Hysterectomy

Hysterectomy is the one of the most common major surgeries among women in the United States -- the most common being cesarean section delivery. An estimated 600,000 women each year undergo a hysterectomy.

A hysterectomy is an operation that is done to remove a woman's uterus. There are three general types of hysterectomy:

• A complete or total hysterectomy which is the most common and involves the removal of the cervix as well as the uterus.
• A partial or subtotal hysterectomy in which the cervix is remains and only the upper part of the uterus is removed.
• A radical hysterectomy in which the uterus, the cervix, the upper part of the vagina, and supporting tissues are all removed.

Occasionally, the operation can include removal of one or both the ovaries which contain the eggs and produce hormones. Removal of the ovaries itself is called an oophorectomy.

A hysterectomy may be necessary for one of the following reasons:

• Uterine fibroids. This is the most common reason for hysterectomies. Fibroids are common, non-cancerous tumors that grow in the muscle of the uterus. Generally, women don’t experience any symptoms or require any treatment if fibroids are present. However, in some cases, fibroids can cause heavy bleeding or pain and therefore require their removal.
• Endometriosis. Endometriosis is when the endometrial tissue which lines the inside of the uterus begins to grow on the outside of the uterus or on other organs. It is the second leading reason for hysterectomies and is most common in women in their thirties and forties, especially in women who have never been pregnant. Endometriosis is usually not a problem for women after menopause.

This condition may cause painful periods and abnormal bleeding, and sometimes results in the loss of the ability to become pregnant. A hysterectomy is generally the option of last resort – done only other treatment methods, such as hormone therapy, have been tried and failed.
• Uterine prolapse. About 16 percent of all hysterectomies are done because of this. Uterine prolapse is a condition in which the uterus has moved down from its usual position into the vagina, because of weak and stretched pelvic ligaments and tissues. This can be result from childbirth or loss of estrogen after menopause. Here again, a hysterectomy is done only if the causing severe problems and other treatments, such as hormone therapy, have not been successful.
• Cancer. Surprisingly, only about 10 percent of all hysterectomies are due to cancers affecting the pelvic organs. The types of cancers that generally require a hysterectomy are endometrial cancer (cancer of the lining of the uterus), uterine sarcoma, cervical cancer (cancer of the cervix), and cancer of the ovaries or fallopian tubes. Other treatment methods, such as radiation or hormonal therapy, may be used as well.

If a woman has her ovaries are removed as part of a hysterectomy before she reaches menopause, surgical menopause will result. The reason stems from the fact that the ovaries are the main source of estrogen and progesterone. Removal of the ovaries will result in the sudden change in the hormone balance – estrogen levels drop off overnight and levels of follicle stimulating hormone (FSH) produced by the pituitary gland shoot up, trying to communicate with ovaries that no longer.

If the hysterectomy does not involve the removal of the ovaries, menopause is not triggered. The ovaries will continue to function normally until the woman reaches her natural age for menopause. If one ovary is removed, estrogen levels are not likely to change – the remaining ovary can supply enough hormones to prevent the premature onset of menopause.

Surgical menopause, or menopause resulting from removal of both ovaries, can be more difficult than natural menopause. There is no transition period for the body – simply an abrupt change. In fact, with surgical menopause, one day your body is in a normal menstrual cycle and the next, it has skipped perimenopause and menopause and gone directly into post-menopause. The physical symptoms can be more intense and more frequent than they would be in natural menopause.

HRT for surgical menopause also provides other health benefits. Estrogen increases the level of high density lipoprotein (HDL) cholesterol or the “good” cholesterol and reduces the amount of low density lipoprotein (LDL) or “bad” cholesterol. With the loss of the ovaries and their estrogen production, the cholesterol levels will be adversely affected and the risk for developing heart disease increases. Hormone therapy will restore the levels of estrogen providing significant protection heart disease.

Aside from the physiological changes, a woman going through surgical menopause is likely to confront a number of emotional and psycho-social changes after the surgery. Normally, the transition from perimenopause through to menopause gives a woman time, often years, to adjust emotionally and to ease into the second part of her life. With surgical menopause, there is no adjustment time. A woman is faced not only with dealing with the shocks caused to her system by the surgery itself, but also the emotional and mental adjustments to her different body. The seemingly overnight loss of the ability to have children is very traumatic. Even for women who may not have wanted children, the loss of the possibility can be depressing. Counseling and support groups are available to help women deal the emotions, changes, and issues they may face.

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