12 April 2011


What is hysterectomy?

A hysterectomy is an operation to remove the uterus (womb). Most hysterectomies are not emergency operations, so you have time to think about your options

The uterus cradles and nourishes a fetus from conception to birth, and aids in the delivery of the baby. It also produces the monthly menstrual flow, or period.

The ovaries have two major functions. One is the production of eggs or ova, which permit childbearing. The second is the production of hormones or chemicals which regulate menstruation and other aspects of health and well-being, including sexual well-being. If the egg that is released during a woman's normal monthly cycle is not fertilized, the lining of the uterus is shed by bleeding (menstruation).

After a hysterectomy, a woman can no longer have children and menstruation stops. The ovaries generally continue to produce hormones, although in some cases they may have reduced activity. Some hysterectomies also include removal of the ovaries, so the supply of essential female hormones is greatly reduced. This can have various effects, as discussed later.


Reasons why hysterectomies may be recommended fall into three categories:
" to save lives;
" to correct serious problems that interfere with normal functions;
" to improve the quality of life.

Cancerous organs and, in some cases, adjoining organs and structures, are removed in order to stop the spread of this life-threatening disease.

These are common non-cancerous (benign) tumors of the uterus and they are the most frequent reason for recommending a hysterectomy. They grow from the muscular wall of the uterus and are made up of muscle and fibrous tissue. Many women over 35 have fibroids, but usually have no symptoms.
In some women, however, fibroids (myomas) may cause heavy bleeding, pelvic discomfort and pain and occasionally pressure on other organs. These symptoms may require treatment, but not always a hysterectomy.There is a type of abdominal surgery (myomectomy) that removes the myoma without removing the uterus. These treatments may be sufficient or they may offer temporary relief and enable a woman to postpone having a hysterectomy, especially if she still wishes to bear children.
Some women choose to do nothing since fibroids will often shrink in size as a woman goes through menopause.

Another common reason for recommending a hysterectomy is endometriosis. This is a noncancerous condition in which cells from the uterine lining grow like islands outside of the uterus. This growth occurs most commonly on the ovaries, fallopian tubes, bladder, bowel and other pelvic structures, including the uterine wall. These cells may cause pain and discomfort by bleeding at the time of menstruation. Symptoms can vary greatly and some women choose to do nothing, or find that drug therapy, pain relief medication or more localized surgery are effective. When these are not effective, hysterectomy may be the treatment of choice.

As a woman ages, the vaginal supports begin to lose their muscle tone and sag downward (prolapse). With prolapse, the bladder and/or rectum may be pulled downward with the uterus. This happens to most women to some degree. For the vast majority, the sagging is minor and symptoms are not severe.
If the prolapse worsens, some women experience a heavy or dragging feeling in the pelvic area, problems controlling bladder and/or bowel function, and occasionally, protrusion of one of the organs through the vaginal opening.

Some women get relief from these symptoms by doing special exercises ("Kegels") to strengthen the pelvic muscles, by taking hormone therapy or by using a plastic or metal ring (pessary) which may help to hold the uterus in place. None of these treats the underlying problem.

A hysterectomy with repair of supporting structures is usually recommended in more serious cases. A woman has to decide for herself if the discomfort is great enough to have a hysterectomy.

Irritation of the lining of the abdomen may cause adhesions (scarring) which bind affected organs to each other. The adhesions can result from endometriosis, infection or injury. The symptoms may include severe pain, bowel and bladder problems and infertility.
Pain relief medication or less drastic surgery, such as laser therapy, can be effective in some cases. In very serious cases, hysterectomy may be recommended.

It is normal for the amount and length of menstrual flow to vary from woman to woman. There may also be differences in menstrual flow from one cycle to the next. If bleeding that is unusually heavy or frequent for you occurs, this may be due to a variety of causes. The most common causes are fibroids and hormonal changes.
Because there can be many reasons for unusually heavy bleeding, getting an accurate diagnosis is vital before deciding on a course of treatment. Depending on the diagnosis, drug therapy or minor surgery may be indicated. Rarely, there can be hemorrhage of the uterus in which case a hysterectomy can be life saving.

This is a common symptom. As with heavy bleeding, there can be a number of causes for pelvic (lower belly) pain. These include endometriosis, fibroids, ovarian cysts, infection or scar tissue. Pain in the pelvic area may not be related to the uterus.
Therefore, a careful diagnosis is essential before considering whether to have a hysterectomy.


A hysterectomy may be life-saving in the case of cancer. It can relieve the symptoms of bleeding or discomfort related to fibroids, severe endometriosis or uterine prolapse. On the other hand, for these non-cancerous conditions, you may prefer to seek alternatives to surgery for these symptoms or other problems related to the uterus and pelvic organs.

Symptoms like pelvic pain or unusual bleeding may not necessarily be related to the uterus. An accurate diagnosis will help you to determine the potential benefits and risks of a hysterectomy.

The risks of hysterectomy include the risks of any major operation, although its surgical risks are among the lowest of any major operation.

Hysterectomy patients may have a fever during recovery, and some may develop a mild bladder infection or wound infection. If an infection occurs, it can usually be treated with antibiotics. Less often, women may require a blood transfusion before surgery because of anemia or during surgery for blood loss. Complications related to anesthesia might also occur, especially for women who smoke, are obese, or have serious heart or lung disease.
As with any major abdominal or pelvic operation, serious complications such as blood clots, severe infection, adhesions, postoperative (after surgery) hemorrhage, bowel obstruction or injury to the urinary tract can happen. In addition to the direct surgical risks, there may be longer-term physical and psychological effects, potentially including depression and loss of sexual pleasure. If the ovaries are removed along with the uterus prior to menopause (change of life), there is an increased risk of osteoporosis and heart disease as well. In making a decision, you should also consider that a hysterectomy is not reversible. After a hysterectomy, you will no longer be able to bear children and you will no longer menstruate. You need to think about the impact these changes would have on you.

Talk about your concerns with your doctor or a counselor and your partner. You may want to bring your partner to your doctor's office to discuss concerns before having the operation.

Should your ovaries be removed along with your uterus if you have a hysterectomy?

If you have a diagnosis of uterine cancer, the ovaries should be removed because the hormones they secrete may encourage the growth of the cancer. They also may have to be removed in severe endometriosis because they produce the hormones that are responsible for endometriosis.
The fallopian tubes are generally removed when the ovaries are removed because they are attached to the uterus and their sole purpose is to serve as a passageway between the ovaries and the uterus.
In cases other than uterine cancer or endometriosis, there is controversy among doctors about the advantages and disadvantages of removing ovaries and tubes as part of a hysterectomy.
Some doctors believe that healthy ovaries should be removed as part of a hysterectomy in women who are are close to menopause or later, when the ovaries' function normally fades.
As a woman ages, the ovaries gradually reduce their production of hormones, but even after menopause they produce small amounts of hormones. Removing the ovaries causes menopause to occur more abruptly. After ovaries are removed or when menopause occurs, hormone replacement therapy often helps reduce the risks of osteoporosis, and reduce menopausal symptoms like hot flashes and vaginal dryness.

Some women report having a strong emotional reaction, or feeling down, after a hysterectomy. Most feel better after a few weeks, but some women do feel depressed for a long time.


All hysterectomies are major operations involving removal of at least the uterus. Some types of hysterectomies involve removing other organs as well. It is important to talk with your doctor about the kind of hysterectomy recommended for you.

    In this operation, only the upper part of the uterus is removed, but the cervix is not. Tubes and ovaries may or may not be removed. This procedure is always done through the abdomen. Leaving the cervix may help with later sexual enjoyment. After this operation, a woman still needs to have regular Pap smears to prevent cervical cancer.
    This operation involves removing both the body of the uterus and the cervix, which is the lower part of the uterus. Hysterectomy can sometimes be done through the vagina (vaginal hysterectomy); at other times, a surgical incision in the lower belly (abdominal hysterectomy) is preferable. For example, if you have large fibroid tumors, it is difficult to safely remove the uterus through the vagina.
    Vaginal hysterectomy, when it can safely be performed, generally involves fewer complications, a shorter recovery period and no visible scar.
    " Complete hysterectomy" is a common non-medical term that usually means a total hysterectomy plus removal of the ovaries and fallopian tubes.
    This procedure is reserved for serious disease such as cancer. The entire uterus and usually both tubes and ovaries as well as the pelvic lymph nodes are removed through the abdomen. Since cancer is unpredictable, other organs or parts of other systems are sometimes removed as well.


Presurgical routines vary from hospital to hospital. Generally:

  • - blood and urine samples are taken.
    - enemas are sometimes given.
    - the abdominal and pelvic areas may be shaved.

After the operation, the hospital stay varies depending on the type of hysterectomy and whether there are any complications.
Since hysterectomy is a major operation, discomfort and pain from the surgical incision are greatest during the first few days after surgery, but medication is available to reduce these symptoms.
By the second or third day, most patients are up walking. Normal activity can usually be resumed in four to eight weeks. Each patient is an individual, so the pace of recovery will vary.
Sexual activity can usually be resumed in six to eight weeks.
You can discuss both presurgical procedures and your recovery, including useful exercises, with your doctor.


Hysterectomy vs.Abdominal Hysterectomy

Laparoscopic Hysterectomy
Abdominal Hysterectomy

When we do a laparoscopic hysterectomy we usually make 2 incisions of ¼ inch and 1 incision of 1/2 inch. With an abdominal hysterectomy we usually need at least a 6 inch incision. Obviously the smaller incisions with laparoscopy cause less pain and interfere less with activities such as walking, coughing, and standing. The hospital stay is usually one night after a laparoscopic hysterectomy and 2 or 3 nights after an abdominal hysterectomy. Laparoscopic hysterectomy patients do not need nearly as much pain medication as abdominal hysterectomy patients. We allow laparoscopic hysterectomy patients to return to work and exercise sooner than abdominal hysterectomy patients. We have had laparoscopic hysterectomy patients return to work in one or two weeks in many cases.

Indications for Laparoscopic Hysterectomy

The indications for a laparoscopic hysterectomy are basically the same as those for an abdominal hysterectomy. Some examples of these indications are:

  • - Fibroid tumors (a.k.a. leiomyomas or myomas)
    - Endometriosis
    - Adenomyosis
    - Abnormal uterine bleeding
    - Pelvic pain
    - Uterine prolapse
    - Pelvic mass
    - Cancer
    - Cancer prevention

Most but not all hysterectomies can be done laparoscopically. Sometimes it is not possible for the gynecologist to know for sure if the hysterectomy can be done laparoscopically until he looks in the abdomen with the laparoscope. We occasionally will start the surgery with a laparoscope and discover we cannot successfully complete the surgery without making a large incision (laparotomy) which we do at that time.

Contra-indications for Laparoscopic Hysterectomy

With new technology constantly being developed the number of contraindications to laparoscopic hysterectomy shrink each year. Some examples of contraindications are:

  • - Severe adhesions
    - Extremely large pelvic mass
    - Some types of cancer

We are unable sometimes to judge if we will be able to do a hysterectomy laparoscopically until we insert the laparoscope


  • > Why do I need to have a hysterectomy?
    > What organ or organs will be removed and why?
    > Will my ovaries be left in place? If not, why?
    > Will my cervix be removed? If so, why?
    > Are there alternatives for me besides a hysterectomy?
    > What are the advantages, risks, benefits of each?
    > What will be the physical effects of a hysterectomy?
    > Are these permanent?
    > What will happen to my figure, my weight, my breasts?
    > How will it affect my sex life?
    > Will I experience menopause (change of life)? Can the symptoms of menopause be treated? What are the risks and benefits of such treatment?
    > Will the operation be a vaginal or abdominal hysterectomy? And why?
    > What can I expect in the hospital? pre-operative procedures? length of stay? anesthesia? infection? transfusion? urinary catheter?
    > What kind of care will I need after my hysterectomy?
    > How should I prepare for coming home from the hospital?
    > How soon can I go back to work? Try heavy housework?
    > When can I resume sexual activity?

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