High rate of hysterectomy performed per year clearly indicates the popularity of this surgery for treating women gynecological problems. But, considering the postoperative complications and life after surgery, alternatives for hysterectomy should be given due importance before finalizing this procedure.
A hysterectomy is an invasive procedure, in which the uterus of a woman is removed for treating underlying medical problems. In the United States, the rate of performing this surgery is found to be one in every 3 women as they reach 60 years. Depending upon the disease severity and future risks, the ovaries and the fallopian tubes may also be removed during the procedure. But, why is this surgery performed? Are there any hysterectomy alternatives? Let’s look into the answers of these queries.
Why is Hysterectomy Performed?
The most common reason for performing a hysterectomy procedure is being diagnosed with severe uterine fibroids. Other probable diseases that may require hysterectomy for treatment are uterine prolapse (uterus losing its original position and falling into the ovary), vaginal bleeding that doesn’t respond to other treatment options, cervical dysplasia and severe cases of endometriosis. Of all the documented cases, about 10 percent candidates participated this procedure for cancer, which may be located in the cervix, uterus and ovaries.
Alternative Treatments for Hysterectomy
It is indeed unfortunate to know that approximately 80 percent of women have fibroids in the uterus. While many are asymptomatic, one out of every 4 patients have serious symptoms, requiring hysterectomy or other medical intervention. In most cases, laparoscopic technique is adopted. And if the procedure involves removal of both ovaries, it marks the end of a woman’s reproductive cycle, i.e. her monthly periods will stop, and she can no longer conceive a baby. Also, hysterectomy negatively affects sexual health of the participants.
In addition, hysterectomy complications occur in about 8 – 12 participants. Those of the abdominal methods are more risky than vaginal procedures. Complications and risks accompanying this surgery include infections, genitourinary problems, hemorrhage, osteoporosis and heart disease. Seeing all these factors, it is concluded that hysterectomies are not totally safe, and should not be the first choice of treatment. In short, it is of utmost importance to discuss hysterectomy alternatives before a woman participates this type of surgery. Following are some uterine diseases and treatment alternatives (other than hysterectomy).
Uterus fibroids refer to benign tumor located in the uterus. Medically known by different terms – leiomyomata, fibromyomas and myomas, they are harmless in most cases and diagnosed in women who are in their fertility years. However medical intervention for uterine fibroids is required for severe cases. Treatment options excluding hysterectomy include:
- Hormonal therapy including gonadotropin-releasing hormone (GnRH), progestin-releasing intrauterine device and androgens.
- Focused ultrasound surgery (FUS) is a noninvasive procedure for ablating fibroids with the help of MRI scanner.
- A surgical procedure called myomectomy, in which fibroids are removed without disturbing the uterus.
- Other hysterectomy alternatives are uterine artery embolization, myolysis and endometrial ablation.
As aforementioned, a woman diagnosed with uterine prolapse has a slipped uterus. It is caused due to loss of muscle tone and muscle injury during child delivery. Based on the severity, it is of two types – incomplete uterine prolapse in which part of the womb protrudes into the birth canal, and complete uterine prolapse, wherein part of the womb slips ways from the birth canal. Other than hysterectomy, uterine prolapse can be treated by:
- Performing special exercises (example Kegel exercise) to help strengthen the muscles of the uterus and pelvic floor.
- Taking oral estrogen or following estrogen hormone replacement therapy, which help improve muscles.
- Uterine prolapse is also treated by introducing pessary that supports and holds uterus in original position.
- To address serious uterine prolapse, uterine suspension surgery is conducted to restore normal position of uterus.
Abnormal bleeding experienced between periods may be a case of vaginal bleeding, which is medically known as menorrhagia. It may be caused due to dysfunctional uterine bleeding, a condition occurred with no known organic disorders. Bleeding may also stem from vaginal injuries, growth of tumor in the vaginal wall, abnormally low estrogen and infections. Prompt treatment for vaginal and uterine bleeding depends on what causes it. For this, treatment alternatives to hysterectomy include:
- Dilation and curettage procedure (abbreviated as D&C) for enlarging the uterine opening and then removing the tissues.
- Medication treatment involving administration of non-steroidal anti-inflammatory medications (NSAIDs), progestins or GnRH.
- Hysteroscopy combined with ablation, polyp removal (polypectomy) and myomectomy, whichever is applicable for the case.
A precancerous condition located in the cervix, it is often diagnosed in women who are in their mid 30s and 40s. In cervical dysplasia, the cells and tissues of the cervical region grow abnormally. Based on the extent of affected cells, it is identified as mild, moderate and in severe cases. Treatment is aimed at removing the unwanted cells, so as to avoid cancer growth. Following are reliable treatment methods for cervical dysplasia:
- Electrocauterization is a procedure conducted to burn away the precancerous cells with the help of electric current.
- Loop electrosurgical excision procedure (LEEP) also involves use of electric current for removing a thin layer from the cervix.
- Laser vaporization is the approach of removing abnormal cells with the help of laser technique.
- Hysterectomy alternatives for addressing cervical dysplasia also include cryosurgery, i.e. using liquid nitrogen to freeze tissues.
In this uterine disorder, the tissue lining of the uterus (endometrium) grows abnormally and that too outside the womb. As with other cases, this uterine condition is prevalent in women who are in their childbearing years. While it may be asymptomatic in most cases, severe pain, bleeding, irritation, infertility and other medical problems are exhibited by some patients. For such cases, treatment for endometriosis is done with the help of the following approaches.
- Hormone replacement therapy and/or administering gonadotropin-releasing hormone (GnRH) medications.
- Oral contraceptives are recommended for long-term period to avoid progression of endometriosis.
- A less invasive laparoscopic surgery for removal of cysts, endometrial tissues (implants) and cysts.
- Laparotomy refers to an open surgical procedure conducted in the abdomen for cutting or burning of implants and cysts.
To conclude with, hysterectomy should be performed only when it is crucial for improving the well-being of a woman. If there is an alternative treatment for hysterectomy, which is suited for the patient’s existing condition, it should be discussed beforehand. Medical researchers have a strong belief that hysterectomy statistics will drop in the coming years, and new reliable options will be developed for addressing non cancerous problems of the uterus.