I heard a voice saying "Everything is fine; it all went well" as I struggled back to consciousness. My surgeon's face swam into view.
I had flown from my home in Utah to Cedars-Sinai Medical Center in Los Angeles for an endometrial ablation, a new out-patient surgical procedure for women with severe menstrual pain and bleeding. The operation uses electricity to create scar tissue in the lining of the uterus, and is performed through the cervix without an incision, so the patient can walk out of the hospital four or five hours later.I fought to stay awake to thank my doctor and then realized he was telling me that he had found a large tumor in my uterus and had removed it. Fear shot through me, but again he said that everything was fine. I wondered why I felt no pain but sank back into oblivion before I could ask.
When I awoke an hour or so later I felt very comfortable and moved slightly to test for pain. There was none. There was also no incision. My doctor had removed the tumor using the same technique that he had used for the endometrial ablation - using fiber optics attached to lights and television cameras to see, he had burned out my tumor with electricity.
I was overwhelmed with gratitude to have escaped the trauma of a hysterectomy. And I was amazed that a large tumor, a tumor as large as a California orange, could have been removed from my uterus without my being cut open.
For more than 10 years I had been told by some of the most respected and highly recommended gynecologists in Utah and Washington, D.C., that I needed a hysterectomy. But none of these experts could find a reason for the excessive pain and bleeding I experienced every month.
I had even had two operations to determine the cause: A diagnostic D&C (dilation and curettage), where the inside of the uterus is blindly scraped; and a laparoscopy, where a small incision is made and instruments are inserted for examination of the abdominal cavity. Neither operation permits visual examination of the inside of the uterus, so the cause of my problems was still a mystery.
And then one day I saw something on television that seemed hopeful - a new technique recommended for women with severe menstrual pain and bleeding where no physiological cause has been found. After a couple of phone calls I was referred to Dr. Philip Brooks, who is on the staff at Cedars-Sinai Medical Center and is past president of the Los Angeles Obstetrics and Gynecology Society.
Brooks explained that the procedure was devised by Dr. Robert Neuwirth at St. Luke's Hospital in New York City. Although it is expected to be approved by the U.S. Food and Drug Administration within a year, currently only a handful of surgeons around the country have been given approval to use it - in New York City, Los Angeles, San Antonio, New Haven, Seattle and Phoenix.
Although many doctors now use lasers to perform a similar procedure, Brooks said the new procedure using electricity is safer because it is easier to control. I was concerned that the electricity might hurt other organs in my body, but he assured me that the electricity is confined to the abdomen, and that metal plates would be placed under me to drain the electricity out of my body without affecting my heart or any organs above my waist.
I didn't know at the time that Brooks would also be using electricity to remove a tumor.
A couple of days after my operation, Brooks showed me a videotape of how the operation looked, literally from the inside. Even with my untrained eye, the difference between a normal uterus and mine was obvious. My uterine opening was entirely blocked by a fibroid tumor.
I watched as slivers of tumor were sliced off by a small wire hoop. I could even see tiny flashes as the electricity cut away neat little sections.
Tumors such as mine are common and are usually benign, as mine was, Brooks explained. Fibroid tumors grow slowly, and mine could have been there 10 years or more without discovery. The intense pain I had experienced every month had been caused by my body trying to abort the tumor.
In the past, the only option for removing such a tumor would have been a hysterectomy - either a partial hysterectomy that involves cutting out the entire uterus, or a total hysterectomy where the ovaries are also removed.
Because both partial and total hysterectomies require incisions, they usually require a week in the hospital (four days if performed vaginally rather than abdominally). The incisions can cause intense pain, and most women take narcotics to control that pain for two or more weeks, according to Brooks. Although the official recovery time is six weeks, some women suffer detrimental effects and find their energy is substantially diminished for up to a year after surgery.
Despite the fact that my tumor was the size of an orange, this new procedure was completed in one hour, and I spent only five hours in the hospital. I spent only three days resting, and my only restrictions after that were that I could not go to my aerobics class for a month (a terrible sacrifice!), could not hike for two weeks or make love for 10 days.
I experienced no pain from the procedure, just minor discomfort in my abdomen, a negligible result considering I had had my insides rearranged and burned. The only painkillers I needed were the two aspirin I took the day of the operation because I had a headache from the anesthesia. For a couple of weeks after the operation I needed a nap in the afternoons.
The menstrual pain I experienced for 10 years is now gone, and I did not have to undergo the agony, mortal risk and lengthy recuperation of a hysterectomy. To me, this new out-patient procedure is a miracle.
Get a hysteroscopic exam if bleeding is excessive
If a woman has abnormal bleeding, her first step should be to have a hysteroscopic examination, a simple procedure in which the gynecologist uses fiber optics to look inside the uterus. This can be done in the doctor's office or on an outpatient basis in a hospital.
A hysteroscopy provides the doctor with more reliable information than a D&C (dilatation and curettage) because it allows the doctor to look directly into the endometrial cavity, which is impossible with a D&C.
Once a diagnosis has been made, the next step is to decide if the problem can only be treated by a hysterectomy, or if an endometrial ablation or some other less intrusive approach, such as administering hormones, would be effective.
If neither the uterus nor ovaries needs to be removed, the endometrial ablation may be a worthwhile option, even if a non-malignant tumor is found.
If a tumor is found it can be removed using the same equipment as for an endometrial ablation. The surgeon can place a hysteroscopic resectoscope through the cervix and cut away small sections of the tumor without removing the uterus and without an incision.
According to the "Journal of Reproductive Medicine," this procedure is a safe and highly effective alternative to a hysterectomy. If you are advised to have a hysterectomy, you might want to obtain a second opinion from a gynecologist who is familiar with this new procedure.