The number of women having the surgery has dropped over the past five years. The figure used to be nearer 90,000 but Robin Parsons a specialist menopause nurse for the Amarant Trust - a research centre for women's health issues - says times are changing. In the Eighties there were huge numbers of hysterectomies done in hospitals around the UK. Women today have more options.



Sometimes a woman may decide that a hysterectomy is the best way to solve problems such as heavy periods, endometriosis, fibroids and PMT. In some situations with cancer of the uterus for example - there's little choice.

But its not an operation that can be undertaken lightly. You won't be able to have any more children, You'll need about 12 weeks off work and a full recovery can take up to two years. Some women experience depression or a reduced libido. If the ovaries are removed, it will result in the onset of the menopause, and women will usually need to go on hormone replacement therapy (HRT) to reduce the risk of osteoporosis and heart disease. One in 50 women experiences complications such as wound infections and there's a death rate of 1 in 2000 - so its no surprise that many seek other surgical and drug based options. Linda Parkinson-Hardman, Director of The Hysterectomy Association says "there are alternatives - many women just aren't aware of them".

DIET

Linda suggests cutting down on meat to see if that helps relieve pain. "Meat tends to be full of hormones, antibiotics and some oestrogens which could make you more likely to suffer from endometriosis and fibroids", she says.

DRUGS

* A low dose contraceptive pill can reduce bleeding in half of the women who try it.

* Tranexamic acid which is used to promote blood clotting can cut bleeding in 60% of cases, although pain is not reduced.

* Mefanamic acid, an inflammatory drug can reduce bleeding by 20% and ease period pain. But side effects include nausea, vomiting and kidney problems. These drug treatments will not affect your long term fertility.

* A new treatment called uterine artery embolisation can be used to treat fibroids. Small particles of a grainy type substance are passed into the arteries to block off the blood supply to the fibroids so they die or are reduced in size. The fibroids can shrink by 50% in three months.

Mirena Coil

Designed as a contraceptive, the Mirena Intrauterine System (IUS) or coil can also reduce heavy bleeding. It's fitted by your GP and left in place. After three months use average blood loss is reduced by 85% and by 12 months the flow is reduced by 97% every cycle. About one third of women will have no periods at all, as the progesterone in the IUS prevents the lining of the womb from building up.

One study looked at 54 women with heavy periods who were awaiting a hysterectomy. After being fitted with the Mirena IUS, just under 70% were taken off the waiting list because they were so happy with the treatment.

Possible side effects include headache, water retention and breast tenderness. Pregnancy is rare, but if it does occur it is advisable to remove the contraceptive as soon as possible to reduce the risk of bleeding, infection or miscarriage.

SURGERY

Endometrial ablation - the womb lining is removed with lasers, electro-surgery or cryotherapy (freezing). It can be used to treat heavy bleeding, fibroids and polyps with a success rate of about 85%.

Balloon thermo ablation - a latex balloon containing a heating element is passed into the uterus and inflated with fluid. It then heats up, destroying the uterus lining. It reduces heavy periods in 85% of cases.

Myomectomy - the surgical removal of fibroids, leaving the uterus intact. This is best suited for small fibroids.

Laparoscopically assisted hysterectomy - a relatively new procedure the uses keyhole surgery to insert a small viewing instrument into the abdomen. The surgeon can then remove the uterus or ovaries if required through the vagina. The small incisions leave the woman with minimal scarring which should reduce recovery time to 6-8 weeks. But the operation takes longer to perform and there is a greater risk of complications. This method is not suitable for women with large fibroids or ovarian tumours.

You can find out more about all the alternatives to hysterectomy on The Hysterectomy Association's website at: