Hysterectomy (excision of the uterus) - Medical specialists

Overview of a hysterectomy

The surgical removal of a female uterus is termed a hysterectomy. A major part of the female reproductive system, the uterus is also known as the womb, and plays a critical role in pregnancy and childbirth. Menstrual blood flow also originates from the lining of the uterus.

A hysterectomy may be recommended for a number of reasons. For instance, this surgery can be employed to combat some kinds of cancer and infections, as well as various chronic pain conditions.

The full extent of any hysterectomy procedure will often vary in accordance with what the surgery is seeking to achieve. It is common for the whole of the uterus to be removed, but on occasion, there may also be a need to remove the cervix, ovaries, fallopian tubes and other surrounding structures as part of the procedure.

After a hysterectomy has been performed, you will no longer be able to menstruate (your periods will stop) and you will be unable to conceive a child.

Who offers hysterectomy treatment?

A hysterectomy is often provided by private health clinics, which are in some cases managed by universities, insurers, mutual societies or religious institutions. In addition, there are state-run hospitals (such as the UK’s NHS), which also employ skilled gynaecological surgeons who specialise in hysterectomy techniques.

What does hysterectomy treatment help with?

Most hysterectomies are performed to treat conditions such as

• fibroids (growths that form inside the uterus),
• heavy bleeding within the reproductive system,
• endometriosis,
• adenomyosis (when endometrial tissue grows into the muscle wall of the uterus),
• uterine prolapse and
• cancer.

When is hysterectomy treatment used?

A hysterectomy is a major operation and therefore is usually only recommended for women whose condition has not responded to more conservative treatment options, and whose childbearing intentions have been realised. In addition, the continuing emergence and development of alternative treatments for a number of the conditions which hysterectomy has traditionally been used to address means that the number of hysterectomies performed should continue to fall.

A hysterectomy could be a recommended treatment for any of the following conditions:

• chronic pain in the pelvic region
• vaginal bleeding that cannot be controlled
• cancers of the uterus, cervix or ovaries
• fibroids, which are benign, smooth muscle tumours that can grow in the uterus
• pelvic inflammatory disorder (PID), which is a serious infection of the organs in the upper part of the reproductive system
• uterine prolapse, which develops when the uterus falls through the cervix and then protrudes from the vagina
• endometriosis, which is a condition that causes part of the inner lining of the uterus to grow outside and beyond the uterine cavity, resulting in pain and bleeding
• adenomyosis, which is a disorder in which the uterine lining breaks through the muscle wall of the uterus

What are the risks of hysterectomy?

Most women who undergo a hysterectomy do not encounter any serious problems or complications as a result of the procedure. Nevertheless, as with many other major surgical interventions, a hysterectomy is not entirely risk-free, and the possible complications could include a reaction to the anaesthetic used, as well as the following:

• urinary incontinence problems
• vaginal prolapse (where part of the vagina protrudes from the body)
• fistula formation (an abnormal connection that can develop between the vagina and bladder after surgery)
• chronic pain

Other risks associated with a hysterectomy procedure include post-operative fever and wound infections, blood clots, haemorrhage, and damage to the surrounding organs, although these are generally uncommon.

Are there alternatives to hysterectomy?

The National Women’s Health Network report that a hysterectomy is the second most common surgical intervention recommended for women in the USA, and is thus generally regarded as a safe, low-risk form of surgery. However, there can be situations in which it is not the front-line option. For instance, it is clearly not the best choice for a woman with a serious condition whose family is incomplete, unless all possible alternative treatments have proved ineffective.

In many instances, the uterus can now be spared, because viable alternatives can be chosen instead. For example, some forms of endometriosis respond to hormone therapy, uterine fibroids can often be removed and the uterus reconstructed using a surgical procedure known as myomectomy, and intrauterine devices have proved effective in both limiting menstrual blood flow and providing symptomatic relief. However, a hysterectomy often remains the only viable treatment for conditions such as uterine cancer or cervical cancer.

A preliminary discussion with your doctor is always a wise first step in determining the best medical strategy for your own specific condition.