What are uterine fibroids?

Uterine fibroids are benign (not cancer) growths that develop from the muscle tissue of the uterus. They also are called leiomyomas or myomas. The size, shape, and location of fibroids can vary greatly. They may be present within the uterine cavity, within the muscular wall of the uterus, on the outer surface of the uterus, or attached to the outside of the uterus by a stem-like structure. A woman may have only one fibroid or many of varying sizes. A fibroid may remain very small for a long time and suddenly grow rapidly, or grow slowly over a number of years.

What are symptoms of fibroids?

• Changes in menstruation

  ○ Longer, more frequent, or heavy menstrual periods

  ○ Menstrual pain (cramps)

  ○ Vaginal bleeding at times other than menstruation

  ○ Anemia (from blood loss) 

• Pain

  ○ In the abdomen or lower back (often dull, heavy and aching, but may be sharp)

  ○ During sex

• Pressure

  ○ Difficulty urinating or frequent urination

  ○ Constipation, rectal pain, or difficult bowel movements

  ○ Abdominal cramps or bloating

• Enlarged uterus and abdomen

• Miscarriages

• Infertility

• Fibroids also may cause no symptoms at all

When is treatment necessary for fibroids?

• Heavy or painful menstrual periods that cause anemia or that disrupt a woman’s normal activities

• Bleeding between periods

• Uncertainty whether the growth is a fibroid or another type of tumor, such as an ovarian tumor

• Rapid increase in growth of the fibroid

• Infertility

• Pelvic pain

Can medication be used to treat fibroids?

• Birth control pills and other types of hormonal birth control methods: These drugs often are used to control heavy bleeding and painful periods

• Gonadotropin-releasing hormone (GnRH) agonists: These drugs stop the menstrual cycle and can shrink fibroids. They sometimes are used before surgery to reduce the risk of bleeding. They can also be used to bridge a woman to menopause when fibroids will then naturally shrink. Because GnRH agonists have many side effects, they are used only for short periods (less than 6 months). After a woman stops taking a GnRH agonist, her fibroids usually return to their previous size

• Progestin-releasing intrauterine device: This option is for women with fibroids that do not distort the inside of the uterus. It reduces heavy and painful bleeding but does not treat the fibroids themselves

• Tranexamic Acid:This medication helps our blood clotting mechanism and will reduce the amount of bleeding when bleeding occurs. It does not treat the fibroids, just the bleeding caused by the fibroids

• Non-steroidal anti-inflammatory drugs (NSAIDs): NSAIDs such as ibuprofen can minimize the pain and some of the bleeding caused by fibroids

What types of surgery may be done to treat fibroids?

• Myomectomy is the surgical removal of fibroids while leaving the uterus in place. Because a woman keeps her uterus, she may still be able to have children. Fibroids do not regrow after surgery, but new fibroids may develop. If they do, more surgery may be needed

• Hysterectomy is the removal of the uterus. The ovaries may or may not be removed. Hysterectomy is done when other treatments have not worked or are not possible or the fibroids are very large. A woman is no longer able to have children after having a hysterectomy

Are there other treatments besides medication and surgery?

• Hysteroscopy

• Endometrial ablation

• Uterine artery embolization

• Magnetic resonance imaging-guided ultrasound surgery

What are menopause and perimenopause?

•       The absence of menstrual periods for 1 year

•       The average age of menopause is 51 years, but the normal range is 45 years to 55 years

•       The years leading up to this point are called perimenopause, it means “around menopause”

•       This phase can last for up to 10 years. During perimenopause, shifts in hormone levels can affect ovulation and cause changes in the menstrual cycle

What are some of the common changes that occur in the menstrual cycle during perimenopause?

•       Irregular bleeding or spotting

•       Longer and heavier periods alternate with shorter and lighter periods

•       The number of days between periods may increase or decrease

•       You may begin to skip periods

How can I tell if bleeding is abnormal?

•       Very heavy bleeding

•       Bleeding that lasts longer than normal

•       Bleeding that occurs more often than every 3 weeks

•       Bleeding that occurs after sex or between periods

What are some of the common causes of abnormal bleeding?

Polyps - Polyps are usually noncancerous growths of tissue that grow on the inside of the uterus. They may cause irregular or heavy bleeding. Polyps also can grow on the cervix or inside the cervical canal. These polyps may cause bleeding after sex.

Endometrial atrophy - After menopause, the endometrium may become too thin as a result of low estrogen levels causing abnormal bleeding.

Endometrial hyperplasia - The lining of the uterus thickens which can cause irregular or heavy bleeding. It is most often caused by excess estrogen without enough progesterone. In some cases, the cells of the lining become abnormal, called atypical hyperplasia which can lead to cancer of the uterus. When endometrial hyperplasia is diagnosed and treated early, endometrial cancer often can be prevented. Bleeding is the most common sign of endometrial cancer in women after menopause.

How is abnormal bleeding evaluated?

•       Endometrial biopsy

What is endometriosis?

Endometriosis is a condition in which the type of tissue that forms the lining of the uterus (the endometrium) is found outside the uterus.

How common is endometriosis?

Endometriosis occurs in about one in ten women of reproductive age. It is most often diagnosed in women in their 30s and 40s.

Where does endometriosis most often occur?

•       Peritoneum

•       Ovaries

•       Fallopian tubes

•       Outer surfaces of the uterus, bladder, ureters, intestines and rectum

•       Cul-de-sac (the space behind the uterus)

How does endometriosis cause problems?

Endometriosis implants respond to changes in estrogen, a female hormone. The implants may grow and bleed like the uterine lining does during the menstrual cycle. Surrounding tissue can become irritated, inflamed, and swollen. The breakdown and bleeding of this tissue each month also can cause scar tissue, called adhesions, to form. Sometimes adhesions can cause organs to stick together. The bleeding, inflammation, and scarring can cause pain, especially before and during menstruation.

What is the link between infertility and endometriosis?

Almost 40% of women with infertility have endometriosis. Inflammation from endometriosis may damage the sperm or egg or interfere with their movement through the fallopian tubes and uterus. In severe cases of endometriosis, the fallopian tubes may be blocked by adhesions or scar tissue.

What are the symptoms of endometriosis?

The most common symptom is chronic (long-term) pelvic pain, especially just before and during the menstrual period. Pain also may occur during sex. If endometriosis is present on the bowel, pain during bowel movements can occur. If it affects the bladder, pain may be felt during urination. Heavy menstrual bleeding is another symptom of endometriosis. Many women with endometriosis have no symptoms.

How is endometriosis diagnosed?

•       History and physical exam

•       Laparoscopy

•       Biopsy

How is endometriosis treated?

Treatment for endometriosis depends on the extent of the disease, your symptoms, and whether you want to have children. Endometriosis may be treated with medication, surgery, or both. When pain is the primary problem, medication usually is tried first.

What medications are used to treat endometriosis?

•       Pain relievers, such as non-steroidal anti-inflammatory drugs

•       Hormonal medications, including birth control pills, progestin-only medications, and gonadotropin-releasing hormone agonists. Hormonal medications help slow the growth of the endometrial tissue and may keep new adhesions from forming. These drugs do not remove endometriosis tissue that is already present

How can surgery treat endometriosis?

Surgery can be done to relieve pain and improve fertility. During surgery, endometriosis implants can be removed.

Does surgery cure endometriosis?

After surgery, most women have relief from pain. However, about 40-80% of women have pain again within 2 years of surgery. The more severe the disease, the more likely it is to return. Taking birth control pills or other medications after having surgery may help extend the pain-free period.

What if I still have severe pain that does not go away even after I have had treatment?

If pain is severe and does not go away after treatment, a hysterectomy may be a “last resort”option. Endometriosis is less likely to come back if your ovaries also are removed. If you keep your ovaries, endometriosis is less likely to come back if endometriosis implants are removed at the same time you have the hysterectomy. 

What is cervical cancer?

1. Cancer which occurs when the cells of the cervix grow abnormally

2. Usually caused by the human papilloma virus (HPV)

3. Common in women worldwide

What are the symptoms of cervical cancer?

There are usually no symptoms during early stages. At later stages of cervical cancer, there can be pelvic pain and vaginal bleeding.

Who is at risk for cervical cancer?

Women who:

• Use oral contraceptives

• Smoke

• Are sexually active

• Have persistent HPV infection or are at risk of being infected with HPV. This includes those with:

  ○ Early sexual onset

  ○ Multiple sexual partners

  ○ A high-risk sexual partner (e.g. a partner with multiple sexual partners or an HPV infection)

  ○ A history of sexually transmitted infections (e.g. Chlamydia trachomatis, genital herpes)

  ○ A history of vaginal or vulvar cancer

  ○ A suppressed immune system

Are there any tests for early detection of cervical cancer?

Yes, the following are cervical cancer screening tests that detect cervical cancer in its early stages:

• Pap smear

• Human papilloma virus (HPV) test

How is a Pap smear and an HPV test done?

These tests can be done during a pelvic examination in the clinic. They take about 10 to 15 minutes.

During the pelvic examination, your doctor will insert a speculum into your vagina to examine your cervix. This may cause mild discomfort but should not cause any pain.

Your doctor will then perform the Pap smear by using a small brush or spatula to gently scrape some cells from the cervix. These cells are then sent to the laboratory to look for abnormal changes. An HPV test can be done along with a Pap smear or as a separate test.

How often do I need a Pap smear and HPV test done?

Aged 21‒29:

• Pap smear every 3 years

• HPV test not routinely needed. It may be done if the Pap smear results are abnormal

Aged 30‒65:

• Pap smear every 3 years or combined Pap smear and HPV test every 5 years

Aged above 65:

• May no longer need Pap smears done; talk to your doctor to determine your needs

More frequent testing may be required if:

• Your Pap smear or HPV test results are abnormal

• You have human immunodeficiency virus (HIV)

• You have other conditions that suppress your immunity

Talk with your doctor to have a personalized plan made.

Do I still need to do Pap smear and HPV test if I have had a hysterectomy?

This depends on:

• Why your hysterectomy was needed 

• Whether your cervix was removed

• Whether you have a history of moderate or severe dysplasia

Do I still need a Pap smear and HPV test if I have had an HPV vaccine?

Yes. You will still require a regular Pap smear and an HPV test. The Pap smear helps to determine presence of abnormal cervical cells. With or without HPV vaccination, this test should be regularly done for early detection and treatment.

The HPV test is also necessary because the HPV vaccine does not protect against all forms of HPV.

I am a transgender person. Should I be tested?

Everyone who has a cervix should get checked on a regular basis. Testosterone therapy may affect test results. Let your doctor know if you are on testosterone therapy.

What is a normal menstrual cycle？

The normal length of the menstrual cycle is typically between 24 days and 38 days. A normal menstrual period generally lasts up to 8 days.

When is bleeding abnormal？

•       Bleeding or spotting between periods

•       Bleeding or spotting after sex

•       Heavy bleeding during your period

•       Menstrual cycles that are longer than 38 days or shorter than 24 days

•       “Irregular” periods in which cycle length varies by more than 7-9 days

•       Bleeding after menopause

At what ages is abnormal bleeding more common？

Abnormal bleeding can occur at any age. However, at certain times in a woman’s life it is common for periods to be somewhat irregular. Periods may not occur regularly when a girl first starts having them (around age 9-14 years). During perimenopause (beginning in the mid-40s), the number of days between periods may change. It also is normal to skip periods or for bleeding to get lighter or heavier during perimenopause.

What causes abnormal bleeding？

•       Irregular ovulation

•       Fibroids and polyps

•       Adenomyosis

•       Bleeding disorders

•       Miscarriage and ectopic pregnancy

•       Cancer

•       Intrauterine device (IUD)or birth control pills

•       Endometriosis and pelvic inflammatory disease

How is abnormal bleeding evaluated?

Your ob-gyn will ask about your health history and your menstrual cycle. It may be helpful to keep track of your menstrual cycle before your visit. Note the dates, length and type (light, medium, heavy or spotting) of bleeding on a calendar. 

You will have a physical exam. You also may have blood tests. These tests check your blood count and hormone levels and rule out some diseases of the blood. You also may have a pregnancy test and tests for sexually transmitted infections (STIs).

What other tests may be needed to evaluate abnormal bleeding？

Dear Sir/Madam:

Greetings！

Thank you for choosing the Jiahui Health Surgery Center for your incision and abscess drainage with or without debridement. We sincerely wish to provide you with a top quality healthcare experience. To fully prepare for your surgical procedure, please read through the following instructions:

Before surgery 

1. Please let your doctor know if you are taking aspirin, clopidogrel (Plavix), warfarin, or any other blood-thinning medications. If necessary, your doctor might request that you stop taking these medications for about a week before the surgical procedure. 

Please follow your surgeon's advice as directed unless instructed by your cardiologist or any other specialist doctors to continue taking these medications. 

DO REMEMBER TO LET YOUR SURGEON KNOW IF YOU ARE CONTINUING WITH THESE MEDICATIONS.

Dear Sir/Madam:

Greeting!

Thank you for choosing the Jiahui Ambulatory Surgery Center for your anorectal surgical procedure. We sincerely wish to provide you with a top quality healthcare experience. To fully prepare for your surgical procedure, please read through the following instructions:

Before surgery

1. Medications 

Please let your doctor know if you are taking aspirin, warfarin, clopidogrel (Plavix), any other blood-thinning medications, or any over-the-counter medications or supplements. If necessary, your doctor might request that you stop taking these medications for about a week before the surgical procedure. 

Please follow your surgeon's advice as directed unless instructed by your cardiologist or any other specialist doctors to continue taking these medications. 

DO REMEMBER TO LET YOUR SURGEON KNOW IF YOU ARE CONTINUING WITH THESE MEDICATIONS.

2. An anesthesiologist will visit you before your surgical procedure if you require general anesthesia. Please provide necessary information for his/her professional evaluation. 

3. Diet recommendations 

4. Fasting requirements

Please stop eating and drinking:

5. Bowel preparation

i.  Dilute 2 packets of prescribed powder in 2 liters of warm water and mix well

ii. Finish the above prepared mixture within 2 hours:

a) Within the 1^st hour, finish 1 Liter of the prepared mixture

b) Within the 2^nd hour, drink 250 ml of prepared mixture every 15 minutes

After surgery

1. Recovering in the surgery center

a) If you have undergone the surgical procedure with spinal or epidural regional anesthesia, your anesthesiologist will instruct you to rest in a certain position for a specific number of hours. After that, you can gradually resume normal activities

b) Usually, pain relief medications are not needed, however please let you doctor or nurse know if you are experiencing pain or swelling so we can ensure you feel more comfortable before leaving the surgery center

c) You can resume your low-residue diet once you do not feel nauseous or dizzy

d) You will not have any real stool formation within 24 hours of the procedure. Therefore, avoid the urge to defecate during this time

2. Home care instructions

a) Bowel movements

• Please check that the Vaseline gauze is passed during your first bowel movement (usually 48 to 72 hours) after the surgical procedure. It is normal if you see some dark red coloration or red blood clots on the gauze

• It is also normal to find slight bleeding and pain during bowel movements 3 to 5 days after the surgical procedure

• Only take stool softeners or medications to relieve constipation prescribed by your doctor

b) Wound care

• Gently cleanse the anal area with water to keep the anal area clean after each bowel movement. You can use a washlet or bath/shower for this. You may also use non-alcohol baby wipes to keep the area clean

c) Diet

• Please start with a soft low-residue diet after your surgical procedure. After 24 hours, you can gradually resume your healthy diet

• Add more fluids, fruits, and fiber into your diet to keep your stools soft. Hard stools may cause your wound to bleed

d) Exercise and activity

• Avoid heavy lifting or strenuous exercise after the surgical procedure until you feel well

• Your doctor will teach you a set of exercises to strengthen your anal muscles to help with wound healing. Please follow your doctor's instructions

e) Follow-up care

• Stitches do not usually require removal after the surgical procedure. Your doctor will arrange a follow-up with you if needed

f) When to call your doctor

Please contact your doctor immediately if you have any of the following:

• Continuous bleeding

• Bloody stools increasing in amount and frequency

• Worsening or severe pain

• Fever higher than 38.0°C, with increased pain in the anal regio

• Increased pain or redness, swelling, or foul-smelling drainage from wound

• Unable to urinate more than 8 hours

Sprains are injuries to the ligaments in a joint. Ligaments are strong bands of tissue that connect the ends of the bones together, providing stable support to the joint. 

If you have sprained your ankle, it means the ligaments around your ankle joint are injured. During this time, your ankle joint will be painful and unstable. It is important that you take good care of your ankle to prevent long-term problems and maintain a good range of motion. 

What medicines will my doctor give me?

Your doctor may give you medications to relieve pain and discomfort. Some of these medications may also help to reduce swelling around your injured ankle joint.

What things can I do at home to feel better?

Eczema is a very common skin condition in children and adults. Your doctor may refer to your eczema as atopic dermatitis. It causes dry, itchy, scaly and red skin. For some, this problem is ongoing with frequent flare-ups that can be extremely uncomfortable and affect your daily life.

What causes eczema?

The outermost layer of the skin in people with eczema is usually drier and more sensitive. They react easily to certain allergens and irritants in the environment. This dryness and sensitivity usually runs in the family.

How will my doctor treat my eczema? 

Your doctor may give you the following treatment to relieve the symptoms of your eczema:

a)       Moisturizing creams or ointments

These keep your skin moist and prevent your skin from becoming dry. Dry skin causes itchiness that encourages scratching. Intense scratching will make it worse at times results in a skin break, increasing your chance of skin infection. 

b)      Steroid creams and ointments

These are applied to your skin to control skin sensitivity, relieve itching and redness. In severe cases, your doctor might prescribe steroid pills for you to take for a short period of time.

c)      Antihistamine pills

Antihistamines are medications that people often take for allergies. They help relieve itching, especially at night, and can also help sleep.

There are other treatments that include wet dressings, injectable medications, and medications that change the way the immune system works. Your doctor may recommend these treatments if you do not get better. Your doctor may also refer you to a skin specialist if your skin problem is severe.

What things can I do at home to feel better?

DOs

•      Use moisturizer generously

•      Apply at least twice daily, especially immediately after bathing while the skin is moist

•      Keep the air in your home moist by using a cool-mist humidifier or vaporizer

•      Take medications to reduce skin itching and irritation

•      Maintain a cool temperature at home. Sudden temperature changes and sweating will worsen the symptoms of eczema

•      Use hypoallergenic fabric for clothing and bed sheets

•      Relax and maintain a calm mood. Some eczema can be worsened by stress and worry

DON'Ts

•      Avoid to use over-heated water during bathing. Hot water irritates and dries the skin

•      Avoid to use harsh soaps and cleansing products

•      Avoid to use perfumes

•      Don’t scratch

Do I need to seek further help from my doctor?

Please contact your doctor if:

a)     Your skin condition does not improve after using at-home care

b)     The skin dryness gets worse

c)     You suspect your skin becomes infected. A skin infection may have the following symptoms:

   •      Pain

   •      Redness

   •      Swelling

   •      Oozing/crusting

d)     The itchiness is disturbing your sleep

What does "fasting" mean?

"Fasting" means not eating or drinking anything for a period of time. People sometimes need to fast before getting a medical test or having a procedure done.

Will I need to fast before my surgery?

You might. It depends on what kind of surgery you are having, and what kind of anesthesia you need. "Anesthesia" is a medical term for different types of medicine they give people before surgery or other procedures. These medicines ensure you do not feel pain during your surgery or procedure.

If you have a scheduled surgery or procedure, your doctor or nurse will tell you if you need to fast before it. If you are only having a “local anesthetic”, you probably won't need to fast. A “local anesthetic” is where medicine is used to numb part of your body. It can be given as a shot, or as a cream, gel, or spray that goes on the skin.

You will need to fast if you are having any of the following:

(1)    General anesthesia – This type of anesthesia makes you unconscious so you can't feel, see, or hear anything during surgery. Some of the medicines are given through a thin tube that goes into a vein, called an "IV." Others are gases that you breathe in.

(2)    Regional anesthesia – This type of anesthesia blocks pain in one area of your body, such as an arm, leg, or the lower half of your body. The doctor will inject medicine around the nerves that go to the area where you are getting surgery.

(3)    Sedation – This is the term for getting medicines to make you relax and feel sleepy.

Why do I need to fast? 

If you have food or liquid in your stomach, some of it could get into your lungs while you are under anesthesia. Normally, your body is able to prevent what's in your stomach from entering your lungs. But anesthesia medicines make it harder for your body to prevent this.

When food or liquids from the stomach get into the lungs, doctors call it "aspiration." This is rare, but can be dangerous if it does happen. That's because it can lead to infection, lung damage, or breathing problems.

How long before my surgery do I have to stop eating and drinking? 

For some people and some procedures, the duration to stop eating and drinking can be different from this general recommendation, such as people with diabetes. It is important you follow your doctor or nurses’ instructions carefully.

The general recommendation

Should I keep taking my medicines before surgery? 

It depends. Your doctor or nurse will tell you which medicines you should take and when. Some medicines need to be stopped before surgery. But for others, it's important that you keep taking them as usual. You might also get new medicines to take before surgery.

Take the medicines your doctor or nurse tells you to. If you need to take medicine right before your surgery, you can take it with a sip of water. If you normally take your medicine with something else, like applesauce, talk to your doctor or nurse about what to do.

What will happen if I don't fast? 

If you don't follow instructions about when to stop eating and drinking, you could be putting your health at risk. Be honest with your doctor or nurse if you did not follow the rules, even if it was an accident. If this happens, your surgery might need to be delayed until a later time.