10 Reasons why you may be considering a hysterectomy – symptoms and causes that lead to hysterectomies

What is a Hysterectomy?

A hysterectomy is surgery to remove your uterus performed by a gynaecology surgeon. Sometimes, the surgeon will also remove your fallopian tubes and ovaries during a hysterectomy. Following a hysterectomy, you will not have periods or be able to conceive.

It is one of the most common gynaecological operations performed in the UK. Around 1 in 5 women will have a hysterectomy in their lives. There are many reasons someone may need a hysterectomy, these are detailed below:

Reasons for a hysterectomy:

1. Fibroids

Uterine fibroids are non-cancerous growths that develop in or around the uterus. These growths are made up of muscle and fibrous tissue and can vary in size from small to very large.

Fibroids can cause pain, heavy periods, abdominal distention and affect fertility. Sometimes they can be completely asymptomatic. They’re one of the most common reasons for a hysterectomy.

Treatment starts with the least invasive options including oral birth control pills or a myomectomy.   If these treatments aren’t effective and the fibroids continue to grow to an unmanageable point, a hysterectomy may be considered.

2. Endometriosis

Endometriosis is a condition where tissue similar to the lining of the uterus starts to grow outside of it. Endometriosis can cause many symptoms including pain in your lower abdomen, back pain, pain during sex, irregular periods and heavy periods. It can also lead to infertility.

Doctors usually recommend hormone therapy including the contraceptive pill or removal of the endometrial tissue before a hysterectomy. If these treatment options don’t help and patients can not live with the condition day-to-day, a hysterectomy is a treatment option.

A hysterectomy can reduce or eliminate symptoms from Endometriosis; however it is still possible for Endometriosis to recur following the surgery. This would be discussed in full with your surgeon, along with all the other risks and benefits before having surgery.

3. Cancer

Cancer is another reason for hysterectomies. These cancers include cancer of the uterus, cervix, ovaries or endometrium. The initial treatment will depend on the type of cancer and the severity of the cancer. Your specialist may also consider other treatments such as chemotherapy and radiotherapy before or after your operation.

Hysterectomies are also used in cases where genetics put you at high risk of developing cancer in the future, such as Lynch syndrome.

4. Prolapse of the uterus

Uterine prolapse happens when pelvic floor muscles and ligaments weaken and stretch, no longer providing sufficient support for your uterus. Your uterus then slips from its usual place and falls into the vagina. Uterine prolapse is more common in women who have had multiple vaginal births. It can also affect people who are significantly overweight and women who have gone through the menopause.

Symptoms of uterine prolapse include urinary issues, a feeling of pelvic pressure, a bulging feeling, bowel problems and lower back pain.

Treatment options for uterine prolapse often depend on how severe the prolapse is. The first treatment would be physiotherapy including certain exercises and devices that can be used at home. In some cases, doctors can repair the weakened pelvic tissues with minimally invasive surgery.

If the above options are ineffective, a hysterectomy may be the treatment of choice. All risks, benefits and side effects would be discussed with your surgeon.

5. Delivery complications

There are times, following the delivery of a baby or during the delivery of a baby, that due to complications, such as severe bleeding, that a hysterectomy may need to be performed. This outcome is rare, but is often lifesaving.

6. Adenomyosis

Adenomyosis is a condition where the tissues that normally lines the uterus grows into the muscle wall of the uterus. This tissue thickens, breaks down and bleeds as normal, causing the uterine wall to thicken, which leads to pain and heavy bleeding.

Adenomyosis often rectifies after menopause, but if symptoms are severe, treatment includes hormone therapies such as the oral contraceptive pill, injection or coil, plus pain medication. If these don’t help manage the situation, a hysterectomy may be an option for those not wishing to maintain fertility .

7. Infection

Pelvic Inflammatory Disease (PID) is a bacterial infection of the female reproductive organs including the womb, fallopian tubes and ovaries. Symptoms of Pelvic Inflammatory Disease include severe pelvic pain, heavy period pain and pain when urinating.

Pelvic Inflammatory Disease is usually treated with antibiotics if it is treated early, as soon as symptoms appear. However, it can damage the uterus if it is not treated and allowed to spread. In these cases, your doctor may recommend a hysterectomy if you have severe PID.

8. Hyperplasia

Hyperplasia means the increase in the number of cells in an organ or tissue. In the case of the uterus, it means that the lining of the uterus is too thick. This condition may be caused by having too much Oestrogen especially due to obesity.  This is not cancer, but it can lead to uterine cancer. Hyperplasia can cause heavy, irregular menstrual bleeding.

First line of treatment for Hyperplasia is hormone therapy. If the Hyperplasia is severe, or your doctor suspects it may develop into cancer, they may recommend a hysterectomy.

9. Placenta Accreta

Placenta Accreta is a pregnancy related condition. It is when the placenta grows too deeply into the uterine wall. This condition can be very serious, but it often doesn’t cause symptoms. It may be identified on an ultrasounds scan, but often presents with heavy vaginal bleeding in pregnancy.

In most cases of Placenta Accreta, the surgeon will perform a caesarean section, followed by a hysterectomy to prevent blood loss that happens when the placenta separates.

10. Gender related reasons

A transgender person may or may not choose to have a hysterectomy. They may decide to only remove the uterus or to remove the uterus and ovaries.

How do I know if I need a hysterectomy?

All of the above conditions are complex conditions and require advice from a specialist consultant. They will be best placed to assess you and formulate a treatment plan, starting with the least invasive option.  A hysterectomy is major surgery and like all surgeries, comes with potential complications. If and when a hysterectomy is discussed, the surgeon would cover all of the risks and benefits with you, as well as the side effects and recovery times, so you are fully informed to make the best decision for you.

If you are experiencing any of the symptoms or conditions above and would like an appointment with a specialist to discuss this further, please contact us on 07805 354110 or email info@practiceforwomen.co.uk