yeah. So very important to distinguish, when we do a hysterectomy, we're only talking about the hyster, the uterus. When we remove the ovaries, it has to say oophorectomy. So whenever there's fibroids and there's a need for surgery, we will do a hysterectomy. Leaving the ovaries behind. It is possible to leave the ovaries behind. Often times they are like, but what happens to the ovaries? How do they stay in there? Because in pictures, in books and what you see in the media is the ovaries attached to the uterus. Yes they are attached, but you can cut them and you can leave them. And their blood supply to the ovaries, which is what keeps them alive and releasing the hormones that we all need, is the aorta. So they basically stay in the body attached to their ovarian, uh, vessels. So it is possible to have a hysterectomy and not go in menopause. Yeah. No, it's, it's amazing what the body can do. Um, there's still, you know, so many ways about his or hysterectomy. Talk about the different types of hysterectomies and um, you know, what kind of women need them. What kind of situations would need needed. Yeah, absolutely. So I think that, um, I just went over the different methods, vaginal, abdominal, laparoscopic. Mm-hmm. My go-to always is laparoscopic. Yeah. Because I feel like that's the most minimally invasive way, uh, to do a, a hysterectomy. Although vaginal is truly minimally invasive, I tend not to do vaginal, especially with big fibroids. Can you imagine taking it out through doing the whole surgery through a vagina? It's quite challenging. It's possible. I, I can't even even imagine. I'm so not a medical person.<laugh>, but you're just so fascinating. I mean, I was surprised by how smooth the recovery was. Yes. You know? Um, talk about the recovery and talk about how this, I mean with all of those new techniques, I mean I, my mother had a hysterectomy and she had a scar right down the middle of her. Yes. Yes. I have no scar. I love it. That's great. I Have zero scar. So that's, And I was out in a day. Yes, same day. Correct. Same day. Wonderful. Yeah. And I think that's pretty accurate to what I currently practice right now. And I think the beauty of that is the robotic hysterectomy, the laparoscopic, the ability to just put five small incisions, about eight millimeter, one centimeter incision in your belly. You put the camera, you put the trochars you do the entire surgery. And then once it's disconnected from the body, it goes out from the vagina. Once you close that cuff, that's your major incision. But overall in the abdomen, it's just the fine incisions that you saw. And oftentimes I do what is called a tap block. So you put local anesthetic in the abdomen in the abdominal wall, which is what usually hurts because your belly needs to get distended to put the gas. Yes. So we could see and sometimes yeah, they may have the discomfort of the gas pain or the shoulder pain, but that's it. It's minimally invasive. So the risk of infection, the risk of, you know, pain, it's significantly reduced because of that. But you do have to recover, Be careful. Yes. You do have to recover and don't get too comfortable because there's a big incision in the vagina. So the recovery, I usually tell my patients no sex for two months.'cause that's your biggest incision. You don't wanna go bath or to the beach or the pool because you wanna let that incision heal. The vagina is an area that is full of bacteria, so you have to take care of that. Mm-hmm <affirmative>. Avoid doing strous exercises. I usually tell them nothing more than a gallon of milk for the first six weeks. Um, but you can do your normal activities. I usually tell them, do not drive for the first two weeks, just because if you're in a car accident, you just had surgery. But they're able to drive. Yeah. It's just that we try to limit. Yeah. No, you wanna work, you wanna give the body time to heal. Yes. Absolutely. It's still a big deal. It is a big deal though. It doesn't, I think it's a big deal. Yeah. It's a big deal. It doesn't look like a big deal. It is a major surgery, but It's a, but it's a very, very, very big deal. You gave us a difference between the partial, the total, and the radical hysterectomy. How do you decide which one is appropriate for each patient? So in general, depending on their age, their fertility life, and in this case their age mostly. Mm-hmm <affirmative>. Because total hysterectomy, whenever I do a hysterectomy, I do total meaning I take out the uterus, the fallopian tubes, and the cervix. It used to be done in the past that doctors will leave the cervix. But I believe it's because of the convenience of then doing the more ation mm-hmm<affirmative>. But that's, we don't do that anymore. So basically once I do a hysterectomy, total hysterectomy, we remove everything and we leave the ovaries. If we leave the ovaries, we call it ectomy. The part of the radical, I think it's more like the gynecologic oncology world where they actually remove everything and even portions of the ov vagina to make sure, because usually that's involved when there is some sort of cancer. And that's why it's good to be done with the oncologist because they do more of a radical, like they take out everything. Right. Whenever they take out the uterus because of a cancer, they also take out the ovaries. Yeah. But I think a lot of women wanna know like, am I old after I do this? You know? I mean, how can you live? I feel great, you know, and I think that's what a lot of women told. But a lot of people feel, oh, now you're old, you had a hysterectomy, you're in menopause. No, that's not true. You are actually full of more life, I would say. Because then now you get to keep your red blood cells and you don't have to lose it every month. And then having anemia. And when you have anemia, guess what? Your hair falls off. So I don't know if you ever noticed, when you have anemia, your hair falls. Now you get to conserve your red blood cells. So no, you're not old because again, your source of hormones is from the ovaries. So especially if the ovaries are staying behind, you are just removing the anatomic organ that allows you to get pregnant. That allows you to have a period. Once you remove that, there was also misconception with the sex life. Right. Which is why people before surgery uses Right. Where we going next. I know my mind. I'm sorry, I'm getting ahead. I Saw it in your forehead, <laugh>, so then when you do a sub cervical hysterectomy. Yeah. The thought also was that you're leaving the cervix and then you're not interfering with the vagina and the vaginal length and being able to have sex and not affected, you don't have To worry about a period every month. People I know. I'm letting you know. Guess what? And you don't need a pap anymore. Right. Especially if your pap smears were normal all your life. Yep. You do not need a pap smear because there's no cervix. There's no way to check. However, if you did have an abnormal pap, even if you had a hysterectomy, you do need a pap smear for 20 years since your last abnormal pap. Yeah. No. So, so important. But let's let people know you do have more life.'cause a lot of things that were dragging you down. You know, they're no longer there. But you still need to go to the gynecologist. Absolutely. Okay. Absolutely. Um, are the, are there alternatives to having a hysterectomy for conditions like fibroids and endometriosis? And how do you help your patients make that decision? Especially like you said, they still wanna have babies. They, they wanna live, you know, they, they, they're not ready to part. That's an amazing question because I could, five patients pop into my mind when you ask that question. So I will tell you what I counsel my patients of the different management options from least invasive to more invasive. The least invasive and more common is birth control pills. Right. Birth control pills will help you because they will suppress ovulation. Therefore less blood, less opportunity for this fibroid, which is a benign growth, but it fits from the blood and then that's what allows it to grow. So birth control pills are the first line less invasive. You can have particular hormone pills that are not birth control pill or contraceptive, but they are, um, suppressors of like the, the ovarian hormones. So they basically induce menopause is a medical menopause induction. Mm-hmm <affirmative>. Because what it does is completely suppressing the hormones to not allow the fibroids to grow. That one would have some side effects like hot flashes because it's simulating menopause. Um, there's other medications like tranexamic acid. Tranexamic acid is not hormones. Wow. It is basically a ular medication. What it does is that it makes you clot faster so that you don't lose so much blood. Oh wow. And it says, never heard of that before. It is a common option that patients like, because I don't want hormones, I don't wanna go to menopause, I don't want surgery. I'm like, you're leaving me with not many options. So tranexamic acid is one that comes in mind because it's a proco and it helps you to not lose blood. Now in the more invasive we have what it's called, uh, uterine artery embolization. I've had one of those. Okay. So there you go. So you've had it and it worked for a very long time. It didnt work. And I have a patient that told me I wish somebody would've told me sooner. That's Why these conversations are important. Yes. So thank you for sharing your personal, because it adds that credibility when you have actually gone through it. Yeah. And it's not just me And I just had a baby and, but this Em, you weren't ready to be quite Done. Right. I was thinking of having another one. But does the em, the, how does the embolization work and how does it affect your fertility? Very Good question because I actually had to do an embolization in one of my patients right. At the time of her C-section. And it was her first baby. So she was definitely not done with fertility and she did not have a fibroid. But it's, the concept is the same. You embolize the uterine arteries. That's exactly what it is. How do you do that? Well, you put a medication through the artery, it's done by the intervention radiologist and then it makes the uterine artery not supply blood to the uterus. So in theory, you're like, what's happening to the blood? You know, you're making a tissue die. Could I potentially have babies? So the evidence says that you could, I've had patients that have gotten pregnant with it. It may affect it because you're compromising the blood supply to the uterus, but there's so many collateral blood supplies to the uterus that you're not completely, completely killing the uterus by not giving the blood to it. When I told you about the ovaries and that connection with the ovarian vessels, there is collateral blood supply that can still go to the uterus to keep it alive, but not to allow it to continue the fibroid to grow. Yeah. So that's a unit embolization. Then there is this new, uh, method that is called the Acea. It's relatively new. I'm starting to do, um, a number of them, I wanna say relatively new, but it's been around for maybe like five years. Um, it's a laparoscopic ultrasound guided fibroid ablation. Hmm. Okay. So we're talking about that. I'm going in with a camera. I see the fibroid. I would have done a myomectomy, but in this case, we're not ready for that myomectomy. We're cutting the uterus. Yeah. Because it's more like bloodier. This case you put an ultrasound, right. Laparoscopically. So the ultrasound goes inside the port. Uhhuh <affirmative>, you can see in the screen they fibroid in an ultrasound image. Mm-hmm <affirmative>. And then you put a needle laparoscopically inside the fibroid and it burns or ablates the fibroid, which means it would leave the fibroid dislocated. You're not killing it. You're dislocating the fibroid. Which in terms of recovery is a lot less painful than a uterine embolization. I don't know how your experience was, but in general, when you deprive blood to a tissue, like what's a heart attack? Right. Heart attack is when you don't give blood to the heart itself. Right. So any type, the tissue dies, it hurts. Yeah. In this case, because of this ablative ablative option that is just ablating or burning the tissue. Killing the tissue by just burning it. Not uhhuh, depriving it from blood, but just burning it. The recovery is much better. And then of course the myomectomy where you cut and also at the end, the more invasive is . Yeah. Just to go over all the methods. No, it's great to have all these options and to hear how it's evolving.'cause a lot of people, this really impacts their lives Really doesn't. Yes. And they should have the option. They shouldn't just do what, you know, they should be educated. Especially to this day, people are educated. Hopefully these talks would educate them. Yeah. And make them feel comfortable about talking about it. Right. Because it's not fun, Educated decision. And speaking of empowerment, what's the biggest piece of advice to help one of your patients if they're considering hysterectomy? Um, you know, to help them feel empowered and informed as they go ahead or make the decision. I have a saying that I feel like it's, I'm gonna carry it forever. Don't ever suffer in silence. I feel that a lot of women are suffering in silence. It'd be menopause. Depression. Yeah. Postpartum depression, anemia, pain, painful sex, fibroid, fear of surgery. Don't let the fear take over. Mm-hmm <affirmative>. Bring it up. Talk to your doctor. Look up your options. And if you're not comfortable, find a second opinion. Yeah. Yeah. No, that's so, it's so important. Um, what's your parting advice for, um, for people who are dealing with fibroids or, you know, like I said, you, you want them to get informed, but it's just, it's so, so many of these young, so many people are so hard for them to talk about these things and, but is there, is there more being done I think for, to get the information out or to help? I don't know. I think that the information is there. Yeah. Go look for it. If you don't feel convinced, go keep, keep looking. Keep finding a provider that speaks to you that you feel heard, that you feel that you understand. Mm-hmm <affirmative>. Don't suffer in silence. There's plenty of solutions. I think the problem is when there are no solutions, Uhhuh, <affirmative>, like if you have cancer, even cancer, I think that's a good point. Yes. Even cancer, there are options. I have patients that have had uterine cancer. Right. And there are ways that you can treat that cell and preserve your uterus, hyperplasia, you know, you, there's options. I just wanna promote women to look for the knowledge and for, to look for explanations for whatever they're going through. Don't settle. Don't just adapt and consider it a normal because so and so did it. Or your mom did it, or Yeah. She dealt with, With it. My mom didn't tell us anything. Right. They didn't tell Us anything. I feel like we're in an era now that yes, knowledge is power. So that's what I would say. Just get the knowledge. Yeah. You've been awesome. This is an excellent conversation. It's so exciting. We could talk forever. Yes. I know. You've gotta be careful. You gotta stop.<laugh><laugh>. Well, we gotta be careful. Thank you so much for sharing your insight with our audience. Remember viewers, be sure to hit that subscribe button on our channel here to keep up with the latest health and wellness information and tips from all of our experts. Thank you so much for watching. Find additional valuable health and wellness information on our resource blog@baptisthealth.net slash news. And be sure to interact with us on our social media channels for live and upcoming events. Baptist Health Talk is brought to you by Baptist Health, the warmer side of care.