Is it the best choice
for excessive menstrual bleeding?
Odds
are great that you are close to someone who has had her uterus surgically removed;
odds are good that if you haven't had yours removed, at some point you will. After
all, as many as one third of women in the U.S. have a hysterectomy by age 60.
It is the second most frequently performed major surgical procedure for women
of reproductive age, after cesarean section.
Hysterectomy
was in the news again this summer when California researchers lead by William
Parker, M.D., reported the routine practice of removing a woman's ovaries during
a hysterectomy has no clear health benefit and actually raises the risk of death
from heart disease and hip fracture.
That
information is surprising, but perhaps not as surprising as learning that many
of the over 600,000 hysterectomies performed annually in the U.S. may be unnecessary.
Think Once,
Twice, Three Times Before Hysterectomy
In
his book A Gynecologist's Second Opinion, Dr. Parker provides startling comparisons
of the incidence of hysterectomy in the U.S. and Europe. Consider the following:
An American woman is twice as likely to have a hysterectomy as a woman in England
and four times as likely as a Swedish woman. French doctors almost never perform
hysterectomy for fibroids, which is the most common reason for hysterectomy in
this country. Cultural attitudes and physician training are just two factors that
contribute to these differences.
Judy
Norsigian is executive director of Our Bodies, Ourselves, a Boston-based women's
health advocacy group. "You need to think once, twice, three times before pursuing
hysterectomy. Sometimes it is necessary, sometimes it is not. It is major surgery
and should not be entered into lightly."
Mona
Alqulali, an obstetrician-gynecologist in Davenport, Iowa, expresses similar words
of caution. "Many of my patients come to me and say their mother had a hysterectomy
and they think they need one, too. Doctors are accustomed to performing hysterectomies
and patients are accustomed to having them. There needs to be greater awareness
of alternative treatments."
Endometrial
Ablation for Excessive Menstrual Bleeding
According
to the U.S. Department of Health and Human Services, 90 percent of hysterectomies
are performed for noncancerous conditions, such as excessive menstrual bleeding.
"In the past,
a woman with excessive menstrual bleeding was treated with hysterectomy," says
Dr. Alqulali. "With the advent of new technology, we have access the endometrial
cavity and we can identify and tackle problems that used to require removal of
the uterus."
Endometrial ablation often can replace hysterectomy for the treatment of bleeding
disorders. With endometrial ablation, the uterus and hormones remain intact. Using
heat or subzero temperatures, the lining of the uterus, which is responsible for
menstrual bleeding, is eliminated. By eliminating most or all of the lining, there
is less tissue to shed each menstrual cycle leading to significantly reduced bleeding.
Her Option Cryoablation
Therapy from AMS is an endometrial ablation process that uses subzero temperatures.
Because the cold temperatures serve as a natural anesthetic, there is no need
for IV sedation. The entire procedure is performed in the doctor's office and
typically takes 30 minutes or less. A full 94 percent of Her Option patients are
free from abnormal bleeding at two years, and 96 percent would recommend the procedure
to a friend.
"This
procedure is a great choice for women and an appropriate first-line defense,"
says Dr. Alqulali.
Sometimes
You May Need a Hysterectomy
Clearly,
there are cases in which hysterectomy is the best treatment choice. If hysterectomy
has been suggested to you, be certain to weigh the pros and cons, inquire about
alternative treatments and understand the potential benefits and risks.
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