Hysterectomy

Hysterectomy (Greek, hystera womb; Greek, ektome – excision) is the removal of the womb. It is a frequently performed operation. There are 625,000 hysterectomies performed annually in the USA and 90,000 in the UK. These figures for hysterectomy do not seem to be falling despite the advent of endometrial ablation (the lining of the womb is destroyed – ).

You may wish to consider:

  • The indications for hysterectomy
  • Risks of hysterectomy
  • Types of hysterectomy
  • Sub-total hysterectomy
  • Conservation of the ovaries at hysterectomy
  • Time in hospital for hysterectomy
  • Smear tests after hysterectomy
  • Surgical alternatives to hysterectomy
  • Hysterectomy and endometrial ablation compared
  • Psychological effects of hysterectomy

What are the indications for a hysterectomy?

Hysterectomy may be indicated for a variety of reasons including:

  • Heavy periods and other Vaginal blood loss problems that do not respond to medical treatment. This is the most frequent reason that hysterectomy is performed whether there is a suspected cause such as fibroids or not.
  • Pelvic pain associated with the womb, ovaries or Fallopian tubes, is another common indication. This may be related to fibroids, endometriosis or pelvic inflammatory disease.
  • Large fibroids when fertility is not required.
  • Premenstrual syndrome. Removal of the ovaries and uterus may prove to be the last resort in treatment for severe premenstrual syndrome.
  • An ovarian tumour in a woman who has reached her later forties. Hysterectomy including removal of both the ovaries and Fallopian tubes (Q 24.23) is usually recommended as the chance of malignancy increases with age. The exact nature of an ovarian tumour cannot be determined without microscopic examination. When an ovarian tumour is removed in younger women, it is appropriate to try to conserve fertility.
  • Cancer of the endometrium and cervix.
  • Utero-Vaginal prolapse. The uterus may need to be removed Vaginally as part of surgery for prolapse (Vaginal hysterectomy – 6).
  • On rare occasions, there may be uncontrollable bleeding following childbirth or miscarriage and an obstetric hysterectomy may be life-saving if other treatments are proving ineffective.

Related Medical Abstracts

  • Treatment of menorrhagia before hysterectomy in a district general hospital. A retrospective review (2001)
  • The epidemiology of hysterectomy: findings in a large cohort study. (1992)

What are the risks of hysterectomy?

A hysterectomy is a commonly performed and generally safe surgical procedure. However, in order to make an informed decision and give your consent, you need to be aware of the possible side effects and the risk of complications. The recovery time post hysterectomy depends on the type of procedure, complications and the individual patient. Women who are overweight, for example, take longer to recover. Exercise and care with diet pre and post hysterectomy can speed up your recover. With laparoscopic hysterectomy, many women have made a complete recovery within 2-3 weeks. When discussing the pros and cons of hysterectomy with your gynaecologist you should take into account possible problems inclusding side effects and complications.

Complications

The risks of surgical procedures in general are discussed in surgery risks. This is when problems occur during or after the operation. The majority of women are not affected. The possible complications of any operation include an unexpected reaction to the

  • anaesthetic,
  • excessive bleeding,
  • infection or
  • developing a blood clot, usually in a vein in the leg (deep vein thrombosis, DVT).

Bleeding after hysterectomy occurring during the first 24 hours is called a primary haemorrhage and occurs if a ligature has slipped.

Secondary bleeding after hysterectomy tends to occur about 10 days after surgery when the wound has become infected and eroded a vessel, usually quite a small one, but sometimes a larger one.

One of the purposes of monitoring a patient immediatelay after an operation is to watch for primary haemorrhage by regularly recording the pulse and blood pressure.

Specific complications of hysterectomy are uncommon but can include

  • damage to other organs and tissues in the abdomen,
  • particularly the bladder and ureters (tubes that carry urine from the kidneys to the bladder).

Further treatment such as returning to theatre to stop bleeding or to repair a damaged organ, antibiotics to treat an infection, or a blood transfusion to replace lost blood may be needed.

The urinary tract (bladder and ureters) are closely related to the uterus and may be damaged. The bowel is normally free from the uterus but may be adherent to it if there has been infection, endometriosis or previous surgery.

Infection in the urinary tract is a relatively common complication requiring antibiotics.

Thromboembolism (surgery risks) has been reduced by encouraging early mobilisation after surgery and the use of anticoagulants.

Bladder symptoms are common following hysterectomy. Antibiotics will help if there is infection. Otherwise these symptoms usually settle with time.

side effects

These are the unwanted, but mostly temporary effects of a successful procedure, for example, feeling sick as a result of the general anaesthetic.

After surgery (abdominal hysterectomy), you will have some pain, swelling and bruising in the abdomen area. These side effects usually clear up within a few days. You will have a permanently visible scar. Although this will be red and slightly raised to start with, it should soften and fade over the following weeks and months.

It is natural to worry that a hysterectomy might affect your sex life. For the majority of women hysterectomy does not diminish sexual activity or enjoyment. Some may be pleased that they can no longer conceive.

If your ovaries are removed, you may develop menopausal symptoms (see hysterectomy and the menopause) such as hot flushes and Vaginal dryness. You would then need to consider hormone replacement therapy (HRT). If sexual intercourse becomes painful because your vagina is dry, local oestrogen or lubricants (available from most chemists) can help.

Related Medical Abstracts

  • Psychosexual health 5 years after hysterectomy: population-based comparison with endometrial ablation for dysfunctional uterine bleeding. (2005-01)
  • EVALUATE hysterectomy trial: a multicentre randomised trial comparing abdominal, Vaginal and laparoscopic methods of hysterectomy. (2004-01)
  • Severe complications of hysterectomy: the VALUE study. (2004-02)
  • EVALUATE hysterectomy trial: a multicentre randomised trial comparing abdominal, Vaginal and laparoscopic methods of hysterectomy. (2004-01)
  • Hysterectomy: evolution and trends. (2003-01)
  • The VALUE national hysterectomy study: description of the patients and their surgery. (2002-01)
  • Hysterectomy for benign lesions in the north of France: epidemiology and postoperative events (2001-01)
  • The effect of hysterectomy on the age at ovarian failure: identification of a subgroup of women with premature loss of ovarian function and literature review. (1987)

Hysterectomy and the menopause.

The menopause is defined as the final natural menstrual period and compares to the menarche which is the first period. The menopause is only one event of the climacteric just as the menarche (pubertyerty) is one event during puberty when there are a whole range of physical and emotional developments. The physical and psychological changes experienced around the menopause relate to the fall in hormone output from the ovaries, most notably oestrogens.

If your ovaries are removed at the time of hysterectomy, you may develop menopausal symptoms such as hot flushes and Vaginal dryness. You would then need to consider hormone replacement therapy (HRT). If sexual intercourse becomes painful because your vagina is dry, local oestrogen or lubricants (available from most chemists) can help.

There is some evidence, that even if the ovaries are conserved at the time of hysterectomy, the ovaries lose their function earlier.

 

  • FSH levels in relation to hysterectomy and to unilateral oophorectomy.(1999-01)

 

What is vault granulation?

Granulation is wet scar tissue, which may cause bleeding or discharge. The Vaginal vault is the top of the vagina following total abdominal hysterectomy. During this operation, the cervix is removed and the top of the vagina is sutured (stitched). The granulation may be cauterised with silver nitrate by your gynaecologist in the clinic at your postoperative visit. This is a painless procedure taking just a few seconds.

What are the different types of hysterectomy?

A hysterectomy is a commonly performed and generally safe surgical procedure.

Abdominal Hysterctomy: Unless there is uterine prolapse, most gynaecologist’s remove the womb through the abdominal wall (abdominal hysterectomy).

Vaginal hysterectomy indicates that the uterus has been taken out through the vagina. When there is prolapse of the uterus and heavy periods, Vaginal hysterectomy and pelvic floor repair (6) may solve two problems.

Figure 24.4 shows the options available at abdominal hysterectomy.

A total hysterectomy is when all of the womb, including the neck of the womb (cervix), is removed (Q 24.24).

Insubtotal hysterectomy, the body of the uterus is removed but the neck of the womb is left in place. Total abdominal hysterectomy and bilateral salpingo-oophorectomy is the removal of the ovaries and tubes (Q 24.25).

Hysterectomy

More complex surgery may be required when the hysterectomy is performed for malignancy.

Lymphadenectomy is the removal of the local lymph glands. During a Wertheim’s hysterectomy, required for some women with early cancer of the neck of the womb (cervical cancer), connective tissue adjacent to the uterus is removed together with the local lymph glands (lymphadenectomy).

Laparoscopic Hysterectomy:Some gynaecologists have been trained to remove the uterus vaginally with the assistance of laparoscopy (laparoscopically assisted Vaginal hysterectomy). As with all minimally invasive procedures (Q4.23), we are only just coming out of the pioneering stages. Usually, three or four small incisions are required to introduce all the instruments that are necessary. It has, however, been shown that if the uterus is not enlarged, an abdominal scar of no more than 10cm is required to perform a conventional hysterectomy and many gynaecologists remain comfortable with this approach. Laparoscopic hysterectomy may require less pain relief after surgery but the operation lasts one hour longer.

Caesarean Hysterectomy:Sometimes, complications occur during childbirth or caesarean section and a caesarean hysterectomy is required.

There is some evidence that vaginal hysterectomy has advantages over abdominal and laparoscopically assisted vaginal hysterectomy.0609

Related Medical Abstracts

  • Surgical routes and complications of hysterectomy for benign disorders: a prospective observational study in French university hospitals. (2007-01)
  • Minilaparotomy hysterectomy assisted by self-retaining elastic abdominal retractor. (2007-02)
  • Changing hysterectomy technique from open abdominal to laparoscopic: New trend in Oslo, Norway. (2007-03)
  • Observational comparison of abdominal, Vaginal and laparoscopic hysterectomy as performed at a university teaching hospital. (2006-01)
  • Vaginal hysterectomy: results and complications of 886 patients. (2006-02)
  • Psychological wellbeing after laparoscopic and abdominal hysterectomy–a randomised controlled multicentre study. (2006-03)
  • Persistent high rates of hysterectomy in Western Australia: a population-based study of 83 000 procedures over 23 years. (2006-04)
  • Laparoscopic hysterectomy versus total abdominal hysterectomy: a comparative study. (2006-05)
  • Hysterectomy rates for benign indications. (2006-06)
  • The psychosocial outcomes of total and subtotal hysterectomy: A randomized controlled trial. (2006-07)
  • Total versus subtotal hysterectomy for benign gynaecological conditions. (2006-08)
  • Surgical approach to hysterectomy for benign gynaecological disease. (2006-09)
  • Abdominal vs Vaginal hysterectomy: a comparative study of the postoperativequality of life and satisfaction. (2006-10)
  • Changing the route of hysterectomy: the results of a policy of attempting the Vaginal approach in all cases of dysfunctional uterine bleeding. (2006-11)
  • The effect of hysterectomy on sexuality and psychological changes. (2006-12)
  • Value of laparoscopic assistance for Vaginal hysterectomy with prophylactic bilateral oophorectomy. (2006-13)
  • Subtotal hysterectomy: evolving concepts with implications for practice (2006-14)
  • Sexual experience of partners after hysterectomy, comparing subtotal with total abdominal hysterectomy. (2006-15)
  • No difference in length of hospital stay between laparoscopic and abdominal supraVaginal hysterectomy–a preliminary study. (2006-16)
  • Vaginal hysterectomy for the enlarged uterus. (2006-17)
  • The role of supracervical hysterectomy in benign disease of the uterus. (2006-18)
  • Gynecologists’ attitudes toward hysterectomy: is the sex of the clinician a factor? (2006-19)
  • Which surgical decisions should patients participate in and how? Reflections on women’s recollections of discussions about variants of hysterectomy. (2006-20)
  • Risk of bladder injury during Vaginal hysterectomy in women with a previous cesarean section. (2006-21)
  • Women’s experiences with short admission in abdominal hysterectomy and their patterns of behaviour. (2005-01)
  • Outpatient Vaginal hysterectomy is safe for patients and reduces institutional cost. (2005-02)
  • Psychosexual health 5 years after hysterectomy: population-based comparison with endometrial ablation for dysfunctional uterine bleeding. (2005-03)
  • Prophylactic oophorectomy at elective hysterectomy. Effects on psychological well-being at 1-year follow-up and its correlations to sexuality. (2005-04)
  • Decision-making tree for women considering hysterectomy. (2005-05)
  • TransVaginal hysterectomy or laparoscopically assisted Vaginal hysterectomy for nonprolapsed uteri. (2005-06)
  • Ovarian conservation at the time of hysterectomy for benign disease. (2005-07)
  • The association of hysterectomy and menopause: a prospective cohort study. (2005-08)
  • Lower urinary tract symptoms after total and subtotal hysterectomy: results of a randomized controlled trial. (2005-09)
  • Lower urinary tract symptoms after total and subtotal hysterectomy: results of a randomized controlled trial. (2005-10)
  • Laparoscopic supracervical hysterectomy compared with abdominal, Vaginal, and laparoscopic Vaginal hysterectomy in a primary care hospital setting. (2005-11)
  • Methods of hysterectomy: systematic review and meta-analysis of randomised controlled trials. (2005-12)
  • Value of laparoscopic assistance for Vaginal hysterectomy with prophylactic bilateral oophorectomy. (2005-13)
  • The effect of total hysterectomy on specific sexual sensations. (2005-14)
  • Hysterectomy: evolution and trends. (2005-15)
  • Sexual functioning after total compared with supracervical hysterectomy: a randomized trial. (2005-16)
  • Incidence of cyclical bleeding after laparoscopic supracervical hysterectomy. (2005-17)
  • Fear of cancer among women undergoing hysterectomy for benign conditions. (2005-18)
  • Safety of combining abdominoplasty and total abdominal hysterectomy: fifteen cases and review of the literature. (2005-19)
  • Does hysterectomy affect genital sensation? (2005-20)
  • Minilaparotomy hysterectomy: a valid option for the treatment of benign uterine pathologies. (2005-21)
  • ACOG Committee Opinion. Number 311, April 2005. Appropriate use of laparoscopically assisted Vaginal hysterectomy. (2005-22)
  • Sexual life following total abdominal hysterectomy. (2005-23)
  • Variations in Vaginal and abdominal hysterectomy by region and trust in England. (2005-24)
  • Total versus subtotal hysterectomy: an observational study with one-year follow-up. (2005-25)
  • Laparoscopic-assisted Vaginal subtotal hysterectomy. (2005-26)
  • Effect of total abdominal hysterectomy on ovarian blood supply in women of reproductive age. (2005-27)
  • Readmission to hospital 5 years after hysterectomy or endometrial resection in a national cohort study. (2005-28)
  • Total laparoscopic hysterectomy utilizing a robotic surgical system. (2005-29)
  • Total laparoscopic hysterectomy utilizing a robotic surgical system. (2005-30)
  • Prophylactic antibiotics for abdominal hysterectomy: indication for low-risk Canadian women. (2004-01)
  • Prophylactic antibiotic administration prior to hysterectomy: a quality improvement initiative. (2004-02)
  • Hysterectomy after endometrial ablation-resection. (2004-03)
  • Hysterectomy improves quality of life and decreases psychiatric symptoms: a prospective and randomised comparison of total versus subtotal hysterectomy. (2004-04)
  • A comparison of abdominal and Vaginal hysterectomy for the large uterus. (2004-05)
  • Vaginal hysterectomy in generally considered contraindications to Vaginal surgery. (2004-06)
  • Vaginal hysterectomy in generally considered contraindications to Vaginal surgery. (2004-07)
  • Clinical opinion: guidelines for hysterectomy. (2004-08)
  • A simplified method to decrease operative blood loss in laparoscopic-assisted Vaginal hysterectomy for the large uterus. (2004-09)
  • Outpatient laparoscopic hysterectomy in a rural ambulatory surgery center. (2004-10)
  • Ovarian function after uterine artery embolization and hysterectomy. (2004-11)
  • Learning laparoscopic-assisted hysterectomy. (2004-12)
  • Severe complications of hysterectomy: the VALUE study. (2004-13)
  • Vaginal hysterectomy. A five year prospective descriptive study. (2004-14)
  • Three methods for hysterectomy: A randomised, prospective study of short term outcome (2001-01)
  • A randomised comparison and economic evaluation of laparoscopic-assisted hysterectomy and abdominal hysterectomy. (2000-01)
  • Total versus subtotal hysterectomy: The last great controversy in gynaecological surgery? (1998-01)
  • A randomised prospective trial comparing laparoscopic and abdominal hysterectomy. (1996-01)

Is it essential to remove the neck of the womb at hysterectomy and what is the place of sub-total or partial hysterectomy?

It had become routine practice to remove the cervix when performing abdominal hysterectomy in the United Kingdom and in the majority of other countries. The arguments in favour of removing the cervix are:-

  • cancer of the cervix cannot develop later.
  • the cervix may be the cause of pain or discharge if it is not removed.
  • there is a greater chance of a blood collection (haematoma) in the pelvis soon after surgery with the subtotal hysterectomy complicating recovery a concept that does not seem to have strong foundation.
  • if the cervix is not removed, there is a greater chance of prolapse in years to come but there are no comparative trials to demonstrate this.

In a partial or subtotal (supracervical = above the cervix) hysterectomy, the ovaries and/or cervix are left intact. These procedures, too, can be performed either abdominally, vaginally, or laparoscopically. Unfortunately, many women aren?t even told about these options. Some doctors remove the cervix automatically as a precaution against cervical cancer.

At our practice, we?ve seen that the benefits of retaining your cervix (more sexual enjoyment and sounder inner pelvic architecture) outweigh the relative risks. For one, evidence exists that an intact cervix may actually benefit proper Pap smear technique. If you do choose to keep your cervix, you will need to continue regular annual screenings and Pap tests.

Image showing partial (supracervical) hysterectomy
Partial (supracervical) hysterectomy – Sub-Total Hysterectomy

A partial or subtotal hysterectomy – The cervix is conserved.

There are, however, times when it may be safer to conserve the cervix.

Occasionally, it may be densely adherent to the bowel (usually the rectum) particularly if there is severe endometriosis in the area. If the gynaecologist believes the risks to the bowel or urinary tract may outweigh the advantages, it may be decided during the operation that leaving the cervix in place (sub-total hysterectomy) is in the patient’s best interest.

Many French women prefer to have the cervix conserved at the time of hysterectomy as there is a suggestion that this prevents reduction of sexual satisfaction. The argument in favour of removing the cervix pre-dates cervical smears. If smears have been abnormal removing the cervix would seem appropriate but if there have been regular smears showing no abnormality sub-total hysterectomy should cause less anxiety in this regard. Some believe that conserving the cervix (sub-total hysterectomy) reduces the likelihood of bladder symptoms in the long-term.

A woman of forty presented with heavy periods and premenstrual syndrome. She had always been keen on a conservative approach. Endometrial ablation had provided temporary improvement but within a couple of years she felt that further surgical intervention was required. She had read extensively and elected to have a sub-total hysterectomy with removal of the ovaries and tubes. Her cervical smears had been normal. The operation was uneventful and she was home on the fourth day. She elected to take HRT tablets (oestradiol 2mg daily). She returned to her work with children by the third week and when we saw her six weeks after surgery she felt like a new woman absolutely wonderful. She will continue to have her routine cervical smears as her cervix has not been removed.

From the late 1990’s, gynaecologists in the UK have become increasingly inclined to discuss the question of the subtotal procedure with their patients when counselling them with regard to hysterectomy.

Related Medical Abstracts

  • Subtotal hysterectomy: evolving concepts with implications for practice (2006-01)
  • Total versus subtotal hysterectomy for benign gynaecological conditions. (2006-02)
  • Sexuality after total vs. subtotal hysterectomy. (2004-01)
  • Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results. (2003-01)
  • Randomised controlled trial of total compared with subtotal hysterectomy with one-year follow up results. (2002-01) Subtotal abdominal hysterectomy: A surgical advance or a backward step? (2000-01). SupraVaginal hysterectomy a less invasive procedure.(1995-01) Subtotal hysterectomy revisited. (1995-01)

Should my ovaries be removed at hysterectomy?

If the hysterectomy is undertaken abdominally, there is a choice of conserving or removing the ovaries (Figure 24.4). When the hysterectomy is undertaken vaginally as part of treatment for prolapse, the ovaries are not usually removed.

Hysterectomy

In a young woman, the ovaries are likely to have longer remaining function than in a woman around the age of fifty. There is, therefore, more advantage in conserving the ovaries in a young woman compared to a woman approaching her menopause. Some women, even beyond the age of fifty are very keen to keep their ovaries, if they appear healthy. Provided they have had the opportunity to make an informed choice, their decision must be accepted.

After the menopause, the ovaries produce very little oestrogen but they continue to produce a significant amount of androgens. By removing the ovaries, androgen production is reduced and this could result in reduced sex drive.

In recent years, it has been found that following hysterectomy, ovaries that have not been removed lose their function, usually within five years. This observation may be partially explained by the fact that some women develop heavy periods within the few years leading up to the menopause and the ovaries appear to lose their function early after the hysterectomy because the menopause was imminent anyway.

Even if there is no history of pelvic pain before hysterectomy, many women (about 1 in 20) will develop pain if their ovaries are conserved and return to have a second operation to remove the offending ovaries later.

Statistically we now know that when the ovaries are conserved at the time of hysterectomy, one woman out of every two hundred and fifty is likely to develop cancer of the ovary at some time in her life. This is not as a result of the hysterectomy but simply reflects the chance of a woman developing this disease. Once or twice each year I see women in their fifties or sixties with ovarian cancer who have had their ovaries conserved at the time of hysterectomy.

Cyclical symptoms (premenstrual syndrome Premenstrual Syndrome – PMS) are usually improved or cured when the ovaries are removed and hormone replacement therapy is commenced.

Finally, hormone replacement therapy has advanced to the stage that, with few exceptions, an entirely satisfactory treatment is available following removal of the ovaries. Every patient undergoing hysterectomy should give these facts careful consideration and indicate at the time of signing consent for operation whether she wishes to keep her ovaries if they appear healthy. If the ovaries appear unhealthy the gynaecologist would generally wish to remove them.

Related Medical Abstracts

  • Oophorectomy in premenopausal women: health-related quality of life and sexual functioning. (2007-01)
  • Attitudes of Italian gynaecologists towards prophylactic oophorectomy at hysterectomy for non-malignant conditions. (2006-01)
  • Current knowledge of risks and benefits of prophylactic oophorectomy at hysterectomy for benign disease in United Kingdom and Republic of Ireland. (2003-01)
  • Current practice of hysterectomy and oophorectomy in the United Kingdom and Republic of Ireland. (2002-01)
  • Hysterectomy with bilateral salpingo-oophorectomy: a survey of gynecological practice. (2001-01)
  • Long-term results of bilateral oophorectomy for the treatment of chronic pelvic pain: Relief of pain and special hormone replacement therapy requirements. (1996)
  • Relation between hysterectomy and subsequent ovarian function in a district hospital population (1994)
  • Bilateral oophorectomy and hysterectomy in the treatment of intractable pelvic pain associated with pelvic congestion (1991)

How long will I be in hospital after my hysterectomy?

Patients undergoing abdominal hysterectomy have traditionally stayed in hospital for at least 6 days. It is increasingly recognised that early discharge from hospital has several advantages:

  • Patients, understandably feel more comfortable in their own environment.
  • There is probably less risk of infection away from the hospital.
  • Early mobilisation reduces the risks of deep venous thrombosis (a blood clot developing in the deep veins of a leg or in the pelvis) or pulmonary embolism (the clot in the vein breaks away and travels to the lung).
  • Early discharge allows optimum utilisation of hospital staff and facilities.

The majority of our patients are home within four or five days and many patients are back to full activity including work within three or four weeks.

Related Medical Abstracts

  • Early hospital discharge following abdominal hysterectomy (1996)?
  • Early discharge after hysterectomy for benign diseases by mini-laparotomy (1995)

Do I still need to have PAP tests (cervical smear) after hysterectomy?

If there have been smears showing moderate or severe abnormality before the hysterectomy, further smears for up to five years are advisable even if the cervix has been removed; these smears are taken from the Vaginal vault. If the cervix has been removed and there were no smear test problems before hysterectomy further smears are not justifiable. If the cervix has been conserved (sub-total hysterectomy) smears should continue along the same programme as for women who have not had a hysterectomy.

If you have had a vaginal hysterectomy, the cervix will usually have been removed.

Related Medical Abstracts

  • Vaginal vault smears after hysterectomy for reasons other than malignancy: a systematic review of the literature. (2006-01)

Support Groups

Members of a support group, provide each other with various types of help and information for a particular shared difficulty.

The support may take the form of providing relevant information,

  • relating personal experiences,
  • listening to others’ experiences,
  • providing sympathetic understanding and
  • establishing social networks.

A support group may also provide ancillary support, such as serving as a voice for the public or engaging in advocacy.

Support groups maintain interpersonal contact among their members in a variety of ways.

Support groups also maintain contact through printed information rich newsletters, telephone chains, internet forums, and mailing lists.

Support groups offer companionship and information for people coping with diseases or disabilities. Support groups may not be appropriate for everyone, and some find that a support group actually adds to their stress rather than relieving it.

Evaluation of the quality of Web sites is discussed in (internet information). You may find that several general women’s health sites may help you (internet information). The following are more specialised relevant Web sites:-

Hysterectomy Support Groups:

  • http://www. Angelfire.com/fl/endohystnHRT/1.html
  • http://www.hystercity.com/
  • http://www.hysterectomy-association.org.uk/
  • http://www.nlm.nih.gov/medlineplus/hysterectomy.html
  • http://www.obgyn.net/ah/ah. Asp?
  • http://womenshealth. About.com/library/weekly/aa112397.htm

HystereCity

63 Calle De Industrias Suite # 480

San Clemente

California 92672

The Hysterectomy Association

60 Redwood House,

Charlton Down

Dorchester

Dorset, DT2 9UH.

Please click on the required question.

  • 1 Are heavy periods a common problem?
  • 2 What is in my menstrual flow?
  • 3 What range of menstrual cycle length is considered to be normal?
  • 4 How can menstrual blood loss be measured?
  • 5 How can I tell if my periods are abnormally heavy?
  • 6 What could be the cause of my very heavy menstrual periods?
  • 7 I have been sterilised. Could this be the cause of my heavy periods?
  • 8 Should I have tests to find the reason for my heavy periods?
  • 9 How will my heavy period problems be investigated?
  • 10 What is meant by anaemia due to heavy periods?
  • 11 What is intermenstrual bleeding?
  • 12 What is a hysteroscopy and D and C?
  • 13 What is cervical cautery?
  • 14 What happens after the D and C?
  • 15 What treatments are available for my heavy periods?
  • 16 What are the medical treatments available for heavy periods?
  • 17 How do the various medical treatments for heavy periods work?
  • 18 What would be reasonable initial treatment for a teenager or young woman with heavy periods?
  • 19 What is a hysterectomy?
  • 21 What are the risks (complications) of hysterectomy?
  • 22 What is vault granulation?
  • 23 What are the different types of hysterectomy?
  • 24 Is it essential to remove the neck of the womb at hysterectomy?
  • 25 Should my ovaries be removed or conserved during hysterectomy?
  • 26 How long will I be in hospital when I have my hysterectomy?
  • 27 I have had a hysterectomy. Do I still need to have smear tests?
  • 28 What are the other surgical alternatives to hysterectomy?
  • 29 How do endometrial ablation and hysterectomy compare?
  • 30 Are there any psychological effects following hysterectomy?
  • 31 How do we decide the best treatment for my period problems?
  • 32 Could I have some recommended hysterectomy support groups?
  • 33 Are there any support groups?

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