Alternatives tohysterectomy

There may be a non-surgical alternative to hysterectomy, depending on your circumstances.

Although it’s considered a relatively safe and low-risk surgery, a hysterectomy isn’t the best option for every woman. The recovery time for hysterectomy can be prolonged, depending on the type of surgery you have. Once you’ve had a hysterectomy you won’t be able to have children, so if you want to preserve your fertility, you’ll most likely want to explore other options first.

Some conditions that can be solved with hysterectomy have alternative treatments. Some alternative procedures are not performed by gynaecologists, so you may need to seek out a different type of practitioner.

Except for cancer, if your symptoms aren’t too bad, you may be able to delay hysterectomy until things either get better or worse. Here are some treatment options for a range of conditions which you can discuss in depth with your doctor:

• Endometriosis. This is where tissue from your uterus grows in other parts of your body, causing pain and bleeding. While hysterectomy is a treatment option for endometriosis, it doesn’t always work and your symptoms may persist. If you’re hoping to preserve your fertility, minimally invasive keyhole surgery to remove the affected tissue is a possible option. The symptoms of endometriosis may be relieved with painkillers, birth control drugs and drugs that block the production of oestrogen by your ovaries.
• Fibroids. These are benign tumours that can grow inside your uterus. For treatment of symptoms caused by fibroids, possible alternatives to hysterectomy include surgery to remove the fibroids alone as well as uterine fibroid embolisation, a procedure that cuts off the blood supply to the fibroids. Certain interventional radiologists offer embolisation. The symptoms of fibroids can also be relieved with painkillers and with drugs that block the production of oestrogen by your ovaries.
• Adenomyosis is a condition in which the inner lining of your uterus grows into the muscles of your uterus. It can cause long, heavy, painful periods plus abdominal pressure and bloating. The symptoms can be relieved with painkillers, oral contraceptives and drugs that block the production of oestrogen by your ovaries.
• Heavy vaginal bleeding. This can cause pain, mood swings and disruption to your life and work. Oral contraceptives or an intrauterine device that releases a hormone can be helpful. If you’ve finished having children, you could try endometrial ablation, where the lining of your uterus is removed. Your gynaecologist can do this as an outpatient procedure. If your first endometrial ablation is not successful, where possible, your doctor may suggest doing it a second time.
• Uterine prolapse. When your uterus drops from its normal position and pushes against the wall of your vagina, it can cause discomfort, back pain, vaginal discharge and painful sex. Depending on the severity of your prolapse, pelvic floor exercises or a device called a pessary (that supports the uterus from inside your vagina) can be tried. In some cases, a procedure to put your uterus back in position can be performed as keyhole or open surgery.
• Chronic pelvic pain can have a number of causes and treatment tends to be more successful if the cause can first be identified. Oral contraceptives, painkillers, trigger point injections and psychological therapies may be alternatives to hysterectomy, which don’t always cure the problem. If your pain is due to an infection, then antibiotics may help.

If you’re using painkillers, oral contraceptives, an intrauterine device or an oestrogen-blocking drug to control symptoms, your symptoms will most likely return when you stop taking them or have an intrauterine device removed. If you want to try for a baby, you’ll have to stop using hormone-containing therapies.