26 January 2009

Half of hysterectomies unnecessary

One in two hysterectomies could be avoided by using either hormone therapy, a short surgical procedure, or balloon therapy. Check out your options before you agree to have one.

Many women accept that they will have a hysterectomy at some time in their life. But the scary thing is that many of these could have been avoided by using hormone therapy, a simple, short surgical procedure, or a new uterine balloon therapy system.

"Between forty and fifty percent of hysterectomies that are performed in South Africa are probably unnecessary," according to Dr Alan Alperstein, leading Cape Town gynaecologist.

"Is it appropriate at this time in medical science to be removing uteri for benign disease when there are alternatives to the management of these conditions?" he asks in the July 2005 issue of the Medical Chronicle. On review of histology from a laborotary in a large city in South Africa during 1999, it was found that 42% of the uteri that were removed, were normal.

Many less drastic alternatives
So why do so many women have hysterectomies? Or, more to the point, why do so many doctors recommend hysterectomies when there are alternatives that are so less drastic?

"Many doctors train at hospitals that do not have access to the new therapies in their training departments. So, many gynaecologists or doctors recommend this drastic surgery, because they imagine that it would prevent future problems, or because they are unaware of how effective and simple alternative methods of treatment can be," said Alperstein at a the launch in Constantia on 29 July 2005 of Johnson & Johnson's uterine health campaign.

He also stressed that women often take their doctor's word when it comes to uterine health, as they often are unaware of alternatives to procedures such as hysterectomies. Many benign conditions that are not life-threatening, such as unmanageable bleeding and fibroids and polyps, can be successfully treated in less invasive ways. This includes hormone therapy, or the Pill, which is generally safe for non-smoking women to take up to the onset of menopause. However, Alperstein warns against hormonal therapy for smokers over the age of 35.

Hysterectomies most often get performed for the following reasons:

  • Excessive bleeding (menorrhagia)
  • Non-cancerous uterine growths (polyps and fibroids)
  • Uterine prolapse
  • Uterine cancer
  • Alperstein stressed that there were sometimes conditions for which a hysterectomy was the only solution. These include the presence of cancerous uterine growths. In this case, a hysterectomy can literally be a lifesaver.

    There are, however, two procedures that can solve problems experienced as a result of fibroids/polyps and excessive bleeding. The first is a myectomy and the second the so-called uterine balloon therapy.

    More about fibroid removal
    Many non-cancerous fibroids and polyps can be removed in an office setting, preventing the inconvenience of hospitalisation and a recovery period of several weeks. This procedure is known as myomectomy and it involves the insertion of a hysteroscope into the uterus, through which safe cutting, removal, vaporisation and dessication can be performed.

    Balloon uterine therapy
    This therapy is mainly used to deal with excessive bleeding by destroying the lining of the uterus. This procedure is also called endometrial ablation. This balloon system, such as Johnson and Johnsons's GYNECARE Thermachoice, delivers heated fluid at a temperature that destroys the lining of the uterus. This procedure takes eight minutes.

    What exactly does this procedure entail? A soft, flexible balloon is inserted into the vagina through the cervix and placed into the uterus without any incision. Then the balloon is inflated with a sterile fluid that expands the balloon to fit the size and the shape of this particular uterus. The fluid in the balloon is heated up to 87 degrees Celsius and is maintained for eight minutes. This procedure can be done under mild sedation, local anaesthetic, or general anaesthetic, depending on the patient.

    After the treatment, the balloon and all the fluid are removed. The uterine lining sloughs off like a period within seven to fourteen days. Cramping can occur during and directly after the procedure, but is usually over in about six hours. Because this procedure destroys the uterine lining, it is not recommended for women who are still planning to have children.

    This balloon system is particularly effective in the treatment of heavy bleeding, and 95% of women reported normal, or less bleeding without additional intervention five years after the ablation procedure. Seventy-eight percent of women evaluated three years after treatment were free from significant menstrual pain.

    Advantages of these procedures
    The advantages of both these above procedures, are that the uterus is not removed, the disruption to your life is minimal (most women can return to work the next day), and your ovaries can continue to produce much-needed testosterone after your menopause.

    Questions all women should ask
    To reach the kind of situation where women become more empowered with regards to decisions in connection with their uterine health, more information needs to be disseminated.

    The following are questions contained in a press release that Alperstein says every woman should ask her gynaecologist before agreeing to have a hysterectomy:

    1. What exactly is my condition?
    2. What are my treatment options?
    3. Could you tell me more about the specific treatment options?
    4. How will the procedure be performed?
    5. What are the risks?
    6. How long will I be hospitalised for?
    7. How long will it take before I can return to my normal activities?
    8. Why are you recommending a hysterectomy in my case?
    (Susan Erasmus, Health24, April 2005)

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