Hysterectomy Surgery and Angioplasty Surgery

Courtesy of Prevention

BE SKEPTICAL: HYSTERECTOMY
Lori Jo Vest was 36 when three doctors told her a hysterectomy was the only fix for her heavy bleeding caused by uterine fibroids. Terrified that she'd be thrust into early menopause--in half of all hysterectomies, surgeons end up removing the ovaries, too--Vest went online and discovered myomectomy, in which the surgeon cuts out the fibroids, sparing the uterus. But her doctors nixed the idea; after all, they said, Vest, who had a toddler, didn't want more children. Then Vest called the nearby University of Michigan, Ann Arbor--and nearly leaped through the phone when she heard they had a clinic for women seeking alternatives to hysterectomy.

"The doctor said I was a perfect candidate for myomectomy," Vest says. She also told Vest that many surgeons dislike the surgery because it's more difficult than a hysterectomy. Now 44, Vest no longer is troubled by heavy bleeding, but she still has her uterus and ovaries. "I don't want to go through menopause until my body is ready," she says.

Hysterectomy is second only to C-section as the most common surgery performed on women in the United States. Each year more than 600,000 Americans have the procedure--twice the rate as in England. A 2000 study found that 70% of the hysterectomies performed in nine Southern California managed-care organizations were recommended inappropriately. "The most common mistake we saw was that doctors didn't try safer, less-invasive approaches first," says lead author Michael Broder, MD, an assistant professor of obstetrics and gynecology at UCLA's David Geffen School of Medicine.

Hysterectomy can be warranted if a woman has cancer, and it can be the right choice in other cases, too--for instance, if medical treatment didn't get your bleeding under adequate control, and you don't want to try a surgery like myomectomy because of the risk of recurrence. But unless you have cancer, "having a doctor say, 'You absolutely need a hysterectomy,' is akin to a waiter at a restaurant saying, 'You've got to have the steak,'" says Malcolm G. Munro, MD, a professor of obstetrics and gynecology at UCLA. "A good doctor should give you a menu of choices."

Protect Yourself
Try hormones or drugs first: Most hysterectomies are done on women under age 45, but if you can manage symptoms of fibroids with medication until menopause, symptoms usually ease naturally. Birth control pills or other drugs help control irregular bleeding. Also check into getting a progestin-releasing IUD (Mirena): It can dramatically decrease bleeding caused by fibroids.

Consider a less drastic procedure: Like myomectomy, uterine fibroid embolization (UFE) preserves the uterus: An "interventional" radiologist carefully closes off blood vessels feeding the fibroids, starving them. A woman may need more treatment after either procedure if the fibroids come back, and both cause a fair amount of discomfort. (UFE can require serious pain meds, although recovery is quicker than after a hysterectomy, and the risks are lower.) For more info on hysterectomy alternatives, go to prevention.com/links.

BE SKEPTICAL: ANGIOPLASTY
When Irwin Melnicoff, a forensic engineer in Boynton Beach, FL, felt a stabbing chest pain at age 45, he went straight to the cardiologist. The diagnosis? A narrowed artery. The answer? Angioplasty. But Melnicoff was scared of surgery; even when the doctor told him he'd die without the artery-opening procedure, he chose drug therapy instead. (He also chose a new doctor.) That was 25 years ago. With the help of daily heart medications, his chest pain vanished. He walks 30 minutes a day, 7 days a week, and feels great.

He made the right choice. Though angioplasty has been hailed by some as a wonder fix for decades, it now turns out that most of the time, the procedure doesn't help. Angioplasty can save your life if it's done during or right after a heart attack. But in other circumstances, it may not do you much good.

"Doctors used to think of heart disease as a plumbing problem--that arteries were like drainpipes gradually being clogged by plaque made up mostly of cholesterol," says Arthur Agatston, MD, a preventive cardiologist and author of The South Beach Heart Program. So it seemed to make sense to use angioplasty, in which a small balloon is inflated in the artery, to get that gunk out of the way by squashing it against the vessel wall. However, research has since shown that problematic plaque actually forms within the delicate inner lining of artery walls.

What does cause a heart attack? If the plaque within the wall ruptures, it injures the artery, producing a blood clot as part of the healing process. Unfortunately, the clot can close off the entire artery--that's a heart attack, and you need angioplasty or bypass surgery immediately. If you have angioplasty, the doctor may also insert a stent, a mesh scaffolding, to hold open the artery.

But if you're not having a heart attack, angioplasty (with or without a stent) won't help and may even do some harm. That's the news from a large trial published in April in the New England Journal of Medicine. People with "stable" heart disease--they weren't having a heart attack, but a vessel was at least 70% closed--fared no worse if they received medical therapy, such as aspirin, blood thinners, and cholesterol-lowering drugs, than if they got angioplasty. During the next 4 1/2 years, neither group was more likely to have a heart attack or stroke or die.

A study published late last year helps pinpoint exactly when it's worth getting angioplasty. That trial showed that if the procedure was done 3 or more days after a heart attack, it didn't help. "We were very surprised--we thought angioplasty would be beneficial even if it was done later," says lead author Judith Hochman, MD, director of the cardiovascular clinical research center at New York University School of Medicine. "But that's why we do studies: to see if the patient really does benefit."

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