Hysterectomy

What is a hysterectomy?
Hysterectomy is the surgical removal of the uterus.
This can be a total hysterectomy which is the removal of the uterus and the cervix, or a subtotal hysterectomy (supracervical) which is the removal of the top part of the uterus and the cervix is left in place. Other organs such as the ovaries and tubes may also be removed at the time of a hysterectomy. For women who are premenopausal, having a hysterectomy means that they are no longer capable of achieving a pregnancy and they should stop having menstrual periods.

Hysterectomy Background
There are around 600,000 hysterectomies performed each year in the US, making it the second most common procedure in child bearing women. To put this into perspective, one in three women in the United States will undergo a hysterectomy by age 60.

The most common conditions requiring hysterectomy are fibroid tumors, adenomyosis, endometriosis and uterine prolapse.

Reasons for Hysterectomy
Fibroid Tumors. These are benign muscle tumors of the uterus that are very common in women. They account for as many as 40 percent of the hysterectomy procedures. They can cause many problems including; pelvic pain, abnormal bleeding, infertility, urinary frequency or retention.

Adenomyosis. This is a condition where endometrial glands that should be present in the lining of the uterus (the endometrium) are found in the muscle of the uterus. (the myometrium) Adenomyosis may cause symptoms of heavy or irregular menstrual bleeding and can be associated with pain.

Endometriosis. The endometrial cells grow outside the lining of the uterus and may attach to other organs in the pelvis or on the surface of the peritoneum which is the layer that lines the inside of the body cavity. The endometrial cells are responsive to hormones secreted throughout the menstrual cycle and will focally bleed and cause inflammation. This may result in pain and scarring of the tissue. Patients may complain of abnormal bleeding, painful periods, painful sex and infertility.

Cancer. Only 10 percent of the hysterectomies performed each year are due to one of the gynecologic cancers. Cancer of the ovary, cervix, uterus or fallopian tubes.

Uterine Prolapse. This is a condition that is most common in postmenopausal women. Uterine prolapse occurs when the uterus has lost some degree of support and may push into the vagina and even come outside the vagina. There are varying degrees of severity and the vaginal walls are also at risk for weakness. Treatments can range from physical therapy and pessary device to pelvic reconstructive surgery that may require a hysterectomy. A pessary device is inserted in the vagina and functions as a brace to hold the uterus and vaginal walls in place. Minimal to moderate degrees of prolapse may be improved with physical therapy to strengthen the pelvic floor.