Alternatives to Hysterectomy Surgery

Medically Reviewed by Dr. K on 20 May 2022

Table of Contents:

  1. Hysterectomy
  2. Uterine Fibroids
  3. Menorrhagia
  4. Uterine Prolapse
  5. Endometriosis
  6. Chronic Pelvic Pain

Hysterectomy

At the age of 60, one-third of American women would have suffered from a pelvic health issue. Every year, around 600,000 women have a hysterectomy, in which their uterus is removed to alleviate painful symptoms. A hysterectomy has been performed on an estimated 20 million women worldwide.

However, if you have painful cycles of heavy bleeding, fibroids, endometriosis, or any pelvic health problem, you should realise that hysterectomy is not the only option.

Uterine Fibroids

These benign tumours are located in the smooth muscles of the uterus and may induce pelvic discomfort, miscarriage, and excessive menstrual bleeding, among other conditions. Women had hysterectomies for a variety of reasons, with uterine fibroids responsible for between 177,000 and 366,000 of the annual statistics.

If the fibroids aren't triggering any complications, it's perfectly safe to follow a “watchful waiting" approach, which involves closely watching the condition with your doctor and deferring treatment before concerns arise. If you're having pain, swelling, or pressure from fibroids, there are a few non-invasive ways to consider:

  • Myomectomy: The fibroids are only surgically removed in this case. It can be performed through abdominal surgery, laparoscopic surgery (entry via the navel), or hysteroscopy (inserting a thin, telescope-like instrument called a hysteroscope through the vagina). A laparoscopic or hysteroscopic procedure is the least invasive, as well as the least expensive and time-consuming. Another open treatment that promises accuracy and smaller incisions is the da Vinci robotic myomectomy. It's possible that what was first believed to be a fibroid is now uterine sarcoma, a disease. As a result, the FDA advises against laparoscopic morcellation, which involves splitting the fibroid into tiny parts before extracting it.
  • Uterine artery embolization (UAE): Uterine artery embolization (UAE), also known as uterine fibroid embolization, is a form of embolization that occurs in the uterus (UFE). Tiny particles are inserted into the uterine arteries supplying the fibroids, shutting off their blood flow. This is a relatively straightforward, noninvasive operation. This operation, unlike a hysterectomy, protects the uterus and can help women prevent surgery. It's been used to help avoid haemorrhage during childbirth or treatment for several years. In 85% to 90% of patients, symptoms increase, with the majority of them improving dramatically.
  • Medical management. Nonsteroidal anti-inflammatory medications (NSAIDs), such as Motrin, may be used to relieve the pain of uterine fibroids. If it doesn't work, another alternative is a class of medications that inhibit the release of oestrogen and other hormones by the ovaries. Premature menopause complications and a reduction in bone density are possible side effects. This is just performed before a planned fibroid removal, not in the long run. After the therapy is stopped, the fibroids can rise again.

Menorrhagia

Heavy menstrual bleeding is referred to as menorrhagia. In certain instances, such as uterine fibroids, the source of the bleeding is recognised, although in some, the cause is unclear. Menorrhagia has a medical definition: losing more than 80 mL of blood per menstrual period. But, most doctors now describe it by how much it impacts your everyday life: triggering nausea, mood changes, and interfering with your job, physical behaviour, and other behaviours.

Besides a hysterectomy, there are a few alternatives for managing menorrhagia:

  • Medication: Oriahnn is a new drug that has been approved as a surgical replacement. Elagolix (a GnRH antagonist), oestrogen, and progestin are used together. It significantly decreases excessive menstrual bleeding in premenopausal women who have uterine fibroids.
  • Medical management. Hospital care for menorrhagia is first-line treatment, which includes oral contraception or an intrauterine implant (IUD) that activates the hormone levonorgestrel. All of these therapies substantially decrease menstrual bleeding, but women report becoming more comfortable with the IUD. These are potentially your only choices if you do choose to have children in the future.
  • Endometrial ablation. The uterine lining may be removed using a number of techniques. These choices can only be seen if you are no longer planning to have children. Thermal balloon ablation, cryoablation, and radiofrequency ablation are new “second-generation" technologies with effective rates of 80% to 90%. Since they are mostly surgical surgeries performed mostly in the doctor's office, they may not carry the same high infection rates or lengthy hospital stays as a hysterectomy.
  • NSAIDs are occasionally used to help decrease blood loss from the uterine lining during menstruation.

Uterine Prolapse

When the uterus moves out of its normal position and presses against your pelvic walls, this is known as uterine prolapse. It may be affected by a variety of factors, but vaginal childbirth is one of the most important. Alcohol, breastfeeding, and obesity are also major risk factors as well.

A hysterectomy would address the issue, although there are other, less invasive options to explore. A vaginal pessary is a removable tube that is inserted into the vagina to protect places where prolapse is occurring. There are many types of pessaries, and your doctor will help you choose the one that is right for you. They don't cure prolapse, although they do help to alleviate symptoms in certain cases. They are frequently beneficial during birth, keeping the uterus in check until it enlarges and invades the vaginal canal.

There are also many surgical options for treating uterine prolapse, and surgeons can use a combination of them. They will need to be paired with a hysterectomy in some cases, but for some women, this is not essential.

According to the FDA, the complications of inserting mesh into the vaginal canal to repair pelvic organ prolapse — a treatment performed nearly 75,000 times in 2010 — may exceed the benefits. Mesh, on the other hand, might be acceptable in certain circumstances.

Repairs of enteroceles, rectoceles (hernias of the colon or rectum through the vagina), and cystoceles (bladder prolapse through the vagina) are among the other forms of operation.

Endometriosis

Endometriosis is a condition in which tissue that acts like the uterus's lining — the endometrium — develops in other parts of the abdominal cavity, such as the ovaries, fallopian tubes, or the uterus's outer surface. It affects about 5 million people in the United States. Pelvic discomfort, painful sex, bleeding during times, and miscarriage are all symptoms. The normal individual experiences symptoms of endometriosis for over two to five years before reaching a diagnosis.

Endometriosis is the cause of around 18% of hysterectomies in the United States, and the procedure does not always solve the problem. If the ovaries are kept in situ, up to 13% of women may experience endometriosis within three years; this figure rises to 40% in five years. And, since endometriosis more often impacts young people, with an average age of about 27, a surgical procedure that eliminates any chances of conception is not really a choice.

Endometriosis treatments vary depending on the nature of the symptoms and the needs of the woman. Pressure may be relieved by over-the-counter or prescribed pain relievers, for example. Women might be administered contraceptive treatments such as birth control pills or medication that drastically reduce hormone levels to relieve inflammation and abnormal menstrual bleeding. These drugs, on the other hand, aren't for women who are attempting to conceive, and they aren't a long-term solution: When you stop taking your drug, your endometriosis symptoms normally return.

Laparoscopic procedure, a minimally invasive method to either remove endometrial growths and scar tissue or burn them away with excessive pressure, is a more long-term solution for endometriosis that is more likely to assist with fertility issues. If the growths cannot be successfully destroyed this way, surgeons may resort to a more painful procedure known as a laparotomy, which entails creating a deeper cut in the abdomen. This has a much longer healing time, but it is still less painful than a hysterectomy and allows you to keep your fertility.

Chronic Pelvic Pain

Many people suffer from chronic pelvic pain: according to some estimates, up to 39% of women suffer from chronic pelvic pain. It is more prevalent in younger women, especially those between the ages of 26 and 30.

Pelvic discomfort may be caused by a variety of factors, including uterine fibroids and endometriosis, pelvic inflammatory disorder, bowel and urinary conditions such as irritable bowel syndrome, interstitial cystitis (inflamed bladder), and musculoskeletal problems. Women that have been sexually abused have a higher risk of developing persistent pelvic pain.

A hysterectomy should be considered a last resort for persistent pelvic pain, particularly because the operation does not relieve several forms of pelvic pain. Working alongside the doctor to identify the source of the discomfort is critical so that care can be tailored to the source, providing you the best possibility of recovery. If you have uterine fibroids or endometriosis, for example, one of the medication choices mentioned above could be the best choice for alleviating chronic pelvic pain.

Some recovery choices can include: Depending on the source of the discomfort,

  • Hormonal treatments, such as birth control tablets, may be used to prevent ovulation.
  • Nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Relaxation techniques, biofeedback, and physical rehabilitation are also options.
  • Abdominal trigger point injections may help alleviate discomfort by injecting drugs into sore regions on the lower wall of the abdomen.
  • Antibiotics if an infection, such as pelvic inflammatory disease, is the source of the pain
  • Psychological help 

Whatever the medical situation, it's most likely that a hysterectomy is the most safe and necessary treatment. However, since there are so many treatments, it's important to talk to the doctor about them all first, to help you make the best choice for yourself.

Sources

Referenced on  3/5/2021 

  1. FDA Safety Communication: “UPDATE on Serious Complications Associated with Transvaginal Placement of Surgical Mesh for Pelvic Organ Prolapse," July 13, 2011.
  2. National Women's Health Resource Center, Washington, D.C.
  3. CDC.
  4. National Uterine Fibroids Foundation, Colorado Springs, Colo.
  5. U.S. Department of Health and Human Services.
  6. Georgetown University Hospital, Washington, D.C.
  7. The University of Maryland Medical Center, Baltimore.
  8. Urologic Nursing.
  9. The American Academy of Family Physicians, Leawood, Kan.
  10. WebMD Medical Reference from Healthwise: “Vaginal Pessaries."
  11. https://www.webmd.com/women/guide/alternatives-to-hysterectomy

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