Alternatives to Hysterectomy
Menorrhagia means heavy vaginal bleeding. In many cases, the bleeding has a known cause, like uterine fibroids (see above), but in other cases the cause remains unknown. There's a medical threshold for menorrhagia -- losing more than 80 mL of blood in each menstrual cycle -- but most doctors now tend to define menorrhagia by how much it affects your daily life: causing pain, mood swings, and disruptions in your work, sexual activity, and other activities.
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 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.