Hysterectomy – Introduction

Heavy menstrual bleeding and other menstrual problems are very common and one of the most frequent reasons for women to consult their general practitioner.  They are the commonest cause of referral to a gynaecologist.  In the past, such referrals frequently resulted in hysterectomy (surgical removal of the uterus), even in cases where the uterus was healthy.   Advances in treatment have increased the options available and nowadays most women can be offered medical treatment or minor surgery and hysterectomy is only necessary if other treatments have failed or where there is an underlying disease present.  Even some diseases of the uterus can be treated without major surgery. 

Twenty years ago, over 20, 000 hysterectomies were performed in NHS hospitals in England for treatment of heavy menstrual bleeding.  In 2002/3 the number had reduced to under 10,000 (figure).  A similar reduction has occurred elsewhere in the UK.  This reduction has occurred because of the availability of simple, safe and effective alternatives.   One of these is the Intrauterine System (IUS); a plastic device containing a low dose of a hormone which, when fitted into the uterus, causes thinning of the uterine lining and reduced menstrual bleeding.   The uterine lining can also be thinned out surgically by a minor operation known as endometrial ablation.  Both of these treatment methods, together with other medical alternatives will be described in detail in later chapters.

Despite these developments some women will still be advised to undergo hysterectomy.  This may be because other treatments have failed or are not suitable or, in some cases, because of uterine or ovarian cancer.   Hysterectomy is an effective treatment for many gynaecological conditions.  Even where hysterectomy is the only option, there may be choices.  The uterus may be removed through the vagina with no abdominal scar (vaginal hysterectomy) or as a “keyhole”procedure  (laparoscopic hysterectomy).  Sometimes only part of the uterus is removed (subtotal hysterectomy).  The gynaecologist may recommend removal of the ovaries as well as the uterus.  Again, all these alternatives will be fully described in later chapters.

The objective of this booklet is to describe the causes of heavy menstrual bleeding and other common menstrual disorders.  It will explain the various treatment options available, both medical and surgical.  It is designed to provide information that will supplement what you are told by your GP and gynaecologist and the various health professionals whom you will meet.  However, even as this booklet is being updated, new developments are taking place and more information is being gathered about existing treatments.  Thus it can never be a substitute for first hand information from your own hospital and informed discussion with the staff involved with your care.

KEY POINTS

• Menstrual problems are extremely common
• There are medical and surgical treatement options available
• The numbers of hysterectomies carried out for treatment of menstrual problems has reduced by half over the last 15-20 years
• The decision to have a hysterectomy may involve more than one surgical option