Hysterectomy for Heavy Menstrual Bleeding Menorrhagia Hysterectomy for heavy menstrual bleeding at a glance Heavy menstrual bleeding formerly known to the medical community as menorrhagia and painful periods dysmenorrhea can be the result of a number of conditions including endometriosis and uterine fibroids. Heavy menstrual bleeding is a common disorder women report to their physicians, experienced by approximately 1 in 5 women, according to the Centers for Disease Control and Prevention.
Heavy menstrual bleeding and the conditions that cause it are treated with hysterectomy when other medical treatments have failed. What is hysterectomy? What is heavy menstrual bleeding? Other potential causes of heavy bleeding and menorrhagia include: Some birth control methods.
Thickening of the endometrial lining, known as hyperplasia. Uterine fibroids or polyps. Uterine or cervical cancer. Certain bleeding disorders that are inherited, and other medical conditions including those of the kidneys and liver. Problems related to pregnancy , such as ectopic pregnancy and miscarriage. The uterus cradles and nourishes a fetus from conception to birth, and aids in the delivery of the baby.
It also produces the monthly menstrual flow, or period. The ovaries have two major functions. One is the production of eggs or ova, which permit childbearing. The second is the production of hormones or chemicals which regulate menstruation and other aspects of health and well-being, including sexual well-being. If the egg that is released during a woman's normal monthly cycle is not fertilized, the lining of the uterus is shed by bleeding menstruation. After a hysterectomy, a woman can no longer have children and menstruation stops.
The ovaries generally continue to produce hormones, although in some cases they may have reduced activity. Some hysterectomies also include removal of the ovaries, so the supply of essential female hormones is greatly reduced.
This can have various effects, as discussed later. Hysterectomy is one treatment for a number of diseases and conditions. If you have cancer of the uterus or ovaries or hemorrhage uncontrollable bleeding of the uterus, this operation may save your life. In most other cases, a hysterectomy is an elective procedure. The operation is done to improve the quality of life: to relieve pain, heavy bleeding or other chronic conditions and discomfort.
There may be other ways of treating or dealing with these problems. Together with your doctor you should weigh all the alternatives and effects of the different choices to help you decide what is right for you. Cancerous organs and, in some cases, adjoining organs and structures, are removed in order to stop the spread of this life-threatening disease.
These are common non-cancerous benign tumors of the uterus and they are the most frequent reason for recommending a hysterectomy. They grow from the muscular wall of the uterus and are made up of muscle and fibrous tissue. Many women over 35 have fibroids , but usually have no symptoms.
In some women, however, fibroids myomas may cause heavy bleeding, pelvic discomfort and pain and occasionally pressure on other organs. These symptoms may require treatment, but not always a hysterectomy. There are promising new experimental drugs that may temporarily shrink the tumors; however, these drugs may have serious side effects.
They are generally very costly. There is a type of abdominal surgery myomectomy that removes the myoma without removing the uterus see Alternatives for additional information. These treatments may be sufficient or they may offer temporary relief and enable a woman to postpone having a hysterectomy, especially if she still wishes to bear children. Some women choose to do nothing since fibroids will often shrink in size as a woman goes through menopause.
Another common reason for recommending a hysterectomy is endometriosis. This is a noncancerous condition in which cells from the uterine lining grow like islands outside of the uterus. This growth occurs most commonly on the ovaries, fallopian tubes, bladder, bowel and other pelvic structures, including the uterine wall. These cells may cause pain and discomfort by bleeding at the time of menstruation. Endometriosis may also cause scarring, adhesions and infertility.
Symptoms can vary greatly and some women choose to do nothing, or find that drug therapy, pain relief medication or more localized surgery are effective. When these are not effective, hysterectomy may be the treatment of choice. As a woman ages, the vaginal supports begin to lose their muscle tone and sag downward prolapse.
This happens to most women to some degree. For the vast majority, the sagging is minor and symptoms are not severe. Some women get relief from these symptoms by doing special exercises "Kegels" to strengthen the pelvic muscles, by taking hormone therapy or by using a plastic or metal ring pessary which may help to hold the uterus in place.
None of these treats the underlying problem. A hysterectomy with repair of supporting structures is usually recommended in more serious cases. A woman has to decide for herself if the discomfort is great enough to have a hysterectomy. Precancerous changes in the cervix are often found on routine Pap smears.
These lesions or abnormalities must be treated, but rarely with a hysterectomy. When detected early and treated effectively, most of these conditions do not progress to invasive, life-threatening cancer. It is only in the case of invasive cancer of the cervix that hysterectomy may be the treatment of choice. A pre-cancerous change can occur when the lining of the uterus endometrium overgrows.
In more severe cases or cases that do not respond to treatment, hyperplasia of the endometrium may lead to cancer of the uterus. Upon diagnosis of cancer, a hysterectomy would be the treatment of choice. Irritation of the lining of the abdomen may cause adhesions scarring which bind affected organs to each other. The adhesions can result from endometriosis, infection or injury. The symptoms may include severe pain, bowel and bladder problems and infertility.
Pain relief medication or less drastic surgery, such as laser therapy, can be effective in some cases. In very serious cases, hysterectomy may be recommended. However, a hysterectomy itself can cause adhesions.
It is normal for the amount and length of menstrual flow to vary from woman to woman. There may also be differences in menstrual flow from one cycle to the next. Uterine fibroids are noncancerous growths that form in the uterus. Fibroids can cause heavy bleeding and pain. Your doctor may first recommend medications or other less-invasive procedures, such as a myomectomy , to treat fibroids. A myomectomy removes only the fibroids and leaves the uterus intact.
If other measures fail or fibroids continue to regrow and produce bothersome symptoms, a hysterectomy may be an option. Cancer is the reason about 10 percent of all hysterectomies are performed. Your treatment approach will depend on the type of cancer you have, how advanced it is, and your overall health. Other options may include chemotherapy and radiation. You may also opt to have a hysterectomy to reduce your risk for developing cancer in the future if you test positive for the BRCA gene.
People with this gene may have an increased risk for ovarian and breast cancers. Endometriosis is a condition where tissue that normally lines the uterus grows outside of it. Endometriosis can cause extreme pain and irregular periods. It can also lead to infertility. Hormone therapy and medical procedures to remove endometrial tissue are usually tried before a hysterectomy.
Adenomyosis happens when the lining of the uterus grows into the muscle of the uterus. This causes the uterine wall to thicken, which leads to pain and heavy bleeding. This condition often goes away after menopause, but if your symptoms are severe, you may require treatment sooner. Hormone therapies and pain medication are usually tried first.
Pelvic Inflammatory disease PID is a bacterial infection that can lead to severe pelvic pain. But, if it spreads it can damage the uterus. Hyperplasia means the lining of your uterus is too thick. If you have any stitches which need removal, this is usually done between five and seven days after your operation. This varies from person to person. Recovery is usually faster if you have had the hysterectomy through the vagina. You are likely to need to rest more than usual for a few weeks after the operation.
You are likely to be recommended to do light exercise and gradually build up the amount of exercise you do. It is likely that you will be shown how to do pelvic floor exercises which are important to continue at home.
Full recovery commonly takes around six to eight weeks. However, it is not unusual for women to take three months until they feel fully back to normal. There is a small increased risk of clots in the veins of your legs deep vein thrombosis following surgery. This risk is reduced by wearing special compression stockings anti-embolic stockings which will be given to you in the hospital.
Some women will also need to have heparin injections in their stomach which work to make the blood less sticky and reduce the risk of a clot developing. Your doctor will explain this in more detail to you. You should not drive until your doctor tells you that you are safe to do so after your hysterectomy. This is usually between three to eight weeks after the operation. You should not drive until you are safe to do an emergency stop.
The time before you can return to work will depend on your job. You can discuss this with your doctor or gynaecologist. Most women no longer need to have cervical screening tests after a hysterectomy. However, if you have had an operation that leaves the neck of the womb cervix in place, or because of cancer, you may be advised to continue having cervical screening tests. Your doctor will advise you about this.
Cochrane Database Syst Rev. I had a full hysterectomy done a year ago. I had everything removed. Since then, my body feels horrible. I now have excruciating pain in my back, hips and my legs are always heavy feeling and cramp Disclaimer: This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Egton Medical Information Systems Limited has used all reasonable care in compiling the information but make no warranty as to its accuracy.
Consult a doctor or other health care professional for diagnosis and treatment of medical conditions.
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