Written by Mr Jayanta Chatterjee for Doctify
Lena Dunham has been making headlines recently. Not for her radical writing, tendency towards nudity and penchant for controversy but instead for her decision to undergo a hysterectomy. Dunham has been a long time sufferer with endometriosis and has been very outspoken about her health journey.
For anyone wondering what exactly a hysterectomy entails and why someone so young would have the surgery (Dunham is 31), we have endeavoured to answer your questions with the expert help of gynaecologist, Mr Jayanta Chatterjee.
What is a hysterectomy?
Hysterectomy is an operation primarily to remove the uterus. Hystera is the Greek word meaning uterus. In terms of medical/surgical definition – a total hysterectomy means removing the uterus and the cervix (womb and the neck of the womb).
In layman’s term, a total hysterectomy is sometimes thought to be synonymous with removal of not only the uterus and the cervix but of the tubes and ovaries as well (also referred to as “full hysterectomy”). In medical terminology this is described as bilateral salphingo-oophorectomy (salphinges are fallopian tubes and oophorectomy means the removal of an ovary) if both the fallopian tubes and ovaries are removed.
Hysterectomy is increasingly being performed through minimally invasive route or in other words by “keyhole” surgery. This could be laparoscopic or robotic. However, there are instances when it still has to be performed by an open laparotomy (the traditional way through an abdominal cut or incision). It can also be performed by the vaginal route depending on the indication.
Under what circumstances would a woman under 35 years old undergo one?
There are various reasons for a young woman to undergo a hysterectomy. However, with medical and conservative management becoming the mainstay of treatment for many benign gynaecological conditions like fibroids, endometriosis, heavy menstrual bleeding, dysfunctional uterine bleeding and pelvic pain, it is rare for a young woman to undergo a hysterectomy without exhausting all such treatment options.
If a woman is diagnosed with cancer of the ovary or the uterus, hysterectomy becomes a necessary part of the surgical treatment. While fertility preserving surgery is becoming common in early cervical cancer (thereby preserving the uterus, tubes and ovaries) management, depending on the stage and other risk factors, it is usually difficult to offer this option in woman diagnosed with uterine and ovarian cancer.
Women who have had chronic and protracted course of disease symptoms, in whom all conservative and medical management plans have failed, hysterectomy may be the only necessary solution even for benign conditions.
What are the consequences of an early hysterectomy?
If a woman undergoes an early hysterectomy whereby she has had her uterus, cervix, tubes and ovaries removed, she goes into early surgical menopause. “Early” would be considered at a time before the onset of natural menopause. This may trigger the onset of menopausal symptoms, like hot flushes, night sweats and other vasomotor manifestations due to the sudden loss of ovarian hormones. This can increase the risk of heart disease, osteoporosis, skin changes, loss of libido, hair loss and other hypo-oestrogenic conditions.
There are some studies to suggest early menopause (surgical or otherwise) can impact on long term memory disorders.
Is there anything that can ease recovery after the operation?
Understanding the symptoms and signs and early recourse to hormone replacement therapy after surgical menopause can significantly improve symptoms. However, it is important to be guided by your gynaecologist/oncologist regarding the use of hormone replacement therapy (HRT) in patents where hysterectomy has been performed as part of cancer treatment.
The understanding of hormone dependent cancers and pathway interactions in such situations is important in making an informed choice about the use of hormonal therapy. The risks and benefits need to weigh up, so as to not significantly increase the risk of cancer recurrence. Similarly, the use of HRT in women who have had hysterectomy due to chronic pelvic pain secondary to severe endometriosis needs to be judiciously administered.
General principles of early mobilisation, eating a balanced diet, gentle exercise and drinking plenty of fluids after the surgery will help in a better recover after such surgery.
Can your ovaries still be preserved?
Depending on your circumstances and the reason for undergoing a hysterectomy you will be advised by your gynaecologist regarding the merits of conserving your ovaries.
For most benign conditions this is an acceptable option unless you are post or peri-menopausal. In women undergoing a full hysterectomy for oncological reasons, who wish to have children in the future, fertility options of egg retrieval and storage, surrogacy and ovum donation needs to be discussion with a fertility specialist prior to the surgery.
Should you seek emotional support in the wake of an early hysterectomy?
There is often a huge emotional upheaval following a hysterectomy occasionally associated with a feeling of loss of femininity in some individuals. In women who have an early hysterectomy the sudden loss of oestrogen can be associated with extreme emotional disturbances ranging from mood swings, irritability to depression and suicidal thoughts. Hence seeking emotional support from close relatives and loved ones is an important aspect of coping and coming to terms after a hysterectomy.
In rare circumstances it is important to seek medical input through your general practitioner to assess to the need for initiating treatment for this.
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