Treatment Options for Prolapsed Uterus
Q.
I have a prolapsed uterus, and I don't want to have it taken out. I asked two doctors if they can just tack it back up, but they both said I didn't need my uterus, so why did I want to keep it? I'm not going to have any more children, but I still want it. If I had cancer, I'd say take it all out, but there is nothing wrong with it except that it won't stay in place. Even if a repair only works for 10 years, I'd be happy for that length of time. I'm only 28. I'm so afraid of going into menopause. I have never been good at taking medicine, and I don't want to take a hormone pill every day. I don't hurt at all, even while having sex. I feel a lot of pressure at the end of the day and have to urinate more, but that's it. If there's a way to fix it, can you tell me what to ask for?
A.
There are several options for uterine prolapse. In general, treatment is necessary only if you are experiencing symptoms such as pain or pressure, urinary incontinence, urinary retention, pain with intercourse, or recurrent infections or ulcerations associated with extreme degrees of prolapse (to the point that the cervix is protruding outside the vagina). If you are not having any symptoms, there is no reason to do anything at all. If the pressure you experience at the end of the day doesn't bother you, then you do not need surgery of any sort. A pessary -- a rubber or latex device that is placed into the vagina to elevate the uterus -- is one such option. Some pessaries look very much like a contraceptive diaphragm and are easy for the user to remove and replace herself. Others look like mushrooms or cubes and must be removed, cleaned and replaced periodically by the doctor; this latter type is not compatible with an active sex life.
Another option is a uterine suspension. This surgery may be done via a laparoscope and involves shortening the ligaments that support the uterus, thus elevating it. Success rates for this procedure are fair.
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