Cattails

Hysterectomy alternatives are available for some

For women experiencing abnormal uterine bleeding, fibroids or chronic pelvic pain, hysterectomy may seem a likely solution. But treatment approaches have changed. Alternatives to hysterectomy may achieve more satisfying results.

"Cancer, chronic pelvic pain, abnormal uterine bleeding or fibroids, other uterine irregularities, and cervical or ovarian cancer - these are all conditions that may warrant a hysterectomy," said Lloyd Bakken, M.D., obstetrician/ gynecologist at Marshfield Clinic Minocqua Center. "In many cases, patients do have treatment options."

Hysterectomy is the surgical removal of the uterus. Depending on the reason for the surgery, it may include removal of other organs and tissue, such as the ovaries.

"A woman's age, childbearing plans, size and location of fibroids or symptom severity are important factors to consider. If the need to treat is not life-threatening, time may be on the patient's side," said Dr. Bakken. "Treatment may begin with medication therapies such as oral contraceptives or hormonal therapies to shrink fibroids or minimize symptoms." Procedural options may follow if these medical approaches are determined ineffective or unsatisfactory, he added.

Dilation and vaginal curettage (D&C) has been a common first-line procedural approach to remove uterine lining tissue. Endometrial ablation is now used more frequently. This procedure uses a hysteroscope to circulate heated fluid, which destroys the uterine lining. Patients are under general anesthesia during the procedure.

"For many patients, this is a quick procedure offering minimal discomfort," said John Twelmeyer, M.D., Marshfield Clinic Minocqua Center obstetrician/ gynecologist. "Patients generally recover within 24 hours and are achieving the desired outcome to significantly reduce or eliminate pain and excessive bleeding."

Despite these options, hysterectomy may be necessary. "The good news is that medical advancements have led to improvements with the procedure," said Dr. Twelmeyer. "Same-day hysterectomy surgery is more routinely available with laparoscopic or minimally invasive techniques and technology."

Leaving the ovaries intact often prevails over reasons for removing them, Dr. Twelmeyer added. Family history of ovarian cancer is a consideration.

If left untreated, uterine bleeding and pain may lead to anemia or overuse of pain medications. "When these conditions affect a woman's daily activities or quality of life, exploring treatment options can be a good first step," said Dr. Bakken.

Long-term implications for a woman's health, family planning, sexuality and quality of life are important considerations for both medication therapy and procedural options, Dr. Bakken noted. "To make an informed decision, a woman needs to understand the possible consequences. Consultation with an experienced gynecologist can help determine the appropriate treatment option."