Removal of Uterus (Hysterectomy)
Hysterectomy is a surgical procedure which is performed to remove the womb (Uterus) of a woman. Surgical removal of womb is required in many conditions.
The womb is a pear-shaped organ part of the female reproductive system. It is the place where growth of the baby takes place when a female is pregnant. Therefore, a woman who had undergone hysterectomy could not get pregnant after this operation.
If a woman hasn’t gone through menopause, then after undergoing this surgery she will not have periods. Menopause is defined as the time when the normal monthly menstrual cycle of a woman stops. The mean age of occurrence of menopause is around 45-55 years.
There are various conditions in which surgical removal of womb is required. Some of the main reasons are as follows:
Fibroids (harmless tissue mass)
These are abnormal swellings of muscle in the uterus. Fibroids are common and mostly symptomless but in some women it may cause heavy or painful menstrual bleeding. Larger fibroids could exert pressure on the bladder, causing pressure symptoms.
Downward pressure on uterus (Uterine Prolapse)
It occurs when uterus slips down into the vagina from its usual place. This could occur in women who have undergone various normal vaginal deliveries or those who are obese. It could also occur in women who are not having their monthly periods anymore (menopausal) because after menopause the supporting tissues of uterus become thin and weak. Moreover, prolapse could also lead to pressure symptoms like increased urinary urgency or frequency, pressure on pelvis and bowel problems.
Cancer of the Uterus (lining of the uterus), Cervix, or Ovary
If there is cancer or pre-cancer mass in any of these structures then hysterectomy may be the best option. Other treatment may also include radiation or chemotherapy.
Painful or heavy monthly periods
In some women, day-to-day life becomes hard because of heavy monthly periods. The causes include hormonal imbalance, any infection or cancer. There can be reasons other than these for heavy or painful periods. Heavy periods could also cause anemia (iron deficiency). However, there are many treatment options for painful or heavy periods, like over the counter pain killers (analgesics), other tablets, an intrauterine system/device which could be either chemical or hormonal. If they do not help in improving the condition then hysterectomy is the best option.
There are some other conditions in which hysterectomy is performed such as pain and bleeding between periods due to a condition called Endometriosis.
Also in some cases when uterine internal walls become thick due to abnormal growth of cells in the inner lining causing severe pain and heavy monthly periods. This condition is called as Adenomyosis.
Following are the types of hysterectomy
Complete removal (Total Hysterectomy): It is an operation in which woman’s womb along with the neck of her womb (cervix) is removed. Ovaries are usually not removed. If along with womb and neck of womb, ovaries are also removed then it is called bilateral salpingo-oophorectomy (BSO).
Removal of Uterus (Subtotal Hysterectomy): This operation involves removal of the womb only. Neck of the womb and ovaries are spared.
Radical Hysterectomy: This operation is also known as Wertheim’s hysterectomy. In this operation womb, along with its neck (cervix), fallopian tubes, ovaries, some part of the birth canal (vagina) and lymph nodes of that area are removed. This procedure is usually required in case of cancer.
Ways of doing Hysterectomy
Following are the ways of performing hysterectomy
Abdominal Hysterectomy - Where the womb maybe removed either by giving a cut in the tummy. It will usually leave a scar over that area.
Vaginal Hysterectomy - Where the womb will be removed through birth canal (vagina). It will not leave a visible scar.
Laparoscopic Hysterectomy - Several small cuts are given in the abdomen and womb is removed through them.
Removal of Ovaries during Hysterectomy
The doctor may remove the ovaries while performing hysterectomy and the decision to remove them depends upon the reason behind performing this operation. Therefore, patient should discuss all possibilities with the doctor before the surgery is carried out.
However, removing ovaries at the time of hysterectomy reduces the chance of ovarian cancer but will cause menopause (discontinue monthly periods).
Hormonal therapy can be given, which could be started immediately after surgery. It will help in relieving signs and symptoms of menopause. Patients who have increased risk of bone disorder causing bones to become porous, brittle and more prone to get fractured (osteoporosis), could also get benefit from hormonal therapy.
There is a small risk of complications during this surgery which are as follows:
2- Heavy or painful bleeding.
3- Damage to neighboring organs like bowel, rectum or bladder.
4- Anesthesia related complications.
6- Hysterectomy is a major procedure. The patient would require to stay in the hospital for about 5-7 days. Full recovery can be seen in 6-8 weeks. Time taken for recovery also depends upon the type of hysterectomy performed. Patient should be rested following the few weeks of surgery. Moreover, lifting of heavy objects should be avoided, for a while. Avoid sex for 6-8 weeks following surgery.
After recovery that is after 6-8 weeks, the patient should visit the gynecologist clinic for routine exams and general health care also. The patient may still need cervical cancer screening (Pap smear) and pelvic exams.
Changes Expected after Hysterectomy
For most women, better quality of life in the biggest change.
Other changes that might be experienced by you after hysterectomy are as follows:
Interruption in Monthly Cycle (Menopause) - If ovaries are also removed during hysterectomy, patient may have signs and symptoms of menopause.
Emotional Effect - Some women may undergo depression of not being able to give birth to a child anymore. It is common to have an emotional response to this operation.
Other Health Problems - If ovaries are removed as well, then that could lead to increased risk of having heart diseases, bone loss and leaking of urine. The patient can also expect of having pain for some days after operation, which could be relieved by medicines. Patient might also have discharge or bleeding from vagina for a few days, therefore sanitary towels are used.
Following the instructions given by the doctor, it is expected that the patient will get use to the changes soon.