A Hysterectomy is a surgery to remove a woman’s uterus

Overview

A excision, or surgery to get rid of the womb, is that the second most typical surgical operation among girls within the us, second solely to cesarean. About one-third of American women will have a hysterectomy by the time they are 60..

Why Is a Hysterectomy Performed?

Several medical conditions can be treated or cured with a hysterectomy. Of the approximately 600,000 hysterectomies each year in the United States, about one-third are performed to treat uterine fibroids. Hysterectomies are also performed to treatendometriosis and to stop abnormal uterine bleeding, although alternative, less invasive treatments for these conditions now are available. Other reasons to have a hysterectomy include:

• endometrial hyperplasia with atypia, an overgrowth of the uterine lining in which uterine cells contain precancerous changes
• cancer of the uterus, ovaries, fallopian tubes or cervix
• pelvic prolapse, in which the ligaments that support pelvic structures like the uterus weaken and the organs drop
• uterine fibroids, when other, less invasive treatments have not provided relief. (Myomectomy, removal of just the fibroids, is a less invasive surgical option for fibroid removal.)
• colon or bladder cancer that has spread to the uterus
• uncontrollable bleeding after childbirth (rarely)

Pros and Cons of a Hysterectomy

For some women, a hysterectomy is the answer to years of suffering from uterine problems. For others, excision may be a pis aller to treat cancer or another severe condition.

Unless you have a severe pelvic infection, cancer or uncontrollable bleeding, there is usually no reason to rush into the decision. Because most hysterectomies ar elective procedures (as against emergencies), there is usually plenty of time to explore all options.

Diagnosis

A hysterectomy may be recommended as treatment for a variety of gynecologic conditions. However, in most cases, a hysterectomy is the most invasive option and only one of various treatments that may be available to you. Like any major surgery or treatment, it should be considered carefully, and you should understand why it’s being recommended and the risks and benefits associated with it.

There has been abundant concern in recent years that too several uncalled-for hysterectomies ar performed. To decide if a hysterectomy is the right procedure for you, consider getting a second opinion. Most insurance companies will cover the cost. You may want to ask your primary care doctor for a referral to another doctor. Seeking the recommendation of another health care skilled might reveal choices you will not have thought of.
Below is a list of conditions that often are treated with a hysterectomy; benefits and risks of other treatment options are also included.

Abnormal Uterine Bleeding (AUB)

Many women with abnormal female internal reproductive organ hemorrhage (AUB) have a excision, but this approach may be more aggressive than necessary. Abnormal female internal reproductive organ hemorrhage, or menorrhagia, refers to menstrual periods that are abnormally heavy, prolonged or both or may refer to bleeding between periods. In general, AUB is diagnosed once abnormal hemorrhage interferes with daily activities and there’s no proof of a physical cause (like cancer or endometriosis).

Abnormal female internal reproductive organ hemorrhage may be a common downside for ladies between ages forty and fifty once secretion levels begin to alter within the 5 to seven years before menopause—when emission periods end forever.

Here are several alternatives to hysterectomy as a treatment option for AUB:

• Endometrial ablation.Endometrial ablation. This minimally invasive surgery uses voltage, heat, a balloon or freezing to destroy the endometrium, or uterine lining. It will minimize or stop serious hemorrhage, but should only be considered in women who are certain they no longer wish to ever become pregnant.Success rates of endometrial ablation vary depending on the specific procedure used and the patient, but success rates for the following three to five years are generally quite high.Risks of endometrial ablation are rare. They include:
  
  • perforation of the uterus
  • injury to other pelvic organs
  • bleeding
  • infection
  • overloading of fluid into the bloodstream
  • accumulation of blood within the uterus because of scarring.
• Hormonal treatments.Abnormal uterine bleeding can also be treated with hormonal treatments, like oral contraceptives (estrogen and progestin) that help to balance your body’s hormones. Natazia, which contains the synthetic estrogen estradiol valerate, is the first birth control pill FDA-approved for treatment of heavy menstrual bleeding that is not caused by a condition of the uterus. The combination estrogen-progesterone pill could facilitate girls World Health Organization opt for oral contraceptives for birth control and don’t have risk factors which will build victimisation secretion contraception inadvisable.
  
• Progesterone IUD. Mirena, an intrauterine device that contains the progesterone levonorgestrel, helps decrease heavy bleeding for some women by slowly releasing progestin into the uterus for up to five years.

Uterine or Endometrial Cancer

Uterine (endometrial) cancer is the most common reproductive cancer in women. Hysterectomy, together with some form of cancer therapy, may be the only treatment choice you have. Your chances of curing this cancer are usually good if it’s diagnosed in its early stages—when the cancer is confined to the uterus and hasn’t spread to other organs.

The type of treatment recommended depends on when the cancer is diagnosed. Hysterectomy is the most common treatment. It generally involves removing the uterus and cervix. This type of hysterectomy is called a total hysterectomy. (Details regarding alternative kinds of cutting out are often found within the Treatment section of this subject.) The surgeon may also remove pelvic lymph nodes to determine if the cancer has spread beyond the uterus.

Surgery may be preceded or followed by radiation therapy and, in some cases, chemotherapy.

Ovarian Cancer

Ovarian cancer is that the fifth-leading reason behind cancer death among girls. It is the leading cause of death from gynecologic cancer because less than 20 percent of cases are diagnosed before the cancer has spread beyond the ovaries. If diagnosed and treated at an early stage, however, the five-year survival rate is up to 94 percent.

The initial treatment for ovarian cancer is surgery to remove the ovaries. A hysterectomy is often performed, too, depending on how far the disease has spread and a woman’s age.

Fibroids

About one-third of hysterectomies are performed every year in the United States to treat fibroid tumors. Noncancerous balls of muscular tissue, fibroids can grow inside the uterus, on the surface of the uterus or in the muscular wall of the uterus. They can range in size from less than an inch in diameter to the size of a grapefruit. They don’t always produce symptoms.

However, even tiny fibroids that bulge into the cavity will cause significant catamenial haemorrhage. Plus, these fibroids may affect fertility by interfering with an embryo’s ability to attach to the uterus. Large fibroids might cause frequent urges to urinate; they can also cause heaviness and discomfort in the pelvic region.

If fibroids aren’t causing any problems, however, you don’t need treatment. Plus, because fibroids tend to shrink after menopause, women in their late 40s or early 50s with fibroid-related symptoms may opt to wait to see if symptoms go away with menopause.

Although hysterectomy permanently removes fibroids (because a hysterectomy removes your uterus), there are other options for treating fibroids. These include:

• Hormone-suppressing drugs.Drugs called gonadotropin-releasing hormones (GnRH) agonists, such as leuprolide (Lupron), nafarelin nasal (Synarel) and goserelin (Zoladex) that are typically used to treat endometriosis, can also help shrink fibroids. Their effects, however, are usually temporary, and the fibroids may eventually grow back larger than before. GnRH agonists also produce side effects in some women, such as hot flashes, headaches, vaginal dryness, constipation and decreased sex drive.
• Myomectomy. This procedure is one of the best options for treating fibroids if you want to preserve your fertility. During an abdominal myomectomy, fibroids are cut out of the uterus and removed through an incision in the abdomen, and the uterine muscle wall is reconstructed with sutures.If fibroids are located in the uterine cavity, they may be removed through the vagina without an abdominal incision in a procedure called hysteroscopic myomectomy. The technique involves the employment of Associate in Nursing instrument referred to as a hysteroscopic resectoscope and is primarily helpful for girls with haemorrhage or fertility-related issues.They may also be removed laparoscopically, using a small telescope called a laparoscope. During this procedure, a few small cuts are made in your abdomen or pelvis, which allow the laparoscope and other small instruments to be slipped inside, thus enabling the surgeon to remove the fibroids without having to make a large incision.The benefit of a myomectomy is that it preserves the uterus and cervix so pregnancy is still possible. Myomectomy is also an option for women who wish to preserve their uterus for any reason.Also, it may take longer to recover from an abdominal myomectomy than from a vaginal or laparoscopic hysterectomy. Although the goal of myomectomy is to preserve your uterus and your ability to have children, the procedure may cause scarring in the uterus that could require you to have a cesarean with your next pregnancy.
• Uterine artery embolization (UAE). In this minimally invasive procedure, a narrow, flexible tube called a catheter is passed through the femoral artery in the groin into the uterine artery. Once there, tiny plastic particles the size of grains of sand are slowly released into the blood vessels feeding the fibroid. The particles wedge in the vessels (but can’t travel to other parts of the body), blocking blood flow to the tumor. Without a blood supply, the fibroids shrink.Fibroid embolization usually requires an overnight hospital stay. Most women come back to traditional activities at intervals per week. Risks include moderate to severe pain and cramping in the first few hours after the procedure, and nausea, fever and infection. Rarely, a woman might enter menopause after embolization. A small percentage of women are readmitted to the hospital after the procedure for complications, some of whom require additional surgery.

Endometriosis

Endometriosis occurs when cells from the endometrium—or your uterine lining—grow outside the uterus and adhere to other parts inside your pelvis, such as the ovaries, bowel, fallopian tubes or bladder.

Hysterectomy is generally recommended for endometriosis only when the disease is severe.

Hormone-suppressing drugs used to treat fibroids are also considered effective for endometriosis since both conditions are affected by your body’s production of estrogen. As with fibroids, benefits from these treatments may be temporary.

Aside from hysterectomy, surgical treatments for endometriosis include:

• Electrocautery techniques, in which stray endometrial tissue is burned away
• Excision, in which endometrial tissue is cut out
• Laser vaporization, which uses the laser to destroy the affected tissue

These procedures can usually be done laparoscopically and are often used when preserving fertility is important. Endometriosis frequently recurs, but the addition of postsurgical medical therapy, such as birth control pills or GnRH agonists, such as leuprolide (Lupron) or danazol (Danocrine), for six months may increase the pain-free interval.

The only definitive treatment for pathology is removing the ovaries to scale back your body’s production of steroid hormone, that triggers the expansion of mucosa tiss

Pelvic Prolapse

Pelvic prolapse (a term that describes when the uterus drops into the vaginal canal) occurs when the ligaments that support the pelvic organs fail.

This weakening will occur with age, steroid deficiency, avoirdupois or when multiple births. Once this girdle support weakens, pelvic organs, including the uterus, bladder and rectum, may sag, resulting in pressure, rectal discomfort and problems with bladder and bowel control.

Losing weight, stopping smoking and avoiding constipation by getting plenty of liquids and fiber in your diet can sometimes help. Additionally, you can strengthen your pelvic muscles with Kegel exercises. To do these exercises, tighten and relax the muscles used to stop the flow of urine. This strengthens the epithelial duct canal and girdle floor muscles, helping control urine flow and enhancing orgasm.

You may also be fitted with a pessary, a device placed in the vagina that holds the organs in place.

Another treatment is short-term hormone therapy to make the vaginal tissue suppler. Estrogen prevents drying and dilution of the epithelial duct tissues. Supplemental estrogen can help strengthen vaginal tissues. However, because of the potential risks of estrogen therapy, such as increased risk of blood clots, breast cancer and gallbladder disease, the decision to use estrogen must be made only after you and your doctor have weighed all the pros and cons.

Surgery can be an option when organs have prolapsed. Surgery could involve making a sling for the bladder or victimisation specialised surgical tape to stay the bladder or female internal reproductive organ in situ, or removing the uterus, via hysterectomy.

Dysplasia

Removing the uterus and cervix was once standard practice for a common precancerous condition called dysplasia, or cervical intraepithelial neoplasia (CIN). Today, cutting, burning or cooling the morbid portion of the cervix is usually suggested for CIN, and hysterectomy is rarely performed for this condition.

Treatment depends on the severity and location of dysplasia, your age, health status and whether you want to preserve your ability to have children.

Treatment

A hysterectomy is used to treat several conditions. If you decide to have a hysterectomy, you and your health care professional should discuss which type is most appropriate. There are three types:

• Total hysterectomy. During this procedure, your uterus and cervix are removed. Your ovaries and fallopian tubes may or may not be removed at the same time. If your ovaries are not removed, you will continue to have menstrual cycle-related hormonal changes, but you won’t have any bleeding.If your ovaries and fallopian tubes are also removed, called a bilateral salpingo-oophorectomy, you won’t have monthly hormonal changes. Removing only the uterus can reduce the blood supply to the ovaries, ultimately decreasing their function, however, this only occurs about 10 percent of the time.The decision about removing the ovaries depends on a few factors, including how close you are to menopause, your current estrogen levels and your risk for some other diseases and conditions. Premenopausal girls could like better to keep their ovaries to produce a natural supply of the hormones steroid, progesterone and testosterone, which are important for maintaining sexual interest and function and preventing menopausal symptoms like hot flashes and decreased bone density. On the opposite hand, some biological time girls with severe PMS, expelling migraines or different hormone-related conditions could expertise AN improvement in their symptoms by removing their ovaries.As far as disease risk is concerned, a study published in the January 2013 issue ofMenopause reported that removing both ovaries during a hysterectomy is associated with a decreased risk of ovarian cancer but an increased risk of osteoporosis, problems with cognition and sexual function, and coronary artery disease. As such, women should review their individual risk factors and the pros and cons before making the decision of whether or not to remove their ovaries during a hysterectomy.Ask your health care professional to explain this information to you so you can better understand your surgical options and the best plan for you.
• Subtotal, partial or supracervical hysterectomy. In this procedure, only the part of your uterus above the cervix is removed. There is a small risk that cancer could develop in the remaining part of the cervix, but routine Pap smears will detect pre-cancer in an easily treatable form. Nonetheless, there may be some benefits to leaving the cervix intact, including a reduced risk of vaginal prolapse (the vagina falling out), shorter recovery time and less postoperative pain. Some women note that leaving the cervix allows intercourse to remain pleasurable.
• Radical hysterectomy. This type of hysterectomy is performed in some cases of cancer. During this procedure, your uterus, cervix, supporting ligaments and tissues, the upper portion of the vagina and the pelvic lymph nodes are removed. Cancer specialists usually perform this type of hysterectomy.

In addition to discussing that organs ought to be removed throughout a cutting out, you and your health care skilled ought to discuss however the surgery are performed. The surgical technique you decide on ought to rely upon your individual designation, personal preference and your surgeon’s coaching. They include:

• Abdominal, or open, hysterectomy. This is the classic form of hysterectomy, involving an abdominal incision. This allows the doc to simply read the girdle organs and provides additional operational area than a duct cutting out. It is generally used for large fibroids or cancer.If you have this form of hysterectomy, expect a two- to three-day hospital stay and a six-week recuperation time. In most cases, your doc will create a “bikini line” incision that your garment hides. Exceptions embody cancer surgery or surgery to get rid of extraordinarily giant fibroids. Complete recovery from abdominal hysterectomy can take six to eight weeks, during which time you’ll gradually feel your strength return and gradually be able to resume your normal activities.
• Vaginal hysterectomy. In this procedure, the surgeon removes the uterus and the cervix through an incision in the vagina, so there’s no large external scar. This form of cutting out is right once there’s female internal reproductive organ prolapse and stripped-down female internal reproductive organ enlargement.Vaginal cutting out are often performed in 2 ways: entirely through the canal or employing a laparoscope, a small, telescope-like device inserted into the abdomen through alittle incision, enabling the surgeon to visualize the pelvic region, also called a laparoscopic-assisted vaginal hysterectomy. Laparoscopically assisted duct cutting out (LAVH) is also used if customary duct cutting out would be troublesome or if the doc needs to raised visualize the ovaries or different girdle organs throughout surgery. During this procedure, the uterus is removed through the vagina.Vaginal hysterectomy and abdominal hysterectomy each take between one and two hours and are performed under regional (epidural or spinal) or general anesthesia. One study found that ladies WHO had duct hysterectomies had considerably fewer complications than those having abdominal hysterectomies. Additionally, the women had shorter hospital stays and returned to their normal activities quicker than the women who had abdominal hysterectomies.Women with large ovarian cysts, a serious case of endometriosis or large fibroids may not be candidates for vaginal hysterectomy.
• Laparoscopic supracervical hysterectomy (LSH).This newer type of hysterectomy also uses laparoscopic techniques to remove the uterus but leaves the cervix intact; in the past, some studies suggested leaving the cervix might help reduce the complications associated with total hysterectomies, such as pelvic prolapse and urinary incontinence. However, the most recent research shows there is no compelling reason to leave the cervix if it can be easily removed along with the uterus. Hospital keep is typically no quite one night, and recovery takes about two weeks.
• Computer-assisted (robotic) surgery. Robotic-assisted laparoscopic hysterectomy is similar to a laparoscopic hysterectomy, but the surgeon conducts the operation from outside the body, using a robotic system of surgical tools. This equipment allows the surgeon to view the hysterectomy on a three-dimensional screen and use wrist movements to control the procedure. Hospital stay is usually one night or less, and full recovery can take up to two to four weeks. Robotic surgery is more expensive, takes longer and has more visible incisions than laparoscopic surgery.

Possible Complications

While discussing hysterectomy techniques with your health care provider, you should also talk about possible complications. Rarely, girls WHO endure a cutting out expertise complications from surgery, most of that square measure minor or reversible. Possible complications include:

• fever and infection following surgery
• urinary tract infection or injury
• if your ovaries are removed, menopausal symptoms, such as hot flashes, night sweats and vaginal dryness,
• constipation
• depression or other emotional problems
• pain or discomfort during intercourse
• loss of sexual pleasure or interest in sex

More serious, but rarer, complications may include:

• hemorrhage requiring transfusion
• injury to the bowel, bladder or other internal organs during surgery, requiring repair
• bowel blockage
• life-threatening cardiopulmonary events such as a heart attack

If your ovaries are removed, you may experience a sudden drop in hormone levels, which may produce menopausal symptoms such as hot flashes, night sweats and dizziness. Postmenopausal oestrogen medical aid (ET), taken soon after surgery, may offset menopausal symptoms. Although the FDA currently needs a warning on all oestrogen product to be used by biological time girls advising health care professionals to visit oestrogen product at all-time low dose and for the shortest doable length of your time, estrogen therapy may still be recommended after surgery to remove the ovaries.

Prevention

There likely isn’t anything you can do or could have done to prevent the conditions for which you are considering a hysterectomy, but there is a lot you can do to prepare for this surgery. Fortunately, few hysterectomies are emergencies, so there usually is plenty of time to prepare.

First, make certain this treatment choice is true for you.

A ablation is also the sole course of treatment for a few conditions, such as cancer of the uterus, for example. But other treatment options may be available. Be sure you’re comfy together with your health care professional’s recommendation. If you want a second opinion, ask what you should do to get one.

These suggestions might assist you prepare and live through your surgery a lot of easily:

• Plan the surgery two or three months ahead of time.
• Review the surgery and recovery needs with your physician. Be sure you understand why and how the surgery is being done. Ask questions if you’re not sure.
• Be sure sure you know what to expect after surgery. How long will recovery take? What type of activities will you be able to do and not do?
• Review family and/or work schedules to determine what timing may work best.
• Ask for (and accept) help from friends and family with your routine; then, schedule it. This might include help with children’s schedules, cooking, pets or household chores, for example.

Facts to Know

1. Many alternatives to hysterectomy now exist including hormonal therapy, the progesterone IUD, endometrial ablation, laparoscopic excision of endometriosis, myomectomy by hysteroscopy, laparoscopy or abdominal incision and uterine artery embolization.
2. About simple fraction of yank ladies can have a excision by age sixty. The United States has one of the highest hysterectomy rates in the world. Many of these procedures may be unnecessary. Hysterectomy rates are higher for African-American women.
3. A hysterectomy is often performed to stop abnormal uterine bleeding. It may also be recommended to treat fibroids that cause symptoms that aren’t successfully managed by other treatment options.
4. A considerable number of hysterectomies are performed to correct symptoms of endometriosis. Endometriosis happens once mucous membrane tissue, that forms the liner of the womb, grows in other parts of the body, causing scar tissue and subsequent pain.
5. Some hysterectomies are performed to treat abnormal uterine bleeding (AUB), or menstrual bleeding excessive enough to disrupt a woman’s life. Abnormal uterine bleeding may be caused by structural problems in the uterus (fibroids, for example), certain medical conditions or hormonal imbalances.
6. Some ladies elect to bear excision to correct girdle prolapse, that happens once the ligaments that support a woman’s girdle organs weaken and lose their certificatory ability.
7. Hysterectomies can be done several ways: A total or complete hysterectomy removes the uterus, including the cervix. A subtotal, partial or supracervical excision removes the womb on top of the cervix. A radical hysterectomy, performed for certain cancers of the reproductive organs, removes the uterus, cervix, supporting ligaments and tissues, the upper portion of the vagina and the pelvic lymph nodes.
8. Developments in laparoscopic procedures have added two more surgical options. In laparoscopically aided canal excision, a surgeon inserts a laparoscope (small telescope) through a woman’s belly button to view the entire pelvis. Parts of the hysterectomy are performed through other small incisions in the abdomen, but most will be completed through the vagina. In a laparoscopic hysterectomy, the entire procedure is performed through laparoscopic incisions in the abdomen.
9. Depending on the type of hysterectomy you have, you may need to stay in the hospital for a few days. Although traditional activities could also be resumed bit by bit, a woman may not be fully recovered until four to six weeks or longer following surgery, depending on the surgical approach used.
10. Some women’s health centers and hospitals offer support groups or social workers to emotionally support hysterectomy patients. Ask your health care professional for a referral.

Key Q&A

1. What are the medical reasons for a hysterectomy?Hysterectomy often is recommended for abnormal uterine bleeding and for treating cancer of the ovaries, uterus or fallopian tube. Hysterectomy can relieve chronic abdominal pain and fibroids, endometriosis and certain other disorders, including pelvic prolapse. In rare instances, hysterectomy may be recommended for colon, rectum or bladder cancers that have spread to the reproductive organs, as well as invasive cervical cancer.
2. How is a hysterectomy performed?The womb could also be removed through either Associate in Nursing incision within the abdomen or through Associate in Nursing incision within the canal. Abdominal hysterectomies ar typically performed for cancer or massive fibroids. Vaginal hysterectomies ar typically performed once the womb organ} is tiny or once shut review of different reproductive organs isn’t necessary. Laparoscopic excision (LH) happens through a small incision within the abdomen victimization Associate in Nursing instrument with alittle camera on the tip. Laparoscopically aided canal excision (LAVH) is performed through the canal, with the assistance of the laparoscope. A laparoscopic supracervical excision (LSH) leaves the cervix intact.
3. Are the ovaries always removed during a hysterectomy?No. When one or both ovaries are removed (in a procedure called oophorectomy), it’s usually because one or both organs are diseased or because the woman is past menopause and wishes to eliminate the risk of ovarian or breast cancer. In biological time ladies, bilateral oophorectomy produces “surgical menopause.” Menopausal symptoms, such as hot flashes, vaginal dryness, insomnia and night sweats can occur suddenly and be more severe compared with natural menopause symptoms. Beginning endocrine medical aid (HT) presently when ovariectomy will scale back or alleviate these symptoms. Removal of the ovaries could increase semipermanent health risks. Discuss the risks and benefits associated with hormone therapy with your health care professional.
   
4. How long does it take to recover from surgery?Although traditional activities could also be resumed bit by bit, full recovery generally takes two to four weeks following laparoscopic or vaginal hysterectomy and four to six weeks following abdominal hysterectomy. Fatigue following any of these procedures may last weeks longer.
5. What are the possible complications from these surgeries?Emotional responses vary, based on the woman’s life experiences, medical and mental health history and her level of support from family and friends.These feelings can include:
   • fever and infection following surgery
   • urinary tract infection or discomfort
   • menopausal symptoms, such as hot flashes, night sweats and vaginal dryness
   • constipation
   • depression or other emotional problems
   • pain or discomfort during intercourse
   • loss of sexual pleasure or interest in sex

   More serious, but rarer, complications may include:

   • hemorrhage requiring transfusion
   • injury to the bowel, bladder or other internal organs during surgery, requiring repair
   • bowel obstruction
   • life-threatening cardiopulmonary events such as a heart attack
6. What are the emotional aspects of hysterectomy?Emotional responses vary, based on the woman’s life experiences, medical and mental health history and her level of support from family and friends.These feelings can include:
   • a sense of loss of the uterus or ovaries and of reproductive function (menstruation and fertility)
   • sadness, anger, depression or anxiety in response to loss
   • a diminished sense of femininity, attractiveness or self-worth
   • anxiety about sexual functioning
7. Will I be able to resume normal sexual activity after a hysterectomy?Ask your health care skilled once you could begin gender once surgery. Because your vagina may be shorter after a total hysterectomy, you and your partner may want to experiment with different positions to find one that is comfortable. Foreplay may enable the vagina to lengthen before intercourse.