Hysterectomy surgery

What is it?

A hysterectomy is an operation to remove your womb (uterus). There are several different types of hysterectomy and several methods for performing the operation, but if possible, the ovaries are left in place as they produce oestrogen. If the ovaries are removed you will immediately experience the menopause.

After a hysterectomy surgery, you will not be able to become pregnant and you will no longer have periods.

A hysterectomy is a commonly performed operation with about 60,000 women in the UK having the procedure every year. Because it is quite a major or drastic operation a hysterectomy is performed only when completely necessary, after other methods of treating your condition have failed.

This article on hysterectomy surgery is written by Jackie Griffiths, a freelance journalist who writes health, medical, biological, and pharmaceutical articles for national and international journals, newsletters and web sites.

Why have it?

A hysterectomy can be undertaken to treat a number of conditions, including:

  • Heavy or painful periods (menorrhagia) – losing excessive amounts of blood every month can cause anaemia and is often accompanied by great pain. Quality of life can be seriously affected.
  • Pelvic Inflammatory Disease (PID) – if not caught early enough, this bacterial infection can spread causing damage to the fallopian tubes and uterus, leading to life-long episodes of pain and discomfort.
  • Cancer – if not caught in the early stages a hysterectomy may be required to prevent the spread of cancer of the ovaries, cervix, endometrium, and fallopian tubes.
  • Endometriosis – this condition can cause pain, severe and irregular periods, and infertility.
  • Prolapsed uterus – weakened muscles in the uterus (due to childbirth, heavy lifting, or the menopause) can lead to the uterus falling down into the vagina causing pain and incontinence.

Different types of hysterectomy surgery

The type of hysterectomy performed will depend on the condition it’s aimed at treating. There are four main types of hysterectomy:

  • Subtotal hysterectomy – just the womb is removed
  • Total hysterectomy – the womb and the cervix are removed
  • Total hysterectomy and salpingo-oophorectomy – the womb, cervix, fallopian tubes, and ovaries are removed
  • Radical hysterectomy – the womb, cervix, part of the vagina, ovaries, the fallopian tubes, plus the nearby lymph nodes are removed

Hysterectomies can be performed in three different ways, either via an abdominal incision, vaginally, or laparscopically.

Abdominal hysterectomy

An incision is made in the abdomen either vertically (mid-line) or horizontally (bikini-line). After the operation, the bikini-line scar is hidden within the pubic hair, however the vertical incision may always be slightly visible. If your womb or fibroids are large, or your ovary has a large swelling it may not be possible to have the bikini-line incision. During an abdominal hysterectomy, the uterus is removed by clamping and cutting the large blood vessels that supply it and tying them off. The top of the vagina is sealed to prevent infection or prolapse and the incision in your abdomen closed with sutures.

Vaginal hysterectomy

This operation is similar to the abdominal hysterectomy except the incision is made internally, in the vagina. The uterus and other organs are removed through the vagina leaving no visible scars after the operation. The top of the vagina is closed to prevent infection or prolapse using dissolvable stitches.

Laparoscopic hysterectomy

A laparoscopic hysterectomy is keyhole surgery, entailing four small cuts in your abdomen below the navel. The operation is performed with the help of an internal camera which relays pictures of the inside of your abdomen onto a screen. The uterus and other organs are removed through the vagina.

Having a private hysterectomy allows you to discuss all the options and choose, with the surgeon, which method you would prefer and what’s best suited to your circumstances. As with all operations there are some risks involved, such as infection, bleeding, or an abnormal reaction to the anaesthetic. Complications specific to a hysterectomy include damage to other abdominal organs (although this is very rare), vaginal problems and ovary failure (if your ovaries were left in place). After a hysterectomy, there is roughly a 50% chance of your ovaries failing within five years (which can in turn cause early menopause). However, hysterectomy surgery can offer a positive solution to several medical conditions that cause continuous discomfort or can be life-threatening.

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