Articles

Hill Physicians Program Informs Women
About Alternatives to Hysterectomy
Hill Health, Autumn 1999
Reprinted with permission from Hill Physicians and Diablo

Yvette Gentry, M.D., an obstetrician/gynecologist, is taking part in a new project designed to help women and their physicians make informed choices.

Mina Wilson was 36 when she heard some alarming news. "You have huge fibroids," said one health professional, describing the noncancerous growths that had invaded the tissues of Wilson’s uterus. Another added, "I’m sorry to say this, but your uterus has to come out.

That was before Wilson met Yvette Gentry, M.D., an obstetrician/gynecologist taking part in a new Hill Physicians project to help women and their physicians make informed choices regarding gynecological health. The program, known as GYN Care, addresses a range of pressing health concerns—including fibroids, pelvic pain, abnormal bleeding and endometriosis— that are all types of benign uterine disease. "Historically, many women with these problems have undergone hysterectomies [surgical removal of the uterus]," Dr. Gentry explains. "Today, there are many alternatives worth talking about."

GYN Care, a collaborative effort withJohnson & Johnson Health Services, strives topresent women with a clear understanding oftheir treatment options. "Educating womenand physicians is a key component," saysChristy Kaplan, R.N., GYN Care projectcoordinator. "We’re also collecting data onwomen’s experiences so that information ontheir satisfaction levels and clinical outcomescan guide future clinical practices."

A COMMON CONCERN
Each year approximately 3 million women areaffected by a form of benign uterine disease. In addition to fibroids, these conditions include the following problems. >Endometriosis occurs when endometrial tissue (uterine lining) grows outside the uterus. This tissue responds to the menstrual cycle in the same way that regular uterine tissue does, breaking down each month. This condition can often cause painful or irregular periods, infertility, and other health problems. For more information, call the Endometriosis Association at (800) 992-3636. For support groups in your area, call (414) 355-2200.

Chronic pelvic pain falls into two main categories: intermittent pain and constant pain. Common causes of inter-mittent pain include severe menstrual cramps, pain at the time of ovulation and endometriosis (described above). Constant pain has many possible causes, includ-ing fibroids (see sidebar at left) and adhesions (scar tissue that forms between pelvic organs).

Abnormal uterine bleeding also has many causes, including pregnancy, infections, blood clotting problems, endometriosis, cancer, hormone imbalances, significant weight loss or gain, obesity, and stress. In some instances—such as when a girl begins menstruation or when a woman nears menopause— irregular menstrual periods are perfectly normal. The GYN Care medical professionals recognize that many women have been dealing with these symptoms for years. They know that helping patients deal with the emotional aspects of their disease is an important part of care. Before Wilson connected with Dr. Gentry, she had been through some trying times. Her symptoms—heavy menstrual bleeding and painful cramping—were difficult enough. But she was particularly frustrated in her attempts to learn everything she could about her medical options. One doctor had recommended hysterectomy without asking if she had children (she doesn’t). Nor did the doctor ask if she wanted to have children (she might). "I was having a lot of angst about the procedure," Wilson recalls. "Frankly, I was mad that I even had to deal with the situation."

CRITICAL QUESTIONS
Dr. Gentry didn’t flinch when Wilson unfurled a long list of questions at her first appointment. Instead, the physician pulled out a model of the uterus and explained everything she could about her patient’s condition. Wilson’s fibroids were indeed large— their volume was comparable to a pregnancy at six months. But that did not make Wilson an automatic candidate for hysterectomy. Removal of the uterus used to be the solution for many gynecological problems, leading to some 600,000 surgical procedures in the United States every year. Today more women are working with physicians like Dr. Gentry to pursue alternatives.

A DIFFERENT PATH
In treating Wilson, Dr. Gentry recommended drug therapy to shrink the fibroids followed by a surgical procedure called myomectomy, which removes the fibroids and leaves the uterus in place. One possible outcome is that if a woman becomes pregnant, the baby may need to be delivered by cesarean section. But the possibility of becoming pregnant is preserved. Wilson’s surgery took place in January. "Most people have high blood pressure prior to surgery because they’re nervous," she recalls. "The nurse told me mine was low. It’s true—I wasn’t nervous because Dr. Gentry had taken so much time to help me feel at ease." Wilson’s recovery was equally smooth. After six weeks, she was back at her job and she was enjoying all of her usual interests. Several months later, her menstrual period came and went without any of the past pain and discomfort. Wilson’s experience with Dr. Gentry makes an ideal model for the doctor-patient relationship, says GYN Care’s Kaplan. "The idea is simple," she explains. "Sensitive, informed physicians working with empowered patients will make the healthiest choices."

What Are Fibroids?
As many as one in four women has uterine fibroids, benign (non-cancerous) tumors that grow in or on the tissues of the uterus. Most women don’t even know they have fibroids because the tumors remain so small. Fibroids can occur at any age, though most are found in women in their 30s and 40s. They occur earliest, grow fastest and are most common in African-American women. When fibroids do cause problems, it is often because of their size and location. A fibroid within the uterine cavity may cause heavy and irregular menstrual cycles and/or pain. A large fibroid sitting in front of the uterus may cause frequent urination.

To learn about additional health resources for women, please consult the Hill Physicians Wellness Guide or call (877) 493-5563.