Endometrial Ablation and fibroids

blog pic 19Endometrial ablation was definitely a term I was unfamiliar with until all hell broke lose in my uterus!  It was presented to me as one of the options to try to deal with my ‘issues’ (other options presented included an IUD, changing my birth control, and as a last resort, a hysterectomy).  Even now, I find it challenging to find much information online about what it is exactly.  This article presents this option quite positively though I was told it is not without its risks and drawbacks (one being that it may only be a temporary solution).  Of course, it was a decision I never had to make due to my emergency hysterectomy surgery but for those of you looking into your options, perhaps this will help:

Endometrial ablation is one of the many minimally-invasive methods used to treat heavy menstrual bleeding due to fibroids or other causes.  It  is very effective in treating the bleeding that can accompany uterine fibroids in 40-60% of those treated, causing endometrial ablation to gain popularity, among other options, for the treatment of fibroids.

How It Works

Ablation procedures remove (destroy) the lining of the uterus, thereby eliminating heavy menstrual bleeding, in some cases, or simply decreasing the bleeding in others.  Abnormal bleeding is typically a result of bleeding from the uterine lining , destruction of this lining can lead to decreased bleeding or no menses without having a hysterectomy.  Because the uterus is preserved, this is also called a  uterine -sparing procedure.

There are no incisions and this procedure can be done in as little as five or 10 minutes in the office or in a hospital out-patient setting.   No recovery time is necessary, and,therefore, no time off from work is required except for the day of the procedure.

The amount of anesthesia needed is minimal, and it can even be performed using local numbing medicine placed in the cervix (a small local pain killer similar to what is done in the dentist’s office).

Things To Consider

As the inside lining or nest is essentially destroyed, the procedure should not be considered if there is even a remote chance that you may want children.

Not only will the nest or cavity of the uterus be unable to properly receive the embryo, if a pregnancy successfully attaches to the nest/ lining, the pregnancy could be frought  with potentially life-threatening difficulties such as placenta acreta, a condition where the placenta or afterbirth does not separate/detach after a delivery as it should.  This can lead to extreme bleeding and possibly an emergency hysterectomy under some circumstances.

There are numerous types of endometrial ablation methods. A consultation with your doctor to discuss your family planning wishes, while providing you with options for treatment will be a good time to address these concerns.

Originally retrieved from here.

Why does race affect surgery procedures?

 
I found this article interesting.  It discusses how race seems to be a factor in type of hysterectomy surgery performed.  These numbers are American so I would be interested to know if such statistics would be true elsewhere.

Race, ethnicity influence chances of minimally invasive hysterectomy

By: MICHELE G. SULLIVAN, Internal Medicine News Digital Network

NATIONAL HARBOR, MD. – Race and ethnicity still appear to play a role in determining which patients receive a minimally invasive hysterectomy, and which undergo a traditional abdominal procedure.

Black, Hispanic, and Asian women were up to 50% less likely to have either a laparoscopic or vaginal hysterectomy, compared with whites, Dr. Katharine Esselen reported at the AAGL global congress.

The findings remained statistically significant even after Dr. Esselen and her colleagues controlled for a variety of patient, financial, and hospital characteristics.

“Racial disparities exist in the mode of hysterectomy in endometrial and cervical cancer, and must be further investigated to better understand the contributing factors so that they may be eradicated,” said Dr. Esselen, a clinical fellow in gynecologic oncology at Brigham and Women’s Hospital, Boston.

The researchers extracted their data from the 2009 National Inpatient Sample. It included 1,000 hospitals and more than 8 million patient stays – representing 20% of the discharges in the country for that year.

In 2009, there were 64,410 hysterectomies performed for gynecologic malignancy. More than half (54%) were for endometrial cancer, followed by cervical cancer (23%), and ovarian cancer (19%). Other cancers made up the remainder.

The majority of surgeries in all these categories were abdominal: 72% of the endometrial cases, 56% of the cervical cases, and 95% of the ovarian cases. Laparoscopic hysterectomy was the surgical mode in 26% of endometrial cases, 23% of cervical cases, and 4% of ovarian cases. Vaginal hysterectomies were performed for 2% of endometrial cases, 21% of vaginal cases, and just 1% of ovarian cases.

A multivariate regression analysis controlled for demographic factors (age, race/ethnicity, insurance); patient factors (cancer diagnosis, fibroids, endometriosis, prolapse, menstrual disorders, age, severity of comorbidities, obesity); and hospital factors (urban/rural, teaching status, size, and region of country).

After adjustment for all of these factors, black women were 43% less likely to have a minimally invasive hysterectomy for endometrial cancer than were white women – a significant difference. Hispanic and Asian women were also significantly less likely to have minimally invasive surgery (MIS), with odds ratios of 0.61 and 0.63, respectively. Native American women, however, were more than five times as likely to have such a procedure compared with white women (OR, 5.26).

Insurance also played a role, Dr. Esselen said. Those with Medicaid were significantly less likely to have a minimally invasive procedure (OR, 0.64) than were those with private insurance.

The findings were similar for ovarian cancer. Black and Asian women were significantly less likely to have MIS than were whites (OR, 0.41 and 0.44, respectively). There was no significant difference seen for Hispanic women.

Medical comorbidities were significantly related to the chance of MIS as well. MIS was significantly less likely in women with moderate loss of function due to comorbid conditions (endometrial OR, 0.47; cervical OR, 0.62; ovarian OR, 0.38). Those with major to extreme loss of function had an even smaller chance (endometrial OR, 0.23; cervical OR, 0.21; ovarian OR, 0.10). The P values on these were all less than .0001.

Obesity only affected MIS odds in endometrial cancer, significantly increasing the chance of such a procedure (OR, 1.27).

Types of Hysterectomy Surgeries

ImageThere are several types of hysterectomy surgeries that can be performed and they all have certain benefits as well as challenges/risks.

Abdominal hysterectomy:  As the name suggests, this surgery involves an incision in your abdomen, often 5-7 inches long.  It may be vertical or horizontal depending on a number of factors.  The recovery time for this type of surgery tends to be the longest out of all of the options.

Vaginal hysterectomy:  The surgeon will make a cut in the vagina and remove your uterus that way.

Laparoscopically-assisted vaginal hysterectomy:  The uterus is still removed through a cut in the vagina but the surgeon will use a laparoscope to assist in this process.  It involves 3-4 small abdominal incisions in order to insert the laparoscope.  The recovery time tends to be shorter with this type of surgery.  This is the procedure I had.

Robotic-assisted hysterectomy:  This is also referred to as the DaVinci method.  It utilizes a small robotic machine that works through small incisions similar to laparoscopic surgery.

There are numerous factors that impact which of these surgeries is best for any given patient including weight, recovery time, and the reason for the hysterectomy.  I will post more about the benefits and challenges of some of these surgeries in a future post.

Types of Hysterectomy

This appears to be one of the most misunderstood aspects of hysterectomy.  I was not clear on this either, before I had a hysterectomy.  I found people would hear about my surgery and then would label it with terms that they were familiar with but did not accurately describe my surgery.  Here are the three types of hysterectomy surgeries as found on the Mayo Clinic Site:Image

Supra-cervical hysterectomy (also referred to as a partial or subtotal hysterectomy): This is the removal of the upper part of the uterus only and leaves the cervix in place (first image pictured above).

Total hysterectomy:  This involves the removal of the uterus and cervix and is the procedure I had (bottom left image).  However, if I told people I had a total hysterectomy they assumed that meant the removal of ‘everything’ which is actually a:

Radical hysterectomy: involve removal of the uterus, cervix, fallopian tubes and ovaries (far right image).  This occurs most often when cancer is present.

To add to the confusion, these are types of hysterectomy based on what is removed.  Types of hysterectomy can also be classified based on the type of surgery performed.  More on that in the next post!

Keyhole hysterectomies better for women, could save health budget $50 million

Here’s a recent article I found comparing abdominal and vaginal hysterectomies.  They are using Australian statistics but I know they’re similar here in Canada too.  I’m so happy I had a gynecologist who was comfortable doing the laparoscopic surgery.  It went really well and I only have 4 miniscule incision marks and I don’t doubt those will eventually disappear.  What do you think about these options?

Australian experts say scarce funding for the health budget is being wasted by surgeons continuing to perform open hysterectomies instead of a less invasive procedure.

Every year, around 30,000 Australian women have a hysterectomy.

About 40 per cent of them will undergo an open hysterectomy, which involves a longer stay in hospital and a greater chance of side-effects.

Professor Andreas Obermair from Brisbane’s Greenslopes Hospital says patients who undergo the open procedure have a much longer recovery period and are in more pain after the operation.

He says 50 per cent of women have a vaginal procedure, which is not invasive.

But he says too many women are still undergoing full, open surgery, which has greater risks of infections and readmission to hospital.

Only about 10 per cent of women are offered the minimally invasive, laparoscopic procedure.

“Not a lot of people would have trained in this kind of procedure and I guess there needs to be a new generation of gynaecologists coming through who are more proficient in the new, less invasive procedures that are better for patients,” Professor Obermair said.

He estimates that if the laparoscopic procedure were offered in all cases, the savings to the health system would be enormous.

“We did the numbers and we calculated that straightaway Australia could save $50 million every year,” he said.

Different procedures have pros, cons: Doctor

Dr Stephen Robson, the vice president of the Royal Australian College of obstetricians and gynaecologists, says hysterectomies are much less common these days than 30 years ago.

Dr Robson says the vaginal hysterectomy is the cheapest and least complicated, but he says it is not always appropriate for every patient.

He says both the laparoscopic and abdominal hysterectomies have pros and cons and there are a number of factors that need to be taken into account when deciding which operation to choose.

Brisbane mother Amanda Renton had the minimally invasive procedure after discovering she had a genetic link to breast and ovarian cancer.

Ms Renton says she is pleased with her choice.

“It was really good to be honest, much better than I could have expected. It’s been three weeks since the operation and I feel really good,” she said.

Health funding being ‘wasted’, Professor says

Professor Obermair says health funding needs to be used more effectively.

“We could put a lot more effort into training doctors, so they are able to offer minimally invasive procedures. At the moment we are wasting dollars here,” he said.

Associate Professor Nicholas Graves from the Australian Centre for Health Services Innovation at Queensland University of Technology says health funding is scarce and needs to be used wisely.

“In the current economic climate with healthcare resources under so much pressure we really need to be adopting these smart and useful innovations as quickly as possible,” he said.

Professor Graves has analysed the cost effectiveness of the laparoscopic hysterectomy compared to an abdominal hysterectomy for treating early-stage endometrial cancer.

His research found that adopting laparoscopic procedures would result in savings to health services and an increase in health benefits.

While the initial surgery costs are higher for laparoscopic surgery, overall doctors say it ends up being cheaper as patients are less likely to end up back in hospital with side effects and infections.

Here’s a video link to the same issue: http://www.abc.net.au/news/2013-09-24/surgeons-wasting-funding-on-hysterectomies/4978906

Menorrhagia

blog pic 21

This is a word I was not even familiar with until about two years ago.  Menorrhagia is heavy bleeding during your period and as I found out over the last couple of years, it can be extremely bothersome!  As I have mentioned before though, I feel like women’s health issues are not discussed widely enough (for example, my spell checker doesn’t even recognize the word!) and therefore a lot of women are left wondering what exactly ‘heavy bleeding’ is.  This site from the NHS is quite helpful.  There is even a little self-assessment test that you can complete that may assist you in understanding what constitutes a ‘heavy period’.  It even creates a list of symptoms that you can take with you to your doctor!

Here’s a blurb copied from the site:  Heavy periods, also called menorrhagia, is when a woman loses an excessive amount of blood during consecutive periods.  Menorrhagia can occur by itself or in combination with other symptoms, such as menstrual pain (dysmenorrhoea).  Heavy bleeding does not necessarily mean there is anything seriously wrong, but it can affect a woman physically, emotionally and socially, and can cause disruption to everyday life.  See your GP if you are worried about heavy bleeding during or between your periods.

I recommend that you check out the site for even more great information!