"I never had regular menstrual cycles until after my third child,” said Ann B., 41, a wife, mother of three daughters and a school teacher.
Ann had monthly periods ‘on schedule,’ but experienced heavy bleeding.
Although her third was born in 2006, Ann said, “I just let it go. But it got worse and worse. Sometimes, I almost couldn’t get to the bathroom fast enough.”
As a teacher, this was beyond inconvenient; she couldn’t just walk out in the middle of class.
“I also had pre-menstrual symptoms (PMS), such as nausea and severe cramping. I knew this couldn’t be normal.”
Ann consulted her OB/GYN, Christine Ladd, MD, who is on staff at Missouri Baptist Medical Center.
“I’ve seen Dr. Ladd since I first moved to Missouri 19 years ago. I trust her completely. She helped me through infertility issues and delivered my girls,” said Ann.
Spotting is not normal.
Another patient of Dr. Ladd, Jean M., 51, said, “A few years ago, I was bleeding a lot and for long periods of time. I had an IUD, which worked for about two and one-half years.”
But then, she began spotting again – and worrying.
“It would continue for about 10 days with three days off. It was never very heavy and I was never in pain. But it was an annoyance and I felt it also affected my energy level.”
Finding a solution.
“In this day and age, we try conservative management first before proceeding to hysterectomies,” said Dr. Ladd.
A hysterectomy is an operation to remove a woman’s uterus. If needed, now it can be performed using minimally invasive laparoscopic surgery techniques. These offer many advantages over a traditional hysterectomy, which is performed by cutting through the stomach muscles.
Jean and Ann tried other ways to control their abnormal bleeding, ultimately deciding on uterine ablations. Jean, whose bleeding was attributed to benign uterine fibroids, used the IUD successfully for awhile; Ann, who believes her issues stem from her history of polycystic ovarian syndrome, had a D&C (dilation and curettage), essentially a uterine wall scraping or cleaning, which can stop excessive bleeding.
“But it didn’t have the hoped for results,” said Ann. “I also tried the birth control pill to control the bleeding, but it had other side effects, so it wasn’t an option.”
Many women try, at the recommendation of their physicians, something as simple as taking scheduled Ibuprofen, or hormones such as progesterone, IUDs, or the birth control pill.
Ablations may help.
“Not everyone can take birth control or wants an IUD, so ablation is another option to control abnormal bleeding,” said Dr. Ladd. “If a patient has endometriosis and keeps forming cysts, they often experience pain, bleeding and the inability to function well, even the inability to go to work.”
“Ablation is good if a woman is finished having children, but experiences heavy bleeding that keeps her from normal activities.”
With ablation, a woman may still suffer PMS, but bleeding is much reduced. An ablation is generally a minimally-invasive outpatient procedure. The patient usually recovers in a day with perhaps just light cramping.
There are three types of ablation – all performed through the vagina with localized rather than general anesthesia. Two methods use heated saline solutions and the third uses electrical energy to remove the uterine lining.
“All are outpatient, generally well-covered by insurance and take about 30 minutes for the actual procedure,” said Dr. Ladd.
Jean, who is pleased with her results, said, “The recovery was quick. The next day I was feeling well and not in any pain.”
Ann, who also is glad she had the ablation, noted that her mother and aunt had similar women’s issues. She has concerns for what her daughters may face, but she’s optimistic, too. “In my mother’s and aunt’s days, they did not have ways to fix problems like we have today.”
Hysterectomies minimally invasive today.
If, ultimately, a woman needs a hysterectomy, she has many more options. She can find a GYN surgeon, who specializes in minimally invasive surgery, performed either laparoscopically or using the daVinci® robot, rather than open incision. Minimally invasive GYN surgery has reduced recovery time (to a couple of weeks versus two months), and has the advantage of smaller incisions and reduced muscle soreness.
“Patients recover amazingly well and fast,” said Dr. Ladd. “They are back to work quickly and within two weeks walking and doing light exercise.”
Peace of mind.
Since her ablation, Ann said, “I now have peace of mind. The bleeding was a constant worry for me.”
In fact, she had the procedure in summer and a couple weeks later went on a family vacation to Florida.
“I was walking extensively through Disney World, Sea World and swimming. Having the procedure has made being a mom and teacher much easier.”
Christine Ladd, MD, is a board-certified obstetrician/gynecologist, on staff at Missouri Baptist Medical Center. She received her medical degree from the University of Missouri School of Medicine-Columbia and completed her residency at Southern Illinois University in Springfield, Ill.