Garofalo Obgyn

As many as 25% of women in the United States experience heavy bleeding during their periods, often when there is no underlying medical condition. If you’re experiencing heavy bleeding during your period, I usually suggest a pelvic exam to check for cancer, fibroids or other causes.

If your bleeding is not a sign of a more serious condition, there may be a new treatment option for you to consider. It’s called tranexamic acid, and it was approved by the FDA for treatment of heavy menstrual bleeding late last year. (Tranexamic acid has been approved for treatment of other conditions since the mid-1980s.)

In tablet form, tranexamic acid is being marketed as Lysteda™. In Lysteda, tranexamic acid works by making the blood in your uterus more likely to form clots. These clots decrease the flow of blood from the lining of your womb.

Does it work?

According to studies discussed at the American Congress of Obstetricians and Gynecologists in May, more than 70% of the women who took the highest dose responded to the medication. Specifically, women with heavy menstrual bleeding who took tranexamic acid for three menstrual cycles experienced significant improvement in their quality of life.

Based on these studies, tranexamic acid is slightly more effective at reducing menstrual bleeding than nonsteroidal anti-inflammatory drugs (NSAIDs) such as Ibuprofen. On the other hand, while NSAIDs offer pain relief, tranexamic acid will not relieve any pain.

Since tranexamic acid is a non-hormonal medication, it tends to cause fewer side effects. Hormonal side effects can include depression, acne, nausea, headaches, bloating, and a decreased interest in sex. In addition, while hormonal medication must be taken almost every day, Lysteda is usually taken three or four times a day during your period.

What are the potential side effects?

Although side effects with tranexamic acid are rare, nausea and muscle cramps sometimes occur. Other possible side effects include headache, sinus and nasal discomfort, back pain, abdominal pain, joint pain, spasms, anemia and fatigue. More severe side effects have included shortness of breath, tightening of the throat and facial flushing. If you experience these side effects, you should contact your doctor.

Women who take Lysteda along with birth control pills, hormonal therapy or certain medications that affect clotting or bleeding may be at higher risk of thrombosis, which is a potentially dangerous condition that occurs when a blood clot forms inside a blood vessel. If you’re interested in taking tranexamic acid, you should let your doctor know about any other medications you’re taking.

More information

If you’d like additional information, you can click on any of the links below, or you can contact my office directly.

Additional resources

Lysteda’s home page

Abnormal uterine bleeding

Dr. John Garofalo, M.D., is gynecologist located in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

If you’re one of the millions of Americans who take dietary or nutritional supplements, or if you’re thinking about taking them, tell your doctor! The U.S. Food and Drug Administration has discovered more than 140 contaminated dietary supplements, and these are believed to represent just a fraction of the contaminated supplements available today.

PMS and menopause 

Hormonal changes caused by PMS and menopause can cause a wide variety of symptoms, including cramps, irritability, mood swings, weight gain and bloating. Some of these symptoms may be managed by taking vitamins, minerals or supplements. But you should be aware that information on these products can be sketchy and incomplete. In addition, quality can be poor, inconsistent, and even dangerous. For example, while tryptophan has been shown to alleviate some PMS symptoms, there have been instances of tryptophan contamination in the past, and the safety of tryptophan’s manufacturing process is still in question.

How could this happen?

Unfortunately, government oversight of supplements is extremely lenient, due to permissive regulations and the FDA’s limited resources. While pharmaceutical drugs must demonstrate safety and effectiveness before they go on sale, there is no such process for supplements. In fact, because supplements are considered neither a food nor a drug, there is no government approval process at all for dietary supplements. The FDA can act only after consumers get sick or a safety issue is reported.

Mystery Ingredients

Certain supplements have been found to contain not enough or too much of various ingredients. Some contain undeclared and potentially dangerous ingredients such as bacteria, toxic plant material and heavy metals. Even more alarming has been the presence of prescription medications, controlled substances and untested experimental compounds. These substances have included everything from diuretics, which can cause dehydration and potassium deficiency, to amphetamines, which can lead to depression and addiction.

Untested chemical modifications

Some companies that make these kinds of products have also been known to modify ingredients’ chemical structures in order to evade detection or reduce the risk of patent infringement lawsuits. This kind of chemical tinkering has allowed some companies to disguise drugs such as fenfluramine, which was used in Fen-Phen and was withdrawn from the U.S. market in 1997 after reports of heart disease.

How can you identify contaminated supplements?

Unless you have a clinical lab at your disposal, it’s very difficult to identify contaminated supplements. Although many are manufactured in China, they aren’t just made overseas or found only on the Internet. Earlier this year, a California-based company pleaded guilty to selling anabolic steroids labeled as weight loss supplements. Many supplements that were found to be contaminated were purchased in mainstream retail stores in the United States.

Why should I tell my doctor?

There are several reasons why you should let your doctor know if you’re taking or considering dietary or nutritional supplements, even if they’re labeled as “Natural” or are made by a reputable company. If your physician knows what you’re taking, he or she will be more likely to correctly diagnose any related side effects and let you know any potential adverse interactions with pre-existing conditions or other drugs you might be taking. More importantly, your physician may be more likely to identify a suspicious or dangerous product. 

More information

If you need additional information, you can click on any of the links below or you can contact my office directly.

U.S. Food and Drug Administration Q&A

The New England Journal of Medicine article

Informed Choice supplement contamination study results

Dr. John Garofalo, M.D., is a certified OB/GYN in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

In the last few months I’ve blogged about several different surgery types that can be performed using the da Vinci Surgical System. (If you’re new to this blog, the da Vinci Surgical System uses five very small abdominal incisions and state-of-the-art remote control technology to convert my hand movements from a console a few feet away into precise movement of da Vinci surgical instruments.) Another condition that can be treated using the da Vinci Surgical System is endometriosis.

What is endometriosis?

Endometriosis occurs when a certain kind of bodily tissue – the lining of the uterus, which is also called endometrial tissue – grows where it shouldn’t. Often it can grow near the ovaries, but it can also appear on most pelvic organs. The problem is that this tissue – wherever it appears – swells with blood during your period. Your uterus expels this blood, but blood in other areas of the pelvis has nowhere to go. 

This swelling can irritate nearby tissues, which can affect your reproductive organs and your monthly menstrual cycle. It can cause cramps and pain during your periods or pelvic pain throughout the month, as well as pain during or after sex. If undetected or untreated, this irritation eventually can cause scarring, which can bind organs together and interfere with efforts to get pregnant.

About 10% of all women will suffer from endometriosis in their lifetimes – usually during their reproductive years. While any woman may develop endometriosis, the following women seem to be at an increased risk:

• women who have a mother, sister or daughter with endometriosis
• women who are giving birth for the first time after age 30
• Caucasian women
• women with an abnormal uterus (including fibroids, adhesions and abnormal uterus shape)

Although there is no known cure, endometriosis can be managed with early diagnosis and treatment.

What are the treatment options for endometriosis?

If simple pain management is not enough, if there are health risks, or if fertility is a concern, endometriosis can be treated with hormone therapy, surgery, or a combination.

Just as birth control pills do, hormone therapy regulates or suppresses the hormones that control your menstrual cycle, which limits the swelling of all your endometrial tissue. Surgery can be used to remove cut away endometrial and scar tissue and, in severe cases, to remove the reproductive organs where the stray endometrial tissue is growing. About one in five hysterectomies (surgical removal of the uterus, and sometimes the ovaries, fallopian tubes and the cervix) are performed because of endometriosis.

Here’s where da Vinci surgery comes in. As with the other da Vinci surgical procedures I’ve written about here, da Vinci surgery provides similar access to an “open” incision but there’s typically less bleeding, less pain, minimal scarring, quicker recovery, a shorter hospital stay, and a lower likelihood of complications. Whether the surgery is just to remove endometrial and scar tissue or to conduct a hysterectomy, most women can expect less pain, less scarring and a much shorter recovery period than if they had undergone open surgery. Compared to non-remote-controlled laparoscopic surgery, da Vinci endometriosis surgery provides far greater access, precision and control.

It’s important to remember that surgery – even a hysterectomy – may not permanently remove endometriosis. After surgery, about 15-20% of patients have endometriosis symptoms again within five years. However, surgery can be combined with hormone treatment to manage endometriosis.

Here’s a quote from a woman who was treated for endometriosis using da Vinci surgery.

“I spent 24 hours in the hospital. I was home by noon the next day. I walked into my house on my own, took a shower, made myself a ham and cheese sandwich and checked my e-mails. The only pain medication I took was a couple of Ibuprofen.” – Penne, California

This quote and others can be found on www.davincistories.com.

More information

If you need additional information, you can follow any of the links below, or you can contact my office directly.

Links to da Vinci surgery resources

da Vinci surgery

da Vinci endometriosis surgery

da Vinci surgery patient stories

Dr. Garofalo’s da Vinci information page

Dr. Garofalo’s da Vinci endometriosis information page

Dr. John Garofalo, M.D., is a certified da Vinci surgeon in Fairfield County, Connecticut. For more information on Dr. Garofalo and his medical practice, go to www.garofaloobyn.com. Dr. Garofalo can be reached for a personal consultation at 203.803.1098.

(PART 2)

In my last blog I wrote about Essure, a relatively new procedure that offers a highly effective option for permanent birth control. One of the best ways to evaluate whether or not a medical procedure is right for you is to look at it in terms of its risks and benefits. Here are some more questions and answers that I hope will help you with your decision.

Is the Essure procedure effective?

While no form of birth control is 100% effective, fewer than one in 100,000 pregnancies occur when tubal blockage has been confirmed by the three-month test. The Essure procedure is the only birth control method with zero pregnancies in clinical trials.

Is the Essure procedure safe?

Studies have shown that the Essure procedure is safe. However, as with most birth control methods, there are risks. In some cases one or both Essure coils may not place properly in the Fallopian tubes and may have to be re-applied.

Is the Essure procedure painful?

In most cases the pain of an Essure procedure is far less and shorter-lasting than the pain often associated with Read more…

(PART 1)

Lately I’ve been getting a lot of questions from my patients about the Essure birth control procedure. Maybe it’s because of the recent publicity from Olympic gold medalist Picabo Street, who announced earlier this year that she’d undergone the procedure. In any case, I thought I’d answer some of the most common questions I’ve heard. I’ve also included some useful links at the bottom of this blog. Read more…

Along with uterine fibroids, which I discussed in my last blog, one of the conditions I treat pretty regularly is pelvic organ prolapse. This is a relatively common condition, affecting more than a third of all women at some point in their lives. It can occur in women of all ages, but it’s more common as women get older. It’s also more common among women who have had a difficult labor or recent abdominal surgery such as a hysterectomy. Smoking, obesity, respiratory disorders and repetitive strain injuries can all make pelvic organ prolapse more likely.

Prolapse literally means “to fall out of place”. When pelvic organ prolapse occurs, organs such as the uterus or bladder fall down or slip out of place, often pushing into or through the vagina. Pelvic organ prolapse can be uncomfortable and it can interfere with urination, bowel movements and sexual activity.

Going back just a decade or so, the most common treatment options for serious pelvic organ prolapse cases were relatively limited. Reconstructive surgery was one option, and hysterectomy was another. Today, an increasingly common option is called sacrocolpopexy. Read more…

da Vinci myomectomy

In my last blog I wrote about hysterectomy (surgical removal of the uterus) and how this surgery is well-suited for surgery using the da Vinci approach. One of the main reasons a woman might consider a hysterectomy is the presence of uterine fibroids, which are non-cancerous tumors that grow out from the muscle layer and connective tissue in the uterus. Uterine fibroids (also called leiomyomas or myomas) are very common, especially during a woman’s middle and later reproductive years: about 20-40% of women will be diagnosed with uterine fibroids at some point in their lives.

In most cases uterine fibroids are harmless. But sometimes they can cause heavy and painful menstruation, painful sexual intercourse, and urinary frequency and urgency. Uterine fibroids that are located inside the uterine cavity can make it difficult or impossible to conceive a child, and they can cause complications in pregnancy, including bleeding, miscarriage, premature labor, or interference with the position of the fetus.

If you or someone you know has problems with uterine fibroids, there are several options for treatment. Read more…

In my last blog, I mentioned that da Vinci surgery provides precision that’s crucial when working in close proximity to delicate organs like the bladder. In addition, the camera technology provides a great deal of detail. If you’re facing the prospect of surgery and you think of the kind of surgery you’d prefer to have, hopefully words like detail and precision are ones that come to mind.

This combination of detail and precision makes da Vinci very well suited for a variety of surgery types and procedures, including several that I do regularly as part of my medical practice. For this blog I thought I’d talk about da Vinci surgery and hysterectomy. Read more…

As I mentioned in my last blog, the da Vinci Surgical System uses a computerized interface between the surgeon and the instruments to conduct surgical procedures. The name “da Vinci” was chosen for the system because legendary artist and inventor Leonardo da Vinci is credited with designing the first robot. It’s also a fitting name because Leonardo da Vinci used anatomical accuracy and three-dimensional details to lend realism to his art.

For many people, the use of robots or robotic tools in surgery raises some concerns. One commonly accepted definition of a robot is “an automatically guided machine, able to do tasks on its own.” This definition is a bit vague, but experts generally agree that robots tend to do some or all of the following: move around, operate a mechanical limb, sense and manipulate their environment, and exhibit intelligent behavior, especially behavior which mimics humans or other animals.

Given only those definitions to describe da Vinci technology, I’d be concerned too. To be honest, I’ve avoided using the word “robot” or “robotic” to describe the da Vinci Surgical System in my website. It’s not really an accurate term, since the da Vinci system is directed and controlled by a human being Read more…

As one of the first doctors in Fairfield County, Connecticut to be certified in da Vinci surgery, I’m asked a lot of questions about the technology and how it can be used to treat endometriosis, uterine fibroids, pelvic organ prolapse and other conditions. Since I’ve seen so much interest and heard so many questions about da Vinci surgery, I thought it would be helpful to use this blog to provide information to women who may be considering or facing surgery.

In the next few weeks, I’ll be posting a series of blogs about da Vinci surgery and how I use it in my own medical practice. If you have any experiences you’d like to share, please feel free to comment. Read more…