1. Types of Hysterectomy
2. Alternative Treatments
3. Benefits of Hysterectomy
4. Disadvantages of Hysterectomy

Hysterectomy is the removal of the uterus to treat problems such as:

• Abnormal or painful bleeding
• Large uterine size
• Prolapse
• Cancer

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)