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Gynaecology
A hysterectomy is a surgical procedure that is performed to remove the uterus, also known as the womb. This may be done to treat a variety of gynaecological conditions; and it also results in the permanent cessation of menstruation and the inability to conceive but if the ovaries are preserved then premature menopause is prevented.
A hysterectomy is a major procedure that is only recommended to a woman when other treatments have proven unsuccessful or are not suitable; and the patient’s quality of life has been significantly affected by the disease. These situations may include:
Early-stage cancers that affects the reproductive organs, such as the uterus, ovary, cervix, or endometrium (the lining of the uterus), may sometimes necessitate a hysterectomy in order to stop the cancer from spreading and to achieve a cure.
Uterine fibroids are non-cancerous tumours within the uterus that can cause heavy menstrual bleeding, pain, and discomfort. A hysterectomy may be recommended if a patient has large fibroids or severe bleeding; and does not wish to have any more children.
Endometriosis is a condition where tissue similar to the uterine lining grows outside the uterus, sometimes resulting in severe pain and heavy bleeding. Adenomyosis on the other hand is a condition where the inner lining of the uterus grows into the muscle layer of the uterus. This can result in particularly painful menstrual cramps and pelvic pain. A hysterectomy may be recommended if hormonal treatments have not worked and the woman does not wish to (or is unable to) have any children.
A uterine prolapse occurs when the pelvic floor muscles become too weak to support the uterus resulting in the uterus descending from its normal position into the vagina. A hysterectomy may be recommended if physiotherapy fails, the supporting structures of the uterus have been significantly weakened and the woman does not wish to have any more children.
There are three main types of hysterectomy surgeries: radical, total, and subtotal. These procedures differ in the extent of tissue removed and the conditions that they are usually used to treat.
A subtotal hysterectomy removes only the uterus and leaves the cervix behind. This is an easier surgical option but is rarely performed nowadays.
This is most common type of hysterectomy and it involves the removal of both the uterus and the cervix. In some cases, one or both ovaries and/or the fallopian tubes may also be removed.
The most extensive type of hysterectomy, a radical hysterectomy involves the removal of the entire uterus along with the fallopian tubes, ovaries, the cervix and the upper part of the vagina. It is usually reserved for cancer cases.
A hysterectomy can be performed in a variety of ways: through a laparoscopic umbilical incision (minimally invasive), laparotomy (open surgery), vaginally (with no cuts on the abdomen) or robotic surgery. The technique used will depend on the complexity of the case, the patient’s preferences as well as the gynaecologist’s expertise.
It is common to experience some pain and discomfort after a hysterectomy, which can usually be managed with analgesics. You may also experience vaginal bleeding and discharge for several weeks post-surgery. Hormonal changes might occur if your ovaries are removed, resulting in symptoms of menopause.
To ensure a smooth recovery, prioritise getting plenty of rest and strictly follow your gynaecologist’s instructions regarding activity limitations and aftercare.
As with all surgical procedures, a hysterectomy comes with certain risks and possible complications. However, these are unlikely to happen in the hands of an experienced gynaecologist and a well-trained medical team at the hospital. These include:
Rest assured that your gynaecologist and medical team will monitor your vital signs throughout the surgery and during your recovery process so as to minimise the chances of any complications arising.
A hysterectomy cannot be reversed. Once a woman’s uterus has been removed, she will no longer menstruate, or have children. If her ovaries were also removed, she will also experience early onset menopause and may require hormone replacement therapy.
This will depend on your condition. In some cases, you may be able to explore less invasive options first, or adopt a wait-and-see approach for the time being.
Some women may also delay having a hysterectomy until they have completed their family.
Regardless of your decision, you should discuss your options and preferences openly with your gynaecologist, who will be in the best position to advise you on how to manage your treatment needs in the short and long term.
The recovery time following a hysterectomy varies depending on the type of surgery that was performed and the individual's overall health. In general, a full recovery takes approximately four weeks. During this time, prioritising rest and adhering to your gynaecologist’s post-operative instructions are essential for optimal healing.
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