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Alternatives to Hysterectomies

  • John T. Slocumb MD

We recently had a blog on hysterectomy for abnormal bleeding. Yet, we also offer alternatives to hysterectomy. These include observation, medical therapy, and D&C with endometrial ablation.

Observation would be considered in a short term bleeding problem. This problem could potentially resolve itself such as in situations of stress, where the bleeding stops when the stress is alleviated.

The next option is medical therapy consisting of hormone therapy. Birth control pills can be used in patients before menopause who have no contraindication to birth control pills. The most common contraindication is the patient over 35 who smokes or a patient who has had a stroke or a blood clot. Progesterone agents are another short-term option for patients with contradictions to birth control pills. A new medicine, LYSTEDA, for controlling cycle flow was introduced in the past few years. Lysteda is used for five days during the cycle starting when menstrual flow begins. This medicine is nonhormonal and classified as an antifibrinolytic, which means it prevents the system from breaking down blood clots resulting in less blood flow during the cycle. However, you cannot use this medication if you have had a clotting disorder.

The next option becomes surgical. A lot of patients have heard of a D&C before. However a D&C is really a diagnostic tool and is not good for treating bleeding problems. We have been doing ablations for years; however, they took a long time and had some extra risks. Yet, over the past several years the endometrial ablation technique has become very simplified. Endometrial ablation basically means to burn out the lining of the uterus. The endometrial lining is what the uterus sheds each month called the menstrual cycle. Usually using some type of heat, the ablation procedures destroy the uterine lining by burning the base layer. These procedures are about 85% to 90% effective. Approximately 40%-50% of the patients will never bleed again.

So, how do we decide on who needs an ablation and who needs a hysterectomy? Sometimes a hysterectomy is needed in a situation that an ablation will not treat the problems such as a very large uterus or large fibroid tumors. Sometimes either procedure could be an option and the risk and benefits have to be weighed. An ablation procedure has very little risk and is an outpatient procedure. This means most patients are out for one day--the day of the procedure. The disadvantage to ablations is there is a failure rate meaning at some point the patient will start bleeding abnormal again. A hysterectomy results in no more bleeding. However, hysterectomy patients have a one or two night hospital stay and a recovery period of 2-6 weeks, with potential serious side effects. The end result is the patient has a lot of options for irregular or heavy vaginal bleeding. We usually try to sit down with the patient and discuss their problems at length and then determine the best treatment for our patients.

Call our office to set up a consultation at 478-744-9683.