New Options to Old Problems: No Need for Hysterectomy?
Dr. George Hubbell, M.D.
Abnormal uterine bleeding (AUB) is one of the most common gynecological problems, affecting 10 million women a year in the U.S. alone. Any woman who has experienced AUB can testify to its significant impact on her quality of life. Bleeding can create anemia, fatigue, social embarrassment, isolation, lost work and a lowered sense of well-being. Traditionally, physicians often treated AUB with either hysterectomy or dialation and curettage (D&C), but recent advances have changed this.
Bleeding is a major reason (66%) for hysterectomies. Certainly, there are still cases when, because of the potential health risk of medical factors, it is still a warranted procedure. However, with 50% of surgical specimens having normal pathologic findings, it is important AUB be treated as a symptom, not a diagnosis. Common causes of bleeding include hormone imbalances, polyps, fibroids, infections and in less than 5% of reported cases, cancer. And often the source only involves the endometrium, the lining normally shed each month, and not the uterus as a whole.
Throughout the last millennium, D&C was the standard to control as well as diagnose bleeding problems. This procedure is becoming obsolete. In a recent study, it missed the true diagnosis in 60% of performed cases. Instead, a hysteroscope, which utilizes a small telescope, can focus on the lining of the uterus. This direct vision helps to insure a correct diagnosis and can also confirm completion of therapy.
Another outpatient or in-office procedure available to physicians is endometrial ablation. During this simple therapy, the lining of the uterus is destroyed, and is highly effective with a majority of patients. Five year satisfaction rates approach 95%, and tolerability for the technique is excellent. Women can return to their normal routines quickly since a hospital stay is not required.
There are additional options available with endometrial ablation. The endometrium can be lasered, cauterized, blanched or frozen. Simply circulating hot water or using a hot water-filled balloon will ablate the lining. Radiofrequency destruction and, most recently, microwave are also possibilities. All methods have been effective and FDA approval exists for all of the most recent ones. However, some have shown to be safer or better tolerated depending on individual situations.
New therapeutic options at Lake Regional Hospital include Thermachoice balloon therapy and HTA, a hydrothermablator, and Novasure. Women can have their abnormal bleeding addressed in usually less than an hour without the inpatient stay required. Finally, women can look forward to a variety of quick, well-tolerated and highly effective treatments to a common problem in the comfort and safety of an office setting.
Dr. Hubbell performed the first Thermachoice ablation in the country and has trained many other physicians on these office techniques. He has also spoken nationally on the topic.
Forms for Endometrial Ablation