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Alternatives to Hysterectomy

Endometriosis continued...

About 18% of hysterectomies in the U.S. are performed due to endometriosis -- and it doesn't necessarily cure the problem. As many as 13% of women see their endometriosis return within three years if their ovaries are intact; the number climbs to 40% in five years. And since endometriosis often affects young women -- with an average age of about 27 -- a surgical option that removes all possibility of pregnancy isn't really an alternative.

Treatments for endometriosis depend on the severity of the symptoms and the woman's needs. For example, pain can be treated with over-the-counter or prescription pain relievers. To treat pain and abnormal menstrual bleeding, women may be prescribed hormonal treatments such as birth control pills or drugs that drastically reduce estrogen levels. These drugs, however, aren't for women who are trying to get pregnant, and they are not a permanent treatment: Going off the medication usually means the endometriosis symptoms come back.

A more long-term treatment for endometriosis that is more likely to help with fertility problems is laparoscopic surgery, a minimally invasive approach to either remove the endometrial growths and scar tissue, or burn them away with intense heat. If the growths can't all be destroyed this way, surgeons can take a more invasive approach, a laparotomy, which involves making a larger cut in the abdomen. This requires a much longer recovery period, but is still less invasive than hysterectomy and offers the prospect of retaining fertility.


Chronic Pelvic Pain

Chronic pelvic pain affects many women: Some studies indicate that as many as 39% of women have some kind of chronic pelvic pain. It's most common in younger women, especially those between 26 and 30 years old.

Pelvic pain can be caused by many things, including the above-mentioned uterine fibroids and endometriosis, pelvic inflammatory disease, and bowel and bladder issues like irritable bowel syndrome, interstitial cystitis (an inflamed bladder), and musculoskeletal issues. Women who have experienced sexual abuse are also more likely to experience chronic pelvic pain.

A hysterectomy should be considered a last resort for chronic pelvic pain, especially since many types of pelvic pain aren't cured by the surgery. It's important to work with your doctor to uncover the specific cause of your pain so that the treatment can be targeted to that cause, giving you the best chance of relief. For example, if you are diagnosed with uterine fibroids or endometriosis, one of the treatment options described above might have the best chance of putting an end to chronic pelvic pain.

Other treatment options, depending on the cause of your pain, may include:

  • Stopping ovulation with hormonal methods like birth control pills
  • The use of nonsteroidal anti-inflammatory medications
  • Relaxation exercises, biofeedback, and physical therapy
  • Abdominal trigger point injections; medication injected into painful areas in the lower wall of the abdomen can help relieve pain.
  • Antibiotics (if an infection, such as pelvic inflammatory disease, is the source of the pain)
  • Psychological counseling

It's still possible that, whatever your health condition might be, a hysterectomy may be the most effective and appropriate treatment. But with many alternatives available, it's important to discuss all your options with your doctor first.


WebMD Medical Reference

Reviewed by Nivin Todd, MD, FACOG on May 17, 2014

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