A matter of choice

There was a time when having a hysterectomy, the surgical removal of the uterus and sometimes the cervix, was the cure-all for women's gynecological health problems.

Used to treat a variety of disorders, hysterectomy served as a tried-and-true remedy, physicians said. If a woman wanted her reproductive problems to stop, remove the organ that produced them.

Such thinking has made the hysterectomy the second-most common major surgery among child-bearing women in the United States. More than 600,000 are performed each year.

As beneficial and necessary as the hysterectomy is for some - it's still the best option for some cancers - arguments arose among doctors in the early 1990s as to whether the procedure should be performed at such high numbers that one out of four women was likely to have the operation by the time she reached 60.

That argument hasn't subsided, and options have been developed to give women a choice other than a hysterectomy, which can dramatically change a woman's view of herself and prematurely lead her into menopause.

"With doctors, as in any profession, there will always those of us at one end and others at the other end of spectrum," said Barbara Levy, the medical director for Women's Health and Breast Center at St. Francis Hospital in Federal Way, Wash., who also practices general gynecology. "None of it is bad medicine ..."

Because hysterectomies can be used to treat so many ailments, there are many smaller procedures designed in the past 20 years that can be used as alternatives to full-fledged uterine removal. Dr. Levy said women should be aware of them.

Options include everything from hormone therapies to outpatient procedures that aim to reduce symptoms without requiring women to go under the knife and lose their reproductive organs.

Those options include a procedure designed for women with heavy bleeding, a common disorder among premenopausal women.

In microwave endometrial ablation, a ceramic-tipped applicator is used to blast the uterine lining with microwaves to stop bleeding. Ablation procedures, in which the lining of the uterus - the endometrium - is destroyed, have progressed from using balls the size of BB's to scrape across the uterus to inserting and filling a balloon device with hot water.

Though Dr. Levy said no technique is superior to another, most usually are effective in stopping heavy bleeding without removing a woman's reproductive organs, she said.

"For those who would prefer minimally invasive procedures, these things (ablations) are all wonderful," Dr. Levy said. "They are not as definite a procedure as hysterectomy but less invasive and require less recovery time."

That's a huge plus for patients, said Deborah O'Shields, a gynecologist at Augusta GYN., P.C., who has performed the three-minute microwave endometrial ablation procedure with success.

"In this day and age when we're all so busy, we can't afford to take four to six weeks off work (for a hysterectomy); this is a great alternative, a good place to start," she said. "MEA is so simple and seems so effective, and it's less time ... considering time out of work, time from family. With this, the next day they're back to work."

Though a procedure such as the microwave ablation could prove beneficial, it isn't for everyone. Some women won't be able or willing to have one. Women with large pelvic masses or with thin uterine walls aren't good candidates. Neither are those who haven't finished having children.

Like the debate surrounding hysterectomies, Dr. Levy said, women shouldn't confuse options for necessity.

"I think we intervene too much," she said. "You do an intervention if a woman's quality of life is affected by the symptoms, like she can't work two days a week. ... To do it as a 'cosmetic' thing to see how much it can reduce bleeding is ill-advised to me."

Still, Dr. Levy is the first to acknowledge that there are times when action is necessary. There will be patients who will need a hysterectomy because of chronic pain or will truly benefit from an ablation procedure or some other treatment. The key is education, she said, but that's made more complicated by the degree to which a woman views her situation.

"Every woman is different," Dr. Levy said. "While heavy bleeding is quite common, one person's heavy is another person's light. ... Some of us (women) just don't have a benchmark; we don't generally talk about this to other women. We don't sit down and have coffee in private parties anymore and discuss our bodies."

Even if women did, the consensus wouldn't go far to assuring anything.

"I think you have to individualize," Dr. O'Shields said. "Some people at all cost - and I don't mean monetarily - they really do not want to have to deal with a major surgery and want to see what else is out there. And there are some people who come in begging for a hysterectomy and you have to persuade them to go for a less-aggressive procedure."

Many women who are candidates for hysterectomies, or one of the options, have a range of benign disorders such as fibroids, a prolapsed (or fallen) uterus, or premenopause complications such as heavy and irregular bleeding.

Those in the premenopause phase often are seeking answers and remedy, and for good reason, Dr. O'Shields said.

"It's a frustrating time," she said. "It's a bigger change than going through puberty. They call it the change of life, and it's definitely a change of life: The body changes physically and emotionally - mentally, you're in a different place; hormonally, you're in a different place because you're losing hormones. You're moody, there's a lot of unpredictable bleeding ... It's a trying time for most women that very few escape and sail through without any kind of assistance."

The good news that keeps getting better is that there are all kinds of assistance available.

"We absolutely have more options than we did 15 years ago," Dr. O'Shields said, "which is why it's very important for all women to see their gynecologist so she can discuss these things with her doctor, so she can be informed about these alternatives and can ask questions.

"Most physicians these days enjoy talking to their patients about their options and helping them in the decision-making process. A woman shouldn't be afraid to ask."

Reach Kamille Bostick at (706) 823-3223 or kamille.bostick@augustachronicle.com.