Hysterectomy

When females have no other alternative of the treatment and have to get their uterus removed, then it is called as hysterectomy. It may also deal with removal of the cervix, ovaries, fallopian tubes, and other surrounding structures.

Depending on the female’s health, the treatment will take its own course. Hysterectomy is performed to treat uterus cancer. Dr. Mayuri Kothiwala utilizes laproscopic assisted or vaginal hysterectomies for faster recovery. There are different types of hysterectomy like vaginal, laparoscopy assisted, supracervical and others. But there can be some risks of infection, pain, and bleeding in the surgical area.

What is hysterectomyand what happens during hysterectomy surgery?

Hysterectomy is a surgery done to remove a woman’s uterus (or the womb). In hysterectomy, whole of the uterus is usually removed. Your fallopian tubes and ovaries might also be removed along with the uterus if required. After a hysterectomy, a woman attains her surgical menopause and can no longer menstruate or become pregnant.

Why would I need a hysterectomy?

You may need hysterectomy surgery forany one of the following when all other measures fail:

  • Uterine fibroids. Uterine fibroids are benign growths from or into the wall of the uterus. They may cause pain and heavy bleeding.
  • Abnormal uterine bleeding. Heavy, prolonged bleeding can be caused by a number of reasons like polyps, adenomyosis, hormonal disturbances, infection, cancer, fibroids etc.
  • Uterine prolapse. Prolapse is a condition where the uterus descends from its usual place down into the vagina. Prolapse is more common in women with multiple vaginal deliveries, but can also happen in obese women or those with chronic cough and constipation. Prolapse can lead to urinary as well as and bowel problems.
  • Endometriosis. Endometriosis is a condition where the endometrial tissue, that normally lines the uterus, grows at places outside the uterus where it doesn’t belong. Endometriosis can grow in any part of the body, most commonly in ovaries. Endometriosis causes severe pain and bleeding during periods.
  • Adenomyosis. In adenomyosis, endometrial tissue of the uterus grows inside the walls of the uterus (myometrium) where it doesn’t belong. This leads to thicker uterine walls and severe pain and heavy bleeding.
  • Cancer of the uterus, ovary, cervix, or endometrium. Hysterectomy may be the best option if you have cancer of the genital tract. This is usually combined with chemotherapy and radiation.
What are the alternatives to hysterectomy?

Hysterectomy is a major surgery. In some cases hysterectomy might be the only option for treatment but in majority, other treatments are tried before resorting to hysterectomy. Theyare:

  • Watchful waiting. Your doctor may wait if you have fibroids in uterus and you are nearing your menopause. This is because many a times, fibroids tend to shrink after menopause.
  • Exercises. In early stages of uterine prolapse, you can try Kegels exercises, which help in restoring the tone of the pelvic muscles holding the uterus in place.
  • Medicine. Your doctor might give you some medicines to help in conditions like abnormal uterine bleeding.
  • Vaginal ring pessary. A ring pessary is a firm made up of silicon. It is inserted inside the vagina to hold the uterus in place in cases of uterine prolapse.
  • Conservative Surgery. A conservative surgery is one in which the uterus is preserved and only the diseased part is removed. It involves smaller or fewer cuts that help you heal faster with less scarring. Examples include:
    • Surgery to help stop heavy vaginal bleeding.
      • Dilation and curettage (D&C) removes the endometrial lining of the uterus that may be the cause for your heavy bleeding. You can become pregnant after this procedure.
      • Endometrial ablation destroys the endometrial lining of the uterus permanently using thermal heat. This surgery is not advised if you are planning for pregnancy in future.
    • Surgery to remove uterine fibroids (myomectomy). This is done in young women who wish to conceive in future. It can be done laparoscopically or abdominally. Laparoscopic myomectomy has its own advantages of speedy recovery, minimum pain and a low complication rate.
How common are hysterectomies in India?

In India, hysterectomy rates are quite low when compared with the western countries. The rate of hysterectomy surgery in India is around 4-6%. This low rate is attributed by the negligence of women health issues amongst the Indian population.

What are the types of hysterectomies?

There are 3 major types of hysterectomies:

  • Total hysterectomy isremoval ofwhole uterus and the cervix. Fallopian tubes are generally removed but ovaries may be left inside if they appear healthy.
  • Subtotal or supracervical hysterectomy– This type of hysterectomy is rarely done. Here the upper part of uterus is removed but the cervix is left in place. The ovaries may or may not be removed.
  • Radical hysterectomy – This type of hysterectomy involves removal ofwhole uterus with cervix, the soft tissue on both sides of the cervix, and the upper part of the vagina. Radical hysterectomy is done incases of cervical cancer.
Will the doctor remove my ovaries during the hysterectomy?

The decision of removing your ovaries during hysterectomy depends on the reason for your hysterectomy.

When hysterectomy is done for benign uterine lesions,your age is less than 65 years and you have not attained menopause, then removal of ovaries is avoided.

Recent studies suggest that the risk of most common type of ovarian cancer can be reduced by removing the fallopian tubes but keeping the ovaries in place.

Does hysterectomy cause menopause?

Hysterectomy involves the removal of uterus. So all women undergoing hysterectomy will stop getting their periods. But the other symptoms of menopause depend on the presence or absence of ovaries. If the ovaries are retained during hysterectomy, you should not have other menopausal symptoms right away. But you may have menopausal symptoms a few years prior to the average age for menopause.When both ovaries are removed along with the uterus during the hysterectomy, the menopausal symptoms may start right away.

How is a hysterectomy performed?

A hysterectomy can be performed via different routes:

  • Abdominal hysterectomy. This is done through the abdominal route where a cut is made in the lower abdomen.
  • Vaginal hysterectomy. Here the hysterectomy is done through vaginal route and there is no cut on the belly.
  • Laparoscopic hysterectomy. This is done with the help of a laparoscope. Laparoscope is a thin telescope with light at one end and camera at the other. It allows your doctor to see your pelvic organs inside your belly. Laparoscopic surgery is done through very fine cuts on your belly.
How long does it take to recover from a hysterectomy?

Complete recovery from a hysterectomy takes time. The time taken to return to normal activities depends on the type of surgery:

  • Abdominal surgery can take from 4 to 6 weeks to recover.
  • Vaginal and laparoscopiccan take from 3 to 4 weeks to recover.

You should take plenty of rest and avoid lifting heavy objects for 4 to 6 weeks after surgery. Your recovery will depend on the type your surgery and your health before the surgery.

What changes can I expect after a hysterectomy?

The biggest positive change seen in women is a better quality of life. You will have relief from your symptoms.

Other changes that you may experience after a hysterectomy include:

  • Menopause.
  • Change in sexual feelings and libido. It is seen that there is vaginal dryness or less interest in sex (loss of libido) after a hysterectomy, especially if the ovaries are also removed.
  • Risk for other health problems. You are at a higher risk for certain conditions like: bone loss, heart disease, and urinary incontinence (leaking of urine) if both the ovaries are also removed during hysterectomy.
Do I still need to have Pap tests after hysterectomy?

Yes you will need a regular paps smear testto screen for cervical cancer if:

  • Your cervix was not removed with your uterus
  • The reason for your hysterectomy was cancer or precancer

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Dr. Mayuri Kothiwala

Gynecologist, Obstetrician; Laparoscopic Surgeon & Infertility Specialist

Dr Mayuri Kothiwala is an experienced Gynecologist in Jaipur taking care of all Obstetrical and Gynecological related health concerns at every stage of women. Having worked for 10+ Years, she is passionate to explore her expertise in rural and remote areas of Rajasthan to educate, diagnose & treat women for their obstetric & gynecology issues, laparoscopy procedures, oncology & urogyne concerns. Dr Mayuri uses the latest and most advanced techniques including sonography, ultrasound, laparoscopy and lasers for early diagnosis and timely management of her patients.

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