Gynaecological procedures in the GP's surgery
An increasing number of women in certain parts of the country have been able to have small gynae procedures – such as hysteroscopy and endometrial ablation - undertaken in the familiar setting of their GP's surgery.
It is expected that this practice will roll out around the country as both GPs and patients appreciate the significant advantages it offers.
Apart from avoiding a potentially long wait for the first consultant appointment, the benefits of having gynaecological procedures in the primary care setting meet government criteria including that fact that the patient is in familiar surroundings and is probably closer to home than if she were referred to a hospital.
In this article we look at two female GPs each with a special interest in women's health who are running successful clinics in which they undertake minor gynae surgery.
In Stratford upon Avon, at Trinity Court, Dr Jo Alliston is offering endometrial ablation in a purpose-built operating suite on the first floor of her general practice. Dr Alliston attended training sponsored by ETHICON™ Women's Health & Urology, run by Dr Sian Jones and nurse practitioner Helen Ludkin, who both work in Bradford Infirmary. In St Albans, Dr Nisha Kedia is operating a successful hysteroscopy service at the Colney Medical Centre. Dr Kedia has also undertaken the training course run by Dr Jones.
Dr Alliston in Stratford is very experienced in endometrial ablation (in this case, Thermachoice) and has published a clinical paper recording the setting up of the clinic in this Practice and the results for the first 87 ladies who were treated there1. The results show the majority of women were satisfied with the operation at one month (96%), two months (93%), one year (92%) and two years (94%).
Dr Nisha Kedia has undergone specialist training to enable her, with the back up of a team of local consultant gynaecologists, to undertake hysteroscopy in Colney.
Dr Kedia is very experienced in this procedure and her experience of undertaking it in the GP setting has been written about in the medical journal 'Pulse2.
Traditionally all gynaecological procedures have been undertaken in a hospital setting, usually after a considerable wait to be seen by a consultant, then a further wait for a bed to be available. But many procedures are very straightforward and can be performed within practices such as Dr Alliston's and Dr Kedia's, once specialist training has been undertaken.
When is hysteroscopy advised?
Generally speaking women are advised to have a hysteroscopy if they suffer from any kind of abnormal bleeding – very heavy periods, for example, or abnormal bleeding during the menstrual cycle or the menopause.
Hysteroscopy is a technique that allows the doctor to see into the womb using a very thin hysteroscope which is passed gently into the cervix so there is a clear view of the inside of the womb and any abnormalities that may be discovered. If needed a small biopsy can be taken and small polyps, or even 'lost' coils, can be removed.
Pain management is quite straightforward in the majority of cases - a simple painkiller about an hour before the procedure is typically recommended such as 400mg of Ibuprofen.
The procedure itself will normally take between five and ten minutes.
What about Endometrial Ablation – Thermachoice?
Endometrial ablation is often recommended when other procedures to cure heavy periods have failed. There is a number of reasons for heavy bleeding. Sometimes it can be from polyps or fibroids, which are non-cancerous growths. Or there may be trouble from the lining of the womb or from new tissue growth. It can even be due to the way blood clots or due to a prescription medicine.
For some women this happens because hormones are out of balance. They control the thickening of the endometrium. A hormone imbalance may make the endometrial lining thicker than usual which causes heavier bleeding.
Endometrial ablation – in this case Thermachoice - is an alternative treatment to more traditional therapies such as a coil, hormone treatment, dilation & curettage (this has usually on a temporary effect) or, most radically, hysterectomy. Thermachoice is minimally invasive. However, it is not suitable for women who might still want to become pregnant.
The technique uses a tiny, heated balloon to remove the endometrial lining of the womb. It's a one-off outpatient procedure and takes about half an hour. Afterwards, 96% of women find either their periods return to normal, are much lighter, or stop completely.
How does it work?
A very small, soft, flexible balloon on the end of a thin tube is eased through the vagina and cervix, and then placed gently in the womb. It is then filled with fluid so that it inflates to the size and shape of the uterus. The fluid is gently heated and circulates around the womb for eight minutes. This destroys the womb's lining. Then the fluid is removed from the balloon and it is withdrawn from the patient's body. Nothing remains in the womb apart from the treated womb lining which simply falls away like a period. As far as pain management is concerned the doctor will usually give a local anaesthetic combined with anti-inflammatory painkillers to help reduce discomfort.
More than half a million women around the world have been treated with Thermachoice. Clinical studies over 5 years have shown it to be a reliable and effective treatment for 96% of women.
More and more GPs and nurses with an interest in women's health are signing up for the training courses – usually held in Bradford. For details of the next course contact Dora Wood at ETHICON™ Women's Health & Urology.
References
1. BJOG – an international Journal of Obstetrics and Gynaecology, 2005, 112 pp 1-4
2. Pulse 25th June 2009 'Outpatient hysteroscopy in general practice'
Published in partnership with the Royal College of Nursing's Practice Nurse Association
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