When is a hysterectomy necessary?

Guidelines to help you know when this gynaecological surgery may be needed.

24 June 2015
by Ruth Rehbock

If you are suffering from gynaecological problems, it’s a good idea to know about the types of treatments available, and if your doctor recommends a hysterectomy, why he has selected that one in particular. 

Experts say the most common condition that requires a hysterectomy is menorrhagia, what is commonly known as heavy menstrual bleeding, which can be very uncomfortable and disruptive. “For women who have had children and completed their family and who suffer from menorrhagia, we may recommend the removal of the uterus – a total hysterectomy as one treatment option,” says Dr Tom Mokaya, a gynaecologist based at Netcare’s Sunninghill Hospital in Sandton.

He says that heavy menstrual bleeding causes a drop in haemoglobin (the protein molecule in red blood cells that carries oxygen from the lungs to the bodies’ tissues and returns carbon dioxide from the tissues back to the lungs) which means these women are always tired. “We normally first recommend the use of the Mirena (a hormonal intrauterine device, or IUD, that’s inserted into the uterus for long-term birth control) to slow the bleeding, but if that doesn’t work, we recommend a hysterectomy,” he says.

The difference between a total or sub-total/partial hysterectomy

Dr Mokaya explains that a total hysterectomy means the uterus, cervix and perhaps also the fallopian tubes and/or ovaries are removed, although the ovaries are usually assessed separately. A partial or sub-total or supracervical hysterectomy means that the uterus is removed and the cervix and/ovaries are left intact.

The ovaries are only removed if they are found to be abnormal or at a pre-cancerous stage. “Women who experience pain or enlarged ovaries must get themselves checked immediately, as either symptom could indicate a problem with the ovaries which will warrant further investigation,” says Dr Mokaya. Doctors will only remove a woman’s ovaries if they pose a serious risk to a woman’s health.

Hysterectomies can be done through an incision in the abdomen or laparoscopically (a laparoscope is a thin, lighted tube which can be used to see and manipulate organs). With laparoscopic surgery, the uterus is removed either through the vagina or through a small incision in the abdomen, both of which allow for a much shorter recovery time.

Gynaecologic cancers and hysterectomies

The most common cancer requiring a hysterectomy is cervical cancer, which is generally caused by HPV (human papillomavirus) infection through sexual contact with an infected individual.

The doctor will recommend a hysterectomy if tests reveal recurrent abnormal cells in the cervix. “We use Pap smears to take samples of cervical cells, which may show low-grade abnormalities, or cells that show high-grade abnormalities,” says Dr Mokaya. With the former, he says, the doctor will continue testing regularly to see if the cells revert to normal on their own, or if they don’t, the doctor will remove those abnormal cells from the cervix. If they find high-grade abnormal cells however, the doctor may recommend the removal of the uterus and the cervix – a total hysterectomy.

Uterine or endometrial cancer occurs mostly in post-menopausal women and may, in some instances, be hereditary. “Endometrial cancer may also be associated with a history of female breast cancer in the family or with a history of male colon cancer,” says Dr Mokaya.

Endometrial cancer may present as heavy menstrual bleeding or post-menopausal bleeding. Once doctors check for, and find, abnormal endometrial cells (cells on the inside the womb) or malignant cancer cells, they will decide on whether a hysterectomy is necessary or not.

A hysterectomy may not always be the only solution

There are other treatment options available for the conditions below, so consult with your doctor first about less invasive treatments versus the necessity of a hysterectomy, particularly if you still want to fall pregnant:

  • Uterine fibroids or growths: These are noncancerous growths of the uterus that often appear during your childbearing years.
  • Uterine prolapse: A prolapse of the uterus occurs when the muscles and ligaments that hold it in place stretch and weaken, causing it to slip down into or protrude out of the vagina.
  • Endometriosis: This occurs when tissue that normally grows inside the uterus grows outside the uterus, causing pelvic pain and infertility.
  • Adenomyosis: This condition sees the thickening of the walls of the uterus as well as heavy bleeding and severe pain.

How Clicks Clinics can help you

Pap smears are available at selected Clicks Clinics. Call 0860 254 257 to find out where you can go for one and to book an appointment today.

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