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Which type of hysterectomy is right for me?
This page should be read once you have decided to have a hysterectomy. Many different factors are taken into account when I recommend a type of hysterectomy to a woman. These include her symptoms, the presence/extent of diseases such as fibroids, endometriosis and cancer, previous or current cervical smear abnormalities, previous vaginal births, previous caesarean sections, amount of uterine prolapse, associated prolapse of the vaginal walls, age, body mass index, family history of ovarian cancer, desire to retain/remove the ovaries, desire to remove/ retain the cervix, the need to recover quickly.
Should I have my ovaries removed?
If you have significant endometriosis and have completed your family, removal of both ovaries will increase the likelihood of your pain resolving, will reduce the likelihood of you needing further surgery, but will cause an immediate menopause. This can be treated with HRT.
Women with healthy ovaries sometimes choose to have them removed to prevent getting ovarian cancer in the future. The risk of a 45 year old woman getting ovarian cancer in her lifetime is around 1 in 100. Most women who develop ovarian cancer will eventually die from it and this makes it a feared disease.
The ovaries stop working at the time of the menopause (average age 51 years) and are not thought to have a significant role after this age. There is some evidence that the menopause occurs earlier in women who have had a hysterectomy. The symptoms of the menopause can be very troublesome for some women but can be treated with HRT. The use of HRT to treat an early menopause is thought to be safe, without the risks that occur when it is used in older women.
Women put different values on the benefits of retaining/removing their ovaries. Some see them as an essential part of their womanhood and are keen to experience a natural menopause in the future. Other women see them only as a potential source of cancer. I provide guidance to my patients, but ultimately it is they who decide whether to have their ovaries removed or not.
I would usually advise women having a vaginal hysterectomy not to have their ovaries removed unless there is a specific reason.
Should I have my cervix removed?
In the past this was recommended to prevent the future risk of cervical cancer. However, the incidence of cervical cancer has dropped greatly due to the modern cervical screening programme. The chances of a 45 year old woman developing cervical cancer in her lifetime is very low if she has had regular normal smears in the past.
The most minimally-invasive hysterectomy involves retaining the cervix. If you have a vaginal hysterectomy, then you will need to have your cervix removed. If you have an abdominal hysterectomy, it is possible that retaining your cervix (a subtotal hysterectomy) will reduce the chance of post-operative bleeding and therefore speed up your recovery.
It is important to remember that you will need to continue to have regular smears if you retain your cervix.
In the past it was thought that retaining the cervix might improve sexual function. Good quality studies have now shown that this is not the case. The effect of retaining the cervix on bladder function is not clear.
Author - Robert MacDermott 2007. Updated 2017