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" As a busy mom, business analyst, and occasional golfer, Amy Mills, 46, of Lancaster, OH, had a hard time coping with her long, increasingly heavy periods. &amp;quot;I couldn&amp;#039;t do anything spontaneously,&amp;quot; says Mills, who was sometimes reluctant to go out for fear of leaking through the super tampon and maxi pad she had to use. The misery went on for two years. Still, when her gynecologist suggested a hysterectomy, Mills was hesitant. The surgery can involve a four-day hospital stay, plus a two-month recovery and unpleasant side effects, such as early menopause symptoms.  But Mills&amp;#039;s doctor also mentioned endometrial ablation, an outpatient procedure that removes the uterine lining \u2014 one of several lower-risk treatments with a far quicker recovery. Mills had the procedure about a year and a half ago and was back in action after a day. &amp;quot;I&amp;#039;m so glad I did it! I feel liberated,&amp;quot; she says.  She was fortunate. Despite years of concern about the unnecessarily high number of hysterectomies for conditions like heavy bleeding, too many women are still having their uteruses removed. In almost 70 percent of cases, hysterectomy is &amp;quot;inappropriately recommended,&amp;quot; reports a significant UCLA study. &amp;quot;Doctors like to stick with what they know, and they know how to do hysterectomies,&amp;quot; says study head Michael S. Broder, M.D. &amp;quot;As a result, women may not be told about less invasive alternatives that may be nearly as effective.&amp;quot;  Of course, the surgery isn&amp;#039;t always elective \u2014 if you have uterine cancer, for example, a hysterectomy can save your life. But if your doctor mentions the operation as a cure for haywire periods, pelvic pain, or fibroids (benign uterine growths), there are other options, depending on your symptoms and life situation. Did You Get a Diagnosis?   When it comes to heavy or prolonged periods, the &amp;quot;vast majority of doctors skip determining a diagnosis and go straight to trying various medications,&amp;quot; notes Paul Indman, M.D., a California gynecologist who is one of the pioneers of minimally invasive alternatives to hysterectomy. That can mean a long period of trial and error. Save yourself the pain by asking your doctor about these tests, which can help you find out what&amp;#039;s wrong \u2014 and point you to the best approach.  Blood tests \u2014 to check for thyroid disorder or other problems that can cause excessive menstrual bleeding. Fix the underlying condition, and that may well clear up monthly problems. Transvaginal ultrasound \u2014 to detect fibroids or other uterine growths, such as polyps. If you have them, the Pill or other hormonal treatments may be less likely to work. (This painless exam is done with a probe inserted into the vagina.) Hysteroscopy \u2014 to directly view the uterine cavity, often as a follow-up to ultrasound. This exam, done with a thin telescope inserted vaginally, also checks for uterine cancer (more likely if you have other risk factors, such as diabetes, obesity, or a family history). Your ob-gyn may take a tissue sample (endometrial biopsy) during the procedure; if no abnormal cells are found, it may be safe or desirable to say no to a hysterectomy and try an alternative.   Next Page: Nonsurgical options to hysterectomies  If you have: Heavy, painful periods, and you may want to become pregnant in the future Consider: Hormonal contraception   Excess, irregular bleeding is often triggered by out-of-whack hormones \u2014 a common problem during the perimenopause years. The lining of the uterus becomes too thick, then sheds in abundance (a condition called menorrhagia). The progestins in some birth control methods stop this overgrowth, so you experience less bleeding and cramping, which frequently comes with it.  The Pill is often the first treatment doctors offer for heavy menstrual bleeding. Unfortunately, it is also often the only one. When oral contraceptives don&amp;#039;t help, which is the case more than half the time, many ob-gyns fail to suggest other solutions, notes Dr. Broder. &amp;quot;It&amp;#039;s not unusual for a woman to go years without adequate treatment,&amp;quot; he says. &amp;quot;By the time she consults a doctor again, she is so worn out by her symptoms, she quickly agrees to a hysterectomy.&amp;quot;  If you haven&amp;#039;t found relief from pain and bleeding after three to six months of taking the Pill the normal way (three weeks of active pills followed by one week of placebos), ask your doctor about trying a different schedule, which can result in fewer periods and/or shorter, lighter, and less painful ones. You can manipulate how often you have a period and how long it lasts with most brands of oral contraceptives, although some are specifically designed to be used on an extended schedule. With Seasonique and Seasonale, for example, you have a menstrual period every three months; with the new Lybrel, you never have one \u2014 you take an active pill every day, year-round. And in another variation on this theme \u2014 Loestrin 24 Fe \u2014 you have a period every month, but it lasts three days, or even less.  Beyond the Pill, other choices include Depo-Provera, the contraceptive injection; about 60 percent of women using this method stop having periods after nine months, and after a year, about 85 percent of women stop, says Stephanie Teal, M.D., an ob-gyn at the University of Colorado School of Medicine in Denver. But with long-term use of Depo, there is a risk of calcium loss in bones and thus a greater chance of osteoporosis. Mirena, a hormone-releasing intrauterine device, also relieves menstrual symptoms: After the first few months with this IUD, most women have only two days of light bleeding or spotting. &amp;quot;It&amp;#039;s terrific,&amp;quot; says Dr. Teal. &amp;quot;It takes five minutes to insert and lasts five years.&amp;quot;  But keep in mind: Hormones don&amp;#039;t necessarily work immediately. It may take a month or two for your periods to lighten.  If you have: Heavy, painful periods, and you don&amp;#039;t intend to become pregnant  Consider: Endometrial ablation This procedure (the one that Amy Mills had) involves removing the uterine lining. A thin probe is inserted through the vagina into the uterus, where it destroys the lining with extreme cold, heat, hot saline water, an electrical current, or other &amp;quot;zapper.&amp;quot; Different doctors prefer different methods, but they&amp;#039;re just about equally effective.  Ablation is performed in a physician&amp;#039;s office or at an outpatient center, under local anesthesia, and usually takes less than 30 minutes. Short-term success is dramatic: Two years after the procedure, about 85 percent of women reported that it solved their bleeding, pain, or other menstrual problem, a large study conducted at several medical centers has found. After four years, though, almost one-third of women felt they needed either a redo or a hysterectomy to control symptoms.  But keep in mind: Endometrial ablation doesn&amp;#039;t make pregnancy impossible, just extremely risky because there&amp;#039;s too little uterine lining to support a fetus. So even if you stop having periods, you need to continue using birth control. Also, if your symptoms are caused by fibroids, ablation may not relieve pain or bleeding.  If you have: Fibroids that cause bleeding or pain, and you don&amp;#039;t plan to become pregnant  Consider: Uterine fibroid embolization A tiny catheter is inserted into an artery near your groin, then threaded up to the uterine arteries. Plastic particles about the size of a grain of sand are injected into the arteries, blocking blood flow to fibroids and causing them to shrink and die. Embolization is usually done in a hospital, with an overnight stay.  The procedure (often called UFE or UAE, for uterine artery embolization) has been done for about a decade, but research is still ongoing. In a recent Georgetown University Hospital study of 200 women, 90 percent reported significantly less bleeding, bloating, pain, and pelvic pressure a year after the procedure. But after five years, another study from Georgetown and one that included more than 500 women from Kaiser Permanente Northern California reported that about 20 percent of the patients had recurrences of their symptoms.  But keep in mind: Your ob-gyn may not mention UFE as an option. Embolization is done by interventional radiologists and some ob-gyns aren&amp;#039;t that familiar with it, notes James Spies, M.D., of the Georgetown University Hospital. To find a specialist, go to the Website for the Society for Interventional Radiology (sirweb.org; click on the doctor finder). A caution: There&amp;#039;s a chance that the procedure will trigger menopause, with the chances going up from about 1 percent at age 40 to about 5 percent at 45 and 10 percent at 50, says Dr. Spies.  If you have: Troublesome fibroids but haven&amp;#039;t ruled out pregnancy  Consider: Myomectomy This surgery removes the fibroids inside your uterus. Depending on the size and location of the growths, your surgeon may be able to do the procedure laparoscopically, through several small incisions in your abdomen. If you&amp;#039;re lucky enough to be a candidate for this technique, you face only outpatient surgery and a recovery time of two to four weeks. The conventional abdominal surgery requires up to a four-day hospital stay and then four to six weeks of recovery. Myomectomy is the only fibroid treatment proven to preserve fertility; about half to two-thirds of women are able to deliver babies after they&amp;#039;ve had the procedure.  But keep in mind: Although about 80 percent of women find relief from bleeding and pelvic pressure for two or more years after a myomectomy, you may develop new fibroids. The chances of recurrence vary depending on your age and the location and size of your fibroids. "^^<http://www.w3.org/2001/XMLSchema#string>
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