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Indications for Hysterectomy


Hysterectomy is the most common surgery performed in non-pregnant women. Until recently, it was the procedure of choice to manage abnormal uterine bleeding and even performed routinely in women who no longer wanted children. Now there are many alternatives to address these problems and needs. Hysterectomy is still commonly performed when conservative methods fail.

The most common reasons for hysterectomy are abnormal uterine bleeding and/or uterine fibroids. Fibroids can cause heavy bleeding but not always. Sometimes the fibroids are so large they cause abdominal pressure and discomfort. They may even contribute to urinary frequency, pain with urination and constipation. Another common reason for hysterectomy is uterine prolapse. This occurs when the support to the uterus weakens and the organ starts to prolapse causing discomfort and even pain.

A malignancy of the uterus, ovaries, cervix and fallopian tube are other reasons for a hysterectomy. In such cases removal of all of these gynecologic organs and some surrounding tissue is required to stop the spread of cancer. The success of the procedure depends on the stage of the cancer. The procedure can be curative in early stage cancers. If the stage is late, then additional treatment with chemotherapy or radiation therapy maybe indicated.

In cases of benign disease, it is important to consider your alternatives before signing up for surgery. Non-hormonal and hormonal medications are an alternative to managing abnormal uterine bleeding. The progestin intrauterine contraceptive device is also a great option for women who have a normal sized uterus. Finally an endometrial ablation is a less invasive surgical option for heavy uterine bleeding in a uterus that is not overly large. The presence of fibroids may complicate the issue a bit but hormonal medications are effective in some cases. Alternatives also include uterine artery embolization.
In the presence of cancer the alternatives are limited and prompt surgical correction maybe the difference between life and death. In cases of very early stage cervical cancer there are less invasive options that will allow young women to retain their reproductive capabilities. In late stage cancers, surgery may not be an option at all and only palliative treatments advised. It is important to be certain that the alternatives being offered are evidence based. This means that the treatment has undergone rigorous scientific investigation and its effectiveness proven.

If you have been advised to have a hysterectomy please understand the reasons for the surgery and the available alternatives to address your problems. Your signature on the informed consents is confirmation of your understanding. It is important that you are clear on every aspect of your surgery. Your involvement will help ensure the best outcome and hopefully aide in a quick return to normal life.

I hope this article has provided you with information that will help you make wise choices, so you may:

Live healthy, live well and live long!
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What is a Hysterectomy?
Hysterectomy Procedure
Understanding the Gynecologic Procedure
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Content copyright © 2014 by Dr. Denise Howard. All rights reserved.
This content was written by Dr. Denise Howard. If you wish to use this content in any manner, you need written permission. Contact Dr. Denise Howard for details.

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