10 Reasons for Hysterectomy, Plus Benefits and Side Effects

1.Uterine fibroids

endometriosis, fibroids are the most common reason for a hysterectomy. There is a very good reason for this. Between 10 and 30 percent of women having a hysterectomy are having it because of uterine fibroids. Uterine fibroids are the most common, non-cancerous growths in women and they grow from the muscle layers of the womb. They can be found in up to 25 percent of white women and over 50 percent of black women in their reproductive years. Surgeons doing hysterectomies for fibroids will be removing more than one fibroid from patients up to 64 percent of the time.

Fibroids can cause problems at any time, but probably the most common time they can become problematic is during the perimenopausal years when hormone levels are changing. Fibroids frequently grow in response to hormones and they cause symptoms due to their size and/or location. Symptoms can include:

Heavy menstrual bleeding, which can lead to anemia;
Pain or pressure in the pelvis and low back;
Increased menstrual pain;
Difficult urination;
Symptoms related to pregnancy loss or infertility (there is a 2-4 fold increased risk of having some of these symptoms treated if the woman is having a hysterectomy);

2.Cancer

Invasive cervical cancer was once the leading cause of cancer death for women in the US, and while this is no longer the case, there are still an estimated 12,200 new cases in 2010. It is highly preventable with regular screening tests and prompt treatment when abnormal cell changes are found. Although there are different surgical options specific to the stage of the disease, in many cases, surgery may involve removing the uterus and cervix, which is an effective treatment for early cervical cancer. With the incidence of advanced cervical cancer decreasing, it is actually becoming less common to see a hysterectomy for cervical cancer in the older age groups, and it is more likely that the patient undergoing the surgery is younger. This is particularly difficult for women who have not had children when the diagnosis occurs. With the technical advances in radical trachelectomy, fertility-sparing surgery is increasingly becoming a feasible option for women with early cervical cancer who have a strong desire to bear children.

3.Endometriosis

The pain of endometriosis can be so severe and debilitating that it seriously affects women’s lives. This damage may result in adhesions, which are bands of scar tissue that may cause pelvic tissues and organs to stick together. Endometrial tissue is more likely to have an abnormal appearance or be located in areas outside the uterus in women who have pain symptoms or infertility. In addition, researchers have found that the severity of endometriosis does not determine the pain levels experienced.

Women who have severe pain may have mild endometriosis, while women with severe endometriosis may have little pain or even no pain at all.It should be noted that there is no association between retrograde menstruation and the extent of endometriosis. Many women with retrograde menstruation in their pelvic cavity do not develop endometriosis.

4.Adenomyosis

Adenomyosis is a condition of the uterus in which the lining of the uterus begins to grow into the muscular wall of the uterus. The result of this is enlargement of the uterus. It can cause symptoms such as heavy or prolonged menstrual bleeding, painful menstruation, and painful intercourse. A woman may also have no symptoms at all. Adenomyosis is often discovered by chance during a routine gynecological examination, investigation, or pelvic ultrasound when a woman is being investigated for another condition.

Adenomyosis is not cancer, though the symptoms may at times imitate those of fibroids or act as a coexisting condition. In the reproductive age group, the symptoms may resolve with the onset of natural or medically induced menopause. This may relieve the symptoms to the point that no further treatment is needed. Treatment for adenomyosis ranges from analgesia, anti-inflammatory drugs, or hormone medication to surgical excision of the adenomyosis or ultimately hysterectomy.

5.Infection

Infection can occur after any type of surgery. The wound infection rate is about 2% to 4% for women who have had an abdominal hysterectomy and less than 1% for women who have had a vaginal or laparoscopic hysterectomy. Infections can usually be treated easily with a course of antibiotics, but if an infection is severe, it may require further surgery to drain the infected area. Internal infections, such as bladder or kidney infections, are usually associated with urinary tract injuries. If a urinary tract injury occurs during surgery, the bladder or ureters (the tubes that drain the kidneys into the bladder) may need repairing, and a catheter may need to be inserted for a short time. This is a relatively uncommon side effect, but it is more common when a woman has had an abdominal hysterectomy. In extremely rare cases, a severe infection can cause damage to or even destroy the uterus transplant site . This can result in a life-threatening infection and may require further major surgery to clean the affected area.

6.General abnormal bleeding

Abnormal vaginal bleeding is the common sign that leads patients to seek medical advice. It’s usually defined by bleeding in between normal menstrual periods, heavy menstrual flow, and other abnormal bleeding. There are numerous causes of abnormal bleeding, and in some cases, once the cause being treated has been cured, there will be no prolonging effect on the patient. For instance, bleeding due to hormone replacement therapy will stop once the medication is halted. Causes of abnormal bleeding consist of a wide range of conditions such as cervical or endometrial polyps, a foreign object in the vagina, or ectopic pregnancy. In some cases, it might be a sign of a serious life-threatening condition like cervical, endometrial, or vaginal cancer. Any postmenopausal bleeding is considered abnormal, and the patient should seek immediate medical attention as it may signify a serious underlying cause. In this case, the patient usually will undergo a series of examinations to confirm the cause.

7.Uterine prolapse

A uterine prolapse is literally defined as a slipping or falling of the uterus from its usual position in the body into the vaginal canal. It is important to understand the normal anatomy to understand the implications of a uterine prolapse. The uterus is held in position by « suspensory ligaments. » There are two anterior and two posterior ligaments. The posterior ligaments are attached to the sacrum and the anterior ligaments are connected to the pubic bone. These ligaments function to hold the uterus in an anteverted position, which means tilted forward with respect to the vaginal canal to which it is connected. A loss of support of the uterus may occur when the ligaments become weakened and are no longer able to support the uterus due to things such as a difficult childbirth, chronic coughing, obesity, anything that places a chronic strain on the pelvic floor muscles. At this point, you may experience feelings of heaviness or notice a bulge at the vaginal opening. A milder form of a prolapse is known as a « procidentia » in which the entire uterus protrudes outward and may even be expelled from the body.

Uterine prolapse can predispose a woman to experience stress urinary incontinence or affect her bladder and bowel function. In some severe cases, it may be very difficult to keep a pessary in place due to the lack of support of the vaginal walls which will be discussed in further detail. Some women may also experience ulceration at points on the exposed cervix or even necrosis of the uterus which is obviously a very serious issue.

7.Uterine prolapse

8.Delivery complications

The « ideal delivery experience » is often shattered into pieces after a chaotic chain of events resulting in an emergency c-section. If one were to envision the experience and recovery involved with a hysterectomy, a failed attempt at delivering a baby would be it. Women who have experienced a failed induction of labour or laboured for as little as one contraction are at risk of requiring a hysterectomy due to the trauma that their uterus has sustained. A major abruption or rupture involving the uterus, cervix, or the blood vessels that supply the uterus is a life-threatening situation for both mother and baby. The severity of these complications can sometimes require an emergency hysterectomy as a means to save the mother’s life or to control the hemorrhaging that has ensued. Women who have required a c-section, regardless of the circumstances, are also at a slightly increased risk of requiring a hysterectomy at some point in the future. This specific form of hysterectomy known as a « repeat c-section hysterectomy » can be rather complex due to the presence of adhesions from previous surgery and compromise of blood supply to the surrounding organs.

9.Placenta accreta

Placenta accreta and its related conditions affect around 7 in 10,000 pregnancies, however this number is rising with the increasing rate of caesarean section. Some studies suggest that accreta and increta affect 40% of pregnancies in women with placenta previa that require a repeat caesarean section. This is because in a previous caesarean section, scar tissue forms in the uterine wall where the incision was made. Normally, the placenta avoids these scarred areas, however in cases of accreta, the placenta has grown into these scarred areas. Up to 66% of patients with placenta accreta will require a blood transfusion, usually due to heavy blood loss during delivery. Any condition of accreta raises the risk of hysterectomy with rates of near 50% with increta and 90% with percreta to effectively control heavy bleeding and prevent hemorrhage.

During a normal pregnancy, the placenta grows into the wall of the uterus and remains there until the baby is born and the placenta follows. In most cases, the placenta detaches from the uterine wall after the baby is born and the uterus then contracts and shrinks, allowing the placenta to be expelled. In some cases, however, the placenta is very deeply attached and fails to detach after delivery, either partially or completely. This is known as a retained placenta. This can cause serious complications including severe bleeding, hemorrhage, and infection, usually occurring within the first 24 hours after delivery. In the case of a partial or complete placenta accreta, the placenta has become so deeply attached that it cannot separate from the uterine wall causing severe bleeding and poor placenta delivery.

10.Gender affirming surgery

Appropriate surgical treatment of the transgender patient is a topic of much discussion and is an evolving field in medicine. Clear guidelines and standards of care for surgical treatment of transgender patients do not exist at this time. This is reflected in the variability in surgical practices seen across centers and the lack of surgical options for certain patient populations. Services for the gender change to male patient are particularly limited in the areas of gynecologic surgery and urology. Transgender individuals still face significant barriers when seeking medical care, with 19% being refused medical care due to their transgender or gender-nonconforming status and 28% experiencing harassment in a medical setting.

Gender affirming surgery is a mastectomy procedure as well as a removal of the reproductive organs. Oophorectomies are not done at MGH and are not typically included in female to male transgender surgery. Hysterectomies are typically done only for medical reasons and not as part of gender affirming surgery. Most often, removal of the uterus and ovaries is done as part of a complex pelvic organ removal needed to treat pelvic pathology. A simple hysterectomy, removal of the uterus only, is not the assumption for males seeking pelvic organ removal, and hysterectomies are not done on quite the same population that is seeking gender change to male.