New Treatments Can Help You Avoid Hysterectomy


New Treatments Can Help You Avoid Hysterectomy

Preparing for a hysterectomy?

Think twice. You might not need it!

One out of three women has a hysterectomy (surgery to remove the uterus) by age 60. But only 10 percent of hysterectomies are to prevent or treat cancer. The rest are for conditions that today may be treatable with less invasive options.

Hysterectomy used to be the only option for women suffering with excessive bleeding, endometriosis, benign tumors and other uterine conditions. But that’s no longer the case.

Less Invasive Procedures Help Uterine Conditions

New, less invasive procedures can be just as effective at treating some conditions while sparing the uterus. That means you can get relief without some of the unwanted effects of a hysterectomy, namely infertility and early menopause.

Below are examples of how less invasive procedures can help women suffering from uterine conditions:

Uterine Fibroids

  • As these benign tumors grow on the sides of the uterus, they can become painful and cause excessive bleeding. Removing the uterus used to be the only cure. But doctors today can surgically remove fibroids while preserving the uterus through hysteroscopic surgery, or minimally invasive or abdominal myomectomy. Other options include a uterine artery embolization, where a radiologist blocks the artery that supplies blood to the fibroid. Restricting blood flow helps shrink the fibroid. Hormone medications also can shrink fibroids, but they sometimes bring on symptoms of early menopause.

Endometriosis

  • In this condition, uterine tissue grows outside the uterus, causing painful cramps, extreme bleeding and infertility. Oral contraceptives may reduce discomfort. So can hormone medications, which shrink endometrial tissue. If medications aren’t effective, surgical procedures such as a laparotomy or minimally invasive laparoscopy can remove endometrial tissue without removing the uterus.

Uterine Prolapse

  • When pelvic muscles get weak, the uterus can “drop” (or “prolapse”) into the vaginal canal. This condition causes pain and sometimes urine leakage or difficulty passing urine or stool. You can strengthen your pelvic muscles by doing Kegel exercises, squeezing and releasing the muscles. Because pelvic muscles can weaken due to obesity or chronic cough, another way to strengthen them is by losing weight and quitting smoking. Another option is to insert a pessary, a small plastic or silicone device, into the vagina to keep the uterus and bladder in place. Or, if you are menopausal or perimenopausal, ask your doctor if hormone replacement therapy might be right for you -- it also can help keep your pelvic muscles strong.

Cervical Dysplasia

  • Cervical dysplasia is a precancerous change of the cervix, detectable with a Pap test. If the change is detected early, doctors can use a loop electrosurgical excision procedure (LEEP) to cut out the abnormal cells. But if the dysplasia moves into deeper tissue or spreads to other organs, a hysterectomy is the best and safest option to prevent cancer.

Abnormal Bleeding

  • Many things can cause abnormal bleeding, such as fibroids, changes in hormone levels, infection or cancer. Depending on the cause, available treatments include hormone medications, minimally invasive surgeries and hysterectomy.

If your doctor suggests a hysterectomy, always ask for a second opinion. An alternative treatment may be better for you.

By Lizabeth Brooks, MD

To see Dr. Brooks or one of the physicians in Cleveland Clinic's Center for Specialized Women’s Health, call 216.444.4HER or visit clevelandclinic.org/womenshealth.