Welcome to episode 2 of Hello Uterus! Today we take a deep dive into fibroids and treatment with our special guest, urogynecologist Dr. Elizabeth Graul.
Get settled in, this is a long one! Welcome back to the second episode of Hello Uterus! In today’s episode, we start off by focusing on you in our Hear Me, Hear Me! Q&A segment. We’ll have your concerns addressed and answered by our fibroid master, urogynecologist Dr. Elizabeth Graul.
This week’s News Break comes from Spain, the soon to be best place to live in as someone with a uterus. Listen in to figure out what is making people, including us, want to move there.
Lastly, discover even more ways the uterus is directly connected to other systems in the body. Reminder: no matter what, we do not shame those who have had or still want a hysterectomy! We’re gonna be Ending on a High Note with a story from Portland, Oregon about the Sports Bra. This is not what you think!
Tune in this Thursday for our After Show conversation with Dr. Elizabeth Graul where we’ll continue the conversation and let you have the virtual gyno conversation we all need. Join us back here every Tuesday for all things uterus, in service to you, uterinekind.
Until next week,
Your Uterinekind Team
Carol:
On this week's. Hello, Uterus. Getting any gyn diagnosis? It can be like navigating underground caves without a headlamp. Not exactly something that we want to be doing. It's fraught with ugly, and many people don't pursue it. Beyond that conversation we've all had with our Gynecologists. It's the birth control pill or the hysterectomy conversation. You know, that one. So if you're tired of a Pat on the head and a cargo ship of Motrin, we have an expert here today to be our guide on advanced treatments and how to make sure you're heard loud and clear in your consultation. This is all in response to this week's Hear me, Hear Me, featuring our expert, Dr. Elizabeth Grohl. Our news takes us to Spain, where you're going to want to relocate to at the end of this episode, I promise. And we go back into data with a study on the cardiovascular effects of hysterectomies. Don't look away. We are not anti-hysterectomy. We are pro research. Just want to point that out. Then finally, last week I said we wouldn't be all doom and gloom. So stay tuned till the end for a new segment ending on a high note, this sports bra is not at all what you think. I'm your host, Carol Johnson, and this is Hello, Uterus.
Let's focus on you. First, we're going to go right into a Hear me, Hear Me, our Q and A segment and this Hear me, Hear Me is from I don't know where to turn. Here's what they say. I've seen three doctors, and all three have said the exact same thing about my symptoms. Really bad cramps for a few days before my period and then really bad cramps and bleeding for the next seven to ten days. And then more cramps right after my period is done like a revenge tour. Perfectly said. I was told to try birth control. And let's see how that goes for a few months. And if you don't experience any relief, we can talk about some other options. This is one third of the month for me at least. And I don't want to take birth control pills. I want to know what's causing it. Help one third of the month at least. I bet that's under reporting because we all do that. So first, I just want to say I'm sorry that this is your experience. And second, I want to say this isn't normal. This isn't normal. So don't let anyone tell you it is. What it is is common. And what you need is a diagnosis, not an assumptive diagnosis, but a real diagnosis. And that can be a long road. But Dr. Elizabeth Graul is here to give us all a head start on troubleshooting menstrual symptoms. We'll also get specific on fibroids and an advanced treatment called Acessa. You want to know about this one. She joins us from Salt Lake City, Utah, where she specializes in uro gynecology, and her research interests are in pelvic reconstructive surgery and incontinence. She received her medical degree from the University of Utah College of Medicine in Salt Lake City, Utah. I don't know how anybody goes to Med school in Salt Lake City and focuses on Med school because I'd be outside all the time. Dr. Graul, thank you for taking the time to be here. For anyone who doesn't live close to your practice, this is a priceless opportunity and I'm grateful. And I know those listening will be as well. So thank you for joining us.
Dr. Graul
Well, thank you, Carol, for having me. I look forward to having a great conversation.
Carol: Terrific. So I hear it all the time. My symptoms aren't taken seriously or they're minimized or referred to as normal. And people themselves experiencing the symptoms often minimize them because they've been told it's normal or they think it's just the way it is because their mom was like this or their aunt was like this. But I also know from talking to people like you that these symptoms are not normal. And what is normal is a care pathway that's fraught with a lot of potholes and a lot of opportunities for people to either get overwhelmed with information or feel like they don't have enough. And so they stay in limbo. So with nowhere to turn and their experience, they've seen three doctors possibly communicated directly that they don't want to take hormones to those doctors clearly suffering, yet the reaction is if she presented with a sinus infection. So how do we change this experience?
Dr. Graul:
Well, I think one of the first things women need to be educated about their bodies, what is normal and what isn't normal so that they know the questions to ask. I think a lot of women don't even know how to have the conversation because they don't know what body parts are there. What could go wrong then they certainly don't have an opportunity to learn about possible treatments. The Internet has definitely helped this situation, and I think that lots of younger women, I definitely see a difference in my younger patient population. They do come in with more information, not all of it accurate, but they definitely have more information and at least are asking the questions and we can get the conversation started. But I think the education component at the beginning is the most important. And unfortunately, as physicians, sometimes we're the ones, and we probably should be the ones that are educating our patients, and that's not really recognized as our role. And I think it should be.
Carol: I agree. At the same time, how much more can you guys handle? And you're different. I know this from reading about people's experiences with you. You'll spend as much time as it takes to make somebody feel comfortable. But in reality, how much time does the average person have with their gynecologist in a problem appointment?
Dr. Graul: Probably 15 minutes.
Carol:
So in that period of time, for me, it seems astounding that anybody could walk out of that and feel confident about making a health decision, especially one that could involve having some type of treatment. Well, you're absolutely right. And I think that coming into the situation, women need to realize that it is a process. And if a 15 minutes appointment is what is given to them the first time, then they need to be persistent until they get to the point where they feel like they're on the right path or the problem has been resolved. You mentioned this idea of how knowledge about anatomy can help somebody connect the dots when it comes to symptoms like heavy bleeding and pain, which are super common. What are some of the other symptoms that may be happening? Like, for instance, nowhere to turn mentions cramps after the period is over. Is that an example of a symptom that might help someone connect the dots? And what are some other symptoms that people should be looking out for?
Dr. Graul: Well, the more specific patients can be with me when they come in, the more I can help them direct the diagnostic process. So things like bleeding and pain together versus maybe pain that's occurring when they are not bleeding, that's an important criteria that helps me maybe better understand what direction we should go, the amount of bleeding that they're doing. Is this something that's been going on all of their menstrual life, or is this something that started recently? Have they had any recent infections or procedures or anything that we can look to to say, well, is there something else that could be involved here? Maybe you've developed some scar tissue. Do they have a new sexual partner? Could there be some infection going on? So the more specific the information, I think the more helpful it is for me. But starting with the very straightforward basics, when do you have the pain? When is it worse? What helps make it feel better? How long have you had it? Just very straightforward questions and really zero in on the primary one or two symptoms.
Carol: Excellent. So let's talk about fibroids. That's an example of a condition where I think people have a hard time really even picturing them. And so probably also a hard time understanding that a symptom like back pain could be caused by fibroids. So we'll carry the symptom conversation forward. Let's zero in on fibroids. In our last episode, we covered the three types of fibroids intramural, which grow within the muscular uterine wall, submucosal, which bulge into the narrow space inside the uterus and then subserosl, which project to the outside of the uterus. Do we have that accurate?
Dr. Graul: That is correct. There is one other type called padunculated, and that means that it can be outside of the uterus or inside of the cavity, but it's quite separate and just connected with a small little stock that sounds like a polyp, but it's a fibroid. But it's an actual fibroid. Yes.
Carol: Okay, so do we know what causes them.
Dr. Graul: We don't there are conditions that we recognize an increased likelihood. Women as they get older, we see it more commonly. Women of color are much more likely to have fibroids than women not of color, women with higher estrogen levels. So the earlier you start your periods, obesity can be associated because you do see higher estrogen levels. And there definitely is a family trait. But we have not identified what that is. We do see it in family histories. So common. And women of color have more and oftentimes larger fibroids. And we're still at the theory stage of why these happen.
Carol: And I have to ask you, why is that the case? Because last week we talked about I don't even know how this happened, but we talked about the first fibroid. I'm not sure if it was the first fibroid, but it was in the believe in England, and it was a fibroid that was removed post mortem. So after the patient died, which should not be shocking when you hear how big this fibroid was. It was £140. Oh, my goodness. Oh, my goodness. Right. That's a human. So it's not like they just started happening right now. Why don't we know more about them?
Dr. Graul: I don't have an answer for you. I think that the majority of women's health issues that's the case. If you look at endometriosis, if you look at just painful periods in general, even if we don't have an explanation and I don't know if it's not a highly researched area, I think that a big part of it is that women have experienced this for so long, and it's just kind of an accepted part of our lives. Women are not going to die from this. So there's not an urgency to pursue research and funding. I've never really seen much research in why they happen. All of the research is in how we treat them right.
Carol: Well, I hope that that changes. Actually. I think there are some bills in Congress right now to support fibroid research. Congresswoman Clark out of New York and Vice President Kamala Harris, before she became vice President, proposed a fibroid research bill. It hasn't been accepted yet, just knowing that that's out there. And I'll put a link to that in the show notes so that you can stay on top of that. And I think that what Dr. Graul is saying is, in effect, this squeaky wheel gets the grease. Is that the thing? I don't know. I'm so bad. I typically have three metaphors edited together, none of which makes any sense at all. But yeah, so that's it. We have to start getting loud about it. And that's really the reason why, Hello, Uterus is here is to help that happen. So let's talk about diagnosing fibroids. It seems like we come into a consultation and we're expressing symptoms that could be the result of a myriad of conditions at that point. Some people move into a treatment pathway that begins with hormones, birth control pills, things like that, to manage symptoms. How does one direct that pathway toward getting a definitive diagnosis, and what does that look like?
Dr. Graul: Well, fibroids are not terribly difficult to diagnose. An exam in a woman, if they're at all large, is quite easy to tell that there are fibroids present, and an ultrasound is basically definitive. You can see fibroids quite easily. It's certainly something that we do very early on in the process.
Carol: I think that then the question becomes how do we move forward?
Dr. Graul: Unfortunately, and as strange as it sounds, care plans are greatly influenced, even I could say dictated by insurance. And so it may be that more definitive therapy isn't even an option until we have shown that we've tried the less invasive approaches. And that's why we automatically will go to, well, let's try birth control pills or some sort of hormonal remedy. The problem with fibroids is that especially as they get bigger, they are usually not responsive to hormonal therapy. I think that the vast majority of physicians will say, we need to try this for a few months. And if it doesn't work, then I think you can move quite rapidly to more invasive treatment options. And if a person doesn't want to take hormonal therapy, do they have the option to advocate, to express that and to advocate for moving beyond that as a first line option? So what I will do in that situation, oftentimes they don't want to take hormones because they've taken them in the past and have had negative experiences. I will make sure that I document that, and that's usually adequate for insurance. I will also move ahead with the patient state that she does not want to take birth control pills. In my heart, I don't think that that should be a problem. But often times from an insurance standpoint, that's not an adequate reason. So when we're submitting pre authorization for a procedure, I will state that the patient does not want to take them. And then we have to decide or learn if the insurance company is going to accept that as a reason to skip that step. And as you said, insurance companies have a huge impact on the care pathway.
Carol: Can we just take a moment to breathe through that for a second?
Dr. Graul: Yes. That is the number one way that people access our healthcare system. And I am basically told when I can do what treatment and what medications I can prescribe, and it's getting worse, it keeps ratcheting down the requirements.
Carol: That is tough to hear, and that has regional implications, too, right? So what is covered in one state may not be covered in another.
Dr. Graul: Absolutely.
Carol: Okay. And that makes my head want to rip off my neck and leave the planet, because that means that even the insurance industry, which should have a really good understanding of care pathways, is basically saying the care pathway is not the priority. It doesn't matter what state you live in. Your uterus is the same, right. So the care pathway should be the same, right?
Dr. Graul: Correct. Yes.
Carol: That's why we're here. So I want to talk about a procedure called assessor, which is something that you provide to your patients. Yes.
Angel: Quick Disclaimer. Hello Uterus is a zero paid influence zone. We do not accept payment from manufacturers of devices, products, and treatments featured on Hello Uterus. Now let's get back to the show.
Carol: Before we get into the details on the procedure, I'd like to reflect back on those types of fibroids and ask you a couple of questions about them. First, when you take a fibroid out, can you describe what it is to us so we can better understand what's in our uterus in and around our uterus?
Dr. Graul: So the majority of the uterus is made up of what is called smooth muscle. The thick wall is just many millions of muscle fibers that are woven together to create a very strong, thick organ. And fibroids are made up of that muscle tissue. It is not in the same organized fashion that we see in the uterine wall. When you feel it, it's almost like a rubber ball. It's very, very hard and firm. It has a little capsule and the edges are very clean cut and definitive even trying to cut through them. They're very dense. Oftentimes not a lot of blood vessels within the mass, but there are blood vessels that are around it that can be a problem when you're dissecting, but the actual tissue is just solid, dense, firm muscle.
Carol: Can you come up with an analogy that maybe involves another part of the body that people are more familiar with that would explain or describe what it would feel like to have something like a fibroid there? I often describe it as imagine, like a knot in your calf muscle. But is there something that you use to express this to people? Like men, for instance, they haven't thought about having a uterus. So how can they understand what this feels like?
Dr. Graul: Wow, that's an interesting question. Maybe if you thought about burying a baseball under the skin in your upper arm.
Carol: Okay, that works. Yeah. So there's a lot of pressure under the tissues, and then it's protruding out of the surface.
Dr. Graul: Wow. That makes sense because the way you were describing it, describing the fibroid and the uterus, the uterus having the woven muscle fibers and the fibroid kind of being like a muscle within a muscle. Yeah. So it's not just that, like, the fibroid itself doesn't hurt. And it's interesting. People always condemn the uterus. You see it all the time. And social media, it's like death to the uterus because that's where they feel the pain. But it's like, Whoa. Actually, the uterus is the one who is experiencing the pain of the fibroid, and the fibroid is what's causing the pain. And I can't imagine how much it takes for someone to go through their day, day in and day out when they have 1, 3,5, 6 fibroids. When that happens, what's happening to the entire pelvic region?
Dr. Graul: It's all determined by size. So a fibroid can be the size of your Pinky thumbnail and not cause any problems at all. Usually as they get a little bit bigger, we're going to start seeing bleeding abnormalities long before we see pain issues. So the bleeding is kind of our first clue that maybe there's something wrong. But as they get bigger, they start to create pressure on other organs of the body so they can press on the bowel and cause slowing down of bowel function, retention of gas, constipation. And that itself is going to cause a lot of pain. If the fibroids are more in front of the uterus, there can be a lot of pressure on the bladder. And patients can feel like they're having to urinate more and more frequently. They never really get away from feeling like they need to go because that pressure is always there. And then if you can imagine a woman that's five or six months pregnant, just that heavy feeling that her whole abdomen is just full of something, that's what a fibroid can feel like. We can feel them up to the belly button and even up higher. And it's no different than a woman who's pregnant.
Carol: That's amazing. And you do hear that you hear people reference a measurement of their uterus during a fibroid exam, and they'll say that the uterus was at the size of a six month pregnant uterus. And yeah, that's a lot to deal with on a day to day basis. You mentioned something interesting, that they can be very small and either asymptomatic or bleeding issues will crop up with these smaller fibroids that perhaps are just beginning to grow. So keep an eye out for bleeding issues. And what that made me wonder was because I've read research that say that women will often go to multiple doctors and that it can take up to eight years to get a fibroid diagnosis. And we'll link to that in our show notes that research. So that makes me wonder if then more hysterectomies happen because diagnosis should have happened earlier, if the diagnosis happened after this has been going on for a period of several months or years and the fibroids went through some growth during that time period that she may be on the other side of options. Is that accurate?
Dr. Graul: The concept that it can take eight years to diagnose fibroids is inconceivable to me. I don't understand it's such an easy diagnosis to make. I don't understand that. But fibroids are very slow growing, and they always start small. I mean, literally they start with a single cell. And so it takes years for fibroids to get large enough oftentimes to even cause symptoms. So just going in for your regular exams, even before you're symptomatic, oftentimes your physician can just feel your uterus and say, gosh, it feels bigger than it felt before, or it's a little bit irregular in its shape. I don't know why it would take eight years to diagnose them. And I think that almost anyone should be able to have a diagnosis before they're at a point where there are no options other than hysterectomy.
Carol: Yeah, absolutely agree. So let's talk about assessment. Can you tell me a little bit about the treatment?
Dr. Graul: Well, it's a very exciting treatment. It's relatively new. It is a laparoscopic surgical procedure. And the real improvement in technique is that there is a small ultrasound device that's literally placed into the abdominal cavity that we can put right up against the uterus. And we can identify every single fibroid both size and position. And that's what helps guide us in treating each individual fibroid. It's very rare for women to have one single fibroid. And so one of the problems is often even if we treat or remove the larger ones, it's not very many years before those smaller ones that were left behind have been grown to a point where they are again causing problems. So this procedure allows us literally to identify every single fibroid in the uterus and treat every one of them without any kind of large incision and with a very short recovery time.
Carol: That would raises the question about the integrity of the uterus itself. If you find these fibroids when they're smaller, I assume that makes them easier to treat and then also enables your uterus to remain strong and intact.
Dr. Graul: That's very true. But I think that the other benefit with Acessa is that it is able to limit its treatment scope to just the fibroid tissue, and so it doesn't damage the underlying uterine tissue. And I think that's a very important distinction from just about any other treatment that we offer.
Carol: Well, okay, so let's move back to this idea of laparoscopic surgery and the tools that you're using. You mentioned one of them, but can you tell us what's in your hands as the doctor during this treatment and where is it going?
Dr. Graul: Okay, so the patient is asleep, an incision is made in the belly button, and a laparoscope camera is placed through that incision. And then two other incisions are placed in the lower abdomen. The location of those incisions will be based on where the fibroids are and how we feel. We will obtain the best access to the fibroids. These incisions are very, very small, less than a centimeter in size. Through one incision, there will be the ultrasound device, and through the other lower incision, there will be the treatment device. The ultrasound device is put up against the uterus. And when the fibroid is identified, then the treatment device is brought in and placed down into the fibroid. They just call it an array. They're little wires that extend down into the fibroid tissue and then radio frequency energy causing heat. And I basically think of this as melting. The fibroid destroys coagulates, cauterizes, whatever word you want to use destroys the fibroid. And you can actually see the destruction on your screen. We have a television screen that's showing us what's going on inside the abdominal cavity and also one that's showing us what's going on inside the uterus and you can actually see the tissues change. So let's say you have a fibroid that's a little bit larger. You can see the treated area, and then you can see, oh, we need to remove the treatment device and put it in another section of that same fibroid to complete treating the entire fibroid. And the device automatically determines the energy necessary and the time requirement necessary to destroy the area that it is working on at that time.
Carol: So we go back to that baseball in the upper arm analogy. If a baseball was able to be deflated, that's what this treatment would do. It would essentially collapse the baseball, which would then relieve the pressure that was created by it on the area in which it is located.
Dr. Graul: Yes, it does two things. It reduces volume, so you're going to have a fairly immediate decrease in pressure, but it also changes the quality. So that baseball would then go to a marshmallow.
Carol: That's why you say melting. Got it.
Dr. Graul: Yes. And it's not immediate. The first month or so, even maybe the first three months, the greatest change in symptoms will be noticeable, but there will be continued shrinkage and change for up to a year. It's something that once the procedures completed, then you just have to be patient until your body has done everything it's going to do in the healing process before you know how much benefit you'll receive.
Carol: Just in the baseball analogy, the marshmallow will always be there, but it will not grow and it will not change in consistency back to a firm, hard mass. It will stay a marshmallow, but it will still be part of your body. Got it. Can you conceive after this treatment?
Dr. Graul: The FDA recommendations say no, and that's primarily because of the lack of data. As I mentioned, this is a new procedure. There have been pregnancies after this procedure, and it was designed with that idea in mind, the whole idea of uterine sparing, because we don't have a good uterine sparing procedure available for younger women with fibroids that want to conceive. So, yes, conceptions have occurred, full pregnancies have been realized, but it is not on the FDA recommendation at this point to say yes. This is approved for anticipating consumption after treatment.
Carol: Okay. In terms of the various types of fibroids, does this treatment treat all fibroids, or is it better for some over others
Dr. Graul: the three that you mentioned at the beginning, the intramural, the subscerosal and the submucosal, as long as the majority of the fibroid is surrounded by normal uterine tissue, it can be treated. We have other ways to treat. I mentioned the padunculated fibroids. If there's a fibroid that's coming off the uterus and it's just on a stock, then we can just cut that stock and remove the fibroid that way. This procedure would not be able to treat that kind of fibroid if it's actually fully inside of the uterine cavity. Again, it needs to be surrounded by normal uterine tissue in the uterine cavity. It would not be. But there are hysteroscopic procedures, meaning a scope going inside of the uterus and then instruments that allow us to remove the fibroid that way. And all of these treatments can be done at the same time. You don't have to have the assessor at one point and then the hysteroscopic removal and then removing a padunculated fibroid. You can have them all done at the same time. It's just that your physician would need to have all of those different treatment options available at that one procedure, and they would need to know how to use them all.
Carol: Anticipating my very next question, Dr. Graul. So this must be what it's like to be in a consultation room with you. You're like two steps ahead. I love that. So that's my question is to make this procedure in the case of assessment part of your toolkit. It's not mandated, right?
Dr. Graul: Oh, no, not at all. Right. So that would suggest then that I could go to a gynecologist down the street from you, and this wouldn't even be an option with this one. As new as it is, I would think that that would be the more common experience.
Carol: Yeah. And also new. And also it requires you to be almost I think people are more familiar with laparoscopic surgery, perhaps when they think of things like knee replacements or maybe not replacement. Not replacements, but like knee surgery. Right. Like a meniscus tear or something with assessor, you're operating like an orthopedic surgeon would. You're doing laparoscopic surgery, and that's not something that you can just pull out of a box and be excellent at. It the first time out of the gate, right?
Dr. Graul: Well, certainly not. However, laparoscopic surgery for gynecology has been around for many, many years. And in fact, to my chagrin, it is slowly replacing vaginal surgery. The residents are being trained far more in laparoscopic and robotic surgery than they are in vaginal surgery. So I think that any gynecologist that you go to is going to have probably excellent laparoscopic skills because that's what most surgeries are turning into, our laparoscopic or robotic skills.
Carol: And you said much to your sugar. And can you expand on that?
Dr. Graul: Well, I'm old, and if you go to the American College of OB GYN, it will say all hysterectomies that can be done vaginally should be unless there is a reason that they cannot be. However, a very small percentage of them are being done vaginally, and the training in residency is becoming less and less. It's much more focused on robotics and laparoscopy and so the skill set is getting thinned out, and we see it mostly in older physicians. And I think that over the next few years, we won't be seeing it much at all. And everyone talks about laparoscopic surgery or robotic surgery being minimally invasive. Those organs are still coming out through the uterus, and it's the exact same incisions. It's just that you're adding the incisions on the abdomen to place the instruments. And with vaginal hysterectomy, you don't need any of those incisions. So I am an old thinking physician that thinks that vaginal surgery is the best unless there's a reason it cannot be done. Why do you think that's happening? Because it would make sense that vaginal surgery could be described as incision less. Right. Not requiring any incisions. It is an incision in the vagina. So it's an incision that you don't see. But there is an incision in the vagina to remove the uterus. And it's happening because of well, everything happens because of money. But the technology that is coming out to support it, they have to use it. And so if a hospital has a robot, it needs to be used. And so instead of using it on the few cases that really require it, then they recruit the use of these devices for what I would call benign surgery. And there's no regulation by the insurance companies to change this because the hospitals get paid the same amount. But then the hospitals use it as a marketing tool to say, we have the latest and greatest technology. And when you see big signs on the freeway for minimally invasive surgery, you see robotics, you don't see a sign for a vaginal hysterectomy. So unfortunately, it's being pushed by industry and finances and not by data money. Oh, boy. Now I'm going to get in a lot of trouble when people from my hospital hear this.
Carol: Actually, I feel like we have to talk about these things. And one of the things that we talk about at Uterin Kind, which produces a show, is that we're not here to vilify anybody. It's really just looking at what is the state of affairs right now and how do we improve it? Because nobody is going to realize their greatest self. Right. Whether that is a patient wanting wellness without delay or it's a health system wanting a. Well community, we're not going to get to that level until we clean up the protocols that we've followed in the past. And more information out there will hopefully do that. You should not get in trouble. And if you do, just let me know.
Dr. Graul: Well, I will say that technology such as robotic surgery has revolutionized things in a very positive way. And I have a partner that does primarily robotic surgery, and she can remove large fibroids in a way that was not available a few years ago. And there are fibroids once they get bigger than about 8 CM. Even Acessa is not a first line choice. So there are wonderful things that are happening. I just think that our mindset in this country is if it's more technically advanced, it's better. And that's just not always the case.
Carol: True words there from Doctor Liz Graul out of Salt Lake City, Utah. Doctor Graul and I are going to go have an after show conversation. I invite you to check back in on Thursday when the Hello Uterus after show episode drops. We're going to dive into well, really, we don't even know. We're going to pretend like we're sitting next to each other on a plane and it's 04:00 in the afternoon and we're feeling chatty, and the people around us are going to get an earful of Uterine conversation. Definitely tune back in. And, Dr. Graul, I just want to thank you for the information on fibroids on a setup, which is an important procedure that people need to know about if they're dealing with a fibroid diagnosis. And then also just a conversation at the top about symptoms and advocating for your pathway. I think the thing that's clear in talking to you is that not every doctor is the same, stating the obvious. And you have what seems to be a very practical, common sense way of interacting with your patients. But you're present with each one. Right. So you have protocols that you follow that you need to follow. But when you're sitting in front of a patient, you see the individual that is that patient. And so we want to give you a round of applause for that.
Dr. Graul: Well, thank you.
Carol: You're welcome. All right. We're going to be right back with a news break.
May 18, is abnormal uterine bleeding awareness day. Aub, abnormal uterine bleeding? Maybe you haven't heard this before, but trust me, most of you have experienced it because one in three women have abnormal uterine bleeding. Abnormal uterine bleeding is caused by things like fibroids, polyps, thickened endometrium, things we talked to Dr. Crawl about like pindununculated fibroid. I think it was such a good word, pedunculated. And I think a good fibroid maybe to have because they can just clip it out. Anyway. May 18, Abnormal Uterine Bleeding day. And I think Spain knew this because they released last week. And it's going to come up for a vote the week that this show is airing. They released a proposal for paid menstrual leave for those experiencing painful periods, aka AUB paid menstrual leave. What a dream. Zillow searches for Spain Skyrocketing as we speak. I beat you to it. And I don't even have a period anymore. But I want to live in a country that thinks that it's that important to provide paid menstrual leave for people because get this, colleagues, coworkers, bosses. We're not joking when we say that having your period, if it's not the slim tampon or the regular tampon kind of period, and if it's a period that's impacted by conditions that haven't been diagnosed because women it is horrible on a multitude of levels. Listen to the after show episode with Dr. Graul. We get into this a little bit. And what she points out about the types of doctors referring patients to her practice, it's fascinating. Aub, in my opinion, is a mental in addition to being a physical condition. It screws with your mental. Wellbeing, I don't menstruate anymore, but when I did, I had this. Nobody told me anything. They're like, oh, it's normal. It's no big deal. You want to take birth control pills? No, actually, I don't, because I'm 40 and I've been trying to get pregnant for a decade, and I still want to have kids. So your one size fits all approach isn't fitting for me. So instead, I went to work sick to my stomach, my head aches, I had diarrhea, and we had one of those 90 startup offices with the bathrooms right in the middle of a warehouse floor. It was really exciting for me to drag my giant bag of stuff. It was the walk of period. Shame. So in addition to the physical symptoms, people experience being totally distracted because they're afraid that when they stand up, they're going to bleed out all over the couch that they're sitting on in the lobby of their clients really gorgeous office right before a super important meeting. I literally had to cancel a meeting because I got out of my car and I bled right in seconds, right through my clothes, right to the pavement. That screws somebody's mental. Wellbeing, I sobbed all the way home. We have to talk about this. We need to talk about it loudly, pretty much everywhere we go. That's kind of why I'm doing what I'm doing, because everywhere I go, these conversations end up happening. And every time I leave a conversation, someone says, thank you. I just can't understand why we don't have more empathy around this condition. But just know that Spain, it's not passed yet, but they're trying to pass paid monthly menstrual leave. And I think that is the smartest thing in the world for productivity. I want you to know this stat, because I want you to be thinking about ways that you can have an impact on this in your community. And sometimes money is really the only word that seems to get people that perk up and listen. This is the data on the direct and indirect costs of abnormal uterine bleeding. Direct cost meaning if you have AUB, this is what it costs you. Indirect meaning this is the cost of AUB on the community. So annual direct costs of living with abnormal uterine bleeding $1,000,000,000.00 1 billion dollars and indirect costs 12 billion with a B dollars just for abnormal uterine bleeding. So when a company says, not important to us, then you can say, have you ever thought about how many millions of dollars you're losing every year due to absenteeism or presenteeism specific to abnormal uterine bleeding? Have you ever talked to the women who work in your company and ask them how their period impacts their ability to be productive on the job? And if you don't want to do it, just send me an email because I will do it. I will have this phone call on your behalf. I will act as your representative. Like, for instance, if angel wanted me to do this, I would say angel sent me to talk to you about abnormal uterine bleeding, and then I will go off. So that's a service we provide. I'm kind of kidding, but I'm kind of not kidding. Actually. There's like breakup services where you can hire somebody to go break up with your significant other, which I think is hilarious, but in this case, it's just period advocate your uterus advocate. Maybe I can just be that for everybody. Recognize that you be awareness May 18, and then also keep an eye on Spain. Some more details are coming this week. We'll keep you posted on TikTok and at hello uterus.com on the blog. When we come back. Research how do hysterectomies impact cardiovascular health?
Participant #1:
At the Mayo Clinic, Dr. Shannon Laughlin-Tommaso lead research into the impact of uterus removal with ovary conservation on cardiovascular health. So that means taking the uterus, leaving the ovaries. This is the type of hysterectomy that I think people hear about from physicians when they're complaining about their periods. So if there's an ovary issue and the ovaries need to come out, this research is not talking about that. This is only talking about the impact of uterus only removal with ovary conservation. So keeping the ovaries and how does it impact your cardiovascular health? Definition time, because we need to know what cardiovascular health means. So this is a general term for the health or the conditions affecting the heart or blood vessels. Cardiovascular diseases or cardiovascular conditions are conditions that affect the heart or blood vessels. So what's most striking about this research is that they found that women who underwent a hysterectomy with ovarian conservation at or before age 35 had an increased risk of congestive heart failure. No joke. 4.6 fold increase of congestive heart failure and a two five fold increase of coronary artery disease. The link to this study will be in the blog post at Hello Uterus.com. You need to read this. There's not a lot of studies out there. And maybe what I should do is have like a post show Cocktail Hour where I read you the study because we absolutely need to understand what they're realizing. And again, I want to point out and I'm going to be repetitive about this because I think it's really important. I don't want to shame anybody who had a hysterectomy who is contemplating a hysterectomy. No shame. None. What I am pointing out there is research, and we need to stay on top of it. We need to inform ourselves, educate ourselves so that we can advocate for our bodies. Now we are going to end on a high note. Oh, my gosh. We need this, don't we? We really, really need this. Actually, I really need this. This Sports bra. Only it's not a bra at all. It's a bar. It is so clever. Jenny Win, this person has gone to the mat for women's sports in such a clever way. It's fantastic. So she is the founder of the Sports Bra in Portland, Oregon. I'm going to Portland, Oregon, just to go to this bar. They probably don't even have gluten free beer, but I'm going to go there anyway. Actually, it's Portland. They probably do have gluten free beer and watch women's sports because get this, that's the only thing on the TVs at the Sports Bra. I want to say that over and over again. The Sports Bra. Jenny Win had an epiphany. She wanted to be able to go out to a sports bar and watch women's sports. And shock of shocks she couldn't find anywhere. So she decided, well, I'm going to open one up. She couldn't get a bank loan. Really? You want a bank loan for a bar for women's sports? Text anyone but Jenny because she wants us to fund a sports bar for women. That can't be a thing. Oh, it's a thing. This is a quote from Jenny. Seeing little girls come in and just stare at the TV or like, point and be like, mom, she's playing basketball. You know, those little ones really catch me off guard. She said, there's barely a day where I don't tear up. I could cry right now. I'm not kidding. These kinds of stories, they really unlock the tier capacity for me because I'm so proud of just humanity. So get this. She got turned down from banks. She couldn't get any funding. So she did a Kickstarter. She raised over $100,000 and it was in a really short period of time and was able to open up the Sports Bra. So again, check it out. It's in Portland, Oregon. If you're in Portland support women's sports because sports and Uterine health are in a tight parallel. Just imagine what it must be like to play a basketball game when you have your period. Women matter, and their careers, sports or not, are just as important as men's careers. And when those careers require you to show up and not be sick, it's pretty challenging when you are literally you have a built in condition that happens every month. And for some of us, it derails our existence. So, Geneva, thank you. I cannot wait to go to The Sports Bra, Portland, Oregon. I'm going to have a cocktail. I could use a cocktail right now after the conversation with Dr. Graul, because all I can think about is how money impacts care. Wait till you hear the after show. We continued our conversation and there's some stuff that she shared that I'm going to be thinking about for a long time and Dr. Graul, thank you again for being on Hello Uterus. I'm stoked to have you come back. I can't wait to talk about incontinence the first time I ever said that. That's a wrap for this week's episode. Thanks to the team at Uterine kind and to our producer angel. She makes it all sound good even when I get really mad. And thank you for listening and subscribing to the show. It's been a thrill to launch this I am so grateful to be here and to have the opportunity to shine a light on these topics and to get into big conversations about them without you. I'm just talking to myself and I do that enough as it is. So please tell your friends, share the podcast let us know what you like, what you don't like, let us know topics that you want us to cover and definitely send in your questions for hear me, hear me. We'll get experts to answer them and so that's like a free consultation. Okay, so show up for that. Check us out on social media. We'll be starting up our TikTok channel this week. We're very excited about that because that's going to allow us to give you breaking news like when Spain does become the greatest country on the face of the Earth. I'll be back next week for another episode of Hello Uterus. I'm excited for what we're cooking up for you next week so please do tune back in. Thanks.