Hysterectomy is the surgery to remove removing the uterus or womb completely. The womb is the organ in the female reproductive system that is hollow and pear-shaped and found in the pelvic region. It is the site of fetus development and growth. The surgery to remove the uterus and other surrounding organs like the cervix, vagina, ovaries, and fallopian tubes is a hysterectomy or total hysterectomy. 

Hysterectomy Indications

There are some common indications for performing a hysterectomy like 

  • 1. Uterine fibroids
  • 2. Menstrual disorders
  • 3. Adenomyosis of the uterus
  • 4. Endometriosis
  • 5. Uterine or another pelvic organ prolapse
  • 6. Precancerous lesions of the endometrium and the cervix. 
  • 7. Abnormal uterine bleeding
  • 8. Malignancy and premalignant disease
  • 8. Uterine leiomyoma
  • 9. Chronic pain in the pelvic region
  • 10. Pelvic infection
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Uterine fibroids – A Hysterectomy Indications 

If uterine fibroids are suspected from various symptoms, it is highly crucial to confirm the actual presence of fibroids. In older patients, a woman’s fertility is not desirable; the surgeon can decide with the patient’s consensus. 

Dysfunctional Bleeding from Uterus

  • 1. Diagnosis of malignant lesions must be done before opting for any treatment. 
  • 2. In patients who do not require being fertile anymore 
  • 3. When hormone therapy does not work
  • 4. When endometrial ablation also fails
  • 5. Endometriosis is diagnosed
  • 6. If the patient herself desires to have a hysterectomy
  • 7. Hormone therapy fails, and fertility is not required
  • 8. Advanced or infiltrative endometriosis
  • 9. Expert suggestion after appropriate diagnosis 
  •  

Indications for hysterectomy post menopause

  • 1. Post-menopausal women have suggested hysterectomy if hormone therapy does not improve the condition and may lead to cancer. 
  • 2. After a particular age when women get their menopause, there is no further requirement of maintaining fertility at the cost of life-threatening conditions posed by a diseased uterus. Therefore hysterectomy is preferred. 
  •  

Indications for Total Hysterectomy

In case there is a need to remove the uterus and the cervix when cancer is invading surrounding organs. It becomes necessary to treat such cancer with a total hysterectomy. 

Indications for Abdominal Hysterectomy

Patients that cannot go for minimally invasive techniques like laparoscopic procedures or robot-assisted hysterectomy because of the large size of the uterus are advised abdominal hysterectomy. Vaginal hysterectomy is not recommended to remove the abnormally large uterus or extensive uterine fibroids; hence abdominal hysterectomy is preferred to prevent further complications.

Indications for Cesarean Hysterectomy

Accreta

A serious condition in pregnancy that arises from excess placenta growth deep into the uterine walls is called placenta accreta. Normally, there is detachment of the placenta after childbirth, but in placenta accreta, it remains attached to the uterine walls even after childbirth. Eventually causing excessive blood loss after the baby’s delivery. This is, thus, one of the indications for performing a cesarean hysterectomy. 

Atony

Uterine atony is the soft or weakened uterus after giving birth to the baby. Atony of the uterus occurs when there is less contraction of uterine muscles that cannot shut the placental blood vessels after the baby’s delivery. This may cause a life-threatening situation due to increased blood loss following childbirth. Immediate treatment steps are needed in such a medical condition. Cesarean hysterectomy is the last resort if other treatments don’t work.

Uterine Rupture

The complete division of uterine layers when it is gravid is called uterine rupture, when three uterine layers separate following the cesarean delivery.

Leiomyomas

The noncancerous or non- tumorigenic growths of uterine cells in childbearing years are called leiomyomas (myomas). 

Indications for Radical Hysterectomy

  • 1. Radical hysterectomy is indicated for female patients with FIGO (International Federation of Gynecology and Obstetrics) stage IA2-IIA of cervical cancer. Such patients are not medically fit to tolerate adverse side effects due to chemotherapy and radiation therapy.
  • 2. Patients with Stage IB1 cervical cancer having a higher risk of metastasis to lymph nodes should be recommended a radical hysterectomy and pelvic lymphadenectomy.
  • 3. Radical hysterectomy is also considered an alternative treatment option for curing the recurrence of cervical cancer.
  •  

Indications for Laparoscopic Hysterectomy

Laparoscopic hysterectomy indications are similar to the indications of hysterectomy. Severe uterine bleeding for more than seven days 

An important indication for laparoscopic hysterectomy is symptomatic fibroids in the uterus. The following symptoms indicate this: 

  • 1. Anemia
  • 2. Pain
  • 3. Pelvic pressure 
  •  

What type of hysterectomy is best for fibroids?

Total hysterectomy is advised for patients who are diagnosed with large fibroids. A minimally invasive laparoscopic hysterectomy is not recommended to treat large uterine fibroids.

FAQs

What are 4 reasons a hysterectomy is performed?

Four main reasons to perform a hysterectomy are:

  • 1. Heavy menstrual bleeding – abnormally heavy bleeding occurs because of fibroids in the uterus.
  • 2. Severe pelvic pain – Pain in the pelvis due to endometriosis, adenomyosis, untreated PID (pelvic inflammatory disease) and fibroids.
  • 3. Uterine prolapse
  • 4. Cancer in the cervix, uterus, or ovaries.
  •  

What are the indications for abdominal hysterectomy?

Indications of abdominal hysterectomy include prolapse of pelvic organs, uterine leiomyomas, pelvic pain, infection due to endometriosis, PID (pelvic inflammatory disease), excessive uterine bleeding and malignant or premalignant cancer or disease.

When is a hysterectomy recommended?

Hysterectomy is the best treatment for highly invasive cancers, majorly in the cervix and uterine lining. It can lead to the growth of the uterine lining to a large extent. These conditions are the cause of intense bleeding and pain.

What are the three types of hysterectomy?

Abdominal hysterectomy – The hysterectomy procedure that involves removing the uterus by making an incision or cut in the lower region of the abdomen 

Vaginal hysterectomy: The hysterectomy procedure involves uterine removal through the vagina without making any incision or cut in the abdominal region.

Laparoscopic hysterectomy – The hysterectomy procedure involves forming a keyhole size cut or incision in the abdomen and removing the uterus through the vagina.

What is the average age for a hysterectomy?

Hysterectomy is more common in women aged between 40-50 years. As the hysterectomy involves the removal of the uterus, the woman would not be able to get pregnant anymore. Regardless of age, women won’t have periods after undergoing a hysterectomy.

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