Hysterectomy is the surgical removal of the uterus. The operation is performed only when other treatments are unsuitable or have been tried without success. The uterus has its most important role during pregnancy when it provides protection and nourishment for the growing baby.
The flow of menstrual blood occurs when the lining of the uterus (endometrium) is shed during the monthly periods. After the uterus is removed, no more periods occur, pregnancy is not possible, menopause my start a year or so earlier than expected.
As the uterus does not produce female hormones, its removal does not change the level of female hormones in the blood. However, if the ovaries are removed during a hysterectomy in a premenopausal woman, the level of female hormones in the blood will decrease quickly. This will cause symptoms of the “change of life” as well as the absence of periods.
After the uterus is removed, the space is taken up by the other organs in the abdomen.
Reasons for Hysterectomy
Most hysterectomies are performed for non-cancerous diseases that are causing disabling levels of pain, discomfort, uterine bleeding or emotional distress. Sometimes, a hysterectomy is important in the treatment of cancer and can be a life-saving procedure. Common reasons for hysterectomy include:
- Uterine fibroids
- Unexplained heavy or irregular menstrual bleeding
- Prolapse of the uterus
- Endometriosis and Adenomyosis
- Chronic and intense uterine pain
- Pelvic inflammatory disease (PID)
- Cancer of the endometrium (uterine lining)
- Cancer of the cervix
- Cancer of one or both ovaries
- Chronic, disabling pain
Types of Hysterectomy
Total Hysterectomy: involves the removal of the entire uterus including the cervix, but the ovaries or the fallopian tubes.
Total Hysterectomy with Bilateral Salpingo- Oophorectomy: includes complete removal of the cervix, uterus, ovaries and fallopian tubes.
Subtotal Hysterectomy: is the removal of the upper portion of the uterus, leaving the cervix in place. The fallopian tubes and ovaries may be left or removed
A radical Hysterectomy: includes the removal of the uterus, cervix, the top portion of the vagina and most of the tissue that surrounds the cervix in the pelvic cavity. The ovaries and pelvic lymph nodes may be left in place or removed.
Surgical removal of the uterus
Abdominal Hysterectomy: An incision about 10-20cm long is made in the lower abdomen. This may be a horizontal cut quite low on the abdomen (bikini line) or a vertical cut from the naval to the pubic bone. This type of operation may be recommended if more extensive surgery must be performed, such as removal of both ovaries and fallopian tubes as well as the uterus. It may also be the operation of choice if large fibroids or extensive areas of endometriosis exist or if a lot of scar tissue is present due to previous infection or surgery.
Vaginal Hysterectomy: The operation is performed through the vagina. In most cases, a hysterectomy can be performed vaginally. In certain circumstances, the doctor may choose to do a laparoscopic hysterectomy or an abdominal hysterectomy. For a vaginal hysterectomy, only dissolving sutures are used and do not need to be removed.
Laparoscopic Hysterectomy: A hysterectomy can be performed using a laparoscope, a thin tele-scope like tube with miniature video equipment that allows the gynaecologist to see the uterus and other organs. The laparoscope and other surgical instruments are inserted through several small incisions in the abdomen and manipulated. Carbon dioxide gas is blown into the abdominal wall clear of the uterus, bowel and bladder, this is done to give a clear view of the uterus and ovaries. The uterus is usually removed through the vagina.
Recovery after Hysterectomy
Recovery times after a hysterectomy will depend on factors such as your age, general health and the type of operation you have had. Recovery after an abdominal hysterectomy generally requires 3-5 days in hospital. To recover fully may take 4 -6 weeks. Vaginal hysterectomy may have a shorter stay in hospital often 1-5 days and may recover more quickly. A laparoscopically assisted hysterectomy may result in a shorter hospital stay 1-4days and sometimes a faster recovery at home.
During recovery many women need assistance around the house. You can help yourself to recover quickly and comfortably by observing the following
- No heavy lifting
- No vigorous exercise
- Follow advice on showering, driving, returning to work and resumption of sexual intercourse