When it comes to gynecological health, women often make the same mistake: They manage symptoms—issues like bloating, pelvic pain, heavy bleeding, and incontinence—instead of dealing with them. Some women choose to do nothing because they accept their problems as normal bumps in the aging process; others are wary of treatment, or simply don’t have the time to slow down. Fortunately, help is at hand.

Uterine Fibroids

Nearly half of all women will develop uterine fibroids—benign tumors that neither metastasize nor grow to the point where they start destroying other parts of the body—and most don’t require any treatment at all. But some grow so large that they cause bloating or heavy bleeding during menstruation or between cycles, or are positioned in areas where they cause significant pain.

For a long time, removal of the uterus was the only treatment plan—but the serious nature of a hysterectomy and its prolonged post-operative recovery left many women feeling like it wasn’t an option at all. The good news is that many women are candidates for uterine fibroid embolization (UFE), a minimally invasive procedure with a far shorter recovery time and fewer complications.

“The vast majority of UFE patients are in their mid-forties,” says interventional radiologist Adam Hecht, MD. “They don’t want to have their uterus taken out. They’re very active; they have families. They cannot afford to take eight weeks off from life. And why should a woman have a hysterectomy in her mid-forties when she’s not going to go through menopause for another five to ten years?”

Whereas hysterectomy removes the uterus entirely, UFE aims more to change its topography. The patient is put under general anesthesia because she has to lie relatively still; then a catheter is inserted through the femoral artery in the thigh, as with a coronary angiogram. But instead of advancing the catheter to the head or the heart, the catheter enters the uterine arteries. Small polyvinyl alcohol particles (they look like grains of sand) are injected through the catheter, and blood flow carries the particles to the uterus and into its arteries. “The particles slowly clog up the arteries,” explains Hecht. “When you block off the blood flow, the fibroids end up shrinking—they get smaller and smaller over time.” Although the fibroids don’t disappear entirely, they decrease significantly enough to resolve symptoms.

The procedure itself takes about an hour, followed by a 23-and-a-half-hour inpatient hospital stay to treat cramping and nausea. UFE is not a quick fix, Hecht admits, “But all of the women I see have symptoms that have gotten worse over time, and they’re used to their symptoms. When I tell them their symptoms will not get any worse but will get better over two to four to six months and they keep their uterus, most prefer UFE.”

Says Hecht, “UFE is so user-friendly, with such an easy recovery. When I call patients one week later, they’re back to their usual activities.”

Urinary Incontinence

“If the bathroom is taking over your life, you should not suffer in silence.” That’s what Patrick Culligan, MD, and his partner, Amir Shariati, MD, tell patients who complain of urine leakage, a common problem that affects more than 11 million American women. Culligan, the director of Urogynecology and Reconstructive Pelvic Surgery at Overlook Hospital and Morristown Memorial, explains that urinary incontinence is a symptom, not a disease, with many possible causes.

The two most common types are stress incontinence, in which urine leakage occurs during any activity that causes pressure, or “stress,” on the bladder (usual causes include laughing, lifting, coughing, or sneezing); and urge incontinence, urine leakage that occurs before a woman has a chance to get to the bathroom in response to an urge to urinate. Women with urge incontinence experience frequent urges to urinate, and often wake up several times during the night to urinate.

Surgical options are available for treating incontinence, but non-surgical methods are just as popular. Pelvic-floor exercises (the same Kegels that women’s magazines are always writing about) are effective in preventing and treating stress incontinence. Occlusive devices are especially useful for women who leak urine during specific activities such as exercise. “Medications are another option,” says Culligan. “They often do the job without creating a lot of side effects.”

Urge incontinence is usually treated with medication or exercise, or with biofeedback to teach patients bladder and pelvic-muscle control. Another option, bladder training, teaches women to urinate according to a timetable rather than an urge to do so. And the bladder diet, which calls for removing such common irritants as coffee, pineapple, tomatoes, and vinegar (for the complete list of bladder irritants, go to Culligan’s Web site at www.mybladderMD.com), has been known to offer relief. “It’s nonscientific,” Culligan says, “but some people swear by it and can say exactly which foods cause problems for them. I’ve seen it happen enough that it’s worth a try.”

Pelvic Organ Prolapse

As a woman ages, her bladder, uterus, or rectum can bulge, sag, or fall, resulting in prolapse. Although this can occur quickly, it usually happens over the course of many years and the symptoms can be hard to recognize. The initial signs can be subtle, like pain during intercourse or the inability to use a tampon. As the prolapse worsens, some women complain of a bulging or heavy sensation in the vagina that increases by the end of the day or during bowel movements. “I’m amazed how long some women put off treatment,” says Culligan. “But you don’t have to do that. You can’t always put everyone else first.”

Although Kegel exercises can be useful in preventing prolapse, once symptoms have become severe, these exercises are of little benefit. What can offer relief is a pessary (a device worn in the vagina like a diaphragm), which is used to support the vagina, bladder, rectum, and uterus as necessary. For most severe instances of prolapse, however, surgery is the best option. “Surgery used to be invasive, but now we have better ways to reconstruct whatever aspect of the anatomy is not working,” explains Culligan.

“A lot of people think these problems are just part of aging,” he says. “It may be common, but it’s not normal. You don’t have to live with it.”

To contact the Division of Urogynecology and Pelvic Reconstructive Medicine at Overlook Hospital,
call (908) 522-7335.