Hysterectomy is the removal of the uterus to treat problems such as:
- Abnormal or painful bleeding
- Large uterine size
a) Types of Hysterectomy
Hysterectomy is usually a total hysterectomy, meaning the cervix (neck of the uterus) is removed with the uterus, as it is part of the uterus.
A sub-total hysterectomy is when the cervix is retained.
The ovaries are conserved in all hysterectomies except when there is a disease, such as cancer, or a significant benign ovarian disease. Hysterectomy is needed usually when alternative treatments have been unsuccessful or are not appropriate.
Hysterectomy is best carried out using a vaginal incision. This avoids abdominal incisions and abdominal surgery.
Abdominal hysterectomy may be needed:
- When there is a very large fibroid
- For extensive endometriosis
- For cancer
- Previous history of repeated Caesarean Sections or major abdomino-pelvic surgery (there will be scars and adhesions near the bladder and bowel)
- When vaginal access in inadequate
b) Alternative Treatments
The following treatments may be used before treatment with hysterectomy
- Hormonal – contraceptive pill, Implanon, Depo Provera and the intra uterine progesterone system (Mirena IUCD)
- Endometrial ablation – this should reduce bleeding, however pain may persist and contraception is required permanently.
- Myomectomy to remove fibroids
- Uterine artery embolisation to shrink fibroids
- Vaginal pessaries for prolapse
c) Benefits of Hysterectomy
- Hysterectomy is highly successful in treating symptoms and improving the quality of life.
- Prevention of cancer (of the uterus and cervix). Pap smears would no longer be required.
- Hysterectomy makes no change to hormones or menopause.
- When hormone replacement is needed it is much simpler without a uterus to consider.
d) Disadvantages of Hysterectomy
- It is impossible to have a child after hysterectomy
- It is major surgery with a longer hospital stay and recovery time (up to 6-8 weeks)
- Possible injuries to pelvic organs located next to the uterus (bladder and bowel)
- Rarely there are long term complications that may affect pelvic organ function (bladder or bowel function)