Healthy Living

What Conditions Warrant a Hysterectomy?

The most pressing reasons for opting for a hysterectomy.

What Conditions Warrant a Hysterectomy?

Upon reaching reproductive age, the womb (uterus) creates ideal conditions for pregnancy, gestation, and delivery of a baby. But many things can go wrong within the female reproductive system. Development of fibroid masses, outgrowths of the endometrial lining, and excessive vaginal bleeding are some of the serious problems that need to be addressed as emergencies.

It is possible, in such a scenario, that the consulting gynecologist may suggest an immediate hysterectomy (uterus removal). The question that begs an answer is whether the symptoms justify a hysterectomy, and if the answer is in the affirmative, whether there are alternative and less invasive techniques for easing the distress. 

1. Development of Rubbery Masses or Fibroids

What happens in the uterus

For reasons that are still being scientifically evaluated, the endometrial lining of the uterus solidifies in patches, creating masses of thickened tissue and muscle called fibroids.

Women at higher risk of developing uterine growths

Women of African American descent, those who are excessively overweight, women with family members who have or have had fibroids, and women who are habituated to consuming red meat and red meat products appear to be at higher risk of developing fibroids in their 30s and 40s as they move toward menopause.  

Fibroids are known to grow in four different ways.

  • Some fibroids form inside the uterine lining, thickening the muscular wall of the uterus.
  • Some fibroids bulge directly into the uterine cavity.
  • There are those that grow outside the uterus into the pelvic area.
  • And, mushroom-like fibroids can grow either internally or outside the uterus, perched on stems.

These fibroids are not cancerous in nature nor known to become malignant, and the majority of women may not be aware they have fibroids because of the complete absence of symptoms. But in women that show symptoms, the severity of the symptoms as described below makes life almost unlivable.

The anatomy of fibroid-induced discomfort

  • Fibroids stretch the uterine wall, making it larger. In some instances, the greater space occupied by an enlarged uterus creates intense pain and discomfort and even makes the woman seem pregnant.
  • The pressure of the larger uterus on the urinary bladder triggers the desire to urinate more frequently, even when the bladder is not full.
  • The downward pressure exerted by a distended uterus on the cervix and upper vaginal passage makes sexual activity painful.
  • The pressure exerted by pelvic fibroid growths on the colon interferes with the functioning of the colon and rectum. Affected women are more likely to complain of Irritable Bowel Syndrome.
  • Fibroids draw a heavier supply of blood and cause intense bleeding during menstruation, besides severe pelvic pain and physical discomfort.
  • The heavier-than-usual uterus distends the stomach and stretches the spinal cord creating frequent backaches.
  • Fibroid masses within the uterus may also interfere with the normal development of the fetus in a pregnant woman, and impede proper placental nourishment of the growing baby.
  • Fibroids that grow into the uterine space can cause infertility by preventing fertilized eggs from creating a firm base in the endometrial lining.
  • The presence of fibroids may also rule out the possibility of a normal delivery and pressure the surgeon to consider a cesarean section.

Alternative Treatments: One of the alternatives to a hysterectomy is the surgical removal of fibroids called myomectomy, a procedure that helps the woman retain her uterus. Another method is to cut off the blood supply to fibroid masses to shrink and destroy them, but such measures may also affect healthy uterine tissue and trigger infertility. There is also the danger of diminishing the blood supply to the ovaries leading the way to their gradual wasting away.

Prognosis: The problem is that targeted surgical interventions do not stop fibroids from redeveloping at a later stage, with intensifed blood loss, pelvic pain, and discomfort. This may leave the surgeon with no other option but to recommend the permanent removal of the uterus.

2. Abnormal Growth of the Endometrium (Inner Uterine Lining)

What occurs in the uterus and pelvic space

In endometriosis, the inner lining of the uterus grows abnormally to form bulbous protrusions both within and outside the uterus. These abnormal uterine outgrowths may also appear on the exterior of the ovaries and fallopian tubes.

Endometrial tissue mimics menses cycles

The problem arises when the tissue outside the uterus starts swelling and shedding the way it is programmed to do inside the uterus during menstruation. The result is peritonitis (infection of the peritoneal covering of abdominal organs).

Pelvic organs such as the urinary bladder and rectum may also adhere to endometrial tissue, creating scars that affect the functioning of these organs. Severe pelvic pain and discomfort and inability to conceive are some of the symptoms that distress women so affected.

Alternative Treatments: The surgeon could laparoscopically remove the offending tissue or suggest hormonal interventions that suspend menstruation for a short period to allow the affected organs to heal and rejuvenate. The problem with hormonal treatment is that it alleviates the symptoms only for as long as the patient is on medication, and the symptoms return when drugs are stopped. Besides, excessive hormone therapy may cause hormone dependency issues and interfere with normal reproductive cycles.  

Prognosis: Regardless of the corrective surgical technique adopted, endometriosis can recur at later stages, necessitating hysterectomy when pain, bleeding, and discomfort become unbearable.

3. Heavy Loss of Blood

Menorrhagia (Heavy and sustained blood loss)

What hormone imbalance does to the body

Bleeding is an integral part of the reproductive function in women as the endometrial lining of the uterus completes its monthly cycle of development and disintegration.  The menstrual cycle is paced and fine-tuned by the balancing action of two vital hormones – estrogen and progesterone. When estrogen dominates the cycle, the endometrial lining bleeds profusely, and this creates pelvic discomfort and painful menstruation. One may dread the arrival of monthly periods and the inevitability of pain and physical discomfort. Many women end up being totally immobilized, albeit for a short duration.

Infrequent ovulation and disrupted menstrual cycles

Another factor that triggers heavy bleeding is the inability of the ovaries to release an egg, which in turn suppresses the production of progesterone, the hormone largely responsible for the smooth conduct of the menstrual cycle. Without progesterone to balance hormonal activity, the female reproductive cycle falls into disarray, creating conditions ripe for excessive bleeding. This is more likely to happen during adolescence and in a woman's late 40s as she approaches menopause.

Bleeding triggered by fibroid masses

Many women develop fibroids in the uterine lining that are asymptomatic and therefore go undetected. These rubbery masses of tissue and muscle of unknown origin may provoke intense bleeding at the time of menses.

Cancer and vaginal bleeding

Uterine, ovarian, and cervical forms of cancer are triggers for heavier-than-normal bleeding.

Alternative Treatments:  Hormonal balancing therapy aims to bring progesterone levels back to normal. Progesterone can be administered either as a topical cream or orally in the form of tablets. Prior to therapy, the endometrial lining is evaluated for cellular abnormalities and the blood count measured to eliminate other risks like cancer. Hormone replacement treatment also calls for a comprehensive change in dietary habits and lifestyle.

Prognosis: A hysterectomy becomes the option of the last resort when excessive blood loss leads to severe anemia (iron deficiency) and progresses to life-threatening complications.