Hysterectomy

According to the U.S. Centers for Disease Control and Prevention (CDC), over half a million hysterectomies are performed in the United States each year, making hysterectomy the second most frequently performed major surgical procedure among reproductive-aged women in the country. It's also the kind of surgery that affects a woman, not just medically, but emotionally as well. A hysterectomy is the removal of the uterus. As a result, a woman will no longer menstruate; she can no longer have children.

Why hysterectomies are done

According to the National Women's Health Resource Center, roughly half of all hysterectomies are done to treat two conditions:

• endometriosis, a condition is which tissue normally found inside the uterus migrates outside the uterus, leading to excessive bleeding and pain (Read about "Endometriosis")
• fibroids or non-malignant growths, when their presence is leading to abnormal uterine bleeding. (Read about "Uterine Fibroids")

A hysterectomy may also be recommended for pelvic inflammatory disease, for chronic pelvic pain, and for uterine and certain other types of cancer. (Read about "Uterine Cancer" "Cervical Cancer") In addition, the American College of Obstetricians and Gynecologists (ACOG) says hysterectomy can be an option for adhesions, which are bands of scar tissue. They can cause the pelvic organs to stick together and can form in the abdomen because of past surgeries or pelvic infections.

A hysterectomy, in and of itself, does not involve the removal of the ovaries, so it does not necessarily bring about menopause (surgical menopause) unless it is done in conjunction with an oophorectomy, in which the ovaries are removed. (Read about "The Ovaries")

Options and alternatives

In a partial hysterectomy, the uterus is removed, but the cervix is left intact. In a total hysterectomy (which is more common), the entire uterus along with the cervix is removed. A radical hysterectomy, which is usually used in cases of gynecological cancer, involves the removal of the uterus, the ovaries, the cervix, pelvic lymph nodes and the upper part of the vagina. The type of hysterectomy used depends on the condition being treated.

A hysterectomy can be done through an abdominal incision or through a vaginal incision. ACOG says an abdominal hysterectomy is major surgery, and can require a lengthy recovery period. Two options that involve a shorter recovery period are the vaginal hysterectomy and laparoscopically assisted vaginal hysterectomy (LAVH). A laparoscope (Read about "Endoscopy") is a small telescope-like device that's inserted through a small cut in the abdomen. It allows a surgeon to examine pelvic organs, to see if the uterus can be removed through the vagina. Laparoscopic supracervical hysterectomy (LSH) is a more recent option. This procedure removes only the uterus and leaves the cervix in place. The recovery time is shorter, but a woman should be aware that she must continue to get regular Pap tests to check for the development of cervical cancer. Robotic surgery has also been added to the mix for ways to perform hysterectomies. With this, computers help control the laproscopic surgical tools. (Read about "Robotic Surgery") Again, the type of hysterectomy used depends on the condition being treated, so a woman should discuss all her options with her doctor.

There are also some alternatives to hysterectomy for treating non-cancerous conditions affecting the uterus, such as fibroids. (Read about "Uterine Fibroids") Fibroids, or benign fibrous tissue growths, are not uncommon. According to the American Academy of Family Physicians (AAFP), between 20 and 40 percent of women older than 35 years or age have fibroids, though many cases of fibroids don't produce any symptoms. In cases where fibroids are causing problems, one procedure that's being used is uterine fibroid embolization. AAFP says this procedure cuts off the flow of blood to the fibroid, causing it to shrink over time. Hospitalization time after this procedure is shorter than for hysterectomy.

There are also procedures such as endometrial ablation that can be used as alternatives to hysterectomy to treat excessively heavy menstrual flow. (Read about "Menstrual Disorders") However, every woman's needs are different; therefore, women should always carefully discuss all options with their doctors.

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