Medical Advances Can Provide Alternative Choice to Hysterectomy

I have found when taking a woman’s medical history that she often doesn’t know when her mother entered menopause. That’s because twenty to 50 years ago many women had a hysterectomy before they hit menopause as a solution to issues such as heavy bleeding or pelvic pain.

Thankfully, hysterectomies are less routine for women today because we have many forms of managing medical issues outside of surgery. A hysterectomy is the removal of a woman’s uterus. It may also include the removal of her cervix – the lowest part of the uterus that connects it to the vagina – and one or more of her ovaries – the organ that produces the majority of a woman’s hormones, estrogen and progesterone.

According to the National Institutes of Health (NIH), in-patient hysterectomies peaked in 1998 and have shown a steady decline up until 2010, when the latest stats were available. Hysterectomies for some of the most common pelvic issues drastically dropped during that time. Those performed for abnormal bleeding, for instance, dropped by nearly 30 percent while those performed for endometriosis dropped by over 65 percent.

Women who experience abnormal bleeding – including frequent, heavy or irregular periods – can often find relief through treatments such as an endometrial ablation, a minimally invasive procedure that scars the uterine lining so a woman’s menstrual bleeding is drastically reduced. 

There are times when a hysterectomy is the best option for a woman. Such cases involve the presence of cancer or when other medical treatments have not provided relief. In these cases, women can benefit from the new minimally invasive approaches. For some women, a hysterectomy is a minimally invasive outpatient procedure, meaning the patient can go home the same day. However, most women should work with their physician to discuss alternative treatments and understand the risks and physical changes that a hysterectomy can bring.

Surgical menopause – A woman who undergoes a hysterectomy prior to menopause, that includes the removal of her ovaries, will enter menopause. This means her body will experience the symptoms of menopause, such as vaginal dryness and hot flashes, caused by a lack of estrogen. 

Hormone replacement – The lack of estrogen will not only create symptoms, but also eliminate a layer of protection the hormone provides to her bones and heart. Hormone replacement therapy can help a woman maintain the benefits of estrogen until she reaches the natural age of menopause. 

Surgical risks – There are risks to any surgical procedure and a hysterectomy is no exception. Women need to know that while procedures have become less invasive there is still a risk to the organs around the uterus which is being removed. 

Katherine Bachman, MD, is an obstetrician and gynecologist with Upper Valley Women’s Center located in Troy.

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