Hysterectomy

Endometriosis is a painful condition with abnormal growth of cells (endometrial cells) where tissue similar to the tissue that forms the lining of your uterus grows outside of your uterine cavity, usually on other organs of the pelvis such as the ovaries and bowels, although it can spread beyond the pelvic region.

The exact cause of endometriosis is unknown, but is more common in women who are experiencing infertility. However, the condition does not necessarily cause infertility. Symptoms can include:

• Painful intercourse
• Pelvic pain which is worse during menstruation
• Painful urination and bowel movements
• Infertility

Fibroids are benign swellings or lumps that grow on the uterus. They can become quite large and press on the bladder, causing urinary symptoms, heavy period or painful periods, and severe abdominal pain. Fibroids are very common and often do not always cause any symptoms.

Genitourinary prolapse, also known as female pelvic organ prolapse is a common gynaecological condition with varying severity. The uterus or parts of the vaginal wall descent and protrude close to or through the vagina and is most common after menopause when the tissues that support the uterus tend to become thinner and weaker. 

Most women will experience menstrual cramps when their periods begin (or just before) which can continue for 2-3 days. Symptoms can range in severity from mild discomfort to severe pain that interferes with daily life.

Painful periods are also known as dysmenorrhea and can be categorised as primary or secondary. Primary dysmenorrhea occurs in women who experience pain before and during menstruation, whereas secondary dysmenorrhea occurs later in life after you have had normal periods. The following conditions can contribute to painful periods:

• Endometriosis
• Fibroids
• Heavy menstrual periods
• Smoking
• Obesity
• Starting your periods at an early age (before 11 years)

Heavy periods in women can affect day to day activities, and are often accompanied with painful cramps and blood clots. Each woman’s menstrual flow and cycle are different, but on average, a woman will lose 30-40ml of blood during her period, whereas a woman with heavy bleeding can lose up to 80ml. This can often lead to anaemia, and so it is recommended you see a doctor if you are experiencing an abnormally heavy flow.

If you develop ovarian cancer, cervical cancer, uterine cancer or cancer of the fallopian tubes, a hysterectomy will likely be recommended. Your doctor will be able to advise on the best course of action for you.

A partial hysterectomy, also known as a subtotal or supracervical hysterectomy removes only the upper section of the uterus, leaving the uterus in place. Your doctor may remove your ovaries at the same time, but this decision depends on the reason for carrying out the hysterectomy. Removing the ovaries will reduce your risk of ovarian cancer, but it will lead to you going through the menopause. However, if your ovaries are not removed, you may still go through the menopause earlier compared to if you have not had a hysterectomy.

Your gynaecologist will be able to advise you of the pros and cons to having your ovaries removed in greater detail.

A total hysterectomy is the most common type of hysterectomy and involves removing all of the uterus, including the cervix. As with a partial hysterectomy, the ovaries, along with the fallopian tubes may or may not be removed. If you undergo a total hysterectomy, you will no longer be required to have smear tests; however, you should continue to have regular well women check-ups.

Radical Hysterectomy

A radical hysterectomy, also known as Wertheim’s hysterectomy involves removing all of the uterus, the cervix, fallopian tubes, ovaries, the tissue on both sides of the cervix, the upper part of the vagina and the lymph nodes. A radical hysterectomy is usually performed if a woman has been diagnosed with cancer.

This is carried out by making a small incision in the vagina to remove the uterus. There are no external cuts and no visible scars.

Your doctor will make a cut in your abdomen (stomach) to remove your uterus. The incision may be horizontal or vertical, with both types healing well and leaving a small scar.

A laparoscopic hysterectomy involves the surgeon using a tiny instrument (laparoscope) with high intensity light and a small high resolution camera in order to see your pelvic organs. The laparoscope is inserted through small cuts (usually 3 or 4) made in the abdomen which allows for the uterus to be cut into small pieces. The uterus is then removed, either through the abdomen or vagina.