- 6 weeks ago
This month’s Stay Well Health Chat brings together Dr. Minda Green and her patient Shannon Rookwood for a candid conversation about uterine fibroids. Dr. Green is an OBGYN and the lead physician for the minimally invasive gynecologic surgery program at Virtua Health.
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00:00Hi, I'm Nicole from 92.5 XTU. Hey, I'm Marissa Magnana from The Preston and Steve Show on 93.3 WMMR.
00:08And today we're chatting about a condition that is all too common for women, uterine fibroids.
00:13It's not often that we get to chat with both a physician and a patient. So this is a real treat
00:18and privilege. Thank you so much, ladies, for being here today. We really appreciate that.
00:23Dr. Minda, right? Minda. Minda. What a cool name. Okay. Dr. Minda Green, an OBGYN and lead physician
00:36for the minimally evasive gynecological surgery program at Virtua Health. Trained at Drexel
00:42University College of Medicine at Hahnemann Hospital. I graduated from Drexel. Go Dragons.
00:47Underwent fellowship for specialization in minimally evasive gynecological surgery
00:51and has a passion for training and educating residents as future generations of physicians.
00:58Oh, thank you. Thank you for joining us today. It's always wonderful to meet all of these Virtua
01:03doctors and these folks that are just making our world a better place. Yes. And her patient,
01:09Shannon Rookwood. Is that right? Shannon Rookwood, born and raised in New York, currently
01:14lives in Burlington, New Jersey with her husband and two pups, adorable, works in human resources,
01:20and she has experienced uterine fibroids firsthand and has been treated at Virtua by Dr. Green. Thank
01:28you so much for being here and sharing your story. This is going to help so many women and men who need
01:33to know about what's going on with women's bodies. So we appreciate this and thank you again.
01:39Thanks for having me.
01:39Let's dive right in. Doctor, uterine fibroids happen in about 40% to 70% of women. That's a lot.
01:46Can you explain them? Because I am one of the people who are not quite sure exactly what they are.
01:52Yeah. So exactly what you said. Extremely common. Even upwards of 60% to 80% of women have them.
01:59The most interesting thing is actually most women don't need to have extensive surgery.
02:04But what fibroids are, they're solid tumors. So they're masses in the uterus itself, so in the womb,
02:10that have the potential to grow over time. The large majority of time, they're not cancerous,
02:16or doctors will use the word benign. But they have the potential to be, but it's very rare.
02:22So the large majority of women that have them are not going to be concerned about having a cancer.
02:27They're solid tumors, extremely common. And when they start to create symptoms,
02:32that's when we're seeing women like Shannon in our office and going through sort of management
02:38and treatment options when they create bothersome symptoms.
02:42So interesting. So Shannon, you've been through some health challenges with uterine fibroids.
02:49Can you tell us a little bit about your personal experiences and what led you to seek treatment?
02:54Yeah. So as a young adult, I developed ovarian cysts and that kind of started me on my journey of paying
03:03really close attention to my body, how I was feeling, you know, what is that? What's happening?
03:10Like it really caused me to be really in tune with my body. Then I started to develop fibroids and
03:17they were small, not causing any significant issues. Um, but then over time I started to have
03:24more heavy bleeding, more painful periods, bloating, fatigue, um, discomfort when laying on my stomach.
03:32Like that was like the big light bulb for me. Um, so the fibroids were growing as Dr.
03:38Green just shared. And that's when I had the first, my first of two myomectomies.
03:43So you had two surgeries, but they kept coming back.
03:49They did.
03:50Wow. Okay. Really quick before we jump in to the treatment, maybe we could talk really fast about
03:56there's a big difference between ovarian cysts and uterine fibroids. I don't think many people
04:01realize that Dr. Green, can you just explain that really quick?
04:05Sure. So remember we talked about the fibroids are masses within the uterus itself. So the uterus is
04:11made of muscle. That's what contracts and squeezes when you have cramps and also when women have
04:16childbirth. So fibroids are accelerated growth of that muscle tissue. So that's why they're firm
04:22and they're solid. They kind of can have the consistency and the appearance of a potato.
04:26So they're hard and soft. You know, the ovaries are attached to the uterus, but they're their own
04:31separate organ. So your ovaries are what makes chemicals, your hormones. And those chemicals
04:37have actions in your body. And one of them is to release an egg or what we call ovulation.
04:43And so when you have, you know, there are conditions where you can develop a cyst. A cyst generally has
04:49fluid in it, right? A fibroid is solid, does not generally have fluid in it. This can also grow
04:55and create pain. So they're both located in the pelvis. The ovary is attached to the uterus, but
05:01they're completely separate organs, right? So cysts often come and go because they have fluid,
05:06right? Just right on your ovary to release that egg or that process of ovulation throughout the
05:13months to get you pregnant, right? And then you don't get pregnant. And then that tissue from the
05:17lining of the uterus sheds. And that's what your menstrual cycle is. And so those are two different
05:23phenomenon, but they can create very similar symptoms in the sense that, right? An ovarian
05:27cyst can get big and grow as well. And that also can be a situation where some women may need surgery,
05:34but the large majority of cysts will resolve on their own. And they don't need surgery because
05:38they do have that fluid, right? They can rupture, they can dissolve. Fibroids are not going to disappear
05:44and go away on their own because they're solid masses. So the part that's very variable is we don't
05:50know why some people's grow or why this one might be the size of a pea and that one might be the size
05:55of an orange or a melon or why, you know, Shannon's were the ones that grow and she might have a sister
06:02or mom and they didn't. That's the part that's so variable between women, but the large majority of
06:07them won't, you know, get to the point where they need to have three surgeries because it is extremely
06:12common, right? 60 to 80% of us will have fibroids at some point in our life.
06:17So interesting. And another thing, we do these every month and I'm like, what women have to go
06:23through? I'm about to blow your mind because first off, Shannon, I need to thank you for being so vocal
06:30and for talking about this with us. I had an ovarian cyst when I was 17 years old and removed one of my
06:37ovaries. And I'm sitting here, I'm like, this is all information that I should know. So are fibroids
06:42and ovarian cysts connected in any way? Not in the sense of cause, completely two separate
06:49phenomenon, just like doctors consider the two structures are completely different organs,
06:55right? So it's not like a cyst on your ovary makes your fibroids grow. So there's no connection
07:01that way, but they can provide similar symptoms. And if a doctor does an exam for an example and might
07:07feel something, it might be hard to decipher, you know, is it an enlarged uterus from fibroids or is
07:14it an enlarged ovary? Sometimes we can tell and sometimes not, but that's where the evaluation process
07:19is so important. And that's where imaging helps us, right? So you get your pelvic imaging and remember
07:25because you have one thing doesn't mean you can't have both. I mean, I've done surveys, right? And women
07:29who have fibroids and a cyst and endometriosis. So just because these are two separate distinct
07:36things doesn't mean they can't coexist because they certainly can by the nature of how common
07:42both of these things are. Well, so you mentioned surgery, but are there non-surgical options for
07:47treating the fibroids? Absolutely. So remember, we talked about fibroids are benign the large majority
07:54of the time, meaning not cancerous. And so, you know, it really is a quality of life issue for whether women
08:00need to do something about it. So there's this kind of notion of if they don't bother us, we don't bother
08:06them type of deal. The two sort of big categories of symptoms is the bleeding side. So heavy bleeding or
08:14irregular bleeding. And those, you know, symptoms are going to be sort of at a continuum, right? Some women have
08:21a predictable monthly cycle and it just so happens to be heavy. Then I have women who can bleed an
08:27entire month, right? We know that that's not normal where we bleed twice in a month and that's not
08:32normal. So there's all sort of different degrees of what women can experience and anything that creates
08:38a problem in our daily life. Like if we have to think about our period in the month, whether it's
08:45what change of clothes I'm going to bring, I can't wear white. I have to put towels down on my bed.
08:51I'm doubling up on pads or tampons or wearing diapers. Like when women do these things to
08:57adapt, that's a problem, right? So we have to change our, what I'm going to wear to work,
09:04you know, what trip I'm going to take, et cetera. That's where it becomes a problem where it affects,
09:09you know, us being able to live our life freely.
09:12You said it. Things women go through.
09:15It literally, it is never lost on me. Like when you think about the fact that like we just walk
09:21around existing with blood pouring out of our bodies once a month, it's crazy or twice
09:27or whatever it may be. Yeah. How long it takes for them to get to us, right? You know, many women
09:35can see a couple of doctors or, you know, even themselves and say, Oh, I've always had heavy
09:41period or that's just me. I'm going to have a heavy period. So they just sort of make an assumption
09:45that this is okay until it isn't right until they get to the point where, you know, the fibroids
09:51have grown or maybe they didn't have an exam or maybe they just were in denial and ignored symptoms
09:57and thought, Oh, well maybe I'm just, my clothes are fitting tighter because I'm not, you know,
10:02as active as I want to be. So there's many sort of reasons that women put themselves on the back
10:08burner, maybe ignore things or maybe are just in denial or don't think that it's a problem
10:14until either, you know, that's why it's so important to, you know, connect with your providers
10:20and get in an office. Cause there are times when I said, did anybody ever tell you had fibroids,
10:24you know, just based on an exam, even if no one really ever knew it's, Oh, I just thought I was
10:29gaining weight or my clothes are fitting tighter. And it's like, no, there's a ball there. That's not
10:34normal. And then we go down the road of, you know, starting an evaluation, but no,
10:39not all fibroids require us to do something about them. It's really the ones that create symptoms
10:46or problems. And certainly there are many options that are out there depending on
10:50the size and location of them. Cause that's, that's important.
10:55So Shannon, symptoms are obviously fairly common as we talked about. And as women, you know,
11:00sometimes like we, we push through, we're like, Oh, it's just normal. We just have to suck it up.
11:07Right. So when did you know it was time to seek treatment?
11:12So I had two myomectomies, which is having the fibroids removed. And I noticed that after a while,
11:20those symptoms were coming back, you know, the heavy periods. Um, but this, this last time it was
11:27impacting more of how I was feeling overall. And I don't know, perhaps because I was younger
11:33the first two times I had the energy, but this last time I just could not, I couldn't just keep
11:40pushing through. I couldn't manage the impact that it was having on my day-to-day life and the need to
11:48always have, you know, uh, a gold bag, right. Just in case, um, was stressful. You know, when Dr.
11:57Green talked about having to really navigate or I'm sorry, negotiate, what do I wear today? Or can
12:04I go to that event? Or can I go swimming or, you know, Oh shoot, I'm going on vacation and my period
12:11is here again. And it's not as simple as, you know, use a tampon and no big deal. Like it really
12:19was so unbearable that the notion of, all right, have a third myomectomy and know that there's a
12:28high likelihood they're going to grow back again. Um, that's when I really needed to talk to,
12:33you know, a specialist, a surgeon like Dr. Green, you know, to determine if a more permanent solution
12:40was something that would be best for me. Um, and my life, you know, kind of my stage where I was with
12:46respect to, you know, my family, like, was it, was there something else I needed to do for me
12:52because I just was so uncomfortable. Yeah. Can you walk us through that conversation? Cause it's
12:57not just getting a knee replaced where, you know, putting in a new one, you'll be great on the other
13:01side. Um, there are a lot of changes within your body happening. And if you don't mind sharing some
13:07of that with us. Yeah. So one of the things that I really appreciated about Dr. Green is the way she
13:14asked questions, like she didn't lead me to the decision. Um, she really explored what I was
13:22feeling, what my desires were, um, kind of what I wanted to, what I wanted my life to be like. And
13:28it sounds, you know, kind of, um, pitchy if you will, to say, but it really was about the type of
13:35life I wanted to live and having that conversation helped me arrive at, I need to make a decision that,
13:43you know, is going to be really permanent. Right. And so, um, removing the uterus, you know,
13:50is a very kind of final decision. Um, and, you know, in conversation with my husband, we were at
13:56a place where we were not, you know, going to explore, um, having children, you know, at that
14:02point. And so it was something that I was willing to do. Um, Dr. Green and I also talked about the
14:09potential of, you know, what do you do with the ovaries? You know, do you leave an ovary so that
14:14you're not immediately in menopause? And so it was helpful to know that I could, um, have the
14:21uterus removed and it doesn't mean I'm immediately going to be menopausal. Um, so that was also helpful.
14:27So definitely having the, um, kind of exploratory conversation, like really challenging myself and
14:35thinking about what is it that I really want. And what I really want to do is be able to go on
14:39vacation and not have to worry. Like I want to be able to just live a, you know, a free life, um,
14:45and enjoy, you know, I work hard. My husband and I work really hard and, you know, we want to be able
14:50to, um, enjoy the fruits of our labor. And I just was not able to do that. And so, um, I just,
14:58I just needed something. Yeah. Dr. Green, you know, Shannon mentioned that like you kind of led
15:05her to the decision. And so what is your approach with helping patients decide if surgery is right
15:12for them? Well, first is you got to hear the story, right? So it's what, what are the symptoms
15:18and what is, um, you know, for many women, when it comes to fibroids in particular, in terms of the
15:23management options, it's, you know, are we going to pursue pregnancy? Um, are we not,
15:29are we pursuing pregnancy in the near future, like in the next six months or a year, or is this
15:34just want the option? So, you know, that's a big, uh, sort of branch in the road for what we're able
15:41to offer people. So if we're going to keep things simple and we weren't going to talk about a surgery,
15:45you know, there are medical things that we can do to control symptoms, right? So the medical things
15:49aren't going to remove the structure of the fibroids, but maybe they help control the bleeding,
15:54right? Um, the second big category is what we call, um, mass effect or bulk symptoms. And that's
16:00from the size of them, right? So I'm pushing on things, the bloating, the pressure, um, the effects
16:06on using the bathroom, you know, you know, getting up at night to pee or, uh, you know, having
16:11constipation or back pain, all of these things, um, those are physical symptoms. So the bleeding can often
16:16be temporized is the word I like to use. So improved, decreased with some type of hormonal
16:22medicine because your menstrual cycle is a hormonal process. So for many women that can be enough,
16:27right? Anything from some type of contraceptive, whether it's a pill, a patch, an IUD that can do
16:33what we call cycle control, but that generally doesn't have any impact on bulk symptoms, right?
16:39So then if we have pressure, then we're talking about doing things that can shrink or remove them,
16:44right? And then deciding, do we do something definitive, which is the word I use for Shannon
16:50is the permanent is when women obviously, um, are not going to, you know, have already made a
16:55decision to not, you know, have children. So maybe they've had children or they've had their tubes
16:59tied or they make a decision that their quality of life is such, or they might've had a road where
17:05they've already, you know, pursued pregnancy and have been unsuccessful or had some outcomes,
17:09or they just make a choice that pregnancy is not for them. Um, and then they might choose
17:14to do something definitive. And that often is a long road. That's the, I've dealt with this for
17:18so many years, you know, very similar to Shannon's story. You know, I've had multiple surgeries and I,
17:23you know, my quality of life is, is what's most paramount to me at this point. So you have to,
17:28you know, meet women where they are and everyone's at a different spot.
17:33Well, the chain of effects is wild. I know there's so many different details that go into this. Um,
17:39while thinking about recovery from if surgery is the best option, um, and also the physical
17:44wellbeing afterwards, um, does this surgery fall into a minimally invasive or traditional surgery?
17:52And what does that mean exactly?
17:54Yeah. So traditional surgery is what we call open incision. So the one that most women can relate
18:00to because the most common surgery that women have a cesarean section, right? So that low bikini line
18:06incision, but you're removing a baby through that, right? So that's a, you know, 15, 13 centimeter
18:12incision across the lower abdomen, right? And so of course, you know, that's going to be
18:16uncomfortable. You're cutting through muscle and the abdominal wall and that's uncomfortable. Um,
18:21and so that's what traditional surgery is, um, particularly abdominal surgery. Um, we can do things
18:26minimally invasive, which means we're using smaller incisions, right? So the smaller the cut, the less
18:31pain, the less, uh, things that you hear about our risks of surgery, bleeding, infection, pain. Um,
18:38and so when the cuts are smaller, it allows people, not just women, but people to get back to their
18:43normal activity faster, right? So particularly moving around, right? I don't think many of us
18:48realize how much we use our belly or our core even to stand up out of a chair or get out of a bed or
18:54turn to wipe ourselves on the toilet. So, um, the smaller cuts really allow women to get back to,
19:02you know, their normal activities quicker. Um, and you know, with that, it includes laparoscopic
19:07and robotic surgery. So, you know, using, uh, a camera inside the belly that, you know, is the size
19:13of a pen, right? And so that incision, you know, width of your finger as opposed to that, you know,
19:19you know, you know, bikini cut incision along, along your lower abdominal wall. So the cuts don't
19:24generally hurt for most people. Um, what we do is we inflate the belly full of gas and that's how
19:30we're able to work. And so that's what minimally invasive surgery is. And almost every field in
19:35surgery has gone minimally invasive because of all the, um, positive outcomes, you know,
19:40in terms of patients, right? Getting patients back to their life with low complication rates.
19:45All of those things are lower, uh, with minimally invasive surgery.
19:50So fascinating while Shannon, I've loved watching your reactions to all of this.
19:55Dr. Green shared some of the, you know, post-op, um, situations, um, but also just earlier when
20:01you're like, I would like to go on vacation with my husband and enjoy our lives. How have you felt as
20:06a patient during all of this? And, um, how has your life changed since surgery?
20:12It's been amazing. I mean, it's one of the best decisions I've made. You know, I would say the
20:17other one was LASIK, but it's like, you know, you make these decisions and then you're like,
20:22oh my goodness, afterwards, you realize how much you were so reliant on these things that were
20:29slowing you down or inhibiting you from really kind of living fully. And so, um, I am so happy.
20:36Um, it was the absolute best decision for me. Um, I feel very comfortable that I had the best,
20:43you know, doctor, um, you know, it really is a relationship and, um, you know, I
20:50build all my beans to her and I feel like she took really, um, great care of me.
20:55And so that helped, you know, along my making the decision, you know, my recovery, um, and just
21:03all of it. So it has been, um, the absolute best, best decision for me yet.
21:08Well, you could obviously tell that you have such a great relationship together, which makes it,
21:14and again, like power of women, right? To just like women understand stuff that when you really
21:20think about what we go through and then just in general, having a period and then add all this on
21:25top of it, having a doctor who is an expert is just amazing. So Dr. Green, it obviously feels good to
21:33hear. I'm sure you have tons of patients that are like this. What would you say to women like Shannon,
21:38who are out there struggling with, with similar challenges? Is there any specific advice that you
21:43have? And, you know, just to make, encourage them, obviously that there's a way to feel better.
21:50Yeah. So obviously trust your instincts, right? We know ourselves the best, um, and seek information,
21:57right? So I always say like when I'm, when I'm training residents is like the doctor means educator.
22:03Like our job is not to make the decision for Shannon or any other patient. It's this is what's
22:09out there. This is what is relevant to you. Cause not everything that's out there is relevant to
22:14every patient either. I mean, that's the other, uh, you know, joy is coming in and educating patients.
22:20And sometimes we even give patients options of things they've never heard of. Um, they say,
22:24well, oh, I didn't even hear of that. I didn't know about that. And so, um, our job is to educate.
22:29And then, you know, as a, as a physician, it's like, what decision are we going to come to together?
22:35Right. And I think that's when, um, you patients are going to feel like they're involved in the
22:41decision, right. That they made the right choice. Um, and then, and that they're involved in their
22:47healthcare plan. And it's not just, you know, the doctor telling them what they want to do. Um,
22:52but we come to a decision that we both are satisfied with together, you know, and, and,
22:57you know, what satisfies what we were talking about a few minutes ago is like,
23:00what is your goal? Right. And then this is what we can do to get you towards your goal.
23:05And there are going to be times when women come back. I mean, I have patients that I've seen and
23:09done repeated surgeries on, and these are the things that we anticipate, right? This is what
23:13can happen if we do X, you know, this is what can happen if we do Y and some women have to get there,
23:19right? Some women, they have to get there even with me where they've been with, you know,
23:23several other people and they have to get there, but you have to be your own best advocate and, um,
23:30seek the information. And if you're not getting it, it's fine to get a second and third opinion.
23:34I have people, you know, come see me. So if you're, um, you know, not sure, or these are
23:40major decisions in women's lives, having a surgery is not a small feat, right? It is,
23:46you know, the woman is the gateway to her family. It impacts your work. If you have children,
23:50God forbid, if you have a complication or all these things that are potential consequences of
23:56a huge decision. So we want to make sure we make that decision together. Um, and so that people
24:01have an understanding of how this can, you know, impact their lives in a good way.
24:06Yeah. I have one more random question, maybe not random, but we don't know what causes this,
24:12right? It's kind of, we're still, hopefully we get research and we're doing that. But I think,
24:17I think you may have mentioned at the beginning of the video that we still really don't know
24:21what causes it. We don't know why, and we don't know why in an individual, especially as an
24:27individual compared to other people. I mean, we know that they're extremely common. We know,
24:32um, that most women don't have significant symptoms, but we also know that they're impacted
24:37by our hormones and our reproductive life. So they have the potential to grow as long as we're
24:42having a menstrual cycle and have hormonal input. So we know that those things tend to not grow
24:48and the symptoms tend to improve if we enter menopause. But if we already had large fibers
24:53in a large uterus right before menopause, and then we get the menopause and we stop bleeding,
24:57I still see those women who then thought, well, if I could just get to menopause and stop the
25:02bleeding, I would be okay. But then they still have the bulk symptoms from the size,
25:06right? Remember we said in the outset, these are not going to disappear on their own. They
25:11might shrink a little bit and there are medications that might help shrink temporarily, but we can't,
25:16we can't, um, they don't go away unless we physically remove them. So it's, you know,
25:22how big location, how many, what are our goals? And so there's many sort of facets of, um,
25:28what direction we're going to go in and what we're able to offer people.
25:32Yeah. And I think again, you know, we're so fortunate to do these, these videos and
25:37there's so many women that just feel like we were told to suck it up. And this is just what
25:41you have to deal with and just, you know, it's life. And you know, one of my, one of my best,
25:46best friends thought she had these debilitating periods and she was just diagnosed with endometriosis
25:51like three years ago. You know, thank God for social media that we're talking about this now,
25:57because women have suffered in silence for so long thinking they just have to suck it up. And now we have,
26:02these incredible doctors, incredible patients sharing their stories and educating women. And
26:06like I said, and men, cause I'm sure there's a lot of husbands or even fathers that were like,
26:11Oh, you're fine. You know? And like, we need them to know like how serious this is. And so Shannon,
26:18thank you so much for sharing your story, Dr. Green, for you sharing your expertise,
26:22like you're going to help so many people with this.
26:24Yes. Yeah. Yeah. And the common theme through all of these videos that we've done
26:30is talk to your doctor, talk to your friends, talk, talk it out because you never know what
26:35you're going to learn out there. If you would like to schedule an appointment with one of
26:38Virtua's minimally invasive gynecologists, call 856-325-4200. It's 856-325-4200. We'll have
26:47it on our website. And these conversations just help people.
26:50Yeah. So thank you again. And I'm honored that I will now be one of your stories.
26:57Nicole has this wealth of medical. I'm a little obsessed with medicine and stuff. You know,
27:02I didn't like to study, so I didn't be a doctor. So now I just get paid to talk to brilliant,
27:07brilliant people. So I love it.
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