Alternatives to Hysterectomy for Dysfunctional Uterine Bleeding

Hysterectomy is a major surgical procedure that is performed through conventional laparotomy, laparoscopy and robotic surgery, or through the vaginal route to avoid abdominal wall incisions. In certain situations, both the abdominal and vaginal routes are used in combination. Hysterectomy is indicated for malignancies of the uterus, uterine cervix, and ovaries; to reduce the risk of future malignancies and genital prolapse; and for dysfunctional uterine bleeding. Dysfunctional uterine bleeding is an aberration caused by hormonal imbalance that is not related to the normal menstrual cycle, with no clear etiology in most cases. Dysfunctional uterine bleeding can be treated medically or surgically. Medical treatment includes non-steroidal anti-inflammatory drugs, the combined oral contraceptive pills, progestogens, danazol, analogs of gonadotrophin-releasing hormone, and the anti-fibrinolytic tranexamic acid. Endometrial ablation and hysterectomy are common routine, low-risk surgical procedures for dysfunctional uterine bleeding but are associated with some comparatively rare serious complications, both operatively and post-operatively. All types of endometrial ablation and hysterectomy remain a mainstay of alternative options for patients where the medical approach proves to be ineffective or is associated with intolerable side effects.