Hysterectomy, or surgical removal of the uterus, is the traditional treatment for uterine problems. Although highly effective, it is a major surgical procedure with a lengthy recovery period and risks of major complications. Several alternatives to hysterectomy, jointly referred to as hysteroscopy, have been developed to treat uterine problems in a less invasive way.
Hysterectomies are performed for many different reasons, including:
- Dysfunctional bleeding
- Painful fibroids
During a traditional hysterectomy, a large incision is made in the lower abdomen and the uterus is removed through the incision. The cervix is usually also removed, and the vagina is closed at the point where it used to join the cervix. In some cases, other organs such as the ovaries are removed during the same surgical procedure, but this is not a standard part of a hysterectomy.
A hysterectomy is a major surgical operation. Most women spend several days recovering in the hospital after the procedure, need several months to recover fully, and will always have a visible scar on the abdomen. Less invasive approaches to a hysterectomy can sometimes be performed. In some cases, the uterus can be removed through the vagina, avoiding the large incision in the abdomen. Laparoscopic procedures, with or without robotic assistance, make use of several tiny incisions to perform the surgery; in these cases, the uterine tissue is also removed through the vagina. These less-invasive procedures have a shorter recovery time and less visible scarring but are still major surgeries.
Hysteroscopy procedures are primarily used to treat dysfunctional bleeding, painful fibroids, and endometriosis. In a hysteroscopy procedure, a special scope is inserted through the vagina and cervix into the uterus. Depending on the patient’s symptoms and what the doctor sees through the scope, the uterine lining can be completely ablated, fibroids can be resected, and localized sites of bleeding can be cauterized.
Hysteroscopy is a much less invasive procedure than hysterectomy. Patients fully recover within a week or two. For most women, it is completely effective in treating dysfunctional bleeding, painful fibroids, and other problems. In many cases, the procedure can be done under a local anesthetic, and the woman can go home that same day. There may be some minor vaginal bleeding for a day or two. Sports and sexual activity may need to be avoided for a few days after the procedure.
One head-to-head study of hysterectomies versus hysteroscopic ablation for dysfunctional bleeding reported that one year after treatment, 78 percent of the hysteroscopic group and 80 percent of the hysterectomy group were completely satisfied with their treatment. All of the women in the hysterectomy group had a complete cessation of symptoms, but median recovery time from the surgery was two to three months. In the hysteroscopy group, median recovery time was only two weeks, and 80 percent had cessation of their symptoms.