Product Info"Hysterectomy, which means the surgical removal of the uterus, is one of the most common operations performed in Western countries: by the age of 55, around one woman in five in Britain may expect to have lost her uterus. Hysterectomy is different from other major operations because it often involves the removal of healthy organs. In general, hysterectomy is a very effective form of treatment and most women who have the operation are satisfied with the results. Problems and regrets are most likely to arise if the operation has been done for the wrong reason or if the woman has uncertainties about it beforehand."

Contents

Contents

Introduction

• The uterus: structure, function and common problems
• Examinations and tests
• Drug treatments for menstrual problems
• Different types of hysterectomy
• Hysterectomy for cancer
• Surgical alternatives to hysterectomy
• Hysterectomy and your ovaries
• Possible complications
• Preparation for a hysterectomy
• After the operation
• Case histories
• Questions & answers

Useful information
Index

Warnings

Important: "This book is intended not as a substitute for personal medical advice but as a supplement to that advice for the patient who wishes to understand more about his or her condition.

Before taking any form of treatment you should always consult a medical practitioner.

In particular (without limit) you should note that advances in medical science occur rapidly and some of the information about drugs and treatment contained in this booklet may very soon be out of date."

Extra Info

 Introduction

Hysterectomy, which means the surgical removal of the uterus, is one of the most common operations performed in Western countries: by the age of 55, around one woman in five in Britain may expect to have lost her uterus. In some countries, such as the USA and Australia, this proportion is even higher, but it is lower in the Middle East because of cultural and religious differences. Fewer women have hysterectomies in Scandinavia where more use is made of drug treatment for menstrual disorders.

Around 10 years ago, an alternative operation was developed which may be a better option than hysterectomy for some women. In the new procedure, called endometrial ablation, only the lining of the uterus is removed and there is no surgical incision into the abdomen. This 'minimally invasive surgery has advantages and drawbacks which will be explained in detail later in this booklet. Even with the new operation being used as an alternative, the numbers of hysterectomy operations being performed have continued to rise, but it remains to be seen whether this trend will continue.

Hysterectomy is different from other major operations because it often involves the removal of healthy, non-diseased organs. The table on page 2 gives the reasons why the operation is done: in over one-third of cases, there is some menstrual problem such as heavy bleeding for which no cause can be found. Medical treatments for most of these can be prescribed by your GP, but research has shown that some are more effective than others. In one recent year, over 800,000 prescriptions to relieve menstrual bleeding were written by GPs in England and Wales, while 73,000 women had hysterectomies and another 10,000 had endometrial ablations. These choices will be explained later in this booklet, but in general it can be said that hysterectomy is a very effective form of treatment and most women who have had the operation are satisfied with the results. Problems and regrets are most likely to arise if the operation has been done for the wrong reason or if the woman has uncertainties about it beforehand.

Not only will you, together with your doctor, have to make a choice between medical and surgical treatment and possibly between hysterectomy and endometrial ablation, but also, even if you decide to have a hysterectomy, you will be faced with more choices. In our mothers' day, hysterectomy almost certainly meant an abdominal operation, a 10-day stay in hospital and a prolonged convalescence. Nowadays, the uterus may be removed through the vagina with no abdominal scar. Some times, only part of the uterus is removed (subtotal hysterectomy). Sometimes, the gynaecologist may recommend that the ovaries should be removed as well as the uterus. Again, all these alternatives will be fully explained in later chapters.

One more complicating factor is that your choice in terms of the type of surgery you have will depend on which hospital you go to, so that not all the options described in this booklet will be available to everyone. Some gynaecologists are involved in new developments; others prefer to use well-tried conventional methods until the newer ones have been more thoroughly assessed. Whether a hysterectomy is suggested may also depend on how familiar your GP is with the various medical treatments and on his or her attitude to hysterectomy.

How do you as the person most concerned fit into all this? Does it really matter what type of hysterectomy you have or where your scar is? Some women may feel that an early return to work is a disadvantage; for others there may be economic or professional reasons for wanting to minimise the recovery time. The object of this booklet is to explain the various treatment options available, both surgical and medical. It is designed to provide information that will supplement what you are told by your GP and gynaecologist, and the various health professionals whom you will meet. However, even as this booklet is being written, new developments are taking place and more information is being gathered about existing treatments. Thus, it can never be a substitute for first-hand information from your own hospital and informed discussion with the staff involved with your care.

Key Points

• Hysterectomy is influenced by cultural attitudes and is more commonly carried out in some countries of the world (for example, the USA) than in others
• Over a third of hysterectomies involve the removal of a healthy uterus
• There are both medical and surgical alternatives to hysterectomy in most cases
• The decision to have a hysterectomy may involve more than one surgical option

Who needs a hysterectomy?
This list shows the most common reasons why a hysterectomy may be performed, although some of the conditions may also be treated without surgery.

About the authors
Dr Christine West is a Consultant Obstetrician and Gynaecologist at the Edinburgh Royal Infirmary NHS Trust. She is a part-time Senior Lecturer in Obstetrics & Gynaecology at the University of Edinburgh and has published many articles on problems relating to the menstrual cycle.

Dr Tony Smith. Family Doctor Publications' Medical Editor-in-chief was for many years Deputy Editor of the British Medical Journal and continues to work as an Associate Editor. He is the Medical Editor of both the Complete Family Health Encyclopaedia and the Family Doctor Home Adviser.

Condition Fibroids Menstrual problems Prolapse Cancer Endometriosis Other Total

Percentage 38.5 35.3 6.5 5.6 5.4 8.7 100.0