Surgery is recommended when none of the treatments mentioned above work. Nowadays there are several choices and each option will be discussed with you before deciding which is the most suitable option for you.
Endometrial Thermoablation (ET)
Regular heavy bleeding - investigations normal
Irregular bleeding - investigations normal.
Problem bleeding - problem found on investigation.
This is a procedure in which the lining of the womb is heated using a catheter with a balloon at one end that is filled with hot fluid under carefully controlled conditions. The surgeon performs a hysteroscopy before inserting the balloon catheter, which allows him/her to view the inside of the womb. This form of heat treatment is used to treat heavy bleeding by destroying the cells of the lining of the womb, Monthly periods subsequently become much lighter or may stop altogether.
The effects of ET seem to be long-term so it is NOT a method that women who want children should choose. If you have a ET you should still discuss contraception with your doctor as some women can conceive after ET and there seems to be an increased risk of an ectopic pregnancy (occurring outside the womb) if this happens. Sometimes a tubal ligation (sterilisation) at the time of the operation is recommended.
Not all women can have ET. There may be technical difficulties (such as when the womb is enlarged or there are fibroids) and sometimes the tissue in the womb may be found to be diseased and other treatment may be necessary.
Hysterectomy
Regular heavy bleeding - investigations normal
Irregular bleeding - investigations normal.
Problem bleeding - problem found on investigation.
Hysterectomy is the most commonly performed major operation in women. In the UK, approximately 20% of women will have undergone hysterectomy by the age of 55 years and in some areas of the USA more than 35% of women aged 60-69 years have undergone hysterectomy.
Types of hysterectomy
These vary according to your condition and how much can safely be left in place. What you and your doctor should aim for is to leave in as much as possible, while ensuring your health.
1. Subtotal hysterectomy:
body of uterus is removed, leaving the cervix in place. This is rarely performed, but, if it is, the woman must continue to have cervical smear tests afterwards.
2. Total hysterectomy:
both the body of the uterus and the cervix are removed. This is the operation most often performed.
3. Total hysterectomy with bilateral or unilateral salpingo-oophorectomy:
body of uterus and cervix, fallopian tube(s) and ovary (ies) removed.
4.
Wertheims hysterectomy:
body
of uterus and cervix, part of the vagina, fallopian
tubes, usually the ovaries, peritoneum (the broad ligament
below the fallopian tubes) and lymph glands and fatty
tissue in the pelvis removed.
In women who have not reached the menopause it is preferable to leave the ovaries, if possible, since their removal will set off a sudden menopause. Then the level of the hormones usually supplied by the ovaries will drop rapidly and the woman may experience night sweats, hot flushes and perhaps, other symptoms. These can be treated by hormone replacement therapy.
Click here for more information on Gynaecology consultants at London Bridge Hospital |
|
