New Ways of Approaching
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 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.