Hysterectomy - Why a hysterectomy is necessary

A hysterectomy is a major operation for a woman that will only be recommended if other treatment options have been unsuccessful.

The most common reasons for having a hysterectomy include:

heavy periods (menorrhagia), which can be caused by fibroids, for example
pelvic pain, which may be caused by endometriosis, unsuccessfully treated pelvic inflammatory disease (PID), adenomyosis or fibroids
prolapse of the uterus
cancer of the womb, ovaries or cervix

Heavy periods

Many women lose a large amount of blood during their monthly periods. They may also experience other symptoms, such as pain and stomach cramps.

For some women, the symptoms can have a significant impact on their quality of life. Sometimes heavy periods can be caused by fibroids, but in many cases there is no obvious cause.

In some cases, removing the womb may be the only way of stopping persistent heavy menstrual bleeding when:

other treatments have proved ineffective
the bleeding has a significant impact on quality of life and it is preferable for periods to stop
the woman no longer wishes to have children

Pelvic inflammatory disease

Pelvic inflammatory disease (PID) is a bacterial infection of the female reproductive system.

If detected early, the infection can be treated with antibiotics. However, if it spreads, it can damage the womb and fallopian tubes, resulting in long-term pain.

A hysterectomy to remove the womb and fallopian tubes may be recommended if a woman has severe pain from PID and no longer wants children.

Read more about pelvic inflammatory disease.

Endometriosis

Endometriosis is a condition where cells that line the womb are also found in other areas of the body and reproductive system, such as the ovaries, fallopian tubes, bladder and rectum.

If the cells that make up the lining of the womb become trapped in other areas of the body, it can cause the surrounding tissue to become inflamed and damaged. This can lead to pain, heavy and irregular periods, and infertility (inability to conceive).

A hysterectomy may remove the areas of endometrial tissue causing the pain. However, it will usually only be considered if other less invasive treatments have not worked and the woman decides not to have any more children.

Fibroids

Fibroids are non-cancerous tumours that grow in or around the womb (uterus). The growths are made up of muscle and fibrous tissue and vary in size.

The symptoms of fibroids can include:

heavy or painful periods
pelvic pain
frequent urination or constipation
pain or discomfort during sex

A hysterectomy may be recommended if you have large fibroids or severe bleeding and you do not wish to have any more children.

Adenomyosis

Adenomyosis is a common condition where the tissue that normally lines the womb starts to grow within the muscular wall of the womb. This extra tissue can make your periods particularly painful and cause pelvic pain.

A hysterectomy can cure adenomyosis but will only be considered if all other treatments have failed and you do not wish to have any more children.

Prolapse of the uterus

A prolapsed uterus happens when the tissues and ligaments that support the womb become weak, causing it to drop down from its normal position.

Symptoms can include back pain, a feeling that something is coming down out of your vagina, leaking urine (urinary incontinence) and difficulty having sex. A prolapsed uterus can often occur as a result of childbirth.

A hysterectomy resolves the symptoms of a prolapse because it removes the entire womb. It may be recommended if the tissues and ligaments that support the womb are severely weakened and the woman does not want any more children.

Cancer

A hysterectomy may be recommended for the following cancers:

cervical cancer
ovarian cancer
cancer of the fallopian tubes
uterine cancer (cancer of the womb)

If the cancer has spread and reached an advanced stage, a hysterectomy may be the only viable treatment option.