Dysfunctional Uterine Bleeding Hysterectomy
Hysterectomy may be part of the treatment of severe dysfunctional uterine bleeding that fails to respond to other measures.
What is a hysterectomy?
Hysterectomy means the surgical removal of the uterus. There are several different ways a hysterectomy can be performed.
For the most part, they differ in regard to:
- How much of the uterus is removed
- How the uterus is removed
- What other nearby organs might be removed along with the uterus
- The size of the incision:
- A larger conventional incision
- A smaller incision using laparoscopy
The surgery may be performed through an incision that is made in the lower abdomen. It is also performed through the vagina. This is called a vaginal hysterectomy. During this surgery, only the uterus can be removed. Sometimes a flexible tube with a light on it is placed into the abdomen to assist with this surgery.
What happens after the uterus is removed?
After this procedure most women feel no different. The removal of the uterus makes future pregnancy impossible. It also removes the source of a woman's menstrual period. If the ovaries are removed, then menopause will occur. This is due to the lack of estrogen hormones. In many cases this will need to be corrected with hormone medicines.
Who needs a hysterectomy?
Your doctor may recommend a hysterectomy to correct a number of different medical problems. A hysterectomy is not recommended for women who are still interested in childbearing and just wish to avoid their menstrual periods.
Problems that may be treated with hysterectomy include the following:
- Recurrent, troublesome vaginal bleeding due to abnormalities (e.g. adenomyosis) of the lining of the uterus.
- Severe weakness of the pelvic floor leading to urinary incontinence. This is a common problem in older women who have given birth to multiple children.
- This can also cause an abnormal protrusion (uterine prolapse) of the uterus out the vaginal opening.
- Uncontrolled monthly pelvic pain and bleeding due to uterine fibroids or endometriosis.
- Uterine fibroids are benign (they are not cancer) tumors of the uterus that may be best treated with hysterectomy.
- Small uterine fibroids are very common so just the presence of them is not an indication for surgery.
- Many smaller fibroids can also be treated with limited surgical procedures that just remove the fibroid, but leave the uterus intact.
- Women who have cervical or uterine cancer that is not treatable using simpler forms of therapy.
- Women who have problems with very heavy or prolonged menstrual bleeding to the point that it is causing anemia (low blood counts).
How is a hysterectomy performed?
This operation is usually performed in a hospital operating room under general anesthesia. This means you are totally asleep during the procedure. You can have nothing to eat or drink for at least 12 hours prior to the operation. You may need an enema and a vaginal douche to help keep the surgical area clean. Pre-medication is usually given to make you sleepy. An intravenous line is started, and a bladder catheter is usually inserted to drain urine during and after surgery.
A standard abdominal hysterectomy is done through an incision in the lower abdomen. The uterus and ovaries are found and removed. Some doctors recommend removing your appendix at this time.
A vaginal hysterectomy removes the cervix and uterus through the vagina. The end of the vagina is closed with sutures. The ovaries and very large uterine fibroids cannot be removed using this procedure. Vaginal hysterectomy is a good option for women who just need the uterus removed.
Fiberoptic instruments allow many abdominal operations to be performed laparoscopically. This surgery uses small puncture-like incisions and long, thin instruments. This allows the surgeon to see and operate inside the abdomen.
What happens after surgery?
Most women do very well after either type of hysterectomy. Most report complete relief of their symptoms and enhanced quality of life.
With abdominal hysterectomy, there will be several days of pain control and convalescence required in the hospital. The incision needs to be kept clean and watched for signs of infection. Since incisions are made through the abdominal wall, activity must be slowly increased and heavy activity limited for 3-6 weeks while healing occurs. Sexual intercourse is usually not recommended for 6 weeks.
Vaginal hysterectomy usually requires a shorter period of recuperation since a large abdominal incision is not necessary. A very short hospitalization or even an overnight stay (after surgery) in an outpatient facility is an option with this approach.
Are there any other changes after surgery?
Although the majority of women recover uneventfully, some women have problems after surgery. A few complain of weakness and fatigue for a period of time. Bladder control problems affect a few women. Menopause will result when the ovaries are removed. From one quarter to one half of women will have some change in their sexual drive.
What are the risks associated with surgery?
Any surgery that requires general anesthesia carries some risk. Complications are more common in women with serious medical conditions. Women who smoke will have a much higher risk of complications than nonsmokers.
Other risks of hysterectomy include:
- Internal bleeding
- Blood clots such as deep venous thrombosis
- Damage to other organs such as the ureters, bladder, or intestines
The organs most likely to be damaged during this procedure are the ureters. It is rare to have a serious complication from a hysterectomy if you are an otherwise healthy person.
After hysterectomy, you should call your doctor if you develop:
- Difficulty urinating or inability to urinate
- Fever or chills
- Increasing abdominal pain
- Repeated vomiting
- Severe constipation with increasing abdominal swelling
- Shortness of breath
- Unexplained chest pain
Are there alternatives to hysterectomy?
Abnormal uterine bleeding often responds to hormonal therapy. Sometimes a simple D and C procedure will help. This is a surgical procedure that removes only the inner lining of the uterus.
Many small cancers of the cervix can be treated without the complete removal of the uterus. Benign fibroid tumors may be treated with a number of procedures. Talk with your OB-GYN physician about which options might be best for you.
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- Bourdrez P, Bongers MY, Mol BW. Treatment of dysfunctional uterine bleeding: patient preferences for endometrial ablation, a levonorgestrel-releasing intrauterine device, or hysterectomy. Fertil Steril. 2004 Jul;82(1):160-6. 
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