Health Concerns - Hysterectomy
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Hysterectomy


Hysterectomy is the most common major gynecologic surgery performed. More than one in three women in the U.S. will have had a hysterectomy by age 60 according to the US department of health and human services.

Defined – Total hysterectomy involves the removal of the uterus and cervix. Subtotal hysterectomy involves only the removal of the uterus. A hysterectomy can be performed in a number of ways. Removal from the vagina is a common and well-accepted approach. If unable to be removed from the vagina, an incision is made in the abdomen to remove the uterus. With the advent of laparoscopy (‘belly button surgery’), many physicians are utilizing this method to help remove the uterus.
Removing the uterus will result in no further menses. However, not every woman that has a hysterectomy will go through menopause or have menopause symptoms.

A common misconception in terminology is the ‘complete’ hysterectomy. Often mistakenly referred to denote the removal of the fallopian tubes and ovaries, this term can be confusing. ‘Complete’ and ‘total’ hysterectomies can be used synonymously, and do not indicate whether the tubes and/or ovaries were removed. If one or both ovaries are removed, then your doctor would denote that detail with a descriptor. The removal of one tube or ovary is called a ‘unilateral (right or left) salpingoophorectomy’. If both tubes and ovaries are removed, then bilateral salpingoophorectomy is used. Therefore, if the uterus and both tubes and ovaries are removed, the correct terminology would be a total hysterectomy (meaning removing the entire uterus) with bilateral salpingoophorectomy (meaning removal of both tubes and ovaries).

Only when a woman has not gone through menopause and she has both of her ovaries removed at the time of hysterectomy will there be a chance of menopause symptoms.

Indications – There are many indications for hysterectomy, including Abnormal bleeding, Gynecologic cancer or pre-cancerous conditions, Pelvic Pain, Fibroids, Endometriosis, and Pelvic Relaxation or prolapse. The most common reasons for hysterectomy include endometriosis and abnormal bleeding. However, each of these indications must be individualized for each situation.

The evaluation for hysterectomy is distinct for each indication. Examples of specific testing, after a thorough exam, that can be utilized includes ultrasound, CT scan, uterine biopsy and diagnostic laparoscopy. Pap smear testing should be done within one year of a hysterectomy. Often, physicians will recommend conservative medical treatments to alleviate problems prior to recommending a hysterectomy. For example, hormonal manipulation with birth control pills may be attempted in some individuals with bleeding, pain or endometriosis. Pelvic floor exercises (link to kegel page at 2.5) or pessary placement may be attempted prior to hysterectomy for pelvic relaxation.

Alternatives – Since most hysterectomies are not done under emergent situations, there is plenty of time to attempt various other treatments and discuss options with your physician. Often, there are a number of options available after a complete work-up and evaluation is done. Medical treatments with medications may be one option. Medical treatments for irregular bleeding include a trial of birth control pills in certain situations. Using hormonal manipulations and/or pain medications may prove beneficial in cases of endometriosis, fibroid, or abnormal bleeding. Conservative surgical methods are another option before deciding on a hysterectomy. Removal of the uterine lining, called endometrial ablation or resection, can significantly reduce bleeding. Removing a problematic fibroid can allow for conservation of the uterus. Each alternative medical and/or surgical option has its unique risks and benefits that must be discussed with your doctore and individualized to your situation. Once a hysterectomy is decided upon, a variety of approaches may be offered depending on the indication and surgeon.

Removing the uterus through an abdominal incision is the most common approach to a hysterectomy. This has the longest recovery period. Usually, 4-6 weeks are needed for full recovery. Removing the uterus from the vagina (vaginal hysterectomy) and/or using laparascopy (often referred to as ‘belly button surgery’) to aid in the vaginal hysterectomy (called a LAVH, or laparoscopic assisted vaginal hysterectomy) can be associated with significantly shorter recovery time and less discomfort.

Complications – Complications can occur during any surgery, and hysterectomy is no exception. Infection and bleeding can occur to varying degrees depending on the extent of surgery. Injury to the bladder and/or urinary tract can occur in up to 3% of all cases. Damage to the intestines can also occur in a small number of cases. Other complications that can occur include incontinence, pelvic pain from scar tissue after surgery, genital prolapse, constipation, fatigue and sexual dysfunction. Psychological problems, such as depression, can occur after a hysterectomy and may be due to the inability of becoming pregnant after a hysterectomy. A thorough evaluation that includes an explanation of the indications for surgery, screen for the psycho logic impact of the hysterectomy and alternatives to surgery should be a part of any pre-operative routine. Alternatively, many woman are relieved to end the discomfort and annoyance of pain and bleeding associated with many of the indications for hysterectomy.

The information provided by MenopauseRx, Inc. is not intended to replace the medical advice of your doctor or health-care provider. Please consult your health-care provider for advice about a specific medical condition.