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Hysterectomy

 

Hysterectomy is the surgical removal of the uterus.  Depending on the woman’s circumstances, fallopian tubes, ovaries and/or the cervix may be removed at the same time.

In Australia, hysterectomy is one of the most common elective surgeries.  Most hysterectomies are performed to treat problems such as:

  • Fibroids
  • Heavy bleeding
  • Endometriosis
  • Adenomyosis (where endometrial tissue grows into the muscle wall of the uterus)
  • Uterine prolapse
  • Cancer

Please note:  Hysterectomy is a major surgery and should not be considered as a first-line treatment for heavy period bleeding.  This surgery should only be considered when more conservative treatment options have not been successful.  The development of new treatments and technologies has reduced the need for hysterectomies in more recent years.

Making the decision to have a hysterectomy isn’t easy, and there can be lots of emotions involved.  It is important to thoroughly discuss all options with your doctor so that you can make an educated decision that’s right for YOU!

 

Types of Hysterectomy surgeries

Sub-total or partial hysterectomy

This is where the fallopian tubes and upper 2/3 of the uterus are removed, the cervix remains.  This procedure is quite uncommon.

 

Hysterectomy with ovarian conservation (commonly referred to as a total hysterectomy)

This involves the removal of the fallopian tubes, uterus and cervix.  The ovaries are preserved.

 

Hysterectomy with oophorectomy

This procedure removes the fallopian tubes, uterus and cervix, along with one or both ovaries.

 

Radical or Wertheim’s hysterectomy

This type of hysterectomy is the most extreme.  It involves the removal of the fallopian tubes, uterus, cervix, ovaries, nearby lymph nodes and upper portion of the vagina.  This surgery is most commonly used in the treatment of some gynaecological cancer cases.

 

 

Risks and benefits of keeping the ovaries

 

Removal of the ovaries during a hysterectomy may be recommended to prevent ovarian cancer, generally to women who have a family history.

 

Ovarian cancer is a very serious diagnosis, as it tends to be quite advanced by the time it’s found.  However, the risk of developing ovarian cancer is low compared to other types of cancer.

 

The side effects of having your ovaries removed can be quite significant.  Ovaries produce hormones called androgens including testosterone.  Testosterone is important for maintaining strong muscles and bones, protein balance, sexual desire and general wellbeing.  Around 35% of a womans testosterone is produced by the ovaries; the rest is produced by the adrenal glands.  Surgical removal of the ovaries can cause a 50% reduction in testosterone levels, this can bring about major deterioration of sexual desire, especially in younger women.  However, research has shown that testosterone therapy can improve the libido and wellbeing of pre-menopausal women.

 

Another of the ovaries jobs is to convert testosterone to oestrogen.  Therefore, removing the ovaries of a pre-menopausal woman brings on an instant menopause, often referred to as “surgical menopause”.  This is caused because the levels of female hormones oestrogen and progesterone are greatly reduced once the ovaries are no longer in the body.  The sudden change in hormone levels can instantly cause menopause type symptoms such as hot flushes, night sweats and vaginal dryness.

 

Therefore, it may be beneficial for many womens future health to keep their ovaries if appropriate, given the side effects of ovarian removal and the relatively low risk of developing ovarian cancer.

 

 

Methods: abdominal, vaginal or laparoscopic hysterectomy

 

There are 3 different ways that a hysterectomy can be performed.  Dr Li will discuss your options with you, and together make a decision that is right for you and your body.  The reason for the hysterectomy, weight, pelvic surgery history and whether you have had children are all taken into consideration when deciding what type of hysterectomy is best for you.

 

Abdominal hysterectomy

An abdominal hysterectomy is generally carried out when more extensive investigation is required;  for example, in the case of cancer, an enlarged uterus, obesity, large fibroids, extensive adhesions, endometriosis or if the woman has never had children.

 

The incision is made horizontally, just above the pubic hair line. 

 

The main advantage of having an abdominal hysterectomy is the reduced risk of urinary tract and blood vessel damage.  This method also allows for the repair of prolapsed if required.  The disadvantage of abdominal hysterectomy is that it is considered the most painful.

 

Vaginal hysterectomy

This involves making a small incision in the upper portion of the vagina so that the uterus may be removed through the vagina.  The advantages of having a vaginal hysterectomy include a shorter stay in hospital, no visible scar and less pain.  Where possible, a vaginal hysterectomy should be performed in preference to an abdominal hysterectomy.

 

Laparoscopic hysterectomy

This procedure involves making 3 or 4 small incisions in the abdomen.  A laparoscope is inserted through one of the incisions and into the abdominal cavity; other surgical instruments are then inserted through the remaining incisions.

 

Laparoscopic procedures are often seen as advantageous due to shorter hospitalization and recovery times compared to open surgery.  It is important that a surgeon is highly experienced in laparoscopic surgery for these benefits to be achieved, be sure to ask questions about your doctors training and experience in this procedure.

 

Risks and complications

As will ALL surgeries, there are risks.  Whilst medical professionals make every attempt to minimize risks, complications can occur that may have permanent effects.  It is important that you are well informed about the possible complications so that you can weigh up the benefits and risks of the procedure.

Please note:  Smoking, obesity and other significant medical problems greatly increase the risk of complications with any surgery.

 

Some complications related to hysterectomy include:

  • Post-operative fever
  • Infection

 

Other more serious complications include:

  • Haemorrhage
  • Formation of a blood clot in the lungs
  • Damage to surrounding organs
  • Urinary complaints

 

It is also important for women considering hysterectomy to be aware of the potential risk of vaginal vault prolapsed following the surgery.  Vaginal vault prolapse is when the top of the vagina drops down due to a reduction in support structures.  The problem can be corrected with further surgery.  The risk of vaginal vault prolapse can be reduced at the time of the hysterectomy by leaving the cervix in place.  It is worth considering; the cervix may be involved in orgasm for some women, and therefore if it’s removed a decrease in sexual response may be experienced.

 

Recovery

 

Following surgery you may experience some abdominal pain and discomfort; this can be relieved with medication.  There may be some vaginal bleeding which should subside after a few days.  Patients are encouraged to get up and walk around the day after surgery.

 

Hospitalisation time varies depending on the individual and type of hysterectomy performed; generally patients can go home after 2-4 days.

 

It is important to rest completely for at least the first few days after surgery.  Standing for any length of time should be avoided.  Sit or lay down whenever possible.  Heavy lifting and prolonged standing should be avoided for at least 3 months after having a hysterectomy.

 

Women generally require 6-8 weeks rest before returning to work or other normal activities.  Sexual penetration should be avoided.