What and Why of Hysterectomy

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The most common surgical procedure in women apart from birth related surgeries is hysterectomy. Almost 3 in every 1000 of women will need to undergo a hysterectomy.
What is Hysterectomy?
A hysterectomy is a surgical operation in which the uterus of a woman is removed. There are various reasons for which the uterus might need to be removed from the abdomen. Of these, the most common is the presence of uterine fibroid. Other common reasons include-
1. Abnormal uterine bleeding
2. Precancerous conditions of the cervix and uterus
3. Endometriosis, and
4. Uterine prolapse.
Uterine Fibroid-
Uterine fibroid, when they cause medical problems are by far the most common reason a hysterectomy is performed. Uterine fibroid are benign growths of the uterus, which means they do not convert to cancer, and are usually harmless and symptom less. However, when  fibroid grow to an excessive size (usually greater than the size of a two-month pregnancy), or if there is pressure, pain, and/or bleeding severe enough to produce anemia then a hysterectomy may be carried out.
Uterine Prolapse-
Uterine prolapse is another condition that can require treatment with a hysterectomy. In this condition, because of weakening of the support muscles and tissues in the pelvic floor area the uterus slides down into the vagina. A first degree prolapse, is one in which the cervix is about halfway down into the vagina. In second degree prolapse, the cervix has slid into the vaginal opening, and in third degree prolapse, the cervix and uterus protrude out of the vaginal opening. Second and third degree uterine prolapse must necessarily be treated with hysterectomy.
Factors leading to these causes-
A vaginal wall weakness can cause conditions like a cystocele, rectocele, or urethrocele, where portions of other tissues balloon into the vagina through the weak opening. This can can lead to symptoms such as urinary incontinence, pelvic heaviness, and difficulty in sexual performance. Any sudden pressure in the abdomen such as in sneezing, coughing, jumping, or laughing can cause an involuntary leak of urine. Childbearing is the most common cause for this condition. Where other measures do not help the patient hysterectomy must be considered.It is also performed to treat uterine cancer or very severe pre-cancers called dysplasia. A hysterectomy for uterine cancer has the obvious purpose, that of removal of the cancer from the body.

When Hysterectomy?
A woman must be thoroughly physically examined before she is elected for a hysterectomy. A complete pelvic exam including manually examining the ovaries and uterus must be carried out. A PAP smear, laparoscopy and endometrial biopsy might need to be performed. Other tests like CT scan, ultra-sound must be done.It is also imperative that preventive and curative medicines be tried to cure the condition before any surgery is resorted to. A complete blood count and an attempt to correct any anaemia must also be made.

For example, hormones and non-hormonal treatments may be tried to reduce bleeding in fibroids. Moderate surgical procedures such as D&C, or removal of the lining of the uterus may be tried. If all fails and bleeding is severe and causing anaemia then a hysterectomy will have to be considered.

In an older patient if bleeding continues despite treatments then hysterectomy may be opted for. Once a decision to carry out a hysterectomy is made, it must also be decided at this juncture whether the ovaries are also to be removed or left in place. This will depend upon the age of the patient as well as the medical reason for carrying out this procedure.

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