Source: Adapted from Family Medical Adviser, Reader’s Digest
What is a hysterectomy?
A hysterectomy is the surgical removal of the womb (uterus). It can be a psychological as well as a physical trauma, as it means that a woman is no longer fertile and may feel unattractive and less feminine. For these reasons counselling is usually offered before and after the operation.
For women with cancer, a hysterectomy can be a life-saver. Menstrual periods will cease after the operation, and for some this brings great relief. A women may also find that her sex life is enhanced as her general health improves and she no longer fears an unwanted pregnancy.
Who is at risk for a hysterectomy?
If a woman has cancer of the uterus or cervix, a hysterectomy may be necessary to save her life. But most hysterectomies are performed to correct persistent pain caused by, for example, severe menstrual problems or pelvic inflammatory disease (chronic salpingitis).
Very painful or exceptionally heavy periods can be caused by fibroids – benign growths on the wall of the uterus. These can sometimes be removed individually, but this is not always successful since fibroids have a tendency to recur. Your doctor may suggest that a hysterectomy is the only option that will alleviate the problem permanently.
Another cause of painful or heavy periods is severe endometriosis, when bits of the uterine lining – or endometrium – migrate out of the uterus and become embedded in other abdominal tissues. If endometriosis does not respond to drug treatment or the surgical removal of any cysts caused by the condition, your doctor may recommend a hysterectomy. Fibroids and endometriosis usually cause no further problems after menopause.
A hysterectomy may also be necessary to deal with a prolapse, when the uterus drops out of position because the ligaments that hold the uterus, bladder and rectum have become overstretched. In severe cases of prolapse the uterus descends into the vagina.
A hysterectomy is carried out under a general anaesthetic. The uterus is usually removed through an incision in the abdomen, but sometimes it is removed through the vagina.
A vaginal hysterectomy is not possible if the uterus is very large or if it is affected by adhesions, and in some cases of cancer and endometriosis.
Keyhole hysterectomy, in which only a small incision is made, may be possible. This type of surgery means that recovery is faster and scarring is reduced, but a specially trained surgeon and specialist equipment are needed.
Following a hysterectomy, a woman will usually need to spend up to a week in hospital; after keyhole surgery, she may be discharged after a day or so. Convalescence takes about six weeks. The lower abdomen will be sore while the muscle tissue heals, and there will be vaginal bleeding and discharge for a few days as the internal wounds heal. After the operation, it is inadvisable to lift anything heavy, to have sex, or to drive for a month or so, to avoid straining the abdominal muscles.
In premenopausal women, healthy ovaries are usually left in place after a hysterectomy, since removing them will bring on menopausal symptoms such as hot flashes and dryness of the vagina, and will increase the risk of developing cardiovascular disease and osteoporosis. Even if the ovaries are left in place, menopause sometimes starts prematurely. Hormone replacement therapy (HRT) is therefore recommended for premenopausal women if their ovaries are removed in a hysterectomy or if they develop symptoms of menopause at a younger age than expected with their ovaries in place.