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Hysterectomy means removal of the uterus or womb. It is one of the most common gynaecological procedures performed and possibly one of the most misunderstood. Many people confuse removal of the uterus with menopause. This is not the case. Removal of the uterus means the end of menstrual periods, however if the ovaries remain, then hormone production continues and no change is noticed, apart from the absence of periods. Menopause will occur one day, but not as a part of the hysterectomy. In some cases of course, it is advisable to remove one or both ovaries at the time of the surgery, however this is unusual and would be discussed at length beforehand.

A hysterectomy is also one of the most successful gynaecological procedure with 100% success rate – after removal of the womb NO MORE MENSTRUAL BLEEDING will ever occur. No other procedure of any type can guarantee such an outcome.  It is typically performed for

  • Heavy and excessive menstrual loss
  • Irregular and persistent periods unresponsive to other therapies
  • Uterine Prolapse
  • Severe period pain often associated with endometriosis
  • High grade precancerous changes of the uterus or cervix

There are a number of variations to the type of hysterectomy. Sadly, the most common form in Australia remains the Abdominal hysterectomy with a large incision made vertically or horizontally in the lower abdomen and requiring 5-6 days in hospital and 6 weeks recovery. It allows a good view of the pelvic organs and is often used if removal of the ovaries is required at the time of surgery or there are other expected problems such as adhesions from previous surgery, large uterine fibroids, endometriosis or previous caesarean sections.

Vaginal hysterectomies are performed via an incision in the vagina thereby reducing the recovery time and risk. They are most often performed if significant prolapse of the uterus is present.

The Total Laparoscopic Hysterectomy, as performed in this practice, converts a case that would have been done via a large incision elsewhere, into a keyhole or minimally invasive operation.  All of the cases noted above that would normally necessitate a laparotomy incision can be done via keyhole surgery by Dr Rosen. In hospital stay is 1-2 days and recovery 2-3 weeks.

A Subtotal laparoscopic hysterectomy combines all the benefits of keyhole surgery however the cervix remains. This is preferred by some patients although there has been no evidence in studies to show any advantages in terms of sexual, bowel or bladder function. Furthermore, Pap smears will still be required in the future and cyclical vaginal spot bleeding may occur at the time of the expected period. Nonetheless this option is available to any patient who would prefer to retain her cervix.

When dealing with the medical problems noted above, all facets of treatment options will be discussed. These include;

  • Medical options
    • The Oral contraceptive pill,
    • Progesterone (Mirena) IUD
    • Non-hormonal medical treatments
  • Surgical options
    • Endometrial ablation (burning away or resecting the uterine lining to try and induce the end of menstrual periods)
    • Laparoscopic myomectomy – keyhole surgery to remove fibroids that are causing symptoms
    • Total Laparoscopic or Robotic assisted Hysterectomy

Every situation is different and treatment must be based on an individual woman’s symptoms, desires and plans.

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