BLOG – HYSTERECTOMY

  • May,1 2022

HYSTERECTOMY

Hysterectomy is a surgical procedure where a woman’s uterus is removed. Uterus is the organ where a child grows when a woman is pregnant. This means that hysterectomy puts an end to the chance of having a child. This procedure is only done for medical reasons. 

 

Reasons why hysterectomy is performed

Some of the reasons why uterus is removed are:

  • Heavy periods / chronic pelvic pain 

Heavy periods may be caused due to many reasons. But there could be heavy bleeding without any reason. In such cases, uterus may be removed if 

  1. Bleeding is heavy & it is affecting quality of life
  2. The woman does not prefer to have children
  3. Other treatments have not worked
  • Endometriosis – A condition in which tissue that lines the inside of the uterus grows outside the uterus in places such as ovaries, fallopian tubes etc. This can cause irregular periods, heavy bleeding etc. In case of endometriosis, hysterectomy may be performed to remove the area of the endometrial tissue.
  • Uterine fibroids – Fibroids are muscular and fibrous tissues that typically develop in the wall of the uterus. Symptoms of uterine fibroids are frequent urination / constipation, discomfort during sex, painful periods etc. 
  • Uterine prolapse – A condition where the uterus slides from its normal position into the vaginal canal, this happens when the tissues & ligaments supporting the uterus weakens. Symptoms of uterine prolapse include urinary incontinence, back pain, finding it difficult to have sex etc. 
  • Thickening of the uterus or Adenomyosis – A condition where the tissue that normally lines the uterus starts growing within the muscular wall of the uterus. It can cause heavy pelvic pain. 
  • Cancer in cervix, uterus, ovaries or fallopian tubes

Except in the case of cancer, this procedure is done after other treatments have been unsuccessful. This is because once hysterectomy is done the woman cannot have children. 

Types of hysterectomy

In hysterectomy, there are some types depending on what parts are required to be removed & for what reasons. 

Total hysterectomy is where the uterus as well the cervix is removed. This reduces the chances of cervical cancer later. 

Subtotal hysterectomy is where only the uterus is removed and the cervix is in place. But this is very rare since once the cervix is left behind, cervical screening becomes a must to rule out cervical cancer at a later date. 

Total hysterectomy with bilateral salpingo-oophorectomy is where the ovaries and the fallopian tubes are removed as well. Mostly this is done when there is risk of ovarian cancer due to family history. 

Radical hysterectomy is a procedure performed as a treatment to cancer when other treatments have failed. This includes removing fallopian tubes, ovaries, parts of vagina, lymph glands & fatty tissue apart from uterus & cervix. 

Hysterectomy – The procedure

Hysterectomy can be performed in three ways

  • Laparoscopic hysterectomy

Also known as keyhole surgery, laparoscopic hysterectomy is performed by making incisions in the abdomen. Tiny tube called a laparoscope and a tiny camera is inserted through the holes using which the surgeon performs the surgery. This is very common today owing to quick recovery, less to no scarring, less pain etc. This procedure is performed under general anaesthesia.

  • Vaginal hysterectomy

Vaginal hysterectomy is a less invasive procedure compared to an abdominal hysterectomy. In this procedure, special surgical instruments are used to remove the uterus & cervix through the vagina. This procedure could be performed under general / local / spinal anaesthesia.

  • Abdominal hysterectomy

Abdominal hysterectomy is an open surgery where incisions are either made vertically or horizontally in the abdomen depending on the requirement. This procedure is performed in case of large fibroids or when ovaries need to be removed. It is performed under general anaesthesia.

Hysterectomy & Menopause

Usually apart from medical necessities, there is a choice to the woman who is going to undergo the procedure to want to retain some parts of her reproductive system. There are implications of the procedure and therefore the decisions are taken based on carefully considering medical history, patients opinion & doctor’s recommendations. 

There is a belief that getting cervix removed causes loss in sexual function. This however is not evidence based. Cervix may be removed along with the uterus since it reduces the risk of cervical cancer. 

A family history of ovarian cancer / breast cancer might make the doctor recommend having the ovaries removed to reduce risk. If a woman has already had her menopause or is nearing one, it might be recommended that the ovaries be removed to reduce risk. If there is no family history, some doctors even recommend leaving healthy ovaries in place since they are responsible for female hormones that protect women against bone problems.  Ovaries are also responsible for sexual desire. However it is at the doctors discretion to remove the ovaries during the surgery if need arises.

Reasons why hysterectomy is performed

Some of the reasons why uterus is removed are:

  • Heavy periods / chronic pelvic pain 

Heavy periods may be caused due to many reasons. But there could be heavy bleeding without any reason. In such cases, uterus may be removed if 

  1. Bleeding is heavy & it is affecting quality of life
  2. The woman does not prefer to have children
  3. Other treatments have not worked
  • Endometriosis – A condition in which tissue that lines the inside of the uterus grows outside the uterus in places such as ovaries, fallopian tubes etc. This can cause irregular periods, heavy bleeding etc. In case of endometriosis, hysterectomy may be performed to remove the area of the endometrial tissue.
  • Uterine fibroids – Fibroids are muscular and fibrous tissues that typically develop in the wall of the uterus. Symptoms of uterine fibroids are frequent urination / constipation, discomfort during sex, painful periods etc. 
  • Uterine prolapse – A condition where the uterus slides from its normal position into the vaginal canal, this happens when the tissues & ligaments supporting the uterus weakens. Symptoms of uterine prolapse include urinary incontinence, back pain, finding it difficult to have sex etc. 
  • Thickening of the uterus or Adenomyosis – A condition where the tissue that normally lines the uterus starts growing within the muscular wall of the uterus. It can cause heavy pelvic pain. 
  • Cancer in cervix, uterus, ovaries or fallopian tubes

Except in the case of cancer, this procedure is done after other treatments have been unsuccessful. This is because once hysterectomy is done the woman cannot have children. 

Surgical Menopause

If ovaries are removed, whatever the age might be, the woman will experience menopause. If either or both ovaries are not removed there is chance of menopause happening within 5 years. 

In any case, it is important to seek medical advice regarding any issue you may be facing.