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more articles by Gelber, Steven A. , MD  |  author's bio

New Ways of Approaching Hysterectomy

New Ways of Approaching Hysterectomy

By Steven Gelber, MD


The field of gynecology has seen many welcome advancements in recent years.  Patients now have the ability to develop treatment plans with their doctors that are highly individualized and based on each patient’s specific medical problems and lifestyle preferences. One area where these advancements have had a significant impact is in new surgical technology for minimally invasive hysterectomy. This surgical procedure is a mainstay in treating heavy or irregular menstrual bleeding that is not resolved through medical or hormone treatment.


Initial considerations in treating menstrual problems


The first step in treatment is to evaluate the nature of the menstrual problem to determine if it is a medical issue or related to lifestyle. If it is medical, the next step is to establish the cause and determine how serious the problem is and whether it should be treated medically or surgically. If the problem is heavy flow, sometimes the solution can be as simple as taking an anti-inflammatory medication, such as ibuprofen, in doses of 600 to 800 mg three times a day for a couple of days prior to and during the first two days of a period. While most people think anti-inflammatory medications are for pain only, in reality they also diminish the flow of blood significantly for most women.


Common problems and approaches to treatment


If you are experiencing problems with heavy blood flow, your doctor might recommend hormone treatment, either progesterone or the birth control pill. If you suffer from irregular periods, your doctor may suggest a full hormone workup to determine the cause. If the root of the problem is structural, such as the presence of uterine fibroids or polyps, you may need an ultrasound to assess the situation. Laboratory testing may also be in order if blood disorders or coagulation problems are suspected. If you have prediabetes or type 2 diabetes and experience infrequent or prolonged menstrual periods, you may have polycystic ovary syndrome.


When you’re not a candidate for medical or hormone treatment


If you suffer from heavy or abnormal menstrual bleeding and previous approaches to treatment have not worked to alleviate the problem, your doctor may suggest a procedure called endometrial ablation. This procedure utilizes either a cautery or heated water to render the uterine lining unresponsive to hormones. This way the uterine lining does not regenerate although the uterine muscles remain intact. Following endometrial ablation, ninety percent of women feel better to the point where they need no further treatment.


New minimally invasive hysterectomy


Hysterectomy is another mainstay treatment of excessive uterine bleeding. Gynecologists at Cayuga Medical Center often perform hysterectomies using a laparoscope to remove the uterus through the vagina, making it much less likely to require a large surgical incision in the abdomen. The recovery time is faster because the surgery is performed through three or four tiny incisions and patients can return to their normal activities much more quickly.


Hysterectomies have also become much more individualized to each woman’s situation. Several different options are available to patients now, including hysterectomy in which the uterus and ovaries are completely removed; removal of the uterus and cervix; and removal of the uterus only, while leaving the cervix in place. Increasingly, women are choosing to leave their ovaries in place, to extend the time during which they can produce their own hormones.


Our goal is to solve excessive menstrual problems without doing more than needs to be done. This is best accomplished when women and their doctors have an informed discussion about what the treatment options are and what is most important to the patient. This enables patients and doctors to tailor treatments to meet the specific needs of each individual.


Dr. Steven Gelber is board certified in obstetrics and gynecology and is a member of the medical staff of Cayuga Medical Center. He is in practice with Ob-Gyn Associates of Ithaca, where he can be reached at (607) 266-7800.


















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