A Hysterectomy is the surgical removal of the uterus. Other associated organs such as the fallopian tubes, ovaries and cervix may be removed at the same time, depending on the type of hysterectomy being performed. This results in a woman being no longer able to menstruate or conceive and bare children following the procedure.
Hysterectomy is one of the most common forms of elective surgery for women in Australia. Most are performed to treat conditions such as fibroids (growths which form in the uterus), heavy bleeding, pelvic inflammatory disease, adenomyosis, endometrioses, uterine prolapse or gynaecological cancers. Treatment of these conditions vary, and some more conservative treatments may be offered which may eliminate the need for a hysterectomy.
There are four different types of hysterectomy:
Sub-total or Partial hysterectomy
Hysterectomy with ovarian conservation
Hysterectomy with oophorectomy
Radical or Wertheim’s hysterectomy
This involves the removal of a woman’s fallopian tubes as well as the upper two-thirds of the uterus, while preserving the cervix.
Hysterectomy with ovarian conservation:
This involves the removal of a woman’s fallopian tubes, uterus and cervix while preserving the ovaries. This is sometimes called a total hysterectomy.
Hysterectomy with oophorectomy:
This involves the removal of the fallopian tubes, uterus and cervix as well as one or both sets of ovaries.
Radical or Wertheim’s Hysterectomy:
This involves the removal of fallopian tubes, uterus, cervix, ovaries, nearby lymph nodes and the upper portion of the vagina. This kind of hysterectomy is used in the treatment of some gynaecological cancers.
What you need to know about Hysterectomy
Hysterectomy is major surgery and is generally not considered as first-line treatment for heavy menstrual bleeding. Hysterectomies are generally prescribed for women when other forms of treatment haven’t been successful. Its important to learn about the risks involved and to be aware of any conservative alternatives you may be able to try before resorting to a hysterectomy.
Making the decision to have a hysterectomy can be a difficult and emotional process, as having the procedure will mean a woman no longer menstruate and therefore no longer conceive children. For some women, the removal of the chance of pregnancy and the cessation of periods will bring relief. For others it’s a sad time as they come to terms with the end of their reproductive abilities.
Benefits and Risks involved when keeping your ovaries
Some gynaecologists will recommend ovary removal during your hysterectomy to prevent the possibility of developing ovarian cancer, others will recommend leaving them intact. The side effects of ovarian removal can be significant, as the ovaries produce sex hormones called androgens including testosterone, which are important for maintaining strong bones and muscles, a good protein balance, sexual desire and libido, and general wellbeing. The ovaries produce 35% of a woman’s testosterone production – and surgical removal of ovaries has been associated with cases of significant deterioration in libido and sexual desire, especially in younger women.
Ovaries also turn testosterone into oestrogen, therefore removing a woman’s ovaries results in a reduction in hormone production, which may bring on instant menopause – referred to as ‘surgical menopause’. The drop in hormone levels can cause menopause-like symptoms – hot flushes, night sweating, vaginal dryness and an increased risk of osteoporosis and heart disease. It’s important to note however that some women who retain their ovaries during a hysterectomy still experience menopause earlier than expected.
Hysterectomy methods – abdominal, laparoscopic or vaginal
Hysterectomies can be performed in three different ways, via the abdomen, vagina, or with a laparoscope. The reason for the procedure, the woman’s physical characteristics, any previous surgeries as well as the surgeons skills and preference will help your medical team determine which method is best for you.