If you have abnormal vaginal bleeding, endometriosis, or uterine myomas, you may be told that the best solution is having a hysterectomy, where they remove the entire uterus (with or without removal of ovaries and the fallopian tubes).
But what most women do not know, is that you do not need to treat all these conditions with a hysterectomy. One should not take this decision lightly as the side effects of a hysterectomy sometimes turn out being worse than the original problems.
The main reasons women are looking for hysterectomy alternatives are:
- They still want to be able to bear children
- Prefer least invasive treatment and short recovery because of their job
- They are afraid of the surgery itself and possible complications
- The fear of entering menopause
- The fear a hysterectomy makes them gain weight
- Anxious that it will affect their sex life
Therefore, surgeons are always looking for better alternatives to hysterectomy to treat the conditions in women, without affecting their womanhood. These alternative options consist of minimal invasive procedures which makes it possible for women to keep their uterus.
Possible alternatives to hysterectomy
For Uterine Fibroids
This only works if you have external uterine fibroids, where the non-cancerous growths are attached to the outer part of the uterus and are usually attached via a stalk. Instead of removing the entire uterus, they can remove the myoma through a laparoscope.
If the fibroids are inside the muscle of the uterus, usually they cannot remove them without having to remove the uterus itself. If you have internal fibroids, however, it is easy to remove them (hysteroscopic myomectomy) so you can have restoration of fertility and less vaginal bleeding.
With this procedure they use a hysteroscope, which is a device that enters the uterus through the cervix and identifies the uterine fibroids. They remove only the fibroids and the uterus will still be able to bear children.
Other hysterectomy alternatives one can use to shrink or remove fibroids include:
- Artery embolization (UAE)
- Laser ablation of uterine fibroids
Endometriosis is when some cells of the lining of the uterus pass through the fallopian tube only to set up residence on the ovaries, fallopian tubes, uterus, bladder, and rectum. This causes extreme pain with menstrual bleeding because these areas of tissue, called endometriotic lesions, can bleed at the time of menses. One option is to remove the uterus along with these lesions to rid the body of the unwanted tissue.
Fortunately, there are other options.
The doctor may prescribe one of the following medications to shrink the endometrial tissue so that the bleeding is less each cycle. There is less pain and the uterus can remain intact.
- Low doses of hormones (estrogen and progesterone)
- Aromatase inhibitors
- GnRH agonists
- progestagens and anti-progestagens
One of the alternatives to hysterectomy is a relatively new procedure named a laparoscopic excision surgery. This way they can find and remove the endometrial tissue that has settled on the pelvic and abdominal structures. They can then burn off these areas and remove them through excision. This will lessen the pain and stop bleeding outside of the uterus, and solve fertility problems. The only downside is that the ovaries may be too damaged by endometrial tissue and not work properly anymore.
For Abnormal Uterine Bleeding
If you have irregular and heavy periods, it is possible that you do not ovulate. The lining of the uterus can build up to such a degree that periods are extremely heavy and painful. It may be so severe that you feel as though a hysterectomy is the only option. Fortunately, there are things you can do to relieve the heavy bleeding without having to resort to a hysterectomy.
Alternatives to hysterectomy for heavy bleeding include the following:
- Medications—you can take birth control pills or a progesterone injection, which serve the purpose of diminishing the thickness of the inner vaginal lining. Your periods will lighten and may disappear altogether. Of course, if you want to become pregnant, you will have to stop these birth control methods. You may even need to take other medication to stimulate ovulation so you can get pregnant.
- Dilatation and Curettage—you can have a procedure in which they scrape off the lining of the uterus. Scraping devices will remove the thick uterine lining and, at least for a while, your periods will be much lighter. It is possible that they need to repeat this procedure every few years.
- Endometrial ablation involves removal of uterine lining called the endometrium. This process reduces your heavy menstrual bleeding, or in many cases it causes you to stop having any more periods. It basically works by causing the endometrium to form scar tissue that stops heavy bleeding. This procedure uses laser thermal ablation, thermal ablation (heat), and other methods. Endometrial ablation is usually an outpatient procedure. The downside of this procedure is that you may take off too much of the uterine lining. In this case the embryo cannot implant properly and you may not be able to have children. This procedure affects your fertility, and therefore is not recommended if you want to have children in future. Also, it is not considered as a treatment option for fibroids.
For Uterine Prolapse
Alternative treatment options to hysterectomy for prolapsed uterus depend mostly on a woman’s age, how severe the prolapse is and the symptoms it produces. Younger women that want more children and have mild symptoms may benefit from some lifestyle changes like;
- Doing regular Kegel exercises
- Not lifting heavy things
- Losing some weight if they’re too heavy
- Quit smoking (coughing puts pressure on pelvic floor)
- Treat constipation with dietary changes (to avoid straining)
- A vaginal pessary is a latex ring that helps help hold the vaginal walls in place and support the uterus. These pessaries are not ideal for everyone as they sometimes cause incontinence, bacterial infections and are often uncomfortable during intercourse
When the uterine prolapse is severe and protrudes out of the vagina it may interfere with intercourse and cause difficulties emptying bowels or bladder.
Other surgeries to repair the weak pelvic floor structures and to support your uterus.
- Uterine Suspension Surgery – By shortening the ligaments that hold the uterus they are able to lift it back in place.
- Sacrocolpoexy – With this procedure they aim to hold the vagina in its natural place by inserting a surgical mesh. They usually do this through open surgery but is now also possible through a few small incisions using the less invasive da Vinci procedure.
- Anterior or posterior repair (colporrhaphy) of the vaginal wall
For pre-cancerous conditions
A Hysterectomy is unavoidable and often life saving when they find a malignant tumor. However, frequently doctors urge women to have a hysterectomy when a pap smear reveals abnormal or pre-cancerous cells. But there are other options for women with an abnormal pap test. One is the LEEP procedure, where they only cut away the abnormal tissue, also known as Loop Electrosurgical Excisional Procedure. The second treatment option is cryosurgery, where they use liquid nitrogen to freeze and destroy the lesions of abnormal tissue.
It is important that women understand that hysterectomy is a major surgery and not always the first line of treatment for all ailments. Other alternatives to hysterectomy need exploring and careful evaluation before making a decision. Ultimately together with her surgeon a woman will choose the best option depending upon her personal case.