HYSTERECTOMY

Hysterectomy.

What is a hysterectomy?

A hysterectomy is the surgical removal of the uterus, or womb. It is the second most frequently performed surgery on women after Caesarean section. Depending on the type of hysterectomy performed and the reason it's being done, removal of the cervix, ovaries and fallopian tubes is sometimes performed during the same surgery. There are three basic types:

Total hysterectomy (or "traditional hysterectomy") - The uterus and cervix are removed. The ovaries and fallopian tubes may or may not be removed.

Subtotal or partial hysterectomy - The uterus is removed but the cervix is left in place. The ovaries and fallopian tubes may or may not be removed. Some gynaecologists feel leaving the cervix may reduce incontinence later in life. Mr Connell uses this technique whenever possible.

Laparoscopic (key hole) hysterectomy.

Whenever possible Mr Connell will try to perform the hysterectomy by the laparoscopic approach. When the woman has large fibroids she will have Zoladex injections to help shrink the womb to make the operation easier. The benefits of this approach is the quicker return to normal.

Why are hysterectomies sometimes necessary?

Fibroids - Usually these are benign (non-cancerous) growths inside the uterus. A fibroid can be as small as a pea or grow larger than a pregnancy. Mr Connell performs most hysterectomies because of fibroids. The can cause problems because of pressure effects on the bladder and bowel.

Menorrhagia - The medical term for excessive menstrual bleeding. Menorrhagia is usually caused by hormonal changes or by fibroids.

Endometriosis - A condition where tissue that normally resides in the uterus appears in other parts of the abdomen. It can cause pelvic pain and infertility.

Pelvic Support Problems - A condition such as uterine-prolapse, when the uterus falls from its normal position and descends into the vagina.

Hysterectomy is also indicated for treating some cancers of the uterus and cervix.

In the vast majority of cases, hysterectomy is an elective procedure. It should be considered only if you cannot be treated with, or have not had success with, less invasive treatments that preserve the uterus.

If you and your doctor determine you need a hysterectomy, ask your doctor about minimally invasive hysterectomy options. Learn more about minimally invasive options such as laparoscopic subtotal hysterectomy. This is Mr Connell’s preferred method.

What are the benefits of keeping or removing my ovaries?

Most gynaecologists will suggest removal of ovaries after the age of 45 years, or where there is a significant risk of ovarian disease (cysts or cancer), or where there are other problems such as severe PMT (PMS).

The ovaries do continue to produce hormones even after the menopause, although in much lower quantities. They will also produce the male hormone testosterone which is thought to be related to sexual desire.

You must discuss this with your consultant in the clinic.

What are the benefits of keeping my cervix?

The cervix connects the upper portion of the vagina to the uterus, providing support for both organs. For this reason, some gynaecologists feel that leaving the cervix in place is important to reduce the chance of pelvic floor support problems. Leaving the cervix may also reduce the chances of developing stress urinary incontinence (the unintentional release of urine). In addition, some research suggests the cervix may play a role in sexual arousal and the ability to achieve orgasm in some women.

On the other hand, retaining the cervix means you may still experience some periodic bleeding. In addition, you - like women who have not had a hysterectomy - should continue to have an annual pap smear to screen for cervical cancer.

A quick visual guide to the female reproductive system

Knowing these terms will help you understand the information provided in this section.