Gynecologic Surgery- Alternatives

Gynecologic Surgery- Alternatives
Your doctor just recommended surgery and you know there must be some sort of process to help make the decision. You understand the problem and are certain that treatment is necessary but unclear if surgery is the answer. Even though you trust your doctor, you realize that you must do your due diligence. What’s next?

The next step is to understand other treatment options. Once the medical evaluation is complete and you and your doctor have a better grasp of the issue, you can then start to discuss treatment alternatives. In many cases, surgery is only one of these alternatives. When treatment is advised (especially surgery), always ask about the availability of alternative treatments. The worse case scenario is that you try these alternatives, they fail and you are back to surgery as an option. You will at this point be confident that surgery is the right choice. One note of caution however relates to a diagnosis of cancer or precancerous changes. In these cases, early surgical intervention can be life saving.

The best example is heavy uterine bleeding. When a woman presents with heavy menstruation and the evaluation reveals this to be simple menorrhagia, a number of options exist. First there is medical management, which consists of medications such as anti-inflammatory agents like Ibuprofen or a clotting agent such as tranexamic acid taken during the heaviest bleeding days. This may suffice for many women. The other option is hormonal therapy either in the form of the standard combination hormonal birth control or progestin only treatment, which can be found as a pill, injection, implant and intrauterine device. Surgical options include minimally invasive procedures such as endometrial ablation and of course a hysterectomy can be done via a variety of routes.

Once the alternatives are listed, a discussion of the pros and cons of each must occur. There are potential side effects and risks for all treatments, not just surgery. You should have a clear understanding of the potential side effects and risk to all treatment considered. Unfortunately in today’s world, it is unrealistic to think you doctor will be able to sit down with you and have an endless conversation about these issues. Please respect their time. Write down the most pertinent information and go do your own research. If necessary you can make another appointment to continue the discussion. Remember, the FDA regulates all these treatments and the risks have been deemed acceptable, i.e., the benefits outweigh the risks in most cases. Just make sure you don’t have any clear contraindications to the treatment. For instance, a woman over the age of 35 who smokes should never take combination birth control. The risk of thromboembolism is too high.

A second opinion may be advisable especially if your doctor is unwilling to discuss alternative treatments; this maybe due to his limited knowledge of alternatives, his personal bias for surgery or his inability to provide the alternative treatment. A second opinion is also advisable if you are just uncomfortable with this provider. You should never let someone perform surgery on you if you are not 100% confident in their abilities. A good source of providers are professional organizations such as the American College of Obstetrician and Gynecologists (ACOG), the Society of Gynecologic Surgeons (SGS), American Association of Gynecologic Laparoscopists (AAGL), the American Urogynecologic Society (AUGS) and other established and respected organizations that focus on specific problems.

If you are considering surgery, make sure you have a clear understanding of the alternatives. Ask questions, take notes and do your own research. I would encourage that you take a spouse, family member or a trusted friend with you to the counseling visits with your doctor. Two sets of ears are better than one especially with a complex discussion such as medical treatment. Be your own medical advocate and do your homework before undergoing a procedure that can’t be undone.

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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