In this article we will look at:
- What is hysterectomy?
- What are the symptoms of afflictions related to the reproductive organs of a woman?
- What kind of a doctor should I consult if I suffer from the symptoms which might require hysterectomy?
- How are different afflictions related to the reproductive organs of a woman diagnosed?
- What are the different types of hysterectomy?
- What are the different methods/techniques of performing hysterectomy?
- What is the cost of a hysterectomy procedure?
- What are the risks involved after undergoing a hysterectomy?
- What is the eligibility criteria for undergoing a hysterectomy?
- What is the success rate of hysterectomy in India?
- More Hysterectomy Related Topics
- In the Spotlight - Latest News on Hysterectomy
You can click on any of the links above to navigate to the section of your interest.
What is hysterectomy?
Hysterectomy is an invasive surgical procedure, performed on women, to remove the entire uterus (womb), or parts of it. With the removal of the uterus and ovaries, the woman experiences premature or early menopause and cannot be pregnant again.
This surgery is normally performed to address different health issues in a woman, such as:
1. Uterine Fibroids - These are abnormal growths that develop in a woman’s uterus and are the most common reason for hysterectomy.
The causes of uterine fibroids include:
- Family history of fibroids
- Hormones such as estrogen and progesterone, which can stimulate the growth of fibroids
- Pregnancy, as the production of estrogen and progesterone are high in a pregnant woman.
2. Endometriosis - It occurs when tissue normally found inside the uterus grows in other parts of the body, such as the abdomen, ovaries, fallopian tubes, ligaments that support the uterus, the area between the vagina and rectum, the outer surface of the uterus, and the lining of the pelvic cavity.
The causes of endometriosis include:
- Immune system disorder
- Retrograde menstruation, which occurs when the menstrual blood containing endometrial cells instead of flowing out of the body, flows back through the fallopian tubes and into the pelvic cavity.
- Transformation of peritoneal cells or cells which line the inner side of the abdomen into endometrial cells.
3. Pelvic Floor Disorders - These are disorders such as uterine prolapse, which occurs when the uterus sags or slips from its normal position into the vagina, or the birth canal.
The causes of pelvic floor disorders include:
- Chronic coughing
- Chronic constipation
- Difficult vaginal delivery
- Frequently lifting heavy objects
- Pelvic fractures
- Surgery (abdominal, vaginal)
4. Abnormal Uterine Bleeding - Constant bleeding which occurs through the vagina.
The causes of abnormal uterine bleeding include:
- Hormonal imbalances
- Benign (non-cancerous) growths like fibroids or polyps
- Complications related to pregnancy
- Medications such as anticoagulants or anti-inflammatory
- Bleeding disorders
- Use of Intrauterine device (IUD)
- Abnormal ovary function
- Adenomyosis, a condition in which glands from the endometrium (tissue lining the inner cavity of the uterus) grow into the uterine muscle causing cramps, lower abdominal pressure, and bloating apart from bleeding
- Illnesses such as thyroid problems, endometriosis, lupus, liver or kidney disease and pelvic inflammatory disease (PID).
5. Cervical Dysplasia - It is a precancerous condition in which abnormal cell growth occurs on the surface lining of the cervix). This is very common among sexually active women, usually under the age of 30.
The causes of cervical dysplasia include:
- Having multiple sexual partners
- Having a partner who has multiple sexual partners
- Immunosuppressed conditions
6. Uterine Cancer - It starts with the growth of abnormal cells in the lining of the uterus. The most important cause of uterine cancer is the hormone estrogen. Estrogen stimulates the lining (called endometrium) of the uterus to grow causing an increase in the growth of abnormal cells.
The causes of uterine cancer include:
- Taking estrogen supplements to relieve the symptoms of menopause may be a possible cause
- A family history of uterine cancer may have increased chances of getting uterine cancer.
- Women who have undergone radiation therapy for any other cancer near their pelvic region may face increased risk of uterine cancer.
- Eating foods high in animal fat.
7. Endometrial Hyperplasia - It is an abnormal thickening of the lining of the uterus due to an increase in the number of endometrial glands. Mostly young women who are just beginning to menstruate and older women approaching menopause are affected by this disorder. The causes of endometrial hyperplasia include:
- Overproduction of estrogen
- Due to unopposed estrogen replacement therapy (taking estrogen without progesterone) in middle-aged women
What are the symptoms of afflictions related to the reproductive organs of a woman?
The symptoms which appear when a woman suffers from any of the above-mentioned health conditions include:
What kind of a doctor should I consult if I suffer from the symptoms which might require hysterectomy?
Should you suffer from any of the symptoms described above, you need to consult a gynecologist, or an obstetrician, or an OB-GYN (obstetrician-gynecologist).
Gynecology deals with afflictions related to the reproductive organs of a woman such as uterus, fallopian tubes, cervix, ovaries, and vagina. Hence, a gynecologist also treats problems related to the bowel, bladder and urinary system, as these are closely related to female reproductive organs.
Obstetrics, on the other hand, deals with the welfare of the pregnant woman and her baby. An obstetrician is a doctor who deals with the complications which arise during pregnancy, such as ectopic pregnancy (which is a condition where the embryo is in a fallopian tube), emergency C-Section, setting the position of a breech baby right, problems with the placenta or high blood pressure which could be a precursor of the serious ailment known as pre-eclampsia.
An OB-GYN or obstetrician-gynecologist is doctor who specializes in both fields and is adept in taking care of the health of female reproductive organs, and also at efficiently treating pregnancy-related complications.
Hysterectomy is performed by a gynecologist or an OB-GYN.
How are different afflictions related to the reproductive organs of a woman diagnosed?
Depending on the symptoms a woman suffers from, different diagnostic tests are performed. Once a diagnosis is made, the doctor decides whether the patient requires undergoing a hysterectomy.
Uterine fibroids are usually found during a routine gynecological exam or an annual PAP smear test. During the gynecological examination, the doctor inserts two fingers of his/her hand into the vagina, while using the other hand to lightly press on the abdomen to check the size of the uterus.
If the patient has fibroids, the uterus may seem slightly larger or of an irregular shape.
The doctor may further ask you to undergo certain imaging tests, which shows a picture of the inside of your body, such as:
- Ultrasound: which uses sound waves to form images.
- Sonohysterography: or saline infused sonography, wherein a saline solution is injected into the uterus to create an image.
- Magnetic resonance imaging (MRI): which uses radio waves to create images.
- X-rays: which uses electromagnetic radiation to create images of the insides of the body.
- Computed Tomography (CT) Scan: which uses X-Rays to scan the body from many angles and thereby create a complete picture.
What makes it difficult to diagnose endometriosis is that the symptoms of endometriosis are very similar to other common conditions often experienced by women. The most definitive way of diagnosing this condition is through laparoscopy.
During the laparoscopy procedure:
- You are administered the required dosage of general anesthesia by an anesthetist.
- Once the anesthesia takes effect, your surgeon makes a small incision near the navel.
- A camera or the laparoscope is inserted through the incision to see the pelvic organs and more specifically to look for endometrial tissue outside the uterus.
- Once the surgeon locates the tissue he collects samples of the tissue to verify if it is endometrial tissue.
Once the location and size of the endometrial tissue is determined the doctor will discuss the best treatment options for you which can include hysterectomy.
Pelvic Floor Disorders
In many cases, pelvic floor disorders are diagnosed during a routine pelvic exam. For conclusive diagnosis and depending on the severity of the symptoms, the doctor may suggest some tests such as:
- Anal manometry: this test evaluates the strength of the anal muscles.
- Cystoscopy: which is done to look inside the bladder and the urethra to look for problems such as kidney stones, inflammation, or tumors.
- Dynamic defecography: which evaluates the strength of the pelvic floor and rectum when the patient undergoes a bowel movement.
- Endoanal ultrasound: which uses sound waves to form images of the anal muscles.
- Urodynamics: which helps to determine how efficiently the bladder and urethra are functioning in a woman and if there are any bladder control problems.
- MRI, ultrasound and other imaging studies: to get more images of the insides of the patient.
Abnormal Uterine Bleeding
If you suffer from abnormal uterine bleeding, the gynecologist may perform a pelvic examination to start with. The other tests that are usually recommended are:
- Complete blood count (CBC) Test
- Blood clotting profile
- Hormone tests, including:
- Male hormone (androgen) levels
- Pap smear and culture to look for infection
- Pregnancy test
- Thyroid function tests
The following additional tests may also be recommended:
- Endometrial biopsy to look for infection, pre-cancer, or cancer, to decide if hormone therapy is required.
- Hysteroscopy, which allows the doctor to look into the uterus through the vagina.
- Transvaginal ultrasound to look for any issues in the uterus or pelvis.
There are no specific symptoms of cervical dysplasia apart from occasional abnormal bleeding. Therefore, it is highly necessary to undergo routine check-ups. It is usually detected in a regular PAP smear test and diagnosed through biopsy.
Abnormal changes in cells can be mild, moderate, or severe. The presence of cervical dysplasia does not mean you have cervical cancer. The PAP test results indicate abnormal changes in the cells which can be mild, moderate, or severe.
To diagnose endometrial hyperplasia, the gynecologist usually recommends:
- A pap smear
- A biopsy of endometrial tissue which can be taken during a pelvic examination.
- A dilatation and curettage (D&C) may be performed. In this procedure, the cervix is widened and tissue samples are obtained from the uterine lining.
- An ultrasound assessment of the thickness of the lining of the uterus
- Hysteroscopy may be performed to detect abnormal areas in the endometrial lining and remove cells for examination in a laboratory.
What are the different types of hysterectomy?
The different types of hysterectomy include:
- Supracervical/Partial Hysterectomy
- Total Hysterectomy
- Hysterectomy With Bilateral Salpingo-Oophorectomy
- Radical Hysterectomy
To know the difference between the types of hysterectomies, how long a hysterectomy procedure takes to perform, and the recovery time involved, please refer to the table below:
What are the different methods/techniques of performing hysterectomy?
A hysterectomy can be done in different ways. The choice depends upon your particular health condition and what the surgeon feels will be convenient for you.
At times, the decision is made while the surgery is in progress and the surgeon is able to see what other problems are present that could be causing the symptoms in you.
The different techniques of hysterectomy are:
- Abdominal Hysterectomy
- Vaginal hysterectomy
- Laparoscopy-assisted vaginal hysterectomy
- Laparoscopic supracervical hysterectomy
To know the difference between each hysterectomy method, and the recovery time involved please refer to the table below:
What is the cost of a hysterectomy procedure?
Depending on the patient’s condition, the particular city in India, the facilities available in the hospital, and the method of hysterectomy the cost can range between Rs. 18,000 to Rs. 2,30,000. (Laparoscopic hysterectomies are significantly more costly than abdominal.)
What is the eligibility criteria for undergoing a hysterectomy?
Patients who are eligible for hysterectomy include those who suffer from:
- Cancer of the ovaries and uterus
- Large uterine fibroids
- Chronic uterine infection
- Severe pain associated with menopause
- Cancerous tumor within the uterus
- Large fibroid
- Chronic and excessive bleeding (menorrhagia)
- Uterine prolapse
- Adenomyosis (Thickening of the uterus)
- Chronic uterine infection
- Severe pain associated with menopause
What are the risks involved after undergoing a hysterectomy?
The risks after undergoing a hysterectomy include:
- Pain, including joint pain
- Occasional spotting or pink discharge for up to about 6 weeks
- Infections occur in 10% of the patients
- Injury to nearby organs or nerve injury
- Anesthesia-related problems such as rapid breathing
- Heavy bleeding may occur in some patients
- Fatigue and loss of sexual desire (conversely some women experience a drastic improvement in their sex life)
- Hot flashes
- Risks are higher in women who are obese or who have diabetes or high blood pressure.
- Stress urinary incontinence
- Weakness of the pelvic muscles and ligaments that support the vagina, bladder, and rectum.
- Early menopause, since the ovaries are removed in case of radical hysterectomy
What is the success rate of hysterectomy in India?
The success rate of any type of hysterectomy procedure in India on an average is 80% - 90%.
More Hysterectomy Related Topics
People interested in this topic also read:
Types of Hysterectomy
- Supracervical/Partial Hysterectomy: Procedure & Side Effects
- Total Hysterectomy Procedure: Side-effects & Recovery Time
- Radical Hysterectomy: Procedure, Side Effects, & Cost
- Hysterectomy with Bilateral Salpingo-Oophorectomy: Procedure & Side Effects
Methods/Techniques of Hysterectomy
- Abdominal Hysterectomy: Procedure & Complications
- Vaginal Hysterectomy: Procedure & Complications
- Laparoscopy-Assisted Vaginal Hysterectomy: Meaning & Side Effects
- Laparoscopic Supracervical Hysterectomy: Procedure & Side Effects
In the Spotlight - Latest News on Hysterectomy
Here are some of the latest news on hysterectomy from India and around the world:
- Reports of private doctors performing hysterectomies on Indian women even when not required is disturbing
- Fibroid embolization: An alternative to hysterectomy?
- Doctor couple from Hyderabad has made ‘saving the womb’ a mission to save women from unnecessary hysterectomies
- Endometriosis: the cause, the complications and how to beat it
1. Baltacı Göktas S, Gün I, Yıldız T, Sakar M, Caglayan S. The effect of total hysterectomy on sexual function and depression. 2018. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4485298/. Accessed February 27, 2018
2. Ala-Nissilä S, Haarala M, Järvenpää T, Mäkinen J. Long-term follow-up of the outcome of supracervical versus total abdominal hysterectomy. 2018. Available at: https://link.springer.com/article/10.1007/s00192-016-3143-0. Accessed February 27, 2018.
3. Danesh M, Hamzehgardeshi Z, Moosazadeh M, ShabaniAsrami F. The Effect of Hysterectomy on Women's Sexual Function: a Narrative Review. 2018. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4720466/. Accessed March 1, 2018.
4. Lai J, Chen H, Chu K et al. In-hospital complications of bilateral salpingo-oophorectomy at benign hysterectomy. 2018. Available at: https://journals.lww.com/menopausejournal/Abstract/2017/02000/In_hospital_complications_of_bilateral.11.aspx. Accessed February 27, 2018.
5. Shetty J, Shanbhag A, Pandey D. Converting Potential Abdominal Hysterectomy to Vaginal One: Laparoscopic Assisted Vaginal Hysterectomy. 2018. Available at: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3960748/. Accessed February 27, 2018.
6. Mishra D. LAPAROSCOPIC-ASSISTED VAGINAL HYSTERECTOMY VERSUS TOTAL LAPAROSCOPIC HYSTERECTOMY. Laparoscopyhospitalcom. 2018. Available at: https://www.laparoscopyhospital.com/Laparoscopic%20assisted%20vaginal%20Hysterectomy%20versus%20total%20laparoscopic%20hysterectomy.html. Accessed February 27, 2018.
7. Odejinmi F, Oliver R. Laparoscopic Supracervical Hysterectomy for Large Uteri. 2018. Available at: https://link.springer.com/chapter/10.1007/978-3-319-22497-8_33. Accessed February 27, 2018.
8. Hanzal E. Total Abdominal Hysterectomy in Benign Conditions: Hysterectomy Techniques for the Normal-Sized and Small Uterus. 2018. Available at: https://link.springer.com/chapter/10.1007/978-3-319-22497-8_89. Accessed February 27, 2018.
Questions answered by trusted doctors
Did you know?
India's rate of hysterectomy is much lower than western countries
More than 22,000 Indian women aged between 15 and 49 out of 700,000 surveyed had undergone a hysterectomy, government data shows.
Reports of unnecessary hysterectomies in India are troubling
Women especially of poor and illiterate backgrounds are conned into surgeries mostly by quacks masquerading as doctors. Women who were seeking treatment for minor ailments were suggested hysterectomies and were also told their uterus is of use once they have babies, which is outrageously wrong and even harmful information.
Hysterectomies are mainly performed in the private sector
Two-thirds of the hysterectomies performed in India were done in the private sector and half of the women who underwent the procedure never went to school.
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Hysterectomy with bilateral salpingo-oophorectomy procedure includes the removal of the uterus, cervix, fallopian tubes, and ovaries. It is commonly performed to treat endometrial cancer.
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