Dr. Ignacio Armas was born in Cuba and moved to the United States with his family when he was 10 years old. He attended medical school at the University of South Florida and currently practices Obstetrics and Gynecology in Brandon and Plant City, Florida. While practicing medicine for over 20 years, Dr. Armas has witnessed many changes in his field. He credits the use of minimally-invasive surgery, the practice of preventive medicine and cancer screening for improving the quality of women’s lives today. Dr. Armas has a special interest in laparoscopic surgery, menopause management and pediatric and adolescent gynecology. He is an advocate of patient education, and he regularly speaks in the community about natural hormone replacement and alternatives to hysterectomy.
Uterus 1: Why did you decide to go into medicine, particularly women’s health?
Dr. Armas: One of the reasons why I went into women’s health and specifically obstetrics and gynecology is because it’s one of the only specialties that really allows you to practice preventive medicine. You’re able to deal with women at all ages and all stages of their lives. You deal with them early in life when they’re going through menarche and issues of development, then when they’re in adulthood and the childbearing years, and then in their menopausal conversion and beyond. It gives the gynecologist great opportunity to work on preventive health and optimal health issues with the patient. You basically see a patient for a lifetime. The other feature that appeals to me about obstetrics and gynecology is that it’s a surgical specialty and an office-based specialty, so it’s a really unique hybrid there.
Uterus 1: How has the practice of obstetrics and gynecology changed since you first became a doctor?
Dr. Armas: Oh it’s changed tremendously; obstetricians and gynecologists are really the unsung heroes of healthcare today. If you look back, and I’ve been practicing for about 20 years now, the number of patients with advanced cervical cancer today has dropped tremendously because we are catching and treating them in a precancerous condition. It’s the same with uterine cancer. So from the point of view of helping women with cancer – it’s just tremendous. And if you look at women who go to a gynecologist on a regular basis, the likelihood today that they will have one of those cancers in an advanced stage is tremendously reduced.
Uterus 1: Would you say that your patients today are more informed about their health and treatment options than earlier generations of women?
Dr. Armas: Another one of the areas where I’ve seen Ob/Gyn medicine changing is in the amount of information that is out there. The average female patient that comes into our office now is a lot more educated and informed, partly because of the Internet. Most women today are interested in staying healthy and prevention. They are generally well-informed and want to be a partner in their healthcare. As a matter of fact, I see one of the major roles I play is that of an educator. I like to give my patients information, or point them to sources of information, because the more informed a person is the more empowered they are.
Uterus 1: Do you see more women coming into your office asking for specific treatments and procedures?
Dr. Armas: Without a doubt, they come in with their notes, they know their options, they’re asking for specific treatments. Now we have so many different options that are available for women. I am very big on community education, and one of the ways I give back to the community is by presenting a lecture series on alternatives to hysterectomy. Now when women come in with bleeding problems in their 30’s and 40’s – which is a huge population – hysterectomy is no longer the only option available to them. Approximately 150,000 hysterectomies are done in the U.S. for abnormal bleeding. I think we as doctors can cut down on those tremendously. So the technology today, the minimally-invasive surgery, the hysteroscopic procedures, all these new advances in medicine provide alternative options where we didn’t have them 20 years ago.
Uterus 1: How has the development of less invasive procedures changed the way you practice medicine?
Dr. Armas: Today, I am doing many procedures that just a few years ago we would have never thought could be done with laparoscopy. The advantage is you decrease the risks, you don’t have to do major abdominal surgery, you change the period of convalescence, so women are getting back to their family and to work a lot faster. You decrease cost because you decrease, or eliminate completely, hospital stay. So for me, obtaining the certification from the Accreditation Council for Gynecological Endoscopy was sort of a driving force to get me to advance my skills as an endoscopist or a laparoscopist. When I started my training, advanced laparoscopy was just in its infancy. I came in when the pioneers were just getting started in laparoscopy. For the longest time all we did with laparoscopy were diagnostics and tubal ligations. It’s the same thing with hysteroscopy, we’re able to do procedures today that we were not able to do a few years ago. The prime example of that is hydrothermal ablation. I have done now hundreds of cases using hydrothermal ablation on patients who had really significant abnormal uterine bleeding. The success rate is in the high 90s. These are very happy people. Some of these women had to bring a change of clothes to work, they’d have to miss a day or two of work, they’d have to wear double and triple protection, and when you’re able to cure them of that without having major surgery, I think it’s tremendous.
Uterus 1: When you diagnose a woman with uterine fibroids, what factors determine which treatment is best for her?
Dr. Armas: Not every woman with fibroids is the same. There are different variables that determine how you council the patient. First, and most importantly, is whether they want to have future fertility or not. The other thing is how symptomatic they are. Some patients have uterine fibroids that are extremely symptomatic, others have very minimal symptoms. The other issue you have to take into consideration is the size of the fibroids, whether they’re bleeding heavy and causing them to be anemic or not. If they come in and they’re extremely symptomatic we go through the options – which in some patients may include endometrial ablation, it may include embolization, it may include myomectomy, and in some patients the only option is hysterectomy. Some patients do come in with an extremely large uterus and there’s no other option available to those patients. But for the most part, you catch the fibroids early, you lay out the options for the patient, and you make a decision about what is the best option for them at that particular time.
Uterus 1: To which women do you recommend endometrial ablation?
Dr. Armas: There are many ablation techniques out there, and they are all pretty good. I think of the endometrial ablation as the best-of -show because it allows me to do a procedure that is very safe, works very well, and in a much broader population than some of the other procedures. I can do it in someone that has a large endometrial cavity, I can do it in someone that has an irregular endometrial cavity, and I can do it in someone that has submucous uterine fibroids. If you have a small uterus with a normal cavity, I think you’re going to get good results no matter what you do, but when you have a procedure that gives you that latitude to be able to do it in different patients, that’s why I like the endometrial ablation.
Uterus 1: How does endometrial ablation work?
Dr. Armas: What endometrial ablation does is it uses some sort of energy force to destroy the lining of the uterus. The options are electricity, heat from hot water, ultrasound, or microwave energy – whatever it is, it’s to create heat to destroy or ablate the lining of the uterus permanently. The hydrothermal ablation uses water at 300 degrees Fahrenheit. That is my preferred method. That is the method that works tremendously well for a much broader population with relatively no side effects.
Uterus 1: What treatments do you recommend for patients with uterine fibroids who are still hoping to have children one day?
Dr. Armas: In a woman that comes in who is having trouble with fibroids and wants to preserve her fertility the most likely recommendation I would make at that point, and again it depends on where the fibroids are, would be removal of the fibroids with operative hysteroscopy. If she has intramural fibromas or subsurosal fibromas, then I would recommend a myomectomy, and that can either be performed laparoscopically or by laparotomy.
Uterus 1: How is the recovery following a laparoscopic hysterectomy different from a traditional hysterectomy by laparotomy?
Dr. Armas: Like day and night. What I usually tell patients who have had children is the difference is like recuperating from a vaginal delivery versus a cesarean section. We have patients [for whom] we do laparoscopic supracervical hysterectomies or we do laparoscopic hysterectomies and those patients leave for home later that day or the next day. They’re typically back to their normal activities within 72 hours or one week. Patients who have the standard laparotomy hysterectomy are typically in the hospital for 2-3 days and require 4-6 weeks of recuperation time. So the recuperation from laparoscopic hysterectomy is drastically shorter than the laparotomy.
Uterus 1: How do you help patients manage the symptoms of menopause?
Dr. Armas: I think the way we look at menopause has changed drastically from the way we looked at menopause five years ago. That is due to some of the issues that came out of the Women’s Health Initiative and the Million Women Study out of England. One of the things that I try to do with my patients is use non-equine hormones. And I like to treat the patient individually by determining their hormone levels in order to tailor the replacement therapy to that particular individual, rather than the approach we had a few years ago which was one dose for everybody. We also try to incorporate other things such as making sure a patient doesn’t smoke, we help overweight patients lose weight and lower their cholesterol if it is high, and we’re trying to make sure patients stay active and take adequate and appropriate calcium supplementation.
So really, the ways we’re trying to approach the premenopause and menopause patient is different from a few years ago in that we’re trying to be more comprehensive and more holistic – trying to treat the whole person, and trying to work in conjunction with their primary care physician to stress the need for proper diet, exercise, and supplementation and avoidance of tobacco and alcohol products.
Uterus 1: You are an advocate of natural hormone replacement therapy -- how do you define “natural”?
Dr. Armas: I don’t particularly like the word “natural” because none of these hormones are natural, that is they’re not found in nature other than in humans, and they [would] have to be produced by the human ovary or the adrenal gland, so the word natural to me is really a misnomer. I like to use the word “bioidentical.” The precursors to these hormones are derived from plants as raw material and have to be converted to the bioidentical form in the laboratory, so in essence they’re not natural.
Uterus 1: Not only do you care for women experiencing menopause, but you are also interested in pediatric and adolescent gynecology. Why the particular interest in the younger generations?
Dr. Armas: I think that dealing with women at all stages of their lives presents gynecologists with a unique situation. We’re able to affect behavior early in a woman’s life. We’re able to tell teenagers about the ill effects of smoking and alcohol. I start my patients on calcium supplementation in their 20s. Also, when they get into their mid and late 20s, I encourage them to start doing breast self examinations so that it becomes a habit. I think we also have the ability to affect changes in nutrition and exercise. I think the younger women today are more prone to exercise than their mothers’ generation, but they tend to eat worse than their mothers’ generation. I always tell my patients no food that comes through your car window is good for you. So we’re in a unique position, hopefully, to affect behavior from an early age.
Uterus 1: Which medical issues are most common in your adolescent patients?
Dr. Armas: The [three] most common things that they come to the gynecologist for are irregular bleeding, dysmenorrhea and contraception.
Uterus 1: What is your opinion of the cervical cancer vaccine? At which age do you think young women should be vaccinated?
Dr. Armas: The cervical cancer vaccine is not available yet. There are studies that are being done currently by Merck. We’re hoping it’s available next year. The teenage population is going to be a prime population for the vaccine. If we can get the teenagers vaccinated before they become sexually active I think it will decrease the epidemic incidence of HPV that we’re seeing today. Of course, there are other sexually transmitted diseases, and when you’re developing a vaccine for HPV you have to balance it – HPV is only one of the diseases, we wouldn’t want people to think “Oh I had this vaccine so I won’t get any of the other sexually transmitted diseases.” Education is so very important, but we’re very excited about the vaccine and we plan to be on board as soon as it becomes available here in the United States, and I think it’s going to be tremendous for women’s health.
Uterus 1: If you had to do it all over again, would you still choose obstetrics and gynecology?
Dr. Armas: Absolutely, without a doubt.
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