Patient InformationHysterectomy

  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)
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