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Alternatives to Hysterectomy

Menorrhagia continued...

Some options for treating menorrhagia, short of hysterectomy:

  • Medical management. Menorrhagia's first treatment of choice is medical, using either oral contraceptives or an intrauterine device (IUD) that releases a hormone called levonorgestrel. Both of these treatments reduce menstrual bleeding significantly, although women report being generally more satisfied with the IUD. If you're still planning to have children in the future, these are probably your best options. 
  • Endometrial ablation. There are a variety of techniques that can be used to remove the lining of the uterus. You should only consider these options, however, if you are done with childbearing. New, "second-generation" methods like thermal balloon ablation, cryoablation, and radiofrequency ablation have success rates up to 80%-90%. These are all outpatient procedures mostly done in the doctor's office, so they don't have the same complication rates and extended hospital stays involved in hysterectomy.
  • Occasionally, an NSAID is prescribed during menses to help reduce blood flow to the uterine lining.  

 

Uterine Prolapse

Uterine prolapse happens when your uterus drops from its normal position and pushes against your vaginal walls. It can be caused by a number of things, but one of the most common causes is vaginal childbirth. Advancing age, smoking, pregnancy, and obesity are also significant risk factors.

Obviously, a hysterectomy will solve this problem -- but there are less drastic approaches that you can also consider. One treatment option is a vaginal pessary -- a removable device placed into the vagina to support areas where prolapse is happening. There are several different kinds of pessaries, and your doctor can help you decide which is best for your situation. They don't cure the prolapse, but can relieve symptoms partially or completely. Often, they can be helpful in pregnancy, holding the uterus in place before it enlarges and invades the vaginal canal.

There are also multiple surgical methods for treating uterine prolapse, and surgeons may use more than one technique. Sometimes, they will have to be combined with a hysterectomy, but for some women it is possible to avoid this step. 

The risks of placing mesh through the vagina to repair pelvic organ prolapse -- a procedure done roughly 75,000 times in 2010 -- may outweigh its benefits, according to the FDA. However, the use of mesh may be appropriate in some situations.  

Other types of surgery include paravaginal defect repairs and repairs of enteroceles, rectoceles (hernias of the intestine or rectum into the vagina), and cystoceles prolapse of the bladder into the vagina.

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Endometriosis

About 5 million American women experience endometriosis, which occurs when tissue that behaves like the lining of the uterus -- the endometrium -- grows in other areas of the abdominal cavity, such as the ovaries, fallopian tubes, or outer surface of the uterus. Symptoms include pelvic pain, painful intercourse, spotting between periods, and infertility. The average woman with endometriosis has symptoms for two to five years before being diagnosed.

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