hysterectomy

Off with the womb

Your Health DR GITA MATHAI

Some women become tired of having a uterus, not because it is the seat of “hysteria” (the ancient Greeks actually believed women became hysterical because they had a hystera, the Greek word for womb or uterus), but for reasons such as severe pain during periods, constant pelvic discomfort or excessive bleeding or even regular periods. Once the uterus is no longer needed to support and nurture a baby, it seems expendable. Surgery seems an attractive option. Hysterectomy (removal of the uterus) is a common surgical procedure. Eight per cent of women in India have had a hysterectomy by the age of 50. There is, however, an urban-rural discrepancy. Almost 20 per cent of urban women have had hysterectomies. Rural women are more conservative and tend not to opt for surgery. Many women have the hysterectomy before menopause, while in their late thirties or forties. The two ovaries situated on either side of the uterus not only produce eggs but also the female hormones which keep a woman’s bones, heart and blood chemistry normal and healthy. During a hysterectomy, the ovaries may or may not be removed. If left behind, with no target organ (uterus), they cease to function within a year or two, even in young women. This causes artificial symptomatic menopause. The sudden withdrawal of female hormones does not give the body time to adjust. There may be hot flushes, 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 disappear, 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. Recurrent infections can occur. Similarly the rectum can protrude into the vagina, causing constipation. A hysterectomy is not a risk-free procedure. There may be excessive bleeding during the operation, clots may form in blood vessels and other organs such as the urinary tract or rectum may be inadvertently damaged. The procedure, however, is necessary if there is cancer in the uterus or cervix. Chemotherapy or radiation or both then follows the removal of the organ. Sometimes, the tissue lining the uterus, the endometrium, grows into the adjacent organs such as the ovaries, bladder and even intestines. With each menstrual cycle the tissue grows a little more. It can cause severe pain during periods and interfere with the functioning of the other organs. Initially, hormone therapy should be tried. Hysterectomy should be the last resort. The muscle of the uterus can grow abnormally, producing noncancerous growths called fibroids. These can be single or multiple, small or large. They can exert pressure on surrounding structures like the bladder and rectum. They can cause excessive bleeding or painful periods. Twenty per cent of the women over 35 have fibroids. Many are asymptomatic and are picked up during an ultrasound of the abdomen. Most of symptoms of fibroids can be tackled medically. It is possible to remove large fibroids without a hysterectomy. Fibroids do not develop into cancer. Childbirth stretches the ligaments supporting the uterus. It can start to slip downwards (uterine prolapse) and may even appear outside the body. It may be possible to surgically tighten these ligaments, or hysterectomy may be the only option. Excessive bleeding during periods can usually be controlled by a judicious combination of tablets. A hysterectomy may seem like a good solution to constant unidentifiable pelvic pain, but it may not relieve the symptom and the cure may be worse than the disease. The uterus can be removed thorough a cut in the abdomen, button hole surgery with a laparoscope or through the vagina. In the latter two procedures, there is no abdominal scar. The choice depends on the size of the uterus and whether the surgeon needs to look at the rest of the organs in the pelvis or not. It can be a “total” hysterectomy when the entire organ is removed or partial, if the cervix (lower part of the uterus) is left behind. The piece left behind can become cancerous in later years, so partial hysterectomies are not popular. It takes around six weeks to recover from a hysterectomy. During that time the patient should not lift heavy objects or perform strenuous activity. You can start exercising after six weeks to build up muscle and bone strength. Start walking for 10 minutes in the morning or evening. Gradually increase this to an hour. Muscle strength can be built up with repetitive movements using light weights. 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