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| Hysterectomy |
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| What is a hysterectomy? |
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Hysterectomy is a surgical procedure done to remove the uterus (womb).
This may or may not be combined with the removal of the Fallopian tubes
and one or both ovaries. Removal of a tube and ovary is called salpingo-oophorectomy.
Removal of both tubes and ovaries is called bi-lateral salpingo-oophorectomies
(BSO). There are different types of hysterectomy. These are described
according to which organs are removed:
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- Total hysterectomy is the most common operation and this means removal
of the uterus and cervix (neck of the womb).
- Sub-total hysterectomy means the removal of the body of the uterus,
leaving the cervix behind.
- Radical hysterectomy involves the removal of the uterus, cervix, a
small portion of the upper part of the vagina and some soft tissue from
within the pelvis. A radical hysterectomy is performed only in cases
of cancer of the cervix.
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| When is it necessary for a woman to have a hysterectomy? |
A woman who has been diagnosed to have cancer of
the cervix or cancer of the uterus will usually have to have a hysterectomy.
This surgery may also be indicated when a woman has ovarian cancer. Sometimes,
when women experience bleeding or pain from the uterus, which is causing
them great difficulty, they may be advised to undergo this surgery even
though they do not have cancer. In such cases, a hysterectomy is done only
if the woman does not wish to have children anymore.
For women who have fibroids, endometriosis, pelvic inflammatory disease
or heavy periods with no explanation, hysterectomy is a choice. If a woman
has a prolapse of the uterus, then a hysterectomy may be performed as part
of the operation to repair the prolapse. |
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| How is hysterectomy performed? |
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Hysterectomy is a major surgical procedure and is performed under general
anaesthesia. In addition to the different types of hysterectomy, there
are different ways by which a gynaecologist might perform the operation.
This will be influenced by the reason for performing the hysterectomy,
the size of the uterus and the experience and preference of the individual
gynaecologist.
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- Abdominal hysterectomy is the most common method and is performed
through an incision, approximately six inches long and made across the
lower abdomen.
- A vaginal hysterectomy is performed through the vagina and
will leave no visible external signs that the woman has had an operation.
- Laparoscopically Assisted Vaginal Hysterectomy (LAVH) is a
method in which the gynaecologist uses key-hole surgery in combination
with surgery through the vagina, in order to complete the operation
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| How will a woman feel after a hysterectomy? |
For the first few days following surgery, strong
painkillers will be prescribed. A woman will be encouraged to be mobile
24 hours after surgery and will usually be eating and drinking during this
time.
Most women stay in hospital for three and five days following a routine
hysterectomy. The convalescence period following a hysterectomy may be 4
to 6 weeks. The recovery time is usually shorter if a vaginal hysterectomy
or LAVH has been performed, rather than an abdominal hysterectomy.
Emotional responses after a hysterectomy vary from one woman to another.
Some women may feel a sense of relief that the inconvenience of monthly
pain and periods is a thing of the past. They may think that they can now
get on with life in a positive manner. Women who have been diagnosed with
cancer are usually very anxious about the success of the surgery. They will
also be concerned about the other forms of treatment aimed at preventing
a recurrence.
Some women may experience a sense of loss. It is advisable for a woman to
talk it over with someone in whom she can confide. |
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| What are the risks of having a hysterectomy? |
| Hysterectomy is a major operation and any major
surgery carries certain risks. Most women undergo this surgery without experiencing
complications. If a woman is overweight, then losing weight before the procedure
will make the surgery easier and reduce the likelihood of post-operative
complications. The complications that could occur include: |
- Heavy bleeding at the time of surgery
- Surgical damage to the bladder or ureters (the narrow tubes which
carry urine from the kidneys to the bladder)
- Infection following the surgery. This may involve the surgical wound
or bladder (cystitis) and requires treatment with antibiotics
- Development of a blood clot in the veins of the leg (venous thrombosis)
is another complication that may develop.
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| Will a hysterectomy affect a woman's sex life? |
| If a woman has been troubled by pain and bleeding
during intercourse, before she had the surgery, she may now experience greater
comfort and relief. This may improve her sex life. Most women are able to
have intercourse again, six weeks after their hysterectomy. In some women,
depression may cause decreased interest in having sex. |
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| Will a woman need to start Hormone Replacement
Therapy (HRT) after a hysterectomy? |
| If a woman has not gone through menopause and her
ovaries have been removed at the time of the hysterectomy, then HRT will
usually be recommended. If the ovaries have not been removed, then they
will continue to produce the female hormone oestrogen and HRT will not be
necessary. |
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| Should a woman who has had a hysterectomy, undergo
a Pap test (Cervical smear test) after the surgery? |
| If there was no cancer present before the hysterectomy
and the cervix has been removed, then there is no need for further smears
to be performed. If a sub-total hysterectomy has been performed then it
is necessary to continue having the tests. |
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| Is there an alternative treatment rather than
having a hysterectomy? |
When a woman has been diagnosed with cancer as described
earlier, there is hardly any realistic alternative to hysterectomy. For
non-cancerous conditions a hysterectomy is suggested when treatment with
tablets or other surgical procedures have been tried and proven to be unsuccessful.
If a woman is having heavy periods with no explainable cause, a gynaecologist
may suggest surgical techniques, which aim to remove or destroy the lining
of the womb (endometrial ablation). This may provide relief of symptoms
without resorting to major surgery. But it is important for a woman to know
that a hysterectomy or endometrial ablation is only for a woman who does
not wish to become pregnant after the surgery. |
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