Hysterectomy

female-reproductive-systemA decision not to be made lightly

A hysterectomy is an operation to remove the uterus (womb) from a woman.

Having a hysterectomy is major surgery. The decision to have a hysterectomy should only be made after the woman has been given adequate information about why, how and what the consequences may be. It is important that each woman thinks about how she feels about losing her uterus.

A total hysterectomy means that the whole of the uterus including the body of the uterus and the cervix are removed. A total hysterectomy does not mean to remove the ovaries. Occasionally a subtotal hysterectomy is performed where the cervix is retained, because the woman’s cervix is very sensitive to touch and plays a role in her sexual arousal or because it is technically too difficult to remove it.

Why is a hysterectomy performed?

  • Cancer of the cervix, uterus, ovaries or tubes*
  • Uncontrollable continuous uterine bleeding – rare*
  • Heavy or persistent bleeding – various causes (some included in this list)
  • Severe chronic pelvic pain – various causes (some included in this list)
  • Endometriosis – severe
  • Pelvic Inflammatory Disease (PID) i.e. chronic infections of tubes and pelvis
  • Fibroids – particularly if there are multiple (many) fibroids, the uterus is large or fibroids are growing rapidly
  • Adenomyosis – endometriosis-like condition in uterine muscle
  • Uterine prolapse*emergency must do at once or as soon as possible

There are three ways a hysterectomy may be performed:

  • Abdominal technique – with an incision either across the lower abdomen or an up and down midline incision
  • Vaginal – where the procedure is performed completely through the vagina
  • Laparoscopic or laparoscopic and vaginal – performed through key-hole surgery either completely or in combination with the vaginal approach

The decision as to which method of hysterectomy is most appropriate depends on:

  • The reason for hysterectomy
  • The facilities/equipment available in the local/regional hospital
  • The surgeon’s skill in laparoscopic hysterectomy, or your local hospital may not have the required laparoscopic equipment

If a woman is unsure of having a hysterectomy or not she should seek a second opinion. Sometimes it is appropriate to take time over making the decision except when there is cancer or uncontrollable life-threatening bleeding. For many women hysterectomy relieves their symptoms and improves their quality of life. Often women say, “I wish I had done this years ago”.

A small number of women take time to recover following hysterectomy. This may be for many reasons. Some of which may be due to:

  • Complications following the operation such as infection or bleeding prolonging recovery
  • Adjusting to the loss of her uterus and end of her ability to have a child – particularly if childless
  • Concern about her femininity and sexuality particularly if the ovaries were also removed
  • Becoming menopausal if the ovaries were also removed before the periods had stopped
  • Feeling unhappy about how she was treated by her doctor and/or the hospital staff

If a woman is struggling with her feelings and wellbeing she should seek help from a qualified practitioner or counsellor.

Deciding to have a hysterectomy

Questions to have answered by your doctor:

  • Why is your hysterectomy necessary?
  • What is/are the reason/s to do it?
  • How will it be done?
  • What type of hysterectomy is recommended?
  • Is it necessary to take out the ovaries as well?
  • How long will the operation take and how long will I be in hospital?
  • What are the potential complications of this operation?
  • Are there tests needed to be performed before the operation including: will a blood transfusion be necessary?
  • How long after the operation do I need to recover and how long will I need to be off work?
  • What can I expect postoperatively?
  • Are there any other options instead of hysterectomy?

Conclusions

Hysterectomy has become a much safer operation because of modern anaesthesia and analgesia and improved techniques. Hysterectomy is still a necessary operation for the various reasons outlined above. Each woman should find out as much as she can about hysterectomy before making a decision and she should also explore what having a hysterectomy means to her.

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