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Hysterectomy

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A hysterectomy (from Greek ὑστέρα hystera "womb" and εκτομία ektomia "a cutting out of") is the surgical removal of the uterus, usually performed by a gynecologist. Removal of the uterus renders the patient unable to bear children (as does removal of ovaries and fallopian tubes), and changes hormonal levels considerably.

Indications

Hysterectomy is usually performed for problems with the uterus itself or problems with the entire female reproductive complex. Some of the conditions treated by hysterectomy include uterine fibroids (myomas), endometriosis (growth of menstrual tissue outside of the uterine cavity), adenomyosis (a more severe form of endometriosis, where the uterine lining has grown into and sometimes through the uterine wall), several forms of vaginal prolapse, heavy or abnormal menstrual bleeding, and at least three forms of cancer (uterine, advanced cervical, ovarian). Hysterectomy is also a surgical last resort in uncontrollable postpartum obstetrical haemorrhage.[1]

Other indications for this surgery include:

  • Certain types of reproductive system cancers (uterine, cervical, ovarian) or tumors
  • As a prophylactic treatment for those with either a strong family history of reproductive system cancers (especially breast cancer in conjunction with BRCA1 or BRCA2 mutation) or as part of their recovery from such cancers
  • Severe and intractable endometriosis (overgrowth of the uterine lining) and/or adenomyosis (a more severe form of endometriosis, where the uterine lining has grown into and sometimes through the uterine wall) after pharmaceutical and other non-surgical options have been exhausted
  • Postpartum to remove either a severe case of placenta praevia (a placenta that has either formed over or inside the birth canal) or placenta accreta (a placenta that has grown into and through the wall of the uterus to attach itself to other organs), as well as a last resort in case of excessive postpartum bleeding
  • For trans men, as part of their gender transition
  • For severe developmental disabilities

Technique

Types of Hysterectomy:

  • Radical hysterectomy : complete removal of the uterus, upper vagina, and parametrium
  • Subtotal hysterectomy : removal of the fundus of the uterus, leaving the cervix in situ
  • Total hysterectomy : Complete removal of the uterus including the corpus and cervix

Benefits

Women with a risk of breast cancer, especially those with BRCA1 or BRCA2 gene mutations, have been shown to have a significantly reduced risk of developing breast cancer after prophylactic oophorectomy.[2] In addition, removal of the uterus in conjunction with prophylactic oophorectomy allows estrogen-only hormone replacement therapy (HRT) to be prescribed to aid the individual through their transition into surgical menopause, instead of estrogen-progestin HRT, which has a slightly increased risk of breast cancer as compared with post-menopausal non-hysterectomized women taking HRT.[3]

The Maine Women's Health Study of 1994 followed for 12 months time approximately 800 women with similar gynecological problems (pelvic pain, urinary incontinence due to uterine prolapse, severe endometriosis, excessive menstrual bleeding, large fibroids, painful intercourse), around half of whom had a hysterectomy and half of whom did not. The study found that a substantial number of those who had a hysterectomy had marked improvement in their symptoms following hysterectomy, as well as significant improvement in their overall physical and mental health one year out from their surgery. The study concluded that for those who have intractable gynecological problems that had not responded to non-surgical intervention, hysterectomy may be beneficial to their overall health and wellness.[4]

One of the conditions most cited by women who have complex pelvic and reproductive issues is pain[5]. This is particularly true for women who have other conditions that amplify pain, such as fibromyalgia and chronic fatigue syndrome.[citation needed] Removal of a condition that is causing pain has a dramatic effect on reducing the overall pain levels of a person with such disorders; for many women with such pain conditions, a hysterectomy is preferable to the continual pain which adds to the burden of their already painful lives, even though the loss of hormones post-surgery may initially contribute to an increase in the symptoms of their disorder[6].

Risks and side effects

Some women find their natural lubrication during sexual arousal is also reduced or eliminated. Those who experience uterine orgasm will not experience it if the uterus is removed. The vagina is shortened and made into a closed pocket and there is a loss of support to the bladder and bowel.

Those who have undergone a hysterectomy with both ovaries removed typically have reduced testosterone levels as compared to those left intact.[7] Reduced levels of testosterone in women is predictive of height loss, which may occur as a result of reduced bone density,[8] while increased testosterone levels in women are associated with a greater sense of sexual desire.[9] Hysterectomy has also been found to be associated with increased bladder function problems, such as urinary incontinence.[10] Hysterectomies have also been linked with higher rates of heart disease and weakened bones.[11]

As part of transitioning from female-to-male

Hysterectomies with bilateral salpingo-oophorectomy are often performed either prior to or as a part of sex reassignment surgery for trans men. Some in the FTM community prefer to have this operation along with hormone replacement therapy in the early stages of their gender transition to avoid complications from heavy testosterone use while still having female-hormone-producing organs in place (e.g. uterine cancer and hormonally-induced coronary artery disease) or to remove as many sources of female sex hormones as possible in order to better "pass" during the real life experience portion of their transition.[12] Just as many, however, prefer to wait until they have full "bottom surgery" (removal of female sexual organs and construction of male-appearing external anatomy)[13] to avoid undergoing multiple separate operations.[14]

References

  1. ↑ Roopnarinesingh R, Fay L, McKenna P (2003). "A 27-year review of obstetric hysterectomy". Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 23 (3): 252–4. PMID 12850853. 
  2. ↑ Rebbeck TR, Lynch HT, Neuhausen SL, et al. (2002). "Prophylactic oophorectomy in carriers of BRCA1 or BRCA2 mutations". New England Journal of Medicine 346 (21): 1616–22. doi:10.1056/NEJMoa012158. PMID 12023993. Retrieved on 2007-06-07. 
  3. ↑ DeNoon DJ (2006-04-11). Estrogen HRT: No Breast Cancer Risk. Retrieved on 2007-06-07.
  4. ↑ Parker WH. Hysterectomy--A Gynecologist's Second Opinion. Retrieved on 2007-06-07.
  5. ↑ "The Female Reproductive System"; reviewed by Wayne Ho, MD, and Stephen Dowshen, MD; written May 2004; retrieved July 2, 2007.
  6. ↑ "Chronic Fatigue and Fibromyalgia Syndromes and How They're Related to Hysterectomies", Frederick R. Jelovsek, MD; written 2006; retrieved July 2, 2007.
  7. ↑ Laughlin GA, Barrett-Connor E, Kritz-Silverstein D, von Mühlen D (2000). "Hysterectomy, oophorectomy, and endogenous sex hormone levels in older women: the Rancho Bernardo Study". J. Clin. Endocrinol. Metab. 85 (2): 645–51. doi:10.1210/jc.85.2.645. PMID 10690870. Retrieved on 2007-06-07. 
  8. ↑ Jassal SK, Barrett-Connor E, Edelstein SL (1995). "Low bioavailable testosterone levels predict future height loss in postmenopausal women". J. Bone Miner. Res. 10 (4): 650–4. PMID 7610937. Retrieved on 2007-06-07. 
  9. ↑ Segraves R, Woodard T (2006). "Female hypoactive sexual desire disorder: History and current status". The journal of sexual medicine 3 (3): 408–18. doi:10.1111/j.1743-6109.2006.00246.x. PMID 16681466. Retrieved on 2007-06-07. 
  10. ↑ Minassian, et al. (2003). "Urinary incontinence as a worldwide problem.". Int J Gynaecol Obstet 82 (3). doi:10.1016/S0020-7292(03)00220-0. PMID 14499979. 
  11. ↑ McPherson K, Herbert A, Judge A, et al. (2005). "Self-reported bladder function five years post-hysterectomy". Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 25 (5): 469–75. doi:10.1080/01443610500235170. PMID 16183583. Retrieved on 2007-06-07. 
  12. ↑ Hudson's FTM Resource Guide, "Why Have A Hysterectomy?", retrieved May 8, 2007.
  13. ↑ Hudson's FTM Resource Guide, "FTM Gender Reassignment Surgery, retrieved May 9, 2007.
  14. ↑ Hudson's FTM Resource Guide, "Types of Hysterectomy", retrieved May 8, 2007.

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