MD REVIEW

Hysterectomy Alternatives

The Party

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The moonlight illuminates an atmosphere filled with lavender incense as a sweet melody drifts through the backyard. Such a serene environment reflects the taste of the elegant host. At age 36, Arlene Thomas is a single woman and a prominent lawyer.

Well-dressed guests carry gifts in beautiful wrapping. Arlene is greeting everyone with a smile of pleasure and a splash of champagne.

Arlene’s expression changes as she leaves the party abruptly. Evading the skeptical eyes of her guests, she rushes towards the washroom. While changing her pad too frequently today, she sees a blood spot on her dress. Though it’s time for her monthly cycle, she’s anxious about bleeding excessively. Long before only a few close friends remain, she loses interest in the party.

Evelyn James, a nurse who is Arlene’s best friend, observes the stress on her face. “What’s the problem, Arlene? You seem pretty tense.”

“It’s about my periods. I’m having excessive bleeding.”

“How long has this been going on?” asks Evelyn.

“This is the second time,” replies Arlene.

Recognizing the sadness and despair in her voice, Evelyn tries to comfort her friend by saying, “I have seen many cases like this at the hospital.”

“Should I be worried?” asks Arlene.

“No,” replies Evelyn with an emphatic tone. “Everything will be all right. We’ll get you an appointment with a great gynecologist named Dr. Sarah.” Arlene’s mood is slightly better after hearing this.

Gynecology Appointment

After revealing her medical situation on the phone, Dr. Sarah schedules an appointment for Arlene the next morning in her ob-gyn clinic. “Hello doctor. How are you? We spoke on the phone earlier.”

“Yes, I remember. Please have a seat.”

Arlene sits down, noticing an omnipresent antiseptic aroma.

While examining Arlene for anemia, Dr. Sarah asks, “Tell me more about your condition.”

“Doctor, I’m having heavy bleeding during my periods. I had to change two pads in almost two hours. I felt embarrassed at my own party. Is it something serious, doctor?” Arlene asks with a timbre that belies comfort.

Delaying response to Arlene’s question, Dr. Sarah inquires, “Do you feel pain below your belly button or have stomach cramps?”

“Yes, I sometimes feel stomach cramps,” Arlene answers.

Dr. Sarah further investigates by asking, “Are you urinating frequently or have constipation?”

“I don’t have constipation but I think I’m using the washroom more frequently than usual,” says Arlene.

Dr. Sarah nods her head while writing something on her notepad. After a brief moment, she asks, “Are you sexually active?”

“Yes,” Arlene replies quickly.

“Do you feel pain or discomfort during sex,” Dr. Sarah inquires.

“No, I haven’t experienced any pain during intercourse,” Arlene responds.

A calmness is present on Dr. Sarah’s face as if she has concluded her medical investigations with Arlene.

“Will the excess bleeding during my periods stop?” Arlene asks with some fear.

“You don’t need to worry much. Although it can have a negative impact on your lifestyle, it is pretty much treatable,” Dr. Sarah pauses for a moment. “Heavy periods are common in women, especially between age 35 to 49 years. There are several treatment options available.”

Arlene feels somewhat relaxed after hearing this. “Doctor, I’m still worried.” She further asks, “Can you tell me what’s the reason for this?”

“In about half of the women that experience heavy periods, there is no underlying reason. In other cases, it can be due to cancerous or non-cancerous causes,” says Dr. Sarah.

“Is it cancer doctor?” asks Arlene with bated breath.

“No, it's not always cancer. There may be fibroids, polyps, endometrial hyperplasia, or adenomyosis. These all are non-cancerous causes.”

Arlene asks with great trepidation, “What treatment options are available?”

“Well, in most cases I recommend a complete or partial hysterectomy. But first, I will perform hysteroscopy to diagnose the reason for abnormal bleeding,” Dr. Sarah replies with a calm voice.

Further questions start to pop up in Arlene’s mind. “Can a woman conceive after a hysterectomy?”

“Hysterectomy is the surgical removal of the uterus. So, it is impossible to either conceive or have a menstruation cycle afterwards,” answers Dr. Sarah.

Arlene shares her optimistic presupposition with Dr. Sarah, “There must be non-invasive options as well?”

“Yes, if you want to conceive, you can pursue other options. These include hormonal treatment for fibroids. Hormones suppress fibroid growth.” Dr. Sarah tells Arlene.

“This sounds promising, doctor,” she says with a thoughtful gaze on her face.

Ovarian Fibroid Alternatives

“Well, there is a downside to hormonal treatment. Fibroids return when you stop the hormonal medication. The medication can also cause early menopause.”

Dr. Sarah notes Arlene’s change in expression and continues, “Uterine artery embolization is another non-invasive technique. When performed correctly by an experienced radiologist, it blocks the blood supply to fibroids, thereby shrinking them.”

“Are there any other non-invasive options?” Arlene asks.

“Well, there are, but they depend upon the size of fibroids. They include myomectomy which is the surgical removal of fibroids without removing the uterus,” says Dr. Sarah.

Arlene grills Dr. Sarah with another question. “Are non-invasive treatments 100 percent effective?”

Dr. Sarah softly responds, “Every treatment option has its benefits and risks. The method used to treat each case depends on individual severity of the problem. Personal factors like the desire to have children also affect the decision.”

“Thank you doctor for your guidance. I want to leave the option open to have children so I hope to first try a non-surgical treatment.”

Before leaving the exam room, Dr. Sarah concludes, “I will recommend an appropriate option following your diagnosis from the hysteroscopy.”

Arlene displays a smile of contentment as she shakes Dr. Sarah’s hand. Later, at home, Arlene updates Evelyn on the positive outlook and thanks her for the ob-gyn referral.

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