SAVE THE UTERUS

Save the Uterus

Dr. I am scared of operations…

Please save my uterus!!

Save the uterus. Yes, that’s the motto of our treatment at Omega!

Heavy menstrual bleeding can be due to many causes.

PALM COIEN classification is the most common method of finding out the cause of bleeding. This is done by the Gynecologist by doing the examination, sonography, and maybe hysteroscopy in some cases.

Did you know that Heavy menstrual bleeding (HMB), is the major cause of anxiety & discomfort among women?

It has a major impact on Quality of Life. It leads to anemia, discomfort, and a negative impact on the relationship with a partner.

The majority, 60% of these patients end up having a hysterectomy- removal of the uterus- within 5 years from the diagnosis. And you know what? One-third of hysterectomies result in the removal of the normal uterus.

Heavy bleeding and abnormal bleeding are seen in almost 30% of women. Mostly in the perimenopausal age group. 70% of OPD visits of this age group are for Heavy menstrual bleeding.

So how do we go ahead?

First thing first. Proper diagnosis is a must before starting the treatment.

Consult your Gynecologists. Ultrasound, especially 3-D and vaginal scans are the best modalities of diagnosis.

Once your Examination and ultrasound are done. Your Gynecologists will conclude the cause of the bleeding.

Well, it can be anything, from fibroids to adenomyosis to hormonal imbalance.

The next step is to do blood tests and then plan the treatment.

Hysteroscopy is the gold standard in diagnosis. It is routinely done in patients with abnormal bleeding along with D & C.

D & C hysteroscopy go together and help in the exact diagnosis of the condition.

Let me tell you at the outset that one cannot avoid operations in all cases. Like, if there is a big fibroid, say 7 cm in size. If and is causing pain, bleeding, and discomfort, then you have no choice but to remove it.

So how do we know that my bleeding does not need surgery and can be managed with some other form of treatment?

Friends, what you need to know is how severe your problem is and what’s the root cause of your problem. Let me explain it to you. Suppose you have this problem of bleeding, which you, at the age of 43 are experiencing for the first time. Your hemoglobin is say, 11 gm %, and on ultrasound, your uterus is normal, or maybe just bulky. Well, you might respond to medical treatment. And I have already told you about the big fibroid causing problems where operation is the only option.

Before starting treatment, you must rule out malignancy or cancer. Don’t be scared of the word Cancer. But hysteroscopy with D & C is the procedure that your doctor might advise you. Again, it all depends on ultrasound findings and your age. When you are around 45 yrs or more, you might need D &C.

Many girls at a young age have polycystic ovaries- PCO. They are more vulnerable to diabetes and cancer of the endometrium in the later stages of life. So, PCO patients have to be more vigilant! There is no reason to worry.

Let me tell you about the new drugs available in the market and their usage in abnormal bleeding.

Well, if you have Adenomyosis or endometriosis as a cause of bleeding then GnRH injections. Leuprolide once a month for 4-6 months might work. Tablets like Dinogest are available and work well.

For fibroids, Ulipristal and Mifepristone are the drugs, available in tablet form, which can be of great help.

While taking such tablets, which can be taken for 3-6 months. Beware of side effects and follow the instructions of your doctor.

Sometimes simple treatments like Oral Contraceptive pills or Progesterone like Primolut N and even tablets like Trenexamic acid is all you need to control bleeding.

Intrauterine devices like Mirena might help in many cases of abnormal bleeding, adenomyosis, and even fibroids.

Newer Surgical modalities are available at Omega-

We, at Omega, are committed to saving the uterus in our patients with heavy menstrual bleeding. For this, we have a battery of treatment options available.

Hysteroscopic resection of the endometrium is one such modality. It’s a minor, daycare surgery done under short anesthesia which does not require an incision or a cut. All we do is just put the hysteroscope through the vagina. And remove the lining of the uterus with the help of a resectoscope. It’s a win-win situation for Drs and Patients as treatment is effective and major surgery is avoided.

Hysteroscopic Myomectomy

One more therapy option which we give to our patients at Omega is Balloon therapy or thermal ablation. This is a simple treatment that requires 6-8 hours of admission. The patient is admitted in the morning. The procedure is done under short anesthesia. Through the vagina, a silicon balloon is inserted. And what it does is simply burn or charring of inner lining at 90 degree Celsius. This helps in the permanent destruction of the inner lining and stoppage of menses.

But you must know that both the above-mentioned procedures cannot be done in women desirous of pregnancy. This means you must finish your childbearing before you opt for this.

Apart from this, we have some more treatment modalities like uterine artery embolization and MR-guided focused ultrasound treatment. Which is becoming popular day by day.

Uterine artery embolization

MRgFUS

So, friends, all you need to do is try to find out the cause of your problem.

Express your desire to save the uterus with your doctor and just have faith in your physician.

That’s all for the day!

Dr Chaitanya Shembekar
Chief Managing Director
Omega Hospital, Nagpur