Full Spectrum of Gynecologic Care

by CHERYL SOOHOO | photography by LAURA BROWN

New clinical programs provide collaborative, cutting-edge care for women of all ages.




“I am a very happy patient,” says Umang Singh of Lake Forest, Illinois.

In summer 2003, after trying to start a family with no luck and seeing several doctors, Singh, then in her 30s, sought help from Magdy Milad, MD, MS, chief of Gynecology and Gynecologic Surgery at Northwestern Memorial Hospital. He found the cause of her infertility: advanced endometriosis. After undergoing small-incision laparoscopic surgery, Singh became pregnant five months later.

Fast forward 13 years. In summer 2016, Singh, now a mother of three, began experiencing heavy uterine bleeding to the point of developing anemia. Her endometriosis had seemingly “returned with a vengeance.” She was told by a gynecologist that a radical hysterectomy and early menopause were in her immediate future, but didn’t believe that was her best option. Neither did Milad. That November, he performed a minimally invasive procedure that quickly alleviated Singh’s problem.

From puberty to menopause, women like Singh keep their reproductive systems healthy with annual checkups and general gynecologic care from their regular gynecologists and primary care physicians. But when routine care becomes something more challenging, obtaining specialized gynecological expertise for complex conditions can frequently result in a disjointed endeavor for patients and physicians alike. Many women must seek answers to their “female” problems on their own, going from one specialist referral to another to find care that best addresses their needs — until now.

In July, Northwestern Medicine launched the Center for Comprehensive Gynecology (CCG) at Northwestern Memorial Hospital, with Milad as its medical director. Featuring a one-of-a-kind multidisciplinary approach, the new center offers women a unique one-stop shop for highly specialized care for complex gynecological disorders and diseases. Housed in the Northwestern Medicine Lavin Family Pavilion, the center integrates the expertise of minimally invasive gynecologic surgeons, interventional radiologists, physiatrists, physical therapists, psychologists and others. All working together as a team in one place and space, these experts deliver collaborative leading-edge care that is patient-centered rather than procedure-focused.

Our mission is to treat women across the spectrum of their lives with leading-edge technology and the latest therapies.

“Our mission is to treat women across the spectrum of their lives with leading-edge technology and the latest therapies,” says Serdar Bulun, MD, the chair and John J. Sciarra Professor of Obstetrics and Gynecology. “Our approach is agnostic across the specialties. It’s not a matter of medical therapy versus surgery versus an interventional radiology procedure. Our goal is to provide the best treatment and follow-up for each and every patient.”

The Center for Comprehensive Gynecology (CCM) team, from left to right: Susan Tsai, MD, Angela Chaudhari, MD, Magdy Milad, MD, MS, and Patricia Handler, MSN.

Milad, medical director of the CCM, is chief of Gynecology and Gynecologic Surgery at Northwestern Memorial Hospital.

The two centers share space and staff in the Northwestern Memorial Lavin Family Pavilion.

Un-Complicating the Complex

Every day, experienced physicians care for women with fibroids, endometriosis, ovarian cysts, uterine abnormalities or tubal disease. While all very common problems of the female reproductive system, they can sometimes become, well, complicated.

“We provide highly integrated specialized care that frequently goes beyond the purview of the general obstetrician/gynecologist,” explains Milad, who is also the Albert B. Gerbie, MD, Professor of Obstetrics and Gynecology and chief of Minimally Invasive Gynecologic Surgery at Feinberg. “Many women with fibroids or in menopause, for example, receive wonderful care from their regular doctors. But if a woman has fibroids so large they are affecting fertility or severe menopausal symptoms that are disrupting their lives, we can help.”

The collaborative approach of the CCG is a particularly distinguishing feature, especially in the case of fibroid treatment. Noncancerous uterine tumors, fibroids can cause a host of symptoms from heavy menstrual bleeding to pelvic pressure and pain. Treatment strategies range from gynecologic surgery (open and minimally invasive) to remove them and/or the uterus, to minimally-invasive interventional radiology procedures such as uterine fibroid embolization (UFE) to shrink them. The options, though, are provided by different physicians: the former, gynecologists and the latter, interventional radiologists. Typically, the two specialty areas work in separate silos, forcing patients to do the legwork. Northwestern Medicine’s CCG may be the first to unite interventional radiologists and gynecologists in one location to jointly see patients.

“It’s unheard of,” says Milad of this rare partnership. “Working physically side by side allows us to offer patients the best treatment strategy for their particular situation and provide thorough follow-up as a team.”

UFE has only been available in the United States since the mid-1990s. One of the early pioneers in the relatively young field, Northwestern Medicine’s interventional radiology team is a national leader in this innovative, nonsurgical alternative to hysterectomy.

Unlike other programs that make the diagnosis and then refer patients out to other specialists, we bring experts to the center to see our patients.

Sexual Health Revolution

Embarrassment prevents many women from bringing up difficulties with sex — from lack of desire to painful intercourse — with their doctors. Yet an estimated 40 percent of women of all ages have physical, medical, hormonal or emotional issues that can interfere with intercourse and intimacy.

“Sexual medicine as well as menopause are two unmet elements of women’s health that often go unaddressed either because the patient is reluctant to discuss symptoms with their physician or the patient and/or their doctor doesn’t know there are clinical experts with solutions to their problems,” says Lauren Streicher, MD, medical director of a recently established Northwestern Medicine clinical center focused on filling this void in the care of women.

In October, the new Center for Sexual Medicine and Menopause (CSMM) opened its doors. Sharing space and staff with the CCG, the CSMM brings together a multidisciplinary team of physicians, advanced practice nurses, certified sex therapists and pelvic floor physical therapists. Comprised of three major areas of expertise, the center offers clinical programs in sexual medicine, menopause and vulvovaginal disorders. In addition to providing a broad array of both hormonal and non-hormonal treatment options, the clinic also features state-of-the-art technology such as the Mona Lisa Touch, a medical CO2 laser that stimulates vulvar and vaginal tissue to restore lubrication and elasticity.

Many major academic medical centers provide some level of sexual medicine or menopause services, especially for patients with specific illnesses like cancer. The CSMM not only addresses the impact of other illness, such as diabetes and heart disease, but also utilizes a collaborative approach that sets it apart.

“Sexual health and hormonal issues touch almost every medical specialty,” says Streicher, an associate clinical professor of Obstetrics and Gynecology. “Unlike other programs that make the diagnosis and then refer patients out to other specialists, we bring experts from dermatology, urogynecology and other disciplines to the center to see our patients.”

Lauren Streicher, MD, ’83 GME, medical director of the Center for Sexual Medicine and Menopause works with state-of-the-art technology, including a medical CO2 laser that stimulates vulvar and vaginal tissue to restore lubrication and elasticity.

Along with clinical care, the CCG and CSMM provide fertile ground at Northwestern Medicine for research and medical training efforts focused on complex gynecologic problems. In obstetrics and gynecology, fellowships in minimally invasive gynecologic surgery are among the most competitive in the discipline across the country. For every one position, there are more than 60 applicants. Says Milad, “There’s a tremendous need for training gynecologists in complex surgical procedures.”

At the CSMM, opportunities will also abound for further educating not only physicians in training and those currently practicing, but also patients themselves, according to Streicher.

“Problems with sexual intercourse and intimacy and even non-sexual hormonal issues are somewhat taboo topics in the doctor-patient relationship,” she says. “Increasing awareness will help to start the conversation among women and let them know that help is readily available, and they don’t have to just accept their situations for the rest of their lives.”