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New procedure relieves agonizing bleeding that afflicts 1 in 5 women

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FORT WAYNE, Ind. - For years, Lisa Lehman, mother of two children and manager of a Fort Wayne, Ind., tanning salon, dreaded her monthly periods.

``The first two or three days, I couldn't go anywhere. I had such pain and cramping. I used to get cramps so bad I could barely walk. It affected my ability to go to work. At times, the bleeding was so heavy, I wondered if something was seriously wrong, so I would call the doctor. I was leaning toward a hysterectomy, but I really didn't want to do that,'' said Lehman, 40.

Fortunately for Lehman - and for an estimated 10 million other U.S. women who deal with menorrhagia, or excessive menstrual bleeding - better options have come along. A year ago, Lehman had an outpatient procedure called NovaSure that corrected her menorrhagia. While it wasn't the first surgical treatment she had tried, Lehman said she is glad she continued to seek the right one for her.

Excessive menstrual bleeding is a problem faced by one in five women, according to the National Women's Health Resource Center, a nonprofit clearinghouse of women's health information. In a normal period lasting five to seven days, only about 1 to 2 ounces of blood is lost. But women with menorrhagia may lose 10 to 25 times that amount.

Hysterectomy was the only treatment option for many years. But it is major surgery and not without risks, including perforation of the bowel. There is a minimal four- to six-week recovery time, and removing the uterus means a sudden change in a woman's hormone balance.

Hormone replacement therapy can be used, but that can take months to get the right balance in the body. Birth control pills also help some women, but the pill can cause blood clots in those over 40 or in smokers. Intrauterine devices have also been an option, but the hormones released by them can cause bleeding between periods.

A newer option is called endometrial ablation, in which the lining of the uterus is destroyed but the uterus itself remains intact.

In the early years of ablation, lasers destroyed the lining by burning it.

But the procedure was very, very hard to do. It took over an hour,'' said Fort Wayne gynecologist Dr. Matthew Sprunger.The laser sometimes would go too deep and perforate the uterus.''

Then there was the resectoscope, in which the lining was cut away - ``like a paint roller removing strips off,'' Sprunger explained. But the resectoscope can't reach all curved areas of the uterine wall. For these kinds of ablation, women are asked to take hormones in advance to thin the lining as much as possible prior to the procedure.

In all forms of ablation, a woman should not conceive afterward, so the procedures are done after a tubal ligation or the implantation of the Essure system that uses nickel-titanium inserts to block eggs from coming down the fallopian tubes.

In 2001, Lehman opted for a procedure called ThermaChoice, in which the lining of the uterus was destroyed via a balloon filled with hot fluid. Circulating the fluid around the balloon, which rests against the uterine walls, takes about 8 minutes. The woman is under general anesthesia. The sloughing of the burned lining occurs over the next week to 10 days, but there can be some discharge up to a month until healing has occurred.

Although Lehman's older sister had success with ThermaChoice, Lehman was among the 15 percent of women for whom the procedure does not adequately relieve heavy bleeding.

Sprunger said about 90 percent of his patients who have had ThermaChoice have had successful outcomes. ThermaChoice is made by Gynecare, a division of Johnson and Johnson Co.

A year ago, with Lehman still struggling with menorrhagia, Sprunger suggested a newer procedure called NovaSure, made by Cytyc Corp. The advantages of NovaSure are several: all areas of the uterine lining are heated simultaneously using radio waves; and the mesh-like gold-plated electrode system conforms to the shape of the uterus. ``The mesh can be administered in a very controlled fashion,'' Sprunger said.

The procedure takes just 90 seconds and is the safest form of ablation, he said, because the device senses when the uterine lining is removed and the electrical energy immediately stops at that point. Another safety feature is a system that identifies possible perforations in the uterine lining before starting the ablation process.

According to the November 2004 issue of the ``American Journal of Obstetrics and Gynecology, success rates with NovaSure are about 97 percent. Two-thirds of women have no periods following the procedure. Complications such as not being able to complete the procedure because of the shape of the uterus occur in fewer than 2 percent of cases, studies show.

Lehman had her procedure under general anesthesia around 7 a.m. and was home by 10:30 a.m.

I could have gone to work the next day. I had no cramping like I did with the ThermaChoice,'' she said.They used to do hysterectomies like crazy. I'm glad there are options now. This is an option I tell other women about.''


(c) 2005, The News-Sentinel (Fort Wayne, Ind.). Distributed by Knight Ridder/Tribune News Service.

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