Question: My gynaecologist wants to try a microwave endometrial ablation before he does a hysterectomy in order to control my heavy painful periods. What do you think about this operation?
In the last few years, doctors have tried a range of new procedures to preserve the uterus and prevent the symptoms being suffered by the woman without resorting to a hysterectomy. One of the more recent, and most successful, is the ptocedure (it isn’t really an operation as nothing is cut) known as microwave endometrial ablation (MEA).
The reason for heavy painful periods is excessive production of the lining inside the uterus (the endometrium) which is shed with every period, and comes away with some bleeding and spasms (cramps) of the muscle that forms the uterus. The procedure involves a brief general anesthetic for ten to fifteen minutes. A thin probe is introduced through the vagina and cervix into the uterus. The probe contains a microwave generator that is carefully calibrated to produce just the right amount of energy to destroy the endometrium (lining of the uterus) without damaging the wall of the uterus or surrounding organs. The probe is turned on for a few minutes and gently moved around inside the uterus to destroy all the endometrium.
MEA is normally carried out as a day surgery procedure, and the woman can go home a few hours later. There are normally some bad period-like uterine cramps for a few days, and a bloody discharge for two or three weeks, but after that, 90% of women have no periods at all, and can therefore avoid a hysterectomy.
The worst outcome is that the procedure fails and a hysterectomy is eventually necessary, but if it works, a simple procedure has replaced significant surgery. You should probably give it a try.

Question: I am concerned about using tampons after reading about the toxic shock syndrome. Is this a significant risk for women, or can I still use tampons safely?
The toxic shock syndrome, despite all the publicity, is actually a very rare condition, and most general practitioners have never seen a case. The people who do develop the condition are extremely ill, and about 5% of them die, despite the best efforts of doctors. Some bacteria, and particularly one called Staphylococcus aureus (the golden staph) which is a common cause of vaginal and other infections, may produce a toxin or poison. Most people have antibodies to protect them from this problem, but in a very small number of people, the toxin may cause severe effects.
The symptoms of toxic shock syndrome are a high fever, dizziness, severe diarrhea, vomiting, muscle aches, fainting and sometimes a rash. An examining doctor will find the blood pressure to be low. The syndrome can occur in anyone, but seems to be more common in women and particularly in women who are menstruating. Treatment involves antibiotics to treat the bacterial infection, and hospitalization to replace the fluids lost with the severe diarrhea and vomiting. There is no specific antidote to the toxin, and so the earlier the diagnosis is made, the better the chances of recovery.
There is no reason why women should not use tampons, as the risk of developing toxic shock syndrome with them is infinitesimally small. Only if the tampon becomes infected is there any chance of developing the syndrome. To reduce the risk to a minimum, ensure your hands are clean before unwrapping and inserting the tampon; use the lowest absorbency tampon necessary for your flow; never insert more than one tampon; do not leave the tampon in for any longer than necessary; and pads may be a better alternative overnight. Make sure you don’t forget to remove the last tampon of your period. There is no evidence that any one brand or type of tampon is more likely to cause the syndrome than any other.
Relax and use the menstrual hygiene product that best suits your needs.