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Hysterectomy |
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| The surgical procedure
of the hysterectomy, removal of the uterus, often accompanied with removal
of the ovaries, or oophorectomy, has become more common in the United States than in
other countries, and more common today than ever before. According to the
National Center for Chronic Disease Prevention (CDC), around 600,000
hysterectomies are preformed yearly in the US, and more than a quarter of
women in the US will have one by the time they reach age 60 (4).
The procedure is not restricted to older women - many of the conditions it
is used to treat arise during adolescence, college years, and after
childbirth. Although modern
medical equipment and training has made this procedure safer, it has also
made it more accessible to women who may not actually require such
treatment. Given these facts, it is valuable to learn the answers to the
following
questions: |
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For women's health issues in the Rochester, New York area, contact Strong Hospital. For students at Nazareth College in Rochester, New York, contact the Health Center, which offers health counseling, health education brochures and pamphlets, and physician referrals. If you come across an unfamiliar medical term, consult the glossary at the bottom of the page for a definition. |
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What is a hysterectomy? |
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A
hysterectomy is a procedure to remove the uterus. There are several
subcategories of hysterectomy including: Further, there are a few different ways
that a hysterectomy can be preformed. These are: |
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 Graphic courtesy of U.S. Department of Health and Human Services Agency for Health Care Policy and Research. http://www.ahcpr.gov/consumer/uterine2.htm#shell4 |
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Why would a woman need or want a hysterectomy? |
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There are two major distinctions of why a hysterectomy would be preformed. The first is non-elective surgery, which is done in cases of uterine, cervical or ovarian cancer, and hemorrhage of the uterus. Severe cases of uterine prolapse may also require removal of the uterus. The second is elective surgery, done when a woman chooses to have a hysterectomy to "improve the quality of life, to relieve pain, heavy bleeding or other chronic conditions and discomfort" (2). Unfortunately hysterectomy is often chosen as an elective surgery when it is not necessarily the most appropriate choice. Especially in underdeveloped countries, hysterectomy may be preformed as a means of birth control. However, even in well developed areas, hysterectomy can be chosen when it is not necessary. In cases of elective surgery, there are often alternatives to hysterectomy that do not involve surgery and may allow a woman to remain fertile. |
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What are the physical side effects? |
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The most obvious physical side effect is inability to bear children after hysterectomy. Other risks include those that accompany any surgical procedure, such as fever and infection, often curable with antibiotics. Abdominal surgery brings with it specific risks including hemorrhage, blood clots, injury to the urinary tract, and scar tissue adhesions (2). However, because hysterectomy has become so common, risks are generally low. According to the CDC, "Hysterectomy is the second most frequent major surgical procedure among reproductive-aged women" (4). If the ovaries are removed as well, as in a Radical Hysterectomy, menopause sets in within the following week, bringing with it strong changes in hormone levels which increase the risk of osteoporosis and heart disease(2). For more information on osteoporosis and menopause, click here. |
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What are the emotional side effects? |
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Although women often report
feelings of slight depression after hysterectomy, this is common after many
different types of surgery as well. The longer the recovery period is, the
longer one may be kept from work and social atmospheres, which naturally
leads to some feelings of depression. |
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What are some alternatives? |
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Doctors recommend hysterectomies
to one in four patients. 82% of those patients accept their
recommendation, 33% without discussing less invasive alternatives (1). Some
alternatives to hysterectomy include: |
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1. Localized Surgery such as Myomectomy:
In the case of fibroids, Myomectomy, a more localized surgery may be preformed to
remove the fibrous benign tumors, leaving the uterus intact. Localized
Surgery also includes laser therapy and microsurgical techniques,
effective on fibroids as well as less serious cases of endometriosis and
pelvic adhesions. Benefits: Uterus is left intact. Pregnancy is often still possible. Risks: The original problem may recur. These operations are less common than hysterectomy, and are often more difficult to perform. |
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2. Drug and Hormone Therapy: Drug or hormone therapy can
often be done in cases of menorrhagia, defined as blood loss of more than
80mL during a menstrual cycle, and non-severe fibroids, prolapse, endometriosis,
and pre-cancer of the uterus (hyperplasia). Many of these therapies work
by shrinking the endometrium (uterine lining), which reduces bleeding in
the case of menrrhagia, reduces pain in the case of endometriosis, and
removes the problem of the overgrown endometrium in cases of pre-cancer of
the uterus. Drugs may cause fibroids to shrink, and diminish the symptoms
of prolapse. Benefits: Uterus is left intact. Pregnancy is often still possible. Surgery is avoided. Risks: Side effects differ according to the type of drug or hormone used for each condition. Many drug therapies are new and experimental and effects are not yet understood. |
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3. Forestalling Treatment: Often
women may choose not to seek any treatment. The symptoms of many disorders
that call for hysterectomy are subjective. Some women may choose to simply
bear the pain and inconvenience of their disorder, either until menopause
when the problem may diminish on its own, or until she is finished bearing
children.
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Related Web Sites
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References
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Created by: Jennifer Taylor on 04/12/02 |
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Nazareth
College |
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Glossary
Cervix: The lower, narrow end (or neck) of the uterus.
Dysfunctional uterine bleeding: Abnormal uterine bleeding that is not associated with a tumor, inflammation, or pregnancy.
Dysplasia: The growth of abnormal cells. Dysplasia is a precancerous condition that may or may not turn into cancer at a later time.
Endometriosis: A condition in which the same kind of tissue that lines the walls of the uterus grows outside the uterus in the pelvic cavity or some other area of the body.
Endometrium: The tissue that lines the inside of the uterus.
Estrogen: A hormone produced in the ovaries that affects the growth and health of female reproductive functions and organs.
Fallopian tubes: Tubes located on either side of the uterus that carry eggs from the ovary to the uterus.
Fibroids: Noncancerous growths that occur most often in the walls of the uterus.
Hormone: A chemical produced by the body that regulates certain bodily functions. Synthetic (man-made) hormones are used in birth control pills and in medicines to treat certain conditions.
Hyperplasia: An overgrowth of the uterine lining, probably caused by excess estrogen. This is sometimes considered to be a precancerous condition, particularly in women who are near or through menopause.
Laparoscopy: A surgical procedure that allows the doctor to look inside the pelvic cavity by inserting a tube-like instrument through a small cut in the abdomen.
Menopause: "The change"; the time when a woman stops having a period (menstruating).
Menstruation: The shedding of the lining of the uterus that occurs each month when a woman does not become pregnant. A woman's "period."
Myomectomy: An operation to remove fibroid tumors.
Oophorectomy: Surgical removal of an ovary.
Ovaries: Small organs that produce hormones, such as estrogen, and eggs. One ovary is located on each side of the uterus.
Progesterone: The hormone that prepares the lining of the uterus (endometrium) to receive a fertilized egg. The man-made form of this hormone may be used to treat very heavy menstrual bleeding and other conditions.
Prolapse: To fall or tilt, as a uterus or bladder might if the ligaments holding it in place become stretched.
Uterus: The organ where babies grow; the womb.
Vagina: The tube-like opening leading away from the uterus to the outside of the body.
(All glossary definitions are direct quotes from the Agency for Health Care Policy and Research. (5))