The word 'Hysterectomy' is derived from its Greek root 'Hysteria' which means the womb and 'Ektomia' implying to cut out of. A Hysterectomy surgery concerns the surgical removal of a woman's uterus. It can also mean the surgical removal of the uterus, ovaries and the cervix. So technically, a Hysterectomy surgery means that the woman can never be a biological mother again.
This type of a surgery, which is one of the most common gynaecological procedures performed, does become important in certain scenarios. It can either be a total (removal of the uterus along with the cervix) or a partial (removal of the uterus but not the cervix).
A Hysterectomy surgery can be carried out for the following reasons: uterine fibroids (the common non-cancerous growths on the uterus muscles), uterine prolapse (a benign condition wherein the uterus drops into the vagina from its usual spot), endometriosis (a condition characterized by the growth of the uterus lining tissues outside the uterus), cancer and hyperplasia ( thickening of the uterus lining resulting in bleeding).
A Hysterectomy Surgery usually takes about two hours at the maximum. General anesthesia is administered after which, an IV catheter will be inserted to supply medications and other fluids.
The process of hysterectomy depends on the type of the surgery. In the case of abdominal hysterectomy, first, an incision (either transverse or vertical) of about 7 inches is made in the lower abdomen. The supportive tissues and the blood vessels around the uterus are excised and then the uterus is taken out through the incision. Finally, the incision is closed. A major advantage of this type is that hysterectomy can be performed even if there is scarring or presence of large fibroids. In the case of vaginal hysterectomy, an incision is made around the top of the woman's vagina. After the ligaments, fallopian tubes and the blood vessels are cut off, the uterus is taken out through the vagina. The advantage here is that scarring is minimal with almost no operative pain. The patient can resume normal activities within a month. However, the chances of complications are more in the case of a vaginal hysterectomy. In the case of Laparoscopically assisted vaginal Hysterectomy, the same procedure is followed with a laparoscope assisting the doctor.
The Hysterectomy surgery is opted for only if other methods haven't been able to provide results. The most common eligibility criteria include:
There are no non-eligibility criteria as such, however:
The possible side effects include:
The basic post-operative guidelines are:
For an abdominal hysterectomy, complete recovery can take about a month to 8 weeks. However, for vaginal/laparoscopically assisted vaginal hysterectomies, the downtime is much shorter; about 1-2 weeks.
The price of hysterectomy in India will range between Rs.1,82,000 to Rs.2,40,000.
Yes, a Hysterectomy surgery offers a permanent solution to the treatment of fibroids.
As a woman goes through life, her hormonal levels change quite dramatically and this can be quite impactful. However, sometimes the impact is not a good one! This can be said to be the cause when it comes to dysfunctional uterine bleeding. This sort of bleeding occurs when the levels the hormones are at cause the menstrual cycle of the woman to become erratic.
Understanding the Diagnosis
When it comes to the diagnosis of an issue such as this, the process must include the ruling out of other more serious problems such as fibroids, a miscarriage, or even cancer which has affected the cervix or the uterus of the woman.
A doctor, post-ruling out these situations, will inform the patient, if dysfunctional uterine bleeding is what is being experienced. When it comes to the matter of how dysfunctional uterine bleeding is to be dealt with, it can be said that the best thing which is to be done is to sit down with the doctor and have a comprehensive chat with respect to what the solutions which are available at hand are.
A dysfunctional uterine bleeding is something which can mar a woman’s daily life, but it really needs not be the case!
In case you have a concern or query you can always consult an expert & get answers to your questions!
Every woman has a unique system, especially when it comes to matters like menstrual cycles and pregnancy. There are some women who go through normal bleeding while for others, it may be less than ideal. Also, there are women who may experience a condition known as Menorrhagia which is characterised by excessively heavy bleeding during menstrual cycles. Cramping and bleeding for longer than a week are the most common symptoms of this condition. Here are ways to treat this condition.
The surgical procedure that is used for uterus removal of a female patient is known as a hysterectomy. From uterine fibroids to cancer in the uterus, there may be a variety of reasons for carrying out this procedure. Here is everything you need to know about the procedure and recovery.
Causes: There are a number of reasons for which one may have to undergo a hysterectomy. If uterine fibroids and other kinds of growth are causing severe pelvic pain and bleeding, then it may be required. This also applied to particularly painful endometriosis. Abnormal vaginal bleeding as well as severe and chronic pelvic pain, are enough of reasons by themselves for going in for this kind of surgery to remove the uterus. Also, when the uterus slides away from its normal position and slips into the vaginal canal, this signifies a condition known as Uterine Prolapse, which will also require treatment in the form of a hysterectomy. Andenomyosis is another reason why this surgery may be required, as this condition results in the thickening of the organ. Finally, if the patient is suffering from cervical or ovarian cancer, then the doctor may recommend this surgery to remove the uterus in case the tumour found has been tested as malignant.
Technique: There are various techniques that may be followed in the course of this surgery, depending on the location, the size and the severity of the condition and the growth that is associated with it.
Risks: While this is mostly known as a low risk procedure, there may be various risks after the surgery including urinary incontinence, vaginal prolapse, formation of fistula where an abnormal link may form between the bladder and the vagina and finally, persistent pain. Infection, haemorrhage and blood clots may also happen in extreme cases.
Recovery: The female patient will automatically start menopause once this uterus removal procedure has been carried out. Usually, the doctor will ask you to refrain from lifting heavy weights for a few weeks after the surgery and also, to abstain from sex for a while. Most female patients reported complete cure of the problem following this surgery. Also, it is not common to find too many side effects after the surgery.
Fibroids are the most frequently seen tumors of the female reproductive system. Fibroids, also known as uterine myomas, leiomyomas, or fibromas, are firm, compact tumors that are made of smooth muscle cells and fibrous connective tissue that develop in the uterus. It is estimated that between 20 to 50 percent of women of reproductive age have fibroids, although not all are diagnosed. Some estimates state that only about one-third of these fibroids are large enough to be detected by a doctor during a physical examination.
In more than 99 percent of fibroid cases, the tumors are benign (non-cancerous). These tumors are not associated with cancer and do not increase a woman's risk for uterine cancer. They may range in size, from the size of a pea to the size of a softball or small grapefruit.
Causes: While it is not clearly known what causes fibroids, it is believed that each tumor develops from an aberrant muscle cell in the uterus, which multiplies rapidly because of the influence of estrogen.
Some women who have fibroids have no symptoms, or have only mild symptoms, while other women have more severe, disruptive symptoms. The following are the most common symptoms for uterine fibroids:
Heavy or prolonged menstrual periods
Abnormal bleeding between menstrual periods
Pelvic pain (caused as the tumor presses on pelvic organs)
Low back pain
Pain during intercourse
A firm mass, often located near the middle of the pelvis, which can be felt by the doctor on examination
Diagnosis: Fibroids are most often found during a routine pelvic examination. This, along with an abdominal examination, may indicate a firm, irregular pelvic mass to the physician. In addition to a complete medical history and physical and pelvic and/or abdominal examination, diagnostic procedures for uterine fibroids may include:
Transvaginal ultrasound (also called ultrasonography). An ultrasound test using a small instrument called a transducer, that is placed in the vagina.
Magnetic resonance imaging (MRI). A non-invasive procedure that produces a two-dimensional view of an internal organ or structure.
Hysterosalpingography. X-ray examination of the uterus and fallopian tubes that use dye and is often performed to rule out tubal obstruction.
Hysteroscopy. Visual examination of the canal of the cervix and the interior of the uterus using a viewing instrument (hysteroscope) inserted through the vagina.
Blood test (to check for iron-deficiency anemia if heavy bleeding is caused by the tumor).
Treatment: Since most fibroids stop growing or may even shrink as a woman approaches menopause, the doctor may simply suggest "watchful waiting." With this approach, the doctor monitors the woman's symptoms carefully to ensure that there are no significant changes or developments and that the fibroids are not growing.
In women whose fibroids are large or are causing significant symptoms, treatment may be necessary. Treatment will be determined by the doctor based on:
Your overall health and medical history
Extent of the disease
Your tolerance for specific medications, procedures, or therapies
Expectations for the course of the disease
Your opinion or preference
Your desire for pregnancy
In general, treatment for fibroids may include:
Hysterectomy. Hysterectomies involve the surgical removal of the entire uterus.
Conservative surgical therapy. Conservative surgical therapy uses a procedure called a myomectomy. With this approach, physicians will remove the fibroids, but leave the uterus intact to enable a future pregnancy.
Gonadotropin-releasing hormone agonists (GnRH agonists). This approach lowers levels of estrogen and triggers a "medical menopause." Sometimes GnRH agonists are used to shrink the fibroid, making surgical treatment easier.
Anti-hormonal agents. Certain drugs oppose estrogen (such as progestin and Danazol), and appear effective in treating fibroids. Anti-progestins, which block the action of progesterone, are also sometimes used.
Uterine artery embolization. Also called uterine fibroid embolization, uterine artery embolization (UAE) is a newer minimally-invasive (without a large abdominal incision) technique. The arteries supplying blood to the fibroids are identified, then embolized (blocked off). The embolization cuts off the blood supply to the fibroids, thus shrinking them. Health care providers continue to evaluate the long-term implications of this procedure on fertility and regrowth of the fibroid tissue.
Anti-inflammatory painkillers. This type of drug is often effective for women who experience occasional pelvic pain or discomfort. In case you have a concern or query you can always consult an expert & get answers to your questions!
Endometriosis is an often painful disorder in which tissue that normally lines the inside of your uterus — the endometrium — grows outside your uterus. Endometriosis most commonly involves your ovaries, fallopian tubes and the tissue lining your pelvis. Rarely, endometrial tissue may spread beyond pelvic organs.
With endometriosis, displaced endometrial tissue continues to act as it normally would — it thickens, breaks down and bleeds with each menstrual cycle. Because this displaced tissue has no way to exit your body, it becomes trapped. When endometriosis involves the ovaries, cysts called endometriomas may form. Surrounding tissue can become irritated, eventually developing scar tissue and adhesions — abnormal bands of fibrous tissue that can cause pelvic tissues and organs to stick to each other.
The primary symptom of endometriosis is pelvic pain, often associated with your menstrual period. Although many women experience cramping during their menstrual period, women with endometriosis typically describe menstrual cramp that's far worse than usual. They also tend to report that the pain increases over time.
Common Signs and Symptoms of Endometriosis may include:
Pain with intercourse. Pain during or after sex is common with endometriosis.
Pain with bowel movements or urination. You're most likely to experience these symptoms during your period.
Infertility. Endometriosis is first diagnosed in some women who are seeking treatment for infertility.
The severity of your pain isn't necessarily a reliable indicator of the extent of the condition. Some women with mild endometriosis have intense pain, while others with advanced endometriosis may have little pain or even no pain at all.
Endometriosis is sometimes mistaken for other conditions that can cause pelvic pain, such as Pelvic Inflammatory Disease (PID) or ovarian cysts. It may be confused with irritable bowel syndrome (IBS), a condition that causes bouts of diarrhea, constipation and abdominal cramping. IBS can accompany endometriosis, which can complicate the diagnosis.
When to see a doctor
See the doctor if you have signs and symptoms that may indicate endometriosis.
Endometriosis can be a challenging condition to manage. An early diagnosis, a multidisciplinary medical team and an understanding of your diagnosis may result in better management of your symptoms.
Although the exact cause of endometriosis is not certain, possible explanations include:
Retrograde menstruation. In retrograde menstruation, menstrual blood containing endometrial cells flows back through the fallopian tubes and into the pelvic cavity instead of out of the body. These displaced endometrial cells stick to the pelvic walls and surfaces of pelvic organs, where they grow and continue to thicken and bleed over the course of each menstrual cycle.
Transformation of peritoneal cells. In what's known as the "induction theory," experts propose that hormones or immune factors promote transformation of peritoneal cells — cells that line the inner side of your abdomen — into endometrial cells.
Embryonic cell transformation. Hormones such as estrogen may transform embryonic cells — cells in the earliest stages of development — into endometrial cell implants during puberty.
Endometrial cells transport. The blood vessels or tissue fluid (lymphatic) system may transport endometrial cells to other parts of the body.
Immune system disorder. It's possible that a problem with the immune system may make the body unable to recognize and destroy endometrial tissue that's growing outside the uterus.
Several factors place you at greater risk of developing endometriosis, such as:
Never giving birth
Starting your period at an early age
Going through menopause at an older age
Short menstrual cycles — for instance, less than 27 days
Having higher levels of estrogen in your body or a greater lifetime exposure to estrogen your body produces
Low body mass index
One or more relatives (mother, aunt or sister) with endometriosis
Any medical condition that prevents the normal passage of menstrual flow out of the body
Endometriosis usually develops several years after the onset of menstruation (menarche). Signs and symptoms of endometriosis end temporarily with pregnancy and end permanently with menopause, unless you're taking estrogen.
The main complication of endometriosis is impaired fertility. Approximately one-third to one-half of women with endometriosis have difficulty getting pregnant. Endometriosis may obstruct the tube and keep the egg and sperm from uniting. But the condition also seems to affect fertility in less-direct ways, such as damage to the sperm or egg. Inspite of this, many women with mild to moderate endometriosis can still conceive and carry a pregnancy to term. Doctors sometimes advise women with endometriosis not to delay having children because the condition may worsen with time.
Ovarian cancer does occur at higher than expected rates in women with endometriosis. Although rare, another type of cancer — endometriosis-associated adenocarcinoma — can develop later in life in women who have had endometriosis.
Diagnosis: To diagnose endometriosis and other conditions that can cause pelvic pain, the doctor will ask you to describe your symptoms, including the location of your pain and when it occurs.
Tests to check for physical clues of endometriosis include:
Pelvic exam. During a pelvic exam, the doctor manually feels (palpates) areas in your pelvis for abnormalities, such as cysts on your reproductive organs or scars behind your uterus. Often it's not possible to feel small areas of endometriosis, unless they've caused a cyst to form.
Ultrasound. A transducer, a device that uses high-frequency sound waves to create images of the inside of your body, is either pressed against your abdomen or inserted into your vagina (transvaginal ultrasound). Both types of ultrasound may be done to get the best view of your reproductive organs. Ultrasound imaging won't definitively tell the doctor whether you have endometriosis, but it can identify cysts associated with endometriosis (endometriomas).
Laparoscopy. Medical management is usually tried first. But to be certain you have endometriosis, the doctor may advise a surgical procedure called laparoscopy to look inside your abdomen for signs of endometriosis.
While you're under general anesthesia, the doctor makes a tiny incision near your navel and inserts a slender viewing instrument (laparoscope), looking for endometrial tissue outside the uterus. He or she may take samples of tissue (biopsy). Laparoscopy can provide information about the location, extent and size of the endometrial implants to help determine the best treatment options.
Treatment for endometriosis is usually with medications or surgery. The approach you and the doctor choose will depend on the severity of your signs and symptoms and whether you hope to become pregnant.
Generally, doctors recommend trying conservative treatment approaches first, opting for surgery as a last resort.
The doctor may recommend that you take an over-the-counter pain reliever, such as the nonsteroidal anti-inflammatory drugs (NSAIDs) ibuprofen (Advil, Motrin IB, others) or naproxen (Aleve, others), to help ease painful menstrual cramps.
If you find that taking the maximum dose of these medications doesn't provide full relief, you may need to try another approach to manage your signs and symptoms.
Supplemental hormones are sometimes effective in reducing or eliminating the pain of endometriosis. The rise and fall of hormones during the menstrual cycle causes endometrial implants to thicken, break down and bleed. Hormone medication may slow endometrial tissue growth and prevent new implants of endometrial tissue.
Hormone therapy isn't a permanent fix for endometriosis. You could experience a return of your symptoms after stopping treatment.
Therapies used to treat endometriosis include:
Hormonal contraceptives. Birth control pills, patches and vaginal rings help control the hormones responsible for the buildup of endometrial tissue each month. Most women have lighter and shorter menstrual flow when they're using a hormonal contraceptive. Using hormonal contraceptives — especially continuous cycle regimens — may reduce or eliminate the pain of mild to moderate endometriosis.
Gonadotropin-releasing hormone (Gn-RH) agonists and antagonists. These drugs block the production of ovarian-stimulating hormones, lowering estrogen levels and preventing menstruation. This causes endometrial tissue to shrink. Because these drugs create an artificial menopause, taking a low dose of estrogen or progestin along with Gn-RH agonists and antagonists may decrease menopausal side effects, such as hot flashes, vaginal dryness and bone loss. Your periods and the ability to get pregnant return when you stop taking the medication.
Progestin therapy. A progestin-only contraceptive, such as an intrauterine device (Mirena), contraceptive implant or contraceptive injection (Depo-Provera), can halt menstrual periods and the growth of endometrial implants, which may relieve endometriosis signs and symptoms.
Danazol. This drug suppresses the growth of the endometrium by blocking the production of ovarian-stimulating hormones, preventing menstruation and the symptoms of endometriosis. However, danazol may not be the first choice because it can cause serious side effects and can be harmful to the baby if you become pregnant while taking this medication.
If you have endometriosis and are trying to become pregnant, surgery to remove as much endometriosis as possible while preserving your uterus and ovaries (conservative surgery) may increase your chances of success. If you have severe pain from endometriosis, you may also benefit from surgery — however, endometriosis and pain may return.
The doctor may do this procedure laparoscopically or through traditional abdominal surgery in more extensive cases.
Assisted reproductive technologies
Assisted reproductive technologies, such as in vitro fertilization (IVF) to help you become pregnant are sometimes preferable to conservative surgery. Doctors often suggest one of these approaches if conservative surgery doesn't work. If you wish to discuss about any specific problem, you can consult a gynaecologist.