Hysterectomy: The Causes of Losing the Uterus

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This is an article from our “Doctor’s Corner” series, brought to you by Samitivej Hospital. Mongkol Chantapakul, M.D. is an OB/GYN and Maternal Fetal Medicine Specialist at Samitivej Sukhumvit hospital. Make sure to read the entire series!

There have been several reasons why women have been required to undergo a hysterectomy and lose their uterus, whether willingly or unwillingly. This can bring up more concerns on gynecological health. According to a survey conducted in the U.S. ten years ago, over 600,000 women had undergone a hysterectomy procedure. Over 90% of the cases were non-cancerous, while the other 10% were cancerous. Details of the reasons for having a hysterectomy are as follows.

Reasons for a Hysterectomy

Uterine fibroid is the most common cause of a hysterectomy and its sizes vary. A report published in a medical journal states that a fibroid can weigh as much as 4 kg, while the average size is 3x4x5 cm and weighs 50-90 g. Most patients with this condition suffer from heavy bleeding during the menstrual period, frequent urination, flatulence or pain in the lower belly.

causes-of-hysterectomy

Endometriosis is occurring increasingly regularly these days. More and more women are choosing to remain single today, and many of them don’t have children until they are older. These factors increase possibility of endometrial tissue development in the pelvis. Such development can be seen on the wall of the peritoneum embedded in one ovary or, in later stages of development, on both sides of the ovary. It may also appear on the wall of the uterus. The severity of the endometriosis varies and the choice of treatment is in accordance with the severity. Some patients do not suffer at all (even though the disease has advanced), while others experience abdominal pain with stomachache during the menstrual period and the pain becomes gradually more intense. For example, in the early stage the pain is relieved at the end of a menstrual period. Then in the late stage, the pain starts before the beginning of the menstrual period and continues even after the period has ended. In some cases, the pain is not related to the menstrual period. For some women, taking oral medication does not help reduce the pain. As a result, they rely heavily on painkilling injections, but this eventually leads to addiction. Additionally, some women are inflicted with infertility. There are also women who feel discomfort in certain parts of the abdomen during sexual intercourse in certain positions. Consequently, some women refuse to have sexual intercourse.

Fibrosis on the wall of the uterus normally occurs after surgery on the pelvic cavity, including caesarean section, myomectomy, or surgery for intestinal obstruction, chronic pelvic inflammatory disease or endometriosis. This can lead to the inability to hold urine for as long as usual or to random pain in the lower abdomen such as when exercising, lifting heavy objects, sitting with the back in a bent position, reaching out vertically to pick something up, holding a baby, performing yoga in positions that require the legs to be spread, or changing the sleeping position from sleeping face up to lying on a side, etc.

Infection in the pelvis caused by a dilation of the uterus as a result of an abortion or pelvic inflammatory disease.

Irregular menstrual bleeding that cannot be permanently cured by taking hormonal treatment.

Chronic lower abdominal pain for longer than three months, leading to a poor quality of life, pain during menstrual period, pain during sexual intercourse, or pain in the coccyx or rectum during defecation. Some women have to rely on Thai traditional massage or hot water bottles, while some have to take a warm shower for almost an hour during menstrual period.

Surgery on the uterus before the onset of cancer, which is commonly found in women who have annual pelvic exams. In most cases, this is caused by an infection of the human papilloma virus (HPV). For women who already have children, do not want to have children, or are aged over 40, they can undergo surgery if they are considered to be at risk.

Surgery on the uterus after a patient has been diagnosed with cancer, including vaginal cancer, cervical cancer, endometrial cancer (cancer in the muscles of the uterus), fallopian tube cancer, ovarian cancer, colorectal cancer, etc.

Sterilization is required in some cases.

Hysterectomy to save the life of mothers after experiencing a postpartum hemorrhage.

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Surgical Techniques for Hysterectomy

A hysterectomy can be performed in many ways, including a total hysterectomy (upper part of the uterus, the body of the uterus, and the cervix) and subtotal hysterectomy, which leaves the cervix intact. The approaches to performing a hysterectomy are as follows.

Conventional exploratory laparotomy, which leaves a 10-15 cm surgical scar in a vertical position or bikini line.

Mini exploratory laparotomy, which leaves a surgical scar of 5 cm in the lower abdomen in the bikini line.

Vaginal surgery, which leaves a surgical scar in the vagina without a surgical scar in the lower abdomen.

Laparoscopically assisted vaginal hysterectomy, which leaves one to five surgical scars of 0.5-1.0 cm in the vagina and the lower abdomen.
Laparoscopic subtotal or supracervical hysterectomy, which leave a surgical scar on the abdomen, without leaving a surgical scar in the vagina.

Natural orifice transluminal endoscopic hysterectomy, which leaves a surgical scar in the vagina.

The choice of surgical approach depends on the developmental stage of the disease; the surgeon’s specialization; and the decision made by the patient, their relatives, and counselors. Currently, there are other approaches that can save the uterus. If you wish to keep your uterus, ask your doctor for advice regarding alternative treatment approaches.

Samitivej, We Care!
Mongkol Chantapakul, M.D.
OB/GYN and Maternal Fetal Medicine Specialist
Samitivej Sukhumvit Hospital

For further information, please contact:

Women’s Health Center
2nd Floor, Building 2
Tel: 66 (0) 2711-8555-6
Call Center: 66 (0) 2711-8181
E-mail: info@samitivej.co.th
Facebook: www.facebook.com/samitivej

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Samitivej Womens Health Center

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1 Comment

  1. Nassarrat Rahman ( Lopa)  /  November 17, 2015, 9:09 pm Reply

    I need Dr. Mongkol Chantapakul’s email address to send my reports from Bangladesh.

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