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MARY WAGNER: Welcome to our webcast. I'm Mary Wagner. We're here today to talk about abnormal uterine bleeding from the patient's perspective. We have two patients and their doctors. First, we have Dr. Steven Cohen who is the Director for the Center for Women's Minimal Access Surgery at Columbia University in New York and we have Dr. Grace Janik who is Associate Clinical Professor at the Medical College of Wisconsin and Director of Reproductive Endocrinology at St. Mary's Hospital in Milwaukee.
Dr. Cohen, would you like to introduce your patient to us?
STEVEN COHEN, MD: Sure. This is Susan Bradshaw, a patient of mine, from last year, who has graciously consented to come in today to tell us a little bit about her story.
SUSAN BRADSHAW: Nice to see you again.
STEVEN COHEN, MD: Thank you. Thank you.
SUSAN BRADSHAW: Well, you know the story, but I came to see you after a series of going to other doctors. About three or so years ago, everything was fine in my life. My period was normal. It's always been very -- you know --light and regular. And it started just sort of intermittently having spotting, not when I was having my period. Then it started to get more regular and then more often and then started getting heavier. So after about almost about two years, I was just like bleeding all the time.
It was very interruptive in my life. I'm a meeting planner, as you know. And I travel a lot and I have kids and I'm normally a very high-energy person. And it pretty much took its toll on me. I had to miss some business flights because I was constantly -- you know -- bleeding and it was very embarrassing. And I finally went to the gynecologist and his story was "Well, you have uterine bleeding. You know what you need to do is have a hysterectomy." And I was not comfortable with that.
So I'm like, okay, well. I remember talking to my -- I remembered that this situation happened to my mother and I called her and I said, what was your story? She said, "Well, I went to the doctor." This is probably about 25 years ago. That was the situation. She was just bleeding all the time and she went to the doctor and she had a hysterectomy.
I remember going to the hospital to see her and how devastating it was to her. She was in the hospital. She was in tremendous amount of pain. She looked awful. I remember having to get her up out of the hospital bed to try and walk her down the hallway back and forth. She was in for at least a week. It was a very long recovery period.
I'm like Wow! This is the option. Then about a little over maybe two years ago, the same thing happened to my sister and it was the same situation. And again, it was the same story. You have to have a hysterectomy. Then she -- I wasn't there for it. But I remember when she came home from the hospital; she had a lot of complications with it. It was very hard on her. It was a very long recovery period. I just was not happy. Like there has to be -- is it? Is that the only option you have?
And I got referred to you. Thank you. And I remember going in and I guess we did the
STEVEN COHEN, MD: Hysteroscopy.
SUSAN BRADSHAW: Yeah, the hysteroscopy and didn't necessarily find anything wrong. You had me come back a couple weeks later to do a shot --
STEVEN COHEN, MD: The depo, the Lupron depo.
SUSAN BRADSHAW: Yeah. We did the shot and then came back four weeks after that and we did the oblation. The first time I went in, it was just absolutely fine. No problem. Just very easy procedure.
And when I went in for the oblation. I was a little nervous about it, but it was very easy. Little anesthetic and was out the same day. By the next day, I was perfectly fine. You said, as a matter of fact, I could take some Advil if I had any pain. But I basically had maybe some very, very mild cramping, but no problems with it. It took care of everything. I'm back to being a normal person and in control of my own body and it not controlling me and having my energy level back. Work is fine. My sex life is fine.
STEVEN COHEN, MD: That's good.
SUSAN BRADSHAW: That was good. It was just great to have the option. I never knew that that was out there. I don't know if a lot of people know that that's out there.
STEVEN COHEN, MD: You bring up some very interesting points. One is that a lot of times as providers we look at life and death situations and major medical diseases and quality of life situations don't impact us as much. So a patient comes in and says, "I'm bleeding all the time." They don't have cancer. They don't have some dreaded disease that is going to kill them so we sometimes don't give it as much due as it deserves. And yet the person who lives with it on a day-to-day basis finds that, you know, it really is. Their life -- they schedule things around their period. Their meetings.
SUSAN BRADSHAW: Right.
STEVEN COHEN, MD: So I think we have to consider when a patient comes in really complaining about her quality of life has changed, we have to take that seriously. And sometimes as providers, we're in a busy schedule. We don't take that as seriously as we ought to.
The second thing is that in the last decade there has been some major changes in how we can treat abnormal bleeding. And yet the profession, some of the profession hasn't really caught up with that. It's still the 25-year-old treatment of -- let me take the uterus out. You'll be done with it. You don't need that uterus anyway -- is sort of what you hear.
But there are interims, except there are better ways of treating abnormal bleeding. Someone who has abnormal bleeding, they don't necessarily want their uterus out. They want their bleeding stopped. And we have less invasive, less risky, shorter, more cost effective ways of treating that and that's why we're trying to get the word out to patients that there are better ways in the new millennium to treat abnormal uterine bleeding.
And the way we did with you is the most effective way. Like you said, a quick diagnostic procedure in the office to look in side to make sure there is no significant pathology. Then we simply without even making an incision, using a little telescope, just destroy the lining of the uterus that comes back every month, so it doesn't come back every month. You still have your hormones, as you suggested. Okay. Your ovaries still work. You don't go through menopause. You just don't bleed like you used to. And after all, that's the reason for doing this and yet you're right back to work and up to your schedule almost without any interruption at all.
SUSAN BRADSHAW: And just the thought of just having major surgery is very frightening and also just having a part of your body removed, which is an integral part of me, that's part of my womanhood, I consider. And if it had to be, it had to be. But if it doesn't, then I don't see any reason to stay a complete person.
STEVEN COHEN, MD: And as a physician, the risk of hysterectomy is much greater than the risk of hysteroscopy or endometrial oblation. They pale by comparison.
So when I have to do a hysterectomy to control something, I'm putting that patient at much more risk than I am -- even in today's modern day than I would be if I do a quick 15-minute ambulatory surgery procedure. There is much less risk with that. So we need to consider risks when we're treating patient's risk and benefit. We always need to weigh those types of things.
And you're very right. You are more fearful of hysterectomy and actually as a provider, I don't want to do a more risky procedure, if I don't need to do that procedure.
MARY WAGNER: Thank you, Susan, and thank you, Dr. Cohen, for sharing your experience with us.
Our second patient also had abnormal uterine bleeding. But her story is a little bit different. Dr. Janik, would you like to introduce your patient.
GRACE JANIK, MD: Hi, Carol. Thanks for coming and sharing your story with us. It's important to share your story because there are a lot of patients out there like you that can benefit from hearing your experiences. How have you been feeling lately? I haven't seen you in a while.
CAROL: I'm great. Thank you.
GRACE JANIK, MD: I think it would be best to start with explaining what happened before you started seeing me.
CAROL: Okay. I had been trying to get pregnant for about two or three years. It wasn't working. My GYN had tried to -- also the problem I was also having was I was having a lot of spotting, like bleeding. Not heavy bleeding, but between and before and after my period, which was always normal. I would have these constant spotting, and also during...
GRACE JANIK, MD: How many days was it on either side?
CAROL: It was immediately before and immediately after and then sometime during ovulation, I would also have it.
GRACE JANIK, MD: Okay.
CAROL: This was a problem because I was trying to get pregnant and it would make it difficult and just uncomfortable to deal with and just to go ahead with the whole procedure of getting pregnant. But when I did try to get pregnant, it wasn't working. It wasn't working.
GRACE JANIK, MD: Annoying to have the bleeding. In addition, difficult to time intercourse.
CAROL: Right.
GRACE JANIK, MD: What happened next?
CAROL: He had also tried to put me on some birth control pills to control the spotting. But that wasn't something that I was very excited with because I was trying to get pregnant and this was going to maybe help with the spotting but not with the whole idea of getting pregnant.
GRACE JANIK, MD: So what did he do instead then?
CAROL: That's actually when I was referred to you, just to check what might be wrong, what might be causing this.
GRACE JANIK, MD: I thought you had a couple of D & Cs before you saw me too.
CAROL: Actually yes, I did. I'm sorry. I had two D & Cs. Those procedures were quite uncomfortable and they did help with the spotting for a couple of months, but then after that, the spotting just returned. And that's actually when I was referred to you because those things didn't help. So.
GRACE JANIK, MD: So you had the spotting, wasn't getting better with the D & Cs. You weren't getting pregnant.
CAROL: Right.
GRACE JANIK, MD: Now you had some testing before you saw me.
CAROL: Yeah, I did, but there was nothing really that they could find.
GRACE JANIK, MD: You had your husband checked out.
CAROL: My husband checked out fine. I checked out fine in terms of being fertile and no problems with -- there shouldn't have been any problems with getting pregnant actually. So.
GRACE JANIK, MD: And why don't you explain what happened when you first saw me. What did we do?
CAROL: When I first saw you, I was nervous. But I had explained my history to you and everything that had been done -- the D & Cs, the bleeding, the fact that I couldn't get pregnant. At which point, you proceeded to give me ultrasound just to make sure -- to see what was going on. And there wasn't anything shocking, but there was something that wasn't quite right. So right there, you proceeded with a hysteroscopy. That's when you found the polyp that was causing the whole big mess. It was removed right then and there. It wasn't at all like my experiences with the D & Cs. It was actually quite different and painless --relatively speaking it was nothing big. And I got to see the whole procedure on the screen. I got to see the polyp and everything. I actually got to go home the same day.
GRACE JANIK, MD: Same day so none of that anesthesia.
CAROL: None of that anesthesia that I had to experience with the D & Cs. None of that discomfort. You know, having to stay home for the weekend because it was just so uncomfortable, the nausea and everything. It was actually just very relieving to me to know that it was taken care of. It was found and taken care of. And except for maybe a little bit of spotting after the procedure, everything just went back to normal. I had my periods like I usually did. That was it.
GRACE JANIK, MD: No more spotting.
CAROL: No more spotting.
GRACE JANIK, MD: And that was about nine months ago, wasn't it?
CAROL: Nine months ago.
GRACE JANIK, MD: What else has happened in the last nine months?
CAROL: Well, two months ago -- I'm pregnant for two months now. And I'm very happy, very excited.
GRACE JANIK, MD: Congratulations.
CAROL: Thank you. So it was really, really great to know that that was something that was possible for me to get done. It was so painless and so quick in one visit. And that finally what the whole goal that I was trying to reach in terms of having a child is going to come true. And now I don't have to deal with the discomfort of the bleeding so I'm very happy.
GRACE JANIK, MD: Congratulations. I'll be happy to get that birth announcement.
CAROL: You will.
GRACE JANIK, MD: What I'd like everybody to know from Carol's story is that your treatment can really be initiated much earlier if you have a precise diagnosis. So her trial of potential birth control pills and the D & Cs all could have been averted had a hysteroscopy been done early on in this two to three year time period of back and forth visits to the hospital could have been avoided, in addition to improving her chances for fertility.
Even for infertility patients who aren't having active bleeding, it is important that some sort of evaluation of the uterus is done because polyps can interfere with fertility.
MARY WAGNER: Well, thank you, Dr. Janik, and thank you, Carol, for sharing your story with us. And thank you for watching our webcast. I'm Mary Wagner.
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SUMMARY