More than a third of all U.S. women will have a hysterectomy, or surgical removal of the uterus, by the time they reach the age of 60. The method of hysterectomy performed relates directly to the underlying reason for the operation itself, in addition to the patient’s health and pelvic anatomy.
There are many reasons why a woman might need a hysterectomy. These include prolapse of the uterus, cancer of the womb, ovaries or cervix, heavy periods caused by fibroids, or pelvic pain attributed to endometriosis and unsuccessfully treated pelvic inflammatory disease (PID), adenomyosis or fibroids.
Prolapse of the Uterus: This occurs when the tissues and ligaments that support the womb become weak, allowing it to drop from the normal position. Often a result of childbirth, symptoms can include back pain, leaking urine, difficulty having sex and a sensation that something is coming down from the vagina. A hysterectomy resolves the symptoms by removing the entire womb.
Cancer: Often, it is the only treatment option for cancer that has spread and reached an advanced stage of cervical, ovarian, uterine, or the fallopian tubes.
Heavy Periods: A large amount of blood can be lost during heavy periods, along with symptoms like pain and stomach cramping. The symptoms can have a negative and substantial impact on a woman’s quality of life as well as health. One cause is fibroids, but that isn’t the case across the board, and often, there is no cause. When other treatments have failed, the woman no longer wishes to have children and the heavy periods are having a significant impact on her life, a hysterectomy is an option.
Endometriosis: When the cells that line the womb are found in other areas of the reproductive system, they can cause the surrounding tissue to become inflamed and damaged, resulting in pain, irregular and heavy periods, and infertility. A hysterectomy can remove the areas of endometrial tissue causing pain.
Pelvic Inflammatory Disease (PID): This bacterial infection of the female reproductive system can be treated with antibiotics if detected early. However, once it spreads, it can damage the fallopian tubes and womb, causing long term pain. A hysterectomy is recommended in cases of severe pain.
Adenomyosis: When the tissue that normally lines the womb grows within the muscular wall of the womb, the extra tissue can cause painful periods and pain in the pelvis. A hysterectomy is generally a last resort and is used if the patient doesn’t want to have any more children.
Fibroids: These non-cancerous growths around the uterus are comprised of fibrous tissue and muscle. Symptoms include pelvic pain, frequent urination, heavy or painful periods and discomfort during sex. Large fibroids or severe bleeding can result in a hysterectomy.
Minimally invasive surgery has become popular, with the procedure being performed vaginally or laparoscopically. The patient generally has shorter recovery times, reduced pain, which may require less post-op pain medication and a lower risk of infection. There has been a shift over the last decade toward the minimally invasive technique.
Both the American Congress of Obstetricians and Gynecologists (ACOG) and the American Association of Gynecologic Laparoscopists (AAGL) have stated that the minimally invasive hysterectomy should be the standard of care.
If you are considering a hysterectomy and have questions about possibly using the minimally invasive procedure, call us at (631) 587-2500 to discuss your options.