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August 22, 2017  
COMMUNITY: Frequently Asked Questions
Uterus1: How do you decide which procedure is best to treat heavy bleeding?
Dr. Craig deFreese: Well, it’s usually something you do in concert with a patient. There are some circumstances where there’s really only one choice if you want a cure. Where somebody has huge fibroids, you can only go in and remove those. You can’t go in and just ablate the endometrium and make things better. But most of the time what I do is sit down with them and explain this is what you have, these are the choices for your treatment—including both medical and surgical therapy—and with each one of them, talk about the good things and the bad things, the pros and the cons, so to speak, about it. And it depends on where somebody is. You’re gonna treat somebody who is 22, who hasn’t had kids, differently than you are somebody who is 40 years old and has already had their kids. And it also depends on patient preference. There are some people, who the hysterectomy is the last thing they’ll do, and they’ll do three surgical procedures before they do that; and there are other people who say, if I’m going to do something I’m going to do one operation one time and that’s it. It’s not like there’s one right thing for everybody—there are different things that are right for different people, depending upon their condition and their outlook.
Dr. Angela Cope: It depends on the stage of life they are in. If they are young and still want to have children, we often talk about hormonal manipulation, usually in the form of birth control pills. Once people are done having children, we have more options for them and most of the time I find they are not interested in taking birth control pills. One of the most common things we’re doing right now is in-office endometrial ablation, which has been really nice for women. It’s really freed them up to have a procedure that will control their bleeding and that can be performed in the office with really no downtime and very little risk. It used to be that one of our only options was major surgery in the form of a hysterectomy.
Dr. Craig deFreese: Well, it’s usually something you do in concert with a patient. There are some circumstances where there’s really only one choice if you want a cure. Where somebody has huge fibroids, you can only go in and remove those. You can’t go in and just ablate the endometrium and make things better. But most of the time what I do is sit down with them and explain this is what you have, these are the choices for your treatment—including both medical and surgical therapy—and with each one of them, talk about the good things and the bad things, the pros and the cons, so to speak, about it. And it depends on where somebody is. You’re gonna treat somebody who is 22, who hasn’t had kids, differently than you are somebody who is 40 years old and has already had their kids. And it also depends on patient preference. There are some people, who the hysterectomy is the last thing they’ll do, and they’ll do three surgical procedures before they do that; and there are other people who say, if I’m going to do something I’m going to do one operation one time and that’s it. It’s not like there’s one right thing for everybody—there are different things that are right for different people, depending upon their condition and their outlook.
Dr. Angela Cope: It depends on the stage of life they are in. If they are young and still want to have children, we often talk about hormonal manipulation, usually in the form of birth control pills. Once people are done having children, we have more options for them and most of the time I find they are not interested in taking birth control pills. One of the most common things we’re doing right now is in-office endometrial ablation, which has been really nice for women. It’s really freed them up to have a procedure that will control their bleeding and that can be performed in the office with really no downtime and very little risk. It used to be that one of our only options was major surgery in the form of a hysterectomy.
Dr. Craig deFreese

Dr. Craig deFreese


Dr. Craig DeFreese is an obstetrician/gynecologist who practices in Altamonte Springs, Orlando, Florida. He started his practice, Devoted to Women, about eight years ago, but has been caring for female patients for more than 19 years. Noting a growing trend in women’s preference for midwives, Dr. DeFreese now shares his office with a nurse midwife who delivers babies for many of his patients.

Dr. Angela Cope


Angela L. Cope, M.D. is a gynecologist at Present Women’s Integrated Healthcare, P.A. in Grapevine, Texas. She received her Doctor of Medicine from Texas Tech University School of Medicine in 1990 and became a board certified gynecologist in November of 1996. She is a member of the American College of Obstetrics and Gynecology, the American Medical Association and the Texas Medical Association. Dr. Cope treats women of all ages and specializes in treating abnormal bleeding. Currently, she resides in Southlake, Texas with her husband and three kids. In her free time, she enjoys camping, watching her children play softball, and taking family trips.

Dr. Craig deFreese

Dr. Craig deFreese


Dr. Craig DeFreese is an obstetrician/gynecologist who practices in Altamonte Springs, Orlando, Florida. He started his practice, Devoted to Women, about eight years ago, but has been caring for female patients for more than 19 years. Noting a growing trend in women’s preference for midwives, Dr. DeFreese now shares his office with a nurse midwife who delivers babies for many of his patients.

Dr. Angela Cope


Angela L. Cope, M.D. is a gynecologist at Present Women’s Integrated Healthcare, P.A. in Grapevine, Texas. She received her Doctor of Medicine from Texas Tech University School of Medicine in 1990 and became a board certified gynecologist in November of 1996. She is a member of the American College of Obstetrics and Gynecology, the American Medical Association and the Texas Medical Association. Dr. Cope treats women of all ages and specializes in treating abnormal bleeding. Currently, she resides in Southlake, Texas with her husband and three kids. In her free time, she enjoys camping, watching her children play softball, and taking family trips.

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