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Dr. Seckin Featured on SiriusXM Radio

Dr. Seckin Featured on SiriusXM Radio

An interview with Dr. Miriam Greene on her show “Dr. Radio: Sexual Health and Gynecology”

This past Monday, March 13th, we had the pleasure of having our founder, Dr. Tamer Seckin featured on SiriusXM Radio earlier this week. Dr. Seckin was interviewed by Dr. Miriam Greene, who has practiced obstetrics and gynecology for over 25 years. Dr. Greene's radio show, "Dr. Radio: Sexual Health and Gynecology," works to educate its viewers by discussing trending topics in women's health, providing not only Dr. Green's expertise to the public but also featured specialists. This past monday, March 13th Dr. Tamer Seckin

Dr. Greene:
Welcome everyone. This is Sexual Health and Gynecology and I'm Dr. Miriam Greene on a freezing cold day here in New York City. I'm so happy to be back and I would like to welcome all my listeners. I have a wonderful show here today. If I can hold my first guest in the studio, he's so nervous and anxious. He's got a very hard job.

Let me just first introduce you to him. Apparently March is endometriosis awareness month. Dr. Seckin is probably one of the most preeminent endometriosis specialists in the country. He's a laparoscopic surgeon, practicing exclusively in the treatment of advanced endometriosis at the Seckin Center for Endometriosis Care and Surgery in New York City. He's affiliated with Lenox Hill Hospital/Northwell Health and is the founder and medical director of the Endometriosis Foundation of America, the first research and efficacy foundation organized by a private physician to raise awareness and emphasize the critical value of early diagnosis and intervention by surgical excision of endometriosis. He's also the author of the book The Doctor Will See You Now: Recognizing and treating endometriosis.

Welcome to the show.

Dr. Seckin:
Thank you for having me.

Dr. Greene:
I'm so happy that you're here. It's funny. Right before this show started, Dr. Seckin's phone rang and he literally panicked. "How long is the show? How long are we going to be here?" Because his patients are really so distressed and so under duress. This patient actually is in the hospital and I can't hear her but I can hear almost the panic in her voice. What is endometriosis? What are the symptoms? How and why does it spread? How can the general GYN treat it? How do you prevent it from getting to that point where the patient's in the hospital and she's under tremendous amount of stress?

I guess we should start with the first question, which is what is endometriosis?

Dr. Seckin:
Endometriosis is a disease of women. It's a disease of menstruation. It's a disease that originates or gets it's cells from the menstrual material. The menstruation material. What makes it as a disease is this menstrual material sits outside the uterus and becomes an inflammation that's oxygen sensitive, often progressive. It sits there but cannot get out. The body constantly fights to remove it, but the inflammation creates scarring.

Over the years, it depends from one patient to another, but this scarring can deform the internal organs and obliterate their functions in a way that interferes with their bowel movements, pain perception, neuropathy, leg pain and all sorts of symptoms that can be associated. All the organs in the pelvis can actually get affected, including big arteries and veins.

Dr. Greene:
Which is what we talked about before. To me, it's not cancer but in a way it's cancer because it can overtake the body in a very malignant way.

Dr. Seckin:
It is not cancer, but it acts like a cancer in the way it stays and spreads in the body, making it difficult to remove. The surgery itself is much different than cancer surgery because cancer cells are many times young cells and scarring is not very heavy and deep in cancer surgery. This is a long process where the cells that have really glued, almost like crazy glue, to different areas of the body making it very difficult to find and remove. Many cancer surgeons don't want to get near endometriosis patients. Period.

Dr. Greene:
I've actually brought generalists into endometriotic surgery because the bowel literally adheres to the posterior portion of the cervix. You can't find the plain between it. It's so obliterated you can't do it. They'd have to rip the rectum out, which is a problem.

Dr. Seckin:
Many times it does. 1 out of 5 the GI system, rectum, bowels are involved. You cannot predict how deep those lesions are until you really start removing it. That's why the surgery becomes challenging. Many of the patients that go back for surgery they have missed bowel lesions and missed deep disease that are not removed. It has to be really stressed that in even more than 1/3 of the early disease cases, symptoms do come back. Many of these patients come back and have repeated surgery. We miss significant early disease in the recognition and in treatment of early endometriosis. Different modalogies are utilized in treating early disease and unfortunately those methods are not related much with removing the disease. Surgeons are burning, lasering and choosing other modalities that are not fully comprehensive forms of lesion removal. This is very important to note, I think.

Dr. Greene:
How many women would you say, statistically, as in "1 in how many..." actually suffer from endometriosis?

Dr. Seckin:
There's only one good study. It's a nurse's study coming from Massachusetts. It's approximately 120,000 patients who go for surgery. In that group, we definitely have 1 in 8 women with endometriosis. However, with today's diagnostic elements we use in definition, I think this number is little over 10%, including the infertility group of women, who are significantly involved with endometriosis. So 1 in 10 women is probably the right answer.

Dr. Greene:
I wrote 1 in 8 but we'll write 1 in 10 because that was a small pool, 120,000 patients. It's probably 1 in 10.

What brings the patient in? What should make the physician suspicious that they may have endometriosis? So many women do report being dismissed by their doctor before they can really get a proper diagnosis. I've heard some crazy stories.

Women being ashamed to talk about their symptoms as they are told such things as, "You're not really a woman as you don't want to take your period."

You hear all sorts of it.

Dr. Seckin:
I think the stigma in these cases can also be seen in the woman's way of looking at it also. Many women look at the other women who have painful periods and are more probably, in my opinion, have a tendency to dismiss it as a possibility. Like everybody else too. They reassure themselves that it is s nothing, even though they may actually have it. Not only that, but their mothers had it and thus a whole family history goes unnoticed. The issue is that type of reassurance plays into the minds of the younger generation, allowing this idea that "their pain is normal" to survive. The same issue goes for doctors as well. There is therefore both patients and doctors who have an awareness issue here that really could help by early detection and break these stigmas and taboos.

The doctors also don't ask the question of do you have painful periods? In other words, the right questions are not being asked whether the patient goes to first a family practitioner or internalist. Some of the right question that should be asked really are, "Does your painful period have any coincidence or overlapping with GI symptoms? Bowel symptoms? Diarrhea? Constipation? Painful period? Urinary symptoms with your IBS? Leg pain? Back pain? And are any of these symptoms significant or overlapping with periods?"

Every doctor should ask ... whatever specialty that they are, how the patient's periods are really behaving.

Dr. Greene:
So what are new diagnostic devices or these methods you speak of that are used in order to find endometriosis? I always feel like endometriosis is really definitively found only if there is a high suspicion by the physician, who will then scope you and use laparoscopy to look inside the body.

Are there other non-invasive approaches or non-invasive tests that you can do to make the diagnosis of endometriosis?

Dr. Seckin:
Unfortunately, there's nothing new as far as early diagnosis of endometriosis whether it is by performing a lab test or any other diagnostic imaging device such as a sonogram, CAT scan or MRI. However, by itself, awareness and vigilance by the doctor's considering endometriosis in their professional diagnosis is the single most important element in improving identifying patients with endometriosis. Usually doctors who really treat endometriosis and are aware of its symptoms and effects on the body, know within 15-20 minutes of questioning whether or not the patient may be suffering from endometriosis. This is due in great part to taking a good and thorough patient history, as well as a physical examination including a sonogram test. Many times, I would say 9 out of 10 in fact, these physicians are correct in their diagnosis of endometriosis upon examining the actual inside of the body in the operating room.

This idea of recognizing endometriosis are, particularly early endometriosis, by certain techniques, is slowly on the rise, especially through new techniques of laparoscopy. Some surgeons are obliterating classical powerful lights with different techniques in order to more clearly visualize believed endometriosis lesions. Our preferred, patented technique is what we call blue dye.

Dr. Greene:
Blue light?

Dr. Seckin:
It is a new dye technique. Whether it is through filtering or creating contrast, our dye makes it much more easy to see early endometriosis lesions, as opposed to just later staged lesions. Classically, endometriosis is recognized with black, blue, berry pigmented lesions in its later stages. But actually 90% of the lesions are not that. They are white.

Dr. Greene:
Amber colored. Clear dots rights?

Dr. Seckin:
Yes, they are like normal colored tissue. It's nothing more than normal appearing tissue. In order to bring this endometriosis tissue to the light, there are techniques called marrow band imaging techniques, that brings the light reflection, which really picks up the diseased tissue. However, I particularly use blue dye contrast technique, specifically blue dye fluid behind the peritoneum. Basically the whole peritoneum is in itself examined without any infraction from the tissues behind. In other words, we get rid of the red and other unnecessary colors. A clear cut.

In fact, this is interesting. I found out later that eye doctors are using this same technique on the retina for when there's blindness and early retina surgery was done to identify the retinal lesion. Because of the powerful light, that escaped from the patient's vision. It's the same idea. I was very amazed to see this.

Dr. Greene:
This is an important point to make, because you're right. Some people will go into the valley and they'll say, "I don't see anything." They don't see those gun powder burns or these discolored lesions, which are really older endometriosis. I find the earlier endometriosis is really missed. You have to have really a strong index of suspicion and also know what you're looking for, which is very, very important.

Dr. Seckin:
We also have recognized the importance of removing the lesions, rather than burning them and lasering them. You know in endometriosis the cells may not behave right. Some of them may have some cancerous tendencies actually. That's why stress the removal of every lesion, and are very adamant, to remove the whole lesion itself and bring it to the attention of pathology. Another doctor examines the tissue under a microscope and really determine what it is. A final diagnosis is made by pathology under a microscope.

Dr. Greene:
Right.

Dr. Seckin:
Rather than a doctor simply calling it endo.

Dr. Greene:
Right. A doctor should always have tissue examined.

Dr. Seckin:
That ensures quality of surgery. That ensures the quality of work that the doctor does and the cause is also confidently pinpointed and a final diagnosis is made. The patient may feel right about what she has. The sad thing is, many times I get patients with no diagnosis at all after having multiple surgeries. The doctor simply just burned the tissue and so on top of having no pathology reports, we don't even see where it was located in the pelvis.

Dr. Greene:
Right. Which is a problem as well.

Dr. Seckin:
It becomes a problem when the patient needs to be re-operated on.

Dr. Greene:
Exactly. It's never the first one. Only in laparoscopy that the patient unfortunately has to undergo sometimes.

We are actually taking questions from anyone who is living with endometriosis or has any questions about endometriosis.

We have a call coming in now from Lisa! Hi Lisa. You're on the line.

Lisa:
Hi there. The question I have pertains to my daughter, who's 22 now but has been having problems for the better part of 8 years. She had so many symptoms that are similar but I feel like so many other syndromes or issues overlap. I guess my question is how early could you be diagnosed with something like this. She has been on almost every birth control. She currently has had to put in the permanent birth control that you inject into your arm and it actually has quit really working to try to control symptoms. They're exactly what you describe. I guess the trigger for me as you were talking was the abdominal type symptoms that she also had in her teenage years. All the way to the point where they were doing colonoscopies to try to rule out Crohn's and IBS. At the same time, she was having all the GYN symptoms with heavy, heavy periods and pain that would last 2-3 weeks at a time. She had a week or two off and then have another 2-3 weeks of heavy periods with pain that would put her on the floor.

How early and how do you distinguish this? She's had CTs and other things.

Dr. Greene:
My earliest patient was 16. That was my earliest patient in the office.

Dr. Seckin:
I think this is the dilemma. When mothers call and mothers are concerned that they already have diagnosed the situation. Let me assure you you're on the right track at least calling today here. I will help you as much as I can. If she has been right now on contraceptive or some progesterone based bar has been placed under her arm and that's the last resort and you say she's getting help right now, I must assure you it's the symptoms that's being treated. There is something else happening with your daughter that sounds like endometriosis. In my opinion, there's a great help from this medicine, which is the birth control pills. Every progesterone like material will help girls and women. However, they are not going to treat the disease itself. They will help the symptoms, but nothing more. It's unfortunate. The disease, in certain cases, is aggressive and has no care for what medicine you use.

For your daughter it's her symptoms that make this evident. Painful periods is overlapping with painful bowel movements and constipation, at times exchanging with diarrhea. If she's sexually active there's pain with intimacy. If there's urinary symptoms, if there's back pain, particularly when she has her periods and if it's reflecting to one leg that she can pinpoint, these are all signs. Listen, there's an endo already causing problems there. It needs to be removed.

The X-rays, MRIs, sonographs may not spot this, unless the disease is advanced, like it's invading the ovary and causing a cyst. An ovarian cyst can actually be an advanced endometriosis actually. But it's causing nodules, will not be seen on a MRI or CAT scan. Only through a thorough doctor's examination will this be evident, when the doctor checks the area behind the cervix and rectum. In that exam your daughter may feel pain during the exam or after the exam or when the doctor is using an ultrasound to examine those areas. It can all be very painful. It's already screaming at you it's endometriosis. It needs to be diagnosed and removed.

Dr. Greene:
The diagnosis is made with a laparoscopy.

Dr. Seckin:
Unfortunately, there is a time that is a "sleepy delay." This is a time wherein surgery shouldn't be done too early. The algorithm of pain and timely intervention has a value, as long as we are all together working with the family and with the patient. Particularly with young patients, the family's role is incredible, especially the mother. The patient should understand what we're doing. Education is big part of it. Avoiding pain medication, narcotics, is a big part of this. Assuring that the right surgical team operates at the right time. Assuring the patient that this diseases is highly treatable is very important. The patient should not lose hope and get lost.

Dr. Greene:
Is Lisa's treatment on the right track?

Dr. Seckin:
It is on the right track because right now the symptoms are controlled. However, despite all these things, if she's still in pain and if she's still experiencing the symptoms, that's alarming, I think. If she is doing excellent, there's nothing to be done probably as long as she wishes. It's the patient's choice. You cannot say no to the patient. I'm not going to do it. She is the one convinced over the years every month. She is the one who's really feeling it. The patient is the boss here.

Dr. Greene:
Lisa, it does sound like the doctor has made the diagnosis. Is that correct?

Lisa:
No. There has been no diagnosis made. They just keep treating her symptoms, thinking the next ... Every time one fails they move on to the next. I think that's what's kind of alarming to my daughter. She's really in charge of a lot of her own care. She's real independent that way. The bar works for about 6 months, maybe a little longer, and then she started getting a lot of breakthrough. Now her periods are almost regular again, which from what she understood wasn't supposed to happen on it. That's what's starting to alarm her again too and makes her wonder why is this starting all over again?

Dr. Seckin:
If her periods started with the bar being under her arm, that means that the longevity of the bar is over. There's some other issue with the right hormone levels in her blood. The bottom line, as you can tell, whether it is being effective or not, her symptoms are coming back. Most importantly, you have to be very vigilant about the specialists. So called GI specialists, they're so good in what they do but they most likely don't really know endometriosis and they don't see endometriosis unless the endometriosis invades the bowel wall. But even still, they don't see the other side of the bowels where the endometriosis invades. Almost 100% of the time, a GI specialist looks inside the bowels, but not on the outside of the bowels where the lesions attach. A GI cannot help this unless they know about the endometriosis. Urinary urologists do the same and cannot help this unless they know. Unfortunately the specialties have gotten so sophisticated in their respective fields that the communication between other specialties has grown very far apart. They don't know each other's issues as well.

As far as gynecologists and our relationship with other doctors, we have great duty to inform other specialists what endometriosis is. All specialists should be talking with one another. From this perspective, the patients are innocent really. You can do so much awareness but if the field of medicine itself does not respond, I think there's a huge problem. Still, I can assure you there are good doctors in town. There are caring doctors in town who knows the surgery very well and can do it and help you with your daughter's issues.

Dr. Greene:
Is there a website that she can go to to find an endometriosis specialist in her area? She's from Indiana.

Speaker 3:
We don't live far from Chicago.

Dr. Seckin:
There are doctors in Chicago, of course. I don't want to give names on the air but basically I can assure you there are very good doctors in the United States who treat endometriosis the way it should be treated. That is removal through excision. I underline the word excision because it's so important. The excision word comes from the way we treat breast cancer or melanoma. When you remove a tissue, pathologists look for the borders, in order to free it from the diseased tissue. Endometriosis is one of those diseases when it is removed, it should be removed completely and as much as possible. Any left endometriosis that is hormonally active will continue to swell or bleed like monthly periods inside. The body will then form additional inflammation.

The surgeon has to become very meticulous. It is precision based. The surgeon has to be very passionate about not leaving any tissue behind. The surgery is once again on one side like cancer surgery. It has to be radical, whether it is conservative or definitive. But on the other side, it's actually like plastic surgery. The tissues have to be reconstructed so the functions of the organs are retained, whether it's the ovary, bowel, bladder or urinary tract. There's a huge amount of inspection and work to be done inside the body. That's why looking for specialists is the smartest thing a mother can do.

Dr. Greene:
Thank you so much Lisa! I think you really opened up a lot of issues that people are going through so we really appreciate your call. We now move on to our next caller, Lynn.

Lynn:
Hi, thanks for taking my call and for having this show on this important topic.

Dr. Greene:
It's very important. Thank you so much for calling. How can we help you?

Lynn:
So, I'm 39, and in the past six months my periods have gone crazy. I've started bleeding for two and three weeks at a time, very heavy periods, passing very serious clots that are enormously painful. My gynecologist has had to try and use different types of estrogen and progesterone just to stop the bleeding. I had to have a blood transfusion. I lost so much blood, I was hospitalized, it's really been crazy.

I've had a lot of imaging and they haven't seen anything that looks like endometriosis to them, but in the most recent sonogram, the radiologist said that we should consider adenomyosis, which he said was a type of endometriosis, but that the only treatment was a total hysterectomy.

I wanted to get your expert advice on whether that might be the case, whether there's other testing or diagnosis that we could do to consider that.

Dr. Greene:
Okay, so, there are, I would say, two types of endometriosis, but it's not really. It's sort of like a subtype of endometriosis. It's called adenomyosis. I call it internal endometriosis. So, now I'm going to just take it to Dr. Seckin and let's hear what he has to say. What do you think?

Dr. Seckin:
Adenomyosis is -

Dr. Greene:
Internal endometriosis!

Dr. Seckin:
Well it is endometriosis occurring inside the uterus. Instead of the glands and menstrual blood escaping, seeping somewhere else in the outside uterus, it's implanting within the muscle portion of the uterus.

Dr. Greene:
Right. And when you get your period, it hurts -

Dr. Seckin:
It's the same symptoms of endometriosis, however, most of the symptoms are seeming like they're coming from the uterus, like heavy bleeding, clots and -

Dr. Greene:
Pain.

Dr. Seckin:
- significant, substantial pain or contractual pain, but it's interesting. Fifty percent of the time, there is endometriosis outside the uterus, too.

Dr. Greene:
Right.

Dr. Seckin:
It depends what the patient's main complaint is. She can be having serious bleeding episodes. She can be anemic and transfused and so forth, so there is uterine disease in this case. Whether the endometriosis is inside the uterine muscle, in general you need to consider it as all over the uterine muscle tissue. Those cases are, unfortunately, difficult to treat with conservative management.

However, there are incidences, which I have dealt myself, when there is focal endometriosis that's confined to one wall, front or back. There's also endometriosis that comes into the uterus from outside due to elements from bladder or bowel areas ... Sometimes, we may get lucky to excise those and reconstruct the uterus. If you are having so much bleeding, one also procedure would be hysteroscopy and ablation of the lining. That will take care of the bleeding. Many of these patients, however, continue to have painful periods even though they've been operated on.

Dr. Greene:
Or they have symptoms when they're supposed to be getting their periods because they're still cycling.

Dr. Seckin:
Their bleeding may decrease with their cycles or the duration-wise, but their pain do not decrease.

Dr. Greene:
So, Lynn, a couple of questions. Are you still interested in fertility?

Lynn:
I actually found all this out because I was pursuing fertility with a reproductive endocrinologist, not successfully, so I'm thinking maybe this is not something that will work for me, so probably no, not into the future, I think. My quality of life is severely diminished (laughs) at this point.

Dr. Greene:
It's interesting about this, because this is what ... It's funny because in doing a fertility work-up, because endometriosis can cause infertility -

Dr. Seckin:
Exactly.

Dr. Greene:
- that's when it's sort of like ... All of a sudden the word comes out. "Oh, maybe you have endometriosis. Maybe you have adenomyosis." And then all of a sudden, after so many years, you've never heard it before, right?

Lynn:
Right, and I'd also say I really appreciate the awareness you're raising here because I really did spend my whole life with very heavy periods, not like what I'm experiencing now, but I always thought I just had to suck it up and take more Ibuprofen and get my work done anyway. Maybe it hasn't ever been normal.

Dr. Seckin:
Let me ask you something ... I'm sure you're aware of it, was your cavity evaluated with hysteroscope or sonohysterography?

Lynn:
Yeah.

Dr. Seckin:
Is there a polyp, anything like that in the cavity?

Lynn:
I did have a polyp earlier, about 11 months ago, they had removed with a whole D&C, but nothing else abnormal. I've had uterine biopsies, we had all the material from the D&C evaluated, which didn't show any sort of cancer cells -

Dr. Seckin:
Did you get a second opinion with a surgeon who exclusively performs these kind of procedures?

Lynn:
No, I have not been able to ... I have not found one. I live in the D.C. area, and maybe I need to look a lot harder. I hadn't really thought about endometriosis until, really, until the radiologist wrote it on their report.

Dr. Seckin:
Well, the bottom line is, you have to know, really, yourself, what you have. In the end, you make the decision.

Dr. Greene:
And also the patient, actually, sometimes makes the diagnosis -

Dr. Seckin:
Of course, of course.

Dr. Greene:
- because they're just so aware. They know.

Dr. Seckin:
The patient knows and tells what the doctor has to do, too, because there is enough information out there it's hard to handle. The issue here is the quality of life, that you already brought up. It's difficult, obviously, when you bleed heavy enough to have transfusion. In the meantime, you have goals of fertility in your agenda, obviously, is a concern ...

Dr. Greene:
I think they should step up the pace though.

Dr. Seckin:
I agree. It's one of the most tough and one of the most challenging elements in endometriosis care, when the decision has to be whether to remove the uterus to increase the quality of life.

Dr. Greene:
Right.

Dr. Seckin:
Can we diagnose other than ways, early? Can we do things about it in other ways? This is probably the hardest part of endometriosis care we are panicking about. In my opinion, adenomyosis can be diagnosed early if it's focal, maybe one day they will do something about it. Yes, we have done people some good with focal adenomyosis, but benefits defused, it's almost impossible to treat this.

Dr. Greene:
And I think it becomes a dilemma for her because she's going for the fertility work-up and she's trying to focus on the fertility issue, and yet somebody's saying the only way to treat adenomyosis is to remove the uterus, and then it becomes problematic and say, "Wait a second I'm going for fertility, now somebody's talking to me about a hysterectomy. But, I've been hospitalized, but I have terrible pain, but I'm bleeding heavily." Those are all the dilemmas and the complexities of your situation that's making decisions very hard for you.

However, on the other note, I do think that they should be a little more aggressive. I think she needs a laparoscopy. I do think she needs for somebody to look in there and be more definitive about what exactly is happening and stop fiddling with all of her hormones right now, but sort of like, focus on let's see what we can do here, and then go to the next step.

Dr. Seckin:
Absolutely. I wouldn't do a hysterectomy unless you want to have a laparoscopy completely diagnosed from the outside of the uterus, there are pictures or video clips are taken, and from inside via hysteroscopy you know what the cavity looks like, and with the MRI get a second opinion with those findings and make a -

Dr. Greene:
Doesn't even sound like she had a hysteroscopy. She had a D&C.

Dr. Seckin:
Exactly. When the laparoscopy is done, it has to be done with the hysteroscopy component -

Dr. Greene:
Oh, absolutely.

Dr. Seckin:
- and have a decent decision in the end.

Dr. Greene:
Yeah, I think you really need to really have a ... shaped up work-up. You know, Lynn?

Lynn:
Got it.

Dr. Greene:
Okay?

Lynn:
Yeah, I have a long to-do list, but I appreciate the guidance.

Dr. Greene:
Oh, thank you. I'm so happy that we were able to help you. So we wish you good luck, and let us know what happens in the future, okay?

Lynn:
Thank you.

Dr. Greene:
You're very welcome.

We are going to continue with our callers because you guys are great. Julie from Massachusetts?

Julie:
Hi.

Dr. Greene:
Hi.

Julie:
My doctor told me that I may have a hemorrhagic ovarian cyst or a endometrioma cyst, and I'm just wondering, do you think that this could become cancerous or should I get a second opinion? It's been over three months since I've had a serious period.

Dr. Seckin:
Quickly, let me help you with this. This is the biggest dilemma when doctors are diagnosing hemorrhagic cysts verus endometriomas. If this cyst has been there more than two months, it's not -

Dr. Greene:
It's not a hemorrhagic cyst.

Dr. Seckin:
It's not a hemorrhagic cyst. If you have symptoms of painful period, or, with this cyst being there, monthly you have some episode of very weird abdominal sensation, discomfort and GI symptoms like nausea at times, pain or constipation, it is telling you there's something up.

Endometrioma itself is the harboring ... The marker of an advanced endometriosis disease. Doctors don't understand this because they haven't seen much of what it does. The endometrioma is like another uterus inside. It bleeds like another cavity.

Dr. Greene:
Right.

Dr. Seckin:
It doesn't bleed like a small amount when it bleeds. It bleeds like a chocolate melting inside. I don't want to scare you, but endometrioma is a serious situation, so many of the advanced endometriosis myths occur because many doctor downplays this. They may not know how to deal with it ... It's a challenging situation.

If you have symptoms ... I don't want to ask whether there's symptoms or not on the radio, but if you have symptoms and the cyst is persisting, I would get a second opinion and get treated.

Dr. Greene:
Yes, I agree.

Dr. Seckin:
We don't even know how old you are, especially if you're young.

Dr. Greene:
I just heard that she said she had no period for three months.

Julie:
Yeah, it's been about three and a half months and I'm 37 now.

Dr. Seckin:
Are you having any symptoms? I have to ask now.

Julie:
I'll feel a slight discomfort down in the abdominal region, like down, like a little cramping, but not really.

Dr. Seckin:
Are you on any medical treatment or any pills?

Julie:
No. Well, my doctor gave me pills to take for five days as she said that it will help bring on the period.

Dr. Greene:
So she might be an ovulatory ... It might be just two separate things going on that -

Dr. Seckin:
It's good to know that, if it's endometrioma, it is ... the visual is very classic on the sonogram, and you can get it -

Dr. Greene:
It looks like dumbbells.

Dr. Seckin:
Exactly. There's a way of differentiating that and you can also do an MRI with contrast. It may give you a different picture of it. They have a way of looking into those cyst contacts.

Dr. Greene:
How large is the cyst?

Julie:
She said three to four centimeters.

Dr. Greene:
It's something that actually has to really be evaluated -

Dr. Seckin:
Well, if it's four centimeters, it is something ... You cannot just sit on it more than three months.

Julie:
She told me to wait two more months before I go back for another ultrasound.

Dr. Seckin:
Well, tell her you're concerned. Do another ultrasound and tell her it will make you feel comfortable.

Dr. Greene:
When was the last scan?

Julie:
About a week ago.

Dr. Greene:
Okay, so do the five days of the B-progesterone, bring on your period, and then I think once you bring on your period, then you can get re-scanned. That's what I would do.

Julie:
Okay. All right.

Dr. Seckin:
It's interesting though, you don't have periods. That's something with endometrioma ... Endometrioma does not cause amenorrhea. It does not delay your period, so you have to bear that in mind, too. Okay?

Julie:
Okay. All right. Well, thank you so much. I appreciate it.

Dr. Seckin:
You're welcome.

Dr. Greene:
You're very welcome, Julie. Thanks so much for calling.


Lots of great callers. I have Tara from New York. Tara, I think has something very interesting to say.

Tara:
Hi.

Dr. Greene:
Hi, how are you?

Tara:
Great, thank you discussing such an important topic. I am 41 years old, and from the age of 20-30 I had three laparoscopies for my endometriosis. It was treated early. Then I saw a fertility specialist for my first pregnancy and went on to have four beautiful baby girls. They're older now -

Dr. Greene:
All at the same time? I hope not all at the same time!

Tara:
No, four in four years. I was able to carry for nine months and they were all healthy and I really appreciated having a doctor who was proactive and that the endometriosis was under control. My question is, now that I am 41, is there a chance that it could come back?

Dr. Greene:
Well, does it really go away? (Laughing)

Tara:
That's true! (Laughing)

Dr. Seckin:
I probably emphasize the fact that the disease is highly treatable. Apparently, you have four kids, it seems like your quality of life is in place -

Dr. Greene:
Horrible already. Quality of life. Four kids, she's like running around -

Tara:
(Laughs)

Dr. Seckin:
In general, your menstrual life is not eventful. I think there's not much to be concerned if you don't have any GI symptoms, your periods are doing well, I don't think there's any reason to be concerned unless there's history of ovarian cancers, this and that, in the family, I wouldn't be worried.

Dr. Greene:
I would definitely use birth control, though, Sweetie.

Tara:
Oh, yeah, we're definitely done. It's nice to know that we're done, too, that four was definitely the final one. But, yes, okay. That makes sense.

Dr. Seckin:
Not on endometriosis control.

Tara:
(Laughs) Yeah, no, not at all. All right, thank you very much.

Dr. Greene:
Thank you, Tara. I think that Tara makes a very good point which is that you can get treated for the endometriosis, and if you aren't, I guess, very proactive about it -

Dr. Seckin:
Well in her case it was timely caught, timely intervention was done and she has her life. That's what the bottom line is.

Dr. Greene:
Right. And then she had treatment, right. Yes, there is fertility issues. Many times, it increases your fertility issues, but I think if you are proactive and you are treated early, there is no reason why you can't have children and I think she was a great point in saying that and I think that that was what was so wonderful about it.


I have Kelly from North Carolina. Kelly, you're on the air.

Kelly:
Yes, hello. Thank you for taking my call.

Dr. Greene:
You're welcome.

Kelly:
The last caller is a great segway into my questions.


I, too, have had endometriosis since I was in my early 20s. I'm 48 now and have three healthy, wonderful children. After my second pregnancy I had my tubes tied because it was a c-section for my twins, and about six months later I started having terrible pains again and my doctor said, "Oh, gosh, Kelly! We've got endometriosis to deal with." It had come back. She has had me on the pill for a good ten years to resolve my endometriosis, and I do not have any problems with my endometriosis.


However, I have three questions and I'm going to go backwards. Is there any other way to treat endometriosis ... I have obviously a mild case and the pill cures that. But is there any other way to treat endometriosis other than the pill for women like me?

Dr. Greene:
So, I think that that's always been trial and error. That's what I think. A lot of people use the pill.

Dr. Seckin:
Yes, but these issues - You are how old? You said you're forty -

Dr. Greene:
Forty-eight.

Dr. Seckin:
Forty-eight. Well, let's roll it back just a little bit. So, basically, endometriosis is a disease that is hormone dependent. Particularly around menopause years, because estrogen-progesterone ratio changes, patients start feeling more symptoms, whether it's endometriosis or not. General menopausal symptoms overlap with symptoms that may also somehow overlap with endometriosis, but the endometriosis symptoms usually may be more pronounced. So if your quality of life is not impacted negatively, I would not try using or manipulated hormones, but if you are symptomatic, there's no harm taking mild birth control pills until you are ready to accept your menopause.

Dr. Greene: I do until 55 if they're pretty healthy.

Dr. Seckin:
Exactly. However, if you really feel like you have seen your symptoms increase with taking estrogen replacement or even menopausal symptoms with birth control, you are like a young girl. You need to be maybe treated well with estrogen removed and move on your replacement therapy until you wish, even till you are over sixty.

Kelly:
I'm on birth control pills and I don't want to give them up and I love you, hearing 55. My doctors have told me between 50 and 52. This is the caveat into my next question. A month ago, I had strained a muscle in my back but I did not realize it was a muscle strain and it went on for a couple ... well for a good solid week and the pain got worse so I went into the ER because I was getting very nervous.

The first thing that the nurse in the ER tested me for was a blood clot because I was on birth control pills, and I wonder, if this is directly related to endometriosis because that is a common way to treat, but do you have the numbers, the statistics, of how many women who have endometriosis on the pill get blood clots? Because that scared me, and I want to ask my doctor to take me off the pill, but she's told me over the phone, "You're no more at risk of having a blood clot at 48 on the pill than you were at 28 on the pill."

I'm just curious as to your professional opinion about blood clots, the pill, and endometriosis.

Dr. Seckin:
First of all, blood clots and endometriosis is a separate issue, and I think it's only birth control on its own that can cause blood clots. A significant chapter of books I'm reading are very concerned about it. There are different opinions on this, but if there's a blood clot formation, even a suspicion of it, we refrain from any hormonal prescriptions, such as birth control.

Dr. Greene:
I agree with you. I think unless you have a clotting issue, which it doesn't sound like you do, if you are at the age of 48, healthy and don't have hypertension or anything cardiovascular issue that might increase your risk for a clot, then I really feel strongly that you're not at any higher risk like your doctor said of having a blood clot from the pill, whether you're 25 or 45... And you don't smoke. I mean, you cannot smoke at all. Smoking will definitely increase your risk of blood clot significantly.

As long as those things are pretty much in place, it should be perfectly fine to take the birth control pill. If you're absolutely frightened to death, I sort of cheat. I don't know how Dr. Seckin feels about this, but I might give a patient a baby Aspirin every other day.

Dr. Seckin:
Well, that's the best idea, I think, in this case.

Dr. Greene:
Yeah, and then you've like, eliminated that sort of blood clot issue. So what do you think about that, Kelly?

[Kelly gets disconnected due to technical difficulties]

Oh, Kelly's down. I'm sorry Kelly, I hope that you got that answer. Well, we're coming towards the end of the show. I know that she had one more question but I don't know what it was.

As far as anything new, anything new down the pike in terms of treatment for endometriosis, or any last words that you might have for physicians or patients that might sort of help increase the awareness of endometriosis out there Dr. Seckin?

Dr. Seckin:
Well, I can tell you one thing. We, at the foundation, have really geared up our awareness campaign for high school students. We have almost reached our goal of raising awareness to over 20,000 students, both boys and girls , in NYC on what is endometriosis and the complications that can arise from it. We're partnered with an L.A. affiliation right now and there's some activity going to be starting there. We have given research grants to software engineers to develop apps, one is coming from Columbia. It should be announced very soon. So be on the lookout.

Dr. Greene:
Wonderful.

Dr. Seckin:
We have also, starting to raise awareness in the D.C. area for the college-aged girls, and are working to study the incidences of endometriosis there.

Dr. Greene:
Wonderful. So it sounds like there is a lot down the pike. Again, Dr. Seckin, thank you so much for coming on the show. We thank you all for tuning in. 

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