Vaginal dryness, hot flushes, sweating and other symptoms of natural menopause may occur. Women who undergo bilateral oophorectomy removal of both ovaries usually take hormone replacement therapy also called menopause hormone therapy ,This is also known as oestrogen replacement therapy, as usually only oestrogens are required to maintain their hormone levels and prevent the long-term risks of premature menopause.
The ovaries play a major role in maintaining the female hormonal system. Their removal results in menopausal symptoms within 24 hours, oestrogen levels fall by 50 per cent. Except if a woman has cancer, doctors recommend that hysterectomy should be a procedure of last resort, when all other treatment options have failed. Some conditions that in the past have been treated with hysterectomy, now have alternative treatment options. These include:. Fibroids are non-cancerous growths that form within the muscular walls of the uterus.
However, most fibroids are small, do not cause symptoms and do not require treatment. For those that do, treatment choice depends on the size, position, and symptoms caused by the fibroids. Heavy menstrual bleeding may be due to fibroids, adenomyosis, cancers, bleeding disorders, other medical conditions and also unknown causes.
Alternative treatment to a hysterectomy for heavy bleeding may include:. Since the introduction of the levonorgestrel-releasing IUD and endometrial ablation to treat heavy or irregular periods, hysterectomy rates have reduced. Alternative treatment to a hysterectomy for uterine prolapse depends on the degree of prolapse, but may include:. For endometriosis , alternative treatment to a hysterectomy may include hormonal therapies, surgical removal of areas of endometriosis, or a combination of both.
If, after talking about all the options with your doctor, you choose to have a hysterectomy, your doctor should discuss several things with you before the operation. You will have a range of tests before your hysterectomy, including a complete blood-count test to check for problems such as anaemia deficiency in red blood cells or haemoglobin.
The operation may be performed via an incision cut in your lower abdomen abdominal hysterectomy , three to four small incisions in your abdomen laparoscopic hysterectomy , or through your vagina vaginal hysterectomy. For an abdominal hysterectomy, the surgeon usually makes a horizontal cut along your pubic hairline your pubic hair may have been shaved around the incision. For most women, this leaves a small scar. Some women may need a vertical midline incision in the lower abdomen, especially if the hysterectomy is for a large uterine fibroid.
An abdominal hysterectomy is generally recommended when a woman has very large fibroids or cancer. For a laparoscopic hysterectomy, the surgeon inserts a telescope laparoscope to see your pelvic organs through a small incision in your navel, and makes another three or four small incisions through which other instruments are used.
Carbon dioxide gas is used to distend inflate your abdomen, like a balloon, so all of your organs can be clearly seen.
The surgeon then removes the uterus, with or without fallopian tubes and ovaries, through the vagina. If the top of the vagina is sutured stitched through keyhole incisions, the operation is called a total laparoscopic hysterectomy. During abdominal hysterectomy, your surgeon detaches your uterus from the ovaries, fallopian tubes and upper vagina, as well as from the blood vessels and connective tissue that support it. The lower part of your uterus cervix is usually removed total hysterectomy but may sometimes be left in place partial hysterectomy.
If necessary, your surgeon may remove additional pelvic organs and tissue, such as your ovaries or fallopian tubes. Before surgery, you may have tests done to check for cancer, which could change your surgeon's approach to surgery.
Tests may include:. The day before and morning of your surgery, you will be instructed to shower using soap provided by your surgeon to reduce your risk of infection. A preoperative cleansing of your vagina vaginal douche or preoperative cleansing of your rectum enema also may be done. Immediately before surgery, you'll receive an intravenous antibiotic medication to minimize your risk of infection after the procedure. During abdominal hysterectomy, your surgeon makes a vertical or a horizontal incision in your lower abdomen.
A vertical incision left gives the surgeon greater access to your pelvis. A horizontal incision right follows your skin's natural lines, usually leaving a thinner scar. A hysterectomy typically is performed under general anesthesia, so you won't be awake during the surgery. The procedure itself generally lasts about one to two hours, although you'll spend some time beforehand getting ready to go into the operating room.
To begin the procedure, a member of your surgical team passes a urinary catheter through your urethra to empty your bladder. The catheter remains in place during surgery and for a short time afterward. Your abdomen and vagina are cleaned with a sterile solution before surgery. To perform the hysterectomy, your surgeon makes a cut incision in your lower abdomen, using one of two approaches:.
The type of incision depends on many factors, including the reason for your hysterectomy, the need to explore the upper abdomen, the size of your uterus and the presence of any scars from prior abdominal surgeries. For instance, hysterectomies performed for endometriosis, large fibroids and gynecologic cancers are done mainly through a vertical incision. An abdominal hysterectomy usually requires a hospital stay of one to two days, but it could be longer. You'll need to use sanitary pads for vaginal bleeding and discharge.
It's normal to have bloody vaginal drainage for several days to weeks after a hysterectomy. Further small incisions may be made on your abdomen through which tiny surgical instruments are passed. Then uterus and cervix are removed along with or without both ovaries and tubes. You can continue taking your regular medications, unless your doctor advises. You may need to have a bowel preparation which will empty your bowel before the surgery.
For this, you should be on a liquid diet soups, jellies, juices or similar drinks for 24 hours before the surgery. Avoid smoking and if you develop signs of illness prior to your surgery, please contact our office immediately. You will be in the recovery room when you wake up from anaesthesia. You may feel sleepy for the next few hours.
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