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Women Have Options Other Than a Hysterectomy

Charles Koh, MD, Gynecologist, Reproductive Endocrinologist and Minimally Invasice Surgeon

Posted: May 1, 2009

Any woman considering getting a hysterectomy (the surgical removal of the uterus) should carefully review all of her options, including getting a second opinion to determine if the surgery is absolutely necessary.
Each year doctors in the U.S. perform about 600,000 hysterectomies, and about one third of all American women have had a hysterectomy by the age of 60! At times, a hysterectomy is appropriate. But recent studies have concluded that many of the operations could have been avoided by using alternative and less invasive treatments.

Conditions With Alternatives
Today, many hysterectomies are being performed to treat non-cancerous conditions such as fibroids, prolapse, excessive menstrual bleeding and endometriosis. There are many less invasive treatment options for these conditions.

For example, pelvic reconstruction surgery done laparoscopically can save the uterus and has demonstrated good long-term results for prolapse, which is the sliding of the uterus out of its normal position into the vaginal canal. We specialize in treating women who have had recurrence of prolapse after receiving other treatment methods that have failed.

We are one of a few centers nationwide with experience in the laparoscopic treatment for endometriosis of the bladder, ureter, bowel and thorax. The endometriosis resection procedure has resulted in lower recurrence rates, and additional surgeries are rarely needed. These procedures spare the uterus so a hysterectomy is not performed.

When is a Hysterectomy the Answer?
A hysterectomy may be necessary to stop the growth of advanced cancer of the uterus, ovaries, or cervix. In many cases, surgery can be performed with minimally invasive or robotic surgery. In some cases only the cervix is removed and the uterus can be retained for pregnancy.

Surprisingly, only 15 percent of hysterectomies performed annually are minimally invasive. A woman who has minimally invasive or robotic surgery will experience less pain and recover faster compared with a patient who has traditional surgery. The smaller incisions used to perform laparoscopic surgery result in less trauma to the body, so healing time is shortened. There also is less risk for infection. The hospital stay for a minimally invasive hysterectomy is typically one night and the majority of women return to work in two weeks.

Additionally, if you already have children and do not plan on having more, or don't want to have children at all, it may make sense to have a hysterectomy for a less serious condition if other treatments have failed. For example, you've suffered for years with fibroid pain and excessive bleeding that hasn’t responded well to drugs or other treatments.

Always Get a Second Opinion
When facing the possibility of getting a hysterectomy, it’s important to check all options including getting a second opinion. Getting the information you need to make a good decision is an important step to a successful outcome.

Charles Koh, MD
Gynecologist, Reproductive Endocrinologist and Minimally Invasive Surgeon
Columbia St. Mary’s

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