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Understanding the reasons for hysterectomy

Before a hysterectomy, discuss these issues with your doctor

  • THE SEVERITY OF YOUR SYMPTOMS, especially if you are considering hysterectomy to relieve chronic pelvic pain, endometriosis or any other noncancerous condition.
  • YOUR CHILDBEARING POTENTIAL. Make sure your doctor knows your feelings about possibly losing your reproductive organs and how it may affect your life plans.
  • ALTERNATIVE THERAPIES, especially if you’re premenopausal. Often, noncancerous problems leading to hysterectomy such as pelvic pain, uterine fibroids and endometriosis subside after menopause. Ask your doctor about ways to preserve your reproductive organs until then.
  • REMOVAL OF THE OVARIES. Ask your doctor why he or she feels this is necessary and what the risks are if you choose to preserve them.
  • THE PROCEDURE ITSELF. Will your doctor perform an abdominal hysterectomy (the organs are removed through an abdominal incision) or a vaginal hysterectomy (the organs are removed through the vagina)? Make sure you fully understand the reasons why a vaginal hysterectomy may not be an option.

No other organ in a woman’s body is as wonderfully specialized—or as changeable—as the uterus. Each month, in anticipation of pregnancy, its lining builds up and then sheds with menstruation. During pregnancy, the uterus swells from the size of a pear to the size of a beach ball, then returns to normal following delivery.

The changeable nature of the uterus also makes it prone to medical problems. Not uncommonly, a problem becomes severe enough to require removal of the uterus, or a hysterectomy. Other times, more conservative surgery or medical treatment may prove satisfactory. Here are some common reasons for a hysterectomy:

Fibroids, benign tumors in the wall of the uterus, are the most frequent reason for hysterectomy. They can grow large, causing pain and heavy bleeding. Depending on their severity, other possible solutions are hormone therapy and myomectomy, a surgery in which only the fibroids are removed.

Heavy nonmenstrual bleeding is another reason for hysterectomy. If hormone treatment fails, removing the uterus is a certain cure. A surgery called endometrial ablation, in which only the uterine lining is removed, is an option for some.

Endometriosis is a common disease in which tissue from the lining of the uterus grows outside the organ, causing severe pain. Drug therapy and laparoscopic surgery may or may not provide sufficient relief. Hysterectomy provides complete and permanent relief.

Hysterectomy can be the best solution for severe prolapse, a sagging of the uterus caused by weakened ligaments. And cancer of the uterus or cervix usually requires hysterectomy.

As these descriptions make clear, the problems that can be cured by hysterectomy are varied, and there’s nothing automatic about their treatment. Each case must be considered individually. If you ever experience unusual bleeding, pain or other symptoms, see your doctor right away or call the hospital for a referral.

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