Hysterectomy

For women suffering from uterine cancer or cervical cancer, a hysterectomy could mean the difference between life and death. But with hysterectomies ranking as the second most common surgery among women in the UK (some 50 000 women will have one each year), how do you know when one is really necessary? Read on to find out more about why a woman might need a hysterectomy as well as some possible hysterectomy alternatives.

What is a Hysterectomy?

A hysterectomy is a surgery performed to remove the uterus (womb), the reproductive organ responsible for carrying a fetus during pregnancy. In some cases, a hysterectomy will also involve the removal of the fallopian tubes and the ovaries, the organs responsible for producing and transporting eggs to the uterus.

There are several types of hysterectomies:

• Complete (Total):The most common type of hysterectomy, this involves total removal of the uterus and the cervix.
• Partial (Subtotal): This refers to removal of the upper part of the uterus, while leaving the cervix in place.
• Radical: This extreme surgery is usually recommended for those with some types of gynecologic cancers such as uterine or cervical. It involves the removal of the uterus, cervix, the upper part of the vagina, as well as some surrounding tissues.

Why Might a Woman Have One?

The most common illnesses hysterectomies are used to treat are:

• Fibroids: Fibroids refer to benign growths in the uterus. It is a common condition among women and as such is the leading cause of hysterectomies.
• Endometriosis: Endometriosis is caused when tissue lining the uterus begins to grown outside the uterus, on the fallopian tubes or other reproductive organs. When other treatments fail, a hysterectomy may be performed to cure endometriosis.
• Uterine Prolapse: When supporting muscles and tissues weaken, the uterus can drop down into the vagina, causing urinary problems, difficulties with bowel movements and pelvic pressure.
• Gynecologic cancers (uterine and cervical): Along with radiation and chemotherapy, a hysterectomy may be offered to women with uterine or cervical cancer to remove the cancer altogether.
• Persistent Vaginal Bleeding: For women with periods that are heavy, irregular or abnormally lengthy, a hysterectomy may be considered once all non-surgical alternatives have been exhausted.
• Chronic Pelvic Pain: Although many forms of pelvic pain may not be cured by a hysterectomy, it can be a last resort for women experiencing pain that is obviously originating from the uterus.

How is it Done?

There are two different points of access for performing a hysterectomy: one is through the vagina and the other is through the abdomen.

Abdominal hysterectomy
To conduct this surgery the doctor must cut through your lower abdomen to reach your uterus, using one of two types of incisions (vertical or horizontal). The advantage to entering through the abdomen is that your doctor will have a better angle to view your reproductive organs and more room to operate. This type of hysterectomy is the most common and is generally recommended for cancer patients or those with large tumors.

The downside is that this type of surgery usually involves more visible scarring than a vaginal hysterectomy, as well a longer and more painful recovery period.

Vaginal hysterectomy
Through a circular incision around the cervix, the doctor will enter your uterus via your vagina. If you do not have a large uterus, have uterine prolapse or another less serious condition, you might be offered this approach, since most patients experience quicker recovery times and minimal or no external scarring.

Laparoscopy-assisted vaginal hysterectomy is a similar procedure with the added advantage of the doctor being able to get a better view of your pelvic organs (through the use of a viewing tool called a laparoscope), while still being able to remove the uterus through the vagina. However, this type of surgery is generally more expensive and has a higher rate of complications than abdominal hysterectomies.

What are the Side Effects of a Hysterectomy?

If you have not already experienced menopause and are having a hysterectomy, you should know that it will be initialized if your surgery involves removal of the ovaries. Also, if you would like to have children you may want to speak with your doctor about possible alternatives, as having a hysterectomy will prohibit you from becoming pregnant.

Some risks of having a hysterectomy include:

• Damage to the urinary tract, bowel or bladder
• Breathing or heart problems
• Blood transfusion, resulting from heavy blood loss
• Opening of wounds

Also, women who have had both ovaries removed during their hysterectomy may experience a decline in their sexual desire and the amount of pleasure derived from orgasm. If this is the case you should speak with your health professional, as there are a variety of treatment options available.

What to Expect Afterwards

Once the anesthetic has worn off many women experience abdominal pain. Painkillers are generally prescribed, as constant pain can actually slow down the recovery process. Some light vaginal bleeding can also be expected, so you should come prepared with sanitary napkins.

Some women also experience difficulty with urination after surgery. In this case, a catheter may be inserted to collect urine into a bag for the first couple of days. Also, some women may not be able to have a bowel movement for up to five days, in which case some food or oral laxatives may be taken.

A physiotherapist will also likely be on hand to assist you in a few pelvic exercises you will need to continue practicing at home. These exercises are designed to assist in regaining control over urination.

In general, most women will be able to resume some of their normal activities (such as bathing and intercourse) after about six weeks.

What are the Alternatives?

If you have cancer, a hysterectomy may be your only alternative. However, if you have a benign condition such as endometriosis, fibroids, or uterine prolapse, then there are other medical and surgical options available, such as:

• Drug therapy
• Endometrial ablation
• Myomectomy
• Uterine artery embolization
• Vaginal pessary

In any case, be sure to discuss all of your options carefully with your doctor before rushing into a decision. Consider getting a second opinion, ask lots of questions and try speaking to other women who have undergone the surgery. And no matter what choice you make, know that a woman is no less complete without her reproductive organs. Too often we define ourselves by our bodies, when it is really our hearts and our minds that make us the wonderful women we are!

Find out more about endometrial ablation in our womens-health forum.