Sept. 11--When Sandra Cintron's mother heard how bad her daughter's fibroid
symptoms were getting -- bleeding that went on for weeks and debilitating pain
-- she thought she knew where things were heading.
"You're going to need a hysterectomy," Maria Perales said. She had one herself
when she was in her 30s.
A lot has changed since then, though, and Cintron, of Northeast Philadelphia,
was able to choose a less extreme treatment for the benign growths on her
uterus. Last week, she had an embolization at Einstein Medical Center, a
procedure that left her uterus intact but cut off the blood supply to the
Choices like this are reducing the use of hysterectomies, once a common
treatment for aging uterus problems that usually are not life-threatening but
can make life miserable for women in the 10 or 15 years before menopause.
Until a generation or so ago, removing the uterus was the "go-to answer for a
lot of things if [the patient] couldn't put up with it anymore," said Jean
Fitzgerald, director of the department of obstetrics and gynecology at
A Columbia University study published last month in Obstetrics & Gynecology
found that the number of inpatient hysterectomies plunged by 248,000, or 36
percent, from 2002 to 2010, from 681,234 to 433,621. "For a surgical procedure,
that's a fairly dramatic decrease," said ob-gyn professor Jason Wright, who led
His team cited an increase in less invasive alternatives for the treatment of
fibroids, abnormal bleeding, endometriosis, other benign growths, and pelvic
organ prolapse. Hysterectomy is still the preferred treatment for uterine
The study raised concerns about whether the falling number of hysterectomies
could make it harder for new doctors to get enough experience while training or
for practicing doctors to maintain their skills. Generally, higher surgical
volume is associated with better quality.
Some hysterectomies can now be performed on an outpatient basis and would not be
reflected in Wright's statistics. He is now collecting data on outpatient
hysterectomies and alternative procedures.
Peter Gearhart, an ob-gyn at Pennsylvania Hospital, said most hysterectomies
still require at least one night in the hospital.
He thinks patient attitudes are also contributing to the shift. "I think you
have a more empowered patient population," he said. Many patients come to him
already knowing they want to avoid a hysterectomy.
On the other hand, he says he still gets some who say: "I want it out. I'm done.
I can't take this anymore." Some change their minds when they hear about other
options. Some don't.
Fitzgerald said she tries to preserve the uterus whenever possible. The key
question, she said, is "Is it behaving badly or is it diseased?"
Einstein ob-gyn Jay Goldberg developed a special interest in alternatives to
hysterectomy when his wife lost her first pregnancy at 20 weeks because of
fibroids. They researched the alternatives and settled on myomectomy, or
surgical removal of the fibroids, because they knew they wanted to have
children. She was pregnant with their oldest son six weeks later. They now have
three children and Goldberg, who runs the Philadelphia Fibroid Center at
Einstein, regularly does the procedure.
Other options for women with bleeding, fibroids, or other common uterine
problems include endometrial ablation, which involves destroying the lining of
the uterus with heat or cold; low-dose birth control pills; hormones; and the
Mirena intrauterine device. Some anti-inflammatory drugs can reduce bleeding
enough to make it tolerable.
Sometimes the goal is to make the symptoms bearable until women reach menopause.
"These problems all get better with menopause," Fitzgerald said.
Contact Stacey Burling at 215-854-4944 or firstname.lastname@example.org.
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