Freeze Away Bleeding -- Dr.’s Q&A
In this Dr.’s Q&A, Seth Jordan Herbst, M.D., explains how using a freezing probe to stop abnormal uterine bleeding could eliminate the need for up to 300,000 hysterectomies each year.
Ivanhoe Broadcast News Interview Transcript with
Seth Jordan Herbst, M.D., Obstetrician/Gynecologist,
Institute for Women’s Health and Body, West Palm Beach, Florida
Topic: Freeze Away Bleeding
What is menorrhagia?
Dr. Herbst: Menorrhagia is either excessive or prolonged vaginal bleeding that interrupts a woman’s life during the menstrual cycle.
How is its cause usually detected?
Dr. Herbst: We first do a routine evaluation on women to make sure that they don’t have any underlying medical problems, [because] it could be hormonal. We also do an evaluation to make sure that there’s no abnormal tissue inside the uterus and or anatomical problems such as benign tumors as fibroids that potentially could cause women to have the abnormal bleeding.
What are some of the other possible causes?
Dr. Herbst: First of all, we want to rule out things such as pregnancy. We want to make sure that there’s no abnormal tissue inside the uterus, endometrial hyperplasia or even endometrial cancer, that could be a possibility if people have heavy bleeding.
For people with menorrhagia, what is done to get the bleeding under control?
Dr. Herbst: Our first-line treatments are always medical treatments. We can use birth control pills; we can use other type of hormones like progestational agents. We then go into older surgical techniques like a D&C [dilatation and curettage], which women usually think that if they have abnormal bleeding. D&C is an old procedure. It’s a diagnostic technique that helps us obtain some tissue from the uterus as well as it can be therapeutic and last for a few months. But usually the problem will return and they’ll end up having the same bleeding problem again. The next things we started to do were other endometrial oblation techniques. The longest one is something called Roller Ball. Roller-Ball ablation is a technique that’s been practiced probably anywhere from 10 to 15 years in this country. It takes a lot of expertise. It’s a very successful procedure but it is technically a very difficult and there’s a lot of complications. The complication rate can be up to 7 percent. Some of the newer techniques and the techniques that we’re discovering now are much easier, much simpler, remove some of the complication rates as in reference to a Roller Ball. We try to get the same desired outcomes that will help women in reference to their periods. The thing that I should stress in reference to these newer techniques we’re really trying to avoid hysterectomy. That’s the procedure that’s used the most in this country for abnormal uterine bleeding.
How common is hysterectomy, and how often they are done?
Dr. Herbst: This is a real big problem in the country. We have probably anywhere from 10 million to 14 million American women who suffer from some type of abnormal uterine bleeding, whether it be heavier periods or prolonged periods as I mentioned or problematic periods that will come every two to four weeks. Women get used to their periods, they get so used to bleeding heavily that they usually won’t even identify when they go to the physician. They’ll think it’s normal and it’s normal for them but it does interrupt their quality of life. They either stay in their homes, they will soil their clothing, they can’t interact with their children, they lose time off from work. The problem is huge; it’s huge for other reasons. It has a huge economic impact; the cost per year to the medical system is extremely high. And the usual treatment that everybody uses for it is hysterectomy. There are 600,000 hysterectomies done in the United States per year. Probably 50 percent of those hysterectomies are related to some type of bleeding problem. If we can reduce the number of hysterectomies done in the United States, we’re not only going to be helping large amounts of women as they will not have unnecessary hysterectomies, but we’ll also impact the economic side of what’s going on in reference to the medical system. And overall, the patients probably do better.
What is the cryoblation technique? How does it work?
Dr. Herbst: Well this new procedure is called Her Option™ Cryoblation Therapy and it uses cryogenics. What we do is after we’ve done a full evaluation for women to make sure that they’re candidates for this procedure, we’ll take them to the operating room (or it could be done in the office at times) and give them anesthesia. We’ll evaluate the uterine cavity, and then we’ll use a freezing probe and will place inside the uterus. We place the freezing probe inside the uterus and select the areas and then we’ll produce an ice ball. In using cryogenics, we’ll destroy the lining of the uterus to a certain level inside the uterus. We try to go to where the tissue originates from so that new tissue re-growth returns.
How cold does the probe get?
Dr. Herbst: During the procedure, the probe will go down to about -100 degrees centigrade. With cryogenics, anything below 20 degrees centigrade is lethal and toxic to tissues. So, we’re able to accomplish the procedure by using this ice ball and getting to a level of where the tissue originates from.
Once the lining is destroyed what happens to their periods?
Dr. Herbst: The goal of the procedure is to help a woman regain her quality of life. As this technique evolves, we’re finding that the amenorrhea craze -- women not having their periods -- is improving. This is an operative tool; it’s a new surgical technique. Right now we’re noticing that probably 50 percent of women who have this procedure will never get their periods back. Probably another 45 percent of women who will either end up with a very, very light period or spot. Some women will continue to have heavy periods that may require other intervention.
What has the response been from some of the women who have had it?
Dr. Herbst: I’ve done over 100 procedures to date, and I will tell you the level of satisfaction is above 99 percent. The reason that the level of satisfaction is above 99 percent is we carefully explain to patients what their expectations will be. If we properly explain what their expectations will be we never let them down. We are able to improve their quality of life by decreasing the amount of quantity of bleeding they have but we also improve their cramping as well as potentially decreasing some PMS type symptoms if they do suffer from it.
What would you say is the benefit of this over the hysterectomy?
Dr. Herbst: Obviously, we try to avoid major surgery at all costs. It can be a procedure that does have complications. I think there is a psychological component of surgery for women if they’re having a hysterectomy that is extremely final and complete. We’re trying to spare women the removal of any anatomic organ that they don’t need to have removed, and we’re able to do this by an easy, simple technique that’s done as an outpatient that has a extremely successful outcome with very, very small complications and a great success rate.
What about the long-term effectiveness of it? Is this forever, will they have to have it done again?
Dr. Herbst: We have statistics for this procedure and similar type procedures, and we’re going out about four or five years. What we notice are that the effects will be long-lasting. We will continue to monitor the patients and continue to find out how long their outcomes will last and what the success will be in the long term.
Is there an ideal patient for the Her Option therapy?
Dr. Herbst: I think anybody who has abnormal uterine bleeding or menorrhagia is a candidate for the procedure if they are evaluated appropriately. We want to again make sure that you don’t have any abnormal tissue, that you don’t have any other underlying endocrine problems or hormonal problems. It [also] depends on the size of the uterus; those are the women that we try to focus in on.
Is there a next step to this cryogenic?
Dr. Herbst: Well, what we’re doing at this point is we’re also looking at destroying soft tissue tumors to the uterus. I have been studying fibroids, which are benign entities of the uterus, and have successfully done cryogenic cryoblation to two women with fibroids and have been very successful with the fibroids being totally gone after two months after their surgery.
Is there anything else you want to add about the procedure?
Dr. Herbst: The procedure is very safe. It’s extremely effective. It has a short learning curve for the physicians that are involved. If a physician is capable of doing a D&C or just even sounding the uterus, they’re capable of doing this procedure. I’ve done all of the individual oblation type of techniques that are currently available, and this technique has the high success rate because it’s capable of destroying to the level of where the tissue comes from. The other procedures don’t get as deep as this procedure into the muscular portion of the uterus where the tissue originates from and don’t go to the strategic portions of where the tissue grows from. So women do get more return of symptomatology with the other procedures than they do with this.
What is about this that is so different?
Dr. Herbst: These cryogenics are able to destroy the tissue down to the level from where this originates, so we get a better long-term result.