The most common reasons for having a hysterectomy include the following:
Heavy, painful periods
Many women find they lose an excessive amount of blood during their periods. This can lead to symptoms of anaemia, such as feeling light-headed and weak. Also, stomach cramps or pains can affect your quality of life.
Heavy menstrual bleeding is caused by fibroids and hormonal imbalances. However, in some cases there is no obvious cause.
A hysterectomy is normally only recommended in the treatment of heavy menstrual bleeding when:
- other treatments have not proved effective,
- your bleeding is having a severe impact on your quality of life, and
- you no longer wish to have any children.
Alternative treatments for heavy menstrual bleeding are:
- Wait and see approach - heavy painful periods will disappear when you reach the menopause.
- Tranexamic acid - which clots the blood in the womb, reducing bleeding.
- Non-steroidal anti-inflammatory drugs (NSAIDs) - which reduce bleeding and relieve pain.
- Hormone therapy - the contraceptive progestogen can be used to interrupt the menstrual cycle, while other hormones can be used to prevent the lining of the womb from growing too quickly.
- Endometerial ablation - a surgical procedure to make the lining of the womb thinner. Having this procedure means that you will be infertile and won't have any more periods.
- Myomectomy - the surgical removal of any fibroids that may be causing your heavy bleeding.
Pelvic inflammatory disease
Pelvic inflammatory disease (PID) is a bacterial infection of the female reproductive system. If detected early, PID can be treated with antibiotics. However, if the infection spreads, it can damage the fallopian tubes and uterus and lead to chronic (life-long) episodes of pain.
Symptoms of pain can be controlled using painkillers (analgesics). However, you may decide you wish to have a hysterectomy if you no longer want to have any children.
Endometriosis
Endometriosis is a condition where the cells that line your uterus are also found in other parts of your body and reproductive system, such as the ovaries, fallopian tubes, bladder and rectum. In the same way that the cells of the lining of your uterus are shed during your period, these other cells are also shed during that time.
This can cause problems as the released blood gets stuck in the surrounding tissue, damaging it. It can cause pain, severe and irregular periods and infertility.
Treatments for endometriosis include hormone therapy and laser surgery. However, if your symptoms are severe, previous treatment has not been effective and you no longer wish to have any children, you may consider a hysterectomy.
Prolapse of the uterus
A prolapse occurs when the muscles supporting the uterus are weakened, causing the uterus to drop down into the vagina. This can occur as a result of childbirth or muscle strain caused by heavy lifting.
Prolapses also often occur after the menopause, as the resulting changes in hormone levels can cause the muscles to lose their elasticity.
Symptoms of a prolapse include:
- back pain,
- pain during sex, and
- incontinence.
Hormone replacement therapy (HRT) can be used to strengthen the muscles supporting the uterus, keeping it in position. There are also a number of surgical techniques that can be used to strengthen the muscles and ligaments.
However if the muscles and ligaments have been severely weakened, a hysterectomy may be recommended.
Cancer
There are four types of cancer that may require a hysterectomy:
- cancer of the cervix,
- cancer of the ovaries,
- cancer of the endometrium (also known as cancer of the womb), and
- cancer of the fallopian tubes.
Cancer of the ovaries and the cervix are the most common. Approximately 3,000 women are diagnosed with cervical cancer every year and approximately 7,000 women are diagnosed with cancer of the ovaries.
If these cancers are detected early enough it may be possible to treat them with chemotherapy and radiotherapy. However, if the cancer has reached an advanced stage, a hysterectomy may be the only viable treatment option.
