Dr. Hanna- Fibroids &
Endometriosis in Manhattan NY

Fibroids are classified based on their location in or around the uterus:

• Subserosal fibroids — Grow on the outer wall of the uterus; may cause pressure symptoms but often do not affect fertility directly
• Intramural fibroids — Grow within the muscular wall of the uterus; can distort the uterine cavity and affect implantation
• Submucosal fibroids — Grow just beneath the uterine lining (endometrium); most likely to affect fertility by interfering with implantation and pregnancy
• Pedunculated fibroids — Grow on a stalk attached to the uterus; can twist and cause pain

Submucosal fibroids are most commonly associated with infertility and are often the target of surgical treatment.

Fibroids may cause a range of symptoms, depending on their size, number, and location:

• Heavy or prolonged menstrual bleeding — Including clots and flooding
• Pelvic pain or pressure — Dull ache or sharp pain in the lower abdomen
• Frequent urination — Pressure on the bladder
• Constipation — Pressure on the bowel
• Pain during intercourse — Deep pelvic pain
• Lower back pain — Radiating pain from the pelvis
• Enlarged abdomen — Visible or palpable mass
• Anemia — From heavy menstrual bleeding
• Infertility — Interference with implantation or tubal function
• Recurrent miscarriage — Disruption of the uterine environment

Endometriosis is classified into four stages based on the location, extent, and depth of endometrial implants, as well as the presence and severity of adhesions:

• Stage I — Minimal — Small, isolated implants with no significant adhesions
• Stage II — Mild — More extensive implants, but still no significant adhesions
• Stage III — Moderate — Multiple implants with some adhesions
• Stage IV — Severe — Extensive implants with dense adhesions affecting pelvic organs

Even mild endometriosis can affect fertility, highlighting the importance of early diagnosis and treatment.

Endometriosis symptoms can vary widely. Some women experience severe symptoms, while others may have none:

• Pelvic pain — Often associated with menstrual periods
• Painful periods (dysmenorrhea) — Severe cramping before and during menstruation
• Pain during intercourse — Deep pelvic pain
• Pain with bowel movements or urination — Especially during menstruation
• Heavy menstrual bleeding — Sometimes with clotting
• Infertility — One of the most common symptoms of endometriosis
• Fatigue — Chronic tiredness
• Gastrointestinal symptoms — Bloating, diarrhea, constipation, nausea
• Painful ovarian cysts — Endometriomas (chocolate cysts)

Dr. Hanna offers comprehensive diagnostic services to accurately identify fibroids and endometriosis:

• Pelvic examination — May reveal enlarged uterus or tender areas
• Ultrasound — Transvaginal or abdominal ultrasound to visualize fibroids and ovarian cysts
• Saline infusion sonogram (SIS) — Ultrasound with saline to visualize the uterine cavity
• Hysteroscopy — Direct visualization of the uterine cavity using a thin, lighted scope
• Laparoscopy — Minimally invasive surgical procedure to visualize pelvic organs and diagnose endometriosis
• MRI — Detailed imaging for complex cases

Laparoscopy is the gold standard for diagnosing endometriosis and can also be used for treatment.

Dr. Hanna offers a range of treatment options for fibroids, from medical management to minimally invasive surgery:

Medical Management:

• Hormonal medications — Birth control pills, progestins, or GnRH agonists to reduce symptoms
• Pain management — NSAIDs for pain relief
• Iron supplementation — For anemia from heavy bleeding

Surgical Options:

• Myomectomy — Surgical removal of fibroids while preserving the uterus. Can be performed hysteroscopically (for submucosal fibroids), laparoscopically, or through open surgery
• Hysteroscopic myomectomy — Minimally invasive removal of submucosal fibroids through the cervix
• Laparoscopic myomectomy — Removal of fibroids through small incisions in the abdomen
• Uterine artery embolization (UAE) — Nonsurgical procedure to shrink fibroids by blocking blood supply
• Hysterectomy — Removal of the uterus (considered when childbearing is complete)

Dr. Hanna recommends the most appropriate treatment based on your fertility goals, symptoms, and fibroid characteristics.

Dr. Hanna offers comprehensive treatment options for endometriosis, tailored to your fertility goals and symptoms:

Medical Management:

• Pain medications — NSAIDs for symptom relief
• Hormonal medications — Birth control pills, progestins, or GnRH agonists to reduce endometrial tissue growth
• Danazol — A synthetic steroid that suppresses endometrial tissue
• Aromatase inhibitors — Reduce estrogen production

Surgical Options:

• Laparoscopic excision — Removal of endometrial implants and scar tissue. This is the gold standard for treating endometriosis while preserving fertility
• Laparoscopic ablation — Burning of endometrial implants
• Laparoscopic ovarian cystectomy — Removal of endometriomas (chocolate cysts) from the ovaries
• Lysis of adhesions — Cutting of scar tissue to restore normal pelvic anatomy

Laparoscopic excision is preferred for fertility preservation as it removes diseased tissue while preserving healthy tissue.

Dr. Hanna helps patients achieve pregnancy after treatment for fibroids or endometriosis:

• Restoring uterine cavity — Myomectomy or hysteroscopic surgery creates an optimal environment for implantation
• Improving pelvic anatomy — Laparoscopic surgery removes adhesions and restores normal pelvic structure
• Optimizing ovarian function — Removal of endometriomas can improve ovarian function
• Timing of conception — Guidance on when to try to conceive after treatment
• Assisted reproductive technologies — IVF or IUI may be recommended based on your individual case

Dr. Hanna works closely with you to develop a comprehensive fertility plan after your treatment.