Hysterectomy

Erin Leahy  ** HYSTERECTOMY  ** A hysterectomy (his-tur-EK-tuh-mee) is the surgical removal of a woman’s uterus. The uterus is the location in which the fetus grows and develops during pregnancy. When the uterus is removed, a woman is no longer able to bear children. Hysterectomies are the second most common type of major surgery performed on women. The most common type of surgery is cesarean delivery. According to the Center for Disease Control (, approximately 600,000 hysterectomies are performed annually in the United States, and an estimated 20 million U.S. women have had a hysterectomy. The Center for Disease Control also reports that overall rates were highest among women between the ages of 40-44 years old.
 * WHAT IS A HYSTERECTOMY? **

There are three types of hysterectomy: 1. **//Partial, Subtotal, or Supracervical Hysterectomy//**: The upper part of the uterus is removed, but the cervix is left in place. 2. **//Total Hysterectomy//**: The entire uterus, including the cervix, is removed. 3. //**Radical Hysterectomy**:// The uterus, cervix, and the structures surrounding the cervix are removed. During a radical hysterectomy, it is common for the ovaries and fallopian tubes to be removed as well. Surgery to remove the ovaries is called //oophorectomy//, and surgery to remove the fallopian tubes is called //salpingectomy.// Radical hysterectomies are often performed to treat different forms of cancer.
 * TYPES OF HYSTERECTOMY **

There are three types of hysterectomy procedures: 1. //**Vaginal Hysterectomy**:// This procedure begins with making a small incision inside of the vagina. From there, the uterus is removed through the vagina. The recovery and healing process for this type of procedure is shorter than other options. 2. //**Abdominal Hysterectomy**:// This procedure begins with a 5-to-7 inch incision across the lower abdomen. The doctor will remove the uterus through this larger incision. The recovery and healing process for this type of procedure is often longer than the other options. Typically, a doctor may recommend this type of hysterectomy if large tumors or cancer are present. 3. //**Laparoscopic Hysterectomy**:// The key component to laparoscopic hysterectomy is the use of a laparoscope. A //laparoscope// is a thin, lighted tube with a camera that can be inserted into the body through a small incision. With a laparoscope, surgeons are able to get a better visual of the patient’s insides. There are three types of laparoscopic hysterectomies: A. // **Total laparoscopic hysterectomy**: // The uterus is removed through multiple small incisions across the abdomen, while using a laparoscope. If the cervix is not removed, it is called a supracervical laparoscopic hysterectomy//.// B. // **Laparoscopically assisted vaginal hysterectomy (LAVH)**: // This is a vaginal hysterectomy, aided with a laparoscope. C. // **Robot-assisted laparoscopic hysterectomy**: // This type of hysterectomy involves the aid of a special robotic machine as well as a laparoscope.
 * HYSTERECTOMY PROCEDURES **

Women have hysterectomies for the numerous and following reasons: // **Cancer**: // If you have cervical, uterine, ovarian, or endometrial cancer – then a hysterectomy, specifically a radical hysterectomy, is the best option. // **Fibroids**: // These are non-cancerous tumors that line the uterus and often cause heavy bleeding and extensive pain. Medicines and other minor surgical procedures are available to help reduce or cure fibroids; however, a hysterectomy is a viable option for women close or past menopausal age. // **Endometriosis**: // This occurs when uterine tissue grows outside of the uterus. This tissue can expand to cover the ovaries, fallopian tubes, and other assorted organs. Endometriosis can cause severe and chronic pain as well as bleeding. Minor surgery and medication is available before a hysterectomy may become necessary. // **Prolapse of the uterus**: // This takes place when the uterus falls down into the vaginal area. Clearly, this can cause problems and lead to urinary and bowel issues. There is an object available called a //vaginal pessary// to hold the uterus in place; however, a hysterectomy is a more permanent, viable option. // **Adenomyosis**: // This occurs when tissue grows within the uterus. This may cause severe pain. If medicine does not work, a hysterectomy is the next option. // **Chronic pelvic pain**: // Hysterectomies are absolutely the last resort for chronic pelvic pain, as sometimes a hysterectomy is not successful in stopping the pain. // **Abnormal vaginal bleeding**: // Abnormal vaginal bleeding may occur for many reasons. From cancer to hormone levels, the possibilities are endless, and a hysterectomy is definitely more of a last resort.
 * WHY DO WOMEN HAVE HYSTERECTOMIES? **

Although a hysterectomy is major surgery, it is also an extremely safe procedure. However, all surgeries present certain risks. Risks from undergoing a hysterectomy include: infection, heavy bleeding, injury to nearby organs, pain during sexual intercourse, anesthesia problems, blood clots, and allergic reactions to medicine. It is important to note that most women do not experience any of those health problems.
 * RISKS **

Recovery varies based on the type of hysterectomy; however, all women will be in the hospital for at least 1-2 days post surgery. Abdominal surgery recovery can take up to 4-6 weeks where vaginal or laparoscopic surgery recovery can take only about 3-4 weeks. Regardless of the type of hysterectomy, no heavy objects should be lifted and no sexual intercourse should take place for 6 weeks after surgery.
 * RECOVERY **

There are varying physical and emotional side effects that accompany hysterectomies. **// Physically //**, a woman’s menstrual cycle may stop depending on the type of hysterectomy. Ovaries produce the hormone //estrogen//, the primary female sex hormone. If the ovaries are removed, no more estrogen will be produced and menopause will occur. //Menopause// is the time in a woman’s life when her ovaries naturally stop functioning. This period is characterized by hot flashes, vaginal dryness, and restless sleep. If a woman’s ovaries are not removed, menopause will not occur; however, the early onset of menopause is more likely to occur. **// Emotionally //**, some women may feel depressed because they have lost the ability to have children. This is more likely to happen with younger women. On the other hand, some women may feel relief and a higher quality of life because their negative symptoms have ceased, such as vaginal bleeding or intense pain. // **Sexually**, // results vary depending on the situation. Some women notice that uterine contractions no longer exist during orgasms. Some women feel more sexual pleasure than ever, though this may be attributed to the loss of pain and/or vaginal bleeding. In the end, there is no true conclusive evidence on sexual function or pleasure.
 * PHYSICAL, EMOTIONAL, AND SEXUAL SIDE EFFECTS **

**// Patient-Provider Communication //** : Deciding to undergo a hysterectomy is a major decision that should not be taken lightly. Since there are so many different types of procedures and hysterectomies, it is important to discuss all possibilities with your doctor to decide what is the best option for you. Open and mutual communication is always key when making the decision to undergo major surgery. **// Partner Communication: //** Communication with your significant other is also extremely important. After undergoing a hysterectomy, the possibility of becoming pregnant or bearing children no longer exists. Both people in a relationship need to be aware of this decision as well as the risk factors accompanied by surgery.
 * COMMUNICATION AND HYSTERECTOMY **

2000-2004 Hysterectomy Fact Sheet: Women's Reproductive Health | CDC Reproductive Health. (n.d.). //Centers for Disease Control and Prevention//. Retrieved April 7, 2011, from http://www.cdc.gov/reproductivehealth/womensrh/00-04-FS_Hysterectomy.htm
 * REFERENCES **

ACOG Education Pamphlet AP008 -- Hysterectomy. (n.d.). //American Congress of Obstetricians and Gynecologists//. Retrieved April 7, 2011, from http://www.acog.org/publications/patient_education/bp008.cfm

Abdominal Hysterectomy - MayoClinic.com. (n.d.). //Mayo Clinic//. Retrieved April 7, 2011, from http://www.mayoclinic.com/health/hysterectomy/MY00163

Carlson, K. (1997). Outcomes of Hysterectomy. //Clinical Obstetrics and Gynecology//, //40//, 939-946. Retrieved April 6, 2011, from the Google Scholar database

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Hysterectomy: Frequently Asked Questions - womenshealth.gov. (n.d.). //Women's Health Information Center | WomensHealth.gov//. Retrieved April 7, 2011, from http://www.womenshealth.gov/faq/hysterectomy.cfm

Hysterectomy: Women's Reproductive Health | CDC Reproductive Health. (n.d.). //Centers for Disease Control and Prevention//. Retrieved April 7, 2011, from http://www.cdc.gov/reproductivehealth/womensrh/hysterectomy.htm

Johannas, L. (2009, February 23). The Debate Over Sparing the Cervix in Hysterectomies. //The Wall Street Journal//. Retrieved April 6, 2011, from http://online.wsj.com/article/SB123543924871955051.html

Magrina, J., Kho, R., Weaver, A., Montero, R., & Magtibay, P. (2008). Robotic radical hysterectomy: Comparison with laparoscopy and laparotomy. //Gynecologic Oncology//, //109//, 86-91. Retrieved April 6, 2011, from the Science Direct database.