Hysterectomy Health Article

Definition

Hysterectomy is the surgical removal of the uterus. In a total hysterectomy, the uterus and cervix are removed. In some cases, the fallopian tubes and ovaries are removed along with the uterus (called hysterectomy with bilateral salpingo-oophorectomy). In a subtotal hysterectomy, only the uterus is removed. In a radical hysterectomy, the uterus, cervix, ovaries, oviducts, lymph nodes, and lymph channels are removed. The type of hysterectomy performed depends on the reason for the procedure. In all cases, menstruation stops and a woman loses the ability to bear children.

Purpose

Hysterectomy is the second most common operation performed in the United States. About 556,000 of these surgeries are done annually. By age 60, approximately one out of every three American women will have had a hysterectomy. Yet it's estimated that 30 percent of hysterectomies are unnecessary.

About 10% of hysterectomies are performed to treat cancer of the cervix, ovaries, or uterus. Women with cancer in one or more of these organs almost always have the organ(s) removed as one part of their cancer treatment.

The most frequent reason for hysterectomy in the United States is to remove fibroid tumors, accounting for 30% of these surgeries. Fibroid tumors are non-cancerous (benign) growths in the uterus, which can cause pelvic and low back pain and heavy or lengthy menstrual periods. They occur in 30–40% of women over age 40, and are three times more likely to be present in African-American women than in Caucasian women. Fibroids do not need to be removed unless they are causing symptoms that interfere with a woman's normal activities.

Treatment of endometriosis is the reason for 20% of hysterectomies. The endometrium is the lining of the uterus. Endometriosis is a condition that occurs when the cells from the endometrium begin growing outside the uterus. The outlying endometrial cells respond to the hormones that control the menstrual cycle, bleeding each month the way the lining of the uterus does. This causes irritation of the surrounding tissue, leading to pain and scarring.

Another 20% percent of hysterectomies are done because of heavy or abnormal vaginal bleeding that can not be linked to any specific cause and cannot be controlled by other means. The remaining 20% of hysterectomies are performed to treat prolapsed uterus, pelvic inflammatory disease, and endometrial hyperplasia, a potentially precancerous condition.

Alternatives

There are several alternatives to hysterectomy today. They include:

Embolization

Uterine artery embolization is not a surgical procedure. Instead, interventional radiologists put a catherter into the artery that leads to the uterus and inject polyvinyl alcohol particles right where the artery leads to the blood vessels that nourish the fibroids. By killing off those blood vessels, the fibroids have no more blood supply, and they die off. Severe cramping and pain after the procedure is common, but serious complications are less than .5 percent and it may protect fertility.

Myomectomy

A myomectomy is a surgery used to remove fibroids, thus avoiding a hysterectomy. Hysteroscopic myomectomy, in which a surgical "telescope," or laparascope, is inserted into the uterus through the vagina can be done on an outpatient basis. If there are large fibroids, however, an abdominal incision is required. Then women typically are hospitalized for two to three days, and require up to six weeks recovery. However, laparascopic myomectomies are also being done more often. They only require three small incisions in the abdomen, and have a much shorter hospitalization and recovery time.

Once the fibroids have been removed, the surgeon must repair the wall of the uterus to eliminate future bleeding or infection.

Endometrial ablation

In this surgical procedure, recommended for women with small fibroids, the entire lining of the uterus is removed. Women are no longer fertile, however. The uterine cavity is filled with fluid and a hysteroscopy,or telescope, inserted to provide a clear view of the uterus. Then the uterus is destroyed using a laser beam or electric voltage. The procedure is typically done under anesthesia, although women can go home the same day as the surgery. Another, newer procedure involves using a balloon, which is filled with superheated liquid and inflated until it fills the uterus. The liquid kills the lining, and after 8 minutes the balloon is removed.

Endometrial resection

Like endometrial ablation, the uterine lining is also destroyed during this procedure, only instead of a laser, an electrosurgical wire loop is used.