Hysterectomy is the surgical removal of the uterus or womb. This can be performed through the abdominal wall, through the vagina (if the fibroids are small) or by laparoscope (a small tube inserted near the belly button) or hysteroscope (a small tube is inserted through the vagina).
The cervix can also be removed and some surgeons remove the ovaries as well, although this is not part of the fibroid treatment and is controversial.
Over 75,000 hysterectomies are performed in the UK each year. 60% of these are for fibroids. There have been recent calls in the medical press to reduce the number of hysterectomies, as less invasive treatments are available.
The abdominal approach is usually used for the treatment of fibroids. An incision is made in the abdomen and through the muscle. The uterus is removed.
There is considerable pain after the operation normally lasting from 3 to 10 days.
The operation is associated with heavy haemorrhaging requiring blood transfusions. A high fever occurs in a large proportion of patients.
The normal stay in hospital is between 5 days and 2 weeks.
Hysterectomy is very invasive surgery. There is danger of a hernia (protrusion of a portion of organ or tissue) if there is any lifting or stretching of the abdomen. For this reason women must not even lift a kettle or drive a car for at least 6 weeks.
Hormone replacement will probably be required if the uterus is removed. If the ovaries are also removed it will normally be given afterwards.
Return to work is normally between 2 and 3 months, depending on the nature of the work. Full recovery may take longer.
Most women will need considerable care at home for at least 6 weeks, because they will not be able to lift or stretch or drive. This means another member of the family or a friend will need to look after them.
Hysterectomy is very successful at removing all symptoms associated with fibroids. There is no re-growth of the fibroids.
It can also protect against cancer of the uterus, and cervix if this is removed and ovaries if they are removed. However, NICE guidelines state that healthy ovaries should not be removed.
The most serious side effects arise because hysterectomy is such an invasive procedure. Urinary tract infection (from the bladder to the kidneys) occurs in 3.3% to 25% of women and wound infections in 25%.
Deep vein thrombosis (DVT) occurs in approximately 15-18% of patients having gynae surgery. This is a serious complication where a blood clot occurs in the leg (usually) due to the surgery and subsequent inactivity. This blood clot can move to the heart and lungs causing a potentially fatal pulmonary embolism.
Surgical damage can occur to the bladder (1.1-1.7%) resulting in incontinence in some. It can also occur in the urinary tract (0.1-1.7%) and the bowel (gut) (0.5-5%). This kind of damage can have long-term side effects. Surgical damage to the bowel can lead to serious infection.
There can also be surgical damage to the nerves supplying the vagina, which will effect the woman's enjoyment of sex considerably.
The overall surgical complication rate is 9-16%.
Menopause occurs 5 years earlier after hysterectomy. Women are infertile and will not have periods.
Normally women will have hormone replacement therapy, as early menopause leads to a higher incidence of heart disease, osteoporosis and bowel cancer.
As a result of changes in hormone levels and early menopause enjoyment of sex and sex drive can be adversely affected.
Women are infertile after hysterectomy.
Sexual dysfunction is a serious long-term side effect of hysterectomy that is usually not mentioned to women and there is also very little research on it. This affects not only the woman's enjoyment and desire for sex, but can also challenge and put a strain on marriages and personal relationships.
If women have been suffering from menorrhagia, vaginal dryness and general illness before hysterectomy, the relief of these symptoms and improvement in general health is likely to enhance their desire for and enjoyment of sex. The loss of the fear of becoming pregnant and lack of periods may have the same effect.
However, hysterectomy is also a direct cause of sexual dysfunction -
There is considerable evidence that some women feel very depressed after hysterectomy. This may be due to the changes in hormone levels, the psychological feeling of loss of femininity or on-going illness. It can be very debilitating to those suffering from it.
For more information please contact the Hysterectomy Association.
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Our Survey and Guidelines
Thanks to all who took part in our survey about the information and choices for their fibroid treatment. Please click here for the Patient Information and Choice Survey report and here for our report on access to UFE treatment with The Medical Technology Group and All Party Parliamentary Group on Improving Patient Access to Medical Technologies.
You MUST be offered an alternative to hysterectomy. Download the quick reference guide to the NICE guidelines.
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