Hysterectomy Choice: Longevity Health Report

According to the British Medical Association, hysterectomy (the surgical removal of the uterus) is one of the most common operations performed in Western countries. Statistics reveal that by the age of 55, around one in five UK women would have undergone a partial or full hysterectomy. In some countries, such as Australia and the US, these numbers are considerably higher.

Reasons for having a hysterectomy:

  • Endometriosis: 5,4%; (click here to find out more about this condition)
  • Cancer: 5,6%;
  • Prolapse: 6,5%;
  • Menstrual problems: 35,3%;
  • Fibroids: 38,5%; and
  • Other: 8,7%.

Hysterectomy is considered to be different from other major operations in that it can often involve the removal of healthy or non-diseased organs, and, for some women, it’s a life- changing decision – particularly if you are still considering having children.

A study entitled The Effect of Hysterectomy on Sexuality and Psychological Changes, published in the US National Library of Medicine National Institutes of Health, reveals that this is a procedure that often does not need to be performed as a matter of urgency, except in the case of cancer. Click here to find out more about this study. Choosing to undergo a hysterectomy takes an informed decision – as problems or reactions may arise if the operation has been done for the wrong reasons. It is imperative that you have a good relationship with your gynae and that you discuss all of your options prior to making your choice.

According to research, the decision whether to have a hysterectomy or not can be a very difficult and emotional process, and has been linked to depression, including severe and prolonged feelings of sadness and hopelessness; diminished interest in activities; significant weight loss or gain; insomnia; and fatigue.

Ultimately, the researchers say, each woman will react differently, and the emotions are a combination of emotional and physical responses.

Professor Alan Alperstein, a Cape-based gynaecologist, explains that a hysterectomy is performed when “uterine pathology impacts or threatens a woman’s health”. Most often this is due to growths (tumors), cancers or precancers. “In these women, there is no doubt that hysterectomy is appropriate. Uterine prolapse and pelvic pain are other indications.”

He adds that many women have hysterectomies due to excessive bleeding. “However, many of these bleeding-related conditions can be managed without hysterectomy. Once pathology is excluded, these excessive bleeders can have hormonal therapy, medical therapy, an intrauterine device with progesterone inserted, or have an ablation of their lining of the uterus.”

Alperstein says this could prevent up to 40% of the hysterectomies performed.

The procedure

There are a number of options with a hysterectomy: they can be done via the abdomen (open surgery), vaginally or laparoscopically. Total hysterectomies involve the removal of the uterus and cervix, and can be done with or without ovarian removal. This is considered to be the most common form of hysterectomy.

The advantage of removing the cervix is that it protects against the risk of abnormal cellular changes, which can in turn lead to cancer. Having a total hysterectomy means you no longer have to go for your annual pap smear, provided, of course, that your uterus was healthy and free of any abnormalities at the time of your hysterectomy.

A subtotal hysterectomy is one that involves removing the uterus, but not the cervix. “This means that the upper part of the uterus (which causes most of the problems) is removed,” states Alperstein. This form of hysterectomy is a shorter and simpler operation, as the removal of the cervix is considered the most difficult part of the operation. However, the disadvantage is that you may still be at risk of abnormal cellular changes, so you will need to continue going for your annual pap smear.

The good news is that research reveals that, even if you go for a total hysterectomy, you will not experience a deterioration in your sex life.

“The decision of the technique to be performed is made by the surgeon, in discussion with you. It will depend on the pathology and skills/experience of the surgeon,” Alperstein notes. In general, the duration of your stay in hospital will be between one and four days. On average, you can expect to take two weeks of rest, with no physical activity, followed by two weeks of slowly getting back to normal activities.

“Assuming no complications, most women feel better by four weeks. Often ‘tiredness’ is the biggest problem. By six weeks, a full recovery is expected,” he says.