Hysterectomy
by Ellen T Johnson and lone Hummelshoj
Are you at the end of your rope with endometriosis pain and have you decided to have a “complete hysterectomy”?
Is your wish and hope that a hysterectomy will alleviate your endometriosis pain?
A friend of ours wanted that, but when we asked her what she meant by “complete hysterectomy,” she replied:
“I don’t know; I just told the doctor to take everything!”
Taking everything…
Before any woman makes “the hysterectomy decision,” one of the many things she should know is exactly what the surgery involves.
Hysterectomy does not guarantee a relief from symptoms or from endometriosis. Surgery is surgeon dependent. If ALL the endometriosis is not removed as the same time as the removal of your uterus and your ovaries — you may still have endometriosis after this procedure.
While hysterectomy may be warranted in certain situations, there may be other, less radical alternatives for women with endometriosis to consider – and, it never hurts to seek a second opinion:
» Treatments for endometriosis
» Finding a specialist
Definition of hysterectomy
The surgical removal of uterus through the abdominal wall or vagina. There are two types of hysterectomies: total and sub-total:
- Total (or complete) hysterectomy
The entire uterus is removed, including the fundus (body of the uterus) and the cervix. - Sub-total hysterectomy
The uterus is removed but the cervix is left intact.
When other organs are removed at the time of hysterectomy, these terms apply:
Oophorectomy
Removal of an ovary. When both ovaries are removed, the surgical procedure is called “bilateral oophorectomy,” whereas the removal of only one ovary is called “unilateral oopherectomy.” When both ovaries are removed, a woman will experience instant and irreversible menopause.
Salpingo-oophorectomy
Removal of fallopian tube and ovary. “Bilateral salpingo-oophorectomy” (BSO) is the removal of both tubes and both ovaries.
Ovariectomy
Another term for removal of ovary (can be total or partial).
Radical hysterectomy
This surgical procedure includes total hysterectomy (uterus and cervix removed), plus bilaterial salpingo-oophorectomy (removal of both fallopian tubes and both ovaries), adjacent lymph nodes, and part of the vagina. Most often, this type of hysterectomy is performed when cancer is present.
Methods of hysterectomy
Hysterectomies are performed three different ways in various combinations:
- abdominally
- vaginally
- laparoscopically
If you are considering hysterectomy, discuss the best approach with your physician. As is true with any type of surgery, make sure the doctor you choose has considerable experience performing whatever method you choose.
TAH – total abdominal hysterectomy
A vertical or horisontal incision is made in the lower pelvis, and the organs are removed through the incision. Recovery time is usually longer than with the other methods.
TVH – total vaginal hysterectomy
The vagina is opened up and the uterus and cervix are removed through the opening. There are no incisions; therefore there is generally a shorter recovery time.
LAVH – laparoscopically-assisted vaginal hysterectomy
This is a total hysterectomy that combines surgery through the vagina with laparoscopy. Through the laparoscope, the surgeon may treat endometriosis at the same time. Although it takes longer to perform, there is generally a shorter hospital stay and shorter recovery time.
LSH – laparoscopic supracervical hysterectomy
This is a sub-total hysterectomy (cervix is retained) done completely through the laparoscope. Some advantages include shorter hospital stays, shorter recovery times, the pelvic support structures are retained, and there is no incision at the end of the vagina (which may cause pain during intercourse). A woman who undergoes a LSH must continue to get annual pap smears.
Supravaginal hysterectomy
Subtotal hysterectomy done completely through the vagina.
The hysterectomy decision
Deciding whether to have a hysterectomy is a very weighty, and personal decision. If you’ve been advised by your doctor to have a hysterectomy, a second opinion is always in order.
Read books, articles, and personal stories about hysterectomy – especially articles written by women with endometriosis. It’s also important to understand that some women experience a recurrence of endometriosis and/or its symptoms after hysterectomy, especially if all the endometriosis is not removed at the same time.
Discuss all the risks and possible side effects with your doctor and with women who’ve undergone hysterectomy. You may want to talk with women in your endometriosis support group about their experiences with hysterectomy.
And finally, consider your decision very carefully because “the hysterectomy decision” is not reversible.
For more information
The links below are all external to Endometriosis.org and do not constitute an endorsement of any opinions or services offered by any of these people or their organisations, nor the content found on their websites. See also our disclaimer.
Recurrent endometriosis pain following hysterectomy
Dr Enda McVeigh, Professor Ray Garry, Dr David Redwine, and Dr Tom Lyons
Does recurrent endometriosis after hysterectomy indicate residual or recurrent disease and what role does HRT choices or ovarian preservation play in the genesis of recurrent pain?
Dr Andrew Prentice and Dr David Redwine
Avoiding hysterectomy
Dr Herbert Goldfarb, author of The No-Hysterectomy Option: Your Body, Your Choice
COMMON SENSE …something you can link to within yourself and which will tell you:
what is right for me?
