It is a big step for any woman to have her womb removed however there are women who need to have hysterectomy.
For reasons other than cancer some indications for hysterectomy include:
- Heavy menstrual bleeding where other less invasive techniques have failed. Indeed a hysterectomy under these circumstances gives 100% guarantee that bleeding will stop.
- Fibroids. Hysterectomy is only used for the treatment of fibroids if family is complete and or more conservative treatments have failed.
- Pelvic pain. Unfortunately hysterectomy will not always cure pelvic pain. The chances of cure will depend on the cause of the pain. The quoted figures range between 70-90%
The morbidity and mortality from hysterectomy has dramatically decreased in modern times, and the method of performing hysterectomies has also changed.
Most early hysterectomies were subtotal hysterectomies where the neck of the womb "cervix" was left behind. This was because the risk in those days was from bleeding, infection and anaesthetic. But with improvements in antibiotic therapy and sterile techniques as well as reliable blood transfusion these risks were reduced. Moving forward it was noticed that as women who had subtotal hysterectomy were at risk of developing cervical cancer. Thus the wheel turned again and more women ended up having total abdominal hysterectomies.in the 1940s however the cervical screening program was introduced, this successfully reduced the morbidity and mortality from cervical cancer
Indeed if a woman has had 3 normal smears and is on a screening program the risk of developing cervical cancer is negligible.
The focus of the ideal hysterectomy for these reasons has thus once again shifted.The focus now is on the least traumatic, the least painful, early recovery, reduced hospital stay, early return to normal activity and family life and least complications
The choices for the modern woman who has decided to have a hysterectomy are:
Laparoscopic "keyhole" hysterectomy
Vaginal hysterectomy
Abdominal hysterectomy
For either type of hysterectomy consideration needs to be given to
- Taking out the ovaries at the same time or not
- Taking out the cervix at the same time or not
- Taking out the fallopian tubes at the same time or not