Options to hysterectomy
Mystie Johnson, MD, is a board-certified OB/GYN on staff at Banner Estrella Medical Center.
Question: I have very heavy bleeding with my period. Are there options that will help me control the bleeding to be more manageable while allowing me to retain fertility?
Answer: There are many answers to this question based on your definition is of the words “very heavy.” For instance, does your menstrual cycle keep you home from school or work? Are you regularly ruining your clothes? You also need to determine why and when you want to retain fertility. Are you currently trying to get pregnant or is it more that you might want a child or another child in the future?
My first recommendation is to talk over these questions with your Ob/Gyn. If your period causes you to stop your life for a couple of days each month, your physician may help you find the answer to a more full life during your period. If you are not trying to get pregnant immediately, it could be as easy as changing your hormones by using your oral contraceptives.
If you are attempting to get pregnant, most likely your physician will recommend an ultrasound or hysteroscopy to determine the cause of your bleeding. Both can be done in the physician’s office and are uncomfortable but not painful. Both provide your physician with a glimpse of your uterine walls—an ultrasound uses waves to see the image through your skin and muscle, a hysteroscopy involves the insertion of a small telescope through the cervix into the uterus.
There are two things your physician is looking for when discussing “very heavy bleeding”—a hormonal imbalance, or a structural problem like fibroid tumors or polyps. If your Ob/Gyn determines that your bleeding is caused by a thyroid dysfunction, you might be able to get some control through medication.
If your Ob/Gyn determines that your bleeding is caused by uterine fibroid tumors or uterine polyps, and oral contraceptives are again not an option, minor surgery may be necessary. It is important to understand that fibroid tumors are usually non-cancerous and that most surgery for fibroid tumors is minimally invasive. From laparoscopy, which allows the physician to view the fibroid through a camera in your cervix, cut the fibroid and remove it through small incisions in the abdominal wall to a laparotomy, which involves an abdominal incision similar to a c-section, most pain and recovery times are minimal. Patients who have a laparotomy typically spend a night or two in the hospital and will have a longer healing time but, with both surgeries, patients can retain the ability to conceive.
Polyps, in either the cervix or the uterine walls, are much simpler than fibroids, in that they typically involve a Dialation and Curettage (D and C), which is a common procedure performed often to fully cleanse a uterus of its contents. Polyps too are typically non-cancerous and can be controlled by oral contraceptives if that is an option.