Dr. Ernst Bartsich: Offering Women Alternatives

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Dr. Ernst Bartsich offers hope to women with fibroids. A Clinical Associate Professor of Obstetrics and Gynecology at Weill Cornell Medical College and an Associate Attending Ob-Gyn at New York Presbyterian Hospital, Bartsich is a proponent of alternative methods to ridding fibroids. "There are alternative procedures to remove fibroid tumors without undergoing a hysterectomy," says the gynecologist.

Fibroids, also known as myomas in medical terms, are round fibrous growths that can be found within the uterine wall. Some are small pea-sized and others can grow to the size of large melons. In general they are benign, but some can become cancerous. However, the dark ages of fibroid tumor treatment is over claims Bartsich. In fact, so concerned is he about informing women of these medical alternatives, that Dr. Bartsich has invested his own time and money educating women about unnecessary hysterectomies.

Hysterectomy surgery is a drastic measure. Women, who have undergone hysterectomy surgery, have had either their cervix, ovaries, and/or uterus removed and in some cases all three. Ultimately, it's a castrating procedure. Some of the side effects of having a hysterectomy can lead to problems with the bladder, liver, sexual dysfunction, a drop in estrogen levels and an inability to get pregnant. While some doctors may tell women in their 40's and 50's, that the uterus is no longer necessary once women pass child bearing age, the fact is, women are receiving hysterectomies as early as age 28. Statistics from the National Institute of Health and Human Services and The Center for Disease Control (CDC) claim that in the United States alone, there are more than 700,000 hysterectomies performed per year, 76% of which were inappropriately recommended and unnecessarily performed. An estimated 3.5 million hysterectomies were performed between 1994 and 1999, at a rate of 5.5 per 1,000 women. Hysterectomies are the second most frequently performed operation on women. Only cesarean section ranks higher. Also, despite the fact that alternative methods have been taught in medical colleges over the last ten years, women 45 to 54 years old actually saw an increase in hysterectomies from 8.9 per 1,000 in 1994 to 10% per 1,000 in 1999. African American women seem to be among the largest number of women with fibroids. Due to lack of information and personal doctor care, many African American women end up receiving unnecessary hysterectomies.

"This is what is hard to understand," says Dr. Bartsich. "Medical schools have been training doctors in alternative techniques that are less invasive than a hysterectomy. These techniques allow women to keep their female organs intact. Yet unnecessary hysterectomies continue to be performed in high numbers. The only time a hysterectomy is needed is when a cancerous growth is present. Many fibroid tumors are benign, however," explained the fibroid Dr.

"Usually, women with fibroids have excessive uterine bleeding which may cause anemia. In fact, some women bleed so heavily, a transfusion is required. Women may experience back and abdominal pain, pressure on the bladder, difficulty getting pregnant, infertility, pain during intercourse, achiness and sluggish bowel movement. Of course, this differs depending on the fibroid size and the woman's body," remarked Dr. Bartsich. "Women may be so anxious to end the pain, bleeding, and pressure on their organs, they don't seek a second opinion when told by doctors a hysterectomy is required. However, there are many ways to remove the fibroid. For example, a hysterosopic myomectomy, depending upon where the fibroid is, removes the fibroid through the vagina. An abdominal myomectomy can remove fibroids through the belly button or through a bikini cut in the abdomen. Small fibroids that are outside of the uterus can be removed through a procedure called laparoscopic myomectomy.

"There is another non evasive procedure - uterine artery embolization. This process puts a blood clot in the uterine artery to choke off the blood supply to the fibroid. This of course, is not recommended for a woman who plans a pregnancy; because you cannot cut the blood supply off to the point where the fibroid shrinks without interfering with the blood supply to the baby," states Dr. Bartsich. "Uterine artery embolization, at this time, is still in the infant stages. With this method, the blood clot can slip over to the ovary and the woman can become menopausal. Doctors don't know what the long range effects of these plastic pellets are. Also, this method causes pain for several months because the fibroid is "choking off." If nothing else works and the woman has massive fibroids there is a procedure called supra cervical hysterectomy. Through this procedure the top of the womb is taken off. This still leaves women with their ovaries, lower part of the uterus and cervix intact. However, once this is done, women cannot get pregnant. This is the closest thing to a hysterectomy without actually being a "hysterectomy," explains Dr. Bartsich.

Another minimally invasive surgery for abnormal bleeding would be endometrial ablation which is a method using electric or laser energy to destroy the uterine lining in order to minimize the uterine bleeding. Also, there are medications that can be used to shrink fibroid tumors. Not every woman responds to these medications. Fibroids can be treated with Lupron, a chemical compound, which blocks out estrogen so that women who use it are temporarily in menopause. Doctors usually determine that if there is no response in 3 months after use, there is no point in continuing it. Furthermore, after 6 months women need to get off Lupron because it can affect their metabolism and bones. Also, there is the possibility that once Lupron is discontinued the fibroids can actually come back and grow even faster. This medication can also be used for infertility and can be used to build up the blood count of someone who has become anemic from heavy bleeding. Doctors often use it to minimize the risk for transfusion before surgery. Additionally, if someone has an abnormality in the cervix and does need a hysterectomy, doctors can shrink the fibroids and do a vaginal hysterectomy.

"If a woman has cancer or pre cancer, a hysterectomy becomes necessary. But other than that, there is no need for a hysterectomy," claims Dr. Bartsich. "Again, it's hard to understand why doctors continue to do hysterectomies to women with benign fibroid tumors when there are alternative procedures available. Most medical plans cover the alternative procedures. Every patient should ask their doctors whether he/she is comfortable with alternative surgeries and if so, how many they have done and what their rate of complication has been. At this time, what causes fibroids is still unknown. What is known, however, is that fibroids feed on estrogen."

Women interested in learning more about fibroids can order: "The Other Choice: The Comprehensive Guide for Women with Fibroids," by Sophie Bartsich. The book is available at www.Xlibris.com or for additional information search the website: www.fibroid-choice.com.

After exploring the book and website, anyone interested in further discussion, can find Dr. Bartsich available for questions through his email: Fibroiddr@aol.com or can contact his office at 212-570-6684.

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