Why should we avoid hysterectomy
The uterus is an organ that sits at the apex of the vagina and has a number of roles. Obviously when childbirth is complete the uterus is no longer needed but does this mean we should remove it as part of an operation for prolapse ? Vaginal hysterectomy and repair is the commonest operation performed for prolapse but does this mean it is the best option
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The uterus is an important part of the support mechanism of the pelvis especially the bladder. At least 20% of patients who undergo a hysterectomy will develop significant bladder problems subsequently developing poor bladder control, urgency, nocturia and discomfort.
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Prolapse is often not immediately evident after a hysterectomy as the pelvis supported quite well by connective tissue until after the menopause when every thing seems to give at once.
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Hysterectomy is associated with a significant reduction in blood flow to the upper vagina and apex of the vault. This has implications later when attempting to fix prolapse
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The normal anteverted uterus has an important protective role against prolapse when it is in the normal position. This is lost after a hysterectomy.
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Hysterectomy is still a significant cause of bleeding, pain, bowel adhesions, ureteric damage and other complications.
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There are now a number of excellent alternatives to hysterectomy that enable a minimally invasive solution for most situations where a hysterectomy would be considered.
A hysterectomy is still an important part of gynaecology and is an important treatment option. Unfortunately, the large number of unnecessary hysterectomies that are done for reasons that would have been better served with a minimally invasive procedure has meant that a number of women are determined to avoid hysterectomy whatever the cost. This approach can lead to undue suffering, pain and discomfort. On occasions it can be life threatening when malignancy, large tumours or endometriosis are inadequately treated.
Alternative treatments empower patients to make good decisions about healthcare and undergo the treatment option that best deals with their own individual situation. A number of options that may be suitable for treating heavy menstrual bleeding without performing a hysterectomy are listed below are are listed below:
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Cavaterm and Thermachoice Ablation These involve using a hot water balloon in the uterus to burn the lining and reduce bleeding
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Endometrial resection and ablation This is the original technique developed in the late 1980s and is still the best option for removal of discrete lumps like fibroids or polyps where an otherwise normal uterus is to be preserved
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Microwave Endometrial Ablation This is the most effective means of treating a patient with bleeding due to small fibroids or some irregularity in the cavity
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Novasure Ablation A new technique that looks like the best option for dysfunctional bleeding in a patient with no fibroids or other causes
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Subtotal Hysterectomy In some situations where large fibroids or adenomyosis are unsuitable for minimally invasive treatment a sub total hysterectomy might be appropriate. In this operation
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Uterine Artery Embolisation This procedure is now available at Sydney Adventist Hospital.
