The MenopauseRx Hysterectomy Guide

Hysterectomy Options

Although hysterectomy is a leading choice for many women with gynecologic problems, many disorders can respond to conservative medical treatments. A thorough discussion regarding medical and hormonal treatments should occur for bleeding, fibroids and pain. For example, bleeding due to endometrial thickening or thinning can be successfully treated with medications such as low dose birth control pills or progesterone supplementation. A treatment used to diminish estrogen production, called a GnRH agonist (such as Depo-Lupron) can treat conditions such as endometriosis, adenomyosis, and fibroids. Also, a special type of device placed in the uterine cavity, called an intrauterine device (IUD or IUS) can be very helpful to control heavy bleeding due to endometrial thickening. While many of these treatments are highly successful, they all have their own pro’s and con’s, including potential side effects, contraindications and specific patient issues. Therefore, it is prudent to discuss all of your treatment options with your health care provider.

There are also a number of conservative surgical procedures that can be useful to control gynecologic problems without the need for hysterectomy. Heavy bleeding due to uterine reasons such as hormonal endometrial thickening can be treated by destroying the endometrial lining using a technique known as endometrial ablation. Polyps and/or fibroids impinging upon the uterine cavity can be selectively removed using a scope placed inside the uterine cavity and removing the growth(s). This is called hysteroscopic endometrial resection. A very specialized procedure done by radiologists can precisely limit blood flow to the uterus and diminish heavy bleeding. This is called a uterine artery embolization.

Pelvic pain due to endometriosis or scar tissue/adhesions can be treated with small incisions in the abdomen to allow a small scope and instruments into the pelvic region. Called laparoscopy, this is the same type of procedure used in commonly done operations to remove the appendix and gallbladder. Removing the endometriosis or scar tissue can effectively treat pain without the need for hysterectomy in select individuals.

Pelvic prolapse procedures may or may not include hysterectomy. The key element is re-supporting the tissues that have dropped or fallen. There are a number of techniques available, with numerous improvements in materials and equipment. Often, using materials such as surgical mesh is used in pelvic prolapse surgery. The specific type of mesh is dependent upon the surgeon preference and type of prolapse present.