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OPERATION HYSTERECTOMY, (September, 2004) A hysterectomy (removal of the womb) is an operation to remove the uterus. The removal of the uterus is suggested for a number of diseases & Just 150 years ago hysterectomy was considered extremely dangerous & was almost abandoned. But today because of the prompt & permanent relief from distressing gynaecological problems of bleeding & pain a hysterectomy offers, this surgery has become very common. Statistics show that about one third of women in United States have had a hysterectomy by the age of 60 years. Even in India it is the second most common major surgery among women, the first being caesarian section delivery. A hysterectomy (removal of the womb) is an operation to remove the uterus. The removal of the uterus is suggested for a number of diseases & conditions. There are a few who consider the uterus, after the last pregnancy, as a useless, bleeding, pain causing organ with a potential for cancer & that it should be removed. This has at times resulted in extirpation of the uterus for trivial reasons. Also there are others who consider the womb as the woman’s soul & its removal as the loss of femininity. But when the uterus is removed for proper indications the quality of life dramatically improves. The uterus is the organ that cradles & nourishes the unborn baby in a woman. It also produces the monthly flow. The removal of the uterus is known as hysterectomy. A hysterectomy can save life, correct serious problems that interfere with the normal functions & improve the quality of life. A hysterectomy is suggested for a number of conditions & diseases. In this newsletter, information about the reasons why a hysterectomy is suggested will be provided. The common reasons for recommending a hysterectomy are the following: FIBROIDS: These are the non-cancerous tumors of the uterus. They grow from the muscles of the uterus. Many women have fibroids but may not have any problems. In some women however fibroids can cause lot of pain, heavy bleeding & pelvic discomfort. These symptoms require treatment. Drug therapy is given to reduce the symptoms. Drugs to shrink the fibroids are also available. But such a therapy is given for a prolonged period & is more expensive. When the woman is interested in childbearing, removal of only the tumor is done. This procedure is called “myomectomy”. Hysterectomy is suggested when there is no relief of symptoms with the medicines. HEAVY BLEEDING: The amount & the length of the menstrual flow can vary from woman to woman & also from cycle to cycle in the same woman. Occasional cycle with heavy flow is quite common especially after the age of 40. If the bleeding is unusually heavy in any cycle or if there is frequent heavy flow, treatment is required. There can be various causes for heavy bleeding. The common ones are hormonal imbalances & fibroids. Depending on the diagnosis, drug therapy is given. At times, however, a hysterectomy may be needed. PROLAPSE: Ligaments & muscles support the uterus. As a woman ages the supports may lose their tone & the uterus may sag down. The uterus is in close relation to the urinary bladder in the front & the rectum behind. When the uterus comes down it may pull the bladder & rectum along with it & cause various symptoms. There may be a dragging sensation in the pelvic area, problems with emptying or controlling the bladder or the bowel. Kegel’s exercises are recommended for strengthening the muscles but are helpful only in the early stages. Pessaries(a ring like device to be inserted into the vagina) can provide temporary relief but does not correct the under lying problem. A hysterectomy with repair of the pelvic floor is the treatment of choice. ENDOMETRIOSIS: In this condition the cells from the lining of the uterus grows like islands outside the uterus (ovary, tubes, pelvic wall) & behaves like the lining & produces the monthly bleeds. This can cause lot of discomfort & pain. Endometriosis also causes scarring, adhesions & infertility. Drug therapy, pain relief medications & localized surgery are usually recommended. But when the family is complete & the response with medication is not good hysterectomy may be suggested. PRECANCER OR CANCER OF THE UTERUS/CERVIX OR THE OVARIES OR THE TUBES: As in other cancers the cancerous organs are removed to prevent the spread of this life threatening disease. Apart from the common causes mentioned above there are other indications for hysterectomy like an ovarian tumor in a patient who has completed the family, long standing pelvic pain with adhesions which is not responding to the medicines, rupture of the uterus & others. The alternatives for a hysterectomy, sexuality after the surgery and the risks will be discussed in the newsletters to follow...Read
Dr R Sukhada Rao, MB, M,D (Ob. & Gynaec.),
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