I was told by my gynaecologist that I have a lot of uterine fibroids. The fibroids are making me bleed a lot during my periods. Now I am told that I have to remove them in a process called a hysterectomy. This sounds serious! What is a hysterectomy?

A hysterectomy is a surgical procedure that removes all or part of your womb.

There are two types of hysterectomy – abdominal and vaginal.

So what is an abdominal hysterectomy?

This surgical procedure removes the womb (uterus) through an incision in the lower abdomen. This incision is similar to the one made during a Caesarean except that the incision for a Caesarean is usually bigger (to remove an actual baby) instead of a fist-sized womb.

A partial hysterectomy removes the uterus, but leaves the cervix intact.

A total hysterectomy removes both the uterus and cervix.

There is also a procedure called total hysterectomy with salpingo-oophorectomy. Although this sounds like a mouthful, it simply means a total womb removal that also removes one or both of your ovaries and fallopian tubes.

This is done primarily when you have cancer in one of those organs.

In an abdominal hysterectomy, the womb (uterus) is removed through an incision in the lower abdomen.

In an abdominal hysterectomy, the womb (uterus) is removed through an incision in the lower abdomen.

What about a vaginal hysterectomy? Can a womb be removed through the vagina?

In the same way a baby can be born, a womb can also be removed through the vagina.

A womb can also be removed via a laparoscope, which uses a long, thin instrument that is passed through a small incision on your abdomen. This is so that you don’t get a very big scar on your abdomen.

It is not always possible to remove your womb through a vaginal hysterectomy or laparoscope. Then you will have to remove it through an abdominal incision.

This usually happens if you have a large uterus (or if the fibroids concerned are too big), if the surgeon wants to check your other pelvic organs for disease, or simply because it is better suited for you.

An abdominal hysterectomy usually takes about an hour. A laparoscopic procedure will take two hours or longer because the incision is small and it takes more time to remove things through a tube.

I need a hysterectomy because I have fibroids. But what about other cases? When does a woman need a hysterectomy?

These are some of the conditions that entail a womb removal:

• Cancer of the uterus (womb) or cervix

• Fibroids: These are actually benign tumours. Many women have fibroids which are small and which grow smaller after they are aged 45 (due to hormonal changes). These do not require removal. But some fibroids cause a lot of pain during menstruation and bleeding, which is serious enough to make you anaemic.

• Endometriosis: In this condition, the tissue lining which forms the inside of the uterus is also present on the ovaries, fallopian tubes, and other pelvic or abdominal organs. This causes a lot of bleeding in places outside the womb during the menstrual cycle, and a lot of pain. When this is out of control, you might need a total hysterectomy together with removal of the ovaries and fallopian tubes.

• Uterine prolapse: This happens when the womb is “weak” and descends into the vagina, causing pressure on the bladder and bowels. This interferes with urination or defecation. It also interferes with sex.

• Abnormal vaginal bleeding.

• Chronic pelvic pain that is attributed to the uterus.

Does this mean that once I have a hysterectomy, I can’t get pregnant anymore? Will I have periods?

You won’t have periods anymore. And you won’t get pregnant anymore. So this is a last resort for women who can’t cure their various diseases in other ways.

Does this mean that I will have menopause? Will I still be able to have sex?

If your ovaries are not removed, you will not be menopausal. Your ovaries will still be there to provide hormones. You just won’t have menstruation.

However, if your ovaries are removed, you will have what is considered surgical menopause.

But think of this way – you will be relieved of the symptoms of whatever condition you had which entailed the hysterectomy in the first place.

You will definitely be able to enjoy all the sex you want. Some women even experience increased sexual pleasure after a hysterectomy because their painful symptoms have been removed.

If you need some counselling for the psychological effects that a removal of a womb (and your reproductive ability and implied “womanhood”) may engender, talk to your doctor about it.

Dr YLM graduated as a medical doctor, and has been writing for many years on various subjects such as medicine, health, computers and entertainment. For further information, e-mail starhealth@thestar.com.my. The information contained in this column is for general educational purposes only. Neither The Star nor the author gives any warranty on accuracy, completeness, functionality, usefulness or other assurances as to such information. The Star and the author disclaim all responsibility for any losses, damage to property or personal injury suffered directly or indirectly from reliance on such information.