An Overview of Hysterectomy

Indications

Hysterectomies are performed for a number of reasons. These conditions fall into one of the following diagnostic categories:

Leiomyomas, or uterine fibroids, are noncancerous growths of uterine muscle that develop in one-third of all women. These fibroids can lead to pain and excessive, irregular vaginal bleeding. Leiomyoma is the most common indication for hysterectomy; once performed, the procedure alleviates both current and recurrent symptoms.^[3] Medical management of symptomatic fibroids is available, but numerous studies report a lack of long-term effectiveness with most medicinal agents.^[4,5]

Pelvic organ prolapse is when the stretching and weakening of the pelvic muscles and ligaments causes the uterus to fall into the vagina. Women with a prolapsed uterus often report pelvic heaviness, low back pain, stress urinary incontinence, difficulty voiding, and sexual dysfunction. Risk factors for prolapse include genetic predisposition, increased age, estrogen deficiencies, pregnancy, vaginal birth, and chronic increased pressure on the abdomen due to chronic constipation or coughing.^[6,7] In mild cases, exercises and physical therapy to strengthen the pelvic floor, in combination with behavioral modification, should be attempted before surgery is considered.^[8] For severe prolapse, however, hysterectomy is the preferred treatment for symptom relief.^[7]

A woman may undergo hysterectomy to eliminate abnormal or irregular uterine bleeding. Menorrhagia is excessive uterine bleeding that lasts longer than seven days; metrorrhagia, which is irregular uterine bleeding or spotting occurring at unexpected times, often occurs in conjunction with menorrhagia. Abnormal uterine bleeding can be caused by a hormonal imbalance or by structural problems such as fibroids or polyps.^[9] Once the cause is identified, medications or surgical methods other than hysterectomy should be attempted to treat the bleeding. If these treatments fail, hysterectomy is an acceptable next step.^[10,11]

Endometriosis, the excessive growth of endometrial tissue outside of the uterus, occurs in one of every five women worldwide.^[12] While infertility and endometrial cancer can result from endometriosis, pain is the most commonly reported symptom.^[13] Pain control is the primary goal of treatment, and pharmacologic options should be initiated prior to surgical intervention.^[14] Hysterectomy should be considered when the pain becomes severe or fails to improve with conservative surgery or medicinal treatments.^[14,15]

Women with premalignant or malignant disease that cannot be cured by cone biopsy, laser surgery, or cryosurgery are candidates for hysterectomy. Some examples of premalignant or malignant disease are stage IB and IIA cervical cancer; stage II endometrial adenocarcinoma; upper-vaginal carcinoma; uterine and cervical sarcomas; and other rare malignancies of the cervix, uterus, and upper vagina.^[16,17]

US Pharmacist. 2008;33(9):HS11-HS20. © 2008  Jobson Publishing

Cite this: An Overview of Hysterectomy - Medscape - Sep 01, 2008.