Hysterectomy is the removal of the uterus. This can be done through either an
abdominal or a vaginal incision, and either with or without removal of the ovaries. Almost 600,000 hysterectomies
are performed each year in the U.S. This makes hysterectomy the second most common major surgical procedure performed
in this country, with the first most common being cesarean section.
The uterus, or "womb", is a hollow, muscular organ located within a
woman’s pelvis. During pregnancy the baby develops within the uterus, and at the delivery it is the contractions
of the uterus that results in the birth of the baby. When a woman is not pregnant, the lining of the uterus is
shed each month during her menstrual cycle.
There are many reasons why a woman might need a hysterectomy. As stated in Te
Linde’s textbook of Operative Gynecology: "Without question, a properly indicated and properly performed hysterectomy
can be of enormous benefit to properly informed patients with significant gynecologic symptoms or disease."
The most common indication for hysterectomy is fibroids. These are benign tumors
that grow on or within the uterus. Most of the time no treatment is needed, but sometimes there is so much discomfort
that surgery is required. Other reasons for hysterectomy include: endometriosis, prolapse (which occurs when the
uterus "drops down" too far), cancer, and problems with heavy bleeding or pain.
For the most part hysterectomy is a safe procedure. Although as with any surgery
there are risks involved. Risks can include blood loss, infection, allergic reaction, damage to the intestine or
bladder, blood clots in the legs or lungs, and possibly even death (although this is very rare, happening in less
than one out of every 1,000 surgeries). Although there is a low probability of any of these things occurring, it
is good to know that alternative treatments are sometimes available.
In particular, when the reason for the hysterectomy is for problems with heavy
bleeding, alternatives include treatment with hormones (such as progesterone) which can sometimes stop the bleeding.
Also, a procedure called "endometrial ablation" is an option for some women. This can usually be done
as an outpatient procedure, and it consists of using electricity to burn away the lining of the uterus. This is
done using a hysteroscope, a telescope-like instrument that is placed through the natural opening in the cervix
(the lower portion of the uterus), and no incisions are needed. Results are good, although some women will still
need to proceed with hysterectomy at some point in the future.
Recently, a device called the "intrauterine thermal balloon" has been
FDA approved for the treatment of irregular bleeding. The procedure consists of placing a plastic balloon into
the uterus through the cervix. The balloon is then filled with sterile water and heated to very high temperatures
which destroys the lining of the uterus. Preliminary studies suggest it may be as effective as endometrial ablation.
The most attractive point of this procedure is that it can be performed in the doctors office. However, not many
doctors have this device yet, and more experience treating patients in this fashion is probably needed before it
can be widely recommended.
When the indication for hysterectomy is fibroid tumors, a procedure called "myomectomy"
can be considered. With myomectomy, the tumors are removed while the uterus is left in place. Often this will require
an abdominal incision, although sometimes the procedure can be accomplished with either laparoscopy ("belly-button
surgery"), or hysteroscopy. Myomectomy is best suited for women who still desire to have children, however,
be aware there is a risk that these tumors could grow back.
Hysterectomies have relieved suffering for millions of women. However, it is important
for patients to realize that in some situations, there are alternatives. Discuss this with your gynecologist who
will help you to decide which procedure is right for you.
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