Articles
Register for |
Ask The Expert |
||
|
|
||
|
This month's topics |
||
| Alternative Treatments | ||
| Question:
Hysterectomy vs. UAE I have had multiple fibroids for years. They have been a symptomatic. Within the last year, however, one of them has enlarged considerably causing constant premenstrual type symptoms (lower back pain, feeling of bloating, etc). My general practitioner suggested a hysterectomy. I am 47 and don't need all those parts anyway, however, I would prefer a less invasive alternative. I have read about Fibroid Artery Embolization. Could you provide your opinion on this procedure? My doctor has referred me to an OBGYN for consultation on a hysterectomy. I would like to explore and be informed on all my options before I make a decision. |
||
| Answer: Regarding UAE, it is a promising technology, but I am a bit more reserved on this option than some people in my specialty. This is because there are no long-term, prospective studies confirming its benefits, safety and effect on fertility. That does not mean it is not beneficial, just that the jury is formally still out. You should certainly consider UAE, however, if your doctor feels it would be appropriate. Besides embolization, other options include (some of which are invasive): * myomectomy (surgical removal of the fibroid) * myolysis (an outpatient procedure to shrink the fibroid using electric current delivered through a laparoscopic instrument) * A course of a GnRH agonist medication to temporarily put you into menopause, thus shrinking the fibroid. This might tide you over until your body goes through menopause naturally, rendering the fibroid a moot issue I would also make sure that the fibroid really is the cause of your symptoms, since other things can cause low back pain and bloating. I would also make sure that there is no suspicion of ovarian pathology, which can also cause similar vague symptoms. A second opinion certainly can be helpful. Good luck, and thank you for your
e-mail! |
||
| Question:
Hysterectomy after Ablation? One year ago, I had a balloon ablation procedure done for menorrhagia. In the last six months the heavy bleeding, clotting, and cramping has returned. Is my only alternative a hysterectomy? |
||
| Answer: Endometrial ablation, whether performed through a hysteroscope or an office procedure like you had, is not always successful in relieving abnormal uterine bleeding. That said, my first thought would be to confirm that there was no obvious adenomyosis or uterine fibroids that would make such a procedure much less likely to be successful. I would also ask if the procedure could be repeated, since repeat endometrial ablations are often performed in the event of a treatment failure. It is not yet clear, at least to me, if office ablations are as effective as the more traditional hysteroscopic procedures done in an operating room setting. Both methods have their strong advocates, but I am more persuaded by prospective data giving long-term results in a large number of patients. We have such data for hysteroscopic ablation but I am not aware of long-term data for the balloon and other office procedures, simply because they have been around for a shorter period of time. You should consult your gynecologist for his or her opinion on your situation. Thank you for your e-mail! |
||
| Question:
A LeForte Procedure
My 81 year old mom has a prolapsed uterus. A LeForte Procedure has been recommended as a treatment option. What does it involve and is it a viable option for someone her age? |
||
| Answer: Ideally, your mother's gynecologist should be able to explain this in more detail. In brief, there are three main ways in the US to manage a symptomatic prolapsed uterus: A pessary is a diaphragm-like object that is inserted in the vagina and supports the uterus, bladder and other structures. It is a good alternative to surgery in that it is often quite effective. The downsides-intercourse usually is not an option, it requires regular visits to a clinician for removal and cleaning, and rarely can be associated with vaginal erosions. A vaginal hysterectomy is definitive treatment-once the uterus is removed it cannot prolapse. Apart from the normal surgical and anesthetic risks, there are few downsides as a treatment for marked uterine prolapse. In an older patient who cannot tolerate an operative procedure of 1-2 hours, a LeForte procedure may be an option. A LeForte colpocleisis is not a definitive treatment since the uterus is not removed. It generally requires less operating time than a vaginal hysterectomy and in select cases can even be performed under regional anesthesia rather than general anesthesia. The surgery involves creating a physical barrier to uterine prolapse by suturing the cervical tissue to the vagina. A small outlet is usually left in order to allow for detection of postmenopausal uterine bleeding and endometrial hyperplasia/cancer. Pap smears are also usually not feasible, nor is sexual intercourse. The uterus is not removed, but the operation does prevent prolapse from occurring. LeForte operations can ultimately break down and fail, even in the best of cases, so it is often not viewed as a long-term solution. Again, your mother's physician can provide guidance on why a LeForte colpocleisis may be the most appropriate option in his or her opinion. Good luck, and thank you for your e-mail! |
||
| Question:
Hysterectomy for Polyps I am 59 years old and bleed every day of my life - from spotting to flowing. My ob feels I need an hysterectomy due to cervical polyps. She feels they are causing the continuous bleeding. I feel there should be a way to stop the bleeding without cutting out my organs. She prescribed Provera, which did lessen the flow but not stop it. I am now using a progesterone cream instead of the Provera. What do you suggest? |
||
| Answer: A few points should be made: * If it has not already been performed, it is important to undergo some form of uterine sampling (either an office biopsy or D&C/hysteroscopy) in order to rule out a premalignant condition or endometrial cancer itself. * If there is no obvious reason for the bleeding other than the polyps, a hysterectomy is an option but depending on the number of polyps it may be possible to remove them and preserve the uterus. Your doctor can best address whether this is an appropriate option or not. Cervical polyps can often be readily removed in the office setting, although very large ones may require an operating room suite. Endometrial (uterine) polyps may require a hysteroscopy to effect removal. * Medical treatment of polyp-related bleeding may not be effective long-term, especially if the polyps are truly cervical in origin rather than uterine polyps. * I would make sure your Pap smear is up to date. It is hard to comment specifically, since there are many things that must be ascertained before establishing if hysterectomy is or is not the most appropriate option. Most importantly, this is a matter that is best addressed by your own doctor. A second opinion may be an option as well if questions remain. Good luck, and thank you for your e-mail! |
||
|
Question: Depo-Provera
is Scary With all of the scary side effect of Depo-Provera, I am not sure that I am comfortable trying this to help with my endometriosis. I had a D&C a month ago and my doctor told me I had endometriosis really bad but he didn't want to do a hysterectomy. He says he wants to try Depo-Provera but I am not really sure I want to do this. What is your view on using this drug. |
||
| Answer: My view is much less important than what can be found in controlled medical trials. There are at least anecdotal reports that DP at higher doses is effective in relieving endometrial pelvic pain in some women. I am not aware that there is a proven benefit on fertility, but it may be helpful in women with chronic pelvic pain secondary to endometriosis. I'm not sure which side effects are scary, but DP is a very safe and effective contraceptive method. Like any progestin-based medication, some women may experience irregular bleeding or a lack of periods, and some women may gain weight. There are additional side effects, as with any treatment, and these are best discussed with your gynecologist. I am assuming that your endometriosis was diagnosed via laparoscopy, as a D&C cannot diagnose this condition (by definition, endometriosis requires the finding of cells from the uterine lining outside of the uterus; a D&C only samples the uterine lining and cannot reveal endometrial tissue outside of the uterine cavity). In general, hysterectomy is often a last resort for women with endometriosis, since there are several medical and surgical approaches to managing this disorder. Please follow-up with your gynecologist for more personalized information. Thank you for your
e-mail! |
||
| Post Hysterectomy | ||
|
Question: Post
Hysterectomy Bleeding I am 32 years old and had a tah/bso with vertical incision in December, due to fibroids in uterus and a cyst on the ovary. I had spot bleeding right after surgery for 3 days and it stopped. Approximately 8 days after surgery it started again, a day after the staples were removed. Is this spotting is normal and how long should it last. Thank you ahead of time for your answers! |
||
| Answer:
I would suggest you contact your doctor for more individualized information, especially since you have been recently operated upon and such spotting may or may not be a matter of concern. Because this is so dependent on many factors, like the details of the surgery, where this spotting is coming from (the vagina or the abdominal incision?) and your current examination, it is not appropriate to render any opinion without a personal knowledge of your status. Please contact your doctor, who I am sure will be most helpful. Good luck, and Thank you for your
e-mail! |
||
|
Question:
Hysterectomy and HRT for a Young Woman I am a 29 year old female. I recently had a total hysterectomy with bilateral oophorectomy and was prescribed Premarin 1.25 mg. My mother is 50 and was diagnosed with breast cancer in 1992 and stage 4 ovarian cancer late 1999. My doctor changed the Premarin prescription to Estratest recently. I have addressed my general concerns about cancer risk and asthma problems. I am very concerned about long term use of HRT. I am trying to get opinions of HRT and their specifics. |
||
| Answer: Because every woman's situation is unique, it is best to have a one-on-one discussion with your doctor about your concerns regarding HRT. In someone as young as you are, HRT is an extremely important consideration in order to prevent the development of osteoporosis. There have been studies suggesting an increased risk of breast cancer with more than 5-10 years of HRT use (depending on the study), but there are also other studies supporting the idea that any risk, if present at all, is minimal. It really comes down to an individualized decision, and this is where your doctor (or a second opinion consultant as well) can be extremely helpful. I would also suggest you speak directly about HRT in relation to your mother's medical history, and ask if there is evidence of a hereditary breast/ovarian cancer syndrome in your family (a more detailed family history would be necessary to establish this one way or the other). Good luck, and Thank you for your
e-mail! |
||
| Question:
Weight Gain Post Hysterectomy I recently had a hysterectomy and am concerned with some the effects it could have on me now. I am 41 years old and am quite concerned with the articles I read concerning weight gain. I have always maintained my weight and I have a terrible fear of weight gain that could be contributed to a hysterectomy. Could you please substantiate any information you may have relating to a hysterectomy and weight gain. Thank you |
||
| Answer: I am personally unaware of any definitive link between hysterectomy and weight gain. Individual experiences of course will vary, so I suggest you consult the doctor who performed the operation for his or her insight.
Good luck, and thank you for your e-mail! |
||
| Question:
Post Hysterectomy Loss of Sex Drive I am a fifty year old woman who had a hysterectomy four years ago. It seems I have lost all sexual drive. I nothing seems to help. My husband and I had a very active sex life and now I no longer enjoy it. It takes a toll on a marriage. Any suggestions? |
||
| Answer: In general, hysterectomy does not affect libido (sex drive) one way or the other. There are anecdotal cases in which libido decreased after the operation, but in most cases these were women with preexisting depression and other issues. My best suggestion is that you discuss this with your gynecologist and ask if a referral to a mental health professional would be appropriate, particularly one who is experienced with sexual dysfunction and couples counseling. There are many ways to manage this, but it is important to seek guidance from your doctor and consider counseling if indicated. Good luck, and thank you for your e-mail! David Toub, M.D. |
||
| Question:
Testosterone Treatment Post Hysterectomy I am 42 yrs old and had a total hysterectomy 10 years ago. I find now I must have implants of testosterone but find them very intrusive and was wondering if there is a crème available to do the same job. |
||
| Answer: I would be interested in learning the indication for testosterone treatment. While it has been touted as a libido-enhancing intervention, I am not aware that this has been established as a necessary treatment option after menopause. I would recommend that you discuss this in greater detail with your doctor, who can best guide you regarding treatment options. Thank you for your e-mail! David Toub, M.D. |
||
| Hysterectomy as Treatment | ||
| Question: Significant Dysplasia In August this year my doctor said I may have a sebaceous cyst or blocked hair follicle and he cut it out. About 4 weeks ago it returned, was much bigger and painful. I was given a course of antibiotics and scheduled for surgery to open it up, however it burst. I continued the antibiotics and drained the cyst twice a day. It took about 5 days but the lump disappeared, but only for 1 day. I went back to the GP before it became too painful and he suggested I see a Gynecologist. At my visit he said it was
nothing, take another course of antibiotics and wait for it to heal by
itself. At that time he did a pap smear. The next day a second lump appeared. When I
phoned the doctor he informed me that my pap smear had come back with a
result of moderate to significant dysplasia. |
||
| Answer: As far as the dysplasia, it sounds as if it was managed appropriately (hysterectomy is not generally indicated for anything less severe than microinvasive cancer) although close follow-up is certainly indicated as for any woman who has had dysplasia treated recently. It is difficult to say what is going on with regard to your leg pain and vulvar cysts (?Bartholins duct cysts/abscesses), but if you are not comfortable speaking with your current physician you may want to consult another one. Only a clinician who is familiar with your history and physical examination is qualified to make a determination of what is going on and how best to treat it, so it is important to see a physician or other healthcare professional about your current issues, including the leg pain. Good luck, and thank you for your e-mail! David Toub, M.D. |
||
| Hysterectomy Information | ||
|
Question:
Depression & Hysterectomy I would like to know if someone who suffers from depression has adverse hormonal reactions after having a hysterectomy? Does the hysterectomy contribute in a negative way to a person suffering from depression? If so, can you recommend a web site where I can do more research? |
||
| Answer:
Hysterectomy, in and of itself, has not been conclusively demonstrated to cause depression and other mental health problems. However, there is some evidence that women with preexisting depression may have worse depressive symptoms after a major operation like hysterectomy. It is not likely a hormonal issue, but rather relates to issues surrounding body image and the nature of this particular operation. For more information you can turn to any of a number of reliable sites sponsored by major hospitals and healthcare organizations (such as the American College of Obstetricians and Gynecologists: www.acog.org). I would steer clear of sites that, while well-intentioned, are not associated with a major, reliable medical institution or organization. Thank you for your e-mail! |
||
|
Question: Bladder
Question After a hysterectomy is it common to have bladder problems? |
||
| Answer:
After any operation involving general anesthesia, there may be some short-lived voiding difficulties, but these usually are resolved by the time of discharge from the hospital. Hysterectomy, because it involves dissecting the bladder off the lower uterine segment, is associated with a potential risk of bladder injury, but I am not aware that any long-term bladder dysfunction generally results. The one exception is radical hysterectomy, performed usually for stage Ib cervical cancer, in which there is a prolonged duration of bladder dysfunction that is unavoidable. It is a normal consequence of the extended dissection necessary to correctly perform this lifesaving procedure. Most women require either some form of prolonged bladder drainage such as a suprapubic catheter, or intermittent self-catheterization. The bladder dysfunction largely resolves within a few weeks of surgery, however. I would suggest you discuss your question with your doctor for more individualized information. Thank you for your e-mail! |
||
|
Question:
Hysterectomy & Sore Breasts I am 44 years old, and have been bleeding very heavily for about a year. I suffer severe period pain, bleeding is excessive and a low iron level. I am considering a hysterectomy, but am not sure whether to have my ovaries out as well. If I leave the ovaries in, will I still get very sore breasts, or will having my ovaries out stop them from being sore. I cannot touch them at all for about 3 weeks of the month, and cannot even put my bra on; they are that tender. I am uncertain about what to do. Could you please offer me some information on this. Thank you. |
||
| Answer: In women over the age of 45 (or younger, if there is a history of familial ovarian/breast cancer syndrome for example), it is not uncommon to offer the potential removal of both ovaries in order to possibly reduce the risk of ovarian cancer. This is an individualized decision for a woman. The risk of ovarian cancer in the general population is about 1:70, and is often undetected until a more advanced stage. On the other hand, removal of both ovaries premenopausally would place a woman into early menopause, with an increased risk of osteoporosis unless hormone replacement therapy were prescribed. This is a decision that is best discussed in detail with your doctor, focusing on your estimated risk of ovarian cancer and the pros and cons of bilateral oophorectomy (removal of both ovaries). Good luck, and Thank you for your e-mail! |
||
| Question:
Hysterectomy & BC I had a hysterectomy but I still have my ovaries. Can I still conceive and do I need to consider BC? |
||
| Answer:
In general, this issue is discussed with women before undergoing hysterectomy. After a hysterectomy, it is not possible to conceive, since the uterus is removed. Retaining the ovaries means that you would not need hormone replacement therapy since an immediate menopause would be avoided. The only way to bear a child would involve use of a surrogate after implantation of fertilized ova, using the ova from your ovaries. You do not need to consider birth control, for the reasons mentioned above. It would be a good idea to also speak with your doctor to clarify this matter, but if you have undergone a hysterectomy then the only option would be surrogacy, and there are many issues that accompany that. Thank you for your e-mail! David Toub, M.D. |
||
| Other Questions | ||
| Question:
What Causes Fibroids? Are fibroid cysts in any way hereditary? Are they caused by a virus that can be transmitted from one person to another? Also, I have had a great deal of stress lately. . .could that stress have caused or increased the chance of the fibroid cysts? Thank you very much ahead of time for your help! |
||
| Answer: Fibroids, while possibly more common among some populations than others, are not transmissible nor are they related to stress. The main factor that influences their growth is the hormone estrogen. There may be some genetic link to fibroids, but I am not aware that this has been definitively established. Please consult your healthcare professional for more individualized information. Thank you for your e-mail! |
||
| Question:
Uterine Replacement
I'm 37 years old, recently remarried and would like to have another child. I have multiple midline uterine fibroids, about 1 or 2 cm's each and my periods are normal. I know I don't have a lot of time but what are my chances of getting pregnant? I do not want a hysterectomy, yet. |
||
| Answer: It is not possible for me (or anyone, really) to give a realistic appraisal of one's chances of conceiving without information such as a thorough medical history, examination and appropriate lab data. I can say that in general, fibroids only rarely cause infertility. In fact, I would go so far as to say that fibroids are quite over-mentioned as a potential cause of infertility, since they rarely block the openings where both fallopian tubes meet the uterus. Fibroids, depending on their size and location, can occasionally cause problems with pregnancy loss and pre-term labor, but if your fibroids are small, it is unlikely that this would be a problem so long as they are not lying directly under the site where the embryo implants. You should certainly speak with your doctor about this issue, and also be aware that unless fibroids cause significant problems there is often no reason to intervene. Also, many things can be done in addition to hysterectomy; feel free to peruse the archives on this forum regarding hysterectomy alternatives. Thank you for your e-mail! David Toub, M.D. |
||
| Question:
What is a Rectocoele
Repair? Could you please explain the rectocoele repair surgery. |
||
| Answer: While this is best explained in detail by your own physician, a posterior colporrhaphy (the most common treatment for a symptomatic rectocoele) is a vaginal operation that involves repairing the supportive tissue between the vagina and rectum. I would defer to your physician for a detailed discussion of risks and benefits as well as alternatives, since that is somewhat individualized. In some cases, such surgery may be performed laparoscopically, depending upon a surgeon's preference and experience. I am not aware that any prospective, controlled study has demonstrated the laparoscopic approach superior to the traditional, vaginal approach to rectocoele repair. Good luck, and thank you for your
e-mail! |
||
| DISCLAIMER: The above represents material for educational and discussion purposes only. The material provided should NOT be used for diagnosing or treating any health problem or condition. It is NOT a substitute for consultation with and advice from qualified healthcare providers. If you have or suspect you have a health problem, consult a qualified healthcare provider. The author and any other party involved in the preparation or dissemination of the material presented are not responsible for any errors or omissions in the material provided above, or any results obtained from the use of such material. |
