Demystifying hysterectomy


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By Dr. Matt Siedhoff

Learn answers to important questions and concerns related to this medical procedure.

Most people donít look forward to having surgery, but for a variety of reasons hysterectomies in particular can be viewed negatively. This is completely understandable ó the procedure is a final statement on the ability to carry a pregnancy, and the uterus is an organ that makes someone uniquely female. Misconceptions about the procedure can lead to fear of what otherwise might be a good treatment option. Hysterectomies arenít always the right choice, but itís important to separate fact from fiction when it comes to this important medical procedure for women. Here are some of the misconceptions and realities of the procedure:

Iím going to be out of commission for six weeks after my hysterectomy

If you have a large abdominal incision, called a laparotomy, for your hysterectomy, thatís probably true. But now, most hysterectomies can be performed in a minimally invasive fashion ó using tiny abdominal incisions with laparoscopic surgery or with no outside incisions at all in the case of vaginal hysterectomy. If you are considering hysterectomy, make sure you seek out someone who specializes in this surgery and can offer a minimally invasive option even for complex cases. Minimally invasive surgery reduces the risk of a number of complications and has a recovery time of about two weeks for most women.

Canít you just remove the fibroids?

Fibroids are very common benign tumors of the uterus and one of the most frequent reasons women have hysterectomies. Removing fibroids and reconstructing the uterus is called a myomectomy and is the right surgical choice for women wishing to preserve fertility. Sometimes myomectomy can be a much more complicated operation, so if future fertility isnít a concern, a hysterectomy may be a better choice.

Why do women have hysterectomies?

Setting aside cancerous conditions, the most common reasons women undergo hysterectomies include:

         Pelvic pain

         Fibroids (benign tumors which can grow quite large and cause pain or heavy bleeding)

         Abnormal bleeding that canít be controlled in other ways

         Prolapse (when the uterus sags downward into the vagina)

I donít want to go through early menopause

The age a woman will begin menopause is not significantly impacted by having a hysterectomy. Menopause is determined by the function of the ovaries, which are often retained when a woman has a hysterectomy and hasnít undergone menopause already. If the ovaries do need to be removed, most of the time a woman can replace the hormones the ovaries make to avoid the negative effects of early menopause.

My sex life is going to worsen if I have a hysterectomy

Good research shows that, on average, sexual function actually improves after hysterectomy, probably because the surgery is addressing a problem that is interfering with sexual health. However, if the ovaries are removed and no hormone replacement is given, that could negatively impact sexuality.

Wonít my bladder fall down if I have a hysterectomy?

Prolapse ó when structures such as the uterus, bladder or rectum sag down into the vagina ó can happen whether a woman has had a hysterectomy or not. Factors such as family history and having delivered children vaginally have a much bigger impact on whether a woman will experience prolapse in the future.

Opinions about hysterectomy can easily be spread by casual story-telling and personal experiences. Although that information can be important, itís also important to remember every situation is different. When making the decision about whether or not to have a hysterectomy, find a doctor who specializes in gynecologic surgery and can offer you a full range of treatment options. You will be able to make an informed decision about what treatment is best for you.

Matthew Siedhoff, M.D., is a gynecologic surgeon on faculty at Cedars-Sinai in Los Angeles, CA, specializing in urogyn and pelvic recon surgery. He is a graduate of Stanford Medical School and completed his residency at New York University School of Medicine. He also received his Masterís degree from University of North Carolina.