Hysterectomy: Everything You Should Know

What are the reasons for a hysterectomy?
Types of hysterectomies
Methods for hysterectomies
After Surgery
Estrogen replacement therapy

There are various reasons why women need to have a hysterectomy, however, sometimes they can be delayed or avoided through having regular pap tests, or a laparoscopy. Some of the more common reasons for having a hysterectomy are:
a)Fibroids-These are non-malignant tumors that often grow to large sizes and press down on other organs, which can cause heavy bleeding or pelvic pain.
b)Endometriosis- Groups of endometrial cells sometimes grow outside of the uterus and attach themselves to other organs in the pelvic cavity. When this happens, the cells build up and bleed each month in accordance with an ovarian cycle. This can lead to chronic pelvic pain, pain during sex and prolonged or heavy bleeding.
c)Endometrial hyperplasia-This is a cause of abnormal bleeding. The over thickening of the uterine lining often due to the presence of very high levels of estrogen.
d)Cancer-Approximately 10% of hysterectomies are performed to treat cancer, either cervical, ovarian or endometrial.
e) Life threatening blockage of the bladder, or the intestines by the uterus, or a growth within it.

It is unnecessary to have a hysterectomy if you experience:
- small fibroids that are not causing problems
- an abortion in the first or second trimester
- cervicitis
- mild dysfunctional uterine bleeding
- pelvic congestion (menstrual irregularity/low back pain)

Types of Hysterectomies
Total Hysterectomy
This includes the removal of the entire uterus, including the fundus and the cervix. It is the most common type of hysterectomy that is now performed. Although the ovaries will not be removed in this operation, many women still experience some menopausal symptoms by the second day after surgery. The possibility of entering menopause should be discussed with your doctor.

Hysterectomy with bilateral oophorectomy
This procedure includes the removal of one or both ovaries, sometimes the fallopian tubes along with the uterus. Reasons for this surgery are; ectopic pregnancy, endometriosis, benign or malignant tumors, cysts on ovaries and pelvic inflammatory disease. If only one ovary is removed, you usually will remain fertile, but if both ovaries are removed, you can experience sudden menopause, premature osteoporosis or circulatory disease.

Radical Hysterectomy
This operation includes the removal of the uterus, cervix, the top portion of the vagina and most of the tissue that surrounds the cervix in the pelvic cavity. Pelvic lymph nodes may also be removed. Although this procedure is relatively rare, it is usually called for in women with cervical cancer or endometrial cancer that has spread to the cervix.

Supracervical hysterectomy
This can also be referred to as a subtotal hysterectomy, this procedure removes the body of the uterus while leaving the cervix intact. This is usually used with women who have a minimal risk of developing cervical cancer.

Methods of Hysterectomy
The method of hysterectomy that you have is determined by your age, the number of births you've had, your condition as well as what your physician thinks is best for you. Each method affects recovery, and scaring.

In an abdominal hysterectomy, the uterus is removed through a surgical incision about 6-8 inches long. This is most commonly used when the ovaries and fallopian tubes are being removed, when the uterus is enlarged and when disease has spread to the pelvic cavity as in endometriosis or cancer. The main surgical incision can be made either vertically or horizontally. A vertical incision will run from about your navel down to your pubic bone. Since this incision provides more room, it is preferred when exploration of surrounding tissue may be necessary, such as in cases where cancer is a possibility, or where there is a previous scar. The horizontal or 'bikini' cut runs along the top of the pubic hairline and is often used in cases of benign disease. It may also be favored for cosmetic reasons, since scarring is less visible. Recovery time is usually longer from this procedure because the incision is made abdominally.

This method, where the uterus us removed through the vaginal opening, is most often used in cases of uterine prolapse or when vaginal repairs are necessary for related conditions. The vaginal is stretched and kept open by special instruments and no external incision is made. Since there is no abdominal incision, vaginal hysterectomy leaves no visible scarring and often involves a shorter hospital stay and a quicker recovery time. This method can affect sexual function because the vaginal may be shortened or tightened during surgery, this can lead to uncomfortable intercourse.

Laparoscopically assisted Vaginal
This procedure is performed with the aid of a laparoscope. Thin tubes are inserted through tiny incisions in the abdomen near the navel. The uterus is then cut and removed in sections through the scoping tube or through the vagina. Although this method can take longer to perform, there is usually a shortened period of recovery in the hospital.

After Surgery
Sometimes after surgery there can be some complications. Being aware of them can help you with preventing them from happening. Some things to watch out for are:
1.Infection-Most infections can be treated successfully with antibiotics, but some infections can be severe. Many surgeons now order antibiotics routinely before surgery. It is also important after surgery to not place anything in the vagina for at least the first 4 weeks. This includes intercourse, tampons, douching, swimming, and baths.
2.Urinary tract complications-Almost half of the women who have hysterectomies will have a kidney or bladder infection following surgery. In most cases the problem is not serious. In a radical hysterectomy, sensory nerves may be cut (sometimes unnecessarily) and women can lose both the sensation of having to urinate and control over bladder functions.
3.Hemorrhage-More than one in ten women require transfusions, some due to undetected preexisting anemia.

After a hysterectomy, many women experience some degree of depression. Your emotional state can be affected by your health, age and diet. Your attitude towards the operation is equally important. If you accept now that you will encounter some depression after your hysterectomy, it will be a lot easier to deal with. If you are experiencing anything beyond a 4-6 week depression, you should discuss it will your physician. It is always helpful to talk to friends, family, spouse. It is important to be able to discuss your feeling with someone.

Sex life
After having a hysterectomy, your sex life can be affected both emotionally and physically. One of the main emotions you will encounter is fear. Thinking about initiating sex after such a major surgery leaves many women feeling apprehensive. It is only normal to worry about pain, or hurting yourself. Once your doctor has said that it is okay to initiate sex, you should not worry about hurting yourself because you have had ample time to heal. You should wait for at least 4-6 weeks before sexual intercourse. There may also be a loss of sex drive after surgery. It does not mean that there will be a loss of sex drive forever, but there may be a decline in your sexual desire from what it was before the hysterectomy.

Even though you will have the okay to have sex about 6 weeks after surgery, it may take a few months before sex can be enjoyed. This may be because the abdomen may feel bruised or sore and the vagina may have shrunk. Uncomfortable intercourse can also be a result of vaginal dryness that can be a result of a deficiency of estrogen. This is a common occurrence when the ovaries are removed. Some ways to help increase pleasure during intercourse can be through:
-using erotic reading, pictures, films, change of location, dancing and activities that physically move the pelvic area
more effort in intercourse to push the penis hard against the far end of the vagina in order to stimulate the peritoneum. Deep penetration is helped by the female-astride position or the man-on-top position with the woman's legs on the man's shoulders and pillows under her hips
use of coconut oil or K-Y jelly to lubricate the clitoris and vagina
more experimentation with oral sex or delicate manipulation of the clitoris
learning to use penetration with fingers first to prepare for intercourse with a penis. This helps lubrication occur more rapidly
try using a new pace. Move slower and respect the fact that stimulation may take longer

After having a hysterectomy, it is extremely important to talk with your spouse and communicate what you are going through. Sharing this information will help your partner understand your physical and emotional needs.

Estrogen Replacement Therapy
It is very important to have a healthy diet and exercise after surgery. As well, estrogen replacement therapy (ERT) can help to control some of the symptoms that usually accompany a hysterectomy. This therapy is especially important for women who have had an oophorectomy (removal of the ovaries and fallopian tubes). The removal of the ovaries before menopause can result in your body experiencing a rapid decline in sex-hormone levels which can result in an instant onset of menopause. Due to the loss of estrogen, many women experience menopausal symptoms, such as hot flashes, night sweats and vaginal dryness. These symptoms can begin as soon as one to two days after surgery and can last longer than the symptoms of natural menopause.

Taking ERT in order to replace estrogen that your body cannot otherwise produce can help to alleviate hot flashes, drying and shrinking of the reproductive structures. This can work to avoid and relieve related problems such as vaginal irritation, painful intercourse and difficulty or burning during urination. It is important to discuss the effects of ERT with your doctor if you have ever had cancer of the breast, uterus, unusual vaginal bleeding, abnormal blood clotting or any heart disease. Taking estrogen, can also help to prevent osteoporosis, the loss and deterioration of bone.

Some women should not engage in ERT. It is always important to discuss your medical history with your physician and the risks that are involved. It is still being researched whether or not breast cancer risk is increased with the taking of estrogen. Some studies show an increased risk in breast cancer with women who take high doses of estrogen for long periods of time. Make sure that your doctor is aware of the following conditions if you have them; high blood pressure, kidney disease, asthma, skin allergy, epilepsy, migraine headache, diabetes, and depression. Some of the side effects that you may experience with taking estrogen are nausea, fluid retention, irregular bleeding and breast tenderness.

Forms of Estrogen

Tablets-The most common type of oral estrogens are conjugated equine estrogen. Tablets are generally taken daily for the number of days indicated by the prescribing doctor.

Injections-For some women, injections will be better suited for them. The injected estrogens are slowly absorbed and circulated through the body over extended periods of time. The injections usually go right into the blood stream rather than through the stomach and liver. Injections are usually given by your physician once every 3-4 weeks.

Transdermal estrogen- This is a Transdermal patch, placed on the skin. It is a new way to take estrogen for the treatment of menopausal symptoms and prevent postmenopausal osteoporosis. It is a small, clear, self-adhesive patch that contains a quantity of estradiol, which is identical to the hormone made by the ovaries. It is released at a relatively constant rate through the porous membrane at the base of the patch. The estradiol travels through tiny blood vessels near the skin's surface and enters the circulatory system. Once it has entered the bloodstream, the estrogen is ready for the organs that need it.

Some users of the patch may experience some sort of irritation around that area of skin. It usually disappears within a few days removal of the patch. When using Transdermal estrogen, it should be changed twice a week. Every new patch that is put on should be placed in a different skin site.

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