The Surgery You (Probably) Don't Need: Alternatives to Hysterectomies

By Janis Graham

Every year, 600,000 women have hysterectomies. More than two-thirds could be cured with simpler, less risky procedures — or even pills.

As a busy mom, business analyst, and occasional golfer, Amy Mills, 46, of Lancaster, OH, had a hard time coping with her long, increasingly heavy periods. “I couldn’t do anything spontaneously,” says Mills, who was sometimes reluctant to go out for fear of leaking through the super tampon and maxi pad she had to use. The misery went on for two years.

Still, when her gynecologist suggested a hysterectomy, Mills was hesitant. The surgery can involve a four-day hospital stay, plus a two-month recovery and unpleasant side effects, such as early menopause symptoms.

But Mills’s doctor also mentioned endometrial ablation, an outpatient procedure that removes the uterine lining — one of several lower-risk treatments with a far quicker recovery. Mills had the procedure about a year and a half ago and was back in action after a day. “I’m so glad I did it! I feel liberated,” she says.

She was fortunate. Despite years of concern about the unnecessarily high number of hysterectomies for conditions like heavy bleeding, too many women are still having their uteruses removed. In almost 70 percent of cases, hysterectomy is “inappropriately recommended,” reports a significant UCLA study. “Doctors like to stick with what they know, and they know how to do hysterectomies,” says study head Michael S. Broder, M.D. “As a result, women may not be told about less invasive alternatives that may be nearly as effective.”

Of course, the surgery isn’t always elective — if you have uterine cancer, for example, a hysterectomy can save your life. But if your doctor mentions the operation as a cure for haywire periods, pelvic pain, or fibroids (benign uterine growths), there are other options, depending on your symptoms and life situation.

Did You Get a Diagnosis?

When it comes to heavy or prolonged periods, the “vast majority of doctors skip determining a diagnosis and go straight to trying various medications,” notes Paul Indman, M.D., a California gynecologist who is one of the pioneers of minimally invasive alternatives to hysterectomy. That can mean a long period of trial and error. Save yourself the pain by asking your doctor about these tests, which can help you find out what’s wrong — and point you to the best approach.

• Blood tests — to check for thyroid disorder or other problems that can cause excessive menstrual bleeding. Fix the underlying condition, and that may well clear up monthly problems.
• Transvaginal ultrasound — to detect fibroids or other uterine growths, such as polyps. If you have them, the Pill or other hormonal treatments may be less likely to work. (This painless exam is done with a probe inserted into the vagina.)
• Hysteroscopy — to directly view the uterine cavity, often as a follow-up to ultrasound. This exam, done with a thin telescope inserted vaginally, also checks for uterine cancer (more likely if you have other risk factors, such as diabetes, obesity, or a family history). Your ob-gyn may take a tissue sample (endometrial biopsy) during the procedure; if no abnormal cells are found, it may be safe or desirable to say no to a hysterectomy and try an alternative.