What is a Hysterectomy?



A hysterectomy is the surgical removal of the uterus.

It can be total where the whole uterus is removed or partial where the cervix which protrudes into the vagina is left in place.

Removal of the uterus means the patient is unable to bear children. Having a hysterectomy appears to increase a woman's risk of developing stress incontinence.

Reasons for hysterectomy include: ,chronic  heavy menstrual flow producing anaemia, pelvic inflammatory disease, cancer in the reproductive system,  endometriosis , fibroids  are  all generally considerations for a hysterectomy.

Researchers analyzed data from more than 165,000 Swedish women who had hysterectomies and almost half a million women who did not.

There is some debate as to whether or not a hysterectomy increases a woman's risk for urinary incontinence because the variance in outcomes may be due to women pre-existing conditions prior to having a hysterectomy. It remains uncertain.

Occasionally, women will express a desire to undergo an elective hysterectomy for reasons as a preventative measure against a strong family history of, in particular, reproductive cancers including breast cancer in conjunction with  BRAC1 or BRAC2 mutation.

1.   BRCA1 and BRCA2 are human genes that belong to a class of genes known as tumour suppressors.

In normal cells, BRCA1 and BRCA2 help ensure the stability of the cell’s DNA material  and help prevent uncontrolled cell growth. Mutation of these genes has been linked to the development of hereditary breast and ovarian cancer.

The names BRCA1 and BRCA2 stand for breast cancer susceptibility gene 1 and breast cancer susceptibility gene 2.

The likelihood that a breast and/or ovarian cancer are associated with a harmful mutation in BRCA1 or BRCA2 is highest in families with a history of multiple cases of breast and ovarian cancer.

It should be pointed out not every woman who has a harmful BRCA1 or BRCA2 mutation will develop breast and/or ovarian cancer.

Research has shown having a partial hysterectomy does not eliminate the possibility of cervical cancer since the cervix itself is left intact and may be prone to cancer.

In young women it is always a consideration to leave the ovaries intact for a normal secretion of hormones if possible. In older women hormone secretions in the years after menopause slow down and hence  ovaries may be removed if necessary.

Hysterectomy can be performed by an ‘open’ abdominal incision or by way of access through the vagina and also by laparoscopic which can mean surgery through the vaginal with additional instruments inserted via a; small hole, frequently close to the belly button.

Vaginal hysterectomy is performed entirely through the vaginal canal and has clear advantages over abdominal surgery with generally fewer complications, shorter hospital stays and shorter healing time. Abdominal hysterectomy, the most common method, is used in cases such as after caesarean delivery, when the indication is cancer or when complications are expected or surgical exploration is required.

With the development of the laparoscopic techniques in the 1970-1980s, the "laparoscopic-assisted vaginal hysterectomy" is less invasive and the post-operative recovery is much faster.

However vaginal hysterectomy was shown to be superior causing fewer short- and long-term complications, more favorable effect on sexual experience with shorter operating times, shorter recovery times and fewer costs and offering much quicker healing.

  Benefits”

“The Maine Women Health Study of 1994" followed for 12 months’ time approximately 800 women with similar gynecological problems (pelvic pain, incontinence  due to prolapse, severe endometriosis, excessive menstrual bleeding, large fibroids, painful intercourse), around half of whom had a hysterectomy and half of whom did not.

The study found that a substantial number of those who had a hysterectomy had marked improvement in their symptoms following hysterectomy, as well as significant improvement in their overall physical and mental health one year out from their surgery.

 The study concluded that for those who have intractable gynecological problems that had not responded to non-surgical intervention, hysterectomy may be beneficial to their overall health and wellness. Somewhat surprisingly, ovarian cancer risk after hysterectomy appears to be substantially lowered even when the ovaries are preserved. 



Consequences of Hysterectomies

X Approximately 35% of women after hysterectomy undergo another related surgery within 2 years.

X The mortality rate is several times higher when performed in patients that are pregnant, have cancer or other complications.

X Ureteral injury from a hysterectomy is not uncommon and can range from 2.2% to 3% of cases.

X Estrogen levels fall sharply when the ovaries are removed, removing the protective effects of estrogen on the cardiovascular and skeletal systems as well as a decrease in bone density and increase in fractures

X Hysterectomy has like any other surgery certain risks and side effects.

X When only the uterus is removed there is a three times greater risk of cardio vascular disease-If the ovaries are removed the risk is seven times greater.

X Reduced levels of testosterone in women can cause height loss

X A substantial number of women develop benign ovarian cysts after a hysterectomy

X The risk for vaginal prolapse is approximately doubled after hysterectomy.

X The formation of postoperative adhesions is a particular risk after hysterectomy because of the extent of scarring by the surgeon’s scalpel as well as the hysterectomy wound is in the most gravity-dependent part of the pelvis.

X As a result a weaker pelvic area may result in incontinence and take longer to strengthen naturally because of the adhesions and inflammation in the area.

X Hysterectomy may cause an increased risk of renal cancer.

X Women who had hysterectomies were 2.4 times more likely to have a subsequent surgery for incontinence within 5 years of the procedure

It’s important to consider all the options before a hysterectomy. Pelvic floor exercises will strengthen the pelvic floor, and improve the general health, tone and wellbeing of this area. While it always may seem like an easy option many times living with hysterectomy can have long term affects whereas the idea of exercising the pelvic area may seem long and arduous particularly if the sufferer is older and has never exercised the area it can genuinely recover after years of neglect. The problem is many older women can’t be bothered.

The Incontinence Foundation of Australia maintains that 70% of all people can be treated for incontinence. Learn about it-don’t just take your doctors assessment as gospel, get a second opinion before you decide.

Remember once you make this decision you cannot go back on it.



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