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Alternatives to Hysterectomy

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Uterine Prolapse continued...

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.

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.

 

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