When a hysterectomy is the only solution

Yet surveys repeatedly show that a considerable percentage of these surgeries are not vital or life saving and that alternative treatment, albeit over longer periods, could have resolved the problem.

The 10 reasons why doctors will recommend a hysterectomy are described below.

 

1.Uterine fibroid 

This is the most common cause of a hysterectomy. Most patients with this condition suffer from heavy bleeding during the menstrual period, frequent urination, flatulence or pain in the lower belly.

 

2. Endometriosis

With more and more women choosing not to have children or waiting until they are older to become pregnant, endometriosis is on the increase. In this condition, endometrial tissue develops in the wall of the peritoneum embedded in one ovary or on both sides of the ovary in the later stages. It may also appear on the wall of the uterus. The severity of the endometriosis varies and the choice of treatment is in accordance with the severity. Some patients do not suffer at all while others experience abdominal pain with stomach ache during the menstrual period and the pain becomes gradually more intense. 

 

3. Fibrosis 

Fibroids on the wall of the uterus normally occur after surgery on the pelvic cavity, including caesarean section, myomectomy, or surgery for intestinal obstruction, chronic pelvic inflammatory disease or endometriosis, which leads to the inability to hold urine for long period and random pain in the lower abdomen when exercising or lifting heavy objects.

 

4.Infection 

Infection in the pelvis is caused by a dilation of the uterus as a result of an abortion or pelvic inflammatory disease.

 

5.Irregular menstrual bleeding 

A hysterectomy may be proposed if the condition cannot be permanently cured by taking hormonal treatment.

 

6.Chronic lower abdominal pain for longer than three months, leading to a poor quality of life, pain during menstrual period, pain during sexual intercourse, or pain in the coccyx or rectum during defecation. 

 

7. Surgery on the uterus before the onset of cancer, which is commonly found in women who have annual pelvic exams. In most cases, this is caused by an infection of the human papilloma virus (HPV). Women who already have children, do not want to have children, or are aged over 40, can undergo surgery if they are considered to be at risk. 

 

8. Cancer, including vaginal cancer, cervical cancer, endometrial cancer (cancer in the muscles of the uterus), fallopian tube cancer, ovarian cancer and colorectal cancer

 

9. Sterilisation

 

10.To save the life of mothers after experiencing a postpartum haemorrhage.

 

A hysterectomy can be performed in many ways including a total hysterectomy (upper part of the uterus, the body of the uterus, and the cervix) and subtotal hysterectomy, which leaves the cervix intact. The approaches to performing a hysterectomy are as follows. 

 

1. Conventional exploratory laparotomy, which leaves a 10-15 cm surgical scar in a vertical position or bikini line. 

2.Mini exploratory laparotomy, which leaves a surgical scar of 5 cm in the lower abdomen in the bikini line. 

3.Vaginal surgery, which leaves a surgical scar in the vagina but no scar in the lower abdomen. 

4. Laparoscopically assisted vaginal hysterectomy, which leaves one to five surgical scar of 0.5-1.0 cm in the vagina and the lower abdomen. 

5. Laparoscopic subtotal or supracervical hysterectomy, which leave a surgical scar on the abdomen, without leaving a surgical scar in the vagina. 

6.Natural orifice transluminal endoscopic hysterectomy, which leaves a surgical scar in the vagina.

 

The choice of surgical approach depends on the developmental stage of the disease; the surgeon’s specialisation; and the decision made by the patient, their relatives, and counsellors. 

It should also be remembered that there are other approaches that can save the uterus. If you wish to keep your uterus, ask your doctor for advice regarding alternative treatment approaches. 

 

Dr Mongkol Chantapakul is a specialist in OB/GYN and Maternal Foetal Medicine at Samitivej Sukhumvit Hospital. Call (02) 711 8555-6.