Alternatives to Having a Hysterectomy

The development of new procedures designed to replace hysterectomy has sharpened criticism that too many hysterectomies are performed unnecessarily, experts say.

* Heavy bleeding can sometimes be treated with a procedure called endometrial ablation, by which just the inner lining of the uterus is removed. The treatment causes sterility but can be performed on an outpatient basis and leaves the uterus intact.

* Myomectomy is an alternative treatment for the removal of noncancerous growths, called fibroids, in the uterus. The fibroids are removed through an incision in the abdomen or through the vagina.

* Several drugs or hormones can also be used to prevent irregular or heavy bleeding or to shrink tumors, says Dr. Herbert A. Goldfarb, a pioneer in the use of some alternative treatments to hysterectomy. And muscle-strengthening techniques, rather than a hysterectomy, can sometimes be used to treat a prolapsed uterus.

But the alternative treatments also entail risks and may not permanently solve a problem, Goldfarb says. In fact, the alternative treatment might end up being less satisfactory than a hysterectomy. But, he says, physicians should explain the options and ask the patient to choose.

“If a woman goes through the effort of trying to save her uterus and it doesn’t work out,” he says, “at least she will have tried.”