Reasons for Hysterectomy

Your doctor may recommend a hysterectomy as treatment for a wide variety of conditions, some of which are listed below. While hysterectomies may sometimes be absolutely necessary, in some cases, the symptoms can be treated with non-surgical options such as hormone replacement therapy or office-based treatment. Make sure you explore all your treatment options with your doctor.

The most common symptoms that lead to hysterectomy are fibroids, heavy bleeding, endometriosis, prolapse, and cancer.

• Fibroids -  Uterine fibroids are common non-cancerous tumors in the uterus comprised of muscle and fibrous tissue. Fibroids grow from the wall of the uterus. As many as 80% of all women could have uterine fibroids, although the majority have no symptoms.  One in four women with uterine fibroids experience symptoms severe enough to require treatment. [1]

  • It is possible for some fibroids to be removed through a different procedure called a Laparoscopic Myomectomy.  This procedure is not a hysterectomy - it removes the fibroid only and allows the patient to keep her uterus.  This procedure is particularly important for women who wish to maintain their fertility. It is important to ask your surgeon if this is an option for your symptoms.
    
    
• Heavy periods - Also known as menorrhagia, cause pain, fatigue and disruption to your quality of life. Abnormal uterine bleeding is defined as:
  
  
  • Bleeding between periods
  • Bleeding heavier or for long periods of time
  • Bleeding after menopause
    
    
• Abnormal uterine bleeding can occur at any age and can be the result of many different causes from hormonal imbalance or the presence of polyps or fibroids. [2]
  
  
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• Endometriosis - Endometriosis is a condition in which cells usually found inside the uterus grow on the surface of the uterus or on other organs in the abdomen. This condition can be painful and can result in irregular bleeding or even infertility.  It is estimated that up to 40% of women with endometriosis will have difficulty conceiving. The most common symptom of endometriosis is pelvic pain. The pain often correlates to the menstrual cycle, but a woman with endometriosis may also experience pain that doesn't correlate to her cycle. For many women, the pain of endometriosis is so severe and debilitating that it impacts their lives in significant ways. [3]
  
  
• Pelvic support problems/prolapse  -  Uterine prolapse occurs when the uterus has descended from its original position in the pelvis farther down into the vagina.  Muscles and ligaments that make up the pelvic floor hold the uterus in place. Uterine prolapse occurs when pelvic floor muscles and ligaments stretch and weaken, no longer providing enough support for the uterus. As a result, the uterus descends into the vaginal canal.  Uterine prolapse often affects postmenopausal women who've had one or more vaginal deliveries. Damage sustained by supportive tissues during pregnancy and childbirth, plus the effects of gravity, loss of estrogen and repeated straining over the years, can weaken pelvic floor muscles and tissues and lead to uterine prolapse. [4]
  
  
• Some uterine and cervical cancers may be treated with hysterectomy or with other treatment methods.
  
  
  • Uterine cancer - Uterine sarcoma is a cancer of the muscle and supporting tissues of the uterus.  Sarcomas are cancers that start from tissues such as muscle, fat, bone, and fibrous tissue.  An estimated 42,160 new cases of uterine cancer were diagnosed in 2009.  Treatment options are available. [5] 
  • Endometrial cancer - Endometrial cancer starts in the inner lining of the uterus, which is called the endometrium.  The endometrium changes during a woman's menstrual cycle. In the beginning part of the cycle, the lining gets thicker in case the woman becomes pregnant.  If there is no pregnancy, the tissue is shed from the uterus and becomes the menstrual flow.  Most cancers of the uterus start in the endometrium and are called endometrial carcinomas. [6]
  • Cervical cancer - Cervical cancer begins in the lining of the cervix. The cancer forms slowly. At first some cells begin to change from normal to pre-cancer and then to cancer. The change in cells is called dysplasia. Dysplasia can be found by a Pap test and can sometimes be treated to prevent cancer.  The American Cancer Society reports that in 2009, there were 11,270 new cases of invasive cervical cancer, which is cancer that has spread beyond the cervix. [7]

Speak up about your hysterectomy choices

If you and your doctor have determined that hysterectomy is the best course of action for your symptoms, make sure you talk through your choices of procedure. Today's less invasive hysterectomy options, like laparoscopic or vaginal, can help you significantly reduce hospital and recovery times, and minimize scarring and pain afterwards. There are some risks and potential complications associated with surgery. Click here for more information.

Talk to your doctor about which organs need to be removed, too. Some research suggests keeping your cervix after hysterectomy may reduce the risk of pelvic floor prolapse and preserve sexual function. A laparoscopic hysterectomy offers a less invasive alternative to traditional abdominal hysterectomy. Learn more about laparoscopic hysterectomy.