Alternatives to Hysterectomy (Surgical Removal of Uterus)

A hysterectomy is a surgical operation to remove the uterus, the organ located in the female pelvis.

During pregnancy, a fertilized egg implants itself in the lining of the uterus where the developing fetus is nourished prior to birth.

Also known as the womb, the uterus is crucial for reproduction.

After undergoing a hysterectomy, a woman cannot become pregnant.

You Have Options Besides a Hysterectomy (Removal of the Uterus)

With the exception of certain gynecological cancers or more rarely a life-threatening situation, such as uncontrollable bleeding after childbirth, there are alternatives to treat every condition and symptom where a hysterectomy is an option.

Options range from medications and hormone treatments to minimally invasive procedures. Since most hysterectomies are elective, a woman usually has time to discuss other means to manage symptoms that may be interfering with the quality of her day-to-day life.

Treating Fibroids Without Hysterectomy

Fibroids are the No. 1 reason for hysterectomies in the United States. Fibroids, also known as leiomyomas or myomas are the most common tumors of the female reproductive systems. They are benign (noncancerous) and arise from the smooth muscle cells of the uterus. Some estimate that up to 80 percent of all women develop fibroids during their childbearing years. (1)

Because they often cause no symptoms, fibroids are usually detected incidentally during a pelvic exam or a prenatal ultrasound. (2)

Fibroids: What Are the Signs and Symptoms?

Symptoms include heavy menstrual bleeding, prolonged menstrual periods (lasting more than a week), pelvic pain, frequent urination, low back pain, or painful intercourse.

While symptoms often respond to medications or nonsurgical treatment, sometimes the symptoms are severe enough to consider a hysterectomy. Hysterectomy is the only permanent solution for uterine fibroids.

Fibroid Treatment Options: Can You Simply Ignore Fibroids?

Yes, you can “watch and wait” before treating fibroids. In the majority of cases, these tumors are asymptomatic and women only learn that have fibroids through a routine gynecological visit.

Fibroid growth and the severity of symptoms are unpredictable and arbitrary — sometimes fibroids stay the same size or shrink on their own without any treatment at all. So, many women decide to “watch and wait” before turning to surgery, especially when symptoms are mild or nonexistent. When symptoms such as bleeding, pelvic pressure, and pain occur, it’s sometimes related to the location of the fibroids rather than their size or number.

If you choose to treat the fibroids, you have several alternative options to a hysterectomy.

These fibroid treatment options include:

Medications to Slow Fibroid Growth and Lessen Bleeding

• Gonadotropin-releasing hormone (GnRH) agonists. (Lupron, Synarel) work by blocking the production of estrogen and progesterone, temporarily stopping menstruation and shrinking fibroids. However, because long-term use can result in severe osteoporosis, these medications are typically used for no longer than six months. Sometimes they are used to in conjunction with other treatments (for example when a woman is close to menopause) or to shrink fibroids that are too large to enable a minimally invasive approach.
• Progestin-releasing intrauterine device (IUD). This can help relieve heavy bleeding.
• Lysteda (tranexamic acid). Many women find relief from the heavy bleeding caused by fibroids with this nonhormonal medication that improves blood clotting.

Other medications and treatments:

Nonsteroidal anti-inflammatory drugs (NSAIDS), including ibuprofen and naproxen, manage pain but don’t decrease bleeding or shrink fibroids.

Iron supplements Your doctor may suggest you take special vitamins if heavy bleeding due to fibroids is causing you to be anemic.

Noninvasive and Minimally Invasive Procedures for Treating Fibroids

• MRI-guided focused ultrasound (FUS) uses focused high-frequency, high-energy sound waves to target and destroy the fibroids.
• Uterine fibroid embolization/uterine artery embolization uses small synthetic particles injected into the uterine artery to block its blood supply. Once the blood supply is cut off, the fibroids die and shrink over the next few weeks to months. Studies have shown a significant risk of miscarriage and the risk of other complications in pregnancy after this procedure, so this option may be better suited for women who don’t plan to become pregnant in the future. (3)
• Laparoscopic myolysis involves destroying a fibroid through extreme heat or cold.
• Myomectomy is the surgical removal of the fibroids without removing the uterus, which enables future pregnancy. As with all other uterus-sparing procedures, there is a risk of fibroid recurrence.

Treatment Options for Endometriosis (Besides Hysterectomy or Surgical Removal of Uterus)

Treatment for endometriosis can involve medication and/or surgery. As with fibroid treatment, a woman with endometriosis has some alternative options to a hysterectomy. Pain medications can help. And hormone therapy can be effective in reducing and eliminating the pain of endometriosis by slowing endometrial tissue growth and preventing new implants (lesions).

The following more conservative options are available to help with symptoms of this often painful condition.

• Pain medications such as nonsteroidal anti-inflammatory drugs (NSAIDS) and ibuprofen (Advil, Motrin IB) are available over the counter and may help ease painful menstrual cramps.
• Orilissa (elagolix) is a new oral drug recently approved by the FDA for the treatment of moderate to severe endometriosis pain.
• Birth control pills may help control the buildup of endometrial tissue that can occur each month.
• Therapy that uses progestin (or synthetic progesterone) such as the Mirena IUD thin the lining of the uterus (and potentially decrease endometrial implants).
• Gonadotropin-releasing hormones (GnRH agonist) can cause endometrial tissue to shrink.
• Aromatase inhibitors are drugs that inhibit the conversion of androgens (such as testosterone) and have been shown to alleviate associated pain.

Other Surgical Options for Treating Endometriosis

Using laparoscopic techniques, surgeons can remove visible endometriosis and scar tissue through cutting (excising), burning, or lasering.

Laparotomy is major abdominal surgery to remove the endometriosis patches.

Another endometriosis treatment is presacral neurectomy, which severs the nerves connected to the uterus to relieve pain.

Some women opt to watch and wait until reaching menopause when endometriosis growth can recede. However, even after menopause your body still produces estrogen, so while symptoms may lessen, they can persist.

Alternative Treatments for Other Conditions That Sometimes Warrant Hysterectomy or Removal of Uterus

Adenomyosis, a condition which results in an enlarged uterus, painful periods, and abnormal bleeding, can be treated in much the same way as endometriosis with hormone medications (including birth control pills, IUD). Anti-inflammatory drugs such as ibuprofen (Advil, Motrin IB) can reduce menstrual blood flow and relieve pain.

Uterine Prolapse and Other Pelvic Support Problems

Women with these conditions may experience pelvic pressure, urinary incontinence, or difficulty making bowel movements. Alternatives to hysterectomy include:

• Laparoscopic surgery to repair weakened supporting ligament muscles.
• Vaginal pessary (a fitted, rubber device inserted into the vagina to hold the uterus in place).
• Kegel exercises, which can help in some cases of early prolapse by strengthening pelvic muscles. This type of physical therapy can be especially important after you have a baby.

Treatments for Chronic Pelvic Pain (Besides Hysterectomy)

Depending on the condition causing the pain, treatment can include medication, physical therapy, biofeedback, or minimally invasive procedures such as trigger point injections or peripheral nerve blocks.