Gynecologic Health

Hysterectomy Alternatives: Making Tough Choices

There are also some ovarian conditions such as premalignant ovarian cysts where both the uterus and the affected ovary are removed.

How can hysterectomy be performed?
There are several ways of doing a hysterectomy. The most common method is abdominal hysterectomy, which means that the uterus is removed through an incision made in the abdomen. A vaginal hysterectomy refers to removing both the uterus and the cervix through the vagina so that there is no abdominal incision.

Vaginal hysterectomy is actually the least invasive approach. But not every woman is a candidate for that type of surgery. It requires that the cervix be taken, so if a woman wants to preserve her cervix that is not possible to do with this method. The other usual reason she might not be a candidate is if the uterus is too large. A lot of women have a hysterectomy because of uterine fibroids and that may make the uterus too bulky to remove vaginally.

Then there are two ways of removing the uterus laparoscopically, which means that a fiber-optic instrument is used to examine the abdominal cavity. One is what's called a laparoscopically assisted vaginal hysterectomy. A laparoscope is used to disconnect a portion of the uterus that's inside the abdomen. Then a vaginal incision is made and the cervix and uterus are removed through the vagina.

A woman can recover more quickly from the laparoscopic method because the incisions are much smaller. And there is not nearly so much postoperative discomfort after the laparoscopic approach as there is with abdominal surgery.

How long is the recovery period?
It depends on what sort of hysterectomy is done and why she is having it. If a woman has a laparoscopic or vaginal hysterectomy and is not ill going into the procedure, she may recover in two or three weeks. But, if a woman has cancer and has a hysterectomy, it's probably going to take two or three months to recover. If a woman is severely anemic and has a hysterectomy, it will probably take a couple of months to recover and get the blood count back to normal.

When is hormone therapy an option?
Hormone therapy is an option that works very well for women who are having abnormal bleeding due to an imbalance in their hormones. And that can take the form of something as simple as birth control pills or Depo-Provera injections.

There is also a very strong hormone therapy called gonadotropin-releasing hormone that essentially puts a woman into menopause, which, of course, makes her quit bleeding.

For women having abnormal bleeding caused by fibroids, endometriosis or adenomyosis, hormone therapy is only successful in maybe 50 percent to 60 percent of the cases.

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