Women may think hysterectomy might help them escape the distressing side effects that are common during menopause. Removing the uterus can affect a woman’s health and well-being in some unexpected ways even though it no longer serves the function of housing a pregnancy. In contrary to common belief, a hysterectomy will not relieve menopausal symptoms and in some cases, it can actually cause menopause. Hysterectomy, though being a major surgery with associated drawbacks, happens to be the second most frequent surgical procedure among reproductive-aged women after caesarean section. Hence, Urogynaecologists in Chennai suggests hysterectomy as an option solely for those who have valid medical concerns that needs to be addressed.
Reasons for hysterectomy in menopause
Hysterectomy in menopause is a major decision that can be best made after careful consideration of the potential benefits and risks involved in it. All aspects of the surgery needs to be discussed in order to be vigilant and consider the benefits and potential consequences of hysterectomy before making the decision. However, hysterectomy could be the only solution in some cases where women undergoing menopause will benefit from. Such conditions during menopause would include:
Premalignancies – Where a precancerous lesion which is a collection of cells possibly from uterus, ovaries, or cervix that may look and or appear to be the same as cancer cells, poised to become malignant are found. Such lesions are frequent between 40 and 50 years of age, with a gradual increase before this age and a decrease thereafter. Premalignant lesions in menopause are usually found in reproductive organs where there is an increased expression of oestrogen receptors, reduced expression of progesterone receptors, or both.
Endometriosis – An oestrogen-dependent inflammatory disease is characterized by the condition where the tissue that usually lines the uterus develops outside the organ too. In the recent past, there has been a paradigm shift from the common belief that endometriosis only affects women of reproductive age. Attention has been drawn to endometriosis in premenopausal and menopausal women too. Laparoscopy is used for the diagnosis and surgical excision of the endometrial tissues along with the uterus especially in menopausal patients.
Adenomyosis– Could be a very painful condition where the cells that normally line the uterus grow deep inside the muscular tissue of the uterine wall. It occurs most often in women older than 30 who have had a full-term pregnancy. It has rarely been found in women who have not had a full-term pregnancy. While most women with adenomyosis do not develop any symptoms, pelvic pain, or heavy menstrual bleeding may be present. If symptoms are severe with approaching menopause, a hysterectomy may be needed.
Prolapsed uterus – It is a situation in which the uterus sags into the vagina because of insufficient muscular support caused by weakening of pelvic support structures during menopause. These changes in a woman’s pelvic floor function often accompany menopause. Though there may be many causes such as heavy lifting or vaginal birth that lead touterine prolapse, lack of oestrogen in menopause actually thins the support structures and tissue that hold the uterus in place, causing it to fall. Uterine prolapse may be treated by removing the uterus followed by reconstruction of pelvic floor in a surgical procedure called a hysterectomy and prolapse repair. Hysterectomy may be performed through an incision made in the vagina, called vaginal hysterectomy or through the abdomen, known as abdominal hysterectomy.
Excessive uterine fibroids/benign tumours – Severe symptoms related to large, severe fibroids require a hysterectomy as the best option, where all or some part of the uterus is removed. Total hysterectomy in Chennai may be recommended for women with severe fibroids and are close to menopause because of the significant chance of malignancy. The entire uterus along with the cervix and in some cases, removing the fallopian tubes as well might be the best option to remove widespread fibroid clusters or large benign tumours.
Chronic pelvic pain – when menopause might induce persistent bleeding with pelvic pain despite prolonged evaluation, hormonal treatment and uterine ablation for removal of polyps or fibroids, hysterectomy may be best recommended as the only solution.
Types of hysterectomy in menopause
The term Hysterectomy refers to the removal of uterus but it can encompass removal of the cervix, fallopian tubes, one or both ovaries and the top portion of the vagina as well. A hysterectomy may be performed in different ways that may be through the vagina, more commonly the abdominal wall, either using laparoscopic or traditional techniques. Options need to be discussed carefully while considering the surgery. The right type of surgery will be determined by the condition requiring hysterectomy. Various types of hysterectomy include:
- Total hysterectomy is the most common type of hysterectomy that involves the removal of uterus and cervix, excluding ovaries.
- Hysterectomy with Oophorectomy involves removal of the uterus along with one or both of the ovaries.
- Hysterectomy with salpingo- Oophorectomy is done to remove the uterus, one or both of the ovaries and fallopian tubes.
- Radical hysterectomy includes removal of uterus, cervix, the top portion of vagina, most of the tissue that surrounds the cervix and the pelvic lymph nodes if required.
- Supracervical hysterectomy is the type where the uterus is removed but not the cervix.
Hysterectomy – A surgical menopause
A hysterectomy that accompanies removal of ovaries would be recommended in the presence of ovarian tumours or to prevent a future cancer of ovaries if a family history of breast or ovarian cancer is reported. In a hysterectomy, surgical removal of the ovaries, which produce oestrogen, will cause menopause immediately. A total or radical hysterectomy that removes ovaries can cause menopause regardless of age and this phenomenon is called Surgical Menopause. A hysterectomy that spares one or both ovaries intact, menopause occurs within 5 years of hysterectomy but hot flashes and other menopausal symptoms caused by the disturbance of the blood supply to the ovaries during the surgery may be experienced temporarily that later subsides. Hormone replacement therapy (HRT) is usually used to help with menopausal symptoms that occur after a hysterectomy treatment in Chennai.