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What is a hysterectomy?
Hysterectomy is the surgical removal of the uterus. Depending on the reason
for the surgery, a hysterectomy may also involve the removal of other organs and
tissue. Hysterectomy ends menstruation and the ability to become pregnant.
A hysterectomy is only one way to treat problems affecting the uterus.
For certain conditions, however, hysterectomy may be the best choice.
Women who want to have children should consider alternatives to hysterectomy.
It’s important to be fully informed of your options and the risks and benefits
of the surgery before making a decision. Be sure to ask your health care
provider to discuss the options that are available to treat your specific
condition.
Conditions that affect the uterus
The following problems affecting the uterus require treatment. This
treatment may include medication, hysterectomy, or other surgeries.
- Leiomyomas or uterine fibroids (benign tumors) that have
increased in size, are painful, or cause bleeding
- Severe endometriosis (uterine tissue that grows outside the
uterus)
- Uterine prolapse (uterus that has "dropped" into the
vaginal canal due to weakened support muscles), which can lead to urinary
incontinence or difficulty with bowel movements
- Cervical or uterine cancer
- Abnormal vaginal bleeding
How will I know which treatment is right for me?
You and your health care provider can discuss the benefits and risks of each
treatment, based on your condition. The method used to treat your condition will
depend on the nature of your problem and the severity of your symptoms.
Personal factors, such as your desire to have children in the future, will
also affect the treatment options that are available to you.
Uterine Disorders and Treatments
Uterine fibroids (leiomyomas)
Hormone medications can be prescribed to shrink uterine fibroids, but
fibroids can return when the medication is stopped. Since the medications mimic
menopause, they may also cause symptoms of early menopause.
Uterine artery embolization is a non-surgical option performed by an
experienced radiologist. During the procedure, the uterine artery is blocked.
This artery supplies blood to the fibroid. Blocking the blood flow helps shrink
the fibroid.
Depending on the severity and positioning of the fibroids, a myomectomy can
be performed to remove the fibroids only, while keeping the uterus intact.
Endometriosis
Oral contraceptives can be used to treat endometriosis, since preventing
ovulation can reduce the discomfort often associated with the condition. Hormone
medications may be used to shrink the endometrial tissue that implants outside
of the uterus. If medications do not effectively treat endometriosis, the
endometrial tissue can be removed by laparoscopy or laparotomy, with or without
laser therapy.
Uterine prolapse
Uterine prolapse may be improved in some cases with Kegel exercises, which
strengthen the pelvic floor muscles that support the uterus and control urine.
Since the pelvic floor muscles can become stretched due to obesity or chronic
cough, losing weight and quitting smoking can also help relieve pressure on the
pelvic muscles.
Another treatment for uterine prolapse is a pessary, a device placed in the
vagina to hold the uterus and bladder in place.
For women past menopause, taking hormones can help keep the pelvic muscle
tissues stronger.
Cervical dysplasia
Precancerous changes of the cervix (cervical dysplasia) that are detected
early
by a Pap test can be treated conservatively, such as with a loop
electrosurgical excision procedure (LEEP). The LEEP procedure removes the
abnormal cells.
When cervical disease moves into deeper tissue layers or spreads into other
organs (as in cervical cancer), hysterectomy is usually necessary (sometimes in
conjunction with radiation and chemotherapy).
Abnormal bleeding
The treatment for irregular, severe, or heavy bleeding depends on the cause.
Fibroids, endometrial polyps, changes in hormone levels, infection, or cancer
can cause abnormal bleeding.
Treatments for abnormal bleeding include dilatation and curettage (D&C),
in which the lining and contents of the uterus are removed; and hormone
medications such as progestins, GnRH agonists, and nonsteroidal
anti-inflammatory medications (NSAIDs).
Hysteroscopic evaluation and management, including polypectomy, myomectomy,
or endometrial ablation, may also be quite effective.
Condition
Alternatives to Hysterectomy
Uterine fibroids (leiomyomas)
1. Gonadotrophin-releasing hormone (GnRH) medication
2. Uterine artery embolization
3. Surgical removal (myomectomy)
Endometriosis
1. Oral contraceptives
2. GnRH medication
3. Laparoscopic surgery
4. Laparotomy without hysterectomy
Uterine prolapse
1. Pelvic floor exercises
2. Pessary (device worn in vagina)
3. Hormone replacement therapy (HRT)
Cervical dysplasia
(pre-cancerous changes)
1. Loop electrosurgical excision
procedure (LEEP)
Abnormal vaginal bleeding
1. Dilatation and vaginal curettage (D&C)
2. Nonsteroidal anti-inflammatory medication (NSAID)
3. Progestins (hormones)
4. GnRH medication
5. Hysteroscopy with polypectomy, myomectomy, or ablation
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