Puno talks about fibroids and endometriosis with our guest Dr. Soyeni Hawkins—a gynecologist and surgeon specializing in the minimally invasive surgical management of fibroids and endometriosis, as well as a women’s health activist, empowering women to be better advocates for their own health.
What are fibroids, anyway? And why do 80% of women have fibroids, yet we never talk about it!?
This week on Girlboss Radio, Puno talks about fibroids and endometriosis with our guest Dr. Soyini Hawkins—a gynecologist and surgeon specializing in the minimally invasive surgical management of fibroids and endometriosis, as well as a women’s health activist, empowering women to be better advocates for their health.
In this episode, you can hear how Dr. Hawkins is pioneering the conversation around women’s health—specifically around fibroids and endometriosis—as well as working to make a non-invasive surgery accessible to anyone who wants it (she was the first to bring it to the state of Georgia). You can hear the passion in her voice as she dives into topics that, historically, haven’t been discussed very openly.
Dr. Hawkins talks about everything from how she became a gynecologist, being personally diagnosed with endometriosis, having intensely invasive surgery that put her out for eight weeks (but bounced back and gave birth to two children) and how her personal experience with the conditions inspired her to specialize in the field.
Puno and Dr. Hawkins talk about their personal experiences with surgery for fibroids and endometriosis, and their go-to tips for surviving a day of work with massive period cramps (hint, it involves getting yourself a period partner and tie-dye sweatpants)
This episode is full of information that might cause you to think twice before ignoring period pain—in yourself and in the women who surround you— which you may think is ‘normal’ but could be underlying signs.
After all, around 80% of women suffer from fibroids or endometriosis. That means if you sat down in a room with 10 of your girlfriends, eight of them have it.
You can listen to the episode now on Apple Podcasts or Spotify, or read the transcript below that has been edited for clarity:
Hey, Hey, it’s Puno and you’re listening to Girlboss Radio.
I am so pumped because today on Girlboss, we’re talking about something that affects 50-70 per cent of people with uteruses before the age of 50, which means a lot of you listening right now might be dealing with this as we speak…and some of you might be dealing with it and you don’t even know.
You’re like, okay what are we talking about? Well, we are talking about fibroids and endometriosis. And that means we’re talking about periods. You can’t talk about fibroids and endometriosis without talking about your periods.
For as long as I can remember, periods are just supposed to suck. Heavy flow. Painful cramps. They’re just all part of the package Aunt Flow brings when she just rolls into town and you’re like, “Dangit Aunt Flo, didn’t you just leave?!”
We’re used to complaining and we’re used to suffering through it, but what we’re not used to is asking, “Is this normal?”
My own cycle had gotten more than just a little bit out of hand and at one point I was going through six Divacups a day. Yes. Six.
And six to eight night pads completely soaked through. That was a lot and I was still thinking in my head, “Is that a lot? I feel like it’s a lot. I’m sure you guys are all hearing this right now. And you’re like, “Girl, that is a lot.” Well, I talked to my GP, she kind of just shrugged it off and said, “Yeah, some people’s periods are heavy.”
So, I thought, okay, she knows. And yeah, periods are supposed to be awful that’s just the way it is. For so long those of us who menstruate have kind of internalized this perception that your period is it’s supposed to be painful. It’s supposed to be a lot. You’re bleeding. It’s a lot. It’s blood.
And when is it a sign of something way more serious? Well, we’re going to be diving into that question today with our guests, Dr. Soyini Hawkins, a minimally invasive gynaecological surgeon who has had her own experiences with fibroids and endometriosis which led her to a career of advocating for women’s health.
Before I started talking to several doctors. I thought my only options were just living with a period that was, let’s be honest, it was just affecting my life. It was a really scary and confusing time for myself. It took forever to get the answers that I wanted. I had to go through at least seven doctors.
So that’s why we’re bringing Dr. Hawkins here today. Dr. Hawkins is not only helping to educate women in alternative options, minimally invasive options but also helping to assure them that their experiences are not the norm and that your period isn’t supposed to be this horrible experience. Your period isn’t supposed to be this awful experience that you have to grin and bear, no matter how painful or chaotic it gets.
And when you’re afraid to sit on your friend’s white couch, because you think you’re going to leak through it, or you don’t really want to work out for seven days because of your period.
But anyway, I’m going to ramble and I shouldn’t. So let’s get into it.
Puno: You are a surgeon and gynecologist that treats patients with endometriosis and fibroids but you also have lived that experience as well. Was this before you were a surgeon?
Dr. Hawkins: Well actually, it was right in the heart of me deciding what I wanted to do with my life and my medical career. I was actually in medical school when I was diagnosed and it was a whirlwind from there because I had absolutely no idea I had fibroids and endometriosis—it was crazy.
Puno: I also had fibroids and endometriosis, I found out two years ago. I’m just so curious, what were your symptoms and what made you proactive to do something about it?
Dr. Hawkins: So, I actually didn’t have symptoms initially. I woke up with pain one day, and at the time my husband, now fiancé, then said okay that doesn’t seem normal, you don’t usually complain, go get it checked out.
A lot of times we leave the men out of the conversation and we don’t ask them how does this make you feel? Or what do you think that your partner is going through? Or how do you feel like you could support them? Because we think about them, right? We’re like, oh we don’t want him to think we’re weak, or we just don’t want any this week—we almost suppress ourselves to please them, but they’re a part of the equation too. So yeah, that was how he got here, to be my husband today, because of his push.
Puno: You were like at the altar and you’re like remember when you dealt with fibroids for me? That’s when I knew.
Dr. Hawkins: Right? And that was the beginning. To elaborate it was actually a quite scary experience. I was diagnosed by my nurse practitioner I had just had my annual exam three months earlier, and the doctor said nothing. Didn’t say your uterus is enlarged. Nothing. He asked do you have any problems or issues, felt around, did a little pap smear and he was out. And when I went and saw the nurse practitioner she was like maybe it’s your fibroids causing your pain. I was like huh what huh? What fibroids? What are you talking about?
My uterus was 16 centimeters at that time and I was more than three months pregnant.
Puno: So, I brought out my measuring tape—what is the size of a typical uterus?
Dr. Hawkins: Eight centimeters—so like the size of your fist.
Puno: My God it’s tiny!
Dr. Hawkins: It’s tiny. Can you imagine two times, three times, four times—I have women in here whose uterus are 30+ centimetres.
Puno: So, this is 18 centimeters right here and that’s how big your uterus grew to.
Dr. Hawkins: Yeah, yes and I never knew it was there. I never knew it was even an issue. Like most people will have heavy bleeding, some type of pain or discomfort, urination problems, back pain—I had none of that. Once I found out the diagnosis I started to have every symptom there was. I started to bleed excessively, and this is horrible it was a whirlwind. My diagnosis wasn’t typical of how most people will find out they have fibroids.
Puno: I never counted the number of pads, or the type of pads. I got the Flo app and it got to the point where I counted eight full diva cups, plus six to eight soaked night pads.
Dr. Hawkins: In one day? That’s a lot. That’s like how are you standing?
Puno: I was like I think this is okay…
Dr. Hawkins: Most women will come in and say, I’ve always bled this heavy, and if I said it to my mom and my grandma they’d be like we all bled that heavy, that’s nothing, it’s just part of being a woman. But understanding that there is a difference between a normal menstrual cycle and a debilitating menstrual cycle and that [heavy bleeding] is not normal is a huge educational piece. So, what is normal? Because your normal might have you in the emergency room next week getting a blood transfusion. I’m sure you were quite weak when you were bleeding that heavy weren’t you?
Puno: I was. And when they did an iron deficiency test fortunately I didn’t have iron deficiency, surprisingly.
Dr. Hawkins: Yeah because you were supplementing yourself well, that’s why.
Puno: So, your nurse practitioner was like maybe they’re fibroids. How long ago was this, were you Googling these things?
Dr. Hawkins: It was when I feel like nobody was talking about it—don’t you feel like that sometimes? I feel like 10 years ago nobody was having this conversation, but fibroids didn’t just start yesterday. So, her thing was, these didn’t grow overnight and you’ve had them for a while—16 centimeters, twice the size your uterus should be. So, we started doing ultrasounds. When she said that question I was like oh wait a minute, what if they did grow overnight? Cause that sounds like cancer to me. And she was like okay let’s do a couple of tests.
I also started seeing a gynecologist who basically followed me every three to four months, I did repeat ultrasounds that they said showed this is not cancer. But during that time period, I started to have cycles similar to how you just described yours. It went from okay this isn’t bothering me to like how you were talking about your iron levels. My iron was significantly deficient I had to get iron transfusions twice a week.
Puno: Oh my gosh, wow.
Dr. Hawkins: I went from nothing, not even knowing they’re there, to within a year I was having cycles every two weeks, I was hemorrhaging essentially, I was anemic, I was working 100-hour weeks with a hemoglobin [count] of seven and it should be 12. It was a whirlwind and I had surgery the next year. My husband was like get this taken care of.
Puno: When I turned 30, all sorts of stuff was happening to me. I think the first question was do I have cancer? Is the fibroid cancerous?
Dr. Hawkins: Fibroids by definition are benign. There is a subset of tumors called leiomyosarcoma which are cancer that can be mistaken for fibroids, but they’re super rare.
Puno: When I was talking to my fibroid surgeon, he was also saying sometimes [people] just don’t realize and they have a grapefruit-size fibroid in their uterus. Why is that?
Dr. Hawkins: Location. Location is everything. I can think of a petite patient, in particular, I could think of who had a 20-centimeter fibroid—one fibroid!
Puno: I’m going to pull out the measuring tape.
Dr. Hawkins: It’s going to blow your mind. It was outside of her uterus and what we call pedunculated, so she never had any symptoms. She didn’t even know it was there. She didn’t she didn’t feel the firmness in her abdomen. She had pain one day that sent her to the doctor and that’s when they found it.
Location is everything, it’s real estate when it comes to fibroids. We kind of get super focused on the size, but you can have a two-centimeter fibroid in the middle of your uterus and hemorrhage.
Puno: I had to have the baby talk. My husband and I have been kind of avoiding it for a bit. Did you have to have that conversation?
Dr. Hawkins: We did, and I feel like back then I didn’t have a lot of support groups, there wasn’t The White Dress Project. I didn’t know that I had the potential to not necessarily feel like fertility was a now, absolutely must-do thing—my doctor at the time did recommend that if I did surgery that I should think about getting pregnant shortly thereafter. And I did, I had my first child in my fourth year of residency, two years after my surgery, and then I had another during my fellowship.
I did a two-year fellowship in minimally invasive surgery, to get back to your first question as to why I do this, and at the end of the fellowship, I had my second [child].
Puno: Oh wow, boom, boom, boom, boom.
Dr. Hawkins: I knocked em’ out.
Puno: Can you explain why it affects your family planning?
Dr. Hawkins: Sure. Potentially, cause a lot of women don’t even find out that they have fibroids until they get their first pregnancy ultrasound. Like legit had no idea it was there—they were small and they weren’t bothering them. [Many women] get an ultrasound because they’re pregnant and it’s like oh boom, the baby and the fibroid are playing together, and it’s fine.
Fibroids will be blamed a lot of times for infertility, it’s not always the reason why but it has a potential to be. Again, usually because of location. So, when fibroids are in that cavity inside of the lining the ones that usually cause the heavy bleeding, it can essentially take up space that the baby needs.
Literally, it’s just right there where the baby needs to implant and it makes it difficult to either get pregnant or stay pregnant, increases the risk of miscarriage, preterm labor, preterm delivery, or [can cause] fetal demise. It really does increase risks with pregnancy depending on that location.
Puno: It is a real estate issue and you have eight centimeters in your uterus, your baby needs to be implanted somewhere and then also they need [room] to grow.
Dr. Hawkins: They take up a lot of space.
Puno: They’re like what is this thing?
Dr. Hawkins: My best friend had a baby last year and I did her ultrasound before she got pregnant. I was like let’s just, you know, check. I have the ability to do an ultrasound for my best friend, let’s just see.
And I was like oh girl you good, you got a little one-centimeter baby fibroid. Honey, that thing was 10 centimeters by the middle of her second trimester.
Puno: So, it grows during pregnancy?
Dr. Hawkins: It grows sometimes because of all the hormones. All the massive hormones can feed the fibroid in the uterus during pregnancy. Sometimes it doesn’t do anything, but a lot of times it will grow because of the hormones in early pregnancy.
Puno: Does anyone know why fibroids happen?
Dr. Hawkins: I like to tell people that fibroids are multifactorial. It’s not necessarily one thing because there’s a genetic factor. When we look at lineage and we look at family history, a lot of times we’ll see that we see it genetically passed down. However, all you have to do is be a woman, and all you have to do is have hormones. Because hormones feed the cells of our uterus to grow fibroids.
What we do know is that there are environmental factors such as the estrogen we consume in our diet. There’ve been even smaller studies that have looked at the things that we put on our skin that’s in our cosmetic products. For African-American women that have been perming their hair for years the paraffins that are in those actual chemicals [could be a cause]. All of those things have been looked at in studies, smaller studies nevertheless, but have been associated with fibroids in the way that they grow.
So yes, to answer your question, hormones do have a part to play but there are other factors. Vitamin D deficiency has been definitely well-researched and linked to growth. So it’s a lot it’s not just one thing.
Dr. Hawkins: 80% of women in reproductive years have fibroids, and some sources will even say 90% of African-American women. So, you’re in a room with all your girlfriends, you’re not the only one.
Puno: When you found out [you had fibroids and endometriosis] was there anybody in your family or friend group that had it?
Dr. Hawkins: That’s so crazy because my mother found out she had fibroids, after I found out I had fibroids, so it kind of went the opposite way. She found out she had fibroids and endometriosis after my diagnosis.
I think what it did was it kind of perked her up to say oh hmm maybe this pain that I have on my side is something else that’s going on that’s more woman or GYN-related. Maybe I need to stop ignoring it. When she honed in on it she found out she too had fibroids and endometriosis. So, it went in the opposite direction but that was an enlightenment to me because I had never talked about it in my family before.
Puno: The studies that have come out, how recent are they?
Dr. Hawkins: So, it’s not that it’s not recent, it’s just that it’s now better understood and better looked at. So even in the NIH (National Institutes of Health) field, they’ve been doing research on fibroids, [but] not on necessarily large enough scales to be what I would consider impactful. We haven’t done enough. Fibroids are most certainly a pandemic—for it to be a pandemic we haven’t really put a lot towards it in the last decade.
Now we’re hearing about it more. Vice President Kamala Harris has actually put forth legislation that is going to put money directly in the hands of research specifically to look at fibroids—she did that just before her Vice Presidency. So, it’s coming around it’s coming around. We’ve been having a discussion but it’s kind of been a slow rev. Now it’s picking up pace and we’re starting to see that this is definitely a pandemic that needs to be paid attention to because it affects so many women.
Puno: That’s what bothers me—if it affects 80 per cent of women why are we just finding out about this now?
Dr. Hawkins: There’s no foundation specifically for this. It’s not cancer, it’s not heart disease. And it’s so interesting because a lot of times I’ve heard people ask that question before. They’ll say oh because it’s a Black woman’s disease and so no one has really made it the headliner. It’s not a Black woman only disease, it absolutely disproportionately affects Black women but I mean it does not discriminate.
I don’t want to take anything or disqualify the fact that it disproportionately affects Black women, but I agree with you, we should have been putting more into the efforts to find out about fibroids a long time ago. Because if fibroids or tumors were growing off a man’s penis all over the place and 80 per cent of them [had it], I guarantee you the research would have been there a long time ago.
Puno: Yeah if they’re like oh yeah my penis was eight centimeters and now it’s 18 I don’t know…
Puno: I read that you found that had endometriosis during [your fibroid] surgery. What is endometriosis?
Dr. Hawkins: Endometriosis is literally when the lining or the endometrium of the uterus is found ectopically, it’s somewhere that should not be. May it be endometriosis of the uterus—inside of the muscle of the uterus—that’s actually called adenomyosis. In the pelvis, which is where it most commonly is found, it could be on the ovaries, it can be on the fallopian tubes, the bladder, the rectum, which usually is where the pain is associated that patients will come in and complain of. It can be on the diaphragm and cause shortness of breath and chest pain. It has been found on an autopsy in the brain and in the lungs.
Puno: What I’m picturing right now is you’ve got your fallopian tubes, and then the uterus, and then it’s like spiderwebs?
Dr. Hawkins: It can be. Usually, stage four looks like that. Look at you, that was a good description, that was a great description.
Puno: If you ever want to use this…
Dr. Hawkins: I love it, oh my gosh.
Dr. Hawkins: So, the stages of endometriosis usually are given based on surgery and for the relation to reproduction, so fertility. But the spider web—stage three or stage four—is not necessarily what is typically seen all the time. Stage one, which is what a lot of women have, they don’t have any of that, they just have tiny spots or lesions on their pelvis somewhere. And when doctors that specialize in it, which is one of the things I now specialize in, we go in and we look with these magnified cameras. We’re looking for that to either remove it or burn it. I remove it, I’m an excision surgeon so we remove it and that actually helps their pain because those lesions cause inflammation and that is what causes the pain associated with endometriosis.
Puno: Like pain, meaning like cramps?
Dr. Hawkins: Cramps, some people will have pain that is almost like shooting pain or a dull kind of nagging, twisting pain. It can be several different types it can be in several different locations. Some people will only have pain with intercourse, or they’ll have pain when they have a bowel movement, or when they urinate depending on where the endometriosis usually is located.
Puno: Endometriosis symptoms sound somewhat similar to fibroid symptoms, no?
Dr. Hawkins: No, because fibroids are going to cause more dysfunction anatomically that’s associated usually with menstrual cycles or like heavy menstrual bleeding and can be painful, but aren’t always. A lot of women with fibroids have absolutely no pain. I had absolutely no pain. And then with endometriosis, the pain comes before their cycles, and sometimes even gets better after their bleeding. That’s because of the effect the estrogen hormone has on endometriosis. So, pain is definitely the hallmark of endo, bleeding is a hallmark of fibroids. You can have endo, and have pain, and completely normal bleeding. You can have fibroids and have heavy bleeding and have no pain. So, they are very much two separate things.
Puno: You’re doing ultrasounds but endometriosis didn’t come into the picture until surgery. Can you not see an endometriosis lesion in an ultrasound?
Dr. Hawkins: No, it’s so hard to diagnose because of that. Statistically, we feel that endo, if you read the textbooks, affects about 10 per cent of the female population. I think that is drastically underestimated because it’s so hard to diagnose. You won’t see it show up on imaging very readily like fibroids because it’s small lesions so they could be there and be microscopic and you just don’t know.
If they are forming something called an endometrioma which is a cyst on the ovary full of endometriosis, that you might pick up, but that’s a small percentage of the endo population. Most of the time the exam is normal, the imaging is normal, you’re going based on really believing— that’s the keyword for doctors that are listening to this—believing your patient when she says she’s experienced in this type of pain and putting the puzzle together.
Puno: When I was looking into this whole thing I was like why isn’t technology here, it’s 2020. You think of an ultrasound, you think of an MRI and you think this is imaging you should be able to see everything. But then when I actually looked at my MRI and I looked at my ultrasound I was like how are they seeing, like what? It looks like static.
Dr. Hawkins: That’s hilarious [laughing]
Puno: In a way as a gynecologist you understand how to look at those images, but it is also still pretty primal in terms of imaging.
Dr. Hawkins: Yeah, we’re getting there. I think we have a ways to go when it comes to the endo diagnosis. They are working on blood tests to try to find it, trying to see if there is some blood work or blood tests that can be taken that might show that a patient has endometriosis.
Puno: Oh my goodness. How can I donate to that Kickstarter? That is so huge, people are going to be like do you have cramps? See if you have endometriosis.
Dr. Hawkins: Yeah because it’s so hard to make that clinical diagnosis right now. There is no non-invasive way. There’s no way without surgery to definitively say someone has endo.
Puno: You found out that you had, did you say type four?
Dr. Hawkins: Phase four, yeah. Stage four, it was everywhere. My surgeon is who I went back and trained with. When I got there and saw the oncologist, he actually sent me to my surgeon because he was a minimally invasive surgeon. He did robotics and laparoscopic surgery and when I went to him he was like uh no ma’am these are too big and you are not a candidate for minimally invasive surgery.
Puno: Oh, your fibroids were too big.
Dr. Hawkins: They were too big, which was a gut punch for me because I was like I’m a resident, I had just got married, and I don’t have time for this. But he did my surgery. I was out for eight weeks it was hard.
Puno: Okay pause, eight weeks?
Dr. Hawkins: Eight weeks, it was horrible.
Puno: Meaning like, were you bedridden for eight weeks?
Dr. Hawkins: I wouldn’t say that I wasn’t bedridden for eight weeks, but put it like this: for two weeks I did not know if I would stand up straight and walk again. It was such a hard recovery for me. And it literally is what catapulted me to say, okay yeah no, there has a better way. This is what I want to go into in medicine, this is what I want to learn about. I want to be him because the fact that my surgery took eight weeks to recover from had nothing to do with him, he did his job, and he did a fantastic job. I had two babies, right away, even with stage four endometriosis, he cleaned that thing up and I did great. I’ve never bled another heavy day since then and my baby is going to be 10 years old. It was fantastic, everything was fantastic, and I went back to him two years later and I said teach me everything you know. Literally, I operated four days out of five days every single week for two years, and I think I’m a very strong surgeon because of that experience with him.
Puno: Because it’s not minimally invasive, what kind of surgery was it?
Dr. Hawkins: So, I had an open abdominal myomectomy. I had a C-section and went home without a baby. It was a large what we call an ecliptic incision. I have a hip to hip incision. If you see the pictures, they take the uterus out, and then take off all the fibroids, and reconstruct it, they make it as perfect as possible, so now my uterus is this big and my fibroids didn’t grow back. That’s a thing too that a lot of women worry about.
Puno: It’s amazing that you recovered in eight weeks [after being] completely cut open. Was this the first time that you ever did surgery?
Dr. Hawkins: Yeah it was my very first surgery. I had absolutely no medical problems that I knew of up until fibroids and then the anemia that came after.
Puno: Was your insurance able to cover that?
Dr. Hawkins: Yes, thank God, yes. The insurance was able to cover the myomectomy.
Puno: Man! Because my surgery wasn’t covered under my insurance.
Dr. Hawkins: Sure, what did you have done if you don’t mind me asking?
Puno: Yeah, I had radiofrequency ablation with Acessa® Is that what you learned?
Dr. Hawkins: So, I do Acessa® now, I was the first doctor to start to start doing Acessa® in Georgia commercially, that was 2019 when I brought it to Georgia.
Puno: So, Dr. Bruce Lee was my surgeon.
Dr. Hawkins: You can’t get better than that, you cannot get better than Dr. Lee.
Puno: Because he’s the one who created it
Dr. Hawkins: Correct yeah, he’s the one who created it.
Puno: How did you know? How did you find out about him?
Dr. Hawkins: So, when I was at AAGL, which is our organization for laparoscopic surgery, I saw the Acessa® and saw the technology. And actually, it’s a funny story because I actually kind of a [[SP? bull gardened?]] my way into their dinner with the CEO. Like hello, I’m Dr. Hawkins I do fibroids. Literally, I was like can I get some wine, please. It was good. I am so not bold with the
exception of fibroids and endo. The is when I get a little bold.
Puno: You’re a warrior
Dr. Hawkins: It was something that I had my eye on, and I wanted to learn more about. Shortly after that, the reps call me and the VP called and were like okay, are you willing to do this fight? Because of what you just said about insurance coverage, it’s a hard process to bring something new into a market it was going to be a fight. They prepared me for that. I told my hospital I wanted it, and my hospital said yeah right, we’re not buying this equipment for you and only you. It took a year for me to convince them.
Puno: Get out, that’s how it works?
Dr. Hawkins: That’s how it works. And now insurances are starting to do better with coverage. But there are unfortunately a lot of patients like you who want Acessa® and they are not getting the coverage from their insurance companies. So, it’s still a fight. It’s still a little bit of a fight, but we’re getting there.
Puno: Why do you think that insurance companies don’t cover it?
Dr. Hawkins: So Acessa® is the newest technology for the fibroids. Since the FDA approval, the rollout has been, I don’t even want to use the word slow. They are taking their time, gratefully so, because this is a technology that you want to be successful. So, insurance [wasn’t] forced to pay attention at the beginning. In places like Chicago and Texas, I’ve gone there to train because they are doing it in higher volume and numbers and they’ve been doing it aggressively since 2012. But when you look at Georgia, Florida, Alabama, and Tennessee and all these places in the south around me, they didn’t know about the technology so we weren’t forcing the insurance to even cover it. Now we’re being a bit forceful, I’ve gone and now we’re being a forceful. I’ve gone to Capitol Hill and talked to legislators, I’ve written letters to Cigna and Blue Cross
and I’ve been aggressive about pushing for it because I think women should have it covered just like myomectomy is covered.
You can cut me open and take out my fibroids or take out my uterus—because they will cover a hysterectomy any day—then you should be able to give me this option to do a minimally invasive approach.
Puno: A hysterectomy, which I didn’t realize was before, is removing your uterus. And they’re like well do you ever want to have kids? I don’t know, I’ve never been so protective about my uterus before but I don’t want to remove that part of my body, I don’t know why.
Dr. Hawkins: You’re a woman and that is an okay acknowledgement. I tell women all the time, let’s discuss everything. Because even though I’m in love with Acessa®, I can do a robotic myomectomy, I can do an open myomectomy, I can do all of these things. I have a buddy down the street that can do a uterine artery embolization—so let’s talk about all of your options. And at the end of the day if you decide that a hysterectomy Is ultimately what you want to do and it fits your goals and ultimately gets you to where you want, then that’s what we’re going to do. But to start there…
Puno: That’s drastic.
Dr. Hawkins: That’s kind of drastic when you don’t even know what all the other options are. Especially since, like you said and I said, our mind does go to our fertility a little bit when we learn that we have fibroids, how could it not, you know? Even if you never thought about it before you’re like, ‘Oh maybe now is time to think about it.’
Puno: You’re fighting for this surgery that also is a little bit of an unknown. What made you so confident that it is worth fighting for?
Dr. Hawkins: It was when I was able to do my own research into it. I heard about it and it seemed like a fad thing to do, and I’m a young doctor so I’m like I want to stay on the cutting edge of technology, but I also need to do the best for my patients.
When I was able to actually look through the research, [I found] Acessa® as a company was fighting for women, period. All of that of gave me the push to say okay I need to vet this out some more, then when I could see the comparatives between Acessa® and a myomectomy, which is [the surgery] I had, and could see that patients can actually end up with similar outcomes as far as their pain, their bleeding, the recurrence of fibroids and things like that, I was like how could I not offer this procedure? You probably attest to this: You go home the same day, the pain is not tremendous, you’re back to work in like three days. How could I not offer that? How could I not have that in my tool belt to be an option for women?
Puno: And the other thing that kind of boggles my mind is that not all gynecologists are surgeons like you. Is that like a level up?
Dr. Hawkins: It is a level up. Just like I’m a gynecologist, there are OB-GYNs that only do cancer and there are OB-GYNs that only do fertility. You’re going to go to someone specific to put a baby in your uterus, I’m not going to do it, you don’t want me to do it.
You don’t want me to deliver your baby, I don’t deliver babies anymore. I’ve had these subspecialties within the field of obstetrics and gynecologists, and subspecialty is minimally invasive gynecological surgery. So, I went to fellowship for two years, I put off making cash money. I could have been out with my friends with their new Lexus, and their new houses. But I was like no, I’m going to go back to school for another two years and be a broke doctor and poor, and my husband is going to support me, and I want to learn how to do this. So, it is a level up, it is a step up in our education and teaching.
Now all I do is surgery, I mean I do 25-27 cases a month, which is a high-level amount for a gynecologist.
Everybody that walks through my door is considering or contemplating surgery. So, I think it’s necessary for people to have these focuses because then I can truly say I’m giving my patients my best.
Puno: I watched this documentary on VICE about Georgia, women’s healthcare, and the assessability to it. Are there a lot of you in Atlanta?
Dr. Hawkins: No. To answer your question, no there are not a lot of me in Atlanta. I feel like I’m fairly successful in my practice, I’ve opened my own practice, this is me you know what I mean? But the next thing I want to do is legacy build. I want to bring in physicians who have the focus and care and compassion to do this, and really focus on this.
Women deserve a subset of doctors that are going to just be laser-focused on what’s causing you pain, what’s causing your ailment. If I have to do surgery, I want to be able to offer you these minimally invasive approaches so you can get back to life. Because the technology is there, why aren’t we using it?
Puno: When you were at the hospital and you had to fight for the Acessa® surgery, was that when you were like I need to open my own practice? Or was that always in the cards?
Dr. Hawkins: My husband would say it was always on the cards. I will say want to take care of my patients. I was not trying to OD on this voyage of mine, but I’ve definitely along the way felt it was super necessary.
I’m in Atlanta. I thought when I moved from Baltimore to Atlanta I was going to have to fight to find patients. I thought that I was going to have to work my way to the top because I’m young, and I’m a woman, and I’m black, and it was going to be a struggle. [That wasn’t the case] at all because there are not a lot of women or people doing what I do. It was a void. Very quickly I realized okay there’s a market here for this, it’s actually a niche that I have and what I specialize in. Opening my own practice was going to be the next step. Making myself more accessible and being able to, again, legacy build and bring other physicians on that I could teach to do what I was doing. My husband will say that it was always, always in the cards.
Puno: He’s like I saw that, called it.
Dr. Hawkins: It feels great to make the decisions and really opened opportunities to just do more.
Puno: Was it scary? Was it like this entrepreneurial kind of thing? Was it distracting?
Dr. Hawkins: It was scary mainly because it was going to be something I kind of had gotten comfortable not having to do. I was with the hospital during my fellowship and when I moved to Georgia I joined a small practice and they had to worry about everything.
So now I’m having to pull in the complexities of not just taking care of the patients, not just taking them to surgery and making sure that they do well from a health perspective, but also making sure that I have the proper staff to cover, to making sure that my facilities look very nice, comforting, and welcoming. And also making sure that I had a presence in advocacy, education, and all of the other components, that I had already started doing before I built my practice, but now with this name behind me, I feel like it’s so much more important. So, the components of it is a little intimidating, but it worked out. And I kept patience, I had a following when I started my practice so that helps.
Puno: Sure, I mean I’d be like wherever you go it’s fine.
Dr. Hawkins: It helps.
Puno: I was reading these reviews about you—I’m just going to gas you up for a little bit—like my other doctor had ignored my complaints for so long, but Dr. Hawkins listened and took me seriously. It goes on and on, but I think what I’m curious about is why do you think thing happens? Why do you think patients have lost trust in their gynecologists?
Dr. Hawkins: Yeah, I do think so, I think patients have to be their own advocate. I was patient for a little while. How is it that I went to my annual and my doctor didn’t feel the 16-centimeter uterus and didn’t tell me? Even though I wasn’t symptomatic, I also wasn’t asking any questions. I wasn’t like okay what was my exam like and is everything okay, or is there anything I should be asking or concerned about? Or, is this cycle normal? Cause it probably wasn’t but he never asked me about it. Do you know what I mean? So, I wasn’t forthcoming with that information. I think we have to figure out how to be our best health advocates.
We have to be able to speak up when it comes to our health. It’s not necessarily an easy thing to do, but if we want to stop suffering we have to tell them what our symptoms are, we have to message them, we have to keep a diary, we have to Google, there’s nothing wrong with that and saying, ‘oh I wonder if this is what’s going on?’ Don’t go crazy with it, but it’s okay to walk in the door and say, ‘I wonder if I have PCOS.’ And sometimes it’ll make the doctor say, ‘Huh, I wonder if you have PCOS.’
It’s okay to do that, so I would start there. I would say that patients, [especially] we as women, definitely have to learn how to speak up for ourselves and our health.
Dr. Hawkins: As we started off with what’s normal, and what’s not normal. Suffering is not normal. Period. Point blank. If you’re missing days of school and work, if you’re feeling like you have a basketball game and you can’t make it to the basketball game again, because of [your] uterus, that’s not normal. You know what I mean?
Puno: Yes, I actually went to UCLA and they had this checklist to ask about your symptoms and your experience. And when I read the symptoms, I just bawled I was like, ‘Oh my God that’s me.’ And then I just realized l have just been living with this. I was just like playing the excuses in my head like, ‘Oh it’s totally fine that you bled all over your sheets again. That was last month and now you’re really good at taking blood out of your sheets.’ I was just like so sad for myself that I didn’t give myself permission to just say that I was in pain.
Dr. Hawkins: Yeah and that’s super important to even just say what you said the way you said it. To give yourself permission to ask for help. To start to just acknowledge that it’s not normal to know that if I mix this much peroxide with this much water I can get this blood out of my sheets. That’s just not a normal thing to know how to do very well.
Puno: I knew on the days that my periods would happen I wouldn’t work out because I knew I would bleed through my yoga pants or whatever. I knew I wouldn’t want to go anywhere, I wouldn’t want to sit on people’s white couches.
Dr. Hawkins: Yeah, your calendar [is planned], like you had to think about what day of the month is this going to be? Can I actually go out and do this event? Or can I hang out with these people? Or, you know, like your whole social calendar was around your cycle. Crazy.
Puno: I wanna do a little role-play if you don’t mind. So, we were thinking, what would it be like to go to my first OB-GYN appointment, and I’d love to bring you on my little shoulder.
Dr. Hawkins: I love it.
Puno: So, we’re going to play some waiting room music. Do you have room music in your office?
Dr. Hawkins: Of course, I do yes.
Puno: Is it good?
Dr. Hawkins: Very good. Sometimes it’s too good. Sometimes my friends will be like what is this savant talking about? What is going on? Like they’re talking about sex in the waiting room? But it’s the jazz version, just leave it be.
Puno: I want the Dr. Hawkins waiting room Spotify playlist, thank you very much.
Dr. Hawkins: My hot girl playlist.
Puno: I mean we’re going to be talking about your uterus might as well?
Dr. Hawkins: Get it started.
Puno: Okay wait, rewind a little bit. Why did I pick this doctor? What do you look for? Or what questions do you think you would ask as a gynecologist, and to find the best gynecologist?
Dr. Hawkins: I think I would want to know what potentially their speciality or interests are. If I’m going into an obstetrician I know that I’m a high risk because I know I’m high risk, then I want to know I’m going to a doctor [who deals with] high-risk. If I’m going in because my bladder leaks when I cough, sneeze, and laugh, I want to go to a doctor that is going to take care of cough, sneeze, and laugh leakage. I think I would want to do research on if my symptoms and what I’m experiencing align with whatever their focus might be.
Puno: Do you do that by calling the office?
Dr. Hawkins: Google girl
Puno: Okay okay, alright.
Dr. Hawkins: Everybody puts their bio on [google] so you should be able to garner a lot, or you could even Google what type of doctor might best handle this. Because if you look up what type of doctor might best be able to treat my endometriosis, you might find a minimally-invasive gynecological surgeon. And then you can say okay so who is a minimally-invasive gynecological surgeon in Peachtree Corners, Georgia? And my name would pop up.
Puno: Okay so I’ve found the doctor, I’ve found the best one. I’ve Googled them and they called me and they’re like, ‘Uh Puno?’ and then I’m like, ‘Okay yeah coming in.’ And I’m walking in then what do I say? Like do I just tell them everything about my periods?
Dr. Hawkins: I would say come armed. A lot of times when you come to see me, I want to see do you have any records? Like have you had an ultrasound, have you had labs, do you have something that shows you’re severely anemic? Not that you have to have all that stuff, but if you have gathered it and got a little file of your medical history, that is actually helpful to us. It is helpful to look through that. I mean, I don’t want 150 pages, but the pertinent stuff, and even if I have to figure out what the pertinent stuff is, that’s fine. It’s helpful to a doctor if you’re going in there with a concern.
Puno: Should I print it out?
Dr. Hawkins: Or just send it. My front desk when they make the appointment, they’ll ask you to just forward it to your portal—we have a portal but not all doctors have a portal—or email it to the front desk through a secure email and we can just load it into your file. And then when you sit down in front of me I’ll say, ‘I see here you had an ultrasound in December, what symptoms are you having and let’s go over your ultrasound together.’ I love doing that with patients to educate them like what’s really going on with your body.
Puno: You were saying earlier that you need to be a better advocate for yourself. I don’t know maybe this is just my perception, but sometimes I feel like it’s going so fast and I don’t know if I’m making the most out of this time with the doctor. What would be your suggestion?
Dr. Hawkins: Maybe having like one or two things that you want to discuss. Like, I want to discuss today the fact that I’m burning when I urinate. Or the fact that I feel fatigued all the time, am I anemic? Because that will lead me to ask questions like, ‘Oh so you’re burning when you start to pee? Do you see any blood in your urine? Have you ever had a kidney stone? Is this every time you have sex that you have this problem?
It’ll lead us down a track to ask more questions because it is our job to be the investigator. But if you give us something to start with we’ll know where to go. If you come in and you’re saying, ‘You know I feel tired all the time, I’m eating ice,’ then that’s our clue to say, ‘Oh maybe she’s anemic. What are your cycles like? How many days is your cycle? how often do you have to change your pad? Is it painful? If your doctor’s not asking you those questions, you need to run. You need get up and kindly say okay thank you I’ve had enough.
Puno: But for real though.
Dr. Hawkins: We have to do the investigating. It is our job, so that when you come to us with a concern we start to ask the questions that’s going to lead us down the path to figuring out what’s going on.
Puno: My gynecologist and Bruce Lee, not only would they ask me so many questions, but they would also explain a lot of things I was curious, is it rude to ask to record?
Dr. Hawkins: I don’t think so. [Patients] might be recording me and I don’t even know. Especially in this day of COVID-19, I’ve had zoom calls with patients and their families. I’ve had husbands on FaceTime because they’re not in the office with us and things like that. So, a recording I think would be fine. I mean, I think that it wouldn’t be rude at all to ask if you did so, because sometimes patients leave and they feel like okay I forgot what she said.
Puno: Okay so I’ve got that information and I’m out the door, I’m feeling like my diagnosis, I guess, wasn’t very helpful or I just feel lost again. I got this a lot when I shared my fibroid story on Instagram. A lot of women were saying I did go to the doctor but I still don’t feel like I have the answers. What would you tell them?
Dr. Hawkins: I would say there’s no harm in a second opinion. Because we are loyal to a fault sometimes, saying things like I’ve been going to this doctor for 10 years, or they delivered my baby and I don’t want to go to anybody else. But if the doctor truly cares about you they would never mind you getting a second opinion. Second opinions are a thing. I have a lot of patients who come in for a second opinion. I even send patients sometimes for a second opinion. I say go talk to your reproductive doctor to see are we all on the same page, and with the same plan. Or sometimes it will take a group of doctors to actually get there. I have many patients who have their primary gynecologist or obstetrician and they’ll send them to me, and say just find out what Dr. Hawkins thinks and we’ll figure out a plan together, nothing wrong with that. So, when you leave sometimes you’re feeling incomplete, I don’t want people to feel discouraged. Don’t stop. Don’t feel like that’s the end. I’m very happy to have patients walk out the door with a plan, even if the plan is I think I need an MRI, do you mind going to get this for me? Then let’s do a virtual and go over the MRI together. Even if you’re not leaving with a full diagnosis, and booking a surgery tomorrow, you’re leaving with a plan for the next steps. You should always leave the doctor’s office with either some resolution, like here you go here’s your antibiotic or a plan for the next step.
Puno: Have you seen a shift of people talking about reproductive health and how has that changed and affected you?
Dr. Hawkins: It’s good. Social media has really opened up doors for more discussion. I can say that I felt alone in my diagnosis even though, clearly, I wasn’t the only one. But [there] just wasn’t this type of community back then. I know for a lot of women, even reading my reviews, they were like oh that sounds like me or you know that patient, cause that’s also how you find doctors sometimes is reading reviews. But all that we have accessible to us now with the world wide web, we’re able to just feel connected to the community. The conversation is much more vibrant, and it helps me because sometimes patients walk in and they are like, ‘I think I want to do Acessa® and then I’ll say let’s talk about it.
Puno: I feel like because we even were able to find you, like you’re just really good on social and really just talking about it on any platform you can get to, was that easy for you? Or did you just feel like that was necessary?
Dr. Hawkins: I feel like the education piece is fundamental. I feel like it was necessary to talk because, like I said, I’m really shy by nature, but I love this. I love this discussion, I love the fact that somebody will hear this and feel empowered to go to their doctor and speak up and get the information. So, I felt like this was super imperative, and I like it.
Puno: If you could imagine a future where it’s normalized, what would that look like?
Dr. Hawkins: An example of that would be knowing that in a room with my 10 girlfriends, probably eight of us have fibroids. So, if I bring the subject up where I say excuse me, I can’t sit on that white couch, you won’t be shamed or feel like you’re going to be shamed or you won’t feel awkward in that openness.
Even going back to what we talked about at the very beginning, having that relationship where we’re pulling in our partners, our mothers, our family members, our little niece who might go through this when she gets older, and having more of the discussion with our support system. Normalizing the discussion will help with the support too and will lead to occurrences where someone might push you to actually want to do more. Like how my husband was like, ‘Hm, you might want to get that looked at.’ So normalizing it is going to be super key in the future, and then hopefully over time it’ll trickle down to the insurance company’s and they will cover everything.
Puno: One of the things that we’re trying to do at Girlboss is really trying to redefine success. How has your definition of success changed from when you were a child to maybe even when you first started in medical school to now? I’m just curious about all the different changes.
Dr. Hawkins: Oh, that’s a deep question. I think success for me has always been measured—which is not good, this is not good, I’m not saying it should be like this—on how I felt like people perceived me. But that was my young version of success. I knew from a very young age I wanted to be a doctor so I was like I’m going to make my parents proud, I’m going to do well in school, I’m going to get into the school I want to get into, I’m going to the degrees I want to get into. I wanted to do it because it was going to make them happy.
I feel like I have been lucky and privileged enough to seat myself in a position where I am truly happy with what I do, and successful. I feel like I have figured it out as far as just getting a balance in life where, I do think I make a lot of people proud, but that’s not what drives me. Making them proud would never allow me to just, you know, be in [the operating room] at eight o’clock at night like I haven’t eaten in six hours, and I’m loving this. You know, making them proud wouldn’t fuel that, as much as me just deciding that the patient waking up the next morning or in a couple of hours and being like okay so what time can I peace out? I feel great, I’m ready to go. Knowing that they’re going to do fantastic, that is my measure of success. The same thing I measure my success in the OR with, what I am now starting to measure my success in life with is what is making me happy.
The first moment she felt truly successful
Puno: I love that. When did you have that first moment?
Dr. Hawkins: Very recently—probably with the start of my practice.
Dr. Hawkins: It was like, I’m doing this for me.
Puno: Yeah and you’re just like, ‘I got this!’
Dr. Hawkins: Yeah, I’m doing this for me because I want to. Not because someone told me I should. Because I’ll be honest, a lot of people were like, ‘Girl, you wanna do what?’ The overhead, I mean, you gotta be responsible for these people.
It was definitely a lot of bumps to that support. With the exception of my husband and I would say, my family. My mother and father were like, ‘Oh yeah you got this.’
Like I said, they said we’ve always seen it in you. But I definitely had more naysayers than supporters. So, I couldn’t have been doing it just for the way it would look to other people. So, it’s recent.
Puno: I’m so happy for your success. Just going through this and finding a doctor that you’re just like oh my gosh I will do anything for you. Just someone that you can completely trust with your body is really something special, and I could just imagine, so fulfilling for you.
Dr. Hawkins: And I don’t take that for granted. I don’t take that trust that my patients have in me for granted. Not one day.
Puno: In terms of legacy is the is the plan to teach a ton?
Dr. Hawkins: Teach in my way. Teach how I wanna teach. I may not be in a university or a big research center, but I can do that within what I feel like is going to be good for me and my family. I like that I’m five minutes from my house, and I can be there for my boys on the weekend so I don’t want to get to the level where that is sacrificed.
So yes, I want to teach, but I’m going to bring new doctors into my practice, I’m going to teach them how to be business savvy, how to be a girl boss themselves when they’re ready to build their own practices. I’m not going to skip the steps of getting the fundamentals in there because I do think that’s part of legacy building.
But I’m also going to do advocacy stuff and do talks like this, and if I do decide to take on students, I might not go to the university and do it, but have them come here. And I also do research. I’ve tried over the years to figure out a way to not my sacrifice my family for my success, or sacrifice my family for the next level of what I want to do. I’m going to take them along with me. But legacy building, when you have the opportunity to, I think it’s just a natural progression when you think about success.
Puno: Being able to democratize minimally invasive surgery is incredible you know…
Dr. Hawkins: I never imagined it. I was like I’m going to Atlanta the big city, it’s going to be a million of me.
Puno: And then you’re like hello? Hello?
Dr. Hawkins: I have patients that come in from everywhere. I have patients that have come from Washington State and I’m like what are you doing here? Why did fly all this way? What is going on? And not to say that I’m dominating the whole nation, not by far, there’s many of us but there’s not enough of us.
Puno: There’s not enough. Ugh, I’m so happy that you chose this and are thriving. It’s awesome too that you have been able to balance that and understand what your deal breakers are in your life and your lifestyle with your family.
And yeah, kind of just defining success the way you want to. It’s like it doesn’t have to be a university. I mean, I’m an online course creator, a teacher as well. And I’m like you know whatever I just need to teach people.
Dr. Hawkins: I love it. Yep, we find a way, we find make fit.
Puno: Okay let’s try this TicTok. So basically, we were thinking that, and I don’t know if maybe this might not even be the right one if you have ideas too. But one thing was: What would you do, what are your tips, what are your thoughts on how to work while you have some cramps or during your period? What’s your go-to?
Dr. Hawkins: Water, heating pad under the desk. No one ever has to know it’s there.
Puno: Oh my gosh, yes, yes.
Dr. Hawkins: And a buddy, that you can be like hey Susie I need a break, I need to go a buddy that’s going to have your back at work.
Puno: Your period buddy.
Dr. Hawkins: Your period buddy, I love that we’re going to coin that term.
Puno: Water, period buddy, and a heating pad. The heating pad is huge. I wish I had mine here but mine is like a little walrus that’s filled with rice and lavender.
Dr. Hawkins: Yes, I have one just like that which I put right here filled with rice and lavender.
Puno: And then um I’m going to add a little bit more to that: chocolate cake and pizza.
Dr. Hawkins: I gave like the calm answer, you’re giving the realness.
Puno: Sweats, definitely. And I like tie-dye sweats, just in case.
Dr. Hawkins: Yes, oh my gosh. Why didn’t I think of that I love it.
Puno: I have my iPad on my tripod stand and TGBBS—The Great British Baking Show.
Dr. Hawkins: Yes, oh gosh. I know that only because my sister is obsessed.
Puno: You knew the acronyms.
Dr. Hawkins: My sister is obsessed with all baking shows especially if they’re British and especially if they’re on Netflix. She’s obsessed.
Puno: But on TGBBS, like they are the kindest people ever you’re just like oh my gosh, you’re helping them make a lemon curd, like you didn’t have to do that.
Dr. Hawkins: My sister is going to die when she watches this if they leave that part in.
Puno: I hope so. There are so many good parts in this, oh my gosh. Well thank you so much, Dr. Hawkins, I mean seriously like you were such a gem of a person I had so much fun talking to you.
And I hope this helps other women because when do you get to talk to a gynecologist like this who is a surgeon as well and know so much about fibroids and endometriosis. It’s just like—I feel very lucky, I’m really glad.
Dr. Hawkins: This is good. Thank you, thank you to Girlboss—I mean honestly again this platform is huge, it’s huge
Puno: I hope so. I mean that’s why we were like we need to get you on like the first six episodes because I’m a huge advocate now but I was like no, nope 80% of women have this, we need to talk about it. If this is for girls, you know, we need to talk about
Dr. Hawkins: I love it, thank you.
We’re feeling inspired to confidently head into our next doctor or gynaecologist appointment armed with the right questions so that we can leave clear on the next steps after Puno’s educational chat with Dr. Soyini Hawkins. That, and to be advocates for our own health.
As Puno says, “I’m a little bummed that I can’t just take that tiny miniature version of her with me every time I visit my doctor. Wouldn’t that be amazing? But know that we can always take what she shared with us today. Great advice on how to take control of the time we have with our doctors.
So don’t be afraid to ask your doctor if you can record your visits so you can listen to it over and over and take time to just understand and process what they said. You don’t have to leave your doctor more confused than when you got there. Nope. And if you are advocating for yourself and your doctor is still giving you the brush off, do like Dr. Hawkins said and run.
Look, you don’t have to stick with a doctor that’s not listening to you. We’re taking your pain seriously for any of you out there right now who are afraid of sitting on that white couch or sick and tired of spending time researching all the ways to get bloodstains out, I hope this episode made it absolutely clear that you are not alone.
I really hope that after you listened to this episode, that if your friend, your roommate, your partner, they complain about their periods and they consistently keep doing it that you share this episode with them, and that hopefully one day they might share their story. To this day, I still get DMs from people thankful for me just sharing.
I mean, the only reason why I shared was because someone else had shared their story and that’s how I found my doctor. So share, let’s share, let’s talk about our periods.”
Be sure to follow Dr. Hawkins on Instagram and check out all her blog and library brimming with resources on fibroids and endometriosis on her website, Fibroid and Pelvic Wellness Center of Georgia.
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