Alternatives to surgery

Alternatives to surgery

Informed Choice Matters

A hysterectomy can be life-changing, but it’s not always the first or only option.
For many gynaecological conditions, there are effective non-surgical or less invasive treatments that may improve symptoms or delay the need for surgery.

Understanding your options gives you the power to make decisions that align with your body, your life, and your goals.

The Role of Conservative Management

Doctors usually recommend exploring conservative (non-surgical) approaches first, unless surgery is clearly the safest option (such as in cancer or severe prolapse).

These options aim to:

Manage symptoms such as pain, bleeding, or pressure

Address underlying hormonal or muscular issues

Support overall pelvic health and quality of life

You can always revisit surgery later. The goal is to ensure you’ve tried what’s appropriate before making an irreversible decision.

Medical and Hormonal Treatments

Hormonal Therapies

  • Mirena® (Levonorgestrel IUS) – a small device inserted into the uterus that releases progesterone to thin the lining and reduce bleeding.

  • Combined or progestogen-only pills – can stabilise hormone levels and lighten periods.

  • GnRH analogues or antagonists – used short-term to reduce oestrogen, shrinking fibroids or calming endometriosis.

These are often first-line treatments for fibroids, adenomyosis, and heavy bleeding. They don’t cure the condition but can bring significant relief, especially before menopause.

Minimally Invasive Procedures

For some conditions, surgery can be targeted, preserving the uterus while managing symptoms.

Endometrial Ablation

Removes or destroys the lining of the uterus to reduce bleeding.
✅ Best for: heavy bleeding not caused by fibroids
⚠️ Not suitable if you plan to become pregnant

Myomectomy

Removes fibroids while keeping the uterus intact.
✅ Best for: fibroid-related bleeding or pressure symptoms, particularly in women wishing to preserve fertility
⚠️ May not be suitable for very large or multiple fibroids. Fibroids can regrow or new ones can form because the underlying tendency remains.
It’s not a permanent solution, but it can offer years of relief and allow time for family planning before considering a hysterectomy.

Uterine Artery Embolisation (UAE)

Tiny particles are injected to block blood flow to fibroids, causing them to shrink.
✅ Best for: fibroid management in women wishing to avoid or delay hysterectomy
⚠️ Fibroids often shrink significantly, but they can regrow or recur later. UAE is not usually recommended for women planning pregnancy. It can also cause post-procedure cramping and temporary menopause-like symptoms, which usually settle over time.
While not permanent, UAE can be a valuable option to manage symptoms and preserve the uterus for longer.

Physical and Lifestyle Therapies

Pelvic Health Physiotherapy

A first-line recommendation for prolapse and pelvic pain.
Pelvic floor training, breathing coordination, and lifestyle modification can improve symptoms, posture, and support, and in mild prolapse, may delay or prevent surgery entirely.

Exercise and Weight Management

Regular movement helps regulate hormones, support circulation, and reduce intra-abdominal pressure.
Evidence shows that muscle strength, flexibility, and cardiorespiratory fitness all positively influence pelvic and reproductive health outcomes.

Nutrition and Gut Health

A balanced diet rich in fibre, antioxidants, and protein supports hormone balance and tissue repair. Inflammation and bloating can exacerbate pelvic discomfort, so addressing these through nutrition can have real benefits.

Psychological Support

Pain, fear, or fatigue can increase tension and worsen symptoms. Mind-body therapies, CBT, or trauma-informed coaching can complement medical care — especially when pain has been chronic.

Sometimes, conservative treatments simply aren’t enough.
Hysterectomy remains the most definitive treatment for:

  • Large or multiple fibroids causing severe symptoms

  • Prolapse with advanced structural changes

  • Cancer, pre-cancer, or uncontrolled bleeding

Exploring alternatives doesn’t mean avoiding surgery at all costs

- it means making sure that when you do choose it, it’s the right decision for the right reason.

When Surgery Is Still the Best Option

Moving Forward

If you and your consultant decide that hysterectomy is your best option, you can move forward knowing you’ve made an informed choice.

Next: Preparing for Surgery, how to get your body, mind, and home ready for a smooth recovery.