Hysterectomy may be a medically necessary in cases such as:
- Invasive cancer of the uterus, cervix, vagina, fallopian tubes, and/or ovaries
- Severe infection of tubes, ovaries, and uterus
- Heavy, irregular vaginal bleeding
- Serious complications during childbirth, such as a rupture of the uterus
- Pelvic pain relieved by other treatments or sever endometriosis
- Pelvic prolapse
For other conditions, it is optimal to evaluate all options before resorting to major surgery.
If your condition is not causing problematic symptoms, you may want to closely observe your symptoms without initiating active treatment. Many women are treated for conditions that do not necessarily require treatment, and the side effects of these treatments can cause more health problems than the actual condition. For many conditions all that is needed is careful observation to monitor if and how the condition changes, or is, hopefully, naturally eliminated.
There are many treatment options for shrinking or removing uterine fibroids without removing reproductive organs. These include using drugs (such as hormones or anti-hormones), uterine artery embolization (UAE) laser ablation of uterine fibroids, cryosurgery, and myomectomy
Hysterectomy is often necessary and life preserving when invasive cancer is diagnosed, however, hysterectomy is frequently recommended when cancer is neither invasive nor life threatening. For pre-cancerous cells, there are a few options that you and your health care provider should discuss. Loop Electrosurgical Excisional Procedure (LEEP) or Conization of the cervix can be used to remove pre-cancerous cells.
Excessive Menstrual Bleeding
Endometrial ablation can be used to treat heavy menstrual bleeding. Dilation and Curettage (D&C) can also be used to thin the lining or abnormal tissue and treat irregular bleeding.
Operative laparoscopy is a surgical procedure that can generally be done on an outpatient basis to remove endometrial growths and adhesions. Pain medication, hormone therapy and other conservative surgical procedures can also be used to control any discomfort associated with endometriosis.
A vaginal pessary (an object inserted into the vagina to hold the uterus in place) can be used as a temporary or permanent form of treatment for a prolapsed uterus. Vaginal pessaries are available in many shapes and sizes and must be individually fitted. Health practitioners suggest that Kegel exercises can be a powerful prevention and treatment tool for strengthening pelvic floor muscles and avoiding prolapse.
When a Hysterectomy Seems Necessary
If none of the above options are viable and a hysterectomy seems necessary, it is important to initiate open communication with your health care provider regarding the specifics of your situation. Here are some important questions that you may want to ask your health care provider before you decide on a hysterectomy:
- What are the risks involved with this type of hysterectomy, and what is the success rate?
- How long will I be in the hospital? Can this procedure be performed on an outpatient basis? What type of surgery will be needed?
- When can I expect to be fully recovered from the surgery?
- How will this surgery affect my sexual functioning?
- What type of anesthesia will be needed?
Types of Hysterectomy
a) Partial Hysterectomy (Supracervical/above the cervix)removes the body of the uterus while the cervix is left in place.
b) Total or Simple Hysterectomy removes the entire uterus and cervix.
c) Hysterectomy with Bilateral Salpingo-Oophorectomy removes the uterus, cervix, ovaries, and fallopian tubes.
d) Radical Hysterectomy removes the uterus, cervix, ovaries, fallopian tubes, and possibly upper portions of the vagina and affected lymph nodes.
Hysterectomy Surgical Options
a) Vaginal Hysterectomy describes a surgical procedure in which the uterus is removed through the vagina. One or both ovaries and fallopian tubes may be removed during the procedure, as well. This surgical approach avoids visible scarring and typically allows for a quicker recovery, as well as less postoperative pain and complications as compared with other types of hysterectomy. Risks associated with the vaginal approach include a slight but serious risk of shortening or damaging the vagina.
b) Laparoscopic-Assisted Vaginal Hysterectomy or Supracervical Hysterectomy employs video technology to provide the surgeon with greater visibility when removing the uterus through the vagina. The laparoscopic-assisted approach entails three small external incisions: one in the navel, through which the laparoscope (small video camera) is inserted, and two others in the lower abdomen for the use of surgical instruments. This procedure may be preferred because of the rapid healing time, a less noticeable scar, and less pain, although actual surgery time is longer than the abdominal approach. Because of the longer time in the operation room and the use of extra electronic equipment, this procedure is also costlier than others. Risks associated with the laparoscopic-assisted vaginal approach include a slight risk of bladder injury and urinary tract infection.
c) Abdominal Hysterectomy is fairly standard and remains the most common approach for removing the uterus and other reproductive organs. When performing an abdominal hysterectomy, surgeons can either use a vertical incision or a "bikini cut" incision depending on the scope of the surgery. The vertical incision cuts vertically from the navel to the pubic hair line, while the bikini cut is a horizontal incision made directly above the pubic hairline. The abdominal hysterectomy approach results in a longer recovery period and more noticeable external scarring but requires less specialty surgical skill and may be less costly and more widely available than other approaches.
Surgical and Post-Surgical Risks
Although the death rate from hysterectomy is low (less than 1 percent) surgical complications are very real and can result in any of the following: infection, hemorrhage during or following surgery and/or damage to internal organs such as the blood vessels, nerves, urinary tract or bowel. Patients have a 5-10% chance of complication (typically infection or fever) while in the hospital and a significantly lower risk 1-2% of more serious complications such as hemorrhage or bladder, blood vessels, nerves and bowel damage depending on the individual's condition and the surgical approach taken.
Removal of the uterus and ovaries at a young age (early forties and younger) may increase risk of heart attack, and chances of experiencing an earlier menopause and symptoms associated with. You may require replacement of hormones when your ovaries are removed.