1. Health

Hysterectomy

When Hystrectomy Is Necessary

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Updated June 10, 2014

Light micrograph showing cervical cancer
Callista Images/Collection Mix: Subjects/Getty Images
Reasons for hysterectomy

Having a hysterectomy is a serious decision and one that should be carefully considered. Your physician may recommend a hysterectomy for a variety of reasons, however, in most cases it's optional and you'll need to make an informed decision based on your medical history. Cases of uterine or cervical cancer will probably leave you with no option, as will cases where a uterine growth has caused a blockage of your bladder or intestines.

Fibroid tumors sometimes necessitate a hysterectomy, although often they're treatable with drugs or they may never cause you any problem. Pelvic adhesions, often caused by pelvic inflammatory disease sometimes are painful enough to require surgery. Severe uterine bleeding brought on by childbirth or severe infection may also leave you with no choice. Treatment of endometriosis can involve removal of your uterus, but each case must be weighed individually. You and your gynecologist should work together to determine the best treatment option for you.

Other reasons for your doctor recommending hysterectomy may include; chronic pelvic pain, uterine prolapse, ovarian cysts, ectopic pregnancy and pre cancerous cells. Alternative treatments are available for these conditions and your physician should try them first, if your health allows.

Types of hysterectomy

A total hysterectomy is one which involves removal of the cervix, uterus, and the fallopian tubes; the ovaries remain intact in this type of hysterectomy, although many women show signs of menopause soon after a total hysterectomy. You should discuss this possibility with your doctor prior to having your hysterectomy.

Hysterectomy with bilateral oophorectomy involves the removal of both ovaries; surgical menopause begins immediately after this surgery and you'll need to begin hormone replacement therapy while still hospitalized, to lessen some of the menopausal symptoms which are sure to follow this procedure. A hysterectomy, of this type, may be required because of ectopic pregnancy, endometriosis, tumors or cysts on the ovaries, or PID.

A radical hysterectomy involves the removal of the uterus, cervix, the top part of the vagina, and most of the tissue surrounding the cervix in the pelvic cavity; pelvic lymph nodes are also removed in cases of cervical or endometrial cancer and is rarely necessary.

Women at low risk for developing cervical cancer may have their cervix left intact and opt for supracervical hysterectomy, with just the body of the uterus removed.

Methods of hysterectomy

Abdominal hysterectomy was once the only type of hysterectomy available. Today several options for hysterectomy are available for your consideration. Your gynecologist is the one best able to determine the procedure necessary for you. In an abdominal hysterectomy, a six to eight inch incision is made in the lower abdomen. The incision is much like one you might receive during a Cesarean birth, being either horizontal, as in the 'bikini' cut, first popularized by Jacqueline Kennedy, or vertical, running from your navel to just above the pubic bone. Hospitalization will last for at least three to five days following such surgery and recovery takes at least four to six weeks. Your physician will advise you when it is safe for you to resume sexual relations, most likely at least four weeks post- surgery.

Other methods of hysterectomy include vaginal, with the uterus removed through the vagina, vaginal hysterectomy can sometimes led to discomfort during sexual intercourse due to shortening or tightening of the vagina; laparoscopic assisted vaginal hysterectomy uses a laparoscope to remove pelvic adhesions which previously made vaginal hysterectomy impossible. In cases of severe pelvic adhesions the probability of abdominal hysterectomy remains. The recovery time for vaginal or laparscopic assisted vaginal hysterectomy is considerably shorter than for abdominal hysterectomy.