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The operation may also be with or without the removal of the ovaries and the fallopian tubes. The uterus is a muscular organ of the female body, shaped like an upside-down pear. The lining of the uterus the endometrium thickens and, after ovulation, is ready to receive a fertilised ovum egg. If the ovum is unfertilised, the lining comes away as bleeding. This is known as menstruation period. If the ovum is fertilised, the developing baby is nurtured inside the uterus throughout the nine months of pregnancy. If a woman has a hysterectomy, she will no longer have menstrual periods or be able to have a child, and will not need to use contraception.

Once a woman has had a hysterectomy of any kind, she cannot become pregnant. If the ovaries of a premenopausal woman are removed, she has had a surgical menopause. This means she will have a drop in production of the sex hormones oestrogen, progesterone and testosterone. 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.

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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. For endometriosis , alternative treatment to a hysterectomy may include hormonal therapies, surgical removal of areas of endometriosis, or a combination of both.

Total Vaginal Hysterectomy

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.

Vaginal Hysterectomy: Recovery, Procedure, and More

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.


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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. If the gynaecologist stitches the top of the vagina through the vagina, it is called a laparoscopically assisted vaginal hysterectomy. A vaginal hysterectomy is performed through an incision at the top of the vagina. It is usually performed where there is a uterine prolapse the cervix and uterus come down into the vagina, or protrude out of the vaginal entrance.

Open surgery still the norm

With good pain relief, recovery may be similar for all forms of the hysterectomy. Although, more care is required regarding the pelvic floor, urination and bowel function after vaginal hysterectomy. It is important to start pelvic floor and abdominal exercises within the first few weeks after surgery. These exercises strengthen the muscles in your pelvis, and help maintain normal bladder function and vaginal muscle tone. Your doctor or physiotherapist will let you know how soon you can start these particular exercises.

Be guided by your doctor, but general suggestions for the four to six-week post-operative period include:. After hysterectomy, you will no longer need contraception or have menstrual periods. If your ovaries were removed, you may experience menopause symptoms starting within a few days of your surgery. If you were still having periods before your hysterectomy, your doctor should discuss oestrogen replacement therapy or other options with you. How long you might need oestrogen replacement therapy will depend on your age.

Hysterectomy can be an effective treatment for gynaecological conditions such as fibroids, endometriosis and adenomyosis, though sometimes endometriosis may recur. If you have had a hysterectomy to treat cancer, depending on the stage of the cancer you will need to have regular check-ups to make sure you are cancer free. You may need to have a regular vault smear test — similar to a cervical screening test but involving cells from the top of your vagina instead of the cervix.

If you have had a subtotal hysterectomy uterus removed but cervix retained then you will need to continue having cervical screening. The following content is displayed as Tabs.

The difficult vaginal hysterectomy: 5 keys to success | MDedge ObGyn

Once you have activated a link navigate to the end of the list to view its associated content. The activated link is defined as Active Tab. Brain surgery is performed for a number of reasons, including alterations in brain tissue, brain blood flow and cerebrospinal fluid Day surgery is completed in one day, usually the person does not have to stay in hospital overnight A colonoscopy can be used to look for cancer of the colon bowel cancer or colon polyps, which are growths on the lining of the colon An endoscope or fibrescope is a long, usually flexible tube with a lens at one end and a video camera at the other The advantage of laparoscopy is that only a small incision is required, which is why it is also known as 'keyhole surgery' Corneal transplant surgery would not be possible without generous donors and their families, who have donated corneal tissue so that others may see Kidneys are often donated after death but more people are choosing to donate one of their kidneys while still alive living kidney donation Discover the facts about organ and tissue donation, decide about becoming a donor and discuss your decision with the people close to you Transplantation varies depending on the transplant organ or tissue so speak with your medical team about surgical procedures, recovery and medications A 'tummy tuck', or abdominoplasty, is cosmetic surgery to remove fat and excess loose skin from the abdomen Eyelid surgery, or blepharoplasty, aims to improve the appearance of the upper eyelids, lower eyelids or both Body contouring is surgery to remove sagging skin and extra fat, and improve the shape and tone of underlying tissue An 'arm lift' is surgery to reshape or reconstruct the underside of the upper arm from the armpit to the elbow Breast reduction surgery removes excess breast fat, glandular tissue and skin to achieve a breast size in proportion with your body Cosmetic genital surgery involves reshaping the labia, vulva or penis to alter their size or shape Buttock and pectoral implants involve surgery to insert shaped silicone pieces into skin cavities Cosmetic surgery carries risks and, in some cases, the results are not what you may anticipate Ear correction surgery, or otoplasty, is usually done to move prominent ears closer to the head or to reduce the size of large ears A facelift is a type of cosmetic surgery that removes or tightens facial skin to make a person look younger Facial implants are used by people who want to restore or improve the normal shape of their face Hair transplant surgery involves taking skin from parts of the scalp where hair is growing and grafting it to the thinning or bald areas, or areas of trauma Liposuction is invasive surgery and is not a substitute for weight reduction or a cure for obesity People may choose to travel overseas to seek medical or surgical treatment that is unavailable in their home country.

This is called medical tourism, and it's a booming industry worldwide. IVF in-vitro-fertilization and ICSI intracytoplasmic sperm injection are assisted reproductive treatment ART procedures in which fertilisation of an egg occurs outside the body A caesarean section is usually performed when it is safer for the mother or the baby than a vaginal birth Sterilisation is a permanent method of contraception that a woman can choose if she is sure that she does not want children in the future Having a vasectomy does not affect a man?

Some women choose to have breast reconstruction surgery to give a similar appearance to the look of their original breast in normal clothes A craniotomy is an operation to open the skull cranium in order to access the brain for surgical repair During laser eye surgery, a computer-controlled laser is used to remove microscopic amounts of tissue from the front surface of the eye After heart bypass surgery, eat a wide variety of fresh fruit and vegetables, wholegrain cereals and cold-water fish If you have large fibroids, you may need an abdominal hysterectomy — surgery that removes your uterus through an incision in your lower abdomen.

Endometriosis occurs when the tissue lining your uterus endometrium grows outside of the uterus, involving the ovaries, fallopian tubes or other organs. Most women with endometriosis have an abdominal hysterectomy, but sometimes a vaginal hysterectomy is possible. Gynecologic cancer. If you have cancer of the uterus, cervix, endometrium or ovaries, your doctor may recommend a hysterectomy to treat it. Most of the time, an abdominal hysterectomy is done during treatment for ovarian cancer, but sometimes vaginal hysterectomy may be appropriate for women with cervical cancer or endometrial cancer.

Uterine prolapse. When pelvic supporting tissues and ligaments get stretched out or weak, the uterus can lower or sag into the vagina, causing urinary incontinence, pelvic pressure or difficulty with bowel movements. Removing the uterus with hysterectomy and repairing pelvic relaxation may relieve those symptoms.

Abnormal vaginal bleeding. When medication or a less invasive surgical procedure doesn't control irregular, heavy or very long periods, hysterectomy can solve the problem. Chronic pelvic pain. If you have chronic pelvic pain clearly caused by a uterine condition, hysterectomy may help, but only as a last resort. Chronic pelvic pain can have several causes, so an accurate diagnosis of the cause is critical before having a hysterectomy for pelvic pain.

Risks of vaginal hysterectomy include: Heavy bleeding Blood clots in the legs or lungs Infection Damage to surrounding organs Adverse reaction to anesthesia Surgical risks are higher in women who are obese or who have diabetes or high blood pressure. It's normal to feel anxious about having a hysterectomy. Here's what you can do to prepare: Gather information. Before the surgery, get all the information you need to feel confident about it.

Ask your doctor and surgeon questions. Learn about the procedure, including all the steps involved if it makes you feel more comfortable. Follow your doctor's instructions about medication. Find out whether you should change your usual medication routine in the days leading up to your hysterectomy. Be sure to tell your doctor about any over-the-counter medications, dietary supplements or herbal preparations that you're taking.

Discuss what type of anesthesia you'll have. You may prefer general anesthesia, which makes you unconscious during surgery, but regional anesthesia — also called spinal or epidural block — may be an option. If you're having a vaginal hysterectomy, regional anesthesia will block the sensation in the lower half of your body. Arrange for help. Although you're likely to recover sooner after a vaginal hysterectomy than after an abdominal one, it still takes time. Ask someone to help you out at home for the first week or so. During vaginal hysterectomy You may have general anesthesia, so you won't be awake for the surgery.

To perform the hysterectomy: Your surgeon makes an incision inside your vagina to get to the uterus Using long instruments, your surgeon clamps the uterine blood vessels and separates your uterus from the connective tissue, ovaries and fallopian tubes Your uterus is removed through the vaginal opening, and absorbable stitches are used to control any bleeding inside the pelvis Except in cases of suspected uterine cancer, the surgeon may cut an enlarged uterus into smaller pieces and remove it in sections morcellation.

Laparoscopic or robotic hysterectomy You may be a candidate for a laparoscopically-assisted vaginal hysterectomy LAVH or robotic hysterectomy. After the vaginal hysterectomy After surgery, you'll be in a recovery room for a few hours and in the hospital for one to two days, possibly longer. Physical effects after a hysterectomy After a hysterectomy, you'll no longer have periods or be able to get pregnant. Levonorgestrel intrauterine devices are highly effective in limiting menstrual blood flow and improving other symptoms.

Side effects are typically very moderate because the levonorgestrel a progestin is released in low concentration locally.

There is now substantial evidence that Levongestrel-IUDs provide good symptomatic relief for women with fibroids.