Medically Reviewed On: July 09, 2008

MARY WAGNER: Welcome to our webcast. I'm Mary Wagner. We're here today to talk about abnormal uterine bleeding from the patient's perspective. Dr. Cohen, would you like to introduce your patient to us?

STEVEN COHEN, MD: Sure. This is Susan Bradshaw, a patient of mine, from last year, who has graciously consented to come in today to tell us a little bit about her story.

SUSAN BRADSHAW: Nice to see you again.

STEVEN COHEN, MD: Thank you. Thank you.

SUSAN BRADSHAW: Well, you know the story, but I came to see you after a series of going to other doctors. About three or so years ago, everything was fine in my life. My period was normal. It's always been very -- you know --light and regular. And it started just sort of intermittently having spotting, not when I was having my period. Then it started to get more regular and then more often and then started getting heavier. So after about almost about two years, I was just like bleeding all the time.

It was very interruptive in my life. I'm a meeting planner, as you know. And I travel a lot and I have kids and I'm normally a very high-energy person. And it pretty much took its toll on me. I had to miss some business flights because I was constantly -- you know -- bleeding and it was very embarrassing. And I finally went to the gynecologist and his story was "Well, you have uterine bleeding. You know what you need to do is have a hysterectomy." And I was not comfortable with that.

So I'm like, okay, well. I remember talking to my -- I remembered that this situation happened to my mother and I called her and I said, what was your story? She said, "Well, I went to the doctor." This is probably about 25 years ago. That was the situation. She was just bleeding all the time and she went to the doctor and he had a hysterectomy.

And I got referred to you. Thank you. And I remember going in and I guess we did the

STEVEN COHEN, MD: Hysteroscopy.

SUSAN BRADSHAW: Yeah, the hysteroscopy and didn't necessarily find anything wrong. You had me come back a couple weeks later to do a shot --

STEVEN COHEN, MD: The depo, the Lupron depo.

SUSAN BRADSHAW: Yeah. We did the shot and then came back four weeks after that and we did the ablation. The first time I went in, it was just absolutely fine. No problem. Just very easy procedure.

And when I went in for the ablation. I was a little nervous about it, but it was very easy. Little anesthetic and was out the same day. By the next day, I was perfectly fine. You said, as a matter of fact, I could take some Advil if I had any pain. But I basically had maybe some very, very mild cramping, but no problems with it. It took care of everything. I'm back to being a normal person and in control of my own body and it not controlling me and having my energy level back. Work is fine. My sex life is fine.

STEVEN COHEN, MD: That's good.

SUSAN BRADSHAW: That was good. It was just great to have the option. I never knew that that was out there. I don't know if a lot of people know that that's out there.

STEVEN COHEN, MD: You bring up some very interesting points. One is that a lot of times as providers we look at life and death situations and major medical diseases and quality of life situations don't impact us as much. So a patient comes in and says, "I'm bleeding all the time." They don't have cancer. They don't have some dreaded disease that is going to kill them so we sometimes don't give it as much due as it deserves. And yet the person who lives with it on a day-to-day basis finds that, you know, it really is. Their life -- they schedule things around their period. Their meetings.

SUSAN BRADSHAW: Right.

STEVEN COHEN, MD: So I think we have to consider when a patient comes in really complaining about her quality of life has changed, we have to take that seriously. And sometimes as providers, we're in a busy schedule. We don't take that as seriously as we ought to.

The second thing is that in the last decade there has been some major changes in how we can treat abnormal bleeding. And yet the profession, some of the profession hasn't really caught up with that. It's still the 25-year-old treatment of -- let me take the uterus out. You'll be done with it. You don't need that uterus anyway -- is sort of what you hear.

But there are interims, except there are better ways of treating abnormal bleeding. Someone who has abnormal bleeding, they don't necessarily want their uterus out. They want their bleeding stopped. And we have less invasive, less risky, shorter, more cost effective ways of treating that and that's why we're trying to get the word out to patients that there are better ways in the new millennium to treat abnormal uterine bleeding.

And the way we did with you is the most effective way. Like you said, a quick diagnostic procedure in the office to look in side to make sure there is no significant pathology. Then we simply without even making an incision, using a little telescope, just destroy the lining of the uterus that comes back every month, so it doesn't come back every month. You still have your hormones, as you suggested. Okay. Your ovaries still work. You don't go through menopause. You just don't bleed like you used to. And after all, that's the reason for doing this and yet you're right back to work and up to your schedule almost without any interruption at all.

SUSAN BRADSHAW: And just the thought of just having major surgery is very frightening and also just having a part of your body removed, which is an integral part of me, that's part of my womanhood, I consider. And if it had to be, it had to be. But if it doesn't, then I don't see any reason to stay a complete person.

STEVEN COHEN, MD: And as a physician, the risk of hysterectomy is much greater than the risk of hysteroscopy or endometrial ablation. They pale by comparison.

So when I have to do a hysterectomy to control something, I'm putting that patient at much more risk than I am -- even in today's modern day than I would be if I do a quick 15-minute ambulatory surgery procedure. There is much less risk with that. So we need to consider risks when we're treating patient's risk and benefit. We always need to weigh those types of things.

And you're very right. You are more fearful of hysterectomy and actually as a provider, I don't want to do a more risky procedure, if I don't need to do that procedure.

MARY WAGNER: Thanks very much for this informative discussion on abnormal uterine bleeding. And thank you for watching this webcast.