Surgery
Hysterectomy is defined as the "surgical removal of the uterus" (womb). It is one of the most common of all surgical procedures and can also involve the removal of the fallopian tubes, ovaries and cervix. Following this operation you will no longer have periods, be fertile, or be able to have any more children.
There are two main ways to perform a hysterectomy. The most common way is to remove the uterus through an incision in the lower abdomen. The second and less common way, is to remove the uterus through a cut in the top of the vagina, where the top of the vagina is stitched. Each operation lasts between one to two hours and is performed in the hospital under a general anesthesia
The are different types of hysterectomy:
- A “total hysterectomy” removes the complete uterus including the cervix. This is the operation most commonly performed.
- A “subtotal hysterectomy” removes the uterus leaving the cervix in place. If you have this operation you will need to continue to have Pap smear tests.
- A “total hysterectomy with a bilateral or unilateral oopherectomy” removes the uterus, cervix, fallopian tubes and both or one of the ovaries. If you have not had your ovaries removed and you have not gone through menopause before your operation, there is a 50 percent chance that you will go through menopause within five years of having this operation.
There are a number of physical issues that are common to all women having a hysterectomy. You will not have any more periods and you will not be able to have any more children. If you have had your ovaries removed you will go through menopause regardless of your age. Menopause is not related to age, it is related to the production of the female sex hormone estrogen. Your physician should discuss Hormone Replacement Therapy (HRT) with you to help you understand the pros and cons of HRT.
Myomectomy is the surgical removal of the fibroids. Only certain fibroids may be treated with this therapy. While this procedure keeps your uterus intact, it can be a surgically challenging procedure and is not performed by all physicians. An abdominal myomectomy is performed through a horizontal incision through the abdomen, similar to a “bikini cut” used in a cesarean section. Most types of fibroids, even very large ones, can be removed in an abdominal myomectomy. The recovery time varies with each patient, but typically is four to six weeks in length. Pedunculated and subserosal fibroids can be removed via a laproscopic myomectomy, which is performed through three small incisions. When a resectoscope is used to remove submucous fibroids, it is called a hysteroscopic resection. The use of a resectoscope requires proper training by the physician prior to use.