The State of Victoria and the Department of Health shall not bear any liability for reliance by any user on the materials contained on this website. Skip to main content. Home Surgery. Actions for this page Listen Print. Summary Read the full fact sheet. On this page. Reasons for a hysterectomy Hysterectomy for women of childbearing age Other roles of the uterus and ovaries Treatments other than hysterectomy Types of hysterectomy Before choosing a hysterectomy Hysterectomy operation After a hysterectomy Where to get help.
Hysterectomy for women of childbearing age Once a woman has had a hysterectomy of any kind, she cannot become pregnant. Other roles of the uterus and ovaries The uterus has important functions other than childbearing, including: sexuality — the uterus rhythmically contracts during orgasm, contributing to sensations of pleasure self-image — the uterus is of great psychological importance to some women for many reasons, including fertility, femininity, sexuality and body image.
These include: fibroids heavy or irregular menstrual periods uterine prolapse endometriosis. Fibroids Fibroids are non-cancerous growths that form within the muscular walls of the uterus. Heavy menstrual bleeding Heavy menstrual bleeding may be due to fibroids, adenomyosis, cancers, bleeding disorders, other medical conditions and also unknown causes.
Alternative treatment to a hysterectomy for heavy bleeding may include: hormone therapies — such as progestins progesterone-like medications , levonorgestrel -releasing IUDs, etonogestrel-releasing implants and Depo Provera combined oral contraceptive pill surgery — endometrial ablation.
Uterine prolapse Alternative treatment to a hysterectomy for uterine prolapse depends on the degree of prolapse, but may include: pelvic floor exercises the insertion of a pessary into the vagina to prop up the uterus surgical repair without hysterectomy. Endometriosis For endometriosis , alternative treatment to a hysterectomy may include hormonal therapies, surgical removal of areas of endometriosis, or a combination of both. Types of hysterectomy There are five types of hysterectomy: total hysterectomy — where the uterus and cervix are removed subtotal partial hysterectomy — where the uterus is removed, but the cervix is left in place.
While removal of the cervix is generally advised because it is a potential cancer site, some women feel that it serves a purpose during penetrative sex. If the cervix is kept, regular cervical screening is still necessary hysterectomy and bilateral salpingo-oophorectomy — where the uterus, fallopian tubes and ovaries are removed.
This operation is performed if the woman has cancer of the ovaries or the uterus, or for chronic pain due to recurrent pelvic infection or recurrent endometriosis radical hysterectomy — the most extensive version of the operation. It involves the removal of the uterus, fallopian tubes, ovaries, upper part of the vagina, and associated pelvic ligaments and lymph nodes.
Before choosing a hysterectomy If, after talking about all the options with your doctor, you choose to have a hysterectomy, your doctor should discuss several things with you before the operation. These include: your medical history — as some pre-existing conditions may influence decisions on surgery and anaesthetics the pros and cons of abdominal open or laparoscopic surgery versus vaginal surgery your support options after surgery your feelings about the surgery.
Hysterectomy operation The operation may be performed via an incision cut in your lower abdomen abdominal hysterectomy , three to four small incisions in your abdomen laparoscopic hysterectomy , or through your vagina vaginal hysterectomy. Abdominal hysterectomy For an abdominal hysterectomy, the surgeon usually makes a horizontal cut along your pubic hairline your pubic hair may have been shaved around the incision.
Laparoscopic hysterectomy For a laparoscopic hysterectomy, the surgeon inserts a telescope laparoscope to see your pelvic organs through a small incision in your navel, and makes another three or four small incisions through which other instruments are used.
This type of hysterectomy may be performed with the aid of a robot. Vaginal hysterectomy A vaginal hysterectomy is performed through an incision at the top of the vagina. After a hysterectomy Immediately after a hysterectomy operation, you can expect to: wake up in the recovery room feel some soreness around the operation site — you will be given pain-relieving medication to enable you to maintain some mobility experience wind pain for a few days have the intravenous IV tube removed from your arm sometime during the first few days, depending on the procedure and your condition have the catheter drainage tube removed from your bladder within 24 hours of surgery, unless your bladder was traumatised during surgery, then it will remain in longer be encouraged to get out of bed and go for short walks around the hospital ward as soon as possible for this reason, adequate pain relief is very important stay in hospital for two to four days, depending on the type of surgery, sometimes longer.
Self-care after hysterectomy Be guided by your doctor, but general suggestions for the four to six-week post-operative period include: rest — try to rest as much as possible for at least two weeks.
You should avoid driving during this time. Always rest lying down exercise — continue with the exercises you were shown in hospital. You should aim to go for a walk each day, unless advised otherwise by your doctor standing — avoid standing for more than a few minutes at a time in the early post-operative period. You can increase standing time as your recovery progresses lifting — avoid heavy lifting and stretching constipation — to avoid constipation, drink plenty of fluids and eat fresh fruits and vegetables.
You may be advised to take stool softeners for the first few days medication — if you have been prescribed antibiotics, make sure you take the full course, even if you feel well sex — it is advised that you avoid vaginal sex until after the post-operative check about four to six weeks after the operation to make sure the vagina is fully healed. If vaginal dryness is a problem, it may be helpful to use a lubricant, or sweet almond oil or olive oil.
However, it is still important to check in with the doctor regularly to see if they have grown. For women with large fibroids or who are severely affected by their symptoms, surgery may be an option. If the woman is in menopause or close to menopause, surgeons may also remove her ovaries. A hysterectomy will definitively end the symptoms of uterine fibroids, which makes it a good choice for a woman with severe symptoms and who does not want or has already had children.
A woman will be unable to get pregnant after this procedure, so it is not a good choice for women who are considering pregnancy in the future. For postmenopausal women, this will not be an issue. Myolysis is a procedure where a doctor inserts a needle into the fibroid. Either an electric current or a freezing mechanism is passed through the needle to destroy the fibroid tissue. Women who have severe symptoms and do not want to have a hysterectomy may be a good candidate for UAE.
This procedure involves blocking the blood vessels that bring blood to the fibroid. This procedure causes the fibroid to shrink, but it also prevents a woman from becoming pregnant in the future.
A myomectomy is an operation that involves removing the fibroids while keeping the uterus. A myomectomy is the best option for a woman who wants to have children in the future. Doctors are not likely to recommend it for women who are already in menopause. In an abdominal myomectomy, a surgeon makes a larger incision in the lower abdomen, removes the fibroids and closes the wound. In a laparoscopic myomectomy, a surgeon makes four small incisions and inserts medical instruments into these holes to remove the fibroids.
In most cases, fibroids will shrink to a much smaller size and no longer cause any symptoms after menopause. Women who take HRT or who still have higher levels of estrogen may not experience a decrease in the size of their fibroids. It is important for a woman who is having vaginal bleeding or other symptoms of fibroids after menopause to see her doctor. Vaginal bleeding after menopause needs to be evaluated to make sure that there is not a more serious cause.
Depression is more common during menopause, but it is unclear if menopause directly causes it. The patient receives a mild sedative to help relax but remains conscious throughout the procedure. The radiologist uses the MRI to target the fibroid tissue and direct the ultrasound beam.
The MRI also helps the radiologist monitor the temperature generated by the ultrasound. MRgFUS is appropriate only for women who have completed childbearing or who do not intend to become pregnant. The procedure cannot treat all types of fibroids. Fibroids that are located near the bowel and bladder, or outside of the imaging area, cannot be treated. This procedure is relatively new, and long-term results are not yet available.
Likewise, it requires an extensive period of time involving MRI equipment. Many insurance companies consider this procedure investigational, experimental, and unproven and do not pay for this treatment. Currently available evidence suggests that the procedure is moderately effective, however UAE may be more effective, with fewer treatment failures and subsequent need for a second procedure.
This is a minimally invasive laparoscopic procedure that uses high energy waves to generate heat that destroys fibroids. Ultrasound is used to verify the correct placement of the radiofrequency device within each fibroid before ablation is performed. The procedure is usually performed on an outpatient basis and is considered a safe and relatively low risk alternative to hysterectomy.
Hysterectomy is the surgical removal of the uterus. The ovaries may also be removed, although this is not necessary for fibroid treatment. Hysterectomy is a permanent solution for fibroids, and is an option if other treatments have not worked or are not appropriate. A woman cannot become pregnant after having a hysterectomy. If the ovaries are removed along with the uterus, hysterectomy causes immediate menopause. Once a decision for a hysterectomy has been made, the patient should discuss with her doctor what will be removed.
The common choices are:. Total abdominal hysterectomy TAH has been the traditional procedure. It is an invasive procedure that is best suited for women with large fibroids, when the ovaries also need to be removed, or when cancer or pelvic disease is present.
The surgeon makes a 5- to 7-inch incision in the lower part of the belly. The cut may either be vertical, or it may go horizontally across the abdomen, just above the pubic hair a bikini cut. The bikini cut incision heals faster and is less noticeable than a vertical incision, which is used in more complicated cases or with very large fibroids. The patient may need to remain in the hospital for 3 to 4 days, and recuperation at home takes about 4 to 6 weeks. Vaginal hysterectomy requires only a vaginal incision through which the uterus is removed.
The vaginal incision is closed with stitches. Newer minimally invasive procedures have become the preferred methods for hysterectomy. ACOG recommends laparoscopic hysterectomy as the second choice for minimally invasive procedures. Laparoscopic hysterectomies use a laparoscope to help guide and perform the surgery, and allows the ovaries to be easily removed at the same time.
The laparoscope is a thin flexible tube through which a tiny video camera and surgical instruments are inserted. A variation of the vaginal approach is called laparoscopic-assisted vaginal hysterectomy LAVH. It uses several small abdominal incisions through which the surgeon severs the attachments to the uterus and, if needed, ovaries. In LAVH, part of the procedure is completed vaginally, as in the standard vaginal approach. In total laparoscopic hysterectomy, the entire procedure is performed via laparoscopy, with the uterus either removed through the vagina or placed in a plastic bag and broken up into small pieces so it can be removed via the small laparoscopic incisions.
The FDA discourages the use of laparoscopic power morcellation with hysterectomy see below in "Complications". Vaginal hysterectomy, LAVH, total laparoscopic hysterectomy, and robotic-assisted laparoscopic hysterectomy may have fewer complications, shorter hospital stays, and faster recovery times than abdominal hysterectomy.
Robotic-assisted hysterectomy is a type of laparoscopic hysterectomy, but the surgical instruments are attached to a robot. The surgeon uses a computer console in the operating room to guide the robot's movements. Before choosing robotic hysterectomy, it is important to find a surgeon who has extensive training and experience with this technique.
Minor complications after hysterectomy are very common. Many women develop minor and treatable urinary tract infections. There is usually mild pain and light vaginal bleeding post operation. More serious complications are uncommon but can include infection, blood clots, or injury to adjacent organs. Laparoscopic power morcellation is a procedure that is sometimes used during laparoscopic hysterectomy or myomectomy.
The power morcellator is a rapidly spinning cutting device that breaks up the uterus into smaller fragments that can be removed through small abdominal incisions. It can push many of these small pieces of the uterus throughout the abdominal cavity. In , the FDA discouraged the use of laparoscopic power morcellation because of evidence that this procedure can spread cancer through the pelvis and abdomen in women who have undetected uterine sarcoma, a type of uterine cancer.
As many as 1 in women who undergo hysterectomy or myomectomy for uterine fibroids have this type of cancer. A black box warning was required on all product labels and several of these devices have been withdrawn from the market since. With even more evidence on the risk of spreading cancer, in the FDA reaffirmed its decision. Power morcellators should never be used in women who are peri- or post-menopausal, or in women who have suspected or known uterine cancer. Younger women who are considering a fibroid procedure using power morcellation should discuss with their doctors all possible risks.
Ask a family member or friend to help out for the first few days at home. The following are some of the precautions and tips for postoperative care:. Women who have had abdominal hysterectomies should discuss with their doctors when exercise programs more intense than walking can be started. The abdominal muscles are important for supporting the upper body, and recovering strength may take a long time. Even after the wound has healed, the patient may have an on-going feeling of overall weakness, for some time.
Some women do not feel completely well for as long as a year while others may recover in only a few weeks. If a woman has had her cervix removed, she no longer needs annual Pap smears, unless she has had a prior history of abnormal Pap testing, or had cancer found at the surgery.
However, women who have had any type of hysterectomy should continue to receive routine pelvic and breast exams, and mammograms. Surgical removal of the ovaries causes immediate menopause. If the ovaries are not removed, they will usually continue to secrete hormones until the natural age of menopause average age 51 to 52 years , even after the uterus is removed.
Because hysterectomy removes the uterus, a woman will no longer experience menstrual periods, even if she has not become menopausal. Studies show that women who have had hysterectomies become menopausal on average 1 to 3 years earlier than would naturally occur.
Your doctor may recommend you take hormone therapy HT after your hysterectomy. Women who have had a hysterectomy are given estrogen-only therapy ET , which may be administered as pills or as a skin patch that releases the hormone into the bloodstream. It can also be given locally to treat specific symptoms such as vaginal dryness see below. Hot flashes and vaginal dryness are the most common menopausal symptoms.
Hot flashes are often more severe after surgical menopause than in menopause that occurs naturally. Sexual intercourse may resume 6 to 12 weeks following surgery. The effect of hysterectomy on sexuality varies among women.
Most studies show no negative impact on sexuality after hysterectomy. A small percentage of women notice a negative impact on their sex drive or response.
Other women report increased sexual drive and pleasure because they are free from the problems that prompted hysterectomy. A vaginal lubricant can help reduce vaginal dryness.
Vaginal moisturizing agents are available over the counter and may be effective. Dryness may be more of an issue due to loss of the cervical mucus. In studies done on the subject, a low-dose vaginal estrogen treatment applied directly into the vagina is the most effective treatment for vaginal dryness.
It will need to be prescribed by your doctor. Topical vaginal estrogen is available in a cream, tablet, or ring that is inserted into the vagina.
American College of Obstetricians and Gynecologists -- www. Hormonal contraception. Williams Textbook of Endocrinology.
Philadelphia, PA: Elsevier; chap American Congress of Obstetricians and Gynecologists website. Robotic surgery in gynecology. Updated March Accessed March 24, An evidence-based approach to the medical management of fibroids: a systematic review. Clin Obstet Gynecol. PMID: www. Bulun SE. Physiology and pathology of the female reproductive axis.
Curr Opin Obstet Gynecol. Benign gynecologic lesions: vulva, vagina, cervix, uterus, oviduct, ovary, ultrasound imaging of pelvic structures. Comprehensive Gynecology. Donnez J, Dolmans MM. Uterine fibroid management: from the present to the future. Hum Reprod Update. Management of fibroids in perimenopausal women. Uterine artery embolization for symptomatic uterine fibroids. Cochrane Database Syst Rev. Uterine artery embolization: A review of current concepts.
Surgical treatment of uterine fibroids within a containment system and without power morcellation. Evaluating the risks of electric uterine morcellation. FIRSTT study: randomized controlled trial of uterine artery embolization vs focused ultrasound surgery.
Am J Obstet Gynecol. Uterine fibroids. Endocrinology: Adult and Pediatric. Philadelphia, PA: Elsevier Saunders; chap Spies JB. Current role of uterine artery embolization in the management of uterine fibroids. Stewart EA. Clinical practice. N Engl J Med. The management of uterine leiomyomas. J Obstet Gynaecol Can. Robotically assisted vs laparoscopic hysterectomy among women with benign gynecologic disease.
Reviewed by: John D. Editorial team. Editorial update on Uterine fibroids and hysterectomy Hysterectomy and uterine fibroids; Leiomyoma; Myoma. Highlights Uterine Fibroids Uterine fibroids, also called uterine leimyomas or myomas, are non-cancerous growths that originate in the muscular wall of the uterus.
Symptoms of Uterine Fibroids Many women with fibroids do not have any symptoms. When symptoms do occur, they may include: Heavy and prolonged menstrual bleeding Painful menstrual periods Pressure and pain in the abdomen and lower back Bloated and swollen abdomen Frequent urination Constipation Pain during intercourse When occurring during pregnancy, fibroids may give rise to complications such as miscarriage, preterm birth, or postpartum hemorrhage.
Treatment Women without symptoms do not need treatment, but they should be evaluated regularly by their doctors. Introduction A uterine fibroid known medically as a leiomyoma or myoma is a noncancerous benign growth of smooth muscle and connective tissue.
Fibroids originate from the thick wall of the uterus and are categorized by where they grow: Intramural fibroids. Grow within the middle and thickest layer of the uterus called the myometrium. Subserosal fibroids. Grow out from the thin outer fibrous layer of the uterus called the serosa.
Subserosal can be either stalk-like pedunculated or broad-based sessile. Submucosal fibroids. Grow from the uterine wall toward and into the inner lining of the uterus the endometrium. Submucosal fibroids can also be stalk-like or broad-based. The Female Reproductive System The primary structures in the reproductive system include: The uterus is a pear-shaped organ located between the bladder and lower intestine. It consists of two parts, the body and the cervix. When a woman is not pregnant the body of the uterus is about the size of a fist, with its walls pressed against each other.
0コメント