Hysterectomy is the surgical removal of the womb (uterus), with or without the removal of the ovaries. This procedure is used to treat a variety of conditions, including heavy or painful periods, fibroids and endometriosis. Hysterectomy should be considered a last resort when all other treatments have failed. A hysterectomy may be total (removal of the uterus and cervix), sub-total (removal of the body of the uterus) or total hysterectomy and bilateral salpingo-oophorectomy (removal of the uterus, cervix, ovaries and tubes).
Hysterectomy is the surgical removal of the womb (uterus), with or without the removal of the ovaries. The uterus is a muscular organ of the female body, shaped like an inverted pear. The lining of the uterus, the endometrium, thickens during ovulation in preparation for receiving a fertilised ovum. If the ovum is unfertilised, the lining comes away. This is known as menstruation. If the ovum is fertilised, the developing baby is nurtured inside the uterus throughout the nine months of pregnancy. Once a hysterectomy is performed, a woman can no longer have children or menstrual periods. Hysterectomy is used to treat a number of conditions, such as excessive menstrual bleeding. In Australia, around 30,000 women undergo the operation every year. There are concerns that more hysterectomies are performed than are necessary.
Reasons for hysterectomy
The conditions that may be treated by hysterectomy include:
- Fibroids, which are non-malignant growths inside the muscular walls of the uterus.
- Heavy or irregular menstrual periods.
- Severe period pain, or dysmenorrhoea.
- Cancer of the cervix, uterus or ovaries.
- Endometriosis, a condition characterised by the migration of cells from the lining the uterus to other areas of the body.
- Prolapse, which means the uterus falls into the vagina because of loose ligaments or damage to the pelvic floor muscles.
- Pelvic inflammatory disease, caused by bacterial infection.
Degrees of hysterectomy
There are three basic types of hysterectomy:
- Total hysterectomy - removal of the uterus and cervix. The ovaries and tubes remain.
- Sub-total hysterectomy - removal of the body of the uterus. The cervix, ovaries and the tubes remain.
- Total hysterectomy and bilateral salpingo-oophorectomy - removal of the uterus, cervix, ovaries and tubes.
Different surgical procedures
The type of procedure used influences the length of hospital stay and recovery time. Hysterectomy procedures include:
- Vaginal - the uterus is removed through an incision in the top-end of the vagina. There are no cuts to the abdomen.
- Vaginal and laparoscopic - an instrument called a laparoscope is inserted through small abdominal incisions to assist in the vaginal removal of the uterus. During laparoscopic-assisted vaginal hysterectomy, surgery is performed through three to four small incisions in the abdomen and completed through the vagina.
- Abdominal - the uterus is removed through a lower abdominal incision. With a total abdominal hysterectomy, surgery is performed through a long abdominal cut similar to that which is conducted for a caesarian section.
Possible complications of hysterectomy include:
- Difficulties with urination
- Decreased sexual desire
- Constant pelvic pain
- Psychological distress
- Complications of any operation or anaesthetic.
Women of childbearing age
Once a hysterectomy of any kind is performed, pregnancy is no longer possible. If the ovaries of a premenopausal woman are removed, then ovulation will also cease. This means there will be a drop in production of the sex hormones oestrogen and progesterone, which can cause vaginal dryness, hot flushes, sweating and other associated symptoms of natural menopause. Women who undergo bilateral oophorectomy, or removal of both ovaries, are usually treated with hormone replacement therapy (HRT) - also known as hormone therapy (HT) - to maintain their hormone levels.
The other roles of the uterus and ovaries
Once the childbearing years are finished, hysterectomy may seem a logical treatment option. This is because pregnancy is often considered to be the only function of the uterus, which may explain Australian's high hysterectomy rate. However, the uterus has a number of other important functions, including:
- Sexuality - the uterus rhythmically contracts during orgasm, contributing to sensations of pleasure.
- Hormone production - some researchers believe the uterus contributes to the maintenance of the female hormonal system. The ovaries also play a major role in maintaining the female hormonal system. Their removal results in instant menopausal symptoms and therefore, unless diseased, they should not be removed during hysterectomy.
- Self image - the uterus is of considerable psychological importance, whether or not it is menstruating and capable of bearing a child.
The conditions that prompt a hysterectomy can often be treated by other means. It is recommended that women consider hysterectomy as a procedure of last resort, when all other treatment options have failed. Other options include:
- Drug treatment - medications may be given to reduce or stop heavy bleeding. This is generally used in the short term to provide symptom relief and to allow women time to explore and consider other treatment options.
- Endometrial ablation - this involves the removal or stripping of the lining of the uterus, which is shed each month as a period. This procedure requires admission to hospital as a day patient. An anaesthetic is used. Endometrial ablation can successfully reduce or stop heavy bleeding in 85 per cent of cases. It is not recommended for women who wish to become pregnant.
- Conservative treatment of fibroids - the size, number and position of the fibroids will determine the treatment options offered. Fibroids can be 'shrunk' using medication or by surgery, which burns them away. They can also be starved of a blood supply required for growth, or they can be individually removed through surgery, leaving the uterus intact. Sometimes a combination of these treatments may be advised.
- Surgical removal of endometriosis - this involves cutting or burning out tissue deposits and adhesions from such areas as the ovaries, bladder, bowel, uterus, pelvic walls and ligaments which support the uterus. Hormone therapy may be used before or after surgery.
- Removal of adenomyosis - localised disease can be excised (cut out) or diathermied (burnt off), leaving the uterus intact. This procedure is recommended for those women who wish to become pregnant. It has a 50 per cent success rate - that is, adenomyosis recurs in approximately one half of cases.
Where to get help
- Your doctor
- Your local women's health centre or community health centre
Things to remember
- Hysterectomy is the surgical removal of the womb (uterus), with or without the removal of the ovaries.
- Hysterectomy is used to treat a variety of conditions, including heavy or painful periods, fibroids and prolapse.
- It is recommended that women consider hysterectomy as a procedure of last resort, when all other treatment options have failed.
You might also be interested in:
- Hysterectomy - surgical procedures.
- Pap tests for all women.
- Pelvic inflammatory disease (PID).
- Reproductive system.
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Last reviewed: June 2011
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