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Hysterectomy — Points to consider

Your doctor may recommend a hysterectomy if none of the treatments for the various conditions mentioned in the previous section have worked. Whether or not to have a hysterectomy, and if so, how soon, all depends on the severity of your symptoms.

If cancer has been diagnosed, you really have very little choice. Having the operation as quickly as possible increases your chances of recovery.

Hysterectomy as a solution for the other conditions is not so clear cut. Often a woman is able to handle pain and bleeding if given drug treatment and iron tablets, and then she will have more time to consider the implications of hysterectomy. Sometimes lesser surgical operations will forestall severe symptoms so that, if a woman wants to have children, this may still be possible. In the case of prolapse, this is rarely dealt with by hysterectomy unless there are other symptoms such as very heavy periods.

If a hysterectomy has been suggested for you, (other than for cancer), the following questions can help you make up your mind about the operation:

• Have I tried all the alternative treatments?
• Are my symptoms so unbearable as to make my life a misery?
• Will the operation relieve all my symptoms?
• Will there be any unexpected effects—am I prepared for an earlier menopause?
• Do I still want to have children?
• What will happen if I decide not to have a hysterectomy?

Earlier menopause

Many women are not told that they can expect to have an earlier menopause after a hysterectomy, even if their ovaries are not removed. One third of women enter menopause within two years of surgery, regardless of age. On average, menopause occurs four to six years earlier than would have occurred naturally.

Diagnosis

Often a doctor will have a fairly good idea of the type of your problem after examining you and listening to your symptoms. The doctor should make detailed notes of your medical history and your concerns. Your blood will probably be tested for hormone levels. You should also be given a pelvic ultrasound scan. The newer transvaginal scans, where the probe is placed inside the vagina, have made diagnosis of pelvic disease much easier.

If the scan shows any abnormalities or is unclear, your doctor may want to investigate further using hysteroscopy, a procedure in which a viewing device is inserted into the uterus. A sample of the lining of the womb (endometrium) may be taken. Endometrial sampling is done either as an outpatient procedure, or by D&C—dilatation and curettage—usually when you are under a general anaesthesia. In a D&C, your cervix will be opened (dilatation) and the lining of your uterus (the endometrium) will be systematically scraped (curettage) with a long, thin instrument. The strips of the lining will then be examined under a microscope.

Since having a hysterectomy is such an irrevocable step, you may wish to have a second opinion from another doctor. You are entitled to this under the NHS, and it is said that a good doctor is one who will offer to arrange a second opinion just before the patient asks for it!

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Originally written by Nancy Duid and Wendy Savage MB FRCOG. This edition revised by Women's Health, July 1999

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