Fertility & Women’s Care

Pelvic Endometriosis

Endometriosis occurs when the tissue lining the inside of the uterus (the endometrium) becomes implanted outside the uterus, usually on the ovaries or the lining of the pelvis. A growth of this tissue creates surrounding scar tissue and causes variable amounts of pelvic pain, which can be mild to severe and tends to worsen over time if untreated.

The cause of endometriosis is uncertain.

Severe period pain, pain during intercourse and during urination is not normal and are some of the most common presenting symptoms of pelvic endometriosis. Some women with this condition show no symptoms.

Endometriosis is also one of the causes for female infertility.

While some women seek help for their pelvic pain (which may occur apart from menses), many women with endometriosis are told that their period pain is ‘normal’ or is just ‘part of being a woman’.

If you have this condition, you should consider all your treatment options and work with your doctor to identify the best treatment option for you.

Treatment Options

Treatment options for endometriosis include pain relievers, hormone therapy, and surgery. The best treatment plan is determined by the location and severity of the symptoms, findings on pelvic exam and plans for future pregnancy.

Surgical options are typically conservative, using minimally invasive laparoscopic surgery to remove the burden of endometriosis and scar tissue without removing the reproductive organs. Dr Suresh Nair specializes in using the robot-assisted laparoscopic surgery using the DaVinci Robot for treating endometriosis.

For those having failed conservative surgery and completed their childbearing, total laparoscopic hysterectomy with or without removal of the fallopian tubes and ovaries provides the greatest promise for symptom relief.

To learn more about your options, make an appointment with your doctor today.

Adenomyoma/ Adenomyosis

Adenomyoma is a nodule that forms around tissue of the inner uterus (endometrial tissue) as a result of adenomyosis. Adenomyosis is a common condition in which the inner lining of the uterus (the endometrium) breaks through the muscle wall of the uterus. Adenomyosis can cause menstrual cramps, lower abdominal pressure, and bloating before menstrual periods and can result in heavy periods. The condition can be located throughout the entire uterus or localized in one spot.

Many women who have adenomyosis also have endometriosis and these two may contribute to infertility problems.

If you have this condition, you should consider all your treatment options and work with your doctor to identify the best treatment option for you.

Treatment Options

Treatment for adenomyosis depends in part on your symptoms, their severity, and whether you have completed childbearing. Treatment options may include pain relievers, hormone therapy, and surgery.

Surgical options are typically conservative, using robot-assisted ablation of the endometrium. Endometrial ablation has been found to be effective in relieving symptoms in some patients when adenomyosis hasn’t penetrated deeply into the muscle wall of the uterus.

Laparoscopic-robot assisted ablation of the endometrium is a relatively new treatment for Adenomyosis.

To learn more about your options, make an appointment with your doctor today.

Excessive Menstrual Bleeding

The medical term for heavy, prolonged (or both) menstrual periods is menorrhagia. Symptoms of menorrhagia or excessive menstrual bleeding may also include cramping, pelvic pain and, in severe cases, anemia.

Excessive menstrual bleeding is a common condition that occurs for many of reasons. Two of the most common causes are: a hormonal imbalance and uterine growths. Metrorrhagia is the term used to refer to uterine bleeding at irregular intervals, particularly between the expected menstrual periods. Menometrorrhagia is the combination of the two, that is, excessive uterine bleeding, both at the usual time of menstrual periods and at other irregular intervals.

If you have this condition, you should consider all your treatment options and work with your doctor to identify the best treatment option for you.

Treatment Options

It is important to see your doctor determine the cause. Treatment will depend on what’s causing the bleeding.

Medication treatment for menorrhagia may include one or more of the following:

  • Nonsteroidal anti-inflammatory to reduce the amount of blood loss and help with pain
    Hormone therapy to stabilize the endometrium (lining of the uterus), regulate menstrual cycles, or correct hormonal imbalances.
  • Hormone secreting IUD (Mirena)
  • Tranexamic acid, a non-hormonal medication that promotes blood clotting.
  • D&C (dilation and curettage). D&C involves dilating the cervix and scraping the lining of the uterus.
  • Hysteroscopy. It allows the doctor to see and remove uterine masses that are in the lining of the uterus and may be causing bleeding. It also allows the doctor to evaluate the uterine lining.
  • Endometrial resection or ablation. In this procedure, the lining of the uterus is removed or destroyed.
    Hysterectomy. This is the surgical removal of the uterus and cervix.
  • Robotic surgery is one of the advanced, minimally invasive treatment options now for Excessive Menstrual Bleeding (Menorrhagia). Using the da Vinci surgery system, your surgeon has a better robotic option to spare surrounding nerves, cause less tissue damage, less pain from surgery, less ris of infection, shorter hospital stay and overall have a minimally invasive method encouraging a better surgical outcome.

To learn more about your options, make an appointment with your doctor today.

Uterine Fibroids

Uterine fibroids are extremely common. Fibroids are often first found during a routine pelvic exam. To double check, an ultrasound may be performed, either transvaginally or abdominally. A three-dimensional (3D) ultrasound or an MRI (magnetic resonance imaging) can also be used to find the fibroids.

If your fibroids aren’t causing you any problems, it is reasonable to consider doing nothing however, its growth must be monitored, especially if symptoms develop such as bleeding or pain, by having exams every six months.

If you have uterine fibroids, you should consider all your treatment options and work with your doctor to identify the best treatment option for you.

Treatment Options

To help prevent more growth of the fibroid, your doctor may recommend that you stop taking birth control pills or hormone replacement therapy. But in some cases, oral contraceptives are prescribed to help control the bleeding and anemia from fibroids, even though in some circumstances hormones may cause fibroids to grow.

Myomectomy, sometimes known as a Fibroidectomy, is a procedure for removal of fibroids. Uterine fibroids are noncancerous (benign) tumors that develop in the womb. The cause of uterine fibroids is unknown. As long as a woman with fibroids is menstruating, a fibroid will probably continue to grow, usually slowly. Fibroids are often described by their location in the uterus: Myometrial (in the muscle wall of the uterus), Submucosal (just under the surface of the uterine lining), Subserosal (just under the outside covering of the uterus), Pendunculated (occurring on a long stalk on the outside of the uterus or inside the cavity of the uterus).

Laparoscopic-robot assisted myomectomy is a relatively new treatment for uterine fibroids. Among the advantages of robotic surgery is it can often allow a women to continue fertility during her child-bearing years. Through robotic surgery, your surgeon can remove uterine fibroids through small incisions with unmatched precision and control.

Using the da Vinci surgery system, you will have an increased opportunity for future pregnancy, lesser risk for infection and shorter hospital stay.

To learn more about your options, make an appointment with your doctor today.

Ovarian Cysts

Fluid-filled sacs (cysts) often form on the ovaries. There are several different types of ovarian cysts, the most common being functional cysts. Often, ovarian cysts do not cause symptoms. You may not realize you have one until you visit your doctor for a routine exam. Ovarian cysts can cause problems if they twist, bleed, or rupture. So it’s important to have regular gynecologic exams so that any problems can be diagnosed and treated. Pain in the abdomen or pelvis is the most common symptom of an ovarian cyst, but most are asymptomatic.

If you have ovarian cysts, you should consider all your treatment options and work with your doctor to identify the best treatment option for you.

Treatment Options

Birth control pills may relieve the pain from ovarian cysts. They prevent ovulation, which reduces the odds that new cysts will form. However, surgery may be necessary if the cyst doesn’t go away, grows, or causes you pain.

Laparoscopic-robot assisted Cystectomy or Oophorectomy, is an exciting new treatment option in minimally invasive surgery for conditions including ovarian cysts or tumors.

What is a Ovarian Cystectomy? What is an Oophorectomy?

Ovarian Cystectomy is a procedure for those benign conditions of the ovary in which a cyst can be removed and when you and your doctor deem it desirable to leave a functional ovary in place. This is particularly true in women who are still in their child bearing years. Thus, if it is technically feasible and where one is assured that there is no malignant tissue present, it behooves those performing pelvic surgery to attempt to perform ovarian cystectomy in preference to oophorectomy, particularly in those patients who want to have children.

Oophorectomy, in contrast, refers to the removal of the ovary. This is a surgical procedure where only one or both of the ovaries are removed. Most often, an oophorectomy is performed in conjunction with a hysterectomy; however, it can be performed without a hysterectomy if the case dictates.

In both situations, Laparoscopic-robot assisted ovarian cystectomy or oophorectomy now allows your surgeon to perform a minimally invasive procedure for ovarian problems.

To learn more about your options, make an appointment with your doctor today.


Hysterectomy which is removal of the uterus, can cure a variety of problems that afflict the uterus and ovaries, including uterine or cervical cancer, ovarian cancer, endometriosis, fibroids, heavy non-menstrual bleeding and uterine prolapse.

Laparoscopic-robot assisted hysterectomy is one of the most effective, least invasive surgical treatment option that allows your surgeon to perform superior precision and control, with only a few small incisions.

Laparoscopic-robot assisted hysterectomy is a new minimally invasive technology that allows for incredibly precise movements, dexterity and control through minimally-invasive surgical openings and powerful 3D vision/magnification. It is widely being employed for hysterectomy surgery because it allows your surgeon to convert an “open incision” hysterectomy to one that results in only 3 or 4 small 8mm incisions.

Robotic surgery gives your surgeon better visualization and magnification in the operating field. This is vital, especially when working with delicate and confined structures like the bladder. Your surgeon has a distinct advantage when performing a total laparoscopic hysterectomy involving adhesions from prior pelvic surgery. Other benefits include shorter hospital stay with fewer post-hysterectomy surgery complications, less pain, blood loss & infection risk, less scarring because of the smaller incisions, and faster recovery period.

To learn more about your options, make an appointment with your doctor today.

Other candidates for Robotic surgery:

  • Women who have had previous surgeries who may have a lot of adhesions internally are also good candidates for robotic surgery because your surgeon will be able to do more complex dissections.
  • Patients with high BMI’s are also good candidates because the Robot helps the surgeon hold up the heavy wall. These patients greatly benefit from robotic surgery because they are at huge risk for infections with large open incisions from traditional surgery.
  • Other candidates for robotic surgery are women who have had difficulty conceiving due to fibroids that distort the cavity. Robotic surgery allows for a quicker recovery and women can try to conceive 8-12 weeks after the procedure.

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