Stephanie Brown, MD, OB/GYN at Advanced Women’s Care of Pittsburgh talks about Minerva.
Interview conducted by Ivanhoe Broadcast News in August 2018.
The story we’re doing today is about heavy bleeding and abnormal bleeding. How common of a problem is it for a lot of women? It’s not something that people want to talk about, but it is a very common problem.
Dr. Brown: It is a very common problem, especially for women after they’ve had children but before they go through menopause. Women don’t ovulate as regularly which allows the hormones to be somewhat out of sync. That’s probably the most common reason you have abnormal vaginal bleeding and heavier uterine.
Is there anything dangerous or concerning about it, or is it generally a matter of comfort for women?
Dr. Brown: Actually, the longer you let yourself have abnormal bleeding, the longer your hormones are not in sync which can increase your risk of uterine cancer through an overstimulation of estrogen and not enough progesterone.
What are some of the treatments?
Dr. Brown: It can range significantly. You could use something as simple as a birth control pill to override the estrogen and progesterone that you make in your own body. Sometimes you can just provide a progesterone supplement and you can perform endometrial ablation. The most aggressive approach would be hysterectomy if necessary.
I want to talk about the hormones. Which hormones are out of balance?
Dr. Brown: It’s mainly the progesterone, especially in your 40s and early 50s.
When you’re talking about heavy bleeding, are you talking about a period that goes on for days on end, or are you just talking about a short period of time where there’s some discomfort?
Dr. Brown: It can vary tremendously from person to person. Most commonly, it’s very heavy. It can be a short amount of time, but it also can linger on and on for 10 to even 14 days.
When trying to describe for your patients what’s heavy, is there a certain amount per hour or a certain number of pads or tampons per hour? What’s your rule of thumb so that they know if it’s too heavy?
Dr. Brown: Mainly if it affects their activities of daily life, it’s worth talking about. In the grand scheme of things, we talk about soaking through a maxi pad in an hour. I don’t like to use tampons as a guide because you can’t really tell.
What percentage of women in their late 30s and 40s have this problem?
Dr. Brown: Potentially up to 30%, 40%, even 50% when you get into your mid to late 40s.
You had mentioned a couple of treatment options from hormones and then on the other end is hysterectomy. I want to talk a little bit about Minerva: tell me about that and where that treatment falls in line with some of the others.
Dr. Brown: It’s a great option for women who can’t take hormones for medical reasons or they don’t respond well or they don’t tolerate the hormones. And it’s a great option for when you don’t want to be as aggressive as a hysterectomy. It kind of meets in the middle. You need to be kind of done having children; that’s important and that’s a criteria. It’s a procedure in which its outpatient; it only takes a few minutes. There are minimal postoperative effects as far as pain or bleeding afterwards, so that’s very convenient for the patient. It is basically a thermal conductive apparatus that’s placed in the uterus that gently removes endometrial lining and glands that produce that heavy bleeding every cycle.
How long after the procedure would patients notice a difference? Does it make an immediate difference and how long does it last?
Dr. Brown: It’s pretty immediate. By their next cycle, they notice a big difference.
Is it a permanent solution?
Dr. Brown: Not always, it’s at least three years. When there’s success with the procedure, there are at least three years of much improved bleeding, if not amenorrhea all together.
For some women, you had mentioned hysterectomy as an option. For some women, if hormones haven’t worked, has that been their only alternative?
Dr. Brown: 15 years ago, I think so. There were very old antiquated ablation techniques that were somewhat avoided because they were dangerous and had significant complication rates. I think those techniques went by the wayside many, many years ago.
What the risk factors and complication rates for Minerva?
Dr. Brown: The complication rates are very low. The risks are mainly if you puncture the uterus or if the cavity is not secure. Minerva tells you that before you can even start the procedure, so there is a safety stop there. They do actually two different kinds of cavity assessment tests to assure that you have a sealed cavity to do the procedure.
Who would not be a good candidate for Minerva?
Dr. Brown: If they have a significantly irregular shaped uterus. With fibroids, septums, or other uterine abnormalities, they probably would not have as good of a success rate because the apparatus wouldn’t fit as well. Usually, the apparatus tells you that too.
If you’re speaking to someone in their 40s, would hysterectomy be a good thing to avoid? Why is it still important to try to avoid that?
Dr. Brown: Well, it’s still a surgical procedure that comes with risks as far as the amount of anesthesia you have to get. There are co-morbidities with other medical issues that they might have that increase their risk of postoperative complications, infection, etc. Many times you want to avoid hysterectomy because of the invasive nature of it, and this is noninvasive.
Is there anything I didn’t ask you that you would want to make sure that people know? Have you had some success with this?
Dr. Brown: I really have. The amenorrhea rates are 73% over three years, which is the highest of all ablation techniques that are out there today, and hysterectomy is avoided significantly. I have less than 1% hysterectomy rate after Minerva.
You had mentioned percentage just before that, 73% in layman’s terms.
Dr. Brown: Amenorrhea means absolutely no menstrual cycle, no bleeding for that whole year.
The patient Ann, whom I talked to, is in that situation where she’s not technically in menopause but she hasn’t had a period. What do you talk to your patients about that for most women will be something a little bit different?
Dr. Brown: Sometimes people are kind of confused when they’re actually going through menopause at that point because they’re lucky enough not to have periods because they’ve had the Minerva procedure. So when they get to that age, we go by other symptoms: hot flashes, night sweats, and those kinds of things. If we think we’re in that range of menopause, we can easily do a blood test to find out for sure.
How many patients have you used this on now?
Dr. Brown: Probably several hundred. It’s been out for three years.
Do you have any financial ties to the company?
Dr. Brown: I do not.
END OF INTERVIEW
This information is intended for additional research purposes only. It is not to be used as a prescription or advice from Ivanhoe Broadcast News, Inc. or any medical professional interviewed. Ivanhoe Broadcast News, Inc. assumes no responsibility for the depth or accuracy of physician statements. Procedures or medicines apply to different people and medical factors; always consult your physician on medical matters.
If you would like more information, please contact:
Kevin Knight, PR
206-451-4823
Sign up for a free weekly e-mail on Medical Breakthroughs called First to Know by clicking here.
