uterus?remove it!

Remedial removal retraced

YOUR HEALTH DR GITA MATHAI

The ancient Greeks believed that women developed bizarre behaviour or “hysteria” because they had a hystera (Greek for womb or uterus) while men did not. Removal of the uterus, therefore, came to be called “hysterectomy”, a nomenclature in use even today. Women are advised to have their uterus removed for a variety of medical conditions. In the developed countries 35 per cent of the women over the age of 60 have had this surgery. Ninety per cent of the surgeries were done for harmless illnesses, which perhaps could have been tackled with medicine. We, in India, are fast catching up and the surgery is performed for a multitude of indications. If you are a woman, it pays to be informed about the surgery, its indications, contraindications and after effects. It is easy to fall into the trap of “my child bearing days are over, what do I need this organ for?” Or, “it bleeds irregularly without warning, hurts and needs to be regularly evaluated for the presence of cancer.” If it really was that useless, in all probability, it would naturally fall off at a certain age, just like our milk teeth. A hysterectomy can be total, when the entire organ is removed, or partial when the lower part, called the cervix, is retained. The ovaries, which produce the eggs (ova) and the female hormones, can be removed at the same time, or left behind. Even if the ovaries are preserved, they usually cease to function in one or two years once the uterus is removed. If the cervix is left behind, any disease process that may develop in it at a later date is difficult to tackle. The subtotal operation has fallen into disrepute and is rarely done. (If you are having a hysterectomy make sure that the surgeon is going to remove the whole organ). There are several techniques for surgery. It can be done through a curved incision along the bikini line. The visualisation is good; the scar disappears into a natural crease and is barely visible. The person is less likely to develop a hernia at a later date. A straight incision leaves a long visible scar. A hernia may develop if the person puts on weight, or there is post operative infection. Surgeons can remove the uterus through “button holes” using a laparoscope. It can also be removed through the vagina without an abdominal incision. The operation is required — • If there is cancer of the uterus, cervix or ovaries. • Sometimes, as a follow through for cancer of the breast, since that tumour may be dependent on the hormones produced by the ovary. • If the uterus itself has descended (prolapsed) and can be seen partially outside the body. • Frequently for uterine fibroids called myomas. These are non-cancerous tumours in the muscle of the uterus. They can be troublesome as they can grow to a large size, press on the urinary bladder and interfere with urination. They also cause stomach pain and increased bleeding. • Sometimes if the menstrual tissue, which lines the uterus and should be shed during menstruation, grows abnormally into the muscle of the uterus (adenomyosis) or into the abdomen (endomteriosis). • If there is uncontrolled and frequent bleeding. Fibroids can be tackled without hysterectomy, with alternative surgical procedures like myomectomy (the uterus remains preserved and the woman retains her reproductive potential) or uterine artery embolisation (a minimally invasive means of blocking the arteries that supply blood to the fibroids). The lining of the uterus, which bleeds uncontrollably or irregularly, can be destroyed by a surgical process called ablation. Medications and hormones, if used appropriately, can control pain and bleeding. An open hysterectomy allows an excellent view of the abdomen so that the surgery can be meticulously done and bleeding controlled. However, it is a major procedure. There can be unexpected bleeding or infection. Recovery takes four to six weeks. Surgical menopause occurs abruptly if the ovaries are removed at the same time. It is different from the natural menopause, in which case the hormone levels fall gradually over a period of time so that the body adjusts to the changes. The sudden lack of hormones leads to night sweats, weakness, depression and insomnia. The bones lose calcium and become osteoporotic. This can lead to fractures, particularly in the vertebrae. As the protective effect of the female hormones disappears, the lipid profile changes and the risk of heart disease increases seven fold. The vagina becomes dry and sex may become painful. The urinary bladder loses part of its supporting wall. It may prolapse into the vagina and urine may be retained. There may be urinary incontinence (involuntary leakage of urine). Recurrent infections can occur. Similarly, the rectum can protrude into the vagina causing constipation. Problems with uterus are also time bound. They will cease with menopause. The after effects of a hysterectomy persist for a lifetime. Before contemplating surgery, consider. Is the disease worse than the cure? Dr Gita Mathai is a paediatrician with a family practice at Vellore. Questions on health issues may be emailed to her at yourhealthgm@yahoo.co.in