WOMENS-HEALTH Messages for May, 1998: Re: Treatment for Hyperplasia

Re: Treatment for Hyperplasia

From: J.Glenn Bradley MD (anonymous@obgyn.net)
Sat, 30 May 1998 15:28:49 -0500 (CDT)

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In reply to: Diane: "Treatment for Hyperplasia"

At Wed, 27 May 1998, Diane wrote: >
>I am 38 yrs old, and have recently been diagnosed with Hyperplasia w/
>mild atypia. I understand that my options are either hormonal therepy
>or Hysterectomy. I'm wondering if Ablation is also an alternitive?
>
>I'm also wondering, if I go the hysterectomy route if Laproscopy would
>be an alternative. Ihave had two c-sections, so I'm not sure if scar
>tissue might be an issue in this procedure.
>
>My last question is, Having atypia hyperplasia would it be neccesary to
>remove the cervex also, if I had the hysterectomy.
>
>Thanks for your help,
>diane
>
>--
>Diane Bowler

Diane: As with everything in life, there are usually different opinions on various subjects, and I will demonstrate this with my views on your "hyperplasia with atypia" problem.If you are young, want to maintain fertility, or want to avoid surgery, progestational therapy will in all likelihood reverse the hyperplasia,.It would require IMHO, continuous endometrial sampling 1-2x per year for a couple of years, to be sure there is no regression. If you are having a bleeding problem, it may still be an option.Endometrial ablation however IMHO, is not a good one because one can never be certain that ALL the endometrium has been destroyed ( atypicalhyperplasia may have a pre-cancerous connotation in as many as 30% of patients) .Thus you either reverse it medically or you ensure total removal. This brings up the subject of hysterectomy. A laparoscopic supracervical hysterectomy will provide the fastest recuperation of any surgical technique I have ever seen, almost painlessly!! ( See my article on my column "Banter with Dr.B" currently on obgyn.net, "The painless Hysterectomy"). I am a total convert to this surgical approach, as I explain in the article. My patients are home in 12-23 hours, on essentially no pain meds and are resuming normal activities in 3-5 days, and sex in 2 weeks!! >I totally disagree with the view point that the cervix serves no purpose.
It would be essential before this approach that endometrial sampling be very thorough, possibly assisted by hysteroscopy (o simple office procedure)

Good Luck

Dr.B

Next message: Ellen: "Re: Endrometriosis"
Previous message: Sue: "confused about hormonal imbalance"
In reply to: Diane: "Treatment for Hyperplasia"

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