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Diseases & Conditions Leading to Hysterectomy - Options and Alternatives
So You've Been Told You Need a Hysterectomy?
If you've been told you need a hysterectomy you might be feeling a bit overwhelmed. This is normal!

This is the time to dig in, do some research, listen with both ears and consider your options.

Where do you begin?

Explore these questions:

  • Have I tried all the alternative treatments?
  • Are my symptoms so unbearable as to make my life a misery?
  • Will the operation relieve all my symptoms?
  • Will there be any unexpected consequences - am I prepared for an earlier menopause?
  • Do I still want to have children?
  • What will happen if I decide not to have a hysterectomy?

    Exploring these questions for yourself is key to moving forward with a plan for a healthier future. Your peace of mind and your health depends on it!

    Fibroids
    Fibroids are abnormal growths of the uterine muscle that are generally benign. They are usually discovered during a routine pelvic exam.

    Non-symptomatic fibroids may require no treatment or surgery. Rather, the doctor may require frequent check-ups (usually every 6 months) to monitor.

    If symptoms are present, fibroids are usually associated with pressure, irregular uterine bleeding, abdominal enlargment or pain.

    For most women with symptomatic fibroids the decision to treat the uterine fibroids is based on issues of quality of life

    Depending on the size and placement of the fibroids, treatment may involve surgery or hormone therapy or both.

    Treatment Options for Fibroids

  • Myomectomy - Fibroids surgically removed, uterus wall carefully repaired.
    -Abdominal incision
    -Laparoscopic surgery - Endoscope is passed through small abdominal incisions.
    -Hysteroscopy - A tiny lighted telescope passed through the cervix into the uterus. No external incisions are needed.
  • Hormone treatment for temporary shrinkage of fibroids (example: Lupron)
  • Uterine Artery Embolization (UAE or UFE) - Procedure in which arteries are blocked, cutting off blood supply to the uterus.
  • Myolisis - Laparoscopic procedure, laser, or electric current is applied to fibroid to coagulate the tumor and its blood supply. Coagulation causes the fibroid to shrink and not return. Similar procedure: cryomyolysis freezes the fibroid.
  • Hysterectomy - Removal of uterus.

    Each day brings news of new treatments for Fibroids which are not addressed here. Explore your treatment options thoroughly.

    Endometriosis
    Endometriosis is a condition in which endometrial tissue grows outside the uterus, usually in the pelvic cavity. It is not a malignant or premalignant condition.

    Symptoms of endometriosis are characterized by pain: pain with menstruation, pain with sexual intercourse and increasingly severe pelvic pain.

    The intensity of suffering caused by endometriosis varies from woman to woman. For most women, a hysterectomy is not necessary to treat endometriosis and its milder symptoms.

    Treatment Options for Endometriosis

  • Continuous low-dosage combined oral contraceptives
  • Progesterone or Progestins
  • Lupron
  • Danazol - a weak compound with androgenic effects
  • Laparoscopy - to remove endometriosis from pelvic cavity.
  • Hysterectomy - removal of uterus and ovaries is used as a last resort for treatment. Although rare, some women's endometriosis is not cured with a hysterectomy.

    Each day brings news of new treatments for endometriosis which are not addressed here. Explore your treatment options thoroughly.

    Uterine Prolapse and Related Issues
    Muscular weaknesses in the pelvic area can result in protrusion or herniation of the uterus, vagina, bladder and/or rectum. Childbirth and aging can lead to a weakening of these muscles that provide pelvic support.

  • Rectocele - fallen rectum
  • Cystocele - fallen bladder
  • Enterocele - fallen small intestine
  • Uterine Prolapse - fallen uterus
  • Vaginal Prolapse - fallen uppermost portion of the vagina

    Non-Surgical Treatment Options for Prolapses

  • Hormone therapy (post menopausal women)
  • Pessary (A device inserted into the vagina to support the prolapse(s) & make the patient more comfortable. There are various sizes, types, and shapes of pessaries, each tailored to fit the individual woman.)

    Surgical Treatment Options for Prolapses

  • Anterior colporrhaphy - surgical correction of cystocele
  • Retropubic urethropexy - elevation of the angle between the urethra and bladder
  • Sling procedure to provide support for the urethra to increase the resistance to urinary flow
  • Posterior colporrhaphy or perineorrhaphy - correction of rectocele
  • Sacrospinous ligament colpopexy - correction of vaginal wall prolapse
  • Re-suspend uterus to preserve fertility
  • Enterocele repair - reinforcement of the vaginal supporting structures to prevent herniation of the small intestine.
  • Hysterectomy

    Prolapse repairs may be done with or without a hysterectomy.

    Abnormal Uterine Bleeding

    Abnormal or dysfunctional bleeding occurs for hormonal reasons, because of polyps, endometrial hyperplasia, and for other conditions including fibroids, adenomyosis, pelvic infection and uterine or cervical cancers.

    Bleeding can be an inconvenience or interrupt your daily activities and may be associated with pelvic pain and uterine cramping.

    Non-Surgical Treatment Options

  • Hormones to regulate ovulation and menstruating for hormone related bleeding
  • Progestin containing IUD (Intrauterine device) for endometrial hyperplasia.

    Surgical Treatments

  • Endometrial Ablation - Removal of the endometrial lining/tissue
  • Hysteroscopy - for removal of polyps in uterus and/or cervix
  • Hysterectomy - removal of uterus

    A hysterectomy is used to treat abnormal uterine bleeding only when other approaches have failed.

    Each day brings news of new treatments for excessive bleeding which are not addressed here. Explore your treatment options thoroughly.

    Pelvic Pain, Infection, Adhesions
    Chronic pelvic pain is a symptom, not a disease, and is a very common symptom. Approximately 10 percent of all women visiting their doctor complain of pelvic pain. This pain may be caused by a variety of conditions including pelvic infection, endometriosis, adenomyosis and pelvic adhesions (from a previous surgery). Other conditions that may cause pelvic pain but are unrelated to gynecology may be irritable bowel syndrome and interstitial cystitis (Discussed below).

    A diagnostic laparoscopy provides insight into the cause of the pelvic pain with the most common findings endometriosis and adhesions as the problem.

    Pelvic Infection/Pelvic Inflammatory Disease (PID) is an infection of the pelvic area and is difficult to diagnose but is usually cured with antibiotics.

    Pelvic Adhesions can usually be treated with laparoscopy.

    Non-Gynecological Causes of Chronic Pelvic Pain

  • addiction or substance abuse problem
  • anxiety
  • arthritis
  • chronic appendicitis
  • chronic interstitial cystitis (chronic bladder infection)
  • depression
  • lumbar disk disease
  • diverticulitis (intestinal inflammation)
  • fibromyalgia
  • hernia
  • inflammatory bowel disease
  • irritable bowel syndrome
  • physical or sexual abuse
  • scoliosis and posture related problems

    Interstitial Cystitis
    Interstitial cystitis is a chronic, and often severe, inflammation of the bladder wall, the cause of which is unknown. Primary symptoms are urinary frequency, urgency, and, for some, severe lower abdominal or perineal pain. However, IC patients rarely test positive for infection in standard urinalysis and urine cultures.

    In some cases, women wiith pelvic pain that is unexplained, a doctor may recommend a hysterectomy assuming her pain is gynecological when in fact her pain may be from undiagnosed Interstitial Cystitis.

    Unexplained pelvic pain should be explored to determine the cause before a hysterectomy is scheduled.

    Cancer
    Cancer is the most compelling reason for a woman to have a hysterectomy. A hysterectomy is usually performed to treat gynecological cancers: uterine cancer, cervical cancer and ovarian cancer.

    Cervical Cancer is easily detected in early stages from a pap smear.

    While hysterectomy is the usual treatment for all gynecological cancers, with cervical cancer, there are other treatment options including cryosurgery, LEEP, cervical conization and carbon dioxide laser. These options depend on your particular cervical cancer's progress/stage.

    Beyond the hysterectomy as a treatment for gynecological cancer, chemotherapy and/or radiation may also be necessary.

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