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Hysterectomy

Hysterectomies, procedures for removing the uterus, are performed for a variety of reasons, such as cancer, fibroid removal and endometriosis. It is the second most common surgery among women in the United States. Power morcellators may be used to assist with the procedure.

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Female Reproductive SystemA hysterectomy is a procedure in which a woman’s uterus is surgically removed. Depending on the type and extent of the hysterectomy, the ovaries, which produce eggs and hormones, and fallopian tubes, which carry the eggs from the ovaries to the uterus, may be taken out as well. Removal of the ovaries is known as oophorectomy, and removal of the fallopian tubes is called salpingectomy. Removal of both together is known as salpingo-oophorectomy.

The uterus, or womb, has two main functions. First, once a month, the uterine lining is shed and a woman experiences her menstrual cycle. Second, if an egg from the ovary is fertilized, it will implant into the wall of the uterus, which “houses” the pregnancy until birth. Once the uterus is removed, a woman can no longer get pregnant and she will not have her menstrual cycle anymore.

Removal of the Uterus and Ovaries

The female reproductive system includes the uterus, ovaries, fallopian tubes, cervix, and vagina. The cervix is the lower end of the uterus that joins with the vagina. These organs are located in a woman’s lower abdomen, as shown in the image above.

There are a variety of reasons a woman may need to have a hysterectomy. This may occur before a woman reaches menopause. If this is the case, the ovaries may or may not be removed depending on the underlying condition as well as recommendation of the physician.

There are two possible scenarios that may ensue:

  • If her ovaries are NOT removed during the hysterectomy, she may enter menopause at an earlier age than most women.
  • If her ovaries are removed during the hysterectomy, she will enter menopause. She then may experience certain menopausal symptoms, such as hot flashes and vaginal dryness, and potential reductions in bone density.

Types of Hysterectomy

  • Partial, subtotal, or supracervical removes just the upper part of the uterus. The cervix is left in place.
  • Total removes the whole uterus and the cervix.
  • Radical removes the whole uterus, the tissue on both sides of the cervix, and the upper part of the vagina. This is done mostly when there is cancer present.

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Surgical Techniques for Hysterectomies

There are different techniques a doctor can use to perform a hysterectomy. The type of hysterectomy chosen will depend on the medical history and health of the patient as well as physician recommendation.

Methods of Hysterectomy
Abdominal Hysterectomy This is done through a 5- to 7-inch incision, or cut, in the lower part of your belly. The cut may go either straight up and down, or sideways across the abdomen, just above the pubic bone and hair.
Vaginal Hysterectomy This is done through a cut in the vagina. The doctor will take your uterus out through this incision and close it with stitches.
Laparoscopic Hysterectomy A laparoscope is a surgical instrument with a thin, lighted tube and small camera that can be inserted into the abdomen through a few very small incisions. It lets the surgeon see the pelvic organs without having to completely open up the abdomen through a larger incision. The laparoscope along with other instruments will be inserted into three to four small cuts in the belly. The uterus can then be cut into smaller pieces and removed through the incisions.
Laparoscopically Assisted Vaginal Hysterectomy (LAVH) The laparoscope is used to guide the removal of the uterus through the vagina.
Robotic-Assisted Surgery Similar to a laparoscopic hysterectomy, this procedure involves a robot, or special machine, performing the surgery through small cuts in the abdomen. It is typically performed when vaginal surgery is not safe, such as in obese patients or those with cancer.

Why do Women Have Hysterectomies?

Reasons for hysterectomies

Your Doctor may choose to perform other procedures during your cardiac catherization.

  • Taking Samples of blood or heart muscle

  • Fibroids

  • Endometriosis or Adenomyosis

  • Prolapse of the uterus

  • Chronic pelvic pain

  • Abnormal vaginal bleeding

  • Default Bullet 7

There are a variety of reasons a woman may need to have a hysterectomy. These include but are not limited to:

Cancer of the uterus, ovary, cervix, or endometrium

Hysterectomy may be the best option if there is cancer in these organs. The endometrium is the tissue that lines the uterus. If you have precancerous changes of the cervix, you may be able to have a loop electrosurgical excision procedure (LEEP) to remove the cancerous cells. Other treatment options can include chemotherapy and radiation. The physician will discuss the stage of the cancer and how advanced it may be, determining the need for a hysterectomy.

Endometriosis

This occurs when the tissue that lines the uterus grows outside the uterus on the ovaries, fallopian tubes, or other pelvic or abdominal organs. This can cause severe pain during menstrual periods, chronic lower back or pelvis pain, discomfort during or after sex, bleeding between periods, and other symptoms. A hysterectomy might be an option in this case when medications or less invasive surgery to remove the spots of endometriosis have not relieved the pain and other symptoms.

Adenomyosis

In this condition, the tissue that lines the uterus grows inside the walls of the uterus, leading to severe discomfort and pain. A hysterectomy is the only certain cure when all other options have been exhausted.

Prolapse of the uterus

This occurs when the uterus falls from its normal anatomical position in the pelvis down into the vagina. This can lead to urinary and bowel problems along with pelvic pressure. A vaginal pessary (a removable support device), which is inserted into the vagina to hold the womb in place, may be a temporary solution to these problems.

Chronic pelvic pain

Surgery is a last resort for women who have chronic pelvic pain that clearly comes from the uterus. Many forms of pelvic pain are not cured by a hysterectomy, so it could be unnecessary and create new problems.

Very rarely, a hysterectomy might be necessary to control bleeding during a cesarean delivery following unusual or atypical pregnancy complications if the other methods used to control bleeding are unsuccessful. Keep in mind that there may be ways to treat your health problem without having this major surgery. Talk with your doctor about all of your treatment options.

Abnormal vaginal bleeding

There are a number of causes of abnormal vaginal bleeding, which include changes in hormone levels, infection, cancer, or fibroids. The main goal of treatment is to decrease pain and the amount of bleeding and/or to correct irregular bleeding with medications. These include hormones, birth control pills, and nonsteroidal anti-inflammatory medications (NSAIDs).

If medications are not successful, there are two procedures which may be performed. First, a dilatation and curettage (D&C), in which the lining and contents of the uterus are removed, may alleviate abnormal bleeding. Second, endometrial ablation, a procedure which also removes the lining of the uterus, can help reduce heavy, prolonged bleeding. However, endometrial ablation should not be performed if a woman still wants to become pregnant or has gone through menopause.

Very rarely, a hysterectomy might be necessary to control bleeding during a cesarean delivery following unusual or atypical pregnancy complications if the other methods used to control bleeding are unsuccessful. Keep in mind that there may be ways to treat your health problem without having this major surgery. Talk with your doctor about all of your treatment options.

Fibroid Tumors

Fibroids are non-cancerous, muscular tumors that grow in the wall of the uterus. Because many women with fibroids have only minor symptoms if any at all, there may not be a need for treatment. Fibroids also often shrink after menopause. In some women, fibroids can cause prolonged heavy bleeding or pain. Fibroids can be treated with medications. There are also procedures to remove the fibroids, such as uterine artery embolization which blocks the blood supply to the tumors. The fibroids may shrink or disappear with time, which can reduce pain and heavy bleeding.

Myomectomy is another procedure which can remove the fibroid tumors while leaving your uterus intact. However, there is a chance that the tumors could come back. A hysterectomy can be the solution, and can cure associated problems from fibroids if medications or procedures to remove the fibroids have not helped, especially if a woman is either near or past menopause and does not want children.

How Common are Hysterectomies?

A hysterectomy is the second most common surgery among women in the United States. The most common surgery in women is childbirth by cesarean section delivery. Over 500,000 hysterectomies are performed each year (Data from the American Congress of Obstetricians and Gynecologists).

What should I do if I am told that I need a hysterectomy?

  • Ask about the possible risks of the surgery.
  • Talk to your doctor about other treatment options. Ask about the risks of those treatments.
  • Consider getting a second opinion from another doctor.

Keep in mind that every woman is different and every situation is different. A good treatment choice for one woman may not be good for another.

Recovery from Hysterectomy

Recovering from a hysterectomy, like any surgery, takes some time. Most women stay in the hospital from 1 to 2 days for post-surgery care. If the hysterectomy is done because of cancer, the treating physician may have the woman stay in the hospital even longer. Recovery time can take up to approximately 6 weeks, but will depend on the patient’s condition and possibly on the type of hysterectomy she received.

After surgery, the woman should make sure to get plenty of rest. Furthermore, she should not lift heavy objects for a full 6 weeks after surgery. Sexual intercourse and tub baths can be resumed after about 6 weeks from the surgery. Research has found that women with a good sex life before hysterectomy can maintain it after the surgery.

Risks of Hysterectomy

Most women do not have health problems during or after the surgery, but some of the risks of a hysterectomy include:

  • Injury to nearby organs, such as the bowel, urinary tract, bladder, rectum, or blood vessels
  • Pain during sexual intercourse
  • Early menopause, if the ovaries are removed
  • Side effects of anesthesia, such as breathing or heart problems
  • Allergic reactions to medicines
  • Blood clots in the legs or lungs, which can be fatal
  • Infection
  • Heavy bleeding
Power morcellation is sometimes used during minimally invasive hysterectomy to facilitate removal of the uterus or leiomyomas (fibroids). However, the technique has come under recent scrutiny due to concern about the risk of intraperitoneal dissemination of malignant tissue, particularly uterine sarcoma.

Power Morcellation Safety Communication

Power morcellation is sometimes used during minimally invasive hysterectomy to facilitate removal of the uterus or leiomyomas (fibroids). However, the technique has come under recent scrutiny due to concern about the risk of intraperitoneal dissemination of malignant tissue, particularly uterine sarcoma.

The U.S. Food and Drug Administration (FDA) recently released a safety communication recommending against the use of uterine power morcellation in hysterectomy. Per Dr. William Maisel, Deputy Director for Science and Chief Scientist at the FDA’s Center for Devices and Radiological Health, approximately 60,000 gynecological procedures utilize power morcellators each year. Ethicon, the division of Johnson & Johnson that manufactures several power morcellators, suspended sales worldwide pending more research and FDA review. It is important to note that this suspension of sales is not a recall.

Pap Tests After Hysterectomy

You will still need regular Pap tests to screen for cervical cancer if you had a partial hysterectomy and did not have your cervix removed, or if your hysterectomy was for cancer. Ask your doctor what is best for you and how often you should have Pap tests.

Even if you do not need Pap tests, all women who have had a hysterectomy should have regular pelvic exams and mammograms.

  1. Office on Women’s Health, US Department of Health and Human Services. Hysterectomy Fact Sheet. Last Updated: July 16, 2012. Available at: http://womenshealth.gov/publications/our-publications/fact-sheet/hysterectomy.pdf. Accessed on: June 10, 2014.
  2. American Congress of Obstetricians and Gynecologists. 2011 Women’s Health: Stats & Facts. Available at: http://www.acog.org/~/media/NewsRoom/MediaKit.pdf. Accessed on: June 11, 2014.