Alternatives to Hysterectomy

In the United States, approximately 700,000 women per year undergo hysterectomy. The risks of hysterectomy include bleeding, infection, changes in sexual function, and more serious operative complications including the risks of death in 1-2 per thousand procedures. Although hysterectomy is a health preserving, life saving operation in many cases, other options are often available which may provide excellent relief of symptoms previously treated by hysterectomy.

Hormone therapy consists of the use of estrogen/progestin medications, anti-estrogens (GnRH agonists), or oral contraceptives.

A new hormone-releasing IUD is available which has shown good results in controlling abnormal uterine bleeding. This IUD provides 5 years of therapy.

Minimally invasive surgery options include Laparoscopy (telescope placed through the belly button), Hysteroscopy (telescope through the cervix into the uterus), and Uterine Artery Embolization (using x-ray control to place small particles into blood vessels, thereby reducing the blood flow to the uterus).

Menstrual Pain present in women past the age of child bearing has been frequently treated by hysterectomy. The FDA has approved the use of oral contraceptives until menopause in women who do not use cigarettes. If treatment with oral contraceptives or anti-inflammatory drugs are not effective and a women wishes to avoid hysterectomy, she may elect a procedure called Presacral Neurectomy, performed by laparoscopy. During this procedure, the surgeon interrupts nerve fibers that carry pain signals from the uterus. This procedure leads to reduced menstrual pain in eight out of ten women.

Hysteroscopy allows a clear view of the lining of the uterus to evaluate abnormal uterine bleeding. If heavy bleeding does not respond to the use of hormone therapy, the treating physician may offer a procedure called Endometrial Ablation. During this procedure, the surgeon cauterizes the lining of the uterus, reducing or eliminating menstrual flow in about eight out of ten women.

Symptoms of Uterine Fibroids, pelvic pain, pain with menses, or heavy bleeding may also be treated by using birth control pills. After menopause, fibroids usually shrink and are not a problem. Fibroids become malignant in only one out of 1000 cases and, therefore, the risks of surgery outweigh the risks of observation, unless symptoms are present. Myomectomy is the removal of fibroids without performing a hysterectomy, using open surgery, laparoscopy, or hysteroscopy, depending on the location of the fibroids. Fibroids recur in 15-30 cases out of each 100 cases treated by Myomectomy. Radiologists and Gynecologists, working together as a team, offer Uterine Artery Embolization in selected cases to shrink fibroids and avoid other surgical treatment.