What is a hysterectomy?
A hysterectomy is the surgical removal of the uterus, a muscular reproductive organ of the female body. The operation may be performed via abdominal hysterectomy, laparoscopic hysterectomy or vaginal hysterectomy. A hysterectomy can include or not include, the removal of the ovaries and the fallopian tubes.
During reproductive years, the lining of the uterus (the endometrium) thickens and, after ovulation, is ready to receive a fertilized egg (ovum). If the egg is unfertilized, the inner-lining sheds away as bleeding and this is known as menstruation. If the ovum is fertilized, a fetus will start to develop. If a woman has a hysterectomy, she will no longer have menstrual periods or have the possibility of becoming pregnant, and she will not need to use contraception to protect herself from pregnancy. If a premenopausal woman has had a hysterectomy then she has had surgically induced menopause.
Having a hysterectomy will cause a drop in the production of the sex hormones which are estrogen, progesterone, and testosterone. A patient may also experience symptoms of natural menopause like vaginal dryness, hot flashes, sweating, etc. These symptoms can be mitigated with hormone replacement therapy. Women who undergo bilateral oophorectomy (the removal of both ovaries) also usually take hormone replacement therapy. The ovaries play a major role in maintaining the female hormonal system. Their removal will typically result in menopausal symptoms, therefore, a woman’s ovaries are not usually removed during a hysterectomy.
Why a hysterectomy?
Hysterectomies can treat a number of conditions including women who experience heavy and irregular or painful menstrual periods. Severe period symptoms can be caused by endometriosis, dysmenorrhoea, adenomyosis and other unknown conditions. Although, there are many other treatments for severe period symptoms that are usually tried first like hormone therapy or surgery. Our office usually recommends hysterectomies for endometriosis management in women who no longer want to get pregnant. Hysterectomies can also be used to treat fibroids which are non-cancerous growths that form within the muscular walls of the uterus. The majority (50-70%) of women have fibroids, however, most fibroids are small, do not cause symptoms and do not require treatment. Hysterectomies can also be prescribed as treatments for patients with pelvic inflammatory disease and cervical, ovarian or fallopian tube cancer. Finally, hysterectomies can also treat uterine prolapse, depending on the degree of the prolapse, where the pelvic floor muscles and ligaments become weak. Those weak pelvic floor muscles and ligaments are no longer able to support the uterus and the uterus descends toward (or into) the vagina. Hysterectomies are recommended to patients who aren’t likely to see results from pelvic floor exercises, pessaries, and other surgeries.
Types of Hysterectomies
The first type of hysterectomies is the total hysterectomy where the uterus and cervix are completely removed. A subtotal (partial) hysterectomy is where the uterus is removed, but the cervix is left in place which means that regular cervical screening is still necessary. A hysterectomy and bilateral salpingo-oophorectomy are where the uterus, fallopian tubes, and ovaries are all removed. This operation is performed to treat women with: ovarian cancer, chronic pain due to recurrent pelvic infection or recurrent endometriosis. A radical hysterectomy is the most extensive version of the operation. It involves the removal of the uterus, fallopian tubes, ovaries, upper part of the vagina, and associated pelvic ligaments and lymph nodes. This is performed if the woman has cancer of the cervix, ovaries, fallopian tubes or uterus. A hysterectomy with prophylactic bilateral salpingectomy is where the fallopian tubes are removed at the time of hysterectomy. This type of hysterectomy is usually recommended because research suggests that early ovarian cancers may originate in the tubes.
Is a Hysterectomy Right for me?
Just like any other surgery, hysterectomies do have potential complications and a recommended recovery process. This a decision that shouldn’t be taken lightly and needs to be talked through thoroughly with the patient’s doctor. After a hysterectomy, the patient will no longer need contraception or have menstrual periods. However, if their ovaries were removed, they may experience menopausal symptoms starting within a few days of their surgery. If they were still having periods before their hysterectomy, their doctor should discuss estrogen replacement therapy or other options with them.
Hysterectomies can be an effective treatment for gynecological conditions such as fibroids, endometriosis, and adenomyosis, though sometimes endometriosis may recur. If the patient has had a hysterectomy to treat cancer or has had a subtotal hysterectomy (uterus removed but cervix retained) then they will need to continue having cervical cancer screenings.
Department of Health & Human Services, Australian. “Hysterectomy.” Better Health, Department of Health & Human Services, 31 Aug. 2014, www.betterhealth.vic.gov.au/health/conditionsandtreatments/hysterectomy.
Hill EL, Graham ML, Shelley JM, 2010, ‘Hysterectomy trends in Australia – between 2000/01 and 2004/05’, Australian and New Zealand Journal of Obstetrics and Gynaecology, vol. 50, no. 2, pp. 153–158.