There are times when a woman\’s reproductive problems are significant enough that her gynecologist recommends a hysterectomy. This is a surgical procedure in which all or parts of the reproductive organs in her pelvic area are removed. This means that she may lose her ovaries, fallopian tubes, uterus, or cervix or a combination of all four. In any of these cases, she will be unable to have children after the procedure.
There are a variety of reasons why a gynecologist would recommend that a woman consider a hysterectomy. However, sometimes these can be delayed or avoided by using other treatment protocols, having regular Pap tests or using a laparoscopy.
Some of the more common reasons for having a hysterectomy include fibroids. Fibroids are non-malignant tumors that can grow from very small microscopic size to the size of a small basketball or soccer ball. As these tumors grow larger they press down on other organs in the pelvic region, which can cause heavy bleeding, pelvic pain, pain during sexual intercourse and a distorted abdomen. (1)
Endometriosis is another reason for women to consider a hysterectomy. Endometriosis is one of the most common causes for pelvic pain and hysterectomies in women in the United States. In this condition groups of endometrial cells will grow outside the uterus and attach themselves to other organs in the pelvic cavity such as the ovaries, fallopian tubes, bladder, and intestines. Doctors have also found that this tissue can migrate into the spine, bladder and brain. Endometriosis can lead to chronic pelvic pain, pain during sex and prolonged heavy bleeding. (2)
Endometrial hyperplasia is a different disorder in which the thickening of the uterine lining becomes hyperplastic, grows larger than normal, but not outside the uterus. It is the cause of abnormal bleeding and is often due to the presence of high levels of estrogen in the body.
Approximately 10% of hysterectomies across the United States are performed to treat either cervical, ovarian or endometrial cancer. In this instance a hysterectomy is often the best choice.
As a woman ages, tendon and ligament support can begin to lose tone and sag downward causing prolapse of the uterus through the vagina. In this prolapse the bladder or rectum may also be pulled downward with the uterus. For the vast majority of women this problem does not require surgery because the organs do not sag significantly. However a hysterectomy with repair of supporting structures is recommended in more serious cases.
Irritation of the lining of the abdomen may cause adhesions, or scarring, which will bind organs to each other. Sometimes laser therapy can be effective but in more serious cases a hysterectomy will be recommended. However, sometimes a hysterectomy can also cause adhesions.
Gynecologists will also recommend a hysterectomy when there is a life-threatening blockage in the bladder or intestines caused by the uterus or a growth within the uterus.
Other reasons which women may consider a hysterectomy but which has been found to be unnecessary are small fibroids, an abortion in the first or second trimester, cervicitis, mild dysfunctional bleeding or pelvic congestion.
Each of the diagnoses discussed above have alternative treatment protocols which may be attempted depending upon the age of the woman, the severity of the disease and her desire to maintain her ability to conceive and carry a normal pregnancy. However, the gynecologist or primary care physician will always look first to the overall health of the woman before deciding that a hysterectomy may not be necessary.
(1) WomensHealth.gov: Uterine Fibroids Fact Sheet
(2) US National Library of Medicine:Endometriosis