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  Hysterectomy - Indications & Alternatives
A hysterectomy is an operation to remove a woman's uterus (womb). The uterus is where a baby grows when a woman is pregnant. In some cases, the ovaries and fallopian tubes also are removed.

These organs are located in a woman’s lower abdomen. The cervix is the lower end of the uterus.  The ovaries are organs that produce eggs and hormones. The fallopian tubes carry eggs from the ovaries to the uterus. Approximately 300 out of every 100,000 women will undergo a hysterectomy.

Indications for a Hysterectomy:

  • Fibroids. More hysterectomies are done because of fibroids than any other problem of the uterus. For many women with fibroids, symptoms are minimal and require no treatment. Also, the fibroids often shrink after menopause. But fibroids can cause heavy bleeding or pain in some women.
  • Endometriosis. This happens when the tissue lining the inside of your uterus grows outside the uterus - on your ovaries, fallopian tubes, or other pelvic or abdominal organs. When medication and surgery do not cure endometriosis, a hysterectomy is often performed.
  • Uterine prolapse. This is when the uterus moves from its usual place down into the vagina. This can lead to urinary problems, pelvic pressure, or difficulty with bowel movements.
  • Cancer. If you have cancer of the uterus, cervix, or ovary, a hysterectomy may be part of the treatment your doctor recommends.
  • Persistent vaginal bleeding. If your periods are heavy, not regular, or last for many days each cycle and nonsurgical methods have not helped to control bleeding, a hysterectomy may bring relief.
  • Chronic pelvic pain. Surgery is a last resort for women who have chronic pelvic pain that clearly comes from the uterus. However, many forms of pelvic pain aren't cured by a hysterectomy, and so this approach can be a permanent mistake.
  • Only 10% of hysterectomy is performed for cancer.


Hysterectomy can be performed in different ways.

Traditionally, it has been performed via either abdominal incision (total abdominal hysterectomy, or TAH, via laparotomy) or vaginal canal (vaginal hysterectomy).

However, the vaginal route cannot be used if the "supracervical" procedure is desired.

Types of Hysterectomy:

Subtotal Hysterectomy: Removal of the fundus of the uterus, leaving the cervix in situ. 

Total Hysterectomy: Complete removal of the uterus including the corpus and cervix.

Radical Hysterectomy: Complete removal of the uterus, upper vagina, and parametrium.

Recovering from a hysterectomy takes time. You will stay in the hospital from one to two days for postsurgery care. Some women may stay in the hospital up to four days.

Recovering from Abdominal Hysterectomy: Complete recovery usually takes four to eight weeks. You will gradually be able to increase your activities. 

Recovering from Vaginal or Laparoscopic Hysterectomy: Most women are able to return to normal activity in one to two weeks.


Women with a risk of breast cancer, have been shown to have a significantly reduced risk of developing breast cancer after prophylactic oophorectomy. In addition, removal of the uterus in conjunction with prophylactic oophorectomy allows estrogen-only hormone replacement therapy (HRT) to be prescribed to aid the individual through their transition into surgical menopause.

Risks and Side Effects

The average onset age of menopause in those who underwent hysterectomy is 3.7 years earlier than average.

A hysterectomy involves some major and minor risks.

Most women do not have problems during or after the operation.

Some risks include:

  • Heavy blood loss, that requires blood transfusion.
  • Bowel injury.
  • Bladder injury.
  • Anesthesia problems (such as breathing or heart problems).
  • Need to change to abdominal incision during surgery.
  • Wound pulling open.
  • When only the uterus is removed there is a three times greater risk of cardiovascular disease. If the ovaries are removed the risk is seven times greater. Several studies have found that osteoporosis (decrease in bone density) and increased risk of bone fractures are associated with hysterectomies.

 Alternatives to Hysterectomy

  • Drug therapy. Certain medications may lighten heavy uterine bleeding or correct uterine bleeding that is not regular. Certain medications can help with endometriosis.
  • Endometrial ablation. If you have heavy or irregular uterine bleeding, this procedure might ease your symptoms. With a special device, a doctor uses electricity, heat, or cold to destroy the lining of your uterus and stop uterine bleeding.
  • Uterine artery embolization. For treating fibroid, this procedure involves blocking the blood supply to the tumors. Without blood, the fibroids shrink over time, which can reduce pain and heavy bleeding.
  • Myomectomy. If you have fibroid tumors, this surgical procedure removes the tumors while leaving your uterus intact. There's a risk that the tumors could come back.
  • Vaginal pessary. This is an object inserted into the vagina to hold the womb in place. It may be used as a temporary or permanent form of treatment. Vaginal pessaries come in many shapes and sizes, and they must be fitted for each woman individually.

Talk to your doctor about nonsurgical treatments to try first. Doing so is really important if the recommendation for a hysterectomy is for a reason other than cancer.

Image: http://www.freedigitalphotos.net/images/view_photog.php?photogid=1499

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