THE decision to undergo a hysterectomy is a serious one that many Jamaican women are faced with – often recommended by doctors when there are issues with fibroids and the woman has completed her childbearing. But the hysterectomy is major surgery that involves the removal of the uterus (womb), which is a symbol of fertility and femininity for many.
According to obstetrician-gynaecologist Dr Anna-Kay Taylor Christmas, a hysterectomy may be complete, where the entire uterus and cervix are removed; or subtotal or partial, where the cervix is left behind.
She pointed out that whether complete or partial, a hysterectomy is dependent on the patient's risk profile.
Below she shares some of the reasons for undergoing a hysterectomy:
1. Uterine fibroids are the top reason (outside of cancer) for a hysterectomy in Jamaica
Dr Taylor Christmas explained that fibroids are very common in our population and among black women in general. She said they can become quite large, causing heavy bleeding and severe pain, which may not respond to other methods of treatment. As a result, a hysterectomy provides the only permanent treatment for uterine fibroids.
2. A hysterectomy is also done to treat certain female cancers
Jamaica unfortunately still has a high rate of cervical cancer, which is treated by a hysterectomy when the cancer is at an early stage. Dr Taylor Christmas pointed out that surgery can also treat cancers of the uterus, ovaries and Fallopian tubes.
3. Managing abnormal bleeding
“It can also be done for management of abnormal or heavy bleeding when other treatment methods have failed,” the doctor said.
4. A hysterectomy can also be performed to treat prolapse of the pelvic organs.
“This happens when the support muscles in the pelvis weaken and cause the cervix, uterus, bladder or bowel to fall down into the vagina,” she explained.
5. Treating endometriosis
Dr Taylor Christmas said in certain circumstances, a hysterectomy can also assist in treating severe endometriosis or adenomyosis, and chronic pelvic pain.
6. Sometimes a hysterectomy has to be done as an emergency measure
The doctor explained that this can happen after a myomectomy (to remove fibroids from the uterus while leaving the uterus intact) when there is heavy bleeding that cannot be controlled. She said it can also be required after giving birth if there is heavy bleeding that is uncontrollable by other methods. “This is done as a last resort, a life-saving measure in these cases, when everything else has been tried and has failed,” she said.
Dr Taylor Christmas said the method chosen to perform a hysterectomy depends on the diagnosis, size of the uterus, presence of other underlying illnesses, and comfort level of the surgeon with the method.
She said it can be done open, where an incision is made in the abdomen and the uterus removed that way, or it may be removed through the vagina. It may also be performed laparoscopically (key-hole surgery), where four to five tiny incisions are made in the abdomen and a camera and other instruments are used through these tiny ports to visualise the pelvis and perform the surgery.
“Laparoscopic and vaginal surgery offer the advantage of a faster recovery time, less pain, less risk of infection and less time off work for patients, but they are not suitable for every patient,” Dr Taylor Christmas cautioned.
Recovery from a hysterectomy generally requires four to six weeks' leave from work.
“Most patients are up and about from the bed the day after surgery, once adequate pain medication is given. Patients typically are able to go home from hospital three days after surgery is done,” she said.
She explained that most patients with fibroids and issues with bleeding report improved sex lives after undergoing a hysterectomy, as those things tend to interfere with a healthy sexual relationship. However, she pointed out that there is also no appreciable difference for these women in sexual function whether the cervix is left behind or not.
And depending on age and other risk factors, if the ovaries are removed, some patients may require hormone replacement therapy to help with the symptoms of menopause.