What is a Hysterectomy?
A hysterectomy is an operation to remove a woman's uterus (womb). The uterus is where a baby grows when a woman is pregnant. Sometimes the fallopian tubes, ovaries, and cervix are removed at the same time the uterus is removed. The cervix is the lower end of the uterus. The ovaries are organs that produce eggs and hormones, and the fallopian tubes carry eggs from the ovaries to the uterus.
Hysterectomy can mean survival if you have uterine cancer. Or if you're a woman with intolerable pelvic pain from endometriosis or heavy, irregular periods, a hysterectomy often means relief from troublesome symptoms. Hysterectomy ranks as one of the most common surgical procedures among women. Hysterectomy is the second most common major procedure among women in the United States. (The most common major procedure that women have is cesarean section delivery.) Each year, more than 600,000 hysterectomies are done. About one third of women in the United States have had a hysterectomy by age 60.
However, hysterectomy ends your ability to become pregnant. The use of such a radical treatment should be carefully discussed with your CHCW physician, as many of the conditions for which hysterectomy is used have alternative treatments available.
When is Hysterectomy recommended?
Hysterectomy may be needed if you have one of the following conditions:
- Gynecologic Cancer, such as cancer of the uterus or cervix. Depending on the specific cancer you have and how advanced it is, your other options might include radiation or chemotherapy.
- Fibroids. Hysterectomy is the only certain, permanent solution for fibroids (benign uterine tumors that cause persistent bleeding, anemia, pelvic pain or bladder pressure).
- Endometriosis. In endometriosis, the tissue lining the inside of your uterus grows outside the uterus on your ovaries, fallopian tubes, or other pelvic or abdominal organs. When medication or conservative procedure doesn't improve endometriosis, you might need a hysterectomy.
- Uterine prolapse. Descent of the uterus into your vagina can happen when the supporting ligaments and tissues weaken. Uterine prolapse can lead to urinary incontinence, pelvic pressure or difficulty with bowel movements. Hysterectomy may be necessary to achieve satisfactory repair of these conditions.
- Persistent Vaginal Bleeding. If your periods are heavy and irregular or last many days each cycle, a hysterectomy may bring relief when the bleeding can't be controlled by nonsurgical methods.
- Chronic Pelvic Pain. Occasionally, procedures are a necessary last resort for women who experience chronic pelvic pain that clearly arises in the uterus. However, many forms of pelvic pain aren't cured by hysterectomy, and this operative approach can be a mistake. Seek careful evaluation before proceeding with such a radical strategy.
Hysterectomy ends your ability to become pregnant. If you think you might want to become pregnant, ask your doctor about alternatives to this procedure. In the case of cancer, hysterectomy might be the only option. But other conditions — including fibroids, endometriosis and uterine prolapse — have alternative treatments that should be considered first.
How is a Hysterectomy done?
Hysterectomy is an inpatient procedure — meaning you're admitted to the hospital to have it done. How long you'll be in the hospital depends on what type of hysterectomy you have and what your doctor recommends. To perform a hysterectomy, a surgeon detaches your uterus from the blood vessels and connective tissue that support it, as well as from the vagina. Depending on your situation, procedures may involve the removal of additional organs and tissue.
Types of hysterectomy procedures include:
- Partial Hysterectomy. Removes the uterus but leaves the cervix in place. By keeping the cervix, your risk of cervical cancer remains, so you'll still need regular Pap tests for screening.
- Total hysterectomy. Removes the uterus, including the cervix.
- Hysterectomy and bilateral salpingo-oophorectomy. Removes the uterus, cervix, fallopian tubes and ovaries. If you haven't already experienced menopause, removing your ovaries initiates it.
- Radical hysterectomy. Extends farther, removing the upper portion of the vagina and some surrounding tissue and lymph nodes. Surgeons use this procedure for certain forms of cancer.
A hysterectomy typically is performed under general anesthesia, so you won't be awake during the procedure. The procedure itself lasts about one to two hours, although you'll spend some time beforehand getting ready to go into the operating room.
Abdominal vs. Vaginal Hysterectomy
Hysterectomy can be performed through an incision in your abdomen (abdominal hysterectomy) or through your vagina (vaginal hysterectomy). Which procedure is best for you depends on your specific situation. Your CHCW surgeon will discuss your options thoroughly with you and will recommend the best possible approach for your condition.
In abdominal hysterectomy, your surgeon cuts through skin and connective tissue in your lower abdomen to reach your uterus. The surgeon uses one of two types of abdominal incisions for the hysterectomy. A vertical incision starts in the middle of your abdomen and extends from just below your navel to just above your pubic bone. A horizontal bikini-line incision lies about an inch above your pubic bone.
The advantage of an abdominal procedure is that your surgeon can see your uterus and other organs and has more room to operate than if the procedure is done vaginally. For this reason, your surgeon may opt for the abdominal procedure if you have large tumors or if your doctor suspects the presence of cancer.
However, abdominal hysterectomy can mean:
- You'll be in the hospital longer.
- You will experience greater discomfort than following a vaginal procedure.
- You'll have a visible scar on your abdomen.
In a vaginal hysterectomy, the surgeon reaches your uterus by making a circular incision around the cervix. This approach is best for benign conditions that lead to hysterectomy when the uterus isn't too large. It's often the best approach for uterine prolapse. With a vaginal hysterectomy, you won't have any external scarring. You may also recover more quickly because you aren't waiting for a large abdominal incision to heal and the nerve signals from the top of the vagina aren't perceived in the same manner as those from the skin.
Laparoscopic Supracervical Hysterectomy (LSH)
A Laparoscopic Supracervical Hysterectomy is a type of hysterectomy that allows women to retain their cervix while taking out the part of the uterus that causes the painful periods and heavy vaginal bleeding. Some women feel that their cervix helps to maintain their sexual function and provides pelvic organ support. Your CHCW physicians are experts at this relatively new procedure. According to an article in the New England Journal of Medicine, patients undergoing a Laparoscopic Supracervical Hysterectomy had shorter operating times, shorter hospital stays and fewer complications than if they were to undergo an Laparoscopic Assisted Vaginal Hysterectomy (LAVH).
How is it done?
Through tiny incisions in the abdomen, LSH allows physicians to use laparoscopy and a surgical instrument called a tissue morcellator to remove the uterus, fallopian tubes and ovaries, while leaving the cervix intact.
Laparoscopes, with their fiber optic light and magnifying video camera, allow your CHCW surgeon to see inside the abdomen and guide the surgeon. With LSH, the uterus and any large calcified fibroids can be removed through small incisions of punctures.
This procedure dramatically reduces pain and trauma to the body. With LSH there is less moving of organs and tissue. The more cutting and tissue manipulation you do, the more discomfort there is afterwards.
With an abdominal hysterectomy, patients spend three to four days in the hospital and most women go back to work in six to eight weeks. When LSH is performed, the patient can potentially go home that evening or early the next morning. Normal activities, such as driving, swimming, sexual relations, etc. may resume within a few days. Most can return to work within two weeks.
In addition to less pain and quick recovery, LSH leaves the cervix intact. This procedure may help reduce the risk of pelvic floor prolapse (falling down from the usual position), urinary incontinence and sexual dysfunction issues sometimes associated with other hysterectomy options.