Uterus removal: Alternative treatment modalities to save uterus

India is witnessing an increase in the number of women especially young women undergoing a hysterectomy which refers to the removal of the uterus Experts have raised concerns regarding this rising number wherein more than 22000 Indian women between 1549 years of age out of 700000 surveyed had undergone hysterectomy reports from 2018 The median age of undergoing the procedure has been estimated to be 34 years which may be associated with early onset of menopause as well as concerns regarding conceptionpregnancy More concerning is the fact that this trend is being observed globally Surprisingly there have also been reports from the medical community that call this procedure avoidable or unnecessary when alternatives are availableIn this article let us look into the need for hysterectomy for the commonly indicated conditions and the possible minimallyinvasive or nonsurgical alternative therapeutic modalitiesHysterectomy may be indicated in cases such as excessive menstrual bleeding chronic pelvic pain or Endometriosis uterine tumors fibroids or cancers of the female reproductive system uterine ovarian cervical fallopian tubes Hysterectomy may be combined with the removal of ovaries oophorectomy or cervix and fallopian tube salpingectomy or removal of all the abovementioned structures total hysterectomy with bilateral salpingooophorectomy Such procedures need to be discussed clearly with the healthcare provider as the surgery has longterm effects on the overall health genitourinary and sexual health longevity and reproductive ability of the woman Regardless of age the procedure will result in early menopause thereby impacting fertility and the ability to bear children Secondary effects such as reduced bone density behavioralemotional changes may also occur due to hormonal imbalance following the procedureThe above reasons do not mean that hysterectomies should be avoided The absolute indications for the procedure are invasive cancer of the reproductive system including the uterus cervix ovaries fallopian tubes vagina severe infection eg pelvic inflammatory disease that does not respond to treatment severe and uncontrollable uterine bleeding due to adenomyosis serious complications during childbirth such as a ruptured uterus prolapse of the uterus etcAlternatives to the treatment of conditions where hysterectomy may be indicatedUterine fibroidsUterine fibroids are the most common condition for which hysterectomy is advised Fibroids are benign tumors that oftentimes do not present with symptoms In fact these tumors may grow from an early fertile age and persist until menopause following which they undergo spontaneous regression due to depletion of sexual hormones Thus surgical treatment may be avoided and a waitandwatch approach may be adopted Cases of symptomatic uterine fibroids may be treated alternatively in a minimally invasive manner by myomectomy Hi Frequency ultrasound ablation uterine artery embolization etc Myomectomy refers to the removal of the fibroids alone Uterine artery embolization involves the injection of small particles into the uterine arteries feeding the fibroids cutting off their blood supply The success rates for these procedures are comparable to that of hysterectomy and are associated with lower rates of complications Hormonal therapy using gonadotropinreleasing hormone GnRH agonists oral contraceptives etc may also be indicatedEndometriosisThis condition refers to the growth of the uterine lining endometrium in other organs commonly the ovaries fallopian tubes bowels outer walls of the uterus and rarely in the kidney bladder or lungs The chief issue faced by women with this condition is difficulty in conceiving Symptoms include pelvic or abdominal pain or pressure along with the heavy menstrual flow Spotting or bleeding may also occur between periods Over time this condition causes scar tissue to form in the affected organs and when the reproductive system is involved leads to infertilityAlternative surgical interventions for the treatment of endometriosis include excisionablation of the endometrium resection of the obliteration caused by scar tissue Laparotomy may be indicated in cases where the minimallyinvasive ablative approach does not remove all the growthscar tissue Although this procedure is more invasive and requires a longer recovery period it is less invasive than hysterectomy and aids in retaining fertilityAs with fibroids hormonal therapy may be indicated in these cases as well Nonsteroidal antiinflammatory medications may be indicated to manage pain Alternative modalities of acupuncture biofeedback have also been reported for the management of symptoms of endometriosis with variable resultsUterine ProlapseIn this condition the muscles and ligaments in the pelvis become weak due to which the uterus may slip down into or beyond the vagina There is constant debate among gynecologists regarding the removal of a falling uterus Some gynecologists suggest that repair of the weakened ligaments and muscles that hold the uterus is sufficient along with physiotherapy rehabilitation pelvic floor strengthening This may be accomplished by laparoscopy called laparoscopic Sacrohysteropexy wherein the weakened tissues can be sutured to the stronger ligaments A vaginal approach of the procedure termed vaginal uterosacral hysteropexy may also be performed as a uterus preserving procedure which leaves no abdominal scarsNonsurgical management may include use of vaginal pessary a removable ringshaped rubber device placed into the vagina to support areas of prolapsed tissue Several kinds of pessaries are available the best for your condition will be decided by your doctor While pessaries do not cure the prolapse symptoms can be relieved partially or completely They may be helpful in pregnancy by holding the uterus in place before it enlarges and invades the vaginal canalAbnormal Uterine BleedingDilation and Curettage D amp C which refers to dilation of the cervix and removal of tissue from inside the uterus by scraping or scooping may be indicated in cases of heavy bleeding Endometrial ablation may also be an alternative approach along with pharmacological agents such as prostaglandin inhibitors oral contraceptives GnRH agonists antifibrinolytic agents etc LNGIUS or commonly called Mirena can be placed in the uterus after the DampC It is a hormonal delivery device which will prevent endometrial proliferation and thereby reduce the monthly bleeding Excellent results in excessive bleedingChronic Pelvic PainLongterm pain in the pelvis may occur due to any of the abovementioned conditions or pelvic inflammatory disease adhesive disease inflammatory bowel disease etc Identification of the proper cause of the condition is mandatory in planning the appropriate treatment Adhesiolysis which means the removal of adhesions are removed in order to restore organ blockade and function may be considered Similarly nerve blocks denervation procedures uterosacral ablation may be indicated to relieve the symptoms of chronic pelvic pain Trigger point injection of pain medications acupuncture physical therapy has also been tried to address the symptoms with varying resultsRemoval of uterus brings with it drastic changes in the physical and emotional as well as reproductive well being of a woman It is therefore important to make an informed choice after a thorough discussion of the effectiveness of each therapeutic modality indicated for the conditionArticleDr Anu Vinod Vij Obstetrics amp Gynecology Motherhood Hospital KhargharCatch up on all the latest Crime National International and Hatke news here Also download the new midday Android and iOS apps to get latest updates