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Women: You Have Alternatives to Hysterectomy

If you're a woman, receiving the news that you have to have a hysterectomy can be a very scary thing. The good news is that breakthroughs in modern medicine can provide a hysterectomy alternative, but don't take our word for it. When you read different women's stories about their hysterectomy diagnoses, keep in mind that information is key to finding the right hysterectomy alternative for you. We uncover the truth behind hysterectomy alternatives, and hope that you'll find a solution to having a hysterectomy.

When Heidi Hormel started cramping and bleeding heavily in 1998, the Hanover, Pa., public relations professional feared the worst. Her periods always had been light, but now, at 35, her pads were soaked within an hour, and strangely bright red. During an ultrasound, the technician gasped, saying: "never seen anything like it."

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The growth, in the muscle tissue of her uterus, was a fibroid — common enough, and usually benign. But the doctor said Heidi's fibroid was odd-looking, and potentially cancerous. And since Heidi didn't want to have children, the doctor advised her to have her uterus removed.

Hormel was terrified. Her own mother had had a horrible experience with her own hysterectomy that nearly sent her straight into menopause. "When they said hysterectomy was what I should do I was so upset," said Hormel. "That was one thing I've always said I'd never have done."

Carla Dionne, a Ventura County, Calif. mother of three nearly leaped at her doctor's recommendation for a hysterectomy when, at 40, she suffered massive bleeding, blood clots the size of a quarter, and a weight gain that made her look six months pregnant.

"I barely made it through a day. I was housebound. I was changing pads all the time. I was anemic and exhausted. I wasn't much of a mother — my kids were taking care of me. I was scared and the doctors kept saying, 'You're not having any more kids, just get rid of your uterus.' I almost did."

Nancy Ryan, a 43-year-old programmer who lives on Long Island, was told by her gynecologist that "the only way to get rid of this [fibroid] for sure is hysterectomy."

None of these women were told of — or knew about — other options to treat their fibroids. In fact, it wasn't until after Ryan did an Internet search that she learned about myomectomy — a minimally invasive technology to treat her fibroid.

Too Many Hysterectomies?

Unfortunately, despite medical advances, women aren't always informed by their doctors of alternatives to hysterectomy — alternatives that can reduce the need for anesthesia, long hospital stays and lengthy recovery times. What's more, there is concern that not all women who receive hysterectomies need them.

In a study published in the Journal of Obstetrics and Gynecology last year, researchers found that hysterectomies had been "inappropriately" recommended to 367 of 497 women. In another study, 16% of women in seven health-care plans were found to have undergone hysterectomies for "clinically" wrong reasons. "We found quite a few women who weren't offered less invasive treatment. It's very disturbing," said Dr. Michael Broder, an assistant professor of obstetrics and gynecology at the University of California School of Medicine in Los Angeles. "It seems pretty likely there are more hysterectomies done in this country than can be justified..."

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Hysterectomies Popular Since Roman Times

Despite publicity about its overuse during the last two decades, hysterectomy — followed by cesarians — is the most common operation performed on American women. By age 60, more than one-third of all women will have had one. First performed 1,900 years ago in Roman times, a hysterectomy involves the removal of the uterus, cervix, fallopian tubes and ovaries. Sometimes ovaries or the cervix, are left intact. Incisions are made through the abdomen or the vagina. While hysterectomy can remove fibroids and eliminate worries of future disease in the uterus, recovery time is sometimes up to two months and some women complain of an impact on their bladders, bowels and sex life.

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A Common Treatment for Fibroids

Most hysterectomies — nearly 40 percent — are for fibroids, which trouble at least 25 percent of all women at some point in their lives, usually between ages 30 and 40. These usually benign tumors often cause heavy bleeding in pre-menopausal years. They can also contribute to pelvic pain, lower back pain, constipation, frequent urination, bladder pressure, pain during sexual intercourse, and, depending on location, infertility and premature birth.

Women also have hysterectomies for unexplained pelvic pain, the "prolapse," or dipping down, of the uterus into the vaginal canal, and endometriosis — stray bits of uterine tissue growing in the wrong places.

Alternatives to Hysterectomy

While many women have no problem with having a hysterectomy — others wish they'd known about their alternatives sooner. "There are a whole new array of interventions women should at least know about," said Gaylene Pron, a University of Toronto epidemiologist. If symptoms develop, Pron explained, women can try drug therapy, including non-steroidal anti-inflammatory drugs and birth control pills and procedures that remove the fibroids (not the entire uterus) and block blood supply to the fibroids.

"The fact is, there are a number of alternatives for hysterectomy that either because of established routine, past training, or stubborn schools of thought within gynecology, haven't been given their due," said Dr. James Spies, a Georgetown University specialist in treating fibroids.

Myomectomy

In October 2000, Ryan opted for a myomectomy — an outpatient procedure in which fibroids are removed via an instrument inserted through the abdomen or vagina. Myomectomy successfully controls symptoms in about 80% of all cases without removing the entire uterus, but it can cause uterine scarring and isn't failsafe; one in 10 women need further procedures because the fibroids grow back.

The American College of Obstetrics and Gynecology concluded in May 2000 that while myomectomy generally provides "excellent resolution of symptoms" research on the subject was "poor" and had rarely been compared with hysterectomy in rigorous studies. For Ryan, it "was the greatest thing I've ever done," said Ryan. "I kept all my organs and I'm pain free — and without some of the physical problems women have with hysterectomies, from bladder to hormone problems."

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Embolization

Hormel — who also searched the Internet for alternatives — seized on embolization, a relatively new procedure that involves threading a catheter into the uterine artery so tiny particles can be injected to block the blood supply to the fibroids.

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The procedure involves a local anesthetic and one-night hospital stay and recovery is about two weeks.

"Many gynecologists don't offer it because they have no personal experience with it, or because it involves a different medical specialty (radiology)," said Dr. Spies. "In medicine, we tend to run in tribes, all reading our own sets of journals, so a new procedure by another specialty can easily get overlooked."

Hormel realized there was a chance her fibroids might grow back, but she was determined to try and avoid what her mother had experienced.

"It wasn't painful. There was a little cramping — but now I have normal periods. I have my life back...I'm so glad I did my homework."

Hormel's advice for other women: "Ask questions. If you don't understand something the doctor says, just question it. If you don't feel it's right, ask if there are other options. Do your reading, get on the Internet, and ask your doctor everything on your mind."

Carla Dionne also had a successful embolization. "I had tremendous shrinkage — and a tremendous change in my life," she said. "I get five hours sleep now. I have energy. No more bleeding — not even a fraction of what it was. No horrific cramps. I lost almost 50 pounds without even trying."

Dionne was so affected by what happened to her that she started a support group and Website, www.uterinefibroids.com, to share information and experiences. "It turns out there's a lot doctors don't tell you, and with my support group I hear about it every day. I just want other women to know."

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