Why are Hysterectomies performed?
Fibroids are the most common cause for hysterectomy, the removal of the uterus. They are associated with as many as half of the 600,000 hysterectomies performed in the US annually. Depending on their location, fibroids can cause either heavy bleeding, pelvic and back pain, or pressure on bowel and bladder. Most hysterectomies performed for fibroids [the medical term is myoma] are performed by the abdominal route since the fibroids may grow to be quite large. Fibroids are almost never cancerous.
Although not as common as fibroids, cancer may affect either the lining of the uterine cavity [endometrial cancer], cancer of the cervix, or sarcoma, a rare cancer in the uterine muscle. These cancers are treated with removing of the uterus. Often the ovaries will be removed at the same surgery to prevent spread.
Endometriosis is another common cause for hysterectomies. In this disease, the lining of the uterus [the endometrium] spreads to other parts of the pelvic cavity such as the ovaries. It is stimulated each month as if it were inside the uterus. Women often complain of intense crampy pain with exercise, intercourse or menstruation when they suffer from endometriosis. Medical therapy may slow the spread of this disease. Laparoscopy may allow a physician to remove some of the disease. In spite of the best efforts, many women require hysterectomy to cure their chronic pain.
Other conditions which may require a hysterectomy include a drop of the pelvic cavity organs.
“The fibroid was really impacting my life. I tried this alternative to hysterectomy (fibroid embolization) and I got better…””
Do You Really Need to Remove Your Uterus?
If you’ve been diagnosed with fibroids and your doctor has recommended a hysterectomy without discussing less invasive therapies, you owe yourself a second opinion. A hysterectomy (the surgical removal of the uterus) is a major operation. In addition to a lengthy hospital stay and recovery period at home, there’s a 30% complication rate and obvious issues regarding a woman’s sexuality, fertility and quality of life once the uterus is removed.
Half of all hystertomies are due to fibroids and most could be avoided. While a removing the uterus will certainly cure a fibroid problem, many women don’t want to lose their uterus. Remember, fibroids are usually not cancerous. You don’t have to rush into anything. Research your options.
Types of Hysterectomies
Removal of the entire uterus is a total hysterectomy. Leaving the cervix but removing the rest of the uterus, is called a sub-total hysterectomy. Removing ovaries ( bilateral salpingo-oopherectomy), is a separate decision which a patient and her doctor make before surgery. Hysterectomies are performed in one of two ways; either through an incision in the stomach or through the vagina. Abdominal hysterectomies are the most common form and typically require the longest recovery time. Some hysterectomies can be done using an instrument called the laparoscope.
In a total hysterectomy, the entire uterus and cervix are removed. Total hysterectomy can be done abdominally with an incision most often made along the bikini line. This procedure requires a longer healing time, approximately 6 weeks to 2 months for full recovery. A total hysterectomy can also be performed vaginally, which does not require a large incision through the belly. Recovery time is roughly 3 weeks to 1 month.
A sub-total hysterectomy, also known as a partial hysterectomy, leaves the cervix intact but the rest of the uterus is removed. Many doctors remove the cervix automatically as a precaution against cervical cancer. These procedures can be performed abdominally, vaginally, or laparoscopically.
This operation is the removal of the ovaries and/or fallopian tubes. This is a separate decision which a patient and her doctor make before the surgery is performed. There are several considerations to think about before consenting to this surgery. This surgery causes an artificial onset menopause due to the loss of natural sex hormones. If this is the only choice available, look into methods of regaining hormonal balance through maintaining a healthy lifestyle and other support measures.
This procedure is performed through an incision in the stomach. It is the most common form and typically requires the longest recovery time.
This procedure is performed through the vagina.
Whether your doctor performs the procedure vaginally or with a small incision in the abdomen will depend on the size of the uterus and the causes of surgery to begin with.
The newer and more sophisticated procedures use laparoscopy to assist the hysterectomy procedure. During a laparoscopic hysterectomy, the organs are visualized and manipulated through a laparoscope, and the uterus is removed either vaginally or through a small incision in the abdomen. This type of surgery results in a much quicker recovery, (typically 1 to 2 weeks) with far less disruption of the bowel and pelvic floor. It is best performed by a laparoscopic specialist, someone that performs this type of surgery often, as not all surgeons are as skilled at this procedure. The choice here depends on the reasons for doing the surgery, the patient’s anatomy, and the surgeon’s preference. If you have a personal preference, definitely communicate this to your surgeon.
While removing a uterus for fibroids will certainly cure a fibroid problem, many women don’t want to lose their uterus. Fibroids are usually not cancerous so you don’t have to rush into anything. Take the time to research your options and find what will work best for you and your lifestyle. Fibroids may be treated by other, non-surgical means like embolization.
Learn more why Embolization might be a better option than Hysterectomy. Fibroid Embolization vs Hysterectomy Surgery