Dear Alice,
I am thinking about having a hysterectomy. There is new research and procedures that have surfaced. This procedure does not commit you to bed rest but for a few days. I heard that you can go back to work in a few days. Could you please give me the name of this procedure and the long-term effects?
Dear Reader,
A quick hysterectomy lesson so that everyone knows what we're talking about.
This is a surgical procedure that removes a woman's uterus. Having a hysterectomy
stops a woman from menstruating and bearing children. A hysterectomy is not
the correct surgery for contraception — that's sterilization.
Hysterectomies are done for many reasons. Some of these include:
- invasive cancer of the uterus, endometrium (the lining of the uterus), or
cervix
- severe and uncontrollable uterine bleeding, such as from complications in
childbirth
- severe and irreversible uterine damage from untreated infection, such as
pelvic inflammatory disease
Hysterectomy has also traditionally been used to treat other conditions for which
there are now other less invasive treatments, before opting for the removal of
the uterus as a last resort. Hysterectomy is no longer the first or only treatment
for:
- fibroid (non-cancerous) tumors of the uterus
- dysmenorrhea — heavy and/or painful periods
- endometriosis — tissue that usually lines the uterus growing on other
parts of the body within the pelvic region
- uterine prolapse — the uterus is no longer fully supported by pelvic
muscles, so it "slips" down into the vaginal canal
According to the Centers for Disease Control and Prevention, each year approximately
600,000 women in the United States have a hysterectomy. It is the second most
common type of surgery performed on women (cesarean sections are number one).
The United States has a high rate of hysterectomy (triple that of the world wide
average), with rates varying significantly within the nation — women in the
South are twice as likely as women in the Northeast to have their uteri removed.
Some experts believe that many hysterectomies are performed unnecessarily —
when more conservative and less invasive treatments would work as well or better.
Whenever you consider major surgery, it is a good idea to understand as much as
possible about the benefits and risks of operation as well as of any alternatives;
this is especially true of hysterectomy.
The American College of
Obstetricians and Gynecologists describes hysterectomy as a treatment of last
resort and recommends that women, before consenting to hysterectomy, get as much
information as possible about:
- the condition for which the hysterectomy is being recommended
- other treatment options
- physical and emotional effects of hysterectomy
What is making you think about having a hysterectomy? What does your health care
provider recommend? What are your feelings? Fears? Concerns? What are the risks?
What do you hope to accomplish via this surgery?
Depending on the reason for the hysterectomy, three types of hysterectomy can
be performed:
| |
Partial (or Subtotal)
The upper part of the uterus is removed, but the cervix is left in place.
This is the least invasive type of hysterectomy — it leaves the vagina
the same length and may have fewer sexual side effects. Because it is possible
to get cervical cancer, women who have this type of hysterectomy still need
to have regular pap smears. |
| |
Complete (or Total)
The entire uterus, including the cervix, is removed. This procedure shortens
the vagina, but eliminates the possibility of cervical cancer in the future. |
| |
Radical
The entire uterus, lymph nodes, and support structures around the uterus
are removed. This is done in cases of extensive cancer. The ovaries and
fallopian tubes may be removed at the same time. This is called a salpingo-oophorectomy.
About half of all hysterectomies performed involve the removal of the fallopian
tubes and ovaries. Women who have their ovaries removed, no matter what
their age, will experience what is known as surgical menopause — the
sudden and complete loss of hormones produced by the ovaries. Women who
have their ovaries removed, especially those who are not yet experiencing
menopause, often receive hormone replacement therapy (HRT). |
The surgical removal of the uterus is usually accomplished in one of several ways:
- Abdominally — through an incision made low on the abdominal wall. Abdominal
hysterectomies usually require a three to six day hospital stay and four to
six weeks of healing until women have fully recovered and can resume their
normal activities. Almost three-quarter of all hysterectomies are performed
this way.
- Vaginally — through an incision in the upper vaginal wall. Vaginal
hysterectomies have the advantage of faster recovery times (usually three
to four days in the hospital and two to three weeks at home) and the lack
of a visible scar. They are typically performed on women who have had children
since their vaginal muscles tend to be more relaxed, and their uteri are more
pliable. Vaginal hysterectomies are not recommended in cases of cancer or
when the uterus has large tumors or other growths (such as endometrosis),
or when ovaries need to be removed.
- Laparoscopically Assisted Vaginal Hysterectomy (LAVH) — the surgeon
makes several small incisions in the lower abdomen through which s/he can
insert surgical instruments and a laparoscope (a small telescope-like device),
which is used for viewing the internal organs. The surgical instruments are
used to detach and remove tissue holding the uterus in place; the uterus is
then removed through the vagina. LAVH has the shortest recovery time (typically,
one to two days in the hospital and one or two weeks recovering at home),
but is still a fairly new procedure, and some experts have raised questions
about its safety.
The risks and long-term effects of hysterectomy depend, in part, on what type
of hysterectomy a woman has, and how the surgery is performed. All hysterectomies
are considered major surgery and pose the rare but serious dangers of severe bleeding,
infection, or blood clots.
The American College of Obstetricians and Gynecologists estimate that half to
one quarter of women who have hysterectomies will experience some mild to moderate
side effects, the common ones including:
- depression
- loss of sexual response or desire
- bowel or urinary tract damage
- osteoporosis and heart disease (when ovaries are removed)
- constipation
- bladder control problems
- pelvic, muscle, and joint pain
Other women, especially those who had significant physical problems from the condition
leading to the hysterectomy, however, report that they have an increased sense
of physical and emotional well-being following hysterectomy.
The decision whether to have a hysterectomy is one that needs to be made mindfully,
after careful consultation with medical professionals, and with all of the facts
at hand.
- Alice
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