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If you've been told you need a hysterectomy you might be feeling a bit overwhelmed and frightened. This is normal! This is the time to dig in, do some research, listen with both ears and consider your options. You might have alternatives!


Ask
These Questions

If you've been told you need a hysterectomy you might be feeling a bit overwhelmed. Where do you begin?

Explore these questions:

  • Have I tried all the alternative treatments?
  • Are my symptoms so unbearable as to make my life a misery?
  • Will the operation relieve all my symptoms?
  • Will there be any unexpected consequences - am I prepared for an earlier menopause?
  • Do I still want to have children?
  • What will happen if I decide not to have a hysterectomy?

Exploring these questions for yourself is key to moving forward with a plan for a healthier future. Your peace of mind and your health depends on it!


Get a
Second Opinion
HysterSisters recommends that you get more than one opinion when your doctor suggests a hysterectomy. You may have a trustful long-standing history with your doctor and feel horrified that we suggest such a thing! This isn't a slap in the face for your personal physician but a smart thing for every patient to do.

Set up an appointment with a different surgeon in a different practice and even perhaps in a different town. Take your records with you but also ask for an exam. Ask if the first recommendation is appropriate. Ask for alternative suggestions.

Get a third opinion. You might find the third suggests an even less invasive solution.

The key is for you, the patient, to get all the information you can before you agree to surgery. You cannot change your mind once the surgery is done. There are no money back guarantees if the surgery is not the cure for your problem. Be smart. Do your homework.


Treatment Options

Medical advances continue to give women alternatives to the hysterectomy. Exploring the various choices and options to the hysterectomy based on your medical needs is essential during this decision time.

It's important to note that unless you are in an emergency situation or are facing cancer, you are provided with the time to learn, research and make your decision based on what is best for you.

The HysterSisters encourages you to try any and every alternative applicable to you, based on your disease, symptoms and medical history in an effort to preserve your uterus .

Endometrial ablation is a medical procedure that removes the lining of the uterus, called the endometrium.

If your periods are very heavy or last too long, your health care provider may prescribe medications that will cause you to have a lighter period. Click here to read more about heavy periods. If the medication does not work, your health care provider may recommend endometrial ablation. After endometrial ablation, you may have no further bleeding, but a small percentage of patients may experience lighter menstrual periods. Click to read more about the endometrial ablation.

Another alternative treatment is the myomectomy. Myomectomy is the surgical removal of fibroids from the uterus. It allows the uterus to be left in place and, for some women, makes pregnancy more likely than before.

Read on for more information about your treatment options.

Not sure what you need for recovery? This set has it all!

Give Me a Second

This message is important for all women who are considering a hysterectomy. We must encourage women to build partnerships with their physicians, and the best way to do this is to ask questions.

Three important things can happen when we get a "second:"

1. We get more information.

2. We may gain a new perspective.

3. We will gain peace of mind.

We've been taught well - to sit up straight, to pay close attention, to be good, to say "please" and "thank you." Give Me a Second encourages persistence. We do need to be engaged with our health decisions. And in the doctor's office, we can be polite - and still ask the right questions for our own benefit.


Fibroids

Fibroids are abnormal growths of the uterine muscle that are generally benign. They are usually discovered during a routine pelvic exam.

Non-symptomatic fibroids may require no treatment or surgery. Rather, the doctor may require frequent check-ups (usually every 6 months) to monitor.

If symptoms are present, fibroids are usually associated with pressure, irregular uterine bleeding, abdominal enlargment or pain.

For most women with symptomatic fibroids the decision to treat the uterine fibroids is based on issues of quality of life.

Depending on the size and placement of the fibroids, treatment may involve surgery or hormone therapy or both. Check with your doctor for your particular treatment options.

Possible Treatment Options for Fibroids

  • Myomectomy - Fibroids surgically removed, uterus wall carefully repaired.
  • -Abdominal incision
    -Laparoscopic surgery - Endoscope is passed through small abdominal incisions.
    -Hysteroscopy - A tiny lighted telescope passed through the cervix into the uterus. No external incisions are needed.
  • MRI-guided focused ultrasound surgery (MRgFUS) - Procedure that uses MRI guided ultrasound to heat the fibroid and cause its cells to die.
  • Hormone treatment for temporary shrinkage of fibroids (example: Lupron)
  • Uterine Artery Embolization (UAE or UFE) - Procedure in which arteries are blocked, cutting off blood supply to the uterus.
  • Myolisis - Laparoscopic procedure, laser, or electric current is applied to fibroid to coagulate the tumor and its blood supply. Coagulation causes the fibroid to shrink and not return. Similar procedure: cryomyolysis freezes the fibroid.
  • Hysterectomy - Removal of uterus.

Each day brings news of new treatments for Fibroids which are not addressed here. Explore your treatment options thoroughly.

Read more about Uterine Fibroids.


Endometriosis

Endometriosis is a condition in which endometrial tissue grows outside the uterus, usually in the pelvic cavity. It is not a malignant or premalignant condition.

Symptoms of endometriosis are characterized by pain: pain with menstruation, pain with sexual intercourse and increasingly severe pelvic pain.

The intensity of suffering caused by endometriosis varies from woman to woman. For most women, a hysterectomy is not necessary to treat endometriosis and its milder symptoms.

Treatment Options for Endometriosis

  • Continuous low-dosage combined oral contraceptives - Birth control hormones help shrink endometrial tissue and reduce pain for most women. They are also likely to keep endometriosis from getting worse. Most women can use birth control hormones for long term with few side effects.
  • Anti-inflammatories - reduce bleeding, inflammation, and pain. Most women can use birth control hormones for long term with few side effects.
  • Progesterone or Progestins - stops monthly growth of the uterine lining (endometrium) along with endometriosis implants elsewhere in the body. Progestin also reduces estrogen production, which stops ovulation and menstrual periods in most women.
  • Gonadotropin-releasing hormone agonists - Lupron - used short term (3-6 months) decreases production of the hormone estrogen to the levels women have after menopause with similar side effects - hot flashes, bone loss, vaginal dryness, increased cholesterol levels, insomnia.
  • Danazol - a drug that lowers estrogen levels and increases androgen levels putting the body in a state that is like menopause and can cause some male physical traits, as well.
  • Laparoscopy - surgery to remove endometriosis from pelvic cavity if other treatments are not affective.
  • Hysterectomy - removal of uterus and ovaries is used as a last resort for treatment. This surgery causes early menopause and is reserved for women with no pregnancy plans and who have had little relief from other treatments. Up to 15% of women continue to have endometriosis pain after a hysterectomy.

Please note: None of the above treatment options are guaranteed to be a cure for endometriosis including hysterectomy.

Each day brings news of new treatments for endometriosis which are not addressed here. Explore your treatment options thoroughly.

Read more about endometriosis and explore our Endometriosis Resources.

Uterine Prolapse and Related Issues

Muscular weaknesses in the pelvic area can result in protrusion or herniation of the uterus, vagina, bladder and/or rectum. Childbirth and aging can lead to a weakening of these muscles that provide pelvic support.

  • Rectocele - fallen rectum
  • Cystocele - fallen bladder
  • Enterocele - fallen small intestine
  • Uterine Prolapse - fallen uterus
  • Vaginal Prolapse - fallen uppermost portion of the vagina

Check with your surgeon to determine which treatment, if any, are available to you based on your particular medical history and diagnosis.

Non-Surgical Treatment Options for Prolapses

  • Hormone therapy (post menopausal women)
  • Pessary (A device inserted into the vagina to support the prolapse(s) & make the patient more comfortable. There are various sizes, types, and shapes of pessaries, each tailored to fit the individual woman.)

Surgical Treatment Options for Prolapses

  • Anterior colporrhaphy - surgical correction of cystocele
  • Retropubic urethropexy - elevation of the angle between the urethra and bladder
  • Sling procedure to provide support for the urethra to increase the resistance to urinary flow
  • Posterior colporrhaphy or perineorrhaphy - correction of rectocele
  • Sacrospinous ligament colpopexy - correction of vaginal wall prolapse
  • Re-suspend uterus to preserve fertility
  • Enterocele repair - reinforcement of the vaginal supporting structures to prevent herniation of the small intestine.
  • Hysterectomy

Prolapse repairs may be done with or without a hysterectomy. Not every treatment is available to every patient. Check with your doctor to determine the best course of action to treat your prolapse based on your medical history and diagnosis.

Read more about Pelvic Floor Prolapse.


Abnormal Uterine Bleeding

Abnormal or dysfunctional bleeding occurs for hormonal reasons, because of polyps, endometrial hyperplasia, and for other conditions including fibroids, adenomyosis, pelvic infection and uterine or cervical cancers.

Bleeding can be an inconvenience or interrupt your daily activities and may be associated with pelvic pain and uterine cramping.

Non-Surgical Treatment Options

  • Hormones to regulate ovulation and menstruating for hormone related bleeding
  • Progestin containing IUD (Intrauterine device) for endometrial hyperplasia.

Surgical Treatments

  • Endometrial Ablation - Removal of the endometrial lining/tissue
  • Hysteroscopy - for removal of polyps in uterus and/or cervix
  • Hysterectomy - removal of uterus

A hysterectomy is used to treat abnormal uterine bleeding only when other approaches have failed.

Check with your surgeon to determine which treatment, if any, are available to you based on your particular medical history and diagnosis.

Each day brings news of new treatments for excessive bleeding which are not addressed here. Explore your treatment options thoroughly.


Pelvic Pain, Infection, Adhesions

Chronic pelvic pain is a symptom, not a disease, and is a very common symptom. Approximately 10 percent of all women visiting their doctor complain of pelvic pain. This pain may be caused by a variety of conditions including pelvic infection, endometriosis, adenomyosis and pelvic adhesions (from a previous surgery). Other conditions that may cause pelvic pain but are unrelated to gynecology may be irritable bowel syndrome and interstitial cystitis (Discussed below).

A diagnostic laparoscopy provides insight into the cause of the pelvic pain with the most common findings endometriosis and adhesions as the problem.

Pelvic Infection/Pelvic Inflammatory Disease (PID) is an infection of the pelvic area and is difficult to diagnose but is usually cured with antibiotics.

Pelvic Adhesions can usually be treated with laparoscopy.

Non-Gynecological Causes of Chronic Pelvic Pain

  • addiction or substance abuse problem
  • anxiety
  • arthritis
  • chronic appendicitis
  • chronic interstitial cystitis (chronic bladder infection)
  • depression
  • lumbar disk disease
  • diverticulitis (intestinal inflammation)
  • fibromyalgia
  • hernia
  • inflammatory bowel disease
  • irritable bowel syndrome
  • physical or sexual abuse
  • scoliosis and posture related problems

Interstitial Cystitis

Interstitial cystitis is a chronic, and often severe, inflammation of the bladder wall, the cause of which is unknown. Primary symptoms are urinary frequency, urgency, and, for some, severe lower abdominal or perineal pain. However, IC patients rarely test positive for infection in standard urinalysis and urine cultures.

In some cases, women wiith pelvic pain that is unexplained, a doctor may recommend a hysterectomy assuming her pain is gynecological when in fact her pain may be from undiagnosed Interstitial Cystitis.

Unexplained pelvic pain should be explored to determine the cause before a hysterectomy is scheduled.


Cancer

Cancer is the most compelling reason for a woman to have a hysterectomy. A hysterectomy is usually performed to treat gynecological cancers: uterine cancer, cervical cancer and ovarian cancer.

Cervical Cancer is easily detected in early stages from a pap smear.

While hysterectomy is the usual treatment for all gynecological cancers, with cervical cancer, there are other treatment options including cryosurgery, LEEP, cervical conization and carbon dioxide laser. These options depend on your particular cervical cancer's progress/stage.

Beyond the hysterectomy as a treatment for gynecological cancer, chemotherapy and/or radiation may also be necessary.

Read more about Gynecological Cancer.

From the Forums

More Hysterectomy
Alternative Resources

Check out these resources to help you make your decisions for surgery. Don't forget our best resource - our Hysterectomy Options discussion forum where thousands of HysterSisters participate daily! AND - Don't forget to ask your doctor for additional resources.

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