Letters to the Editor

August 1, 2008

Letters written to the editor with comments regarding articles and departments in Contemporary OB/GYN.

Is 'induced amenorrhea' a misnomer?

What are we taught? Give a patient a diagnosis, give her the medical terminology her condition will be labeled and coded as, and finally, explain the meaning of the condition. Confusion exists when we persist in labeling disparate conditions with the same medical term.

We have expanded the options for menstrual control and elimination of menses. The contraceptive use of injectable progestins, implanted progestins and intrauterine levonorgestrel have been joined by the essentially acyclic dosing regimens of newer oral contraceptive formulations, all of which induce amenorrhea in their users. Yet we persist in the use of terms that confuse and inappropriately label our patients.

I propose that we adopt a new term for this induced amenorrhea, azomenorrhea. Patients can be taught that this is a condition of health and an anticipated side effect, and one that is safe.

Suzanne Trupin, MD
Champaign, IL

Evaluating endometrial ablation techniques

According to the World Health Organization, menorrhagia afflicts an estimated 30% of reproductive-aged women. While we should applaud another article validating the effectiveness of endometrial ablation as an alternative to hormones or hysterectomy ("Evaluating endometrial ablation techniques" [2008;53(June):22-33], by Howard T. Sharp, MD, and Amber Bradshaw, MD), the irony is why is this highly successful solution being kept secret from those who suffer month-after-month with excess menstrual bleeding?

Perhaps in today's time-constrained managed-care world, too many doctors' modus operandi is similar to the United States Army's, "Don't ask, don't tell?" Likewise, many women's fear of hysterectomy often keeps them silent. The introduction of a variety of global ablation devices over the past decade makes this procedure quick and simple to perform. So we can't blame physician reluctance on lack of technical mastery as we did with hysteroscopic predecessors. Perhaps it is inadequate reimbursement that keeps gynecologists from readily offering ablations, or is it some other rate-limiting factor?

I will challenge my colleagues to tear down a major barrier that prevents many women from proceeding: fear of the operating room. Imagine your anxiety if your dentist required a trip to the operating room and general anesthesia to simply fill a cavity? I promise you performing office endometrial ablations is not barbaric. (We accomplish this humanely with generous oral sedation and a paracervical block.) In addition, this saves patients and health insurance companies thousands of dollars and justly rewards doctors at an enhanced non-facility rate of payment. Most importantly this venue will make this life-improving treatment available and appealing to many more women afflicted with heavy periods. I suspect you will enjoy what we have experienced, happy patients contagiously spreading the word about your state-of-the-art practice and your reasonable solution for problem periods.

So why have you kept endometrial ablation a secret? Will you continue to do so?

Scott Kramer, MD
Fremont, CA

Drs. Sharp and Bradshaw reply:

We appreciate your interest in endometrial ablation and agree that it is a safe and effective option for women with idiopathic menorrhagia. We respectfully disagree that it is being kept a secret. Not only have the editors of Contemporary OB/GYN published a cover story on this technology, but the information has been widely disseminated in several publications. It has been the focus of a recent ACOG Practice Bulletin,1 as well as a Clinical Expert series published in Obstetrics and Gynecology.2

REFERENCES

1. Endometrial Ablation, ACOG Practice Bulletin #81. May 2007.

2. Sharp HT. Assessment of new technology in the treatment of idiopathic menorrhagia and uterine leiomyomata. Obstet Gynecol. 2006;108:990-1003.