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Medical Encyclopaedia

Check out the A to Z guide of medical conditions. Read up about the most common medical conditions, their symptoms and find out what treatment and support is available.

D

Diabetes

Hysterectomy

Introduction:

A hysterectomy is an emotional subject for most women, because it is associated with the end of fertility and the ability to have babies. The procedure involves the surgical removal of the uterus (womb) and it’s one of the commonest female procedures, with around 40,000 procedures performed in the UK every year on the NHS. It is performed for a variety of reasons, but should only be considered after other options have been explored.

1. What is a hysterectomy?
2. What are the different types of hysterectomy?
3. What are the different techniques used in hysterectomy?
4. What conditions require a hysterectomy?
5. What are the risks with a hysterectomy?
6. What can patients expect after surgery?
7. What are the alternatives?

What is a hysterectomy?

A hysterectomy involves the complete or partial removal of the uterus.

The fallopian tubes and ovaries may also be removed, depending on the reasons for the hysterectomy. The procedure can be done either through the abdomen or the vagina, and again, this depends on your medical history and the reasons for surgery.

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What are the different types of hysterectomy?

• The most commonly performed is the total hysterectomy and, as the name suggests, involves removal of both the uterus and cervix (neck of the womb)
• A partialhysterectomyor subtotalhysterectomyis the removal of the uterus, but the cervix is left intact
• A radicalhysterectomy is the most extensive surgery as it includes the removal of the uterus, the cervix and most surrounding tissue, some ofthe upper vagina and possibly the pelvic lymph nodes, which is normally performed if cancer is diagnosed

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What are the different techniques used in hysterectomy?

• Abdominalhysterectomy involves an incision of around six to eight inches through the abdomen (the lower stomach area). The incision can be vertical from the pubic bone up to the navel or horizontal across the top of the pubic hairline. This technique is common when the ovaries and fallopian tubes are being removed, when the uterus is enlarged or disease has spread
• Vaginalhysterectomyhas no visible scarring as the uterus is removed through the vagina. This is common when the vagina also needs repair
• Laparoscopic supracervicalhysterectomy(LSH) uses very thin, flexible tubes, which are lit and contain a tiny camera. They are inserted through small incisions around the abdomen or through the vagina. The surgeon then uses small surgical instruments to remove the uterus without affecting the cervix This surgery is less invasive than other procedures, can be performed relatively quickly and requires a much shorter recovery time. However, as this surgical procedure is relatively new, the surgeon will need special training and the whole operation will cost more to perform. If the surgeon has not had training in this procedure, there may be an increased risk of complication due to injury. Complication rates for this type of hysterectomy are higher than for an abdominal hysterectomy.

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What conditions require a hysterectomy?

There are many reasons that a patient may be offered a hysterectomy, but it is normally a last resort after other treatments, both surgical and non-surgical, have been tried.

Here are a few possible conditions that can result in ahysterectomy:

• Fibroid tumours are usually benign tumours, which grow inside the uterus. They can vary in size from that of a pea to a grapefruit. As they grow larger they place pressure on other organs, causing heavy menstrual bleeding or pelvic pain
• Menorrhagia or excessive menstrual bleeding can be caused by hormonal changes, fibroids, infection or disease. If other treatments don’t succeed a hysterectomy may be the only option available
• Endometriosis is a condition where tissue normally found inside the uterus appears in other parts of the abdomen. This causes severe pain, painful intercourse and abnormally heavy bleeding. It can also lead to infertility
• Endometrial hyperplasia is the term for a thickening of uterine lining often through high levels of oestrogen. Again, it causes abnormally heavy bleeding
• Pelvic support problems, such as a uterine prolapse, where the uterus drops down into the vagina, because the muscles supporting it are weak or damaged. It is very common in older women, as pelvic muscles weaken and organs effectively fall downwards. This can affect the uterus, the bladder, the urethra (the tube carrying urine from the bladder) and, on rare occasions, the intestines. Depending on the nature of the prolapse surgery is normally undertaken to repair the prolapse.
• Cancer is often treated with a hysterectomy, if it is cervical, ovarian, or endometrial

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What are the risks with a hysterectomy?

It is essential that patients fully discuss the procedure and any concerns with a gynaecologist before the hysterectomy.

As with any surgical procedure, there are risks around general anaesthetic, bleeding and infection control, but these are risks which every hospital does its utmost to minimise for all surgery.

However, there are some more specific risks with a hysterectomy, which include injury to nearby organs, such as the bladder and blood vessels, injury to the bowel and the possibility of painful intercourse after surgery.

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What can patients expect after surgery?

The vast majority of patients recover fully from a hysterectomy, but much depends on the nature of the condition being treated, the type of hysterectomy and the technique used, as well as many other factors.

Women who have not yet gone through the menopause will require oestrogen replacement therapy, as they will enter a menopausal state, if the ovaries are removed at the same time.

Pain relief is used after surgery and a catheter is normally used so that urine can be passed. Movement is encouraged as early as possible to avoid blood clots and normal eating and drinking should resume as soon as the bowel functions again.

Recovery time for hysterectomy will depend on how old you are and what your general health is like. Most women who have had a vaginal hysterectomy will normally go home after three or four days, while those who have had an abdominal hysterectomy will return home within five to seven days.

Sexual health issues

Most patients report a full recovery within six to eight weeks of the operation. While recovering, patients should avoid lifting heavy objects and refrain from sexual intercourse until fully healed.

One of the main concerns for women is the effect a hysterectomy will have on their sex life. Gynaecologists suggest that those who have experienced a healthy sex life before a condition arose which prompted a hysterectomy, will return to a healthy sex life post-operation.

Patients who find that the surgery has affected their sexual function should speak to their gynaecologist or GP.

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What are the alternatives?

There are a number of surgical alternatives which may mean that a woman can keep her uterus. A patient should explore all the alternatives with their GP or gynaecologist.

Alternatives tohysterectomy:

• Uterine Artery Embolisation: this technique works by injecting a fluid into the blood vessels that feed the fibroids in or around the uterus. The fluid blocks the blood vessels and the fibroids shrink, as they no longer have a blood supply. This reduces the bleeding and pain they cause. The technique is used to treat large fibroids and can shrink them by up to 60 per cent. However, as this is a new procedure is not available in all hospitals, you should ask your doctor about availability
• Myoma Coagulation (myolysis): like uterine artery embolisation, this technique attempts to kill off fibroids by cutting off their blood supply. A needle that transmits electrical current is inserted into the fibroid and seals blood vessels with heat. A similar procedure called cryomyolysis uses liquid nitrogen instead of electricity
• Microwave Endometrial Ablation (MEA): this procedure is very quick and uses a probe, heated by microwave technology, to reduce the thickness of the uterine (womb) lining. In tests the majority of women reported a reduction in period pain and bleeding disappeared or reduced significantly. Other ablation techniques that remove unnecessary tissue include laser and thermal balloon
• Myomectomy: removal of fibroids but not the uterus (womb) is known as a myomectomy. It can be performed through the abdomen or the vagina depending on the location and size of the fibroids

Clickthrough information and support links:

The Hysterectomy Association
Cancer Help (Cancer Research UK)
Cancer Backup

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  References:

This article has been written for PruHealth by Dr Foster Research. All Dr Foster Research (DFR) health content is provided for general information only, and should not be treated as a substitute for the medical advice of your own doctor or any other health care professional.