Hysterectomy: Alternative Options and Medical Therapy
Guest: Dr. David Soper – Obstetrics/Gynecology
Host: Dr. Linda Austin – Psychiatry
Dr. Linda Austin: I am Dr. Linda Austin. I am interviewing, today, Dr. David Soper who is professor of Obstetrics and Gynecology at the Medical University of South Carolina. Dr. Soper, thanks for being with us today. Let’s talk about hysterectomy. Dr. Soper, in the old days when women had heavy menstrual bleeding, hysterectomy was certainly the treatment of choice. I understand that situation has changed now. Where are we today, who is a good candidate for that procedure?
Dr. David Soper: Well Linda, I am happy to be able to talk about hysterectomy because of the exciting new changes that have occurred over the last several years. The first issue is that if you really do not want to opt for hysterectomy, there are enough minor surgical procedures that are outpatient in nature that can be done to allow you to avoid hysterectomy. We are now developing new medicines that if patients really want to avoid going to the operating room, and almost every one of them can do that just by opting for medical therapy. Occasionally patients that have anatomical abnormalities and certainly patients that have malignancies are still going to have to have the uterus removed. Or it may that surgery is a good option for them because the medical therapies are contraindicated because of coexisting medical problems or medicines that they cannot use because, say, they are smokers. But, the first message I want to send is that you do not have to have a hysterectomy unless that seems to suit your needs as a patient.
Dr. Linda Austin: So, who is a typical patient for whom, you as a gynecologist, might find yourself evaluating, does this person need hysterectomy or is there a medication? What are the symptoms that person might have?
Dr. David Soper: The most common indication for hysterectomy, particularly in South Carolina, is the presence of uterine fibroids. These are benign tumors of the uterus and they cause abnormal uterine bleeding, usually very heavy bleeding, sometimes associated with severe menstrual cramping. Those patients become candidates for hysterectomy, if they either do not want medical therapy or they fail medical therapy, which many of them do.
Dr. Linda Austin: Let’s talk first about the medical therapy then. What are some of the options?
Dr. David Soper: Well, actually, medical therapy can be as easy as just taking iron supplements and as complicated as taking what is called GnRH agonist which are medicines that put you into a medically induced menopause that is reversible. Lupron shrinks fibroids, stops menstrual bleeding. Then, if patients actually want to opt for surgery down the road, because it shrinks the size of the uterus, it makes the surgical procedure even easier.
Dr. Linda Austin: So, is the typical process, then, that you would start with medication for most women and see if that is satisfactory?
Dr. David Soper: Typically we discuss all the options. So, if a patient comes and sees me because they have abnormal bleeding, we do the physical examination, they have uterine fibroids, we go over the medical therapies like birth control pills, other hormones, Lupron. We talk about conservative surgical procedures, endometrial ablation which is done as an outpatient, or uterine artery embolization which is available here through our department of radiology. Then we talk about hysterectomy which now can be done laparoscopically.
Dr. Linda Austin: Dr. David Soper, thank you very much.
Dr. David Soper: Thank you.
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