The hysterectomy, an operation to remove the uterus, is the
second most frequent major surgical procedure among reproductive-aged women,
after cesarean section.
Approximately 600,000 hysterectomies are performed each year in the United
States — and one in three women will have had one by the age of 60.
The hysterectomy procedure
may or may not include a bilateral
oophorectomy -- the removal of both ovaries. Only if a woman has her
ovaries removed she will go through menopause. Removal of the uterus alone does
not automatically trigger menopause because the ovaries will continue to
make hormones. However, since the uterus is removed, the woman will no longer
have her periods and cannot get pregnant. She might have hot flashes because
the surgery can sometimes affect the blood supply to the ovaries. Later on, she
might have natural menopause a year or two earlier than expected.
Some women decide
to remove their ovaries and fallopian tubes at the same time as their uterus
because she has a real or perceived vulnerability to ovarian cancer. This is a
personal decision usually based on age, health and doctor's recommendation.
Hysterectomy: Is It Right for You?
There are some urban myths in the female community that hysterectomy
might help to relieve or totally eliminate the often-distressing side effects
of menopause. A hysterectomy, however, will not be able to relieve menopausal symptoms; to the contrary, in some cases, it can
actually cause the body to undergo menopause prematurely.
In addition, a hysterectomy is major surgery, and its
associated drawbacks make this an option solely for those who have valid
medical concerns that need to be addressed. Risks associated with a
hysterectomy can be serious, including the following:
* Blood clots
* Infection
* Excessive bleeding
* An adverse reaction to anesthesia
* Damage to the urinary tract, bladder, or rectum during surgery
* Premature menopause
* Bowel blockage
* Death, in rare instances
* Blood clots
* Infection
* Excessive bleeding
* An adverse reaction to anesthesia
* Damage to the urinary tract, bladder, or rectum during surgery
* Premature menopause
* Bowel blockage
* Death, in rare instances
"No one should have a hysterectomy — or any surgery —
if it's not necessary," says Jerry Nosanchuk, a Michigan-based osteopathic
physician who specializes in treating menopausal women after a hysterectomy.
"You need to be vigilant and consider the benefits and potential
consequences of hysterectomy before making the decision to have one. On the
other hand, there are instances when surgery is a reasonable decision."
Conditions when Hysterectomy
is Recommended
For some conditions, a hysterectomy is the only true cure.
Women who might benefit from a hysterectomy include those suffering from the following conditions:
* Premalignancies, cell changes signaling possible uterine, ovarian, or cervical cancers
* Endometriosis, a condition in which the tissue that usually lines the uterus develops outside the organ instead
* Adenomyosis, a very painful condition in which tissue that usually lines the uterus grows deep inside the uterine muscle wall
* Prolapsed uterus, a situation in which the uterus sags into the vagina because of stretching or lack of muscular support
* Excessive uterine fibroids, or benign tumors in the uterus
* Chronic pelvic pain
* Premalignancies, cell changes signaling possible uterine, ovarian, or cervical cancers
* Endometriosis, a condition in which the tissue that usually lines the uterus develops outside the organ instead
* Adenomyosis, a very painful condition in which tissue that usually lines the uterus grows deep inside the uterine muscle wall
* Prolapsed uterus, a situation in which the uterus sags into the vagina because of stretching or lack of muscular support
* Excessive uterine fibroids, or benign tumors in the uterus
* Chronic pelvic pain
What Happens in a Hysterectomy?
A hysterectomy can be performed in several different ways,
through the vagina or through the abdominal wall, using traditional or
laparoscopic techniques. While the term hysterectomy refers to the
removal of the uterus, this procedure may also include the removal of the
cervix, one or both ovaries, and/or the fallopian tubes. Women should educate
themselves and discuss these options carefully with their doctor if they are
considering the surgery.
"Removal of the ovaries would be recommended if ovarian
tumors are present [or there is a] family history of breast or ovarian cancer
or simply to prevent future cancer of the ovary," says Dr. Pinkerton.
Prophylactic, or preventative, surgery to remove the ovaries
is also sometimes recommended for women who have inherited genetic mutations
that put them at higher risk of breast and ovarian cancers and who no longer
want to have children.
Abdominal
Approach
If your uterus is
large, or if the surgeon wants to physically inspect other organs during the
procedure, you might be recommended an abdominal approach to hysterectomy.
Using the traditional abdominal approach, the surgeon makes a single large
incision through the wall of the lower abdomen to access the uterus. The
incision can run vertically, from just below your navel to the level of the
pubic bone, or horizontally across the bikini line. The direction of the
incision depends on factors such as the presence of other scars on the abdomen,
the reason for the hysterectomy, and the need to look at other organs. With
abdominal laparoscopic surgery, the doctor makes a few smaller incisions and
inserts special surgical instruments through those access points.
With any surgical procedure, the patient risks a bad reaction to anesthesia, blood loss during or after the procedure, and blood clotting after the procedure. Hysterectomy risks also include possible damage to other organs in the pelvis such as the bladder and urinary tract. Compared to abdominal laparoscopic surgery, the traditional approach using a single large incision incurs a greater risk of post-surgical infection, and healing takes longer--about six to eight weeks.
Vaginal Approach
In the vaginal
approach, instead of reaching the uterus through an incision in the abdomen,
the surgeon passes special instruments up through the vagina. She makes an
incision through the wall of the vagina to reach the uterus, cutting it away
from the fallopian tubes and connective tissue before removing it through the
vaginal incision. With the vaginal approach, the patient has the option of
using regional anesthesia to numb the lower half of the body, rather than using
general anesthesia. For patients with risk factors for general anesthesia, this
might be a good option.
Compared to the abdominal approach, vaginal hysterectomy allows faster recovery and less hospital time. Patients can expect to stay in the hospital for a day or two following the surgery, and full recovery generally takes one to two weeks.
Alternatives to Hysterectomy
Hormonal Therapy
Various types of
hormonal therapy may be potentially effective alternatives to hysterectomy for some
women with noncancerous uterine problems. Hormone injections, birth control
pills or hormone-secreting intrauterine devices may help control abnormally
heavy or prolonged uterine bleeding, reports the American Congress of
Obstetricians and Gynecologists.
In a 2006 study published by the "Cochrane Database of Systematic Reviews," Dr. Jane Marjoribanks and colleagues report that hormone-secreting intrauterine devices prove as effective as surgery in improving quality of life among women with abnormally heavy uterine bleeding. Hormone-based treatment may also help relieve symptoms associated with uterine leiomyomas and endometriosis.
Uterus-Preserving Surgery
Surgery to
correct a uterine problem rather than removing the uterus may be an alternative
for some women with noncancerous gynecological conditions. Gynecological
surgeons can often remove leiomyomas from the uterus with a procedure called a
myomectomy. The American Congress of Obstetricians and Gynecologists reports
that the leiomyomas do not grow back after a myomectomy. New fibroids, however,
may develop in some women. A myomectomy typically preserves the option for
future childbearing.
A uterine suspension procedure can reposition the uterus with a sling-like device to relieve symptoms associated with uterine prolapse, reports the Cleveland Clinic. Women with endometriosis may elect to have the areas of abnormal endometrial tissue removed, leaving the uterus intact. Endometriosis may recur after this surgical procedure, notes the American Congress of Obstetricians and Gynecologists.
Endometrial Ablation
An endometrial
ablation procedure destroys the uterine lining tissue, or endometrium. The
endometrium is the tissue involved in menstrual bleeding; destruction of this
tissue typically eliminates or significantly reduces menstrual bleeding.
Endometrial ablation may effectively relieve symptoms associated with
abnormally heavy uterine bleeding and small uterine leiomyomas, reports the
American Congress of Obstetricians and Gynecologists. The procedure may be an
alternative to hysterectomy for women with these conditions who do not desire
future childbearing.
Doctors use different techniques to perform endometrial ablation, including freezing, heat application, and microwave, radiowave or electrical energy. Endometrial ablation is performed as an outpatient procedure. The doctor inserts the instruments into the uterus through the cervix; the procedure does not require surgical incisions.
After Hysterectomy
After the operation, you will need to stay a
few days in the hospital to recover. The time spent depends on the type of
operation you had and your progress. Your doctor might prescribe antibiotics to
prevent infections, as well as pain medication.
Complete recovery from abdominal hysterectomy usually takes
6-8 weeks. During this time, you can slowly increase the level of your
activities but don't overdo it! Listen to your body and do everything in
moderation.
Get plenty of rest and avoid lifting during the first two
weeks. You can then begin to do light chores, some driving, and even return to
work as long as your job does not involve too much physical activity. Once the
bleeding, pain and abdominal pressure have stopped, you can resume normal
activities. Around the sixth week following the operation, you can take baths
and resume sexual activity, but demanding exercises should be put off until 3
months after your operation.
Women who have had a vaginal hysterectomy generally recover
more quickly and are able to resume their activities earlier than women who
have undergone an abdominal hysterectomy.
What Will Change?
For pre-menopausal woman, the periods will stop after the
hysterectomy. She can no longer get pregnant. If the ovaries are removed, she
might go through distressing menopausal symptoms (hot flashes, mood swings,
sleep disturbance, vaginal dryness etc). This may cause even more severe symptoms
than a natural menopause.
Some women have also reported a decrease in sexual pleasure
with the removal of the cervix but this has not been scientifically proven. In
fact, most women report either an increase in sexual pleasure or no change at
all.
Sources and Additional Information: