There are a number of reasons for hysterectomy, however, in some cases less invasive treatments should be explored before making an informed choice about whether to go ahead. Some of the reasons for surgical intervention are non-elective meaning no option, however, others such as fibroids and endometriosis are elective meaning optional.
According to NHS statistics over 60,000 hysterectomies are performed in the U.K. each year, with over half a million women undergoing this major operation in the U.S.
The decision to have a hysterectomy is not to be taken lightly as it will end your ability to become pregnant. If your ovaries are removed this will bring on surgical menopause (immediate onset of menopause symptoms, very often more severe than those experienced with natural menopause). Should one or both of your ovaries remain intact you may still have an early onset of menopause, around 1-2 years following your operation.
Reasons for Hysterectomy
Invasive cancer of the reproductive system including the uterus, cervix, ovaries, fallopian tubes, endometrium (the tissue that lines the uterus-womb).
Hysterectomy may be the best option if you have cancer in these organs.
Other treatment options include chemotherapy and radiation.
If you have precancerous changes of the cervix, a loop electrosurgical excision procedure (LEEP) may be possible to remove the cancerous cells.
In some cases surgery becomes a necessary last resort for women with chronic pelvic pain arising in the uterus.
In other cases, hysterectomy provides no relief from many forms of pelvic pain and an unnecessary hysterectomy can create a new set of problems.
Abnormal/Prolonged Vaginal Bleeding
Treatment depends on what is causing the bleeding.
Infection, cancer, fibroids and hormone levels can all cause persistent heavy bleeding.
Nonsteroidal anti-inflammatory medications, birth control pills and hormone medications can correct irregular bleeding or lighten heavy bleeding.
Dilation and curettage (D&C) removes the lining and contents of the uterus. This procedure is used for the treatment for abnormal bleeding.
Endometrial ablation removes the lining of the uterus to help stop heavy, prolonged bleeding. This procedure is not for you if you want to become pregnant or if you have reached menopause (you have reached menopause when you have not had a period for 12 months).
Serious Complications During Childbirth
In cases of this kind a hysterectomy may be the best and only option.
This is caused by your uterus slipping down into your vagina due to weakened supporting ligaments and tissues. This can lead to pelvic pressure, difficult bowel movements and urinary incontinence.
An object called a vaginal pessary might help for a time.
Hysterectomy may be necessary to achieve acceptable repair of these conditions.
This occurs when the tissue that lines the uterus grows outside the uterus on your ovaries, fallopian tubes or other pelvic and abdominal organs. This causes chronic pain in the lower back and pelvis, severe pain during menstrual periods, bleeding between periods, pain during and after sex.
Nonsteroidal anti-inflammatory medications, birth control pills and hormone medications are all prescribed to treat endometriosis.
Laparascopic – keyhole surgery is the least invasive technique available. The surgery destroys or cuts out the endometriosis tissue.
Laparotomy – major surgery which is used if your endometriosis is severe or extensive.
Hysterectomy – although it can be an option it is one rarely used these days. There is no guarantee that the endometriosis will not return, especially if your ovaries are left intact.
Non-cancerous uterine tumours that grow in the wall of the uterus.
Many women have minor symptoms and do not need treatment.
In some cases fibroids can cause pain or prolonged heavy bleeding.
Nonsteroidal anti-inflammatory medications, birth control pills and hormone medications are all used to treat fibroids.
A procedure called Uterine Artery Emobilization can be performed. This procedure blocks of the blood supply and without blood the fibroids will shrink.
A procedure called Myomectomy is sometimes performed to remove the tumours leaving the uterus intact, however, there is a risk that the tumours will reappear.
In some cases a hysterectomy is performed if medications or less invasive procedures have failed and when a woman is either close to or past menopause and does not want children. A hysterectomy will cure problems related to fibroids. Fibroids do tend to shrink after menopause when hormone levels decline.
The tissue that lines the uterus grows inside the walls of the uterus which causes particularly painful periods.
Nonsteroidal anti-inflammatory medications and hormone medications are used to treat adenomyosis.
Hysterectomy should only be carried out as a very last resort.
Useful link: You will find more information at the Hysterectomy Association.
Why a hysterectomy is necessary. (April 2014) Retrieved from http://www.nhs.uk/Conditions/Hysterectomy/Pages/Why-it-is-necessary.aspx
Hysterectomy. Retrieved from http://patient.info/health/hysterectomy-leaflet
Hysterectomy. (Dec 2014) Retrieved from http://www.womenshealth.gov/publications/our-publications/fact-sheet/hysterectomy.html
The Mayo Clinic; Patient.co.uk; NHS Direct
The Mayo Clinic; Patient.co.uk; NHS Direct