It’s frightening how many doctors resort to hysterectomies, often treating it as a go-to surgical procedure. In reality, there are more suitable and less invasive alternatives to this type of surgery.
What Is A Hysterectomy?
Hysterectomies are operations that remove part or all of a woman’s uterus.
The most common type of hysterectomy is the total abdominal hysterectomy or TAH. Approximately 65 percent of all hysterectomies are TAHs. During a TAH, an incision is made into the abdomen to access the uterus. At that point, an incision can be made to remove the uterus; this process is known as a vaginal hysterectomy.
Common Reasons To Have A Hysterectomy
There are several reasons why a woman would be encouraged to undergo a hysterectomy including:
● Abnormal vaginal bleeding
● Uterine prolapse: The uterus slides out of its normal position into the vaginal canal.
● Endometriosis: The tissue that typically lines the uterus instead grows outside of the uterus.
● Cancer (of the cervix, uterus, or ovaries)
● Adenomyosis: Thickening of the uterus
● Chronic pelvic pain
Hysterectomies To Treat Uterine Fibroids
The most common reason for a hysterectomy is uterine fibroids. Fibroids are muscular growths in the uterine wall. While typically benign (one in one thousand are malignant), uterine fibroids can cause excessive bleeding, pain and discomfort, and reduce a woman’s chances of becoming pregnant. Forty percent of women are said to develop this condition by age 40.
Large fibroids can cause a serious bleeding condition known as menorrhagia. It can result in embarrassing situations in public due to bleeding through clothing. However, one of the most concerning aspects of the condition is that blood loss can lead to anemia in women. One in five women between the ages of 35 and 49 suffer from menorrhagia.
Why Choose An Alternative To Hysterectomies?
A hysterectomy may be positioned as an “elective surgery,” but it is often a life-changing procedure. Many women who undergo hysterectomies either immediately enter menopause or begin menopause years earlier than they otherwise would. If a woman wants to get pregnant, a hysterectomy makes this impossible.
Potential side effects may be disconcerting to women. These include blood clots, hemorrhaging, infections, or damage to nearby organs. Hysterectomies require weeks or months of recovery, during which a woman may cope with changes to her sex life that can impact her relationship with her partner. Incontinence and chronic pain are also cause for concern.
Side effects aside, seeking an alternative to a hysterectomy is perfectly logical. “Women no longer need to choose between suffering and major surgery,” explains Dr. Glenn Schattman, a reproductive surgeon at the New York Presbyterian Hospital. Scattman told the New York Times that “the overwhelming majority of [women]” now have the opportunity to be “treated with minimally invasive procedures or medication.”
Here are some of the alternatives.
Myomectomy
Myomectomies are surgical procedures to remove fibroids from the uterus. For women who wish to have children, a myomectomy could even increase her chances of becoming pregnant.
Myomectomies can be done a number of ways.
● An abdominal operation
● Laparoscopic myomectomy: Entering through the naval
● Hysteroscopic myomectomy: Entering through the vagina while using a hysteroscope (thin, long telescope-type tool).
Laparoscopic or hysteroscopic procedures may be utilized as they are more cost-effective, less invasive and involve a far shorter recovery time. For women seeking to cope with fibroids, myomectomies are said to control symptoms nearly 80 percent of the time.
About 10 percent of women who get myomectomies require additional surgery because fibroids grow back. There is also a chance of uterine scarring.
Uterine Artery Embolization
Uterine artery embolization (UAE), also known as uterine fibroid embolization (UFE), is a procedure where the fibroids are injected with small particles that cause them to shrink. Not only does a UAE prevent the loss of the uterus, it is also ideal for women who wish to avoid surgeries altogether.
Although an option for uterine fibroids, the process is mainly used to stop hemorrhaging after childbirth or surgery.
"Many gynecologists don't offer [the UAE] because they have no personal experience with it, or because it involves a different medical specialty," said Dr. James Spies, a Georgetown University specialist in treating fibroids. "In medicine, we tend to run in tribes, all reading our own sets of journals, so a new procedure by another specialty can easily get overlooked."
The UAE procedure improves symptoms in 85 to 90 percent of patients.
Medication
Painful conditions, such as uterine fibroids, may be temporarily treated with nonsteroidal anti-inflammatory drugs (NSAIDs).
It’s also possible that certain estrogen/hormone-blocking drugs may be used to reduce or treat symptoms. These drugs can cause pre-menopausal symptoms and a loss of bone density.
Usually, medication is a temporary alternative that is offered prior to surgery to remove fibroids.
Greater Education Required About Alternatives To Hysterectomies
Too many women mistakenly believe that a hysterectomy is their only choice. This often leads them to delay any form of treatment.
“I can’t believe how many women are essentially bedridden during their periods for a year or two before they see a doctor,” said Dr. Schattman. “They are still scared that heavy bleeding means they will need a hysterectomy.”
Unfortunately, that fear is tied to misinformation and a startling number of medical professionals who only recommend a hysterectomy, even if a less invasive and more efficient option is available. According to a study published in the Journal of Obstetrics and Gynecology, hysterectomies had been "inappropriately" recommended to 367 of 497 women. Even more troubling, sixteen percent of women had received hysterectomies for reasons that were “clinically” wrong.
Dr. Michael Broder, an assistant professor of obstetrics and gynecology at the University of California School of Medicine in Los Angeles, said that it was common for women patients never be offered “less invasive treatment” options. Said Dr. Broder, "It seems pretty likely there are more hysterectomies done in this country than can be justified."
Hysterectomies are more common than they should be, but this can change as women become better educated about alternatives. Before accepting that a hysterectomy is your only option, it’s best to be informed about other possibilities and to talk with your doctor about what procedure is best for you.