Uterus “101,” the “Cliff Notes”

Your uterus (“womb”) is an organ that is crucial for pregnancy and delivery. It provides a safe haven for a fertilized egg to grow into your child, and then it acts to send your baby out of the birth canal at the right time, using a unique muscle structure that assures a direction of push (out!).

When not pregnant, your uterus prepares for pregnancy by revising its lining to make it suitable for implantation—every month—and when that doesn’t happen, discards that lining (what you see as your “period”) and starts the process all over again. Month after month, until menopause, when this cycle ends because of the falling hormone levels in your body.

After menopause, your uterus does nothing, although some say it contributes to sexual sensation with the mechanical act of intercourse.

Who should have a hysterectomy?

When a woman is no longer interested in childbearing and her uterus is negatively impacting her quality of life, and when her problems cannot be controlled in any other fashion, removing it makes sense.

Who should not have a hysterectomy?

Any woman who may want children or any couple who wants to keep their options open, because hysterectomy is a final burning of the pregnancy bridge. Unless it’s cancer, seldom is hysterectomy absolutely necessary.

What things can create a need for hysterectomy?

• Uterine or cervical cancer is not something that does well with conservative approaches. Such a tragedy means you’re making life-or-death decisions by choosing to have a hysterectomy.
• Fibroids: fibroids can result in pelvic pain and heavy bleeding, both of which can become severe enough to treat. A conservative approach is just removing the fibroid, but when they are too numerous or continue to occur, a woman can consider a final solution for them by undergoing a hysterectomy.
• Heavy periods: bleeding can be caused by clotting disorders, fibroids, adenomyosis, obesity, certain medications, or hormonal problems from the ovaries, thyroid, or pituitary gland. It is very subjective as to whether bleeding is so bad that it warrants hysterectomy; however, if it can’t be controlled and gets to the point at which blood transfusions become necessary, that is often a deciding factor in favor of hysterectomy.
• Endometriosis: certainly robotic surgery has gone a long way to treat endometriosis while sparing a woman’s reproductive organs; nevertheless, a woman can make a personal decision as to whether to pursue hysterectomy as a final solution once she has weighed in with her fertility intentions. Rarely, the scarring from endometriosis can completely fill up the pelvic area around the uterus and rectum, such that this “frozen pelvis” is best combined with hysterectomy when a woman is finished with childbearing; if not, the robotic system is the best protection for dealing with such complicated anatomy and disease while sparing the uterus.

How are problems controlled in other ways?

This depends on the problem with your uterus. If a fibroid is making you experience irregular or heavy bleeding, the fibroid can be removed, sparing the rest of your uterus, keeping your fertility intact. If hormonal bleeding is the problem, an experienced gynecologist can manipulate your hormones to hide the problem, as with birth control pills or with a hormonal IUD. If other conditions, such as adenomyosis or polyps, cause heavy bleeding, the lining that is doing the bleeding can be cauterized (a vaginal approach), sealing those bleeding sites shut.

However, none of these other solutions are considered guarantees. If the problem is your uterus, nothing short of removing it will guarantee you an end of your problem. While this is worth your refusal if you may want children, if you’ve finished adding to your family you may be just delaying the inevitable. Yet, hysterectomy is a big deal, and no one could argue with your trying to be conservative, even if you’ve finished having babies. Short of cancer, hysterectomy is very much a personal decision.

How is a hysterectomy performed?

Hysterectomy has had a lengthy history of variations in the way it’s been performed. While last generation’s woman undergoing hysterectomy may have had a large abdominal incision using scalpels, retractors, and a lot of stitches, today’s minimally invasive laparoscopic/robotic surgery has turned her operation into the same-day cosmetically sensitive procedure of tiny incisions, fast recovery, and a minimum of pain that it is today. This is the approach Dr. Ulas Bozdogan of NJ Endometriosis favors, for all of the above reasons. In fact, it’s the same approach he uses in his fibroid and endometriosis surgeries.

What are complications from hysterectomy?

The real problem with hysterectomy is that it is still a real operation, in spite of how often it is done or how uncomplicated its recovery has become. As such, you’ll be signing a consent that cites the same risks as the hysterectomy in the past: bleeding, infection, and damage to other structures.

That being said, today’s robotic approach—like Dr. Bozdogan uses—offers meticulous dissection and unparalleled visual and tactile interaction that lowers the risk of these complications as much as it has improved the cosmetic concerns. Therefore, even though you’ll be signing an informed consent form like the ones from last generation, the reality is that—while still possible—it is unlikely to happen to you. You have to understand that you have no special protection or guarantee from complications, but you’re stacking the deck in your favor with a hysterectomy specialist like Dr. Bozdogan and his first choice for hysterectomy—the da Vinci robotic system. (He not only favors it, but teaches it to other surgeons!)

Hysterectomy: conclusion

Hysterectomy, removal of your uterus (“womb”), is also removal of your chances of ever having a baby. Only cancer mandates a hysterectomy. Everything else is a judgment call—

Is a problem with bleeding or pain so bad that you’re willing to have a hysterectomy to solve that problem?

This question must also consider childbearing, of course; but if hysterectomy is a right decision for you, today’s robotic surgery like that Dr. Bozdogan of NJ Endometriosis performs, is your best approach for state-of-the-art surgical technique that offers minimal scarring and down-time.