Prof. Dr. Gamze Sinem Yücel

A brief review of female reproductive anatomy may be of help in understanding hysterectomy. The uterus is a hollow, pear-shaped muscular organ located in the lower abdomen and pelvis.At the upper end of the uterus, the fallopian tubes open on each side. The outer end of each tube lays next to an ovary. The ovaries lay next to and slightly behind the uterus. At its lower end, the uterus narrows and opens into the vagina. The lower end of the uterus is called the cervix.

The uterus removal surgery is called hysterectomy. Hysteroscopy and hysterectomy are completely different procedures. Hysteroscopy is viewing the uterine cavity with a camera. Hysterectomy is surgery for removing the uterus.

Hysterectomy

There are different types of hysterectomy. Uterus surgery for removal (hysterectomy) can be performed by open surgery (laparotomy) or laparascopy (key hole surgery), or vaginally. Uterus (hysterectomy) can be performed for different causes. Hysterectomy for endometriosis and fibroids are very common.

Fibroids are common cause of hysterectomy

Fibroids (also known as leiomyomas) are noncancerous growths of uterine muscle that occur in up to one-third of all women. Fibroids may become larger during pregnancy, and typically shrink after menopause. They may cause excessive bleeding and pelvic pain or pressure. Uterine fibroids can be at different size and number. Hysterectomy for fibroids can be performed by laparoscopy if fibroids are small. When hysterectomy for myoma is planned, preoperative evaluation of the patient determines the route of surgery (laparotomy or laparoscopy).

Laparotomy requires an incision (cut) in the lower belly to remove the fibroids. Laparoscopy uses several small incisions in the abdomen. Laparoscopic surgeon uses thin instruments and a camera (laparoscope) to remove the fibroids. The fibroid can then be removed through a bigger incision or broken into smaller pieces for removal (“morcellation”). Expert laparoscopic surgeons can perform laparoscopic hysterectomy for large fibroids. Fibroids are removed in young women, this is called myomectomy and there is no need for hysterectomy in many cases. Hysterectomy for fibroids is performed in women over 45 years of age where childbearing age is over. When fibroids are suspicious for malignancy, hysterectomy is required.

Hysterectomy is very rarely performed after polypectomy

Hysterectomy is indicated if the histopathology examination of the polyp is malignant.

Dysfunctional uterine bleeding

Dysfunctional uterine bleeding (DUB) and excessive uterine bleeding, called menorrhagia, can lead to anemia (low blood iron count), fatigue, and contribute to missed days at work or school. Menorrhagia is generally defined as bleeding that lasts longer than seven days or saturates more than one pad per hour for several hours.Dysfunctional uterine bleeding (or any uterine bleeding after menopause) can also be a sign of uterine cancer. All women with these symptoms should undergo evaluation. DUB might not respond to medical treatment. In these cases hysterectomy is the treatment of choice.

Hysterectomy is performed after D&C

Hysterectomy is performed after D&C to sample the endometrium. (Dilation and curettage [D&C] is a procedure in which material from the inside of the uterus is removed. The “dilation” refers to dilation (opening) of the cervix, the lower part of the uterus that opens into the vagina,”Curettage ” refers to the scraping or removal of tissue lining the uterine cavity [endometrium] with a surgical instrument called a curette. A D&C procedure may be done for different reasons, including to look for the cause of a problem, such as abnormal uterine bleeding; for treatment of a miscarriage or postpregnancy bleeding; or for first trimester abortion [pregnancy termination].

Hysterectomy is a surgical procedure to remove all or part of the uterus.

If endometrium cancer is detected in this case then surgery for endometrial cancer needs to be performed. If cervix cancer is detected radical hysterectomy is performed which is a surgical procedure that involves removing the uterus, cervix, some of the vagina, and connective tissues surrounding the cervix and uterus (parametrium). The ovaries do not necessarily have to be removed during a radical hysterectomy for cervical cancer; this decision depends upon your age and other factors. At the time of radical hysterectomy, the lymph nodes in the pelvis, and sometimes higher up in the abdomen, are removed and evaluated to check for spread of cancer.

Endometriosis

Endometriosis is definitively treated with hysterectomy and removal of both ovaries and tubes. Endometriosis is also a problem after hysterectomy if ovaries are not removed and can be a cause of chronic pelvic pain.

Hysterectomy may be performed for pelvic organ prolapse

Pelvic organ prolapse occurs due to stretching and weakening of the pelvic muscles and ligaments. This allows the uterus to fall (or prolapse) into the vagina. Prolapse is more common in women who have been pregnant and/or had vaginal childbirth, and in those with certain genetic factors, lifestyle factors (such as repeated heavy lifting over the lifetime), or chronic constipation. In this case usually vaginal hysterectomy is preferred. Vaginal hysterectomy is a procedure in which the uterus is surgically removed through the vagina.

There are two main parts of the uterus the upper side of the uterus is corpus uteri called the lower part is called the cervix.

Abdominal hysterectomy

Abdominal hysterectomy may be performed for cervical abnormalities: Hysterectomy is rarely needed for severe cervical precancer that does not resolve after other procedures (such as cone biopsy).

Abdominal hysterectomy may be performed for endometrial hyperplasia. Endometrial hyperplasia is the term used to describe excessive growth of the endometrium (the tissue that lines the uterus). It can sometimes lead to endometrial cancer. Although endometrial hyperplasia can often be treated with medication, a hysterectomy is sometimes needed or preferred to medical therapy.

Total abdominal hysterectomy

Total abdominal hysterectomy may also be performed for severe bleeding after childbirth : Hysterectomy may rarely be required in women who have uncontrollable bleeding after childbirth.

After uterus removal

Pelvic pain after hysterectomy depends on route of surgery (laparotomy or laparoscopy or vaginal hysterectomy). Surgical removal of the uterus is less painful if performed by laparoscopy.

The uterus removal side effects are minimum. After removing uterus, light bleeding is more commonly observed side effect. Bleeding after uterus removal may last up to 15-20 days. Uterus removal (hysterectomy) cases need to stay in the hospital for 1-2 days after the procedure depending on the type of surgery.

Ovary pain after hysterectomy might occur only in cases with ovarian pathologies and if the ovaries are not removed during hysterectomy.

Pelvic pain years after hysterectomy may underlie other problems rather than gynecological pathologies.

Hysterectomy is a major surgery and it can be done in different techniques in different ways laparoscopic surgery is one of the ways to remove the uterus.

Ovarian cyst after hysterectomy may be seen in some cases where ovaries are not removed simultaneously. Cyst on ovary after hysterectomy maybe left untreated if the cyst is benign and unilocular. Ovaries may be removed concomittantantly with uterus depending on your age or co-existing ovarian diseases. In this case procedure is called total abdominal hysterectomy and bilateral salpingo-oophorectomy (TAH-BSO) which means the removal of both your fallopian tubes and ovaries in addition to your uterus.

Studies of women’s response to hysterectomy show that most women are satisfied with their results. Most reported improvement in symptoms, such as pain and vaginal bleeding. Sexual function and enjoyment, interest in sex, and pain with sex improved after hysterectomy for most women. However, everyone’s situation is different, and your results will likely may depend upon several factors, including your age at the time of surgery, the reason for surgery, and whether you have a history of mood problems.

Hysterectomy price

The cost of the uterus removal surgery depends on the type of surgery itself. Hysterectomy prices in Turkey range from 3000 to 3500 dollars on average.

Frequently Asked Questions

What are 3 reasons a hysterectomy is performed?

A hysterectomy is performed for various reasons, including heavy periods due to fibroids, pelvic pain caused by conditions like endometriosis or fibroids, prolapse of the uterus, and cancers of the cervix, ovaries, or womb. The reasons for this surgery vary and should be discussed with a healthcare provider.

How is life different after a hysterectomy?

Life after a hysterectomy may be different, especially if you haven’t entered menopause yet. You may experience hot flashes, mood swings, changes in sexual desire and enjoyment, and vaginal dryness. These symptoms can be managed with hormone therapy, lubricants, and other treatments. It’s also important to follow a healthy lifestyle and attend regular check-ups with your gynecologist.

What happens when uterus is removed?

When a hysterectomy is performed, the uterus is surgically removed, which means you will no longer be able to conceive. If you haven’t gone through menopause yet, the surgery will cause your periods to cease, regardless of your age. This procedure is more prevalent among women aged 40 to 50.

Does removing uterus affect your body?

Yes, removing the uterus can affect the body in the short-term, but the risks are usually mild and minimal. The most common risks include blood loss, which may require a blood transfusion, and damage to surrounding areas such as the bladder, urethra, blood vessels, and nerves. These risks generally occur within the first 30 days after the surgery.

Why would a woman remove her uterus?

A woman may choose to remove her uterus through a hysterectomy due to various reasons. These include heavy periods caused by fibroids, pelvic pain caused by conditions like endometriosis, PID, adenomyosis, and fibroids, as well as prolapse of the uterus. It is a common surgical procedure that can be done through different methods as recommended by the doctor, depending on the woman’s specific case.