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Hysterectomy

A hysterectomy involves surgery to remove the uterus, primarily to resolve a problem with heavy bleeding.

A hysterectomy involves surgery to remove the uterus, primarily to resolve a problem with heavy bleeding. Hysterectomies are very common among women in the United States, with only cesarean section deliveries occurring more often. The U.S. Department of Health and Human Services reports one in three women undergo a hysterectomy by the age of 60. Health conditions that can necessitate a hysterectomy include abnormal bleeding, chronic pain in the uterus, gynecological cancer, endometriosis, fibroids and uterine prolapse. Less invasive procedures exist for treating menstrual disorders, but women generally report higher satisfaction with a hysterectomy.

Conditions Treated by a Hysterectomy

Some women experience heavy, uncontrollable bleeding during menstrual cycles. A hysterectomy may be the only option that brings relief. Similarly, a hysterectomy may be the last option for women with chronic pelvic pain who havent responded to other treatments.

Gynecological cancer occurs when abnormal cells grow and spread in the female reproductive organs, which include the uterus, fallopian tubes, ovaries, cervix, vagina and vulva. Cervical, vaginal and vulva cancer can be caused by the human papillomavirus (HPV). Genetics, aging, smoking and environmental factors can also contribute to the growth of cancerous cells.

Endometriosis is the growth of uterine tissue outside of the uterus. The tissue growth typically occurs within the abdominal cavity, on the outer-surface of the uterus and the pelvic cavitys lining, but it can also grow in the vagina, cervix, bladder, bowels, vulva, lungs and limbs. Because uterine tissue sheds during the menstrual cycle, endometriosis causes internal bleeding.

Uterine fibroids are muscular tumors that are nearly always benign. Fibroids are also called leiomyoma. Fibroids can appear as one tumor or several tumors within the uterus, and can grow to the size of a grapefruit or larger. They can cause persistent bleeding, bladder pressure, anemia and pelvic pain.

Uterine prolapse occurs when ligaments weaken and the uterus descends into the vaginal cavity. Symptoms of uterine prolapse include pelvic pressure, incontinence and constipation.

Types of Hysterectomies

Hysterectomies can be categorized into three different types: subtotal, total and radical. During a subtotal hysterectomy, the top part of the uterus is removed, but the cervix is left in place. The ovaries and fallopian tubes are left or removed, depending on the patient. A total hysterectomy removes the uterus and cervix. A total hysterectomy with bilateral salpingo-oophorectomy also removes the fallopian tubes and ovaries. A radical hysterectomy is performed in the case of serious disease, such as advanced cancer. The uterus, cervix, both fallopian tubes, the ovaries, pelvic lymph nodes and possibly parts of the vagina and vulva are removed.

During a hysterectomy, the reproductive organs can be removed either through the abdomen or the vagina. A laparoscopic tool is often used to allow the physician to see into the abdominal cavity without a large incision. A vaginal hysterectomy is less invasive, results in less visible scarring and has a shorter recovery period. Radical and subtotal hysterectomies are always abdominal surgeries. Total hysterectomies can be either abdominal or vaginal. Patients with large fibroids may not be able to safely undergo a vaginal hysterectomy.

Hysterectomy Risks and Side Effects

Like all surgical procedures, hysterectomies can pose potential risks. According to the Mayo Clinic, patients who are obese, diabetic or have high blood pressure face higher surgical risks. Vaginal and abdominal hysterectomy risks include:

  • Infection
  • Blood clots or loss
  • Damage to neighboring organs
  • An adverse reaction to anesthesia
  • Premature menopause
  • Death in rare cases

 

The possible side effects of a hysterectomy depend on the patients age, menstruation cycles, health condition and the type of hysterectomy performed. If the patient had menstrual periods at the time of surgery, those periods will stop following the hysterectomy. If the ovaries arent removed, the patient will still experience hormonal changes consistent with a typical menstrual cycle but there will be no bleeding. If the ovaries are removed, the patient can expect to experience menopause symptoms, including hot flashes, mood swings, vaginal dryness and night sweats.

Studies on post-hysterectomy side effects have reported a small number of patients may experience constipation, weight gain, pelvic pain and earlier menopause even when the ovaries were not removed, according to the Agency for Healthcare Research and Quality.

Hysterectomy Recovery

Complete recovery from an abdominal hysterectomy takes approximately four to eight weeks. A vaginal hysterectomy typically requires one to two weeks of recovery time. Patients should expect to stay in the hospital for two to four days following surgery. Activity can gradually increase during the recovery period until the patient can participate in normal daily activities without pain. Sexual activity can resume after six weeks of recovery time for both types of hysterectomies.

Hysterectomy Alternatives

Although hysterectomy is typically the last course of action for patients who have exhausted all other options, alternatives to the surgery are available. Cancer patients may avoid a hysterectomy if the cancer responds to radiation and chemotherapy. Endometriosis can be controlled with medication and other surgical procedures to remove the overgrown uterine tissue. Occasionally, painful and irregular periods that lead to excessive bleeding and anemia can be resolved with the use of hormonal contraceptives.

Endometrial ablation is an option for women who want relief from irregular or heavy periods without removing the uterus. Balloon endometrial ablation involves inserting a small balloon into the uterus through the vagina and inflating the balloon with heated water. The balloon stays in the uterus for eight minutes and damages the endometrial lining of the uterus so it can no longer slough off and regenerate. Although some women require ablation to be performed twice, it is up to 90 percent effective at reducing or stopping bleeding in the first five years, according to University of Maryland Medical Center. Older methods of endometrial ablation used electrical energy with heat or cold to destroy the endometrial lining.

Hysterectomy Prevention

Some conditions, such as endometriosis that requires a hysterectomy, are not preventable. Safe sexual practices can help prevent the contraction of HPV, although condoms do not completely protect against the sexually transmitted disease. Annual Pap smears are critical in early diagnosis of gynecological cancer, which can ultimately prevent the spread of cancer and the need to remove cancerous organs. Women can help prevent uterine prolapse by performing Kegel exercises to strengthen the ligaments and tissues that support the uterus. Kegel exercises are performed by tightening the same pelvic muscles used to interrupt urine for several seconds, then releasing. Maintaining a healthy diet and weight can also help prevent uterine prolapse.

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