Uterine Fibroid Tumor Treatment Hysterectomy

A hysterectomy is the complete removal of the uterus. The surgery is surprisingly common: by age sixty, 37 percent of women have had a hysterectomy. Approximately 600,000 hysterectomies are performed every year in the United States, and of these, between 170,000 to 300,000 a year are performed as treatment for uterine fibroids.

Critics argue that the surgery is overused, especially in light of other less-invasive fibroid treatment options, such as myomectomy. The choice to have a hysterectomy is a personal one, and requires a frank discussion of the pros and cons with your gynecologist.

Heavy Menstrual Bleeding

Fibroids can cause heavy menstrual bleeding that can, in turn, lead to anemia. Because removing the uterus immediately stops menstruation, hysterectomy has long been seen as the most effective way to prevent heavy menstrual bleeding.

Ovary Removal and Menopause

Certain forms of hysterectomies remove one or both of the ovaries. The removal of both ovaries will result in immediate menopause. Women who have only one ovary removed are fifty percent likely to begin menopause within five years of the operation. Age does not play a role in this statistic.

Irreversible Infertility

Hysterectomies remove all chances of becoming pregnant. Women who are planning to have children should ask their doctors what their medical alternatives are before agreeing to a hysterectomy. The operation is permanent.

Preoperative Care: GnRH Agonists

Before surgery, hormone therapy with a GnRH agonist is often recommended. GnRH agonists (gonadotropin releasing hormone agonists) block the production and activity of estrogen. Estrogen is one of the causes of fibroid growth; GnRH treatment causes the tumor to shrink. This makes surgery easier. During GnRH treatment, women may experience hot flashes and mood changes; this is called “medical menopause.”

Types of Hysterectomy

Total: Also called a panhysterectomy, the operation removes the uterus, and the cervix. The uterus is removed through an incision made in the abdomen.

Total Hysterectomy with Bilateral Salpingo-Oophroectomy: In addition to the uterus and cervix, the fallopian tubes and ovaries are removed.

Subcervical: The operation leaves the cervix intact, removing the uterus and sometimes the ovaries. Some studies suggest that women who undergo this surgery report fewer side effects.

Vaginal: The surgical incision is made through the vagina. While this has the advantage that it leaves no visible scar, a uterus with large fibroid masses cannot be removed with this procedure. A vaginal incision does not provide the surgeon with as clear a view of the uterus as the abdominal incision. Recovery rates are shorter.

Laparoscopic-Assisted Vaginal Hysterectomy: A hollow tube called a laparoscope is inserted through a small abdominal incision and relays pictures to a television screen. These pictures provide a clearer view of the uterus during a vaginal hysterectomy.

Hysterectomy Recovery

Hysterectomy recovery times range from four to six weeks, with six weeks being the most common time frame. During the hysterectomy recovery period, women should avoid lifting objects whenever possible. Sexual activity is not recommended until six to eight weeks after the operation.

Side Effects and Complications

Surgical side effects can include infection and blood loss. Damage to the urinary tract or bowels can occur during surgery, resulting in bowel obstructions or urinary incontinence. Mortality rates from the surgery are low: 11 out of every 10,000 hysterectomies are fatal.

After surgery, the sudden onset of menopause may occur (depending on whether ovaries were removed or not). Side effects such as hot flashes, anxiety, mood changes, and depression may all occur. Many women associate their uterus with their sense of womanhood, and its loss can cause emotional distress, especially if further children were planned.

Sexually, some women report a drop in sexual enjoyment after hysterectomy. Orgasm quality may change as a result of the surgery. Other women find their sex life improves because painful symptoms are no longer present. Vaginal dryness may occur, requiring the use of lubricants before intercourse.