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Women Are Undergoing Hysterectomies as a Last Resort, Thanks to Advances in Technology That Have Made Uterus-Saving Therapies . . . : The Treatments of Choice


BALTIMORE — As she entered midlife, Connie Koller was losing almost a week of every month to her abnormally heavy menstrual periods. Employed full time in the accounting department of Baltimore's Good Samaritan Hospital, trying to keep up with the schedules of three children, the 41-year-old Parkville, Md., woman often felt as if she were having to plan her life around her periods.

"I was afraid to go anywhere because of the excessive bleeding," she says. "I knew I had to do something."

Like many women in their 40s, Koller was experiencing pelvic pain and bleeding that affected the quality of her life. Tests revealed that her symptoms were caused by endometriosis and fibroids, noncancerous tumors growing in her uterus.

In the past, fibroids were usually treated by removing the uterus of women who had finished having children. In Koller's family, other relatives had undergone early hysterectomies because of fibroids.

Koller, however, had a relatively new option: She chose endometrial ablation, outpatient surgery that removed the lining of her uterus as well as her fibroids. The procedure, which she underwent a year ago at Greater Baltimore Medical Center, stopped her menstrual bleeding altogether while preserving her uterus.

"I didn't have one pain, one cramp," she says. "The only effects I had afterward were from anesthesia. There isn't any real change in your body as a female--except that I haven't had my period since the procedure."

Like a hysterectomy, endometrial ablation usually renders women infertile. It's not meant for everyone who is suffering from abnormal bleeding, doctors caution, and is not always certain to correct the problem. But many women are now considering this treatment along with other procedures that are less invasive than hysterectomy for such benign conditions as endometriosis, chronic pelvic pain and uterine prolapse.

"Typically, patients who now undergo a hysterectomy for a condition like fibroids have failed other forms of uterine therapy," says Sandra Brooks, director of gynecologic oncology in the department of obstetrics and gynecology at University of Maryland Medical Center.

Over the last decade, more gynecologists have learned how to perform new, uterus-saving procedures using technologically advanced tools. And as they have expanded the range of procedures they feel qualified to perform, they have offered more treatment options to their patients.

From 1975 to 1994, the number of American women 30 to 54--the category most apt to get a hysterectomy--increased by 16.5 million. During that time, however, the number of hysterectomies performed annually in hospitals decreased from 724,000 to 556,000, according to the National Center for Health Statistics. (Those numbers do not reflect hysterectomies performed in separate surgical centers.)

Although hysterectomy is the treatment of choice for gynecologic cancer, at least 80% of hysterectomies are still performed for other reasons. Recognizing that the surgery may prove the best ultimate solution for a persistent gynecologic problem, the American College of Obstetricians and Gynecologists emphasizes it should be considered a treatment of last resort.

Current research suggests that the uterus continues to create beta-endorphins, the body's natural painkillers, and prostaglandins, which help prevent blood clotting, after menopause.

Prostaglandins, in particular, may help protect women against heart disease.

"The years when doctors were doing hysterectomies at the drop of a hat are over," says Thomas Elkins, director of general gynecology and obstetrics at Johns Hopkins Medical Institutions. "It used to be that after we had done a certain number of D&Cs [dilation and curettage to scrape and remove uterine lining], we'd go to hysterectomy because we didn't know enough and couldn't tell enough of what was going on. The newer technology has taken away that concern."


Koller had put up with abnormal bleeding for almost nine years before her surgery. Her previous gynecologist had attributed her discomfort to endometriosis, a condition in which the uterine lining grows outside the uterus, and had led her to believe that hysterectomy was her only option.

After Koller's health insurance changed and she was free to find a new physician, she reread a newspaper article she had saved about gynecologist James Dorsey's success with endometrial ablation at Greater Baltimore Medical Center. She sought his advice. Dorsey found that her bleeding was caused primarily by fibroids, a condition which could be treated by endometrial resection and ablation. In treating her, he used new instruments that he says makes the procedure quicker and safer than before.

Physicians emphasize it is important for women to be aware of all of their treatment options and to seek care from gynecologists who are skilled at performing many procedures.

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