The decision to have a hysterectomy is not to be taken lightly. It is important to have explored alternative, less invasive therapies before making the final decision.
The majority of women do well after a hysterectomy, their symptoms are resolved and they return to normal activity. Satisfaction with the outcome will often depend on what the symptoms were and how well women were counseled regarding the process and what their expectations were.
From the social point of view, it is a procedure that is surrounded by a lot of controversy.
Hysterectomy has long been regarded as an operation performed by hyster-happy often male surgeons.
In fact the medical historian Roy potter saw the rising tide in the number of hysterectomies as a manifestation of the abuse of gynaecological surgery to control women in the 19th century.
Natalie Angier in her book: Woman an intimate geography, goes on to state: Despite this major operation being routine despite the numerous indications for hysterectomy, it would be nice to find someone a doctor to blame for being hyster-happy. Unfortunately no such monster can be found and the explanation for the frequency of hysterectomy lies within the organ (the womb) itself.
Her views and those of others are backed up in some very large studies (the 1994 Maine women’s health study and the Maryland study), and in fact women are no more likely to have a hysterectomy if their surgeon is male or female.
1. Quality of life
Large studies that have looked at this issue have found that hysterectomy is associated with
- An increased health related quality of life
- Improved sex life
- Increase in general health
- Improved psychological outcomes
- Three quarters of women who had anxiety or depression before hysterectomy no longer had 12- 24 months follow up
- 3-10% of women who previously had no such symptoms went on to develop them
2. Bladder function
Most studies demonstrate improvement or no difference in incontinence symptoms post hysterectomy
Miller et al AMJOG 2008 identical twin study
- Hysterectomy did not predispose to incontinence
- Most women with urinary incontinence prior to hysterectomy will have significant improvement
- 10% will have new or worsening symptoms.
- Most women will have improvement of symptoms at 12 months post hysterectomy
3. Bowel function
There is usually no deterioration of bowel function after hysterectomy for the majority of women however about 3% may notice some sluggishness
4. Prolapse
Hysterectomy does increase the risk of prolapse. A study by the Oxford family planning unit (Mant 1997 BJOG),followed 17,032 women from 25-39 for an average of 17 years
- Annual incidence of surgery for prolapse was 0.16% per year
- For women with hysterectomy for reasons other than prolapse 0.29% per year
- The incidence of surgery rose from 1% at 3 years and 5% at 15 years
4. Effect of hysterectomy on the ovaries
- Women who have a hysterectomy can expect that their ovaries will stop full function about 3-5 years before they would have been expected to without a hysterectomy