Hysterectomy

Hysterectomy is the surgical removal of the uterus that can sometimes save the life of a woman. Hysterectomies are usually performed abdominally or vaginally. Laparoscopic hysterectomy is also performed in some cases.

Reasons for hysterectomy

Gynecological cancer: Cancer of the uterus or cervix usually necessitates removal of the uterus and cervix. Endometrial cancer, cancer of the uterus or cervix or fallopian tubes usually requires hysterectomy surgery.

Endometriosis: In some cases of severe bleeding following endometriosis, a hysterectomy surgery is advised. This is the second leading reason for hysterectomies.

Fibroids: While most fibroid tumors can be treated by non-surgical methods, hysterectomy surgery may be the only permanent solution.

Uterine prolapse: When the uterus moves from its usual place down into the vagina, it can affect other organs such as the bladder. This can happen due to childbirth, obesity, loss of estrogen after menopause and weak pelvic ligaments and tissues.

Other reasons for going for a hysterectomy surgery range from heavy or irregular menstrual periods to dysmenorrhea. Severe pelvic inflammatory disease can sometimes necessitate a hysterectomy.

Types of hysterectomy surgery

Total hysterectomy involves removal of the cervix and uterus. It is known as Oopherectomy. Partial hysterectomy is a surgical procedure to remove only the upper part of the uterus, leaving the cervix in place. This type of hysterectomy is referred to as supra cervical hysterectomy or subtotal hysterectomy. Radical hysterectomy involves removal of the uterus, cervix, upper part of the vagina and the supporting tissues.

Hysterectomy surgery performed prior to menopause can bring about severe and prolonged symptoms as compared to natural menopause. A woman can experience bone loss, loss of libido, depression and anxiety. Many women may need hormone replacement therapy (HRT) following total hysterectomy where the ovaries are removed before menopause.

Surgical menopause

The ovaries produce estrogen, progesterone and androgens to regulate the menstrual cycle. When a hysterectomy occurs, these hormones get suddenly interrupted and their levels fall resulting in symptoms of menopause. This is termed surgical menopause. Although removal of ovaries becomes unavoidable in most hysterectomy surgeries, every effort is made by the surgeon to leave the ovaries intact in order to avoid the sudden absence of hormones. Most often, surgical menopause is caused quite dramatically when there is surgical interference like hysterectomy, bilateral oophorectomy, where both the ovaries are removed. A woman undergoing surgical menopause experiences certain symptoms more profoundly than women going through menopause normally. Since there is abrupt disruption of hormones after hysterectomy, the menopausal symptoms are more severe, more frequent and last longer when compared to natural menopause. The symptoms are triggered by the body's sudden inability to make certain hormones due to the removal of ovaries.

Estrogen is immediately given after surgery to try to prevent the intense changes especially the hot flashes that can occur in woman undergoing hysterectomy. However the use of estrogen is itself controversial and it is not usually recommended for women with existing or high risk of cardiovascular disease. A lowest dose of estrogen for the shortest possible time is recommended.

Surgical menopause risks

• Women with surgical menopause are seven times more prone to cardiovascular disease risks.
  
  
• They run the risk of osteoporosis as estrogen plays a vital role in bone formation.
  
  
• Gum tissues are affected and regular dental check ups are advised to tide over this problem.
  
  
• Women younger than 45 years and who have had their ovaries removed face a mortality risk 170% higher than women who have retained their ovaries after oophorectomy. Hormone replacement therapy is commonly advised as it is believed by many doctors to mitigate the mortality risks.
  
  
• There is a definite lowering of sexual desire in women who have undergone surgical menopause. This reduction is greater than that seen in women undergoing natural menopause.

Uterine Prolapse

The uterus lies in the pelvic cavity supported by connective tissue and pubococcygeus muscle. Uterine Prolapse is a condition where the uterus slides from its normal position into the vaginal cavity. This can be attributed to loss of muscle tone or weakening of the muscles holding the uterus against the pelvic wall. Uterine prolapse can occur due to aging or childbirth trauma on account of large babies or difficult labor. Other causes for uterine prolapse include pelvic tumor, obesity and chronic constipation. Lack of exercise and tight corsets can lead to uterine prolapse. Lack of adequate rest in the post pregnancy stage or heavy manual work can lead to uterine prolapse.

A woman suffering from uterine prolapse suffers lower back pain. There is a feeling of bearing down or heaviness in the pelvis. There may be increased frequency in urination and pain during sexual intercourse. A woman might suffer discomfort in the lower abdomen and heavy menstrual periods. Difficulty in passing stools, hemorrhoids and urinary tract infection might be noticed due to complications owing to uterine prolapse. A pelvic examination reveals any uterine Prolapse or protrusion of the cervix into the lower part of the vagina.

Treatment Options : In severe cases, reconstructive surgery restores the uterus to its correct position and then strengthens the pelvic floor. Sacral Colpopexy Sacrocolpopexy is a surgical procedure for reconstructing the pelvic organ.

Treatment for uterine prolapse depends on the degree of prolapse and the woman's age and general health condition. Vaginal pessaries may be able to hold the uterus in place for mild uterine prolapse. But there may be side-effects such as irritating and foul smelling discharge and ulcerations. Kegels exercises can go a long way in strengthening the pelvic floor muscles. Hormone therapy such as estrogen replacement can prevent further weakening of the pelvic muscles. Hysterectomy is the surgical option to treat uterine prolapse. Uterine prolapse can be prevented with good antenatal care and proper rest and following correct lifting techniques.