A hysterectomy is uterus removal surgery. There are many reasons that a uterus must be removed, but in all cases, the woman’s health calls for such a procedure.
Reasons For A Hysterectomy
A woman’s reproductive system goes through three major hormonal changes during her lifetime. Puberty, pregnancy, and menopause all cause dramatic hormone shifts that can cause complications with the uterus, ovaries, or fallopian tubes.
Uterine fibrosis is the development of benign lumps that grow in the uterus. These lumps are not cancerous but cause pain, bleeding, cramping, painful sex, and the urge to urinate. A hysterectomy will remove these lumps and the uterus, relieving the symptoms and guaranteeing they do not come back.
Cancer of the uterus, cervix, or ovaries can call for the removal of all or some of these organs. The procedure must happen before cancer spreads.
Prolapse is when the uterus slides from its normal position into the vaginal canal. Prolapse can cause the collapse of other structures, such as the vagina and rectum. Removal of the uterus will maintain the structures of other pelvic organs.
Endometriosis is when uterine tissue develops outside the uterus. It often causes extreme pain, heavy periods, and infertility. Endometriosis makes certain hysterectomy procedures more difficult.
Abnormal Vaginal Bleeding
If the uterus cannot maintain the uterine lining, a woman can experience bleeding not connected to menstruation.
Chronic Pelvic Pain
A uterus that is not performing correctly can cause severe pain in the pelvis.
Adenomyosis is the thickening of the uterus, which causes pain and makes it unfit for a fetus.
Types Of Hysterectomy
There are several different hysterectomy types; the procedure may not refer just to the removal of the uterus but to the removal of any combination of the reproductive organs.
Removal of the upper part of the uterus takes place but the cervix remains. Some OB/GYNs will recommend this if they are uncomfortable or untrained in the removal of the cervix. See the advantages and disadvantages of leaving the cervix intact below.
A partial hysterectomy is the removal of the uterus and the cervix. The ovaries and fallopian tubes remain intact.
The uterus, cervix, and upper portion of the vagina are removed. Radical hysterectomies usually take place when cancer is present. No other hysterectomy removes any part of the vaginal canal.
Oophorectomy is the removal of the ovaries. This can take place with or without the removal of the uterus, especially in cases of ovarian cancer. One or both ovaries can be removed.
The removal of the fallopian tubes is a salpingectomy. The fallopian tubes connect the ovaries to the uterus. When a woman gets her “tubes tied,” the fallopian tubes are severed and tied to prevent pregnancy. One or both fallopian tubes can be removed.
Total Hysterectomy and Bilateral Salpingectomy-Oophorectomy
This is the term for the procedure in which the uterus, cervix, both ovaries, and both fallopian tubes are removed. It is also called a total hysterectomy. This occurs in the case of progressed cancer.
In order to fully understand the effects of the different types of hysterectomies, one must understand the purpose of the various reproductive organs and the effects of their removal. Some organs produce hormones and removing them will spur changes in the body.
The uterus, or womb, is the organ that houses the fetus during pregnancy. It does not produce hormones, but removing the uterus makes the body unable to become pregnant. Once the uterus is removed, there will no menstruation as there is no uterus to shed its uterine lining.
The ovaries house and release the eggs, or ovum. The ovaries also produce estrogen and other hormones that a woman uses post-puberty, during pregnancy, and in perimenopause. Menopause is the process of the ovaries no longer producing these hormones. The removal of the ovaries will prompt menopause, and women will experience hot flashes, mood swings, and the other symptoms that go along with this change. If only one ovary is removed, a woman will not experience this until she is at the age of menopause. Women who have already completed menopause will not go through it again at the removal of the ovaries. A woman can no longer become pregnant when her ovaries are removed. Pregnancy is still possible if only one ovary has been removed.
The fallopian tubes are the tubes between the ovaries and the uterus that houses the egg while it waits for fertilization. The removal of the fallopian tubes will not affect hormones but will prevent a woman from becoming pregnant.
The cervix is the opening between the uterus and the vaginal canal. During pregnancy, the cervix prevents the fetus from moving outside of the uterus and dilates during birth to let the baby out. The cervix does not produce hormones. The removal of the cervix does not affect vaginal lubrication, cause prolapse, lessen sexual satisfaction, or guarantee a safer hysterectomy procedure. A cervix that has not been removed with the uterus during a hysterectomy can cause vaginal bleeding, a higher potential for cancer developing, and thus the need for more pap smears. The cervix may need to be removed to prevent the risk of cancer.
Methods For Hysterectomy Surgeries
An OB/GYN can use one of several different methods when performing a hysterectomy. Each has its all own advantages and disadvantages. Ask for information about which procedure is best for your situation.
A vaginal hysterectomy is a procedure in which the uterus and other organs are removed through the vaginal canal.
There are no incisions with a vaginal hysterectomy, making it the least-invasive form of hysterectomy, and the recovery is very quick as a result. It is especially effective in correcting prolapse. A vaginal hysterectomy is also cost-effective.
A vaginal hysterectomy requires room in the vaginal canal to remove the uterus, as a result, it is not the best option for women who have not give birth vaginally. Larger uteri masses are more difficult to remove as well. There is a larger risk of bleeding due to an injury of the uterine or ovarian arteries and high risk of complications with patients who have had a cesarean section or previous pelvic surgery because the surgeon will have difficulty seeing other issues or complications in the area.
A laparoscopic hysterectomy requires three to five small incisions in the abdomen. The procedure is then completed using long tools to remove the uterus or other organs.
Laparoscopic surgery offers a faster recovery time. The patient is out of the hospital the next day and can go back to work two weeks later. It is safe to use if patients have undergone other pelvic procedures, such as a cesarean section, in the past. It is generally a better option for those who have large uterine masses to be removed or who are not candidates for vaginal hysterectomies. The OB/GYN completing the procedure has full access and visibility, lowering the risks of complications.
There is a risk of injury to other organs, such as the bladder, and possible conversion to an open hysterectomy due to extreme endometriosis. It is less readily available because specialized training is required to complete the procedure safely.
Open Abdominal Hysterectomy
Open abdominal hysterectomies are still the most common procedures that take place. This is due to lack of training for laparoscopic hysterectomies.
An open hysterectomy surgery allows for removal of any size masses.
A large, 6- to 12-inch incision is made across the abdomen. This causes severe pain and 6 to 8 weeks of recovery. There are also higher hysterectomy complication rates, due to the invasive nature of the procedure.
Founder and Medical Director of ARIZONA GYNECOLOGY CONSULTANTS
Dr. Kelly Roy is a specialist in surgical gynecology and advanced laparoscopy (and hysteroscopy). She is a long-time resident of Arizona and obtained her Bachelor of Science degree in Biomedical Engineering at Arizona State University before finishing her Doctorate of Medicine at the University of Arizona in 1997.
Dr. Roy completed her residency in Obstetrics and Gynecology at the then “Banner Good Samaritan Hospital” (now Banner University Medical Center), in Phoenix Arizona in 2001.
Well known for her teaching and surgical ability, she is on the faculty at the residency program at both Banner University Medical Center and Saint Joseph’s Hospital in central Phoenix and is a Clinical Assistant Professor of Medicine at the University of Arizona College of Medicine, Phoenix Campus. Dr. Roy has taught advanced surgical techniques to medical students, residents, fellows and colleagues for over 15 years.
Dr. Roy is also a consultant to the medical device industry and has participated in the design and clinical testing of many instruments and surgical devices available on the world-wide market today.