Why Would I Need a Hysterectomy?

Hysterectomy is the second most common surgery for women — behind only C-sections. Each year, 600,000 women undergo this procedure, which removes the uterus and cervix.

Why would a woman get a hysterectomy?

Women may need a hysterectomy for a variety of reasons. Here are some past and current health conditions that may lead to a hysterectomy:

• Uterine fibroids – Benign tumors located in the uterus, fibroids affect approximately 30 to 40% of women during their lifetime. If medication or other treatments fail, the woman may choose a hysterectomy.
• Abnormal, irregular, heavy or painful periods
• Pelvic pain
• Pain during intercourse
• Cancer

“We typically see women in their 40s and 50s having hysterectomies as that is when bleeding abnormalities usually appear,” said Molly Uhing, MD, Avera OB/GYN, “but we see women as young as their 30s all the way to their 70s needing this procedure due to health concerns.”

Hysterectomy is only considered a last-resort measure as treatment for ongoing pain or health problems if a woman is of child-bearing age.

What can women do to help prevent the necessity of a hysterectomy?

The health issues that typically lead to hysterectomies rest in your DNA, and while there’s no surefire way to prevent the awakening of your genetics, you can take steps to improve your odds. Maintaining a healthy weight may help control bleeding as well as prevent cancers. If you do experience heavy periods, using hormone therapies or other minimally invasive office procedures early on can lessen the likelihood of a future hysterectomy.

“While hysterectomy is still the second most common surgery for women, the need for them among women is actually decreasing because we are finding and addressing those health issues before we get to that point,” explained Uhing.

What is a hysterectomy procedure like?

There are three ways the procedure is typically carried out. In the majority of cases, hysterectomy is a minimally invasive procedure:

• Transvaginal: The uterus and cervix are removed through the vagina. Cost effective and minimally invasive with the lowest complication rate, this is the gold standard of hysterectomies. It’s especially ideal for women who have a small uterus and have had previous vaginal deliveries.
• Laparoscopic: In this procedure, the surgeon uses either laparoscopic instruments or robotic arms to remove the uterus and cervix through small incisions made in the abdomen. Sometimes the incision is made through the belly button, resulting in virtually no scar afterwards. This same-day procedure offers a less than 1% complication rate and shorter recovery, making this another good option for patients.
• Open surgery: Much like a C-section, an open surgical hysterectomy involves an incision along the lower abdomen. This option is extremely rare as it requires a longer recovery and poses a higher complication rate.

“If you need a hysterectomy, know your options,” said Uhing. “Ask if you’re a candidate for robotic surgery or another minimally invasive procedure that carries low risk.”

What about the other reproductive organs in a woman’s body?

It might be recommended that the fallopian tubes are also removed during a hysterectomy — called a bilateral salpingectomy — because it greatly reduces the woman’s risk of ovarian cancer. The ovaries remain to provide a natural hormone source.

However, a bilateral salpingo-oopherectomy removes both the fallopian tubes and ovaries. When a patient has a family history of ovarian cancer, or if she is postmenopause, this route can eliminate much of her risk for ovarian cancer.

What concerns do women have about hysterectomies?

Unfortunately, Uhing has found that many women try avoiding the hysterectomy they need in fear of losing their sex drive or hormones and starting menopause early. This isn’t true.

“Female hormones are primarily produced from the ovaries, which are rarely removed at the same time as a hysterectomy,” explained Uhing. “Because the hormones that come from the ovaries are so important to a woman’s long-term health, the only time we consider removing them is if there’s a specific problem with the ovaries or if there’s a personal or family history of cancer.”

What is recovery like after a hysterectomy?

Unless you have a more invasive surgery, hysterectomy can be an outpatient procedure. In most cases, you’ll go home the same day. For the more common transvaginal and laparoscopic procedures, you’ll take pain medications for three to five days, be back to work within two weeks and follow a lifting restriction of no more than 10 pounds for about six weeks.

Hysterectomies often resolve heavy bleeding and pelvic pain. Advanced options lessen pain and recovery time, and in most cases help you feel better than before.

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