musings on women's health

I’m not opposed to the surgical option, it’s just that there are many roads to Rome, and sometimes an indirect route is more satisfying. Don’t misunderstand; I’m an Ob/Gyn surgeon. It’s what I do, but not to the exclusion of everything else. There are times when surgery is necessary, life-saving, difficult to avoid. There are few ethical or acceptable options available in the case of a ruptured tubal pregnancy, for example. The patient presents in the emergency department bleeding internally, often in shock, sometimes requiring an immediate blood transfusion. Things do not go favourably for her if there is any delay in stopping the bleeding -operating, in other words.

On the other hand, fibroids -benign uterine muscle growths- present a different spectrum of choices. In the past -admittedly with fewer therapeutic tools at their disposal- surgery was the favored option if they were at all symptomatic. Medications meant to slow their growth or decrease vaginal bleeding, were fraught with side effects and seldom satisfactorily resolved the problem. Pain, anemia, or increasing symptoms from the ever-expanding tumours were often the only alternatives to surgery. And because there was a long-honoured tradition of removal, surgery was expected, maybe even desired. If all the female members of your family had hysterectomies, you might be inclined to view yours as inevitable, even if undesirable.

But there is a profound difference between life-saving surgery, and elective surgery. In the latter, options become important. The ability, and knowledge to be able to choose solutions, to see if they will work or even lessen the burden of the condition is an important step in problem solving. Moving from a simple attempt at life style or diet modification for, say, painful periods, to medications of increasing sophistication -and cost- to a hormone-containing intrauterine device, to laparoscopic investigation of the pain in the operating theatre might be a sensible route to follow. Or at least to know about.

For fibroids causing heavy menstrual bleeding -they don’t all do this, by the way- the use of antiprostaglandin medications (ibuprofen being the most widely known of these) to attempt to decrease the bleeding, maybe followed , if necessary, by the progesterone-containing intrauterine device if appropriate, and then if that fails, blocking off the blood supply to the artery that is responsible for providing nutrients to the growing fibroid (embolization)- all of these could be considered before resorting surgery.

Clearly there are features of each problem that might suggest other creative adaptations, although my point is not that they should be chosen, but rather acknowledged. We all have a right to determine our own unique paths through the thorns of life, and we should be given enough background and knowledge to allow us to make informed choices -choices whose logic and consequences we can understand. In  non-life threatening situations we may make a choice we regret, but if there are a series of progressively more serious options, we would probably be more accepting of their side-effects than if we had been forced into the treatment before we were ready.

Yes, I am a surgeon, and if surgery were the correct choice all along, then you will work your way along the path and eventually realize that for yourself. And come to accept it. It’s not my place to force you there. I am neither your father nor your boss. I do not possess absolute knowledge of the inevitable consequences of your actions. I see myself as merely a guide through a dark and often confusing forest, pointing out each fork in the road and offering suggestions that years of experience have taught me about the smoother trail.

It is, I hope, what doctors do.