A hysterectomy is the surgical removal of the uterus, and potentially the cervix, ovaries and fallopian tubes.
Why have a hysterectomy?
A hysterectomy is generally considered a last resort treatment. For most conditions, there are other therapies that should be tried first, as a hysterectomy is a major surgery, with a long recovery and some risk. Particularly if the ovaries are also removed, there are a lot of issues to consider, and life changing, irreversible consequences.
Most common reasons for hysterectomy include:
Fibroids – non-cancerous growths that occur in the uterus. Most fibroids are small and don’t cause symptoms, but when they do become problematic, treatment is required. Fibroids can sometimes be shrunk with hormonal treatment, or minor surgery to just remove the fibroids. If these options fail, a hysterectomy is the last option.
Heavy or irregular and painful menstrual periods – Heavy and painful periods can cause a significant reduction in quality of life. Other, less invasive options include hormone therapy (progestins or the contraceptive pill can often reduce bleeding and pain), or less invasive surgery, such as endometrial ablation. An endometrial ablation removes the endometrium via a day procedure, and results in significantly reduced bleeding, and sometimes completely stops menstrual periods. Periods can still be painful, however and the endometrium will sometimes grow back over time, resulting in the heavy bleeding returning. If these therapies fail, a hysterectomy is the only permanent solution.
Adenomyosis – a thickening of the uterine lining, where the endometrium grows into the muscular uterine wall. It causes varying degrees of bleeding and pelvic pain. An endometrial ablation is often successful, but the condition often tends to recur. Few surgeons would opt for hysterectomy without first trying an ablation, but if that fails, the only cure for adenomyosis is hysterectomy.
Uterine prolapse – where the uterus slides down into the vaginal canal. Milder cases may be improved with pelvic floor exercises or a surgical repair without hysterectomy. More severe cases can only be resolved with hysterectomy.
Endometriosis – Hormonal treatments may reduce endometriosis severity, or surgery to just remove the areas of endometriosis can be performed. Often a combination of all of these approaches works best, and in severe cases, ultimately hysterectomy is necessary. Endometriosis and the pain it causes, can continue after hysterectomy, however.
Cancer of the uterus, cervix or ovaries. In early cancer, just the cancer can be removed. Depending on risk of cancer spreading, a hysterectomy may be the best option to ensure cure.
Depending on your personal circumstances, there are several types of hysterectomy and different surgical types of hysterectomy. Which method your surgeon performs will depend on the condition being treated, and your sometimes your anatomy.