A “hysterectomy” refers to a surgical procedure that removes a woman’s entire uterus, including the cervix. However, depending on the reason for surgery, a surgeon may recommend removal of other parts of the reproductive system such as the ovaries and fallopian tubes. In some cases, a woman may choose to preserve the cervix and have only the body (fundus) of the uterus removed.
Your physician may recommend a hysterectomy to treat the following:
- Uterine fibroids, which are typically non-malignant tumors of the uterine muscle
- Endometriosis, tissue from the interior lining of the uterus that grows outside the uterus.
- Heavy menstrual bleeding that fails to respond to non-surgical treatment.
- Prolapse of the uterus, which occurs when the uterus slips into, or protrudes from, the vagina.
- Endometrial hyperplasia, a precancerous over-thickening of the uterine lining.
- Cancers of the cervix, ovaries or endometrium.
Nevertheless, several promising alternatives to hysterectomy are now available for non-cancerous situations, according to Andrew I. Brill, M.D., a San Francisco gynecologist and director of Minimally Invasive Gynecology Surgery Program at California Pacific Medical Center. “These options can address common women’s pelvic problems while preserving the uterus and, in some cases, also preserving fertility and allowing future pregnancies,” he says.
- Medications for Heavy Uterine Bleeding — Two non-surgical options may help reduce bleeding while offering birth control: birth control pills and the Mirena IUD. The Mirena IUD is inserted into the uterine cavity where it gradually releases a progesterone-like hormone that thins the uterine lining. More recently, a medication to improve blood clotting in the uterus also has helped women with heavy uterine bleeding.
- Endometrial Ablation — Endometrial ablation uses heat to remove the lining of the uterus. The heat can come from a device inserted into the uterine cavity. Endometrial ablation is especially useful for women with chronic heavy uterine bleeding who otherwise have a normal uterus and uterine lining, which can be confirmed by biopsy. The procedure can take place in the doctor’s office or as an outpatient procedure, with pain medication used to treat the discomfort immediately following the procedure. Since endometrial ablation destroys the endometrium, or lining of the uterus, it is not an option for women who still wish to have children.
- Myomectomy — During myomectomy, the doctor removes uterine fibroids through a standard incision in the abdomen or by laparoscopy, a type of surgery that uses a small telescope and instruments that are passed through very small incisions. Myomectomy may be the surgical procedure of choice for women who have fibroids but still wish to become pregnant. ”Success can vary depending on the location of the fibroids and the skill and experience of the surgeon, so it is not an option for everyone,” Dr. Brill says.
- Uterine Artery Embolization — Uterine Artery Embolization helps shrink fibroids in women who are not good candidates for surgery. During the procedure, a radiologist injects microscopic pellets via a large artery in the groin that provides blood flow to the uterus. By targeting the specific area of a fibroid, uterine artery embolization can starve the fibroid of its blood supply, causing it to shrink in size over time. Although heavy bleeding often improves with this procedure, volume shrinks only 40-50 percent. The procedure requires at least an overnight stay, as the treatment results in temporary, severe discomfort that requires intravenous pain medications. Certain types of fibroids, best identified using MRI, cannot be treated by this technique.