I think women are, to some degree, conditioned to just “deal with” some of our challenges of being female. Periods are usually a little to very difficult to deal with. I see teens in my office affected enough, they are missing school or sports when on their periods. As a teen, I learned from my own mom how to alternate ibuprofen and Tylenol to help with my cramps, so I could make it through a school day.
Many women wish their uterus would just shrivel up after having kids and no longer even exist. We tolerate periods in our teens because that seems to be a rite of passage. Then we tolerate them from 20’s-40’s because they allow us to have children. We often treat those bad periods with birth control pills or progesterone, IUD’s, between our kids for birth control, but also because periods are difficult. Once we know we want no more children, or no children at all, suffering with our periods just seems ridiculous.
When I finished training 16 years ago, hysterectomies were still very common for women who had completed their families and having menstrual problems. Since then, we utilize medical management a lot more and the number of hysterectomies for my practice has declined. We know that many women can safely continue to use birth control pills in their 40’s, until menopause. We also use progesterone IUD’s, Mirena being the most common, A LOT. They can often eliminate the period for the 5 years the IUD is in and then it can be replaced as many times as needed. If this isn’t helping, then it can be removed and all other options are still available.
An endometrial ablation is a procedure that can be done to reduce or eliminate the period on a more permanent basis than an IUD. The challenge with the ablation, is that if it isn’t working well, then a hysterectomy is often the next step. There can be conditions where birth control pills, progesterone IUD’s and ablations don’t work well. Women with a lot of fibroids may not have success with these other methods and will need a hysterectomy. Adenomyosis is another condition where the glands that line the uterine cavity invade the muscle of the uterus. This condition can make it so the non-hysterectomy treatments don’t work.
I cannot say the percentage of women with these problems in their 40-50’s because I see more of the problem cases, as women without a problem don’t seek help for this. Also, I am often surprised at how many women just tolerate horrible periods, assuming they are normal or that everyone is going through it.
Average age of menopause is 51.5 years old. I see women from their early 40’s and beyond, often complaining of changes in their periods. Also, during that time, they may have had their tubes tied or their husband’s had vasectomies for permanent birth control. Then they no longer need birth control pills or an IUD. With no hormone management, their “natural” periods are found to be quite difficult.
Hysterectomies are still the right choice for many women, but should almost never be offered as the first or only option. As listed above, there are many other non-surgical options. I approach every woman by going through all the options. They often provide feedback as to why many or all of these are not good choices for them and then we may proceed to surgery. There may be many problems, not just heavy periods, that need to be addressed and surgery is the only option to take care of all of them.
The good news with hysterectomies is that many can be done with a “minimally-invasive” approach, which means laparoscopically (using small incisions, long slender instruments and a camera to perform the surgery). Nearly all of my hysterectomies are done this way. I also choose to use the daVinci robot to assist me in my laparoscopic surgeries. For me, I am faster and more proficient with more complicated cases using this approach.
I try to ask, and every woman should discuss, the quality, frequency, duration of her periods with her gynecologist, particularly when she has completed her family. We don’t have to suffer with our periods simply because they keep coming. We have options and they don’t always include surgery. If a woman’s gynecologist is pushing too hard for surgery as the only option, I would encourage a second opinion. Also, if a woman’s gynecologist will not consider or discuss a hysterectomy at all, I also think a second opinion is warranted. We physicians need to have open discussions with our patients about the available options that are appropriate for them. We need to explain why certain options would not be safe or best for them. We need to work as a team with our patients to find the best, individual solution for each patient.
Dr. Andrea N. Smith is an experienced physician specializing in women\’s healthcare as an Obstetrician/Gynecologist. She earned undergraduate degree in Business Finance at the University of Colorado. She then went on to complete her medical degree at the University of Colorado Health Sciences Center. After completing medical school, Dr. Smith completed an obstetrician/gynecologist residency at Exempla Saint Joseph\’s Hospital in Denver, Colorado. Dr. Smith started a private practice in Colorado twelve years ago. She has been practicing in Utah for the past seven years. Dr. Smith\’s areas of special interest include:
- Minimally invasive gynecological surgery
- Prolapse and Incontinence Problems
- Normal and High Risk Pregnancies
In her free time, Dr. Smith enjoys hiking, biking and skiing with her children. Dr. Smith is currently accepting new patients and accepts most insurance plans. Dr. Smith is now seeing new patients at the University of Utah Women’s Health Center on the Salt Lake Regional Medical Center Campus. To schedule an appointment, call 801.213.4000.