Ovary Health

Hysterectomy Alternatives: Making Tough Choices

By Christine Haran

Today it's almost commonplace for women to have their uteruses removed. In fact, hysterectomy is the most common major gynecological operation in the United States. One reason for its popularity is that this type of surgery can treat a wide range of conditions, from cancer to uterine fibroids. Over the last five years, however, there has been controversy about whether physicians have been too quick to recommend hysterectomy.

Hysterectomy is a procedure in which a woman's uterus is surgically removed, but her estrogen-producing ovaries, are spared. According to the American College of Obstetricians and Gynecologists, hysterectomy should only be recommended after alternative options have been explored with a patient, and that a woman who has been advised to have one should consider getting a second opinion.

A number of alternative procedures have been developed to treat fibroids, heavy menstrual bleeding and other conditions that might once have required the complete removal of the uterus. This may be particularly important for women who may want to preserve future fertility or who are poor candidates for surgery. But sometimes hysterectomy is the right choice, and newer, less invasive approaches have made it a much easier procedure from which to recover.

Below, Sandra Emmons, MD, an associate professor of obstetrics and gynecology at Oregon Health Sciences University (OSHU) and a physician in OSHU's alternatives to hysterectomy program, discusses women's options and how they can make the best possible decision.

What is a hysterectomy?
Well, the word "hysterectomy" means removal of the uterus and it encompasses the body of the uterus as well as the cervix. In talking about hysterectomy, we're not talking about removing the ovaries. I think one of the most common misunderstandings is that a woman having a hysterectomy has to have her ovaries out and therefore has to undergo menopause. It's certainly possible to leave the ovaries and remove the uterus and not cause a hormonal upset.

Why would a woman have a hysterectomy?
There are a lot of potential reasons why the uterus may be removed. On the most serious end of the spectrum, cervical cancer or uterine or ovarian cancer may prompt the hysterectomy.

A woman may have fibroid tumors, which is a benign condition that causes the smooth muscle of the uterus to grow, both inside and on the surface of the uterus, and become quite large. A woman may have a condition called adenomyosis, which also makes the uterus enlarge and bleed heavily with the periods. Women may have a condition called endometriosis, which causes pain with periods and sometimes even pain not associated with the menstrual periods. Women may have various prolapse conditions where the uterus falls outside the body through the vagina.

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