By Aaron Sudbury, MD, Gynecologist

Aaron Sudbury, MD 300 Riverside Drive East Suite 1700 Bradenton, FL 34208 941-745-5115

Many women who have gynecologic problems such as heavy or irregular periods, pelvic pain, pelvic prolapse or fibroids may assume their only option is a traditional abdominal hysterectomy.

With advances in medicine, a number of less invasive procedures and treatments have been devised. Many may even preclude a patient from requiring surgery. Newer surgical procedures may reduce surgical risks, complications or recovery times for those who ultimately require surgical intervention.

Hysterectomy is the most commonly performed surgical procedure in the United States among nonpregnant women, with five to six women out of every 1,000 having their uteruses removed in 1997. One in every three women will ultimately undergo this procedure.

The most frequent reasons for hysterectomy include fibroid tumors (benign overgrowth of the uterine wall's smooth muscle) and pelvic relaxation (the loss of support of the uterus, bladder, rectum or vaginal wall causing it to protrude or "drop").

Serious complications occur in about six out of every 10,000 hysterectomies, and minor complications occur in about one out of every 100 cases, with infection noted in about one-third of women postoperatively. However, the satisfaction rate is 99 percent following a hysterectomy.

Medical research has shown many medical therapies may improve or completely alleviate patient symptoms, often avoiding major surgery. Problems such as pelvic pain, fibroids, endometriosis, or heavy or irregular vaginal bleeding may be treated with pills, implantable devices or injections. Although they may cause side effects in some patients, they are well tolerated for the most part without putting the patient through the risk or recovery associated with surgical procedures.

For example, birth control pills, progesteronecontaining intrauterine devices or nonsteroidal antiinflammatory medications (ibuprofen, naproxen, etc.) may reduce irregular, painful or heavy periods in many women if taken appropriately. Other medications, including SSRIs (selective serotonin reuptake inhibitors) such as Sarafem or Zoloft, are used to treat certain types of painful periods.

Many other options exist for a multitude of problems. It is important that patients explore these options with their physicians to see if they are appropriate candidates.

The development of new surgical techniques and the advancement of older surgical techniques has led to a greater number of options for women faced with the need for surgical intervention.

Endometrial ablation is one such technique that is used to treat problems such as dysfunctional bleeding and painful periods. It has a 90 percent satisfaction rate and is an outpatient procedure with much less risk than hysterectomy. The procedure takes about 20 minutes and is usually done under sedation. The patient returns home about one to two hours later and is usually back to work in a few days.

Advances in endoscopic techniques, where a small camera and instruments are used through a tiny incision or no incision at all, have offered treatment of many problems with little or no scars and a rapid recovery. Hysteroscopy inserts a small camera through the cervix, allowing for the surgical removal of many fibroids, polyps or abnormal uterine tissue while leaving the uterus intact. Laparoscopic techniques use similar instruments through tiny incisions in the abdominal wall, allowing for almost any surgical procedure that can be performed traditionally through a larger abdominal incision.

Another advantage of endoscopic techniques is that they are often outpatient procedures. Patients arrive at the hospital the day of their procedure and are discharged to the comfort of home a few hours after completion. Recovery is much more rapid and patients are back at work or their normal daily living in a matter of days, not months. Patients also are appreciative of the aesthetic outcome. Hysteroscopic and laparoscopic techniques are surgeon dependent. Not all surgeons perform these techniques.

Often forgotten is the vaginal hysterectomy, for those who ultimately require the removal of the uterus for successful treatment. The vaginal route of removal offers the patient a faster recovery, less pain and no visible scars. It offers definitive treatment to gynecologic problems in which hysterectomy is indicated.

Each patient is unique, and problems are often complex. It is imperative that patients speak with their physicians about their problems and discuss all their options in detail to find the solutions that fit them best. Patients have more options than ever before. They should explore what is available and appropriate for them as individuals.