The surgical removal of the uterus is known as hysterectomy. The extent of hysterectomy depends on the reason why a woman needs surgery. Sometimes the doctor may remove ovaries and fallopian tubes. The ovaries produce estrogen and other hormones. If a woman has not reached her menopause, a hysterectomy will put a full stop on the periods or monthly bleeding. A woman is not able to conceive after hysterectomy. If the ovaries are removed before she reaches her menopause, the loss of hormones will cause her to suddenly enter menopause.
Reasons for removal of the uterus
There are several reasons why a woman needs uterus removal. It includes:
1. Uterine prolapse
The uterus moves into the vagina from its normal place in the abdomen. This results in uterine prolapse. This happens as a result of weak and stretched pelvic ligaments. This condition may occur due to multiple childbirths, obesity or following menopause. This may result in trouble with bowel movements, urinary problems or pelvic pressure. An alternative treatment depends on the degree of prolapse but may include pelvic floor exercises or insertion of a pessary into the vagina to prop up the uterus.
2. Severe bleeding after childbirth
Uterus removal may also be performed to control severe bleeding after a woman gives birth to a baby. You may try alternative methods such as hormonal therapy or combined oral contraceptives.
3. Abnormal vaginal bleeding
Many women suffer heavy or unusual bleeding. There may be an infection, changes in hormonal level, cancer or fibroid which may cause heavy or prolonged vaginal bleeding.
The tissue that normally lines the uterus grows outside the uterus on the ovaries and other nearby organs where it doesn’t belong. This can cause severe pain and bleeding during periods and may cause infertility. Alternative treatment may include hormonal therapy.
In this situation, the tissue that lines the uterus grows inside the uterine walls. This can also cause heavy bleeding and severe pain.
Types of cancer
The woman may have her entire uterus removed to treat uterine cancer. The uterus operation may also be performed to treat cervical or ovarian cancer. Hysterectomy is the best treatment if you have cancer in any of these areas.
1. Uterine fibroid
It is the most common noncancerous tumor that grows in the muscles of the uterus. Hysterectomies are the most performed because of fibroid than any other uterus problem. Uterine fibroid also causes too much pain and bleeding.
When the level of estrogen increases and the lining of the uterus becomes too thick, it results in hyperplasia. This causes abnormal bleeding.
Some other reasons for hysterectomy are chronic pelvic inflammation disease, heavy bleeding and chronic pelvic pain.
What is the reason the doctor removes ovaries during hysterectomy?
The removal of the ovaries during hysterectomy depends on the reason why hysterectomy is performed. Ovaries may be removed to lower the risk of ovarian cancer. However, women who have not yet come to the menopause stage may lose estrogen protection, which helps women from conditions such as heart diseases. You can talk to the doctor about the risks and benefits to keep or remove the ovaries before getting a hysterectomy.
What are the types of hysterectomy?
The types of hysterectomies are:
- Total hysterectomy: This involves the removal of both uterus and cervix and is the most common type of hysterectomy performed.
- Partial or subtotal hysterectomy: In this, the uterus is removed but the cervix is left intact. Some women feel it serves the purpose during penetrative sex. But regular cervical screening is still needed.
- Hysterectomy and bilateral salpingo-oophorectomy: It involves removal of uterus, cervix, fallopian tubes and ovaries. This operation is performed when a woman has a uterus or ovarian cancer. This may also be performed when there is chronic pelvic pain due to recurrent pelvic infection.
- Radical hysterectomy: It is an extensive surgical procedure in which the uterus, cervix, ovaries, fallopian tube, the upper part of the vagina, surrounding tissues and lymph nodes are removed. It is performed when a woman has cancer of the cervix, ovaries, fallopian tube or uterus.
Hysterectomy surgical procedures
Hysterectomy is performed through an incision or a cut in your abdomen (abdominal hysterectomy) or three to four small incisions in your abdomen (laparoscopic hysterectomy) or through your vagina (vaginal hysterectomy).
- Abdominal hysterectomyThe surgeon makes a large incision in the abdominal wall which leaves a scar for a few women. The skin and tissues are cut to reach the uterus. It is an open surgery where the uterus is removed from that incision. Following abdominal hysterectomy, the woman stays in the hospital for 2-3 days and the recovery takes a little longer as compared to laparoscopic surgery. It is recommended when a woman has very large fibroid or cancer.
- Vaginal hysterectomyThe surgeon makes a small cut at the top of the vagina and removes the uterus and cervix (if required) is separated from the connecting tissues and removed from the vagina. If the surgeon does not remove the cervix, it is reattached when the surgery is done. The incision is closed with no scarring. The pain is less and the patient heals quickly in vaginal hysterectomy as compared to abdominal hysterectomy.
- Laparoscopic hysterectomyIn a laparoscopic hysterectomy, the surgeon inserts a telescope-like instrument to see the internal organs through one of the small incisions in the navel. The surgeon makes three to four small incisions, so other surgical instruments are inserted through the other incisions to remove the uterus. Carbon dioxide is used to inflate the abdomen so that all your organs can be seen clearly.
The uterus is removed with or without the fallopian tubes and ovaries, through the vagina. When the top of the vagina is stitched through the incision, it is total laparoscopic hysterectomy and if the top of the vagina is stitched through the vagina itself, then it is known as laparoscopically assisted vaginal hysterectomy.
Long-term effects of hysterectomy
You will no longer need contraceptives or have menstrual periods after hysterectomy. If the ovaries are removed, you may experience menopause after few days of hysterectomy. Hysterectomy is an effective treatment for gynaecological conditions such as fibroid, adenomyosis and endometriosis. If you opt for a hysterectomy to treat your cancer, you need to have regular check-ups to make sure you are cancer free. Above all, consult your health care provider if you need to have periodic Pap test and it is important for all women to have regular gynecologic examinations for a healthy life.