Hysterectomy: Alternatives
Overview
What is a hysterectomy?
Hysterectomy is the surgical removal of the uterus. Depending on the reason for the surgery, other organs and tissue may also need to be removed at the time of hysterectomy. Hysterectomy ends menstruation and the ability to become pregnant.
A hysterectomy is only one way to treat problems affecting the uterus. For certain conditions, however, hysterectomy may be the best choice.
Women who want to have children should consider alternatives to hysterectomy. It’s important to be fully informed of your options and the risks and benefits of the surgery before making a decision. Be sure to ask your healthcare provider to discuss the options that are available to treat your specific condition.
What conditions can affect the uterus?
The following problems affecting the uterus may require treatment. This treatment may include medication, hysterectomy, or other surgeries or procedures.
- Leiomyomas or uterine fibroids: These are benign tumors that have increased in size, are painful, or cause heavy bleeding.
- Severe endometriosis: In this condition, uterine tissue that grows outside the uterus.
- Uterine prolapse: The uterus "drops" into the vaginal canal due to weakened support muscles, which can lead to urinary incontinence or difficulty with bowel movements.
- Cervical or uterine cancer or pre-cancer
- Abnormal vaginal bleeding
Procedure Details
Uterine Disorders and Treatments
How are uterine fibroids (leiomyomas) treated?
Hormonal medications can be prescribed to shrink uterine fibroids, but fibroids can return when the medication is stopped. Since these medications mimic menopause, they may also cause symptoms of early menopause.
Uterine artery embolization is a non-surgical option performed by an experienced radiologist. During the procedure, the uterine artery is blocked. This artery supplies blood to the fibroid. Blocking the blood flow helps shrink the fibroid.
Depending on the number, size, and location of the fibroids, a myomectomy can be performed to remove the fibroids only, while keeping the uterus intact.
Other medications or procedures may be used to treat the symptoms of the fibroids without shrinking or removing them. Treatment is individualized according to the problems caused by the fibroids, which varies depending on their size and location.
How is endometriosis treated?
Oral contraceptives can be used to treat the symptoms of endometriosis, since preventing ovulation can reduce the discomfort often associated with the condition. Hormonal medications may be used to shrink or suppress the endometrial tissue that implants outside of the uterus. If medications do not effectively treat endometriosis, the endometrial tissue can be removed by laparoscopy or laparotomy, with or without laser therapy.
How is uterine prolapse treated?
Uterine prolapse may be improved in some cases with Kegel exercises, which strengthen the pelvic floor muscles that support the uterus and control urine. Since the pelvic floor muscles can become stretched due to obesity, smoking, or chronic cough, losing weight and quitting smoking can also help relieve pressure on the pelvic muscles.
Another treatment for uterine prolapse is a pessary device placed in the vagina to hold the uterus and bladder in place.
For women past menopause, taking hormones can also help keep the pelvic muscle tissues stronger.
For some patients, surgery is an option, which may or may not involve removal of the uterus.
How is cervical dysplasia treated?
Precancerous changes of the cervix (cervical dysplasia) that are detected early by a Pap test can be treated conservatively, such as with a loop electrosurgical excision procedure (LEEP). The LEEP procedure removes the abnormal cells.
When cervical disease moves into deeper tissue layers or spreads into other organs (as in cervical cancer), hysterectomy is usually necessary (sometimes in conjunction with radiation and chemotherapy).
How is abnormal bleeding treated?
The treatment for irregular, severe, or heavy bleeding depends on the cause. Fibroids, endometrial polyps, changes in hormone levels, infection, or cancer can cause abnormal bleeding.
Treatments for abnormal bleeding include dilatation and curettage (D&C), in which the lining and contents of the uterus are removed; non-hormonal medications such as nonsteroidal anti-inflammatory agents (NSAIDs.); hormonal medications such as progestins, GnRH agonists, or oral contraceptive pills; and placement of the progesterone intrauterine device (IUD) to decrease bleeding and pain.
Hysteroscopic evaluation and management, including polypectomy (a procedure to remove a polyp), myomectomy (a procedure to remove fibroids), or endometrial ablation, may also be quite effective, allowing some patients to avoid hysterectomy.
Risks / Benefits
How will I know which treatment is right for me?
You and your healthcare provider can discuss the benefits and risks of each treatment option, based on your condition. The method used to treat your condition will depend on the nature of your problem and the severity of your symptoms.
Personal factors, such as your desire to have children in the future, will also affect the treatment options that are best for you.
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