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Last year, more than a half-million American women had hysterectomies. But thanks to new treatment approaches, countless others avoided the surgical removal of their uterus. What are your options if you are suffering from fibroid tumors, abnormal bleeding or endometriosis - the 3 leading causes of hysterectomies today? New remedies for fibroids Fibroids are bundles of muscle and connective tissue that grow inside or outside the uterus, or within the uterine wall. Affecting up to 40% of females during their reproductive years and beyond, they may cause heavy bleeding and severe pain. Two procedures may hold the answer for millions of women. The first, a hysteroscopic myomectomy, involves the removal of individual fibroids from the inside of the uterus, leaving the organ intact. "The fibroids are shaved from the wall of the uterus," says Dr. Vivian Dickerson, chief of the Division of Gynecology at UCI Medical Center. "There's no incision, no loss of fertility, and almost no recovery time." One drawback: The procedure can't be performed if the fibroids are inside the uterine wall or outside the uterus. In addition, the fibroids can grow back. However, 60% of women do not have problems with fibroids after a hysteroscopic myomectomy. The second procedure, uterine artery embolization (UAE), shrinks fibroids by cutting off their blood supply. Tiny sponge particles are delivered through the femoral artery to the 2 uterine arteries that nourish the tumors. As a result, the growths are starved to death. "Emboli-zation isn't for women who hope to become pregnant," explains Dickerson. "However, UAE leaves the uterus intact and halts the bleeding." Patients can expect a hospital stay of up to 48 hours to control pain. Controlling abnormal bleeding Heavy or irregular bleeding accounts for one-fifth of all hysterectomies performed in the United States. But a growing number of experts believes that only a small percentage of cases require hysterectomies. Instead, ibuprofen, oral contraceptives or other hormones can often slow down the flow or eliminate heavy bleeding completely. If these strategies don't work, a procedure called endometrial ablation may be the answer. This uterus-saving option destroys the innermost lining of the uterus by electric current. Sixty to 70% of patients who have this procedure experience shorter and lighter periods. Another 20% never have periods again. As a result, the procedure is not recommended for women who may want to become pregnant. Endometriosis With endometriosis, bits of the lining of the uterus grow in the abdomen and on the ovaries. The result is chronic pain and other problems. For mild cases, some women may benefit from the long-term use of ibuprofen and oral contraceptives, or the short-term use of hormones called GnRH agonists. These medications are used to control pain and slow the progression of the disease. But if the problem persists, outpatient laparoscopic surgery may be the answer. Here, a thin, lighted tube with magnifying lenses is inserted into the abdomen through a small incision. The stray endometrial growth can then be destroyed with an electrical device or laser introduced through another tube. If the disease is more extensive, major surgery may be required, resulting in a larger abdominal incision and longer recovery time. Source: UCI Medical Center. Toll-free information: 877. UCI.DOCS. FAST FACTS • Approximately 600,000 hysterectomies are performed each year in the United States at an estimated annual cost of more than $5 billion. More than one-fourth of U.S. women will have this procedure by the time they are 60 years of age. Hysterectomy is the second most frequent major surgical procedure among reproductive-aged women. • From 1980 through 1993, an estimated 8.6 million U.S. women had a hysterectomy. • Each year, rates were highest among women ages 40-44 years and lowest among women ages 15-24 years. • Of all hysterectomies, 55% were among women ages 35-49 years. Source: Centers for Disease Control and Prevention |
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