www.rfay.com.au

Dr Roger McMaster-Fay

Gynaecologist and Endoscopic Surgeon - Clinical Lecturer, Sydney University

What is a hysterectomy?

A hysterectomy is the removal of the uterus (or womb). The uterus is where the baby grows during pregnancy. The uterus is also the source of menstrual blood (your period) when the lining sheds once a month. This means that after a hysterectomy there will be no pregnancy and no more periods.

A total hysterectomy is the removal of the uterus and the cervix (the neck of the uterus).

The ovaries are sometimes removed from pre-menopausal women because of their particular disease (e.g. endometriosis), but whenever possible they are conserved because they will continue to produce hormones until it is time for their natural menopause. If the ovaries need to be removed, the fallopian tubes are removed with them.

Hormone replacement therapy is usually administered by a hormone implant inserted at the time of hysterectomy. This can be discussed with your doctor.

Hysterectomy is sometimes done as part of a vaginal prolapse repair. Prolapse is when the uterus and/or the bladder, and/or the bowel have dropped from their normal position.

The most common reasons for having a hysterectomy are:

• Heavy or irregular bleeding, not relieved by other methods
• Fibroids that may be causing bleeding or discomfort
• Uterine pain not relieved by other methods
• Endometriosis symptoms
• As part of the Vaginal Proplapse Repair operation
• Pre-cancerous changes in the uterus or cervix
• Benign or malignant tumours of the uterus, cervix or ovaries.

Types of Hysterectomy

There are three ways to do a hysterectomy. You will need to discuss with your doctor which methods are suitable for you:

1. Abdominal Hysterectomy
The uterus is removed through a cut in the abdomen. The top of the vagina is stitched together.

2. Vaginal Hysterectomy
The uterus is removed via the vagina. The top of the vagina is stitched from below so there is no abdominal scar.

3. Laparoscopic Hysterectomy
This is the newest technique. The surgeon uses a laparoscope, which is a small instrument like a telescope, and operates through several small cuts in the abdomen. Sometimes the operation is completed via the vagina, or it may all be done through the laparoscope.

In all cases, the top of the vagina heals and the abdominal organs fill the space left by the uterus, which is about as big as a fist.

The operation is always done under anaesthetic, which may be general, spinal or epidural.