Gynecologic Surgery-Making the Decision

Gynecologic Surgery-Making the Decision
So your doctor, just advised you to have a gynecologic surgical procedure, what should you do or say? It is important to understand a number of things before agreeing to undergo a surgical procedure. It is imperative you make sure the decision that is right for you. This article will review the basic issues related to the decision to undergo surgery.

Gynecologic surgery is the most common elective surgery in women. Gynecologists perform outpatient and inpatient procedures for a variety of gynecologic problems. In most cases surgery is the correct choice but in others there are alternatives or the procedure isn’t needed at all. Let’s face it; medicine is a business and a number of decisions made by healthcare organizations may not be in your best interest. You need to be your own advocate.

The first step requires understanding your problem. What was the reason you sought care? Did you need reassurance or is the issue truly bothersome? Is the problem interfering with your productivity or the quality of your life? Did your doctor indicate the problem was life threatening or could become life threatening? The initial healthcare visit should identify the cause of the problem and measure the severity of the problem. This helps guide decision-making.

A common gynecologic problem I see is menstrual disorders. This could include heavy menstruation, irregular cycles, painful periods, frequent bleeding or no periods at all. Heavy bleeding can be quite subjective and it is the doctor’s job to try to provide some objective measure of the problem. Questions like- “how often do you change your pad or tampon during the heavy days? Or how many pads do you use per cycle? Or does the blood soak through your clothing?- helps to quantify the problem. Blood tests to check for anemia also are helpful to provide an objective measure of the problem.

A second part of the evaluation is to determine the cause and in the case of abnormal menstruation, the list is long. It could be normal, fibroids, polyps, a bleeding disorder, abnormal pregnancy, endometriosis, cancer and other problems. Identifying the likely cause then leads to a list of treatment options. In most cases, there is usually more than one option for treatment. An example includes heavy menstruation in a woman who has completed her child bearing and has an unremarkable evaluation. The potential options might be the use of a clotting agent during the period, use of an antiflammatory medication during menses, combination birth control pills, progestin only pills, progestin intrauterine device, endometrial ablation and lastly a hysterectomy.

The decision to have surgery is not usually made after one visit. The first step is to understand the problem and come up with a potential diagnosis. This is usually achieved after a series of examination, tests and discussion. In addition more conservative treatments maybe tried first. This isn’t an option in every case as surgery maybe needed to prevent the development of cancer and in situations like this time is of essence. Sometimes the procedure is both diagnostic and therapeutic: an example being a hysteroscopy to evaluate the cavity of the uterus which may also allows for the removal of an offending polyp.

So, if you have been offered, recommended or told to have surgery by your doctor, step back and analyze all of the above. Do you understand the diagnosis? Is the problem a real problem? If the answer is yes then you are ready to move on to the next steps of the process, which includes understanding the alternative treatments, understanding the surgical procedure, its goals, the risks, potential complication and long term consequences.

I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!


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