This article is an interview with Dr. Gong Xiaoming by Sohu Health. Sohu Health: Gathering top medical experts and spreading the latest health concepts, hello everyone and welcome to the Sohu Health interview room. As we all know, the uterus is an important organ for women to produce menstruation and nurture a fetus, but the uterus is also a very dangerous part of the body, and many people have hysterectomies recommended by doctors for disease reasons to completely clear the hidden danger of disease. But patients are often apprehensive about the absence of the uterus, so is hysterectomy really the best option to treat uterine disease? How can we remove the lesion and preserve the uterus? Today we have invited Professor Gong Xiaoming, a well-known obstetrician and gynecologist, to talk to you about alternative options for hysterectomy. Hello, Professor Gong, please say hello to our users. Xiaoming Gong: Hello everyone, I am Xiaoming Gong. Uterine diseases are divided into functional and organic, and are closely related to women’s menstruation and pregnancy Sohu Health: Today we are talking about hysterectomy alternatives, corresponding to uterine diseases, first of all, please introduce what are the main diseases that occur in the female uterus, and what are the main causes? Gong: The difference between men and women is not in the heart, lungs, liver and other organs, but more uterus and ovaries, therefore more obstetrics and gynecology. Some of the uterus-related diseases are functional, the so-called functional is like hormonal disorders after causing functional uterine bleeding, after regular menstruation, hormonal disorders will disappear, the situation appears to improve. There are also some organic problems, such as fibroids, adenomyosis, polyps on the endometrium, and in some cases, cancer or inflammation of the uterus, all of which are caused by uterine diseases. The main problems caused by uterine diseases are related to menstruation, heavy or light or irregular menstruation. There are also problems related to pregnancy, such as infertility or miscarriage, and miscarriage during pregnancy are uterine related problems. Patients often experience the need for hysterectomy due to certain diseases, mostly caused by uterine fibroids or tumors, and others due to conditions such as heavy menstruation. For these diseases, the most traditional way is to remove the uterus and remove the patient’s disease after the removal of the uterus. Uterine diseases are caused by multiple factors Uterine fibroids are the most common in gynecological surgery Sohu Health: What are the main causes of uterine diseases? For example, the most common uterine fibroids are related to hormones, which tend to grow when estrogen is high and shrink after menopause when estrogen subsides, so in a sense they are related to hormones. On the other hand, it is also related to genetic factors, as a mother with fibroids has a relatively high risk of her daughter developing fibroids. In general, uterus-related diseases are multifactorial diseases that cause a variety of problems. It can’t be attributed to a single factor because it is caused by a different cause. Sohu Health: What are the effects of uterine diseases on women’s health? There are reports that more than one million women have their uterus removed each year, can you list the diseases for which doctors often recommend hysterectomy? Gong: Usually the hysterectomy is recommended because the patient has severe symptoms, such as fibroids, which are the most common gynecologic surgical condition and cause excessive menstruation, bloating or uncomfortable urination, and other conditions that lead the patient to seek medical help. In addition, pain is also a consideration for hysterectomy, such as severe menstrual pain due to myasthenia gravis, which usually constitutes a condition for hysterectomy. Other reasons for hysterectomy are functional uterine bleeding or recurrent uncontrollable bleeding of various kinds, not to mention malignant tumors. Removal of the uterus is more common, close to 1/3 to about half of the patients due to fibroids. Hysterectomy has little impact on a woman’s body Psychological trauma needs to be a key consideration Sohu Health: When doctors recommend hysterectomy they often point out that the uterus is useless after having a baby, is this a reasonable statement? Is hysterectomy the best option to treat uterine diseases? Gong Xiaoming: It is necessary to consider both psychological and physiological aspects. It may be simple if you just look at a person as a living organism, but people often have many social and psychological factors. In terms of disease and physiology alone, the uterus has two main roles, the first is to menstruate, and the second is the organ that nurtures life. After a woman has completed her reproductive function, if she does not care about menstruation, hysterectomy does not have a great impact on her body as a whole, nor does it have much to do with hormone levels or the patient’s youthful state. Many diseases require the removal of the uterus, but the ovaries can be preserved, which is considered from the physiological diseases. However, one should not consider the physiology alone. Some women feel that regular monthly menstruation will make them feel better psychologically, while others think that the uterus is a particularly important organ in life, and that if there is still menstruation, there is still hope for conception, and when the uterus is removed, these things will be gone. For the patient, the doctor cannot consider only one factor, not just the solution of the patient’s disease, but also whether it will leave the patient with psychological problems. Ultimately, doctors counseling patients have to be specific to the problem and need to explain to the patient the pros and cons of removing the uterus for disease reasons. If the patient accepts that hysterectomy is a complete solution to the problem and that the procedure to preserve the uterus may cause a recurrence of the disease, hysterectomy is a relatively good option to improve the quality of life. If the removal of the hysterectomy at the same time will bring the patient a major psychological trauma, the doctor can not eliminate through the explanation, this part of the patient should be treated differently, to take care of the patient’s psychological feelings, should not be everything, to communicate with the patient, to do the explanation work to the patient, if the final acceptance is OK. Sohu health: is a two-way choice. Gong Xiaoming: doctors and patients participate in the decision-making process with each other. Hysterectomy is not the only method alternative options for better symptom control Sohu Health: you just mentioned that hysterectomy is not the only method, there are other ways to solve uterine disease? Gong Xiaoming: In fact, in the clinical process, with medical advances there are many ways to solve the problem of hysterectomy or not, the first, the most important disease facing hysterectomy is the problem of fibroids, what can be done without cutting? It is possible to remove the tumor and leave the uterus behind, which is certainly the first choice for patients, especially for those with fertility requirements. I have done 418 patients with fibroids. When the patient came to me, she was already operated for the second time, and all the doctors at that time gave her the judgment that the uterus could not be kept and must be cut out. The patient said I just want to try, and I said I can’t guarantee that you will be able to have children, but let’s try. It took me three hours to remove the tumors one by one, but I didn’t expect that this patient would be able to have children, because after the removal of fibroids, about 50% of patients can have children naturally, and 50% of patients may not be able to have children naturally. In this case it was a trial for us, but it worked and she had a baby two years later. She chose to have her uterus removed during the second cesarean section because it was already bothering her and she chose to have a hysterectomy. We say that such a procedure makes sense for patients, especially those with fertility requirements, and it can be considered for patients who have to keep their uterus to get rid of the tumor. Resection of uterine fibroids can be an alternative to hysterectomy. In addition to resection surgery, there are other options that can be considered as medical technology advances. If the patient has excessive menstrual flow, we can adjust the menstrual cycle and the menstrual flow with medication. Usually women do not have excessive menstrual flow after menopause, and it is a way to delay it until then. Therefore, for individual patients, especially for patients with functional uterine bleeding, atypical endometrial hyperplasia, complex hyperplasia of precancerous lesions, or even early endometrial cancer, it is possible to preserve their reproductive function with medication to prevent them from having a hysterectomy. Other patients with myoglandular disease can be treated medically to relieve menstrual pain and also avoid hysterectomy. In addition to hysterectomy medications, there are interventional treatment options. The first one is uterine artery embolization, which is performed by inserting an arterial catheter into the uterine artery at the base of the thigh to block the uterine vessels and inhibit the blood supply, so that the disease may be relieved by the lack of blood supply to the lesion after treatment. This method is effective in patients with uterine adenosis and fibroids, and can be tried in patients with excessive menstrual flow. Other interventions include focused ultrasound, where ultrasound is focused like sunlight across the belly to the tumor or target location, and localized heating allows the local temperature to reach over 60 to 70 degrees, causing the lesion to necrotize, which also serves to destroy the lesion without removing the uterus, allowing the disease to be treated. The treatment of concentrated ultrasound is currently suitable for uterine diseases such as fibroids and myometriosis, and has achieved good results clinically, with many patients recovering quickly from treatment without surgery. Of course, this method is not 100% effective for all patients, clinical statistics, 80% of the patient’s symptoms are controlled by gathering ultrasound. There are other methods, for example, for patients with excessive menstruation, submucosal fibroids or endometrial hyperplasia, we can remove the endometrium through hysteroscopy, and the fertility function will be reduced after the removal, but the menstrual flow will be reduced. This is a symptomatic treatment and may not necessarily solve the underlying problem, for example, the original disease is myxomatosis, but the menstrual flow is reduced by endo-removal, which is helpful for patients with excessive menstrual flow. In addition, placing a contraceptive ring with hormones directly in the uterine cavity can also have the effect of reducing menstrual flow. All of these treatment options can guide us to bring the lesion under control, so that the patient’s symptoms can be controlled and ultimately achieve the goal of not cutting the uterus. In fact, from now on, there are many treatment options that can replace hysterectomy. Sohu health: drugs and putting the contraceptive ring and so on are conservative treatment, you just said it only relieves the symptoms, how effective for the control of the disease, in other words, with the development of the disease, eventually whether to rely on surgical methods of treatment? Gong Xiaoming: In terms of the probability of disease treatment, there will be some patients who lose the ring and have recurrent disease, or the disease is not under control. But for the patient, if the disease can be controlled by conservative methods, then the hysterectomy may not be necessary later. Many diseases will disappear naturally after menopause, for example, myasthenia gravis, which is painful when menstruation occurs, but not when menstruation occurs, so hysterectomy is not necessary. The patient is 46 or 47 years old, and after two or three years of menopause she will no longer have dysmenorrhea, which can be controlled for a few years. For this disease, the patient should be offered a non-hysterectomy option, even if 80% may be good and 20% may be bad, but at least the patient is given an additional 80% option. This option is very desirable for many patients who do not want to have their uterus removed, avoiding a lot of psychological, family and external pressure. Yin surgery is the least traumatic, but malignant tumors still require hysterectomy Sohu Health: What advice do you have for choosing a treatment plan for uterine disease, taking into account the size of the trauma to the human body? Gong Xiaoming: We usually adhere to the principle that we should not use methods that are less traumatic to the patient, because the larger the wound, the slower the patient’s recovery and the more painful the wound. We do particularly minimally invasive treatment, such as ultrasound treatment, after the surgery is completed, the patient can walk back to the ward directly from the operating bed. A smaller wound is arterial embolization, which requires 24 hours of braking and no scar on the stomach after the treatment is completed. The recent years have seen the popularity of lumpectomy, both hysteroscopic and laparoscopic, for a faster recovery than traditional open surgery. Therefore, the current mainstream approach is that even if you want to operate, even if you want to do hysterectomy, do not do a large open surgery, but choose minimally invasive, preferably negative surgery, negative surgery is to remove the uterus from inside the vagina, followed by lumpectomy. The arterial embolization focused ultrasound, medication or contraceptive ring is also a good method. Sohu Health: When choosing a surgical plan, less trauma and patient’s fertility requirements are the factors to be considered. Gong Xiaoming: There is also the consideration of tumor benignity and malignancy, most malignant tumors need to be cut clean. Except for some early highly differentiated tumors, such as early endometrial cancer, and some patients who especially want to have children, we can try to preserve their fertility. Minimally invasive surgery is not suitable for all patients, and the specific conditions need to be analyzed when choosing it Sohu Health: Minimally invasive surgery such as hysteroscopy and laparoscopy is being used more and more in clinical practice, is it suitable for all patients? Gong Xiaoming: It is definitely not suitable for all people. The overall trend is to prefer treatments that are less invasive and allow patients to recover faster, with less pain and less scarring. This trend is different from the traditional open surgery in the past. Minimally invasive surgery is the absolute trend, and now about 95% of patients with uterine diseases can be performed through negative or minimally invasive surgery. Is it suitable for everyone? No. For diseases that are not easy to deal with, open surgery or even traditional treatment options are still needed. From the doctor’s point of view, it is necessary to judge the patient’s specific situation, and some patients may have adhesions in the stomach after multiple surgeries or have more tumors. As mentioned before, it is not possible to remove 418 fibroids one by one through laparoscopy, which would result in a lot of bleeding and a very long operation time for the patient, and this situation is suitable for traditional open surgery. The advantages of new alternative treatment options are significant More than half of the hysterectomy can be avoided Sohu Health: What are your views and insights on new treatment methods such as arterial embolization or focused ultrasound therapy, depending on the analysis of the disease? Gong Xiaoming: very good question, I have previously read some other experts’ opinions in interviews, I think this matter must be matter of fact to draw conclusions. As a traditional obstetrician and gynecologist is to hold the scalpel, in the past, like arterial embolization, focused ultrasound treatment, etc. usually need to be referred to other doctors, such as to ultrasound doctors, to radiologists to do it, many obstetricians and gynecologists are reluctant from the heart alone. But I hope that doctors can look at these issues from a fairer perspective and objectively consider which treatment option is beneficial to the patient, and we also suggest that patients can choose their own path. I don’t do arterial embolization myself, but I can refer appropriate patients to radiologists, for example, patients who have a second surgery, or patients with particularly large myomas facing perimenopause, and let the radiologists try. They insert a tube in and the procedure is over in less than half an hour. Doing open surgery to peel off the tumor may take a lot of time and bleed a lot. For focused ultrasound therapy, I personally have been very interested and concerned about this technology, which has about 17 years of clinical application in our country. From the technology itself is relatively mature, unlike some people say this technology is not mature, we have seen too many cases, the overall view of the two-year efficiency rate of about 80%, two years later found that the patient does not work, or the two-year process found that the process is not well controlled 20% of the patients, we need to turn to surgery or take other forms of treatment. But the remaining 80% of patients are good, clinicians sometimes tend to see the 20% failure, but not the other 80% success, resulting in the impression that “this technology is immature”. But we have to look at the technology in general, and we have to look at it from a more objective standpoint, and we have to speak from objective information. Similarly for the treatment of myasthenia gravis, we found that many patients through ultrasound treatment, dysmenorrhea symptoms relieved, while in the past this patient can only do everything, hysterectomy will not be pain, or digging out the lesion, lesion digging out you can once, the second how to do, what about recurrence? The advantage of ultrasound treatment is that it can be repeated, so even after the patient relapses can still be treated repeatedly. I personally think it is quite promising. First, the recovery is relatively fast, the patient can quickly get out of bed. Second, it can be treated repeatedly. Of course, the disadvantage is that there is no pathology, and another disadvantage is that relatively speaking, the degree of destruction of the lesion is not as clean as surgery. In the face of specific patients, the advantages and disadvantages must be fully considered and compared before we can say whether it is suitable or not. Sohu Health: Is the recurrence rate or complication rate of uterine disease higher when hysterectomy alternative therapy is implemented? But the choice of disease plan depends on the age of the patient, if the patient is already 45 years old, it is best to use conservative methods to control the disease until menopause, but if we assume that the patient is only 35 years old and has painful menstrual cramps, if the patient is not willing to cut the uterus, we can try some conservative treatment plans first, but because there is still a long time before But since menopause is still a long time away, then it is inevitable that the patient will face a situation of multiple attempts. For example, if a 35-year-old patient has completed her reproductive function and does not want to have children, and her menstrual pain seriously affects her quality of life, she needs to communicate with the patient whether she is willing to cut or to try conservative methods, which may be effective or may be repeated, and in addition to communicating with the patient, she may also need to communicate with her family to choose the appropriate treatment plan. . Sohu Health: Alternative therapies have their own advantages. After hysterectomy, there will be psychological and physical trauma, can you please imagine if alternative therapies can eventually replace hysterectomy in the future? Gong: I still don’t think so. I can only predict that more than half of hysterectomies can be avoided in the future. Now, from my consultations or from patients referred from overseas, there are many cases where we can take a hysterectomy-free approach. In general, we have more options, but we can never eliminate hysterectomy, after all, there are still some diseases and conditions that require hysterectomy, such as cancer. Uterine diseases are mostly determined by genetic factors Menstruation and pregnancy maintenance need to pay attention to Sohu health: for the prevention of female uterine diseases you have what advice? Gong Xiaoming: prevention is actually quite difficult, the generation of disease from the general direction and genetic quality, you are born destined to get some diseases. From the point of view of maintenance or prevention, because women’s uterus diseases have a lot to do with the process of pregnancy and childbirth. It is better not to consciously create opportunities for miscarriage, after all, it can cause trauma to the uterus. In Chinese medicine, the cold stimulation of menstruation can cause dysmenorrhea in women, and we have found that many women suffer from cold stimulation during menstruation, leading to problems such as myasthenia gravis, and proper menstrual warmth is still helpful. The health of the usual sexual life also needs attention, in addition, the recovery after the birth of a child also needs attention, such as premature postpartum strain on the uterine prolapse is a negative aspect. The overall preventive measures are not too many, and often related to genetic qualities. Sohu health: here we are nearing the end of the interview, please tell us about your clinic time, so that patients can visit. Gong Xiaoming: now I am doing freelance practice, not signed with any hospital employment relationship, basically according to my own rhythm in the clinic, now in Beijing, Shanghai, Hangzhou and Shenzhen have clinics, you can check from my WeChat public account (Dr. Gong Xiaoming) on the specific daily clinic time and location. Sohu Health: Finally, do you have any other summary or advice about hysterectomy or alternative therapies? Xiaoming Gong: To summarize, when one doctor says he wants to give you a hysterectomy, you should seek the opinion of a second doctor. Maybe you can find a way to relieve your disease without a hysterectomy, which for many patients is a way to change the treatment plan of the disease. Of course, we hope that the many doctors around the country will be able to master these methods and avoid more hysterectomies. Sohu Health: Very good advice and explanation, thank you very much for coming to our interview room today, we have any related obstetrics and gynecology problems can also consult with Mr. Gong, I believe Mr. Gong must give you a very satisfactory answer. Gong Xiaoming: My self media account in Sohu you can follow. Sohu Health: Good, thank you very much for watching, goodbye! Gong Xiaoming: Thank you all!