Menstrual cycles of 21-35 days are considered normal. Cycles longer or shorter than this are irregular and should be evaluated by your doctor. Irregular cycles may occur because of weight loss or gain, vigorous exercise, stress illness, or other changes that affect your body. For the first few years after menarche, menstrual periods are often irregular. A young woman may have only three or four periods a year. Menstrual cycles usually become lighter and less frequent as menopause approaches and hormone levels decrease. In some cases the cycles will become erratic and heavier around perimenopause.
Bleeding that is heavier than usual, or lasts longer than a week may also be abnormal. It can have a number of abnormal causes such as hormonal imbalance, coagulation disorders( problems with blood clotting) uterine polyps, uterine fibroids (benign tumors of the uterine muscle), uterine adenomyosis (sponginess), hyperplasia (pre-cancerous growth), cancer.
Medical treatment with birth control pills, hormones, and other homeopathic and conventional medications is the first line of therapy for the treatment of irregular bleeding and heavy periods in our practice.
If medical options do not work or are not the appropriate treatment option for the disorder, the following surgical options can be recommended. The goal in our practice is to allow every patient to explore all options prior to definitive surgery. We feel it is your right to know that there are other methods of treatment besides hysterectomy, and we are willing to try all options. It is important to understand that your physicians will educate you about the best route of surgery for your particular case. Our goal is to have our patients have the safest, most comfortable surgery and to be able to return to normal activity as soon as possible.
Dilation and Curettage:
D&C is a very common surgical operation. The procedure is performed under general anesthesia which is very safe. The cervix (opening to the uterus) is dilated with the help of instruments, and the lining of uterus is then removed. Sometimes doctors may perform hysteroscopy at the same time as the D&C. A thin telescope – like instrument is inserted through the cervix and allows the doctors to visualize the lining of the uterus directly. These procedures are performed to empty the uterus after a miscarriage to remove polyps in the uterus which may cause irregular bleeding to remove pre-cancerous or cancerous overgrowth of the lining of the uterus.
Uterine Lining Ablation – Endometrial Ablation
Many women have long, heavy and painful periods. This is known as abnormal uterine bleeding. One treatment for this is uterine ablation also referred to as endometrial ablation. This procedure involves destroying cells in the endometrium or lining of the uterus. The lining of the uterus is burned with special equipment under general anesthesia. Patients do not feel any burning pain. The scar tissue which forms from the burning process will either stop any bleeding from the uterus, or minimize it during the menses. The success rate of this procedure in our practice is 75-80%. This procedure is performed as a treatment for the following problems:
Who Should Consider This Treatment?
- Heavy menstrual cycles
- Adenomyosis – which causes heavy bleeding
- Uterine fibroids
Women who have heavy, long and/or painful periods. Women who are finished with childbearing and no longer wanting pregnancy.
How Effective Is Ablation?
Ablation helps decrease the amount and length of your periods. Most women see a significant decrease. Some women may have very minimal to no period after ablation. Additionally, some women may require a repeat ablation or further treatment. Approximately 92% of women are satisfied with their ablation.
What Tests Will I Need Before Ablation?
Women considering ablation will need to have a sonohystogram and endometrial biopsy. These tests allow us to see the lining of the uterus to check for causes of abnormal uterine bleeding such as polyps, fibroids, etc. These tests are performed in out office.
Is Ablation Birth Control?
No, although ablation destroys endometrial cells in the lining of the uterus, it does not prevent ovulation. It may still be possible to become pregnant. After ablation, it will still be necessary to use some type of birth control.
How Is Ablation Performed?
Uterine ablation is performed vaginally. There are no incisions necessary.
What Are The Options For Ablation?
Dr. Simon and Dr. Brodkin offers two types of ablation: Her Option and Novasure. Her Option is cryoablation that involves freezing the endometrial cells with a wand. It may be necessary to freeze several zones of the uterus. This procedure is performed in our office. Novasure is ablation that involves heating and burning the endometrial cells. A gold mesh expands within the uterus, heats and is then retracted. This procedure is performed in an outpatient surgical center. Both Novasure and Her Option were approved by the in 2001.A comparison of these 2 procedures is provided below.
What Risks Are There With Ablation?
Risks include uterine perforation, bleeding infection and injury to other organs in the pelvis or abdomen. Safety precautions are followed to minimize these risks. Uterine ablation may also cause a delay in diagnosis of endometrial cancer since one of the warning signs of abnormal bleeding.
For more information on these ablation procedures you can visit their websites at Her Option
Cryotherapy of Uterus
Freezing of the lining of the uterus
The concept is the same as Balloon Ablation except instead of using heat the lining of the uterus is frozen.
Myomectomy is a surgical procedure that removes only the fibroid, leaving the uterus intact. Fibroids are overgrowths of the smooth muscle of the uterine wall. Fibroids can occur as one single growth or multiple growths. Myomectomy can be performed through an open abdominal incision or through laparoscopic techniques(small abdominal incisions through which instruments are introduced to the abdomen to perform the myomectomy). Myomectomy is performed in patients that are interested in future fertility or preservation of the uterus for other reasons.
Radiologic Fibroid Embolization:
Radiologic Fibroid Embolization is a procedure that blocks the blood supply to the fibroids, causing them to shrink. This procedure is performed in the hospital byInterventional Radiologists. This procedure is less invasive than conventional surgery and has a success rate 60-75%. Embolization is reserved for patients who are done with child bearing, and are perimenopausal or menopausal.
A Hysterectomy is the removal of the uterus and is one of the most common types of surgery performed in women. There are different kinds of hysterectomies. A partial or supracervical hysterectomy is when the cervix is NOT removed. A total hysterectomy is when the cervix IS removed. Both, the supracervical or total hysterectomy can be combined with the removal of the tubes and the ovaries which is called a salpingo-oopherectomy. Some of the reasons for a hysterectomy are: uterine fibroids, endometriosis, uterine prolapse, cancer, endometrial hyperplasia (heavy growth of uterine lining), menstrual and menopausal symptoms, cervical dysplasia (precancerous changes) and pain.
There are different methods to perform a hysterectomy:
- Vaginal Hysterectomy
The uterus, cervix and tubes and ovaries are removed through incisions through the vagina. All the blood vessels are sutured vaginally. Most patients can go home from the hospital the day after the surgery and they can return to work or normal activity within 2-4 weeks after surgery.
- Abdominal Hysterectomy
The uterus, cervix and tubes and ovaries are removed through an incision in the lower abdomen. Most patients can go home within 24-48 hours after surgery. And they can return to work or normal activity within 4-6 weeks after surgery.
- Laproscopic Supracervical Hysterectomy
The uterus is removed and cervix is left. The uterus is removed through very small abdominal incisions. Through these incisions small operative instruments are introduced, and the procedure is performed. Most patients can go home the day after surgery, and can return to normal activity within 1-2 weeks.
- Laproscopic Total Hysterectomy
The uterus AND cervix are removed through very small abdominal incisions. Through these incisions small operative instruments are introduced, and the procedure is performed. Most patients can go home the day after surgery, and can return to normal activity within 1-2 weeks.
It is important to understand that your physicians will educate you about the best route of surgery for your particular case. Our goal is to have our patients have the safest, most comfortable surgery and to be able to return to normal activity as soon as possible.
- Laproscopic Assisted Vaginal Hysterectomy
A combination of a vaginal hysterectomy and laporoscopy will allow the doctor to release adhesions and assist in removal of the uterus without an abdominal incision.
- Robotic Hysterectomy
Many women have a hysterectomy to treat cancer, chronic pain, irregular bleeding, uterine prolapse, fibroid or endometriosis. Previously, this surgery was traditionally performed with an abdominal incision. Today, women have additional options for hysterectomy including: vaginal, laparoscopic and computer assisted daVinci.These types of hysterectomies are considered minimally invasive. These less invasive surgeries provide many benefits over the open abdominal surgery. They allow for a shorter hospital stays and faster recovery times. Additionally, these surgeries decrease risk of infection, reduce pain, blood loss and scarring.
The vaginal approach to hysterectomy often includes a laparoscopic assist. Laparoscopy involves making small incision in the abdomen to allow instruments and cameras to aid in the surgery. The daVinci hysterectomy is similar to laparoscopy. However, the daVinci also provides increased precision of surgical instruments.
Although the daVinci is sometimes refer to as a robotic surgery, it is more correctly described as a computer aided surgery. The computer can not move or decisions on its own. It must have input or be directed by the surgeon. The computer takes this input and refines it to reduce tremors and provide highly precise movements.
During the operation, the surgeon sits at a computer console with a monitor screen. A computer cart, which has 3 or 4 arms, is placed next to the patient. The surgeon controls the arms of the cart from the console while observing real time images. An assistant stands with the patient to aid with the passing of instruments to the computer cart.
The daVinci was approved by the FDA for hysterectomy in 2005. However, it has been in use for studies since 1999.
For more information you can visit www.daVinciSurgery.com