Dr. William Parker is a Clinical Professor at the UCLA School of Medicine with private practice in Santa Monica, California. He is on the editorial advisory board of The Journal of the American Association of Gynecologic Laparocopists. He is a reviewer for a number of obstetrics and gynecology journals.
Dr. Parker discusses possible alternatives to hysterectomy. He emphasizes that in many cases hysterectomy is not required, and encourages women to pursue alternative treatments to surgery.
Dr. Parker:
The alternatives to hysterectomy will depend on what the original problem is. So let’s just take the two most common indications for hysterectomy. The first would be fibroids. First of all, the majority of women, probably 80% of women with fibroids don’t need any treatment at all, just watching them over a period of time when women get their menopause the fibroid shrink. If you’re not having heavy bleeding or pain or other symptoms, you don’t need anything and I see a fair number of women who have been told by other physicians to have a hysterectomy and they need to do nothing. So that’s always good news when you come in here; you need to do nothing.
Myomectomy, just removal of the fibroids and preservation and reconstruction of the uterus would be an alternative and there are there ways to do that. One is the traditional way through bikini incision for larger fibroids, but smaller fibroids can be taken out through the belly button with laparoscopes and then fibroids in the uterine cavity can be shaved out through the cervix without even any incisions as in outpatient with two-day recovery. So those are surgical options.
We also have laparoscopic super-cervical hysterectomy which is a hysterectomy, but is really a week recovery instead of a six-week recovery. So, if hysterectomy is what you choose to do, that’s a less invasive way to go. Uterine artery embolization where fine little particles are put into the blood vessels going into the uterus and fibroids that makes the fibroids shrink over a period of few months works really well both for bleeding and for pain.
There’s something new called magnetic resonance focused ultrasound, pretty new, we don’t have a lot of good long-term data, but they basically put you in an MRI to focus ultrasound waves through your body and cook the fibroids from the inside out and the preliminary data are now available, but no real long-term data but that’s now available in some communities.
If bleeding is the problem then usually either an IUD or progesterone containing IUDs that can be inserted; this is used a lot in Europe and they have incredibly good success rates, probably in the 90% success rate. So just a small little device placed in the uterus; stays in there for five years; can get rid of the heavy bleeding.
There are medications you can take orally for heavy bleeding. There’s also a surgical procedure where we burn out, cauterize the uterine lining cells, the cells that are bleeding. Again, done through the cervix, no incisions, outpatient procedure, one-day recovery, no pain, and this has 90% success rates.
So, there are lots of options now. We have come a long way in the less decade or two and we have a lot to offer, and if hysterectomy is the first thing your doctor says, if there are no alternatives given, get another opinion.
About Dr. Parker, M.D.:
Dr. William H. Parker is board-certified by the American Board of Obstetrics and Gynecologists and is an elected Fellow of the American College of Obstetricians and Gynecologists. He has managed the unusual by having a successful private practice and a very impressive academic medical career. Dr. Parker is a Clinical Professor at the UCLA School of Medicine and is in private practice in Santa Monica, California.
Dr. Parker is chair, Department of Obstetrics and Gynecology, Saint John's Hospital and Health Center and the former Chair of the Department of Obstetrics and Gynecology at Santa Monica-UCLA Medical Center. Dr. Parker was elected President of the American Association of Gynecological Laparoscopists in 2000, an international association of over 4,000 gynecologists from 53 countries, after serving on its Board of Trustees for many years.
Dr. Parker served two terms as an Editor of The Journal of the American Association of Gynecologic Laparoscopists and is now on the editorial advisory board. He is also a Reviewer for the journals Obstetrics and Gynecology, Journal of the American Association of Gynecological Laparoscopists, New England Journal of Medicine, Journal of Gynecologic Techniques, American Journal of Obstetrics and Gynecology and Fertility and Sterility.
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Video:
https://www.empowher.com/reproductive-system/content/what-are-alternate-choices-hysterectomy-dr-parker-video