Interviews from the 34th Clinical Meeting of the AAGL Advancing Minimally Invasive Gynecology Worldwide held November 2005 in Chicago, IL, USA
Treatment Options for Heavy Menstrual
Bleeding
John Bertrand, MD, University of Texas Southwestern, Dallas, TX; Ted Anderson,
MD, Women's Healthcare Specialists, Nashville, TN and Thomas Purdon, MD,
Clinical Professor of Ob-Gyn Arizona Health Sciences Center, Tucson, AZ
View the video (06:17)
Dr. Anderson: Hi there, I'm Dr. Ted Anderson and we are talking to you from the meeting of the American Association of Gynecologic Laparoscopists where we have just had a large symposium talking about treatments for abnormal uterine bleeding in women, specifically we've been talking about endometrial ablation which is an alternative that allows us to treat the bleeding without having to remove the uterus. We're basically just destroying the lining of the uterus and that's why it is called an endometrial ablation.
I have with me tonight here two of my colleagues with an enormous amount of experience in this and they'd like to give you a little bit of information about if this might be an appropriate procedure for you and how you might go about having this procedure done.
Endometrial ablation is a very brief procedure that from which you can recover in probably less than 24 hours, it involves destroying the lining of the uterus with some sort of energy, there are many different kinds that are available, but in doing so it generally takes about a day out of your life. You have the procedure done in the morning, you go home that afternoon and by the next day you are back to your normal activities. Eight out of ten women will be able to avoid a hysterectomy for abnormal uterine bleeding after having this procedure done. That is absolutely remarkable. Approximately five out of ten women will be able to enjoy absolute cessation of menstrual periods although that is not the goal of this procedure, we do find that this is significantly a benefit. We also see a decrease in pain, a decrease in PMS-like symptoms so there is a wide variety of benefits that you might enjoy after having this procedure done.
I'd like to introduce Dr. Tom Purdon who is from Arizona. Dr. Purdon is a former President of the American College of Obstetricians and Gynecologists and a well recognized authority on abnormal uterine bleeding. We know that over the years our knowledge of abnormal uterine bleeding has changed and as that continues to evolve we now believe that there are many forms of abnormal bleeding that may not respond to hormones like we used to think. Why don't you tell us a little bit about the evolution of our thought on that?
Dr. Purdon: I'd be happy to, thanks Ted. Certainly this is a huge problem for women all over the world but certainly we are talking about the United States, maybe as high as 7 million women between the ages of 35 and 55 are suffering for really unnecessary reasons when you get right down to it, with heavy, heavy menstrual flow. There are various causes for this, it can be things like polyps and fibroids inside the uterus that are causing this, but there's a great number of women who have abnormal bleeding because there is simply a problem with the lining of the uterus or perhaps it's a hormonal problem. In the past, as Dr. Anderson indicated, we thought that a high percentage of these women who didn't have the pathological lesions had hormone problems as a cause for this abnormal bleeding and we would try to treat them with hormonal therapy of some type.
New evidence in the United States as well as in other countries around the world are beginning to show that there's a high percentage of women who actually are ovulating correctly and their hormones are okay but they are still having heavy menstrual flow. This is referred to as ovulatory dysfunctional uterine bleeding and it doesn't make any sense, when you look at it carefully, for those women to continue to try and manage this with hormones and that's why this endometrial ablation procedure that we've been talking about today is a very important step for women to consider.
Dr. Anderson: Thanks, Tom. You know that one thing we know about endometrial ablation is that it was initially done in a hospital setting and over the past several years the techniques for doing this have evolved and our ability to do this safely and comfortably in the office has evolved.
I also have with me Dr. John Bertrand from Dallas, Texas who has probably done more of these procedures in an office setting than anyone else in the United States. John, why don't you tell us a little bit about what women might expect in that procedure.
Dr. Bertrand: Thanks, Ted. It's really exciting to be here tonight and be able to convey this to you, that those of you who are suffering heavy, heavy bleeding that there is a cure that you can now have in the office. This requires a very simple office visit for evaluation and then another day out of your life when you come and you have the procedure. The procedure is such that it allows you to be back to most normal activity within 48 hours. Many women, it is presumed that more than 4.5 million women will not even seek therapy for lots of different reasons, fear of the hospital, fear of hysterectomy, and this message needs to get out that they can now come to the office and be treated and have the problems of heavy bleeding solved. It's extremely exciting and I'm glad to be able to be here tonight to spread this message and help those out there that are in need.
Dr. Anderson: That's great John. So, if you're suffering from abnormal uterine bleeding you need to know that hysterectomy need not be the answer that there are many other different very effective and very safe mechanisms of dealing with abnormal bleeding. We know they are very effective we have lots of experience with their safety and now we know that these can be offered to you by physicians like Dr. Bertrand in an office setting so it will be very convenient, less invasive and less intrusive to your lifestyle. If you do suffer from abnormal uterine bleeding you need to determine whether this may be an appropriate procedure for you, so you need to ask your physician whether endometrial ablation might be an appropriate option for your bleeding.
Thank you very much for your attention. If you have any questions you can certainly always contact us through the OBGYN.net website.