Alternatives to Hysterectomy

One-third of American women experience some type of pelvic health disorder by the time they're 60. And about 600,000 women every year have a hysterectomy -- removing their uterus to relieve troubling symptoms. Overall, an estimated 20 million women have had a hysterectomy.

But if you have painful periods with excessive bleeding, fibroids, endometriosis, or another pelvic health problem, you should know that there are new alternatives to hysterectomy to consider.

Uterine Fibroids

These tumors, usually benign, are generally found on the smooth muscles of the uterus, and can cause pelvic pain, infertility, and heavy menstrual bleeding. Their cause is complex, but one thing is clear: Uterine fibroids are a major reason why women have hysterectomies, accounting for between 177,000 and 366,000 of the annual total.

If your fibroids are causing no symptoms, it's entirely reasonable to adopt a strategy called "watchful waiting" -- monitoring their status with your doctor and not having any surgery unless problems develop. But if you are experiencing pain, discomfort, or pressure symptoms, there are several less-invasive options for treating fibroids:

• Myomectomy. This is the surgical removal of the fibroids alone. It can be done through an abdominal operation, laparoscopically (entering through the navel), or via hysteroscopy (inserting a thin, telescope-like instrument called a hysteroscope through the vagina). A laparoscopic or hysteroscopic approach is least invasive, and these are also less costly and require shorter recovery time. 
• Uterine Artery Embolization (UAE), also known as Uterine Fibroid Embolization (UFE). This is a fairly simple, noninvasive procedure in which small particles are injected into the uterine arteries feeding the fibroids, cutting off their blood supply. It's been used for years to help stop hemorrhage after childbirth or surgery. Symptoms improve in 85% to 90% of patients, most of them significantly. 
• Hysteroscopy. The insertion of a thin, telescope-like instrument (called a hysteroscope) through the vagina can be used if the fibroid is primarily within the cavity of the uterus. This is a minor surgical procedure with minimal recuperation time, but can only be offered to women who have fibroids within the lining of the uterine cavity. 
• Medical management. Painful symptoms of uterine fibroids can be initially treated with nonsteroidal anti-inflammatory agents, like Motrin. If that isn't effective, another option is a class of drugs that blocks the ovaries' production of estrogen and other hormones. Their side effects can include symptoms of premature menopause and a decrease in bone density.

Menorrhagia

Menorrhagia means severe vaginal bleeding. In many cases, the bleeding has a known cause, like uterine fibroids (see above), but in other cases the cause remains unknown. There's a medical threshold for menorrhagia -- losing more than 80 mL of blood in each menstrual cycle -- but most doctors now tend to define menorrhagia by how much it affects your daily life: causing pain, mood swings, and disruptions in your work, sexual activity, and other activities.

Some options for treating menorrhagia, short of hysterectomy:

• Medical management. Menorrhagia's first treatment of choice is medical, using either oral contraceptives or an intrauterine device (IUD) releasing a hormone called levonorgestrel. Both of these treatments reduce menstrual bleeding significantly, although women report being generally more satisfied with the IUD. If you're still planning to have children in the future, these are probably your best options. 
• Endometrial ablation. There are a variety of techniques that can be used to remove the lining of the uterus. You should only consider these options, however, if you are done with childbearing. New, "second-generation" methods like thermal balloon ablation, cryoablation, and radiofrequency ablation have success rates up to 80%. These are all outpatient procedures, so they don't have the same complication rates and extended hospital stays involved in hysterectomy.