Hysterectomy 101

Hysterectomy is the most common non-obstetrical surgical procedure done in the United States wherein a woman’s uterus or womb is removed.

What necessitates a hysterectomy?

Several medical conditions necessitate hysterectomy, the most common of which are the presence of uterine fibroids, severe pelvic pain, heavy menstrual bleeding, endometriosis, pelvic relaxation and uterine prolapse.

Uterine fibroids or uterine leiomyomata are the number one reason hysterectomy is performed. Although benign growths in the uterine lining, uterine fibroids are often associated with heavy bleeding and a lot of other menstrual discomfort experienced by women who elect to have a hysterectomy.

Pelvic relaxation is another medical condition that could be remedied by hysterectomy. When a woman experiences pelvic relaxation, there is a loosening of the support muscles and tissues in the pelvic area. This often leads to impaired sexual performance and urinary incontinence or the inability to hold in one’s urine. In some cases, urinary incontinence gets so bad urine leaks out when a woman coughs sneezes or laughs. Though the exact reason for pelvic relaxation is still unknown, childbearing has been identified as the major contributing factor.

How is a hysterectomy performed?

A hysterectomy is commonly performed by an incision done through the abdomen (abdominal hysterectomy) or through the vagina (vaginal hysterectomy). Both procedures take about 2 hours to complete while hospital recovery time can be longer with an abdominal hysterectomy than a vaginal one. But on the average, both require anywhere from 4 to six days hospital stay.

What are the types of hysterectomies?

1. Total Abdominal Hysterectomy

Total abdominal hysterectomy is the most common type of hysterectomy wherein the doctor removes the woman’s uterus, including her cervix.

Some of the conditions that can be treated by a total abdominal hysterectomy are cancer of the ovary and uterus, endometriosis, and large uterine fibroids. It may also be done in cases of unbearable pelvic pain, but only after a thorough medical examination has been done to identify the real cause of the pain, and only after several failed attempts at other forms of medication.

Quite obviously, women who desire to have children are not good candidates for this procedure unless it is required by a life-threatening condition such as the removal of a cancerous growth in the uterus.

2. Vaginal Hysterectomy

A vaginal hysterectomy is the procedure to remove the uterus through the patient’s vagina. This is most appropriate only for conditions such as uterine prolapse, endometrial hyperplasia, or cervical dysplasia because in these three the uterus is not too large as to require removal through the abdomen.

3. Laparoscopy-Assisted Vaginal Hysterectomy

A laparoscopy-assisted vaginal hysterectomy is very similar to the vaginal hysterectomy procedure above. The only difference is that it makes use of a laparoscope, a very thin viewing tube with a magnifying glass-like device at the end of it.

Depending on the severity of the condition, some women would greatly benefit from having a laparoscope used during vaginal hysterectomy because it would allow the whole upper abdomen to be thoroughly examined during surgery.

The use of the laparoscope would also be beneficial for the early detection of endometrial cancer, or as a preparatory step to oophorectomy or the removal of the ovaries. Compared to a simple vaginal hysterectomy or total abdominal hysterectomy, laparoscopy-aided vaginal hysterectomy is a more expensive procedure. Aside from the cost implications, it has been found to have a higher incidence of complications that resulted to longer hospital stays.

4. Supracervical Hysterectomy

Supracervical hysterectomy is a much simpler type of hysterectomy that requires less time to perform. For this reason and the fact that it spares the patient’s cervix, this procedure is preferred by most surgeons. What remains of the cervix, called the “stump”, may actually give some form of support to the vagina, preventing the risk of vaginal prolapse.

Women may elect to have this procedure if there is not reason to have their cervix removed. In most cases the cervix is actually better left in its place, as when the patient is diagnosed with severe endometriosis.

5. Radical Hysterectomy

Radical hysterectomy is an even more extensive procedure than a total abdominal hysterectomy because it involves the removal of the upper vagina and of tissues surrounding the uterus.

Radical hysterectomy is most often performed on patients diagnosed with early stages of cervical cancer. Unfortunately, radical hysterectomy is also associated with a higher incidence of injury to the bowel and urinary system as compared to abdominal hysterectomy.

6. Oophorectomy (Removal of the ovaries) and Salpingo-Oophorectomy (Removal of the Ovaries and Fallopian Tubes)

Oophorectomy is the medical procedure to remove the ovary while salpingo-oophorectomy is the removal of the ovaries and the adjacent fallopian tube.

These two procedures are commonly performed on patients with cancer of the ovary. Also for the removal of a suspicious ovarian tumor, or because of the presence of Fallopian tube cancer (which is very rare). These two procedures may also be performed due to complications of infection, or in combination with hysterectomy because of cancer.

On rare occasions, a woman with inherited breast or ovarian cancers will opt to have an oophorectomy as a preventative (prophylactic) measure to reduce the risk of a worse case of ovarian or breast cancer.

What are the usual complications of a hysterectomy?

Some of the usual complications of hysterectomy include pain, infection and bleeding in the surgical area. Compared to vaginal, an abdominal hysterectomy has a higher percentage of post-operative infection and pain.

What are the alternatives to a hysterectomy?

Hysterectomy for conditions other than to stave off cancer is generally not considered until after all other tests or medications have been tried and were unsuccessful. Besides medication, there are now newer procedures, such as uterine artery embolization or surgical removal of a portion of the uterus (myomectomy), that are currently being used to treat excessive uterine bleeding.

As a general rule, before undergoing any type of hysterectomy, a woman should consider taking the following tests to select the best procedure for her:

1. A complete pelvic exam wherein the ovaries and uterus are thoroughly examined.

2. An up-to-date pap smear.

A pelvic ultrasound, depending on what the physician finds on the above.