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A hysterectomy, or the surgical removal of the uterus, is one of the most common surgeries performed on women. It is second only to the cesarean section.

Half a million of these procedures happen every year. Many different conditions may necessitate surgical intervention like a hysterectomy, whether it be full or partial. Here are some of them.

Conditions that can lead to a hysterectomy

1. Pelvic Inflammatory Disease

Pelvic inflammatory disease, or PID, is a bacterial infection of the uterus, fallopian tubes, and ovaries. It occurs when bacteria travels up into the reproductive tract from the vagina.

Although the classic symptom of PID is pelvic pain, in many women it may not cause any symptoms initially. In fact, you might not even realize you have PID until you have trouble conceiving or develop pelvic pain.

A hysterectomy is usually the last thing a doctor will recommend to treat PID, but for cases where the infection doesn’t respond to antibiotics or other treatments, it is an option.

2. Endometrial hyperplasia

Endometrial hyperplasia is an overgrowth of the cells lining the uterus. It leads to a thickening of the lining. It occurs when the uterus is exposed to estrogen without progesterone. 

The most common symptoms of uterine hyperplasia are abnormal bleeding, bleeding between periods and periods that last longer than usual. Although it is usually a benign condition, it can lead to cancer in some women.

Uterine hyperplasia is most commonly treated with hormones, or with an outpatient dilation and curettage (D&C) procedure where the extra tissue is surgically removed.

In extreme cases or postmenopausal women, a hysterectomy might be an option.

3. Placenta accreta

Placenta accreta is a dangerous condition that occurs during pregnancy.

During a healthy pregnancy, the placenta is loosely attached to the side of the uterus and detaches naturally after the baby is born. With placenta accreta, the placenta attaches very deeply to the uterus.

It can cause severe hemorrhaging if it separates, putting both mom and baby in danger. WhenI this happen, an emergency cesarean section and hysterectomy may be performed in otder to prevent dangerous bleeding.

4. Uterine fibroids

Uterine fibroids are noncancerous tumors that grow in the muscle of the uterine wall. No one is quite sure what causes these growths. However, they can become quite large if left untreated.

Fibroids can form without any symptoms at all. You might not know you have them if you don’t experience abnormally heavy bleeding, spotting between periods, and back or pelvic pain.

A hysterectomy is an option for patients who don’t respond to treatment or have fibroids that grow back repeatedly. However, there are other options. Uterine fibroid embolization is an outpatient procedure that uses a small catheter to cut off the blood supply to the fibroid, causing the tissue to die. This procedure is done under light sedation. Usually, the incisions are so small you don’t even need stitches.

5. Adenomyosis

Adenomyosis is a condition that is similar to endometriosis. The lining of the uterus grows into the muscular uterine wall. This causes severe cramps, heavier periods, and pressure and bloating in the abdomen.

It occurs most commonly in women who have had children and those that have undergone uterine surgery. An MRI or transvaginal ultrasound is necessary to diagnose this condition.

You can treat the symptoms of adenomyosis with over-the-counter anti-inflammatory medications or prescribed hormone therapy. In more severe cases, endometrial ablation, which destroys the lining of the uterus, or uterine artery embolization can be useful.

If these treatments aren’t successful, or not possible for whatever reason, a hysterectomy becomes a possibility.

6. Endometriosis

Endometriosis is similar to adenomyosis in that the uterine tissue grows where it isn’t supposed to be. In this case, the endometrial tissue grows outside of the uterus and onto other organs in the abdomen or throughout the body.

Some patients don’t experience any symptoms, while others may feel pain in the belly, severe menstrual cramps and pain during sex. They may also find it hard to conceive a child.

Over-the-counter anti-inflammatory medication can help treat some of the symptoms. Surgery to remove the invading endometrial tissue can reduce some of the symptoms as well. If you’re done having children, a hysterectomy can help reduce symptoms by eliminating the source of the tissue that is spreading throughout the body.

7. Uterine Prolapse

The uterus is held in place by a series of muscles. If those muscles weaken, the uterus can slip down into the vagina. This is known as uterine prolapse and can occur at any age.

Everything from pregnancy and childbirth to the lower levels of estrogen in the body after menopause to a chronic cough can cause uterine prolapse. Pregnancies that ended in a vaginal birth, obesity, pelvic surgery and family history all increase your risk of uterine prolapse.

Minor cases of uterine prolapse may not require treatment. But if the prolapse is affecting your daily life, there are treatment options. Uterine suspension is a surgery that moves the uterus back into its correct place and holds it there by either repairing the connective tissue or adding mesh that secures it. Vaginal pessaries inserted into the vagina can also provide additional support. In severe cases, a hysterectomy is necessary.

8. Cancer

The primary treatment for endometrial cancer is a hysterectomy. Depending on the patient’s age, the doctor may also choose to perform a bilateral salpingo-oophorectomy (BSO). That is to say, removing the ovaries and fallopian tubes as well as the uterus. This is to prevent cancer from remaining in the body. BSO may not be recommended for premenopausal women.

The severity of the surgery will depend on how far cancer has spread. If it has spread outside the uterus, the surgeon may choose to perform what is called a radical hysterectomy. In addition to removing the uterus, cervix, ovaries and fallopian tubes, the tissue surrounding the uterus and the upper part of the vagina are also removed.

The bottom line

There are a number of conditions can result in a hysterectomy. However, most of them have other treatment options you can try before taking resorting to surgery.

The only circumstance where removing the uterus is unavoidable is when surgeons find evidence of endometrial cancer.


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