Women's Health Alert: New treatments for pain and bleeding
In September 2003, Ginny Wieczerzak experienced the worst menstrual period she'd ever had. "I never had any gyn problems, and my periods were always regular. And then... well, then it all changed," she remembers. Seemingly overnight, Wieczerzak went from having a normal, monthly period to heavy, erratic bleeding. It was so unpredictable that she set up work-coverage plans with her colleague in case she needed to bolt from meetings. She was sick, dizzy and baffled: "I thought... 'How could I be so regular one minute, and so irregular the next?'"
An ultrasound revealed the cause: a plum-size fibroid growing in her uterus. Wieczerzak and her husband considered the treatment options laid out by Virtua obstetrician/gynecologist, Eric Grossman, MD. These included hormonal therapy, surgical fibroid removal and hysterectomy. Wanting a definitive end to the problem, Wieczerzak opted for a hysterectomy, the removal of her uterus.
Different approaches to hysterectomy
In addition to open abdominal hysterectomy - in which the uterus is removed through a four-inch abdominal incision - there are minimally invasive options such as laparoscopic and vaginal hysterectomies. For some women, it may be appropriate to remove the ovaries and cervix in addition to the uterus. "Your doctor can discuss the options with you and help you choose the best treatment for your disorder - and your lifestyle," says Dr. Grossman. Depending on the technique used, recovery can take two to six weeks.
A minimally invasive approach
Dr. Grossman recommended that Wieczerzak have a laparoscopic supracervical hysterectomy, a minimally invasive procedure that would remove the uterus and fibroid through a few tiny incisions, but leave the ovaries and cervix intact. He explains the benefits: "When the ovaries are removed, it launches women into an early menopause because of a drop in hormones. Leaving the ovaries intact prevents this. In this procedure, the cervix is also left intact, which some studies show helps preserve sexual function."
One of the greatest benefits to minimally invasive surgery is the quick recovery time and reduction in post-operative pain. Wieczerzak was very pleased at how quickly she bounced back after surgery: "I went home the morning after my surgery and felt good enough to go Christmas shopping a few weeks later." However, Wieczerzak notes that the greatest benefit was gaining back her overall wellness: "This was such a sudden, life-disrupting problem - it was really wearing on me. Right after surgery, I started feeling like myself again," she says.
Sophisticated new options offer many benefits
"Sometimes, it takes a dramatic occurrence like sudden, heavy bleeding for women to learn about the new techniques and medications that are available to treat common problems or concerns," says Virtua obstetrician/gynecologist Monica Agar, MD. She advises women to use their annual gyn exam to catch up on the latest options in gynecological care - from treating bleeding irregularities to choosing the right contraception. Below are some of the latest options available.
Concern: Heavy menstrual bleeding
Standard treatment: Depending on the cause, options include dilation and curettage (D&C), hormone therapy or surgery.
Latest option: Endometrial ablation
"Endometrial ablation is becoming one of the most common procedures used to treat heavy bleeding," says Dr. Agar. "During this procedure, the lining of the uterus is destroyed through one of several methods: hydroablation and balloon or thermal ablation, which uses heated fluid to destroy the lining; electrocautery, which uses electrical energy; cryoablation, which freezes the lining; and, microwave ablation, which uses microwave energy to heat and destroy tissue."
Benefits: Endometrial ablation usually is performed as an outpatient procedure with only local anesthesia. Recovery generally takes a few days to a few weeks. Periods become light to moderate and sometimes cease all together.
Risks: Women who want to become pregnant should not choose this option. While serious complications are uncommon, a small number of women may experience bleeding, infection or injury to the uterus or other organs.
Concern: Convenient birth control
Standard treatment: Birth control pills, diaphragm, copper-based intrauterine device (IUD) are popular birth control options.
Latest option: Hormonally based intrauterine system (Mirena)
A trained gynecologist inserts a tiny, t-shaped plastic device into the uterus. Over time, the device releases small amounts of hormones that work to prevent pregnancy.
Benefits: This device is 99.9% effective in preventing pregnancy. It lasts for up to five years and may be removed at any time without affecting fertility.
Risks: This option is not suitable for women with a history of pelvic infections, or for those who have an abnormal uterine cavity. Side effects may include menstrual changes, cramps, breast tenderness and mood changes. Serious complications are rare but may include perforation of the uterus and expulsion of the device.
Concern: Permanent birth control
Standard treatment: Tubal ligation (tubes tied) has long been the standard.
Latest option: Microinserts (Essure)
"A trained gynecologist routes two, tiny, spring-like inserts through the vagina, cervix and uterus and places one into each fallopian tube," explains Dr. Grossman. "Within three months, tissue grows around the inserts. This blocks the fallopian tubes and prevents sperm from reaching and fertilizing an egg."
Benefits: Patients go home on the day of the procedure. There's no incision or need for general anesthesia. Recovery takes one to two days.
Risks: "This procedure is considered irreversible so women who want to become pregnant should not use it," says Dr. Grossman. "In addition, patients must use another form of birth control for at least three months after the procedure until a diagnostic test shows tissue growth has fully blocked the fallopian tubes."