1. Fibroids.
An estimated one-third of hysterectomies are done to treat fibroids. One alternative, if the fibroids aren’t causing any real problems, is the “wait and see” approach: You have a pelvic exam every six months so your doctor can keep tabs on their development.
If you’re in considerable pain, however, you might want to have surgery to remove the fibroids. In this case, a myomectomy could be your best option: This procedure allows a surgeon to take out the fibroids while repairing your uterus and leaving it intact. You might also try hormone therapy; taking synthetic progestin or natural progesterone often alleviates fibroid-related bleeding. Some doctors prescribe GnRH (gonadotropin-releasing hormones) to shrink fibroids so that surgery won’t be necessary, but in general, they shouldn’t be used for a period longer than six months. Since the GnRH hormones drugs induce a sort of artificial menopause, they’ll likely be prescribed only if you’re near menopause. The good news is that when you reach menopause the fibroids will begin to shrink naturally.
A relatively new method of treating fibroids without surgery is uterine artery embolization (also called uterine fibroid embolization). In this procedure, the doctor makes a small cut in your groin and inserts a catheter into an artery above the fibroid. Through the catheter, tiny particles are injected into the artery. The particles then block the blood flow to the fibroid, causing it to shrink. While artery embolization has been in use for over 20 years, it has only recently been approved in the treatment of fibroids. The U.S. Food and Drug Administration cautions that the procedure isn’t without risk, with premature menopause, pelvic infection, pregnancy complications, and delayed diagnosis of uterine cancer being reported by some women. While the number of complications have been small, they are significant, the agency says.
Focused ultrasound surgery is another treatment you may want to consider. An MRI scanner helps doctors locate fibroids and focus high-frequency sound waves on them to destroy them. So far, ultrasound surgery appears to be a useful, non-invasive treatment, however, its long-term effectiveness is not known, and since it is not yet a standard treatment, your health insurance may not cover it.
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2. Endometriosis.
There’s quite a variety of treatments for endometriosis, a painful condition in which the tissue that lines the uterus grows into neighboring areas. You can try drug therapy (including GnRH and progesterones); oral contraceptives may also relieve cramping and pain. Some gynecologists also recommend adding fish-oil supplements or sardines to your diet to reduce menstrual cramps. If these approaches don’t work, you may want to have a surgeon remove the abnormal growths. Your surgeon may also use a tiny device called a laparoscope to look at the cysts and lesions, which can then be removed or vaporized with a laser.
3. Dysfunctional uterine bleeding.
Women with excessive or protracted menstrual bleeding related to ovulation problems can be treated with a surgical procedure called dilation and curettage, or D & C. The cervix is dilated and the uterine lining is scraped out. Another option is drug therapy, in which progestins, oral contraceptives, or nonsteroidal anti-inflammatory drugs (NSAIDs) such as ibuprofen may be used. Another approach is to destroy the uterine lining in a process called endometrial ablation. It can be done through laser surgery or a new procedure known as “uterine balloon therapy.” In this technique, a balloon is filled with liquid and inserted into the uterus through the vagina; then the liquid is heated, eliminating the uterine lining.
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4. Chronic pelvic pain.
Drug therapy, using NSAIDs or oral contraceptives, for instance, is one option. In addition, some women have reported relief with the use of biofeedback, acupuncture, or relaxation techniques, though no studies have been done to confirm the effect.
5. Prolapsed, or “dropped,” uterus.
For this condition, in which weakened pelvic muscles have allowed the uterus to “relax,” you can have a pessary placement, which is an office procedure. A device called a pessary is inserted into your pelvic area to hold the uterus in place.
Remember the important thing when weighing your options is considering what’s best for you. After conducting your own research, consult with your doctor and get a second opinion if necessary before making a final decision. You also have the right to change doctors if you aren’t feeling heard by your current doctor.