The choice for women
The average woman will have more than 400 periods in her lifetime when the lining of the uterus (endometrium) is shed. For some women, however, this natural but complex action can become a severe problem whereby excessive, prolonged and sometimes painful bleeding prevents them leading a normal lifestyle. On "heavy days" they may even be housebound.
The problem can affect their wellbeing and may lead to iron deficiency (anaemia) and fatigue.
Periods may be accompanied by painful menstrual cramps (dysmenorrhoea) due to excessive blood loss. This condition is known medically as menorrhagia, and also as Heavy Menstrual Bleeding (HMB) and Dysfunctional Uterine Bleeding (DUB).
Women today are empowered to consider their options regarding careers, family status and health. As such, women are keen to consider alternatives when faced with making decisions regarding choice of medical treatment - especially for those decisions which impact on their bodies and their sense of self as a woman.
Surgical treatment of Heavy Menstrual Bleeding (HMB) often follows failed or ineffective medical therapy. However, in approximately half of all cases referred to a gynaecologist, there is no clear pathology for HMB. Hysterectomy is carried out on 60% of women referred to secondary care with HMB. This operation involves removing the entire uterus, thus producing permanent menstrual cessation. Hysterectomy is, however, associated with a high level of post-operative complications, occasional mortality and is believed to increase the risk of developing other diseases and conditions, including urinary incontinence. Women undergoing hysterectomy require a period of convalescence before resuming normal activities.
Concerns about the safety of hysterectomy, the increasing weight being given to patient preference and the high cost of hysterectomy mean that hysterectomy should no longer be considered to be the primary surgical option for women with HMB.
One study has shown that 36% of women referred to a gynaecologist had a treatment preference. Many experts have argued that patient preference should be an important guide to treatment choice, and may strongly influence outcome success.
Less invasive surgical techniques have been introduced with the purpose of removing the entire thickness of the endometrium while leaving the uterus intact and producing amenorrhoea or hypomenorrhoea. These techniques are generically called Endometrial Ablation (EA) techniques.
It's your body
Unlike hysterectomy, endometrial ablation does not guarantee that a woman will never have another period. However 8 out of 10 women find that their periods are much lighter or stop completely and are pleased that they have avoided the longer recovery time needed after hysterectomy. MEA does not affect hormone production by the ovaries so the menopause will happen at its natural time. There are alternatives to hysterectomy, and women should seek out more information, seek out second opinions and see if there are choices that may be more appropriate for them. Women may decide that hysterectomy is right for them or they may decide that an alternative would be better for their overall wellbeing.
Microsulis has developed Microwave Endometrial Ablation: MEA – a third -generation EA treatment that has substantial benefits compared to alternative methods of EA. Treatment time for the actual procedure (i.e. excluding anaesthetic preparation etc.) is approximately three minutes, which is substantially less than other methods of EA (e.g. balloon ablation takes 8-20 minutes). Very few complications of surgery have been recorded and rates of further surgery are extremely low.
MEA has the following advantages over its competitors:
- Minimally invasive transcervical procedure
- Does not require distension fluids
- Minimal physician learning curve
- General, regional or local anaesthesia can be used
- Short recovery period
- Minimal post-operative pain
- Clinical evidence shows unparalleled efficacy and long-term patient satisfaction
- Clinically validated to be effective on women with HMB in the presence of mild to moderate fibroids or polyps or congenital abnormalities
- Low treatment cost
- Short outpatient procedure (average treatment time is three minutes).
The MEA treatment has the following advantages over current surgical and ablative procedures on the market:
Advantages to the patient:
- Safe: No risk of fluid overload
- Office, day or outpatient procedure
- Minimally invasive procedure, no abdominal scars or cutting
- Short recovery period with minimal post-operative pain
- Improved or non-existent dysmenorrhoea (period pain)
- Option for general or local anaesthetic
- High patient satisfaction and amenorrhoea rate
- Ability to treat irregular cavities and those with fibroids.
Advantages to the surgeon:
- No risk of fluid overload
- Quick and simple procedure, short learning curve
- Suitable for local or general anaesthetic
- Suitable as office, day patient or outpatient therapy
- Irregular cavities and fibroids are not a contra-indication
Advantages to the hospital/clinic:
- Low treatment cost
- No consumables
- Applicable to the widest range of patients suffering from HMB
- Fast treatment not requiring dedicated facilities and staff
Hysterectomy is not the only – or even the best – option for treating HMB
A woman should be advised of all treatment options and their associated risks and benefits so that she can work with her doctor to choose the treatment that is best for her.
