Hysterectomy

What is a Hysterectomy?

A Hysterectomy is a surgical removal of the uterus. It ends menstruation and the ability to become pregnant.

How is it done?

A hysterectomy generally takes 1 to 3 hours. It may be performed under general or regional anesthesia. During a Hysterectomy, the uterus may be completely or partially removed. The fallopian tubes may also be removed. Removal may be done through a low midline transverse (bikini) incision, a vaginal incision or through laparoscopic incisions on the abdomen. After surgery, a catheter may remain in place for 1 to 2 days to help the bladder pass urine. The average hospital stay depends on the type of surgery but is usually from 2 to 3 days.

Why is it done?

Hysterectomy may be performed to treat:

• Abnormal uterine bleeding that is not controlled by other treatment methods
• Severe endometriosis (uterine tissue that grows outside the uterus)
• Uterine fibroids (benign tumors) that have increased in size, are painful or cause bleeding
• Increased pelvic pain related to the uterus but not controlled by other treatment
• Uterine prolapse - (uterus that has "dropped" into the vaginal canal due to weakened support muscles) that can lead to urinary incontinence or difficulty with bowel movements
• Cervical or uterine Cancer
• Complications during childbirth (like uncontrollable bleeding)

Risks & complications

There are possible risks and complications associated with anesthesia, including respiratory or cardiac malfunction. Other complications include:

• Wound complication (i.e. abscess, disruption)
• Excessive bleeding or blood clots
• Infection
• Bladder, ureter or bowel injury
• Pain with intercourse, decreased libido, or reduced ability to have an orgasm
• Temporary abdominal distention due to bowel ileus or transient decreased bowel movement

Following surgery, some women may feel a sense of loss or become depressed, but these emotional reactions are usually short-lived.

Risks can be reduced by following the surgeon's instructions before and after surgery.

Alternatives

Alternate treatment options will depend very much on the source of the problem. The surgeon may discuss alternative approaches to Hysterectomy:

• Birth control pills or other medications may be helpful in treating prolonged bleeding
• Endometrial ablation (removal of the lining of the uterus) may help with very heavy periods
• Drugs can be used to shrink uterine fibroids
• Myomectomy, or surgical removal of fibroids, is major surgery; one in three women have tumors recur in 5 years
• Chronic pain may be treated with anti-inflammatory drugs, birth control pills, or physical therapy

Expectations after surgery

Removal of the ovaries along with the uterus in pre-menopausal women causes immediate menopause, and estrogen replacement therapy may be recommended.