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|Are There Alternatives To Hysterectomy?
Yes, in many instances, there are alternatives. A hysterectomy procedure should only be considered as a last resort when all other alternatives have been exhausted. Over 600,000 American women and 75,000 UK women undergo a hysterectomy every year. It is estimated that by the age of 60, one in three American women will have had their womb removed. One recent large-scale study found that as much as 15 percent of these surgeries were unnecessary. Some states now have what is called an informed-consent law which requires a surgeon to inform the patient of all risks associated with the operation as well as any appropriate alternatives. While a hysterectomy is generally a safe surgery, it is a major procedure and like all major surgery has potential serious complications. Hysterectomy complications include fatal blood clots, hemorrhaging, damage to surrounding organs and infections. There are also a range of potential side effects such hot flashes, depression, weight gain and sexual arousal issues (read more under hysterectomy side effects).
If you want a simple explanation of the operation, see: what is a hysterectomy?
List of Possible Alternatives
|Uterine Fibroids (pictures)
Non-cancerous tumors that grow outside, in or on the wall of the womb. They can range in size from a seed to a grapefruit, or even larger. The largest on record weighed 140 pounds.
Hormone pills, which need to be taken long-term, to shrink the fibroids.
Surgery to remove the fibroids but leaves the womb intact.
Uterine Artery Embolization
A newer therapy which is performed by a radiologist. It restricts the growth of fibroids by cutting off their blood supply.
||Nonsteroidal anti-inflammatory drugs (NSAIDs)
Painkillers such as ibuprofen.
IUD (Mirena) or contraceptive pill.
D&C (Dilation and curettage)
To scrape out the womb, usually reduces bleeding, but it may come back.
A procedure which destroys the lining of the womb. It is performed on an out-patient basis.
|Chronic Pelvic Pain
Very painful periods (dysmenorrhea)
|Nonsteroidal anti-inflammatory drugs (NSAIDs)
Such as birth control implants (Implanon) and birth control injections (Depo-Provera).
If it is caused by other conditions like endometriosis or fibroids.
A condition where fragments of the womb end up attaching to other organs causing pain (pictures).
Oral contraceptives, GnRH agonists, Danazol. Also the non-surgical abortion drug mifepristone.
Removal of growths via keyhole surgery (laparoscopy), using techniques like laser surgery, electrocautery or curettage (scraping).
The womb slides or falls from it's normal position down into the vagina.
A rubber or plastic donut-shaped device is inserted into the vagina to keep the uterus in place. This can be a temporary or permanent repair.
Surgery to Repair the Uterus
Sacrospinous fixation which involves using nearby tendons to support the uterus.
When Is A Hysterectomy Definitely Necessary?
There are certain medical cases where a hysterectomy is always necessary, usually to save a woman's life. These situations are:
1. To stop severe uncontrollable bleeding (hemorrhage), this is a potential complication of childbirth.
2. As a last resort for severe infections such as a burst abscess associated with symptoms of pelvic inflammatory disease (PID).
3. To remove a cancerous lump from the womb, vagina, fallopian tube or ovaries.
The next category is less clear-cut. The need for surgery depends on how severe the condition is:
1. Severe recurrent cases of PID.
2. Severe widespread endometriosis or adenomyosis with symptoms that are so debilitating the woman cannot function normally; and hormone therapy has been tried. It is more likely to be performed if the woman is past childbearing age so pregnancy is not a requirement.
3. Uterine fibroids that are very large and pressing down on nearby organs.
4. Menstrual periods that are so heavy and frequent they are debilitating; and have not responded to hormone therapy or endometrial ablation.
5. The presence of pre-cancer tissue - such as cervical dysplasia (CIN) and endometrial hyperplasia.
6. A uterus prolapse (collapsed womb) that is interfering with bowel or bladder function and cannot be corrected with lesser surgery.
It should not be performed:
1. Due to backache or pelvic pain, small fibroids, irregular periods, menstrual cramps, ovarian cysts or uterine polyps unless ALL other lower risk alternatives have been tried.
2. For sterilization alone - tubal ligation is much easier and cheaper.
How Can I Avoid An Unnecessary Hysterectomy?
The best way is to become a fully informed partner in the decision making process. Assuming the operation is elective (performed as a treatment choice rather than as an emergency), as we have seen above, there are alternatives. Research shows that younger, newer qualified gynecologists tend to be faster to recommend the alternatives than their older colleagues. So be aware, your doctor is not infallible. It is reasonable to get a second opinion, even a third if necessary. This is particularly important for premenopausal women who may wish to retain their fertility. Often there is some alternative that will allow her to keep her fertility until menopause, by which time her condition will probably have cleared up on its own.