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Nathan Mordel, M.D. »Janet Lefkowitz, D.O. »

Surgical/procedural alternatives to hysterectomy

April 03, 2017
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Hysterectomy, which means removal of the uterus (womb), should always be the last resort in surgical armamentarium. Some of the indications for hysterectomy include menorrhagia (prolonged and heavy menstrual flow) and symptomatic leiomyomata (fibroids). Though the vast majority of hysterectomies can and should be done in a minimally invasive way without overnight stay, it still constitutes a major surgical intervention. Non-hysterectomy interventions need to be considered and exhausted before deciding to remove the uterus.

Endometrial ablation, which means destruction of the uterine cavity lining, can be used to treat menorrhagia (prolonged and heavy menstrual flow). This procedure entails no incisions and no removal of uterus and takes less than 10 minutes to perform. Patients can go back to normal activities in 2-3 days. It is effective in about 75% of cases. The remaining 25% may need a hysterectomy later on.

Myomectomy, which means removal of fibroids, is done to treat symptomatic leiomyomata (fibroids). The vast majority of myomectomies can and should be done in a minimally invasive way without overnight stay. Preservation of the uterus is achieved. If they wish so, patients may get pregnant 3 months after myomectomy.

Uterine fibroid embolization (UFE) is done to treat symptomatic leiomyomata (fibroids). UFE is done in a minimally invasive way with only a small incision in the groin. Fibroids are not eliminated but their volume and activity are decreased. Uterus is preserved. UFE is effective in about 80% of cases. The remaining 20% may need a hysterectomy later on.

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