Understanding Hysterectomy and the Different Types

A hysterectomy is the surgical removal of the uterus or womb, sometimes also removing the cervix, and sometimes not, sometimes taking out the fallopian tubes and ovaries and sometimes not. When people talk about potentially having to have a hysterectomy what they do not always realise is that the procedure has come a long way and there are different hysterectomy types depending on your condition. It is not usually the first medical treatment offered as it does mean that the woman receiving it will not be able to conceive anymore.

Why women might need a hysterectomy

There are all kinds of reasons why a woman might need a hysterectomy and that is something you need to talk with your doctor about perhaps to exhaust other options first. But some of the more common reasons include;

• Fibroids - these are growths that grow in the walls of your uterus, in the uterine cavity or outside it and they are non-cancerous but in a very small number of women when other treatment options have not been successful, a hysterectomy is one option. In the majority of cases when women have fibroids they do not even have symptoms. For those that do, there are many other treatment options that doctors will talk to you about before a hysterectomy is the only solution.

• Very irregular or heavy periods - again only after trying newer methods of treatment such as endometrial ablation, hormone therapies, or putting in an IUD. Heavy bleeding can be the result of several medical issues.

• Crippling period pains - perhaps caused by endometriosis or adenomyosis.

• Cancer in any part of the womb - though now a last resort after other options have not been successful.

• PID (pelvic inflammatory disease) - usually as a result of an STI leading to a bacterial infection.

• Endometriosis - alternative treatments used first might include hormonal therapies or surgical removal of the area.

• Prolapse - when the uterus drops into the vagina often from childbirth because of loose ligaments or pelvic floor muscles that are damaged this is a last resort treatment. Other treatments depend on how bad the prolapse is but could include pelvic floor exercises, surgical repair that does not include a hysterectomy or the use of a pessary to prop the uterus up.

Hysterectomy types

There are now five hysterectomy types. They are;

1. A Total Hysterectomy - Both the cervix and the uterus are removed.

2. A Partial or Subtotal Hysterectomy - Where the cervix is left but the uterus is removed. Usually, it is advised for the cervix to come out too as it is a point where cancer can develop but some women prefer to keep it. If that is the case the woman needs to have regular cervical screening.

3. A Hysterectomy and Bilateral Salpingo-oophorectomy - The type used more when the patient has cancer in the uterus or ovaries or when there is a lot of pain from recurrent endometriosis or recurrent pelvic infection. The ovaries, uterus and fallopian tubes are taken out.

4. A Radical Hysterectomy - The most extensive of the hysterectomy types it means the removal of the upper part of the vagina, the uterus and fallopian tubes, the ovaries, associated lymph nodes and pelvic ligaments. Performed when the woman has cancer spreading into all those areas.

5. A Hysterectomy with Prophylactic Bilateral Salpingectomy