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Alternatives to Hysterectomy

A hysterectomy is a common surgery in the United States. In fact, nearly five out of 1,000 women will undergo this surgical process. Hysterectomies are done to relieve a woman of her pain or save her life.

Are hysterectomies done too frequently? Some people including physicians agree that hysterectomies are overdone. However, there are certain cases in which a hysterectomy is the only option such as uterine or ovarian cancer.

Hysterectomies should be the last resort for most medical problems, including abnormal uterine bleeding. In fact, over 600,000 hysterectomies are performed for this very reason. However, there are newer options that can treat any non-life threatening diseases rather than going through a hysterectomy.

When compared with a hysterectomy, the newer techniques/medicines mean there's less of a risk, you recover faster and it's far less costly. For some reason, these techniques are great because they can give you the ability to become pregnant later in life.

As with any good thing, there are are also some negatives to these newer techniques. For instance, there often has been no evidence of long-term safety and there's not been enough time for proof of the new technique's effectiveness. Still, it's always good for a woman to ask for alternatives as opposed to just accepting the hysterectomy as is.

Sufferers of Abnormal Uterine Bleeding

For any woman 30 years old or younger, a hysterectomy is the most commonly selected treatment for abnormal uterine bleeding. What is abnormal uterine bleeding? It's when the woman deals with infrequent, unpredictable or lengthy bouts of heavy bleeding between and during periods.

Causes of Abnormal Uterine Bleeding

There are several causes of abnormal uterine bleeding. What are the causes?

  • Fibroids
  • Growth of endometriosis
  • Imbalances of hormones

There are cases in which no single cause has been discovered for the woman's bleeding. In any case, the bleeding is a major inconvenience and can be quite uncomfortable and painful to deal with. Long-term, heavy bleeding can cause a life-threatening condition known as anemia.

Medications For Abnormal Uterine Bleeding

One of the first treatments doctors use for abnormal uterine bleeding is a medication such as estrogens and progestins. However, these can only be used in specific cases. Oral treatments are sometimes used but have not been approved by the FDA.

Alternative Treatment For Abnormal Uterine Bleeding – Endometrial Ablation

When you suffer from abnormal uterine bleeding, there is another option to hysterectomy called endometrial ablation. What does this entail? It uses electric energy, cold or heat to get rid of the endometrium in the efforts to stop the bleeding.

There is a catch with endometrial ablation: The treatment is not permanent. The ablation method also has several risks attached to it, including cervical laceration, infection, uterus perforation and consuming copious amounts of fluid.

Who Should Not Consider Endometrial Ablation

Women who would like to have children in the future should not consider endometrial ablation. It should not be considered as a form of birth control. If a woman was to get pregnant after the treatment, she would have a high-risk pregnancy due to the lack of uterine lining for the fetus to attach to.

How The Treatment Is Performed, Side Effects To The Procedure and Complications

This treatment is typically done as an out-patient procedure with only a local anesthesia. Some women do stay overnight due to complications that can arise with most surgical procedures.

There are side effects with this procedure that include: nausea, vaginal discharge and vomiting. Complications that can arise with it include blood loss that requires a blood transfusion, damage to internal organs that was done accidentally and uterine perforation.

A Cause for Abnormal Uterine Bleeding – Fibroids

Approximately 200,000 hysterectomies are performed each year to rid a woman of her fibroid problem, which can be very small or very large. Fibroids are also a cause behind abnormal uterine bleeding. While the majority of fibroids go unnoticed, some can cause you heavy bleeding and/or pain.

It's possible that large fibroids can make a uterus swell. This means that a hysterectomy will be necessary.

Medications To Help With Fibroids

If you're looking for a temporary fix to your fibroids, your doctor can prescribe medications that can help. If you have anemia, your doctor will want to give you an injection containing a gonadotropin-releasing hormone that will stop any estrogen production for three months before your surgery. Estrogen is a cause for fibroids and stopping its production means the fibroids will begin to shrink.

However, the injections have their own risks and side effects. These include bone density loss, hot flashes and mood swings. Therefore, the injections are not to be used for more than three months. Without an operation, fibroids will grow once more.

A surgeon may suggest that a woman get rid of just the fibroids during the process. This process is called myomectomy and can be done using one of two techniques.

First, cut off the blood supply flowing to the fibroids. Second, use myolysis to shrink the fibroids. Myolysis (using of an electric current) is not often suggested because there are no long-term safety records.

The procedure chosen will depend on several factors including:

  • Size of fibroids
  • Location of fibroids
  • How severe the symptoms are
  • If the woman wants future children

Before undergoing any treatment, your physician will need to get a sample of your uterine lining to make sure that there are no cancer cells present.

Myomectomy

What is a myomectomy? It's a surgical process in which the surgeon will remove the fibroids and leave the uterus alone. This means a woman can still have children in the future.

Keep in mind that myomectomy is a major surgery and will have similar disadvantages to a hysterectomy. For starters, there's the possibility of scarring and pain. Another drawback to myomectomy is that the uterine wall is usually weaker, and any children might need to be delivered by cesarean section.

A myomectomy tends to be a bit more complicated than a hysterectomy because the uterus will need to be reconstructed.

Uterine Fibroid Embolization

Another way to be rid of fibroids is to block the arteries that carry the blood to them. It's called uterine fibroid embolization or uterine artery embolization. This procedure is not nearly as invasive as a hysterectomy or myomectomy.

A gynecologist will need to examine you first for possible problems that could cause bleeding. Local anesthesia is used during the process while the radiologist threads a small tube into the uterine artery. Afterward, a dye is injected to view the blood flow to the fibroids.

Once this is done, embolic agents will be injected slowly through a catheter to block fibroids from receiving the blood supply. One thing to note is that this process has been done for more than 20 years, but mainly to stop hemorrhaging. It wasn't until the 1990s that the procedure was applied to fibroids.

Possible Problems With Uterine Fibroid Embolization

There are many risks with this type of procedure; yet, if you want to have children following the procedure, this method allows for that possibility. So what are the other risks?

  • Possible ovarian failure, which can lead to early menopause
  • Infection
  • Fibroid expulsion from the uterus, which means another surgery down the road
  • Radiation exposure complications
  • Blood clotting
  • Blockage of artery in lungs
  • Death

 

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