Should I have a hysterectomy, or are there other options?
Perhaps is was suggested that you consider a hysterectomy for heavy bleeding or fibroids. These problems are very common in women in their late 30’s and 40’s. You should know that there are non-surgical options that can control symptoms and avoid a major surgical procedure.
First of all, anyone with abnormal bleeding or a pelvic mass should be evaluated. Although uterine cancer is rare in women before the age of 50, a pelvic sonogram and/or an endometrial biopsy can evaluate the uterus and ovaries and decrease that concern.
Heavy menstrual cycles can be controlled often by using oral contraceptives. Birth control pills are very safe for women in their 40’s if they are not smokers or hypertensive. Birth control pills will manage the irregularity of the intervals between cycles that occurs in peri-menopause, and
markedly decrease the amount of flow. Additional benefits of oral contraceptives are that the pills can eliminate some of the hormonal irregularity of the peri-menopause which can cause hot flashes, mood changes, and insomnia.
If heavy bleeding is the issue, an IUD containing progesterone will often make the menstrual bleeding very light or absent, while also providing contraception. The progesterone IUD lasts for 5 years, and is inserted easily in the office.
Minor surgical procedures can also control heavy bleeding. A uterine ablation is a procedure that cauterizes the endometrial lining, so that bleeding is markedly reduced. Most often the procedure is performed in the hospital, but some doctors perform this in the office. A hysteroscopy and D&C (dilation and curettage) may be performed at the same time to evaluate the endometrial cavity. The results are permanent and should be performed after childbearing is completed.
If you have fibroids that are in the uterine cavity, a procedure can be done that resects these fibroids. There are several devices that shave off the portion of the fibroid which is in the cavity, and if most of the fibroid can be removed, bleeding can be markedly reduced. This procedure is most often done in the hospital as a same-day surgical procedure, and the recovery is minimal. Most patients would be able to go back to work in a day or two.
If you have large fibroids and they are causing symptoms of heavy bleeding or pressure on other organs, a minimally invasive procedure, a uterine artery embolization, can be done by a radiologist. The uterine artery is catheterized through a vessel in the groin, and the uterine artery is blocked by small pellets that block the vessels that supply blood to the fibroids. The result is that the blood supply to the fibroids is cut off, and the tissue undergoes necrosis or cell death. Most patients need pain killers for several days, but the size of the fibroids decrease over the next several months, and menstrual bleeding is often much decreased.
Although each case is individual and a physician who performs gynecologic procedures can help you decide which procedures are applicable to your situation, it is important to know your options so that you can make an informed decision.
Marilyn C. Jerome, MD
Foxhall OB-Gyn Associates