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July 7th 2015

Hysterectomy: Removing the cradle of life

They say life begins at 40. The old adage holds true for all women. But unfortunately, all her health problems too start around the same period of time.

And among those, a lion share goes to gynecological complaints, which often culminates to hysterectomy. According to Dr. Mayadevi Kurup, Senior consultant and Lead, Aster Women's Health Department, Aster Medcity, Kochi, a huge number of women undergo hysterectomy every year.

However, more than 50 per cent of it are unnecessary ones. Dr. Mayadevi says hysterectomy is the second most frequently performed surgical procedure all over the world. Mayadevi explains certain essential details about Hysterectomy in a candid conversation with Onmanorama:

Need to undergo hysterectomy

The surgery is being performed for non-life threatening conditions such as uterine fibroids, menstrual irregularities, endometriosis, pelvic inflammatory disease, prolapse of the uterus etc. It's also performed to prevent them from cancer, severe bleeding, restoring function (prolapse uterus) and in relieving painful conditions such as endometriosis and adenomyosis.

Role of menstrual irregularities

Any women above age 40 should be investigated properly if she faces gynecological irregularities. Most middle aged woman fail to seek treatment on time as they tend to take the symptoms as natural signs of menopause and life-threatening diseases such as cancer go unnoticed. Hence, investigations are mandatory through pap smear test, endometrial pipelle biopsy, D&C, radio imaging etc.

Fibroids not cancerous

Fibroids are non-cancerous tumours that grow in and around the uterus. These growths are made up of muscle and fibrous tissue and vary in size. Women with fibroid uterus can either have no symptoms or heavy or painful periods, pelvic pain, frequent urination or constipation.

A woman with uterus fibroid, but not troubled by any irregularites need not seek any treatment. They need only followup scan to see the trend in growth, although they are slow-growing tumours. Surgery becomes inevitable only when medical management fails or symptoms affect the women's quality of life. Conservation of uterus and removal of fibroid alone is advisable for those who would want to preserve their fertility. In certain situations, blood supply to fibroid is blocked so that it gets shrunken through radiological intervention.

The case of uterine prolapse

It happens due to weakening of the tissues, which support the pelvic organs. The chances are high with increasing age, mutiple vaginal births, obesity, longstanding cough, constipation, heavy weight lifting, lack of female hormone estrogen and large fibroid uterus. Usually, it gets diagnosed during gynecological examination. Nonetheless, it can be prevented to a great extent if women are made aware of doing postnatal exercises after delivery. If the symptoms are mild, one can get away with pelvic floor exercises, physiotherapy, vaginal tissue suppor (using pessary) for a trial period of time. But if the symptoms worsen, the best option will be hysterectomy.

Chocolate cysts in the ovary

Women with chocolate cysts or endometriotic cysts can have heavy painful periods, severe pain during intercourse, infertility etc. The treatment depends upon the woman's age and fertility status. Operative laparoscopy is a usual surgical procedure to remove cysts in ovary. However, the procedure should be done carefully in a woman who would want to reproduce, preserving the ovarian tissue.

As menstruation itself will increase the progression of the disease condition, the patient may be given hormonal medication to temporarily stop cyclical bleeding and reduce symptoms. If medication, hormone therapy and other conservative surgical procedures fail to give relief to the patient, a hysterectomy, along with removal of ovaries, is definitely inevitable to prevent future risk of ovarian cysts.

It is very important for a woman to look into the details of her diagnosis when a hysterectomy is suggested. She should ask for various other possibilities to avoid such a major surgery. A hysterectomy is typically necessary only when all other options have become unsuccessful and a woman's life or her quality of life is at risk. She should be given all options. All advantages and negative elements should be explained to the patient and family well in advance.

A patient-centred approach based on the thorough knowledge of current medical evidence forms the cornerstone of modern gynecology care and our women deserve that, Dr. Mayadevi concludes.

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