Hysterectomy

What is a hysterectomy?

A hysterectomy is an operation to remove the uterus (womb).

A total hysterectomy means both the uterus and the cervix are removed. A total hysterectomy does not mean the ovaries are removed. If the ovaries are removed this is a hysterectomy with oophorectomy (removal of the ovaries).

Occasionally a 'subtotal' hysterectomy is performed where the cervix is retained. If a hysterectomy is required due to cancer or risk of cancer it may also be recommended to take out the fallopian tubes, due to some research suggesting ovarian cancer may sometimes originate in the tube[1] [2].

Having a hysterectomy is major surgery. The decision to have a hysterectomy should only be made after you have been given adequate information about why you need one, how the surgery will be performed, what will happen to your body and what the consequences may be. It is also important to think about how you may feel about losing your uterus and whether you need help and support coping with those feelings.

Why a hysterectomy might be performed

• Cancer of the cervix, uterus, ovaries or tubes. This diagnosis means the hysterectomy must happen as soon as possible.
• Uncontrollable continuous uterine bleeding. This is rare but also makes a hysterectomy important to do as soon as possible.
• Heavy or persistent bleeding. Various causes of heavy bleeding can result in a woman needing a hysterectomy.
• Severe chronic pelvic pain. Various causes such as infection, endometriosis and adenomyosis can mean a hysterectomy is the best treatment.
• Endometriosis. If severe, a hysterectomy may be the best treatment, often with removal of ovaries and tubes to prevent reoccurrence.
• Pelvic inflammatory disease (PID). Sometimes caused by chronic infection of the fallopian tubes and pelvis, PID can mean hysterectomy is the appropriate treatment.
• Fibroids. A hysterectomy may be necessary if there are multiple fibroids, the uterus is enlarged or fibroids are growing rapidly.
• Adenomyosis. A condition where cells that usually line the uterus are found in the muscle layer of the uterus causing heavy bleeding and pain.

Ways to perform a hysterectomy

There are four ways a hysterectomy may be performed:

1. Abdominal technique
   An incision is made horizontally across the lower abdomen and vertically down the midline of the abdomen.
2. Vaginal
   The surgery is performed via the vagina.
3. Total laparoscopic
   The surgery is keyhole surgery.
4. Laparoscopic assisted vaginal
   The surgery is keyhole surgery in combination with the vaginal approach.

The decision as to which method of hysterectomy is most appropriate depends on:

• the reason for the hysterectomy
• the facilities/equipment available in the local/regional hospital
• the surgeon's skill in laparoscopic hysterectomy.

Should you have a hysterectomy?

If you are unsure about having a hysterectomy, you should seek a second opinion.

Sometimes it is appropriate to take time making the decision except when there is cancer or uncontrollable life-threatening bleeding.

For many women, hysterectomy relieves the symptoms and improves quality of life. Often women say, 'I wish I had done this years ago'.

A small number of women take time to recover following hysterectomy. This may be for many reasons including:

• complications following the operation such as infection or bleeding which prolongs recovery
• adjusting to the loss of the uterus and the ability to have a child, particularly if a woman does not have children and wanted children
• concerns about femininity and sexuality, particularly if the ovaries were also removed
• becoming menopausal if the ovaries were removed before periods had stopped
• feeling unhappy about the doctor and/or the hospital staff's treatment

Questions to think about

You may like to consider the following questions when thinking about whether or not to have a hysterectomy: