{"id":426,"date":"2020-08-13T20:36:46","date_gmt":"2020-08-13T20:36:46","guid":{"rendered":"https:\/\/brooksidepress.org\/basic_obgyn\/?page_id=426"},"modified":"2020-08-13T20:36:46","modified_gmt":"2020-08-13T20:36:46","slug":"uterine-fibroids","status":"publish","type":"page","link":"https:\/\/brooksidepress.org\/pa_obgyn\/advanced-training\/uterine-fibroids\/","title":{"rendered":"Uterine Fibroids"},"content":{"rendered":"<p><iframe loading=\"lazy\" title=\"vimeo-player\" src=\"https:\/\/player.vimeo.com\/video\/112209724\" width=\"640\" height=\"360\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><\/iframe><\/p>\n<p>Duration 6:00<\/p>\n<input type='hidden' bg_collapse_expand='69e9b5545d9bf1040040056' value='69e9b5545d9bf1040040056'><input type='hidden' id='bg-show-more-text-69e9b5545d9bf1040040056' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b5545d9bf1040040056' value='Hide Transcript'><button id='bg-showmore-action-69e9b5545d9bf1040040056' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#ffffff;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b5545d9bf1040040056' ><\/p>\n<p class=\"p2\">Uterine fibroids, also known as leiomyomas, are common, benign, smooth muscle tumors of the uterus. They are found in nearly half of women over age 40 and infrequently cause problems. Synonyms include Fibroids, Myomas, and Leiomyomata.<\/p>\n<p class=\"p2\">Fibroids tend to grow under the influence of estrogen, and regress when the estrogen levels are reduced. Thus, growth frequently occurs during pregnancy, followed by regression following delivery. After the onset of menopause, fibroids generally regress.<\/p>\n<p class=\"p2\">High-dose birth control pills, by virtue of their high estrogen content, can cause fibroids to grow larger. Low-dose birth control pills, in contrast, leave circulating estrogen levels the same (or reduced) and do not stimulate fibroid growth. Low doses of estrogen used to treat menopausal symptoms usually do not stimulate fibroid growth.<\/p>\n<p class=\"p2\"><b>Symptoms\u00a0<\/b>Most women with uterine fibroids have no symptoms, but some do. Symptoms that might be experienced include:<\/p>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li class=\"p2\"><b>Heavy menstrual flows<\/b>: This happens more often with submucous fibroids (just below the surface of the endometrium) that expand the cavity size leaving a much larger surface area for bleeding. Pedunculated fibroids that protrude into the uterine cavity and also cause\u00a0menorrhagia or heavy bleeding by interfering with the normal contractile mechanisms of the uterus.<\/li>\n<li class=\"p4\"><b>Another symptom can be Bleeding between periods<\/b>: Pedunculated fibroids and submucosal fibroids can mechanically traumatize the uterine lining, leading to dysfunctional bleeding.<\/li>\n<li class=\"p4\"><b>Another symptom is Pain<\/b>: This may take the form of menstrual cramps, painful intercourse on deep penetration, pain of acute fibroid degeneration, and chronically inflamed fibroids with a dull, aching or heaviness that is mostly constant.<\/li>\n<li class=\"p4\"><b>Infertility is sometimes related to fibroids<\/b>: Fibroids, depending on their location, can interfere with fertility.<\/li>\n<li class=\"p4\"><b>There\u2019s also Pelvic Pressure<\/b>: This heaviness in the pelvis is distracting and annoying but not dangerous.<\/li>\n<li class=\"p4\"><b>Stress Urinary Incontinence may be a symptom<\/b>: The fibroid bulk and irregular contour of fibroids can distort the pelvic anatomy sufficiently to interfere with normal urinary retention and release.<\/li>\n<li class=\"p2\"><b>Finally,\u00a0<\/b>If large enough and filling the pelvis, fibroids can put pressure on and partially obstruct the ureters, increasing the risk of infection, stones and renal disease.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p class=\"p2\"><b>Clinical Findings are usually straightforward.<\/b><\/p>\n<p class=\"p2\">The uterus is irregularly enlarged and usually somewhat asymmetrical. It may be tender and may assume very large sizes. Unlike the soft uterus containing a pregnancy or adenomeiosis, the fibroid uterus is very firm.<\/p>\n<p class=\"p2\"><b>Confirmation of Diagnosis<\/b><\/p>\n<p class=\"p2\"><b><\/b>The diagnosis is usually based on the clinical findings of an enlarged, irregularly shaped, firm uterus that may or may not be tender. Sometimes, the diagnosis is unclear and\u00a0diagnostic tests are used to delineate the fibroids and rule out other problems.<\/p>\n<p class=\"p2\"><b>Ultrasound\u00a0<\/b>is a reliable means to show the fibroids and distinguish between ovarian and uterine growth.<\/p>\n<p class=\"p4\"><b>MRI and CT Scanning\u00a0<\/b>can be useful, showing, for example, whether the ureter is obstructed and ruling out bowel involvement.<\/p>\n<p class=\"p4\"><b>Laparoscopy\u00a0<\/b>is Rarely used for diagnostic purposes when considering fibroids, but it might occasionally be used for confirming the diagnosis of fibroids as opposed to an adnexal mass.<\/p>\n<p class=\"p2\">As the risk of malignancy in a mass thought clinically to be a fibroid is &lt;1%, histology is only infrequently chosen to make the diagnosis of fbroids, you are concerned because of rapid growth or other quickly evolving symptoms<\/p>\n<p class=\"p2\">Let\u2019s consider\u00a0<b>Mangement Options.\u00a0<\/b>No single treatment plan is best for all women with fibroids. In most cases, no treatment is required. The fibroids are measured and observed over time, with the expectation that at menopause, they will regress. However, for those with significant symptoms, very large fibroids, or rapidly growing fibroids, a number of treatments can be considered. Important factors in deciding therapy are the severity of the symptoms, associated symptoms, age, and preservation of fertility:<\/p>\n<p class=\"p2\">Hysterectomy is the only permanent cure for fibroids. It provides definitive treatment, but requires major surgery, abdominal, vaginal or laparoscopic.<\/p>\n<p class=\"p2\">For women who wish to preserve their childbearing capacity, Myomectomy, or removal of just the fibroids, while leaving the uterus alone, could be the best option. Unfortunately, myomectomy is often a more\u00a0complicated procedure than hysterectomy, involving longer recovery, greater risk of blood transfusion and greater risk of infection. There is no certainty following surgery that other fibroids will not grow.<\/p>\n<p class=\"p2\">Birth Control Pill and other Progestins are sometimes used to treat fibroids. While these will not shrink fibroids, they may be effective enough in controlling the symptoms (particularly bleeding) that the patient can make it through to menopause.<\/p>\n<p class=\"p2\">GnRH Analogs such as Lupron can also be used. Through suppression of the release of gonadotropins, these GnRH Analogs effectively reduce estrogen concentration to menopause or near menopause levels. This has the desired effect of shrinking the fibroids. Unfortunately, after 6 months, when the GnRH must be stopped, the fibroids will rapidly re-grow, making this only a temporary treatment. But temporary treatment may be very satisfactory if the goal is to shrink the fibroids to a more manageable size prior to surgery. The menopausal symptoms can usually be controlled with add back estrogen, if desired.<\/p>\n<p class=\"p2\">Embolization is another option in some areas. Under interventional radiology guidance, a catheter is threaded through the uterine arteries and a bolus of tiny plastic pellets injected. These pellets lodge in the small arterioles leading to the fibroids, reducing their blood flow and causing necrosis. Good results have been reported in a limited number of cases by skilled hands in a few centers. Serious complications have also been noted, leading to emergency surgery and life-threatening problems. Whether this approach will prove to be widely accepted remains to be seen.<\/p>\n<p><\/div>\n<hr \/>\n<p><iframe loading=\"lazy\" src=\"https:\/\/www.youtube.com\/embed\/Bzx17Sa0jAY\" width=\"560\" height=\"315\" frameborder=\"0\" allowfullscreen=\"allowfullscreen\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><\/p>\n<p>Duration 9:23<\/p>\n<input type='hidden' bg_collapse_expand='69e9b5545de747014812888' value='69e9b5545de747014812888'><input type='hidden' id='bg-show-more-text-69e9b5545de747014812888' value='Show Transcript'><input type='hidden' id='bg-show-less-text-69e9b5545de747014812888' value='Hide Transcript'><button id='bg-showmore-action-69e9b5545de747014812888' class='bg-showmore-plg-button bg-blue-button  '   style=\" color:#f7f5f5;\">Show Transcript<\/button><div id='bg-showmore-hidden-69e9b5545de747014812888' ><\/p>\n<p>&#8211; To hear that there&#8217;s a chance that you might<br \/>\n00:02<br \/>\nlose your uterus, is unnerving to say the least.<br \/>\n00:10<br \/>\nThe first indication that I had fibroids was fatigue.<br \/>\n00:13<br \/>\nI got to a point where I was always tired.<br \/>\n00:16<br \/>\nAnd I found myself always sleeping<br \/>\n00:18<br \/>\nand not feeling rested.<br \/>\n00:19<br \/>\nAnd so while I had other symptoms before then,<br \/>\n00:22<br \/>\nthat was the main indicator to me that<br \/>\n00:24<br \/>\nsomething was wrong, you need to figure out what it is.<br \/>\n00:26<br \/>\n&#8211; What led me to the doctor was the ER,<br \/>\n00:29<br \/>\nbut I will go back.<br \/>\n00:30<br \/>\nAbout eight months before I ended up in the ER<br \/>\n00:34<br \/>\nand then with my new doctor,<br \/>\n00:35<br \/>\nI was having super heavy cycles,<br \/>\n00:38<br \/>\nI couldn&#8217;t even function when my cycle was on.<br \/>\n00:40<br \/>\nI&#8217;ve always had very heave and sometimes painful periods<br \/>\n00:43<br \/>\nbut I could normally take an ibuprofen and be cool.<br \/>\n00:47<br \/>\n&#8211; I&#8217;ve always been anemic and I just attributed that<br \/>\n00:50<br \/>\nto genetics and my environment<br \/>\n00:52<br \/>\nand it wasn&#8217;t until late twenties<br \/>\n00:55<br \/>\nwhen I felt like my anemia was impacting my quality of life.<br \/>\n01:01<br \/>\n&#8211; I found out later that I was very anemic,<br \/>\n01:04<br \/>\nto a point where, as it started to get worse<br \/>\n01:06<br \/>\nand started to progress, I was always cold<br \/>\n01:08<br \/>\nand could never ever get warm.<br \/>\n01:10<br \/>\n&#8211; I go to the doctor and I&#8217;m like, &#8220;Hey it&#8217;s time<br \/>\n01:13<br \/>\n&#8220;for my pap smear but I have these questions<br \/>\n01:15<br \/>\n&#8220;because my body is doing things that are even abnormal<br \/>\n01:19<br \/>\n&#8220;for me and I&#8217;m a person with a heavier cycle.&#8221;<br \/>\n01:22<br \/>\nSo I told them what was going on and he was like,<br \/>\n01:24<br \/>\n&#8220;Oh okay, no problem, I&#8217;m just going to give you<br \/>\n01:27<br \/>\n&#8220;some birth control and you should be good.&#8221;<br \/>\n01:29<br \/>\nWell I&#8217;ve heard people that take birth control<br \/>\n01:31<br \/>\nthat feel better in a couple of months.<br \/>\n01:33<br \/>\nI was like, &#8220;Okay, so that&#8217;s gonna be my story.&#8221;<br \/>\n01:35<br \/>\n&#8211; My period started to get very heavy.<br \/>\n01:38<br \/>\nDefinitely a big indicator I think<br \/>\n01:39<br \/>\nfor a woman anytime your menstrual cycle changes.<br \/>\n01:42<br \/>\n&#8211; First I tried to manage the symptoms in terms<br \/>\n01:44<br \/>\nof my anemia, then I realized that I was losing weight.<br \/>\n01:48<br \/>\nI&#8217;m a small person to begin with and when I got down<br \/>\n01:51<br \/>\nto 105 pounds, I wondered if it was stress<br \/>\n01:54<br \/>\nbut then I said, &#8220;Wait a second, what&#8217;s happening?&#8221;<br \/>\n01:56<br \/>\nSo I went to my ob\/gyn again and I realized that I&#8217;d<br \/>\n01:59<br \/>\nlost so much blood because of my heavy periods.<br \/>\n02:03<br \/>\nAnd then he ordered immediately a blood transfusion.<br \/>\n02:06<br \/>\nSo I was a bit nervous about a blood transfusion<br \/>\n02:08<br \/>\nso I said what are my options?<br \/>\n02:10<br \/>\nAnd then he recommended iron infusions<br \/>\n02:12<br \/>\nand that was a way to build my iron up.<br \/>\n02:14<br \/>\n&#8211; When I can think back to maybe there was the first change<br \/>\n02:17<br \/>\nin my cycle, was about two years before I actually<br \/>\n02:21<br \/>\nhad my surgery to have them removed.<br \/>\n02:23<br \/>\nBut again at that time I didn&#8217;t recognize anything.<br \/>\n02:25<br \/>\nThat was probably, when I think back, the very first,<br \/>\n02:28<br \/>\ncould&#8217;ve been the earliest symptom.<br \/>\n02:30<br \/>\nThe one thing about fibroids is that<br \/>\n02:32<br \/>\nthey don&#8217;t know how fast they grow.<br \/>\n02:33<br \/>\nThey progress differently in every single person.<br \/>\n02:35<br \/>\n&#8211; Every cycle I&#8217;m still having the same exact period.<br \/>\n02:39<br \/>\nNot only is it the same for a few months,<br \/>\n02:41<br \/>\nit starts to get worse.<br \/>\n02:42<br \/>\nThe bleeding&#8217;s heavier, the periods are lasting longer,<br \/>\n02:45<br \/>\nthe pain is worse.<br \/>\n02:47<br \/>\nAnd I&#8217;m like, &#8220;Okay, well maybe it&#8217;s just<br \/>\n02:48<br \/>\n&#8220;the wrong birth control.&#8221;<br \/>\n02:50<br \/>\nBut honestly I didn&#8217;t even feel like<br \/>\n02:51<br \/>\ngoing back to the doctor, so I just kind of ran with it<br \/>\n02:55<br \/>\nuntil I landed in the ER.<br \/>\n02:56<br \/>\n&#8211; Over the course of a year, I did every other week<br \/>\n02:59<br \/>\niron infusions and we checked it after a while,<br \/>\n03:02<br \/>\nand it was still low.<br \/>\n03:04<br \/>\nHe said, &#8220;You may want to consider options<br \/>\n03:06<br \/>\n&#8220;to getting your fibroids removed.&#8221;<br \/>\n03:08<br \/>\nAnd I was really nervous because I didn&#8217;t want<br \/>\n03:10<br \/>\nto go do any kind of invasive surgery.<br \/>\n03:11<br \/>\nSo there&#8217;s a procedure I opted for initially<br \/>\n03:15<br \/>\nwhich was MyoSure.<br \/>\n03:16<br \/>\nIt was an outpatient experience so no down time,<br \/>\n03:19<br \/>\nwas able to go back to work in two days.<br \/>\n03:22<br \/>\n&#8211; My doctor, as soon as she went to examine me,<br \/>\n03:25<br \/>\nshe was able to feel the fibroids.<br \/>\n03:27<br \/>\nAnd she was able to feel that they were pretty sizable.<br \/>\n03:30<br \/>\nWe initially didn&#8217;t want to have surgery,<br \/>\n03:32<br \/>\ndoctors try to avoid that if they don&#8217;t need to<br \/>\n03:34<br \/>\nbut my symptoms progressed so much that<br \/>\n03:35<br \/>\nnot only did I end up having to have surgery<br \/>\n03:37<br \/>\nwe moved it up.<br \/>\n03:38<br \/>\n&#8211; The day before I went to the ER I was taking a shower,<br \/>\n03:42<br \/>\nand then next thing I know I&#8217;m blacking out.<br \/>\n03:44<br \/>\nThe next day I got up and went into work<br \/>\n03:46<br \/>\nand I was still in all this pain but<br \/>\n03:48<br \/>\nI&#8217;m like, I&#8217;ve been doing this since I&#8217;ve had a period,<br \/>\n03:51<br \/>\nI&#8217;m not gonna not go to work because of my period.<br \/>\n03:53<br \/>\nSo I&#8217;m sitting at my desk and next thing I know,<br \/>\n03:56<br \/>\nI get this pain that was so severe.<br \/>\n03:59<br \/>\nI go to the bathroom and as a person with a heavy cycle<br \/>\n04:03<br \/>\nto say that I was completely freaked out<br \/>\n04:07<br \/>\nwhen I went to the restroom,<br \/>\n04:09<br \/>\nI was like, &#8220;OMG, am I hemorrhaging?&#8221;<br \/>\n04:12<br \/>\nI call the advise nurse and I&#8217;m telling her<br \/>\n04:15<br \/>\nwhat my symptoms are and she&#8217;s like<br \/>\n04:16<br \/>\n&#8220;You need to go to the ER, you can&#8217;t even wait for<br \/>\n04:19<br \/>\n&#8220;a next day appointment, you need to go.&#8221;<br \/>\n04:22<br \/>\n&#8211; I was like, &#8220;Okay cool.<br \/>\n04:23<br \/>\n&#8220;Let&#8217;s see what my next cycle will tell me.&#8221;<br \/>\n04:27<br \/>\nAnd after that it just got worse<br \/>\n04:29<br \/>\nto the point where, I was filling a maxi-pad,<br \/>\n04:33<br \/>\nan overnight pad, in an hour.<br \/>\n04:35<br \/>\nI was extremely insecure about being anywhere public<br \/>\n04:39<br \/>\nduring that time.<br \/>\n04:40<br \/>\nI just did this procedure, why is it even<br \/>\n04:43<br \/>\nworse than it was before?<br \/>\n04:45<br \/>\nSo that was the point where I decided,<br \/>\n04:47<br \/>\nwith consultation from the doctor and my family<br \/>\n04:50<br \/>\nthat I needed to get a myomectomy.<br \/>\n04:51<br \/>\n&#8211; When she confirmed that I had them,<br \/>\n04:53<br \/>\nthat was a relief in a way<br \/>\n04:55<br \/>\nto know that that&#8217;s what was wrong.<br \/>\n04:57<br \/>\nWhat did kind of hit me and what got me the most nervous<br \/>\n05:01<br \/>\nand scared about them was when<br \/>\n05:03<br \/>\nwe talked about having surgery.<br \/>\n05:05<br \/>\nAnd anytime they tell you you have to have surgery,<br \/>\n05:07<br \/>\nthere are risks associated with it.<br \/>\n05:08<br \/>\nThey&#8217;re going to do surgery to remove some things<br \/>\n05:11<br \/>\ninside and outside your uterus.<br \/>\n05:13<br \/>\nThere&#8217;s always a risk that you could lose it.<br \/>\n05:15<br \/>\nI cried about it, I thought about it,<br \/>\n05:17<br \/>\nI overthought it.<br \/>\n05:17<br \/>\nI realized I still had to do it,<br \/>\n05:19<br \/>\nin order to at least attempt to keep a healthy uterus<br \/>\n05:23<br \/>\nto hopefully be able to have children later.<br \/>\n05:25<br \/>\n&#8211; I go to the ER, and I&#8217;m signing in and<br \/>\n05:27<br \/>\nthey&#8217;re asking me what my symptoms are<br \/>\n05:28<br \/>\nand again I&#8217;m still feeling like a complete idiot<br \/>\n05:32<br \/>\nbecause here I am telling these nurses that<br \/>\n05:34<br \/>\nI&#8217;m coming to the ER for my period.<br \/>\n05:37<br \/>\nI almost felt like I was being judged,<br \/>\n05:39<br \/>\nI probably wasn&#8217;t, it was probably all in my head<br \/>\n05:41<br \/>\nbut I felt like it.<br \/>\n05:42<br \/>\nAnd the doctor comes in and they take my blood count,<br \/>\n05:45<br \/>\nand he was like, &#8220;You&#8217;ve lost almost enough blood<br \/>\n05:48<br \/>\n&#8220;to warrant a blood transfusion.&#8221;<br \/>\n05:50<br \/>\n&#8211; They had to build up my iron to get the myomectomy,<br \/>\n05:52<br \/>\nso a series of months again, doing the iron infusions.<br \/>\n05:56<br \/>\nDecember 15 of 2011 was when I had my myomectomy surgery.<br \/>\n06:00<br \/>\n&#8211; Come to find out the doctor that I went to see<br \/>\n06:03<br \/>\nabout the symptoms eight months earlier,<br \/>\n06:05<br \/>\nthat gave me the birth control,<br \/>\n06:07<br \/>\nhe didn&#8217;t tell me I was anemic.<br \/>\n06:09<br \/>\nSo I&#8217;m severely anemic at that point<br \/>\n06:11<br \/>\nand then this happens and of course<br \/>\n06:13<br \/>\nthat takes my blood levels all the way down.<br \/>\n06:16<br \/>\n&#8211; Fast forward, had my myomectomy, great,<br \/>\n06:18<br \/>\ngot married and of course we want to start a family.<br \/>\n06:21<br \/>\nAnd the first thing I did when I went to my doctor<br \/>\n06:24<br \/>\nwas check to see if I had fibroids, and lo and behold<br \/>\n06:27<br \/>\nthey came back.<br \/>\n06:28<br \/>\n&#8211; I think having all of the symptoms before<br \/>\n06:31<br \/>\nI was able to recognize certain things that were happening<br \/>\n06:34<br \/>\nto my body that made me feel like they were back.<br \/>\n06:36<br \/>\nI only found out this past June for sure that they were.<br \/>\n06:39<br \/>\nIt&#8217;s pretty common.<br \/>\n06:40<br \/>\nI believe it&#8217;s at least there&#8217;s a 50% chance<br \/>\n06:43<br \/>\nthat they can recur.<br \/>\n06:44<br \/>\n&#8211; We have not discussed any non-surgical options.<br \/>\n06:47<br \/>\nIt really comes down to which type of surgery I&#8217;ll need.<br \/>\n06:51<br \/>\nAnd to be honest, even if she were able to put me<br \/>\n06:53<br \/>\non a different birth control or do something like that,<br \/>\n06:57<br \/>\nhonestly I want this fibroid out.<br \/>\n06:59<br \/>\nTo say that the last year and a half has been awful,<br \/>\n07:03<br \/>\nthat&#8217;s an understatement.<br \/>\n07:04<br \/>\n&#8211; A few years ago I&#8217;d gone through the procedure,<br \/>\n07:06<br \/>\nand in less than three years they came back.<br \/>\n07:08<br \/>\nI was really nervous when we were thinking about conceiving,<br \/>\n07:11<br \/>\nwhat would happen.<br \/>\n07:12<br \/>\nAnd fortunately for us, we were able to conceive,<br \/>\n07:15<br \/>\nand the fibroids and the fetus coexisted.<br \/>\n07:19<br \/>\n&#8211; Fibroids themselves are fairly common.<br \/>\n07:21<br \/>\nMost people just don&#8217;t know that they have them.<br \/>\n07:23<br \/>\nA lot of people go through life with them<br \/>\n07:26<br \/>\nand just don&#8217;t really have symptoms at all.<br \/>\n07:28<br \/>\nAnd that&#8217;s why they don&#8217;t know a lot about it,<br \/>\n07:31<br \/>\nNot until people have symptoms, &#8217;til they come in<br \/>\n07:33<br \/>\nand we found out that something is wrong with them.<br \/>\n07:35<br \/>\n&#8211; In all my research that I&#8217;ve done on fibroids<br \/>\n07:39<br \/>\nI found out that it affects African-American women<br \/>\n07:42<br \/>\nmore prominently than any other race.<br \/>\n07:45<br \/>\nAnd as I think about my friends, I can count probably<br \/>\n07:48<br \/>\nover a dozen of my friends who&#8217;ve either had a myomectomy,<br \/>\n07:51<br \/>\nfibroids or something of that nature.<br \/>\n07:54<br \/>\nAnd it&#8217;s a bit disheartening because you just think about<br \/>\n07:57<br \/>\nsomething&#8217;s that prevalent, it&#8217;s just like<br \/>\n07:59<br \/>\nyou have the myomectomy, you have these other procedures,<br \/>\n08:02<br \/>\nbut they grow back,<br \/>\n08:02<br \/>\nso it&#8217;s like why are they growing back?<br \/>\n08:04<br \/>\n&#8211; We do so much.<br \/>\n08:06<br \/>\nWe have to come in to work and succeed,<br \/>\n08:09<br \/>\nwe have to be fly outside of work,<br \/>\n08:11<br \/>\nwe have babies, we take care of homes.<br \/>\n08:14<br \/>\nBut the thing that we don&#8217;t always do<br \/>\n08:16<br \/>\nis take care of ourselves.<br \/>\n08:18<br \/>\nPut your health first, if there is something wrong,<br \/>\n08:20<br \/>\nand you haven&#8217;t been to the doctor<br \/>\n08:22<br \/>\nor you&#8217;re afraid to go because you don&#8217;t have insurance,<br \/>\n08:25<br \/>\nlook into other options.<br \/>\n08:27<br \/>\nAnd for women who do have the insurance,<br \/>\n08:30<br \/>\nbut don&#8217;t make the time, go make the time.<br \/>\n08:33<br \/>\nBecause at the end of the day, you only get one body.<br \/>\n08:36<br \/>\nAnd if you&#8217;re not taking care of that one body, then what?<br \/>\n08:39<br \/>\n&#8211; I have two lessons.<br \/>\n08:40<br \/>\nOne is about really doing your own research.<br \/>\n08:43<br \/>\nOnce you are able to do that and understand<br \/>\n08:45<br \/>\nwhat&#8217;s happening, you are a better patient<br \/>\n08:48<br \/>\nbecause you know what questions to ask your doctor<br \/>\n08:50<br \/>\nand can advocate on behalf of yourself.<br \/>\n08:52<br \/>\nThe second thing I learned, I think perhaps<br \/>\n08:54<br \/>\nthe most important was that sharing is caring.<br \/>\n08:58<br \/>\nSo the idea of me sharing this with my friends<br \/>\n09:01<br \/>\nand family members and not keeping it to myself<br \/>\n09:04<br \/>\noffered me the opportunity to gain<br \/>\n09:06<br \/>\nmuch more knowledge than I initially had.<\/p>\n<p><\/div>\n<hr \/>\n<p>&nbsp;<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Duration 6:00 \ufeff Duration 9:23 &nbsp;<\/p>\n","protected":false},"author":1,"featured_media":0,"parent":160,"menu_order":13,"comment_status":"closed","ping_status":"closed","template":"","meta":{"footnotes":""},"class_list":["post-426","page","type-page","status-publish","hentry"],"_links":{"self":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/426","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages"}],"about":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/types\/page"}],"author":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/users\/1"}],"replies":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/comments?post=426"}],"version-history":[{"count":0,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/426\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/pages\/160"}],"wp:attachment":[{"href":"https:\/\/brooksidepress.org\/pa_obgyn\/wp-json\/wp\/v2\/media?parent=426"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}