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Medical Edge Newspaper Column from Mayo Clinic
NEW PROCEDURE SAFER THAN HYSTERECTOMY FOR HEAVY MENSTRUAL FLOW
DEAR MAYO CLINIC:I am an investment banker with a health problem
that threatens my career. I’m 39.
Three months ago I started to get really heavy periods. They’re so heavy
I can barely make it through a meeting without fear of spotting. I went
to my local ob-gyn, and he found nothing unusual, including my Pap test.
He said I have something called “menorrhagia,” and I tried the hormone
pills he gave me. They didn’t seem to work and I couldn’t stand the side
effects, so I stopped them.
Now he suggests a hysterectomy. This floors me. I’m not married and I
don’t want children. I also don’t want major surgery. But the heavy flow
controls my life now. Is hysterectomy really my only option? What is happening
to me? — St. Louis
ANSWER: No, hysterectomy is not your only option. With your doctor,
investigate an alternative known as “global endometrial ablation.” It
involves minimally invasive, outpatient surgical destruction of the endometrial
tissue of the uterus. Most women can resume normal activities the following
day.
An earlier form of endometrial ablation was practiced in the 1980s, but
because it required considerable training and skill, the procedure never
became widely available. In the last several years, however, newer technologies
have been developed that are fast, safe and effective — hence the new
descriptive term in the procedure’s name: “global” endometrial ablation.
It refers to the fact that advances have made it easier to use for surgeons,
and more safe and effective for patients, therefore giving it a wider
— more global — reach.
Global endometrial ablation technologies use various forms of energy and
devices to ablate, or destroy, the tissue lining the uterus. The energy
forms include high-frequency radio waves, thermal energy, freezing and
microwave energy. In some cases, the procedure can be done in as little
as five minutes in a doctor’s office, under local anesthesia, with or
without sedation.
The condition you describe, menorrhagia (men-or-AZH-ee-a), refers to heavy
menstrual bleeding. Worldwide, it affects approximately one in five women
of reproductive age. It can be a significant social and psychological
problem — even an economic problem when it interferes with work, as your
experience indicates. As a result, menorrhagia is a frequent medical complaint
of women in their 20s, 30s and 40s.
In the past, oral contraceptives, dilation and curettage and hysterectomy
have been the main treatment options for menorrhagia. Oral contraceptives
are not always successful in reducing flows, and are associated with such
side effects as weight gain and mood swings. Women also become dissatisfied
with what they perceive to be a long wait for the pills to take effect.
D & C has been used as the first surgical option for women who want
to maintain their fertility, but results have not been consistently satisfactory,
and the procedure is no longer recommended for treating menorrhagia. Hysterectomy
carries all the risks, discomforts, recovery time and economic costs of
major surgery. It also eliminates any possibility of future pregnancies.
Global endometrial ablation is an effective alternative to hysterectomy
— and like hysterectomy, should only be considered by women who are certain
hey don’t want to bear children. Pregnancy after global endometrial ablation
can be dangerous to both mother and fetus because the uterus lining has
been altered. The risks include fetal growth restriction and uncontrolled
bleeding.
If the patient is certain in her decision to end childbearing, global
endometrial ablation is preferable to hysterectomy because it is safe,
effective and produces high levels of patient satisfaction — all without
the risks of major surgery and the six weeks of recovery time.
No matter which global endometrial ablation technology is used, results
are excellent. One federal study showed that two years after the procedure,
94 percent of women were satisfied with the results.
— Abimbola Famuyide, M.D., Obstetrics and Gynecology; Mayo Clinic, Rochester,
Minn.
Additional Resources:
Appointment
Information
Hysterectomy
Heavy
Menstrual Bleeding
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Medical Edge from Mayo Clinic is an educational resource and doesn’t
replace regular medical care. To e-mail a question, go to www.mayoclinic.org,
or write: Medical Edge from Mayo Clinic, c/o TMS, 2225 Kenmore Ave., Suite
114, Buffalo, N.Y., 14207. For health information, visit www.mayoclinic.com.
© 2004 TRIBUNE MEDIA SERVICES, INC.
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