Download Hysterectomy is no longer the only answer for excessive bleeding

House Calls
January 31, 2007
Hysterectomy is no longer the only answer for excessive bleeding
By Ravi S. Johar, MD
It’s estimated that excessive menstrual bleeding affects one in five women. It is a
primary reason more than 600,000 women undergo a hysterectomy each year, making it
the second most common major surgery performed on females in the United States.
However an elective hysterectomy is no longer the only option. There are some
relatively new, exciting outpatient procedures to treat painful, excessive bleeding.
First, what causes excessive menstrual bleeding? For some women, the problem
is hormone-based. Birth control pills and other medications can help regulate the
hormonal imbalance and address this cause of bleeding.
For most women, however, excessive bleeding is generated by an anatomical disorder
inside the pelvic region. The most common of these disorders involve fibroids ― benign
(non-cancerous) growths in the wall of the uterus that affect anywhere from 20 to 50
percent of women in childbearing age.
Women may be familiar with a common surgical procedure called a myomectomy.
Instead of removing the entire uterus (hysterectomy), myomectomy removes only the
fibroid tissue from the uterus. The problem is that fibroid growth tends to recur over
time.
A non-invasive procedure called MRI-guided focused ultrasound (Ex-Ablate) is a
particularly exciting alternative to myomectomy. This procedure is based on the same
premise in which kidney stones are often dissolved non-surgically.
High doses of ultra focused sound waves destroy the fibroids from outside the body
through the skin. The attending gynecologist is guided by MRI images, which provide
3-D imaging of internal organs without radiation, to pinpoint the fibroid mass.
During the procedure, the patient lies on her stomach on a table above a standard MRI
scanner and the gynecologist manipulates the ultrasound waves to “melt away the
fibroids.” The patient requires only some very mild sedation and is able to walk home
and resume her normal activities the same day.
Endometrial ablation is an effective alternative to hysterectomy in the treatment of
menorrhaghia or heavy irregular bleeding. A telescopic device is inserted through the
vagina and the cervix into the uterus. Through this device a heating element or a radio
frequency device is used to vaporize the lining of the uterus.
A new procedure, called NovaSure, can be appropriate for women who have completed
childbearing. A gold mesh is deployed around the uterine lining. A current of electrical
energy is applied through the mesh for about 90 seconds. The mesh is removed and the
procedure is completed in a matter of minutes. The typical recovery is a matter of only
a few hours and someone can return to their normal activities the next day.
These are just a few of the medical approaches now available for women to relieve the
pressure and pain caused by heavy and excessive bleeding. Most of these outpatient
procedures result in excellent outcomes.
About 50 percent of women will never have menstrual bleeding again. The large
majority of the other half (about 75 percent) reports a tremendous improvement. Only
about 10 percent of women may still need to consider a hysterectomy to relieve the
condition.
Always consult your gynecologist before choosing to undergo an elective hysterectomy.
Together, you and your doctor should check into all the options. In some cases a full
hysterectomy may still be necessary, but for many others, a less invasive, quicker
recovery procedure can be the answer.
Dr. Ravi S. Johar, MD, is a board certified obstetrician/gynecologist with the SSM
DePaul Medical Group on staff at SSM DePaul Health Center. Dr. Johar can be reached
at (314) 344-7585. For more information about SSM DePaul and its physicians, visit
www.ssmdepaul.com or call (314) SSM-DOCS.