Hysterectomy

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.

• 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.

• 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.

• Difficulties with urination
• Decreased sexual desire
• Constant pelvic pain
• Psychological distress
• Complications of any operation or anaesthetic.

• 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.

• 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.

• Your doctor
• Gynaecologist
• Your local women's health centre or community health centre
• Women's Health Information Centre Information line Tel. (03) 98345 3045, TTY (03) 9344 2849, Country callers Tel. 1800 442 007

• 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.

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