Why Hysterectomy is needed

We frequently hear about women going for Hysterectomy (removal of uterus) these days. Hysterectomy is the second most common major surgical procedure performed in women worldwide .

" I don't want to bear this menace of menstruation. I want to get rid of it. That is why I went for this major operation." - words of a 35 year old women who got rid of her womb recently.

But Nature created the Human body in the way it is for a purpose. If you want to go against it without valid reasons, you will have to face certain consequences too. The risks include...injury to nearby organs, anesthesia problems, such as breathing or heart problems, blood clots in the legs or lungs, infection, heavy bleeding, early menopause, if the ovaries are removed, pain during sexual intercourse. Some women who also have their cervix removed, however, may experience a drop in testosterone and possible sexual dysfunction.

In recent years, an increasing number of studies have shown long-term adverse effects of hysterectomy on the pelvic floor and some studies have demonstrated unwanted effects on other health aspects. Long-term effects of hysterectomy on the pelvic floor that should be considered in surgical decision-making are: pelvic organ prolapse ( a type of pelvic floor disorder, can affect many women. In fact, about one-third of all women are affected by prolapse or similar conditions over their lifetime - the "pelvic floor" is a group of muscles that form a kind of hammock across your pelvic opening. Normally, these muscles and the tissues surrounding them keep the pelvic organs in place. These organs include your bladder, uterus, vagina, small bowel, and rectum. Sometimes, these muscles and tissue develop problems.  And as women age, pelvic organ prolapse and other pelvic floor disorders become more common)*, urinary incontinence, bowel dysfunction, sexual function and pelvic organ fistula formation, neurodegenerative diseases. These outcomes are particularly relevant as life expectancy has increased and sequela (a condition which is the consequence of a previous disease or injury) may occur a long time after the surgical procedure and severely impair quality of life.

There are some studies showing that hysterectomy may be associated with increased risk for cardiovascular disease. The risk was consistent for both incident coronary heart disease and stroke. Early menopause is a probable risk factor for cardiovascular disease, and ovarian failure subsequent to hysterectomy may be a possible biological explanation for the association between hysterectomy and cardiovascular disease.

Why actually hysterectomy is needed...

The most common reasons for having a hysterectomy include:

Heavy periods – which can be caused by fibroids, for example and the resultant anemia -
in some cases, removing the womb may be the only way of stopping persistent heavy menstrual bleeding when other treatments haven't worked, the bleeding has a significant impact on quality of life and it's preferable for periods to stop, the woman no longer wishes to have children
Pelvic pain because of PID – which may also be caused by endometriosis, unsuccessfully treated pelvic inflammatory disease (PID), adenomyosis or fibroids. If detected early, the PID infection can be treated with antibiotics. However, if it spreads, it can damage the womb and fallopian tubes, resulting in long-term pain. A hysterectomy to remove the womb and fallopian tubes may be recommended if a woman has severe pain from PID and no longer wants children.
Endometriosis is a condition where cells that line the womb are also found in other areas of the body and reproductive system, such as the ovaries, fallopian tubes, bladder and rectum.

If the cells that make up the lining of the womb become trapped in other areas of the body, it can cause the surrounding tissue to become inflamed and damaged. This can lead to pain, heavy and irregular periods, and infertility.

Fibroids are non-cancerous tumours that grow in or around the womb (uterus). The growths are made up of muscle and fibrous tissue, and vary in size. The symptoms of fibroids can include: heavy or painful periods, pelvic pain, frequent urination or constipation, pain or discomfort during sex. A hysterectomy may be recommended if you have large fibroids or severe bleeding and you don't want to have any more children. Adenomyosis is a common condition where the tissue that normally lines the womb starts to grow within the muscular wall of the womb. This extra tissue can make your periods particularly painful and cause pelvic pain.
Prolapse of the uterus: A prolapsed uterus happens when the tissues and ligaments that support the womb become weak, causing it to drop down from its normal position. A prolapsed uterus can often occur as a result of childbirth.

Symptoms can include back pain, a feeling that something is coming down out of your vagina, leaking urine (urinary incontinence), difficulty having sex
Cancer of the womb, fallopian tubes, ovaries or cervix.

Modes of hysterectomy: total abdominal hysterectomy, where the entire uterus including the cervix is removed; subtotal abdominal hysterectomy, where only the uterus is removed; and radical hysterectomy performed for malignancies. Hysterectomy, either total or subtotal, may be performed by different techniques, including the vaginal route, laparotomy or laparoscopy.

The surgical option is an abdominal hysterectomy, the traditional approach. This procedure is the most invasive surgery with the most noticeable scar. In this procedure, the uterus is removed through a large incision in the abdomen — a horizontal cut along the bikini line, or a vertical incision if required. Over time, any scars from a hysterectomy will usually become lighter in color, but the skin will never look exactly the same. Some women, especially women of color, are prone to keloids, a thickening of the scar tissue.

Non-invasive Hysterectomy:

Vaginal hysterectomy: This is the most minimally invasive surgery, with the uterus taken out through the vagina. There is no visible scarring.
Laparoscopic supracervical hysterectomy: Three to four small incisions are made in the abdomen in this surgical procedure. Through them, the doctor inserts a thin, lighted tube with a camera (laparoscope) to see inside your pelvis; the uterus is sectioned into small pieces that are removed through the incisions.
Laparoscopically assisted vaginal hysterectomy: This procedure requires small abdominal incisions and a vaginal incision. A laparoscope and other surgical tools are inserted in the abdominal incisions, and the uterus is removed through the vagina.
Robotic-assisted hysterectomy: This type of hysterectomy procedure, performed with the aid of a computer and robotics, involves small abdominal incisions.
Menopause occurs when the ovaries stop producing the hormones estrogen and progesterone, which regulate menstruation. Unless you have your ovaries removed during a hysterectomy due to a medical reason, you likely won’t enter early menopause. But while most women don’t experience early menopause after a hysterectomy, some women may, even if they keep one or both ovaries, according to a Duke University study published in the journal Obstetrics & Gynecology in December 2011 (1). Researchers aren’t sure whether it’s the surgery itself or the underlying condition leading to a hysterectomy that brings on early menopause in some cases.

Consult and discuss with doctors to avoid hysterectomy as far as possible if you are still young. But when all other treatment alternatives are exhausted, hysterectomy may help — many women are relieved to be out of pain, especially if they’re not concerned about fertility.

Citations:

1. http://journals.lww.com/greenjournal/Fulltext/2011/12000/Effect_of_...

* Causes for Pelvic Organ Prolapse: Anything that puts increased pressure in the abdomen can lead to pelvic organ prolapse. Common causes include: pregnancy, labor, and childbirth (the most common causes), obesity, respiratory problems with a chronic, long-term cough, constipation, pelvic organ cancers, surgical removal of the uterus ( hysterectomy).