The uterus has many roles to play and is not just an incubator for the baby.
Removal of the uterus or hysterectomy should be the last option as it may be followed by negative consequences which may significantly impact the quality of a woman’s life. Loss of the uterus could lead to a woman feeling incomplete or inadequate, thus affecting her self esteem.
The loss of hormonal balance can create myriad symptoms, including premature ageing, weight gain, vaginal dryness, and so on.
There are also other complications, including heightened incidence of urinary incontinence. It has been shown that hysterectomy (even without removal of the ovaries) during a woman’s reproductive years, increases the risk (triples the risk according to some studies) of heart attack during the remaining reproductive years. If the ovaries are removed as well, the risk of developing heart disease and osteoporosis is further increased.
Yet, world over, it is the second most common surgery in women, only next to caesarian section delivery.
However, with the advances in diagnosis and management of various gynaecological disorders, many options have been unlocked for women which can “save their uterus”.
Any surgical procedure should be performed only if there is a valid reason to it. In conditions like malignancies, hysterectomy is definitely recommended. But in benign conditions, it may be avoidable.
The most common reasons for doing hysterectomy in a woman are fibroids of uterus, heavy periods, prolapse of uterus, ovarian tumors and cancers of genital organs. In the US more than half million women undergo hysterectomy each year and it is estimated that by the age of 65 one third of women will have had their uterus surgically removed. However, with the availability of alternative treatments, the rate of hysterectomy is decreasing. In India, by the age 60, at least 33 per cent of women have already undergone hysterectomy. The incidence seems to remain same or is increasing despite awareness and informed education.
Women are often unaware that there are alternatives. Many women in this second group find sufficient relief from their symptoms once their condition is restored through our ‘Save Your Uterus” approach and related treatment.
But sometimes, in spite of the alternative treatments, a woman may have to undergo hysterectomy. In such a case, it may be done by a laparoscopic or a minimally invasive surgery which ensures quick recovery as there is very less blood loss and pain.
Uterine Balloon Therapy
A new development and technique, called Uterine Balloon Therapy (UBT), is invented solely to prevent hysterectomies in women who suffer from unmanageable periods and who no longer desire fertility.
This is a simple procedure by which the inner lining of the uterus is compressed and thinned out with a special balloon inserted inside the uterus for a period of eight minutes. The balloon is connected to special equipment which helps to raise the pressure and temperature of the water in the balloon. With this heat and pressure, the inner lining (endometrium) is partially destroyed which leads to reduced bleeding later. The advantage of this procedure is that there is no blood loss, no pain, it is over in 10-15 minutes, does not involve hospital stay, and helps to save the uterus of about 95 per cent women in whom the uterus is otherwise normal.
Sometimes a fibroid, even though small, sits in the cavity of the uterus and causes extreme pain and bleeding, or multiple fibroids may sit within a uterus and cause the problem. The uterus can be saved by just removing the fibroid in the cavity through a telescope (hysteroscope) inserted in the uterus through the vagina, or the multiple fibroids in the muscle of the uterus could be removed through the telescope (laparoscope) inserted through the navel. These procedures are a boon for women who wish to save their uterus.
A polyp is a growth in the uterus that might be the cause of your heavy periods . Hence removal of this polyp will correct your condition. This may be done via a hysteroscope and is called hysteroscopic polypectomy. This is a short daycare procedure that helps avoid hospitalisation, discomfort and expense of major surgery.
Mirena (Hormone loaded Intrauterine device)
Mirena is a revolutionary device which has drastically reduced the incidence of hysterectomies done for heavy periods. Though there is slight irregularity of menstrual cycle in initial months, it is usually well tolerated by patients.
The pros for this procedure are amenorrhoea in 99 per cent of patients, contraception, decreases size of fibroid and treats anaemia as it decreases bleeding. However it needs to be changed as its life is of five years only, is expensive and the woman can suffer initial irregular menses, leading to spotting.
Gonadotropin-releasing hormone agonist (GnRH agonist)
These are medications that will temporarily shrink fibroids by about 30 per cent as they temporarily stop oestrogen production. Once the effect of agonist is over, which may vary depending on the dose given, the fibroids grow back to their original size. Thus, this treatment is temporary and is used in women approaching menopause, or who are not fit for surgery or awaiting surgery.
Uterine Artery Embolisation(UAE)
UAE is a radiological procedure recently introduced as an alternative treatment for symptomatic uterine fibroids. The procedure is usually done under conscious sedation and local anaesthesia, without general anaesthesia. Six months after UAE the average fibroid is reduced in size by 40-60 per cent. UAE reduces uterine bleeding and symptoms related to uterine size such as urinary frequency and pelvic pain.
The American College of Obstetrics and Gynaecology cautions about its potential for infection and other serious complications requiring emergency surgery. This is also not recommended in women desirous of fertility.
MRI Guided Focused Ultrasound
Relatively new, this is a non invasive technique useful for targeting single fibroids. Under MRI guidance, high intensity ultrasound waves are focused on the centre of the fibroid and the heat generated destroys the fibroid. The size of the fibroid has been shown to reduce modestly (about 13 per cent), but symptomatic relief was reported in close to 80 per cent of patients. The pain associated with treatment procedure will necessitate pain killers. The procedure may cause skin burns at the treatment site and possibly some damage to adjacent tissues such as nerves.