Hysterectomy is a surgical procedure that refers to removal of the uterus. A hysterectomy is used to treat many different conditions that can affect a woman in her lifetime. Sometimes a hysterectomy is needed to save a woman’s life, and other times it is done to improve quality and restore health.
Conditions for which a hysterectomy is performed include:
A hysterectomy refers to removal of the uterus, not the ovaries. Hysterectomy will not lead to menopause unless the ovaries are also removed. Most of the time the ovaries can be left in place during a hysterectomy.
There are different types of hysterectomies, depending on what other organs are removed along with the uterus, and will be determined by you and your surgeon based on your condition, age, and other factors. The different types include:
Uterine fibroids, also called “leiomyomas” or “myomas”, are non-cancerous tumors of the uterine muscle (although rarely they may be cancerous). Fibroids are very common and can affect 20-80% of women, most commonly in women aged 30-40s. Fibroids can be in any location and any size. A woman can have multiple fibroids or just one.
Many women with fibroids have no symptoms, and in these women the fibroids can be watched without any need for further treatment or surgery. Fibroids can cause pelvic pain, heavy bleeding and anemia, painful periods, painful sexual intercourse, enlargement of the abdomen, and physical pressure on the bladder or rectum causing frequent urination and constipation. Fibroids can also cause pregnancy complications and difficulty getting pregnant.
If fibroids are suspected, an ultrasound is performed. Sometimes a saline sonogram is performed to look for small fibroids in the uterine cavity. MRI can also be helpful to evaluate the location and size of fibroids. Surgery to remove fibroids, called myomectomy, can be performed safely and most of the time can be performed in a minimally-invasive fashion. Fibroids that are in the uterine cavity can be removed by passing a camera, called a hysteroscopy, vaginally into the uterine cavity. Other fibroids are removed through the abdomen through laparoscopic or robotic surgery. It is important that the fibroids are taken out of the body, once separated from the uterus, in a manner such that potential cancer is not spread. We routinely utilize a technique to remove the fibroids from the abdomen by placing them in a bag and making a small abdominal incision for extraction. Alternatively, hysterectomy can be performed to treat fibroids.
Myomectomy is a surgical procedure where fibroids, which are benign tumors of the uterus, are removed without removing the whole uterus. This is usually done in order to preserve the uterus and preserve the potential for pregnancy. Myomectomy can be performed in a number of ways, depending on the number and size of the fibroids and their location.
Endometriosis is a condition where the tissue that lines the uterine cavity grows outside of the uterus, most commonly in the peritoneum, ovaries, fallopian tubes, behind the uterus, and on the surfaces of the uterus, bladder, rectum or intestines. The most common symptom of endometriosis is chronic pain in the pelvis, usually right before or during the menstrual period. Women with endometriosis may also have pain with sexual intercourse, urinary urgency and pain, and pain during bowel movements. Because of the inflammation and scarring associated with endometriosis, there may be difficulty in getting pregnant. Endometriosis can be treated medically or surgically, and often both modalities are needed. Surgical treatment of endometriosis can help relieve or improve pain, and can restore fertility. Medical/hormonal therapies are often needed after surgery to further treat endometriosis and prevent or delay recurrence.