Alternatives to Hysterectomy
One of the most radical operations a woman can undergo is a hysterectomy. Every year up to 73,000 British women have their womb removed and also sometimes the cervix, ovaries and fallopian tubes.
The number of women having the surgery has dropped over the past five years. The figure used to be nearer 90,000 but Robin Parsons a specialist menopause nurse for the Amarant Trust - a research centre for women's health issues - says times are changing. In the Eighties there were huge numbers of hysterectomies done in hospitals around the UK. Women today have more options.
Sometimes a woman may decide that a hysterectomy is the best way to solve problems such as heavy periods, endometriosis, fibroids and PMT. In some situations with cancer of the uterus for example - there's little choice.
But its not an operation that can be undertaken lightly. You won't be able to have any more children, You'll need about 12 weeks off work and a full recovery can take up to two years. Some women experience depression or a reduced libido. If the ovaries are removed, it will result in the onset of the menopause, and women will usually need to go on hormone replacement therapy (HRT) to reduce the risk of osteoporosis and heart disease. One in 50 women experiences complications such as wound infections and there's a death rate of 1 in 2000 - so its no surprise that many seek other surgical and drug based options. Linda Parkinson-Hardman, Director of The Hysterectomy Association says athere are alternatives - many women just aren't aware of thema.
Linda suggests cutting down on meat to see if that helps relieve pain. aMeat tends to be full of hormones, antibiotics and some oestrogens which could make you more likely to suffer from endometriosis and fibroidsa, she says.
* A low dose contraceptive pill can reduce bleeding in half of the women who try it.
* Tranexamic acid which is used to promote blood clotting can cut bleeding in 60% of cases, although pain is not reduced.
* Mefanamic acid, an inflammatory drug can reduce bleeding by 20% and ease period pain. But side effects include nausea, vomiting and kidney problems. These drug treatments will not affect your long term fertility.
* A new treatment called uterine artery embolisation can be used to treat fibroids. Small particles of a grainy type substance are passed into the arteries to block off the blood supply to the fibroids so they die or are reduced in size. The fibroids can shrink by 50% in three months.
Designed as a contraceptive, the Mirena Intrauterine System (IUS) or coil can also reduce heavy bleeding. It's fitted by your GP and left in place. After three months use average blood loss is reduced by 85% and by 12 months the flow is reduced by 97% every cycle. About one third of women will have no periods at all, as the progesterone in the IUS prevents the lining of the womb from building up.
One study looked at 54 women with heavy periods who were awaiting a hysterectomy. After being fitted with the Mirena IUS, just under 70% were taken off the waiting list because they were so happy with the treatment.
Possible side effects include headache, water retention and breast tenderness. Pregnancy is rare, but if it does occur it is advisable to remove the contraceptive as soon as possible to reduce the risk of bleeding, infection or miscarriage.
Endometrial ablation - the womb lining is removed with lasers, electro-surgery or cryotherapy (freezing). It can be used to treat heavy bleeding, fibroids and polyps with a success rate of about 85%.
Balloon thermo ablation - a latex balloon containing a heating element is passed into the uterus and inflated with fluid. It then heats up, destroying the uterus lining. It reduces heavy periods in 85% of cases.
Myomectomy - the surgical removal of fibroids, leaving the uterus intact. This is best suited for small fibroids.
Laparoscopically assisted hysterectomy - a relatively new procedure the uses keyhole surgery to insert a small viewing instrument into the abdomen. The surgeon can then remove the uterus or ovaries if required through the vagina. The small incisions leave the woman with minimal scarring which should reduce recovery time to 6-8 weeks. But the operation takes longer to perform and there is a greater risk of complications. This method is not suitable for women with large fibroids or ovarian tumours.
You can find out more about all the alternatives to hysterectomy on The Hysterectomy Association's website at: www.hysterectomy-association.org.uk
Frequently Asked Questions
novasure womb ablation - has any woman had this done?
I am due for this operation in january but I am not entirely convinced that this operation is going to solve my problem. I have spoken to my doctor and she is going to write to the specialist that will carry out the procedure about my concerns.
I would like to hear from anybody who has had to have this done or is waiting for it. I am not unduly worried about the heavy bleeding as I have had to put up with that for the last 25 years, I am more concerned about the in between periods symptoms. I get extremely bad mood swings, insomnia, and above all I get a bad stomach ( not period pains, some different pains) and bad back ache in the 2-3 weeks in between bleeding.I also have very irregular bleeding, sometimes 8 days early or late. I have also been diagnosed as having an over large womb although I do not have fibroids.
I have had 2 kids and badly want more ( my youngest is 15 ) but it never happened after youngest came along. I never took any kind of contraception.
Once I've had this procedure done it cannot be reversed and I cannot have any more children as you have to be sterilised. I still to this day want another child and never did get a reason why it never happened again.
I want to be sure that if I have this operation is it going to cure all my symptoms and also is there any chance of complications while or after having it done.
Please be honest any women that has had it done, has it improved your lives?
The ablation will not stop your symptoms completely (as most of our "pms" symptoms are due to hormonal fluctuations.), however, they will minimize. I did not have the procedure but my best friend did. She did not have horrible bleeding and the pain, while bad at first eased with in 24 hrs. She did have trouble stopping bleeding, even tho she was not bleeding heavily. She had to take bc pills for 2 months, and now seems to be fine. She still has light spotting for one day, when her period would occur. The reason for this is because some of the endometrial tissue lines the upper part of the cervix and is not removed. Some possible complications are: perforation, or tearing of the uterus, uterin or bowel burns. Nova sure seems to have less chance of these complications. Do make sure that you are 100 percent ready to have this done. Talk it over with your doctor and check on other options as well if you are not sure. Good Luck!
Gestational Surrogacy after Tubes Tied and Novasure Ablation!?
I had my tubes tied August 2007. In 2005 I had a laproscopy to check for cysts, fibroids and endometriosis which I had when I was in my late teens. I have always had heavy and painful periods. I have had two pregnancies and do not want another child of my own. I am going in for a D & C on friday to try and help the clotting that will stop up our toilet and heavy bleeding of which I have for 5-6 days and then really light for 3-4 days after the 5-6 heavy days all of which is very DARK, mucousy and fleshy. I am hope the D & C will help. I am also looking into a Nova-sure Ablation and I understand the information to say you must use contraception to prevent conceiving. Does that also mean that if the embryos and sperm were zyogted in a petri dish that I could not carry the child full term unless some of the lining were left behind on accident ( I have two friends unable to either get pregnant or carry a pregnancy without 30% chance of death). The two surrogacies will not be for at least a year or more. Im just looking at my options. Also if the ablation is far enough in the past is it possible for new lining to form?
No you will not be able to carry a child that is why you need the birth control. Your linning does not grow back.
Questions about Fibroid Tumors in uterus?
I am anemic and have been on an iron supplement since August (5 months). I went back to the dr 3 weeks ago because I started feeling really tired and weak again, and my periods have gotten worse and worse. I thought maybe my hemoglobin was low again. My dr did blood work and my iron was fine so she referred me to my gynecologist. After doing the exam (which was more painful than ever) he told me that he wanted me to come back for an ultrasound because he thinks I have fibroid tumors in my uterus. Now I realize these are questions I should have asked my dr but I was kind of overwhelmed and couldn't think of these questions at the time. I have done some research online but I can't find the answers I'm looking for. Can fibroids cause a mucous like discharge? Can they cause a slightly extended stomach? I am 5'5" and 120 lbs and I'm very thin but I look like I am pregnant or have a small beer belly. Could the pain from my exam had been caused by fibroids? Could the dr have felt them during the exam? Could the cramps or pains I've been having even when I don't have my period be caused by the fibroids? Can fibroids be a cause of anemia? He also told me about a new procedure called NovaSure. Has anyone had this done? And if I do have fibroids and have to have a hysterectomy what is the recovery period? Thank you in advance?
I realize that you may not know the answers to all of these questions, but even if you answer one it will help!
Do I have womb cancer?
I'm 37 and for around 7 years I suffered extremely heavy periods. They were so severe that I needed blood transfusions. Eventually I agreed to Novasure and went into have surgery at the beginning of January this year. I had a laparoscopy and hysteroscopy done [among other things] and so the surgeon was able to see inside my womb. His words to me were, 'I didn't like what I saw so I did a D & C and I've sent your endometrium off for tests. If it comes back with a bad result, I will have to do a hysterectomy.''
I've just recieved a letter that explains what they did during the operation and it says that the lining of my womb was very thickened so it was hard to do the Novasure. He said after the D & C he did the Novasure again and saw nothing worrying.
So what does this mean?
Why in the letter does he say there was nothing worrying and yet he did a D & C because he didn't like what he saw?
And what would they be testing my womb lining for anyway?
I was sterilised too so I can't have children now
Also, I don't have any fibroids or polyps but I have had polycystic ovaries for about 10 years that I know of.
Can a 37 year old get womb cancer?
My results came back ok, I don't have cancer :O)