Hysterectomy

Hysterectomy is the surgical removal of the uterus. In a total hysterectomy,the uterus and cervix are removed, and, in some cases, so are the fallopian tubes and ovaries. In a subtotal hysterectomy, only the uterus is removed. Ina radical hysterectomy, the uterus, cervix, ovaries, oviducts, lymph nodes, and lymph channels are removed. The type of hysterectomy performed depends onthe reason for the procedure. In all cases, menstruation stops and a woman can no longer bear children.

In the United States, about 600,000 hysterectomies are done every year, making it the second most common operation. By age 60, roughly one out of every three American women will have had a hysterectomy.

Most (30%) of all hysterectomies in the United States are done to remove fibroid tumors. Fibroid tumors, or "fibroids" are non-cancerous (benign) growthsin the uterus. They can cause pelvic and lower-back pain and heavy orlengthy menstrual periods. Treatment of endometriosis is the reason for 20% of hysterectomies. In endometriosis, the cells of the uterine lining (the endometrium) begin growing outside the uterus. These outlying cells still respondto the hormones that control the menstrual cycle and bleed each month, justas they would if they were inside the uterus. This irritates the surroundingtissue, leading to pain and scarring.

Another 20% percent of hysterectomies are done because of heavy or abnormal vaginal bleeding that cannot be linked to any cause and cannot be controlled by other means. A further 20% of hysterectomies are performed to treat prolapsed uterus, pelvic inflammatory disease, and endometrial hyperplasia, a potentially precancerous condition.

About 10% of hysterectomies are performed to treat cancer of the cervix, ovaries, or uterus. Women with cancer in one or more of these organs almost always have the organ(s) removed as one part of their cancer treatment.

A total hysterectomy, sometimes called a simple hysterectomy, removes the entire uterus and the cervix. The ovaries are not removed and continue to secrete hormones. Total hysterectomies are always performed in the case of uterineand cervical cancer. The total hysterectomy is the most common kind of hysterectomy.

If the reason for the hysterectomy is to remove uterine fibroids, treat abnormal bleeding, or relieve pelvic pain, it may be possible to remove only the uterus and leave the cervix. This procedure, called a subtotal or partial hysterectomy), removes the least amount of tissue.

Radical hysterectomies are performed on women with cervical cancer or endometrial cancer that has spread to the cervix. A radical hysterectomy removes theuterus, cervix, top part of the vagina, ovaries, fallopian tubes, lymph nodes, lymph channels, and tissue in the pelvic cavity that surrounds the cervix.This type of hysterectomy removes the most tissue and requires the longest hospital stay and recovery period.

The frequency with which hysterectomies are performed in the United States has been questioned in recent years. It has been suggested that many hysterectomies are unnecessary. The United States has the highest rate of hysterectomies (number of hysterectomies per thousand women) of any country in the world.Also, the frequency of this surgery varies across different regions of the United States. Rates are highest in the South and Midwest.

Hysterectomy is a relatively safe operation, although like all major surgeryit carries risks. These include unanticipated reaction to anesthesia,internal bleeding, blood clots, damage to other organs such as the bladder, and post-surgery infection. The risk of death is about 1 in every 1,000 (1/1,000) women having the operation.

Other complications sometimes reported after a hysterectomy include changes in sex drive, weight gain, constipation, and pelvic pain. Hot flashes and other symptoms of menopause can occur if the ovaries are removed. Women who haveboth ovaries removed and who do not take estrogen replacement therapy run anincreased risk for heart disease and osteoporosis. Women with a history of psychological and emotional problems before the hysterectomy are more likely toexperience psychological difficulties after the operation.

Although there is some concern that hysterectomies may be performed unnecessarily, there are many conditions for which the operation improves a woman's quality of life. In the Maine Woman's Health Study, 71% of women who had hysterectomies to correct moderate or severe painful symptoms reported feeling better mentally, physically, and sexually after the operation.

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