Treatments & Therapies

Hysterectomy – Treatment, Effects & Risks

Hysterectomy

Hysterectomy is the surgical removal of the uterus . The term uterine extirpation is also used synonymously with hysterectomy .

What is the hysterectomy?

The medical term hysterectomy comes from the Greek. Hystéra means womb and the word ectome can be translated as cut or cut out. If the ovaries are also removed during the surgical removal of the uterus, i.e. the womb, the procedure is referred to as a hysterectomy with adnexectomy (on one or both sides).

Adnexa is the medical term for the ovaries. Subtotal hysterectomy is often differentiated from total surgery. While the cervix is ​​not removed during supracervical hysterectomy , the entire uterus is removed during total surgery. Hysterectomy is usually performed for benign conditions. In gynecological surgery , the procedure is quite common. Possible indications are, for example, cysts or fibroids . Around 150,000 hysterectomies are performed in Germany every year. 50 percent of all women are between 40 and 49 years old when their uterus is removed.

Function, effect & goals

The uterus can be removed for a variety of reasons. Benign tumors and functional diseases of the uterus are the main indications for hysterectomy. 90 percent of operations are performed because of such diseases. 

One possible indication is menstrual irregularities . These are also known as menstrual cycle disorders. Anomalies in the bleeding rhythm can be distinguished from anomalies in the intensity of the bleeding. Additional bleeding or persistent bleeding in the absence of ovulation and the complete absence of menstruation (amenorrhea) are also among the menstrual disorders. However, an indication for a hysterectomy is mainly increased bleeding. While amenorrhea usually does not cause any problems for women, excessive bleeding can lead to anemia (low blood count). However, the most common reason for a hysterectomy is the uterus myomatosus. These are uterine fibroids. Fibroids are benign tumors that develop and grow under the influence of estrogens , progesterones and growth factors.

Women often do not notice the fibroids. Depending on the location and size, however, pain , constipation , difficulty urinating, or discomfort during sexual intercourse can develop. Due to the disturbed regeneration of the mucous membrane, bleeding or anemia can occur. In addition, pedunculated fibroids can rotate, causing an acute abdomen . 17 percent of all hysterectomies are performed for endometriosis . Endometriosis is a benign, chronic condition that can cause severe pain.

This is caused by uterine lining that has settled in the body outside of the uterus. For example, the ovaries, the vaginal wall, the intestines or even the lungs and brain can be affected. Like the normal uterine lining, the disrupted uterine lining also reacts to the menstrual cycle. Endometriosis is a common cause of infertility . If the pain due to endometriosis is too high and you do not want to have children, the uterus can be removed.

Another reason for a hysterectomy is a uterine prolapse . In uterine prolapse , the uterus pushes through the birth canal to the vagina. The uterus can partially protrude from the vagina.

Only in 10 percent of all cases is the uterus removed due to a malignant disease. Possible indications are malignant tumors of the ovaries, the cervix or the body of the uterus. A hysterectomy may also be necessary after injury to the uterus or in the case of birth complications with uncontrollable bleeding. A rough distinction can be made between a simple hysterectomy, a hysterectomy with adnextomy, a hysterectomy with pelvic floor plastic surgery and a total operation. The choice of surgical procedure depends on various factors. The indication, the size and shape of the uterus, the mobility of the uterus, the experience of the surgeon and the facilities of the clinic all play a role in the decision-making process.

In a vaginal hysterectomy, the uterus is removed through the vagina. Laparoscopic hysterectomy, also known as TLH or total laparoscopic hysterectomy, is performed using a laparoscope and other instruments inside the abdominal cavity. Laparoscopic and vaginal hysterectomy procedures can be combined. In laparoscopically-assisted hysterectomy (LAVH), the uterus is operated on laparoscopically and removed through the vagina. In addition, a laparotomy can be performed with preservation of the cervix. This operation is also called a subtotal or supracervical abdominal hysterectomy.

Total abdominal hysterectomy is performed through an abdominal incision without preserving the cervix. During vaginal removal, the cervix is ​​also removed. With the abdominal and laparoscopic surgical procedures, there is an opportunity to preserve the cervix. With both methods, the fallopian tubes and ovaries can be removed at the same time. Of course, this additional removal should only be carried out if there is a corresponding indication.

In some stages of cervical cancer , the Wertheim-Meigs radical hysterectomy is the procedure of choice. Here the uterus, the associated holding apparatus, the upper third of the vagina and the pelvic lymph nodes are removed.

Risks, side effects & dangers

It should be noted that hysterectomy in a woman leads to total infertility. In women who want to have children, the uterus should only be removed if there is no other option.

The removal of the uterus rarely leads to wound healing disorders or injuries to the ureters , bladder and intestines. Bleeding can also occur. Other complications of hysterectomy include urinary tract infections , incisional hernias, adhesions, painful intercourse and prolapse.

Lisa Newlon
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Hello! I am Lisa Newlon, and I am a medical writer and researcher with over 10 years of experience in the healthcare industry. I have a Master’s degree in Medicine, and my deep understanding of medical terminology, practices, and procedures has made me a trusted source of information in the medical world.