The MenopauseRx Hysterectomy Guide

Reasons for Hysterectomy

While there are many reasons for a hysterectomy, the majority of hysterectomies are performed for either excessive bleeding or pain.

Bleeding:

Excessive menstrual flow (also known as menorrhaghia) can occur for a variety of reasons. The treatment usually depends on the cause. Typical reasons include both hormonal and structural causes. Hormonal reasons are likely to cause the lining (endometrium) of the uterus to become abnormally thickened, which can lead to heavier menstrual flow. This is especially common during the perimenopause transition.  Occasionally, the lining (endometrium) can become very thin which can also lead to abnormal bleeding.  Structural causes of heavy menstrual flow include the development and growth of polyps or fibroids within the uterine cavity/endometrium. Polyps are abnormal growths that can bleed and are either benign or cancerous. Fortunately, the majority are non-cancerous or benign. Fibroids are non-cancerous, abnormal growths that are made of muscle tissue.  They can develop and grow anywhere within the reproductive tract. Many women with fibroids have only minor symptoms and do not need treatement. Fibroids often shrink after menopause. If they become large or grow in or around the endometrium, they can lead to heavy and/or irregular bleeding.

Pelvic Pain:

Pelvic pain is another common cause for hysterectomy. Conditions associated with pelvic pain include endometriosis, fibroids, adenomyosis, and adhesions/scar tissue. Endometriosis occurs when the tissue that lines the uterus grows outside the uterus on the ovaries, fallopian tubes or other organs. This can lead to severe pain before and during a menstrual cycles and pain with intercourse. Adenomyosis is a condition where the lining of the uterus grows into the muscle part of the uterus and can cause severe pain, bleeding and an enlarged uterus.

Pelvic Prolapse:

Pelvic prolapse can lead to hysterectomy. This is a condition where the connective tissue supporting the uterus, bladder and/or rectum become weakened and the uterus and/or pelvic organs slips from its usual place down into the vagina. This weakness can lead to a ‘drop’ of these organs and cause pain, such as pulling, aching, or pressure.  Often, in addition to pain, bleeding from constant rubbing of prolapsed tissues or incontinence can occur.

Cancer:

Gynecologic cancers can lead to hysterectomy. Cervical, uterine, fallopian tube and ovarian cancers do occur with varying frequency and are, in most cases, treated surgically with hysterectomy. Some pre-cancerous changes on the cervix can be treated without hysterectomy by removing the abnormal areas.

Work Up:

A specific evaluation or 'work-up' is necessary to determine which treatment is best. Also, specific testing needs to be done prior to any treatment. 'Crossing the T’s and dotting the I’s' is very important to make sure the best outcome is achieved. A thorough pelvic exam and up-to-date pap smear is necessary. Often, a pelvic ultrasound and/or endometrial tissue sampling (biopsy) is needed. Laboratory testing is frequently used to determine blood counts and hormonal levels. Lastly, a detailed review of your medical history is prudent before making a treatment decision.

If irregular or heavy menstrual bleeding is the problem, many doctors will have a patient utilize a 'menstrual calendar' to track their bleeding patterns. This often is helpful to shed light on any patterns that may be developing and can help track treatment success. Click here for a downloadable 'MenopauseRx Menstrual Calendar'.

The Survival Kit contains free educational materials and coupons for products to relieve menopause symptoms, including hysterectomy information.