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Is hysterectomy needed?
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It's a common operation. But is it really necessary?
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Samanthi, who is only 37, has been told that she requires a hysterectomy. She is in a state of panic. During a routine check-up, she was found to have a small 3.0 cm fibroid in the uterus, after an ultrasound scan. She has always had regular periods and has minimal pain during the periods. Does she really need this surgery?
What is a hysterectomy?
A hysterectomy is an operation to remove a woman's uterus. Sometimes, the ovaries and fallopian tubes are removed along with the uterus. Unfortunately, hysterectomy has become one of the most common operations being offered to women. Be cautious, and look at your options before agreeing to undergo this surgery.
What should you do if you are told that you need a hysterectomy?
If you have a benign condition such as heavy bleeding, fibroids or endometriosis, there are often other treatments that can be tried first. In most cases, a hysterectomy need not be done immediately. There is time for you to get more information and look into possible alternatives. Before you decide what to do, it is important that you understand your condition and your options for dealing with it.
In cases of serious disease, such as cancer, a hysterectomy is not an option — it is a life-saving choice. If you are told that you should have a hysterectomy:
* Talk to your gynaecologist about your options. Ask about other treatments that are available for your condition.
* Consider getting a second opinion from another gynaecologist.
* Keep in mind that every woman is different and every situation is different. A good treatment choice for one woman may not be the best for another. `My sister had a hysterectomy' is not a good reason for you to have one.
* Remember that hysterectomy is a major surgery. Some women do suffer complications after undergoing the operation.
How is a hysterectomy done?
Hysterectomies are done through a cut in the abdomen (abdominal hysterectomy) or the vagina (vaginal hysterectomy). Laparoscopic hysterectomy is also available in selected cases. The type of surgery that is done depends on the reason for the surgery.
If the ovaries are removed along with the uterus before a woman reaches menopause, then she will enter that stage. Usually, the ovaries are not removed before the age of 45. Always discuss with your gynaecologist if the ovaries can be retained at the time of the hysterectomy.
Why do women have hysterectomies?
Hysterectomies are most often done for the following reasons:
* Uterine fibroids: Fibroids are common, benign (noncancerous) tumours that grow in the muscle of the uterus. More hysterectomies are done because of fibroids. Fibroids often cause no symptoms and need no treatment, and they usually shrink after menopause. A hysterectomy is only required if fibroids cause heavy bleeding or symptoms due to their size.
* Abnormal bleeding: Between the ages of 35 and 45, many women suffer changes in their menstrual pattern. This is because the normal pattern of ovulation may be affected. Most of these conditions return to normal on their own or can be treated with medications. A hysterectomy should not be the first option.
* Endometriosis: This is another benign condition that affects the uterus. It is most common in women in their thirties and forties, especially women who have never been pregnant. It occurs when the endometrial tissue (the inside lining of the uterus) begins to grow on the outside of the uterus and on nearby organs. This condition may cause painful periods, abnormal bleeding, and sometimes, loss of fertility. Endometriosis can be treated with laparoscopic surgery. A hysterectomy is only needed if alternative treatment has failed.
* Uterine prolapse: Here, the uterus moves from its usual place down into the vagina. Uterine prolapse is due to weak and stretched pelvic ligaments and tissues.
Other organs such as the bladder can also be affected. Childbirth, and loss of oestrogen after menopause, may contribute to this problem.
* Cancer affecting the pelvic organs account for only about ten percent of all hysterectomies. Cervical cancer (cancer of the cervix), endometrial cancer (cancer of the lining of the uterus) and cancer of the ovaries often require hysterectomy. Depending on the type and extent of the cancer, one can go in for other kinds of treatment such as radiation or chemotherapy.
What are the alternatives to a hysterectomy?
Oral medication: Medication such as tranexamic acid and mefenamic acid can reduce the menstrual flow significantly and has been shown to reduce the necessity for hysterectomy.
A new kind of intrauterine device delivers medication directly to the lining of the uterus and can reduce heavy bleeding considerably.
Endometrial ablation is a technique for destroying the lining of the uterus and can be offered in cases of heavy bleeding.
GITA ARJUN
(The author is a Chennai-based obstetrician and gynaecologist with a special interest in women's health issues)
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