V. Hysterectomy questions answered

A hysterectomy is a surgical procedure to remove the uterus, or womb. Once a woman has a hysterectomy she can no longer become pregnant or have a period. Here are V. (five) frequently asked questions about hysterectomies.

I. Why would I need a hysterectomy?

There are a variety of reasons why you may need or choose a hysterectomy. Typically, it is performed when medication and/or less invasive options are not the best alternative, or when these modalities have been ineffective in treating the problem(s).

II. What kind of problems or symptoms would cause the need for a hysterectomy?

Here are five (V.)

i. Heavy periods, due to issues including hormones, polyps, endometriosis, fibroids, and ovarian cysts are a common symptom or problem which may result in having hysterectomy.

ii. Pelvic pain can occur due to endometriosis, adenomyosis, fibroids or infection. In some instances a hysterectomy may be a good option in helping to manage these symptoms and the resulting pain.

iii. Non-cancerous tumors of the pelvis or fibroids are benign growths of the uterus that can become quite large and thereby cause pain and pelvic/abdominal discomfort, as well as bleeding which can result in anemia or physical disfigurement (protrusion of the lower abdomen). There are some nonsurgical treatment options to help reduce the size and consequences of the fibroid. Surgical intervention such as removing the fibroid or a myomectomy or removing the uterus, a hysterectomy. Less commonly, one may have a non-cancerous tumor of the ovary that requires surgical intervention and you may opt to have this remedied along with a hysterectomy (in this case removing the ovary or ovaries and the uterus).

iv. Cancers of the female reproductive tract (cervix, uterus, tubes and ovaries) are treated with a hysterectomy and sometimes with removal of adjacent structures. In addition, a woman who may be at risk for cancer due to family history, or genetic risk factors as well as personal breast cancer risks may be advised to have a hysterectomy and/or with removal of ovaries and tubes.

v. Prolapse or weakened pelvic floor muscles in some women, may note a pressure, bulge or protrusion of some of the pelvic organs. She may note changes in her ability to urinate or defacate. This happens more commonly in women who have had large babies, many babies and/or difficult vaginal deliveries. In these instances, an option (and there are others) may include a vaginal hysterectomy.

III. Is removing the cervix part of a routine hysterectomy? How do I know if I should have my cervix removed?

The cervix, or the opening of the womb, is a separate organ structure that is attached to the uterus. It may or may not be advised to be removed at the time of hysterectomy. If you have a pre-cancer or cancerous changes to the cervix (which a pap test will determine), then the cervix should be removed. If the procedure is being performed for cervical cancer, the hysterectomy may be even more expansive, removing other adjacent structures and tissues. If the hysterectomy is being performed for benign or noncancerous conditions, it is important to review with you physician. Some women are reluctant to remove the cervix because they fear it will interfere with sexual function and satisfaction. However to date, there is no data to support this. Note that when the cervix is removed for a benign condition, then a pap is no longer necessary. If the hysterectomy is performed and the cervix is not removed, then routine screening pap smears should be continued as part of preventative care management. 

IV. Is removing the fallopian tubes + ovaries part of a routine hysterectomy? How do I know if I should remove these as well?

If a hysterectomy is being performed for a cancer, then it is more likely that you will be advised to remove the tubes and ovaries at the time of the hysterectomy. If you have a personal history of breast cancer or an increased genetic risk due to family history or known genetic predisposition, then this is more likely to be advised. Recent data does show that removing the fallopian tubes can reduce cancer risk in women. However, some doctors will be less likely to advise removal of ovaries in low-risk women regardless of age as they believe that a small basal rate of protective hormones are continually produced from the ovaries. Note that in women who undergo a hysterectomy and have not yet undergone spontaneous menopause, removing the ovaries will cause this to occur abruptly.

V. Are there different types of hysterectomies?

There are a variety of ways a hysterectomy can be performed. The operative approach is based upon the reason for the procedure, the body habitus, health of the patient, size of the pelvic organ(s) being removed, the comfort/skill set of the surgeon and the tools available.

These are the V. (five) types of hysterectomies.

i. Total abdominal hysterectomy

In this approach the uterus and cervix are removed through an incision or cut made on the abdomen.

ii. Total vaginal hysterectomy

The uterus and cervix are removed through the vagina without an abdominal incision.

iii. Subtotal (or supracervical) hysterectomy

In this operation, only the uterus is removed. This can be performed with an abdominal incision or in certain instances, with minimally invasive instrumentation.

iv. Total hysterectomy with removal of tubes and ovaries (TH-BSO)

This can be done with an incision abdominally or minimally invasive through the vagina and in this instance the uterus, cervix, tubes and ovaries are all removed.

v. Radical hysterectomy

A radical hysterectomy is TH-BSO plus removal of surrounding tissue, this is done for cancer related indications.

Verbena does not provide medical advice, diagnosis, or treatment and is not a medical provider. Discuss all/any hysterectomy issues, questions or concerns with your personal doctor.

If you think you may have a medical emergency, call your doctor or 911 immediately.