What you need to know about hysterectomy

What is hysterectomy?

Hysterectomy is the removal of the uterus (womb), and, in most cases, the cervix (neck of the uterus). In the UK, about 75,000 hysterectomies are carried out each year. It is one of the most common operations. This information will explain why you might need a hysterectomy, and answer some of the questions you might ask about it.

Why might I need a hysterectomy?

In a few cases, a hysterectomy is a lifesaving measure. The reasons for this would include cancer, or massive bleeding (“haemorrhage”) from the uterus. Most of the time, though, a hysterectomy is carried out to relieve distressing or painful symptoms, caused by a number of conditions, including:

Endometriosis — when the lining of the womb is present outside of the womb — on the surface of the womb;
Fibroids — namely benign tumours, developing in the wall of the womb;
Heavy menstrual bleeding that hasn’t responded to other treatment such as medication;
Prolapse of the womb;
Severe pre-menstrual syndrome and/or period problems;
Cancer of the womb or ovaries.

Since a hysterectomy means you have no more periods and you cannot have children, it is a particularly major step for younger women to take.

Problems treated with a hysterectomy

Fibroids
Fibroids are swellings of the muscle cells in the wall of the uterus. They are not malignant, but they can cause very heavy periods. If a fibroid is big enough, it can exert pressure on the bladder and the bowel. This could mean you need to pass urine frequently, and you may have problems with bowel function.
Endometriosis
The endometrium is the lining of the uterus. Sometimes, patches of the endometrium are found somewhere else in the abdomen. This is called endometriosis. Common sites include the space behind the womb, the ovaries and the outside wall of the uterus. It does sometimes occur on the bowel or other parts of the abdomen. The patches still respond to changes in your hormone levels, and they bleed into the tissues where they are stuck. The body reacts by building barriers of fibrous tissue around the sites of endometriosis. This in turn can produces “internal scarring” and painful knots of tissue. Endometriosis causes painful, heavy periods and pain on intercourse. In younger women, it may also be associated with difficulties in conceiving. By removing the uterus, often the painful symptoms stop, though not always.
Heavy menstrual bleeding
This is one of the most common reasons for a hysterectomy. Extremely heavy, possibly painful, long-lasting periods can be a very distressing and disabling condition. They can happen even though there is nothing wrong with the uterus itself. It is usually a last resort since there are several other forms of treatment.
Prolapse
Sometimes the muscles and ligaments supporting the uterus have become so weak that the uterus cannot stay in place and slides down into the vagina. This is uncomfortable and sometimes painful. It can also lead to further problems such as incontinence, difficulty emptying the bowels and painful sexual intercourse. A prolapse can be a reason for hysterectomy.
Severe pre-menstrual syndrome
Together with period problems, this is a further possible reason for hysterectomy.

How hysterectomy is carried out
A general anaesthetic is always necessary. There are three different types of hysterectomy:

abdominal hysterectomy;
vaginal hysterectomy; and
laparoscopically-assisted vaginal hysterectomy.

Abdominal hysterectomy
Hysterectomy - abdominal An incision is made in the abdomen, usually below the bikini line. Many blood vessels are tied off. Then the surgeon cuts the uterus free, and takes it out through the same incision.

Vaginal hysterectomy
This is done through the vagina. The cut is made inside the body at the top of the vagina, so there is no visible scar. The uterus then comes out through the vagina.

Laparoscopic hysterectomy
Hysterectomy - laparoscopic This uses a very fine telescope, called a laparoscope, (the technique is sometimes called keyhole surgery). This is inserted into the abdomen through a very small cut near the navel. It has a tiny video camera in the end of it. The surgeon pumps up the abdomen with carbon dioxide gas to make more room inside. He or she then uses the laparoscope to get a close-up, view.

Hysterectomy - laparoscopic 2 Two or three further small cuts are made in the abdomen, and fine tubes are inserted into them. They provide narrow channels for other surgical instruments, such as a laser, scissors and forceps, used in the actual operation itself.

When the uterus is snipped free, it is removed through the vagina. Then the surgeon stitches up the small incisions on your abdomen.