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Hysterectomy

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

What is a hysterectomy?

Hysterectomy anatomyA hysterectomy is an operation to remove the uterus (womb). The uterus is an orange-sized muscular organ that sits just above the vagina in the pelvis. The purpose of the uterus is to keep the foetus safe and nourished during pregnancy. At the top of the uterus, there are two fallopian tubes - these tubes carry eggs from the ovaries to the uterus, ready to be fertilised. The cervix is at the base of the uterus where it meets the vagina.

It is estimated that, by the age of 55, about 1 in 5 women will have had a hysterectomy.

 

Why would I need a hysterectomy?

There are a number of common reasons why a hysterectomy may be considered. Often, it is an option only after other treatments have failed or are considered unsuitable.

  • Heavy bleeding - also known as menorrhagia, this accounts for approximately half of the hysterectomies performed each year in the UK. The cause can be due to fibroids, thyroid problems or hormone imbalance, but often no specific cause can be found. More information can be found by clicking here.

  • Prolapse - this happens when the supporting ligaments of the uterus become weak, and the womb drops into the vagina causing a dragging feeling, backache or incontinence. Prolapse may be caused by heavy lifting, pregnancy or as a result of the menopause. A plastic ring can sometimes be used to hold the womb back in place, but if this does not work then surgery may be needed.

  • Pain - severe period pain may result from such causes as pelvic inflammatory disease (PID) or endometriosis, and can make life miserable. Medication may be useful in early cases, but if left for too long then hysterectomy may be required.

  • Cancer - a hysterectomy may be required for cancer of the uterus (endometrial), fallopian tubes, cervix or ovaries. Radiotherapy and chemotherapy may also be used, depending on the type of cancer.

 

Points to remember

If the hysterectomy is being performed to treat cancer, then there is little choice as your life may be at risk if you do not have the operation. For other reasons, a few questions to consider are:

  • Will the operation relieve my symptoms?

  • Have all other treatments been tried?

  • Are the symptoms unbearable?

  • Do I still want children?

  • Am I prepared for the side effects and risks?

If you cannot fully answer all these questions, then think carefully before having a hysterectomy, as it cannot be reversed. Never feel scared to talk to your specialist about these issues, who may be able to help you with your concerns.

 

How is a hysterectomy performed?

A hysterectomy can be performed through the abdomen, through the vagina, or by keyhole (laparoscopic) surgery.

  • Abdominal hysterectomy - a cut is made either horizontally in the bikini line just above the pubic area, or occasionally vertically in the midline of the abdomen.

  • Vaginal hysterectomy - this leaves no scars as the uterus is removed from inside the vagina.

  • Laparoscopic hysterectomy - small cuts are made in the abdomen, and special telescopes are then passed through into the abdomen. The specialist can examine the abdominal contents and uterus, and sometimes remove the uterus through the keyhole incisions. Sometimes, though, this is not possible and one of the above two approaches is then needed.

 

The method used will often depend on the reason having the operation, such as size of fibroids or other growths. The cervix is occasionally left in place but this is usually removed with the uterus. Depending on the reasons for the surgery, the ovaries may also be removed at the same time, as may any nearby glands.

 

What happens after hysterectomy surgery?

About one third of women will enter menopause within two years of hysterectomy. On average, menopause will occur 4-6 years earlier than it would have done naturally. If the ovaries are removed then menopause will start straight away, with symptoms such as hot flushes, night sweats, dry hair and skin, and mood swings. This can usually be treated with HRT (hormone replacement therapy) medication.

You can usually go home after a few days, and will need to relax at home for a couple of weeks. You can usually go back to work after 6-8 weeks, but discuss this first with your specialist.

 

What are the risks of hysterectomy?

The risks vary slightly depending on which type of procedure you have, but generally include:

  • Hernia - if the deep tummy muscles do not heal well after the surgery, the underlying bowel could push through the muscle, being seen or felt as a lump. Hernias may need an operation to treat them.

  • Infection - this may require antibiotics, or rarely further surgery.

  • Bleeding - most bleeding can be controlled at the time of the hysterectomy, but occasionally heavy bleeding can occur. If the operation is being performed vaginally or laparoscopically, then a cut may need to be made in the abdomen to allow access to the bleeding area. Heavy bleeding may also require a blood transfusion.

  • Injury to other structures - injury to bowel, nerves or blood vessels is rare from hysterectomy but can occur, which may need further surgery.

  • Adhesions - surgery in the abdomen will lead to scar tissue forming. This can stick to nearby bowel, which may cause problems such as obstruction. This can require further surgery.

  • Difficulty passing urine - if this happens you may need a tube (catheter) for a day or two to help you pass water.

  • Recurrence - the cancer could return after surgery, needing further operations or radiotherapy and chemotherapy.

  • Blood clots in the legs - clots in the calf (deep vein thrombosis / DVT) can usually be treated with medication, but a DVT can (rarely) move to the lungs. This can cause breathing difficulty, or even be life threatening.

 

Other SurgeryWise articles

You may also be interested to read our articles on fibroids, heavy periods, uterus cancer or cervical cancer

 

Read an account of a Patient's Real Experience of a hysterectomy

 

Any procedure involving skin incision can also result in unfavourable scarring, wound infection, or bleeding. This list of risks is not exhaustive, and you should discuss possible complications with your specialist. Whilst these risks will seem very worrysome, and indeed can be serious, it should also be borne in mind that many people have no postoperative problems whatsoever.

The information provided is as a guide only and you should discuss matters fully with your specialist before deciding if this is the right procedure for you. Please also read our disclaimer

 

 

 
 
 
 
 

 

 

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