Scott Webb (Host): Welcome to UK HealthCast, the podcast from UK HealthCare. I'm Scott Webb. And today, we're going to hear from OB-GYN, Dr. Sarah Kluck, about the extensive services and care that UK HealthCare offers to women of the Commonwealth.

 Doctor, it's so nice to have you here today. We're going to talk about women's health services that are offered at UK HealthCare, and it's great to have you on, great to have your expertise. And i just want to start off by having you tell us about what you treat, the kinds of patients you see in the Obstetrics and Gynecology Department, if you will, at UK HealthCare.

Dr. Sarah Kluck: Of course. So at our clinic, I essentially provide comprehensive care. So, that includes maternity care for pregnant patients, well-women care like annual visits and Pap smear screening, and the medical and surgical treatment of different gynecologic conditions like fibroids, endometriosis, abnormal bleeding, sexual health, gender dysphoria, menopause transition. The list could go on and on. But again, essentially, I take care of any patient ranging from adolescence and puberty through pregnancies and deliveries, during midlife transitions and beyond. I'm actually particularly passionate about providing a minimally invasive approach to surgery, whether that be laparoscopic or robotic surgery.

Scott Webb: Yeah. So, the full range, and we're going to talk a little bit more detail about fibroids, abnormal bleeding, endometriosis, and so forth. Before we get there though, when should patients begin seeking care from a provider in Obstetrics and Gynecology?

Dr. Sarah Kluck: So, that's a good question. Technically speaking, our American college of OB-GYN recommends that the first reproductive health visit should really take place between the age of 13 and 15. That being said, I feel like most patients probably don't come to see me that early. They're probably a little bit older than that. So, I mean, if somebody is sexually active, or they're considering becoming sexually active, or certainly if they're having any menstrual concerns, they should probably think about coming to see their OB-GYN.

Host: Okay. Yeah, I have a 16-year-old daughter, so I'm taking some notes here. I'm like, "You know, we haven't made appointment yet." Yeah, maybe it's time. So, I just want to have you talk a little bit more about fibroids and abnormal bleeding, which you mentioned. What are some of the common symptoms, and when should a patient seek the advice of a doctor if they have these signs or just are, you know, generally concerned?

Dr. Sarah Kluck: Fibroids in general are these benign growths within the uterus, and they're very common in women who are reproductive age. They can actually occur in up to 70% of patients by the time of menopause. Of course, not all patients with fibroids have symptoms. Only about, I would say, about a quarter of patients with fibroids actually, you know, seek medical advice or require some sort of intervention for their fibroids. And the most common symptoms of fibroids are abnormal bleeding. So, that can be menstrual cycles that are heavier or longer than normal or a separate category of symptoms that we call bulk symptoms. So, this is when women have pelvic pressure or fullness, they may have pain with sexual intercourse, urinary frequency or constipation, and all of these things can occur when these large fibroids are pushing on different areas of the pelvis, such as the bladder or the bowel. And fibroids, they can be located in different places within the lining of the uterus, in the muscle of the actual uterus itself, or attached to the outer surface of the uterus. And they can range in size from tiny little growths to even larger than a grapefruit per se. So depending on where they're located and their size, they can cause different symptoms for different women.

Host: Right. And you gave us a sense there of what the sign symptoms might be. And if someone is concerned, obviously reach out to their provider, get referrals if necessary, but good to just have a general understanding. And you touched earlier on endometriosis. So, let's talk about that. How do you treat it, how common is it, how much of a concern should it be for patients or prospective patients?

Dr. Sarah Kluck: Yeah, definitely. So, endometriosis, similar to fibroids, is a really big health issue for a lot of women that we see in our office. And it can even affect up to 10% of reproductive age women. And that prevalence goes up even higher in women who have infertility or chronic pelvic pain. So, those are kind of the big symptoms of endometriosis that we see is that pain and that infertility.

And just like fibroids, treatment of endometriosis is very individualized. So, it really depends on what types of symptoms the patient's having, how severe their symptoms are, the extent of the endometriosis, what their reproductive desires are, and whether they've had, you know, side effects from medications in the past.

Host: Yeah, I see what you mean. It's not a one-size-fits-all. It's very sort of patient-specific, right?

Dr. Sarah Kluck: Exactly. So, I talk to my patients about the fact that endometriosis is really a chronic issue that often needs a long-term treatment plan, sometimes, you know, all the way up to menopause. So, my goal is really to maximize the use of the medical treatment options that we have so we can avoid multiple surgeries in one patient.

So, I'll often start with recommending a non-steroidal medication, like ibuprofen, if a patient hasn't tried that, or hormonal options. So, that can range from all different types of pills, intrauterine device, implant, injections, things of that nature. And many women are really able to improve significantly with medical treatment. But of course, you know, if that fails or if there's other reasons to intervene with surgery, for example, infertility or an ovarian endometrioma, which is a type of cyst, an endometriosis cyst that can occur, then we can offer surgery.

Host: Yeah. And you mentioned earlier that minimally invasive surgery is a passion of yours. Maybe you can just, you know, just a little bit of a broad overview of what that would mean in practical terms.

Dr. Sarah Kluck: Sure. Yeah. So, surgery, for example, endometriosis usually involves a laparoscopic procedure. So, that's making a few small incisions on the abdomen and using a small camera and instruments to basically take a good look at the whole pelvis and evaluate for signs of endometriosis, scarring, et cetera. And then, we try our best to take down all of that scar tissue from endometriosis and remove any endometriotic implants that we can visualize throughout the pelvis.

Host: Yeah. And as we're saying here, you know, surgery may or may not be indicated for some patients or many patients, but you kind of go through, you get patient history, you kind of like start small and work your way up to potential surgery. And then, as you're saying here, minimally invasive is probably the gold standard for endometriosis, right?

Dr. Sarah Kluck: Exactly, certainly.

Host: Yeah, that's perfect. I just want to give you an opportunity here at the end. You know, what makes UK HealthCare unique and how they care for women around Kentucky, how you in particular care for patients in Kentucky?

Dr. Sarah Kluck: So, I actually joined about a year and a half ago, so I still feel relatively new to UK. But I'm incredibly proud to work here and take care of women in Kentucky. So, I've worked at a couple other academic institutions in different states, and UK really stands out to me for its deep dedication to improving the health and lives of the people of the Commonwealth.

So, there's really this strong mission and purpose here. And I think it really allows people to collaborate between specialties and really take the best care of patients. And one thing that kind of stands out to me actually is we have a multidisciplinary program here, our fibroid program. So, we collaborate with Interventional Radiology, Urology, Colorectal Surgery, and I feel like it really helps us offer patients, you know, these complex surgeries that they may need and really the most cutting edge treatment options that we have available. So, I feel lucky to work here and be able to offer my patients all of those options.

Host: Yeah. Well, that's perfect. I appreciate your time today. Nice to meet you. Certainly, we hope listeners benefit from your expertise and your passion and just sort of taking us through things. So, thanks so much.

Dr. Sarah Kluck: Thank you so much for having me.

Host: And for more information go to ukhealthcare.edu and search women's health.

And that wraps up another episode of UK HealthCast from UK HealthCare. Please remember to subscribe, rate and review this podcast and all the other UK HealthCare podcasts. I'm Scott Webb. Stay well.