Gynaecology Services - Hysterectomy
Medical Conditions Which May Require a Hysterectomy
Heavy Menstrual Bleeding (Flooding)
The most common reason for a hysterectomy is heavy menstrual bleeding. This can be associated with fibroids or endometriosis. However, it is quite common to find the removed uterus appears to be perfectly healthy, and that there is no apparent cause for the heavy bleeding.
It is not unusual for women suffering this symptom to use two tampons and several sanitary pads at a time and still find blood soaking into their clothing or even onto their shoes several times a day. For other women the flooding may not be so heavy but may still cause them to take time off work or to be house-bound for several days each month. Only you can decide if the amount of blood you lose during a menstrual period is an unacceptable problem for you. If, for instance, you are close to menopause you might decide to wait and not have an operation.
Some women have very painful periods without an excessive loss of blood, with no apparent disease causing the pain. Many treatments are available, including hormone treatment and complementary therapies. A hysterectomy should be the option considered when other treatments have not been successful.
Fibroids are benign growths in the uterus which are caused by hormone stimulation. They often disappear after menopause. They are detected by an internal examination. Fibroids can be present with no other symptoms, or they can cause minor discomfort, or heavy bleeding. They can also occasionally distort the shape of the uterus causing it to press on the bladder, rectum or nerves . This may result in incontinence, constipation or lower back pain. Fibroids can be removed by surgery (myomectomy or multiple myomectomy) which does not involve the removal of the uterus. However, this is not always possible. Some complementary therapies have proved effective.
Pelvic Inflammatory Disease (PID)
This is usually in the form of a bacterial infection which attacks the uterus, ovaries and fallopian tubes. The symptoms are fever and pelvic pain, which may be either sharp or dull and achy. PID is usually treated with antibiotics and hysterectomy should be the last resort.
Endometriosis occurs when the tissue which lines the uterus grows outside the uterus. Endometrial deposits respond to the same hormones as the lining of the uterus, and with each monthly cycle can bleed and cause inflammation in the pelvis. This can result in formation of scar tissue and adhesions.
Hormone therapy which suppresses ovulation may be successful in symptom control. When the endometriosis is extensive or chronic, a hysterectomy may be required for the management of symptoms.
Diagnosis of endometriosis is confirmed by laparoscopy which is an exploratory surgical procedure which allows the Doctor to see the organs inside the pelvis and abdomen.
A prolapse may occur in women who have had several children. The ligaments which hold up the uterus get overstretched and the uterus presses on the bowel or bladder and may protrude into the vagina. Surgery can be carried out to repair the pelvic floor. If the prolapse also involves the uterus a hysterectomy may be required/
If there is a diagnosis of cancer of the cervix, ovaries or the uterus, a hysterectomy is usually necessary.
Acknowledgements & Source
The information in this page has been drawn from a variety of sources, primarily the following books:
Sandra Coney and Lynn Potter (Heinemann Reed 1990)
Hysterectomy Information Package
Southern Canterbury Women’s Wellness Centre
Staff at Christchurch Women's Hospital
So You're Having a Hysterectomy
Megan Gressor (Gore & Osment Publications)
Some illustrations by Marisa Swanink
Cervical Cancer: A book for Every Woman.