WOMEN’S HEALTH

Dr. Carlos Salup

ABNORMAL uterine bleeding (AUB) is responsible for as much as one third of the office visits to the gynecologist.  It can be caused by a wide variety of problems including pregnancy, anatomical problems like fibroids, polyps, hormonal problems and cancer.

The normal menstrual cycle is created by a complex feedback system including the pituitary gland, ovary and uterus. When the system is working properly the lining of the uterus or the endometrium goes through several changes and at the end, the period starts.

All women with abnormal uterine bleeding should have a complete history and physical examination by her gynecologist.  The information given to the doctor should include frequency, duration, and volume of the abnormal bleeding.  Women that are 35 and older require an endometrial biopsy and sometimes a hysteroscopy  which is a way for your doctor to look at the lining of your uterus usually in the office using a thin viewing tool called a hysteroscope.

MAKE SURE you’ve undergone a very thorough, comprehensive diagnostic work-up of AUB to ensure an accurate diagnosis, and, in collaboration with your physician, get educated on all of your options for treatment and what is safest, and has the greatest probability of success for you.

Treatment Options
There are multiple treatment options depending on type and severity of symptoms and the causative factors revealed by the diagnostic work-up. A patient’s option is also dependent on their future plans, i.e. wanting children in the future or not.

Hormonal treatment is often successful.  Birth control pills, especially for younger women who desire children in the future, are very effective hormonal management.  This course of therapy is started only after a full work up is completed.

Most cases of AUB can be treated medically.  Surgical measures are reserved for situations when medical therapy has failed or is contraindicated.

D&C is an appropriate diagnostic step in a patient who fails to respond to hormonal management.

• The addition of hysteroscopy will aid in the treatment of endometrial polyps or the performance of directed uterine biopsies.
• As a rule, D&C is rarely useful for therapeutic use in AUB because it has not been shown to be very effective.

The most common surgical procedure done for abnormal uterine bleeding is a hysterectomy, which is removal of the uterus. Abdominal or vaginal hysterectomy might be necessary in patients who have failed or declined hormonal therapy, have symptomatic anemia, and who experience a disruption in their quality of life from persistent, unscheduled bleeding.

• Not every hysterectomy means that the ovaries have to be removed.  This is an extremely important discussion you must have with your gynecologist prior to the hysterectomy.
• Hysterectomies can be done in the traditional abdominal form or laparoscopically.  The wonderful thing about the laparoscopic hysterectomy, or better known as laparoscopic assisted vaginal hysterectomy (LAVH), is the recovery time.   I am still delighted and impressed by how quickly my patients recover. They are usually back to normal within two weeks. Some are back to work within one week.  I try to do the majority of my hysterectomies laparoscopically. Unfortunately not every patient that needs a hysterectomy is a candidate for the laparoscopic approach.

Endometrial ablation is an alternative for those who wish to avoid hysterectomy or who are not candidates for major surgery.

• Ablation techniques are varied and can employ laser, rollerball, resectoscope, or thermal destructive modalities. Most of these procedures are associated with high patient satisfaction rates.
• I am partial to one of the thermal destructive modalities, Endometrial Cryoablation.  In this procedure, we basically freeze the endometrium under local anesthesia in the office utilizing live ultrasound guidance.  The real-time ultrasound guidance makes it extremely safe because we can see exactly where the probe is in the uterus.  The two monitors we use for the procedure allows the doctor, the ultrasound tech and the patient to watch as the procedure is being done.
• Multiple clinical studies with over 2000 patients have demonstrated that this procedure’s success rate is over 90 percent.
• Cryoablation causes minimal discomfort because freezing the endometrium also numbs it and results in minimal pain.
• The recovery time for cryoablation is considerably shorter than for hysterectomy of any type.
• I prefer cryoablation which is done under local in the office in comparison to the other types of ablations that are mostly done in an outpatient facility and under general anesthesia. Also, in most cases the cost of cryoablation is considerably less than other ablation modalities.

Dr. Carlos Salup is a Board Certified Obstetrition/Gynecologist; a Fellow of the American College of Obstetrics and Gynecology; and member of MIMA since 1985. Dr. Salup specializes in laparoscopic surgeries and endometrial cryoablation, and his practice still includes obstetrics and gynecology and he is accepting new patients beginning at the age of 14. You may reach Dr. Salup at 321-729-6166, OR CLICK HERE FOR MORE INFORMATION.

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