Uterine Health

Treatment Options That Help

You Take Charge Again

What We’ll Talk About Today

I. The Female Reproductive System

II. Uterine Conditions & Treatment Options

-Menorrhagia

-Fibroids

III. Hysterectomy

-Laparoscopic Supracervical Hysterectomy

IV. Questions & Resources

Uterine Health and You

• Reproductive functions change as you move

through life

• Hormone imbalances, infection and disease

can affect the function of your uterus

• This presentation will discuss fibroids and

heavy periods, common in women in their 30s

and 40s

Overview of Reproductive System

Uterus

Ovaries

Endometrium

Fallopian tubes

Cervix

Vagina

Female Anatomy

Uterus

The Menstrual Cycle

Hypothalamus

Pituitary

Ovarian

Uterus

Heavy Periods

and Treatment

Options

What is Excessive Menstrual

Bleeding?

• Unmanageable or

heavy bleeding month

after month

• Also known as

menorrhagia

(men-or-ah-zha)

•1 out of 5 women have heavy periods

For some women, this means:

• Bleeding for more than 7 days

• Using more than 10 pads or

tampons per day during a

period

• Feeling tired, worrying about

embarrassing accidents and

generally feeling frustrated

that periods rule one’s quality

of life

Changes in Your Menstrual Cycle

• Many women experience a change in their

periods six or more years leading up to

menopause – commonly referred to as

perimenopause

• Typically, women in their 30’s and 40’s may

experience heavier periods

• Some women always have heavy periods

What Causes Heavy Bleeding?

• Hormonal imbalance

• Fibroids (benign

uterine growths)

• Infection/Disease

How is Heavy Bleeding Diagnosed?

• Pelvic Exam

• Ultrasound

• Hysteroscopy

• Endometrial Biopsy

Hormonally-Caused Heavy Bleeding

and

Treatment Options

Medication

• Birth control pills may be prescribed to

control heavy bleeding

• Drawbacks:

• Not always well tolerated

• Not always effective

• May have to be taken until menopause

Endometrial Ablation

• Removes uterine

lining and

preserves the

uterus

• Performed under

general or local

anesthesia

• Option for women

past childbearing

Endometrial

lining

GYNECARE THERMACHOICE*

Uterine Balloon Therapy

• Can be performed under local anesthesia

• Simple outpatient treatment, no incision

required

• Treats endometrium, preserves uterus

*Trademark of ETHICON, Inc.

How It Works

•Uses hot liquid in balloon to treat uterine lining

•Minimally invasive, inserted through cervix

•Procedure is quick, uterine lining is treated for 8 minutes

•Uterine lining will slough off like a period in 7-10 days

Benefits of

GYNECARE THERMACHOICE

• 95% of patients report normal bleeding

levels or less*, 93% patient satisfaction

• Clinical data shows that women who have

menorrhagia and have undergone treatment

with Thermachoice experienced a decrease

in painful periods

• Non-hormonal, one-time treatment

Drawbacks of

GYNECARE THERMACHOICE

• Rare side effects include blood loss, heat

burn of internal organs, perforation or

rupture of uterine wall, leakage of heated

fluid into cervix or vagina

• All medical procedures have potential risks

Who is a Candidate?

• Pre-menopausal woman

• Childbearing complete

• Normal pap smear and

biopsy

Patient Testimonial

“There were two days out of every

month that I knew that I wasn’t going

to be able to leave the house and I

would have to reschedule

appointments or just totally miss

work. It’s great now. I really don’t

have to plan around my menstrual

cycle. I know what I’m in for

basically and it’s not at all what it use

to be so I’m very glad I got the

THERMACHOICE treatment done.”

Debby

Fibroids

And Treatment Options

Fibroids

• May cause heavy bleeding, pain, infertility

• Occurs in 20% of pre-menopausal women

• Exact cause is unknown, but evidence

suggests that many fibroids require

estrogen to grow

Types of Fibroids

Intramural:

occurs within

uterine wall

Submucosal:

grows into

uterine cavity

Pendunculated

subserosal: grows

from uterine wall to the

outside uterine cavity

• Pelvic exam

• Ultrasound

• Hysteroscopy

• Laparoscopy

How are Fibroids diagnosed?

Medication

• Typically used to shrink fibroids before

surgical removal

• Fibroids may return soon after

discontinuation of treatment

• May produce menopause symptoms

Fibroid Removal – Surgical Options

• Myomectomy

• Embolization: A non-surgical option

Myomectomy

• Removes just

fibroids, preserving

uterus

• Women may still be

able to have children

• Types:

• Open

• Laparoscopic

• Hysteroscopic

Benefits of Hysteroscopic and

Laparoscopic Myomectomy

• Can maintain fertility, preserves the uterus

• Option to avoid major surgical procedures

• Outpatient procedure, no hospital stay

Hysteroscopic Myomectomy

Abdominal Myomectomy

Drawbacks of Myomectomy

• Fibroids may come back after surgery, and

repeat surgery may be necessary.

• Other potential risks include:

• Bleeding, infection, damage to vital organs

• May result in perforation to uterus

Fibroid Embolization

• Blocks blood supply to fibroids causing

them to shrink

• Appears effective, long-term results

unknown

• Not recommended for women planning to

have children

Hysterectomy

• Surgical removal of uterus

• May or may not remove the fallopian tubes and

ovaries

• Should only be considered after other

options have been explored

• Major surgery, usually requires hospital

stay

Is It Necessary?

• In most cases, hysterectomies are elective

procedures

• Know your options:

Different ways to perform hysterectomy

Abdominal Hysterectomy

• Major surgery; most invasive

type of hysterectomy

• Removes uterus and cervix

through abdominal incision

• Performed under general

anesthesia

• Requires hospital stay of

3-6 days, long recovery period

(up to 6 weeks).

Vaginal Hysterectomy

• Removes uterus

and cervix through

incision inside

vagina

• Typical hospital

stay, 1-3 days

• Average recovery

time, 4 weeks

Laparoscopic-assisted Vaginal

Hysterectomy (LAVH)

• Removes uterus

and cervix

• Laparoscope

inserted through

small incision in

navel

• Typical hospital

stay, 1-3 days

• Average recovery

time, 4 weeks

Not Your Mother’s Hysterectomy

Laparoscopic Supracervical Hysterectomy

An innovative approach

Laparoscopic Supracervical

Hysterectomy

Using laparoscopy:

(small abdominal incisions)

• Detach and removes top

part only of the uterus

• Leaves cervix (lower

portion) in place

• Considered a partial

hysterectomy

LSH

Benefits:

• Typical hospital stay, one day or less

• Average recovery time, six days

• Less invasive, minimal scarring

• Less traumatic for your body

LSH

Why should I consider preserving my cervix?

May help reduce complications

associated with total hysterectomies,

such as pelvic floor prolapse and

urinary incontinence

LSH

Is there any downside to retaining my cervix?

You will need to continue regular pap

test to screen for cervical cancer and

you may still have slight bleeding every

month

LSH Procedure

Hysterectomy Risks (for all types)

• All surgery involves risks

• Potential risks include blood loss, infection,

damage to internal organs

• Long-term complications may include

incontinence later in life

• Risks of general anesthesia

Know All of Your Options For Uterine Health

• There are many potential treatment options

• Get informed

• Talk with your doctor

Frequently Asked Questions

• How do I know what treatment option is best

for me?

• Can I get pregnant after any of these

treatments?

• Do any of these problems resolve

themselves?

• What are success rates of each medication

and surgical procedure available?

• What surgical alternatives do I have other than

hysterectomy?

Resources

Where you can find more information:

• www.healthywomen.org

(National Women’s

Health Resource Center -- NWHRC)

• www.acog.org

(The American College of

Obstetricians and Gynecologists)

• www.asrm.org

(American Society for

Reproductive Medicine)

• www.aagl.org

(The American Association of

Gynecologic Laparoscopists)

• www.apgo.org

(Association of Professors of

Gynecology and Obstetrics)