Why are hysterectomies performed?

Fibroids are the most common cause for hysterectomy; they are associated with as many as 40% of hysterectomies performed in the US. Depending on their location, fibroids can cause either heavy bleeding, pelvic and back pain, or pressure on bowel and bladder. Most hysterectomies performed for fibroids [the medical term is myoma] are performed by the abdominal route since the fibroids may grow to be quite large. Fibroids are almost never cancerous.

Cancer may involve the uterus. Although not as common as fibroids, cancer may affect either the lining of the uterine cavity [endometrial cancer] or cancer of the cervix. Both of these cancers are treated with hysterectomy. Often the ovaries will be removed at the same surgery to prevent spread. Hysterectomy may also be necessary for more rare malignant growths within the walls of the uterus call sarcoma. Sarcoma may look like fibroids on imaging, and it is important that your doctor has evaluated you for this rare malignancy.

Endometriosis is another common cause for hysterectomy. In this disease, the lining of the uterus [the endometrium] spreads to other parts of the pelvic cavity such as the ovaries. It is stimulated each month as if it were inside the uterus. Women often complain of intense crampy pain with exercise, intercourse or menstruation when they suffer from endometriosis. Medical therapy may slow the spread of this disease. Laparoscopy may allow a physician to remove some of the disease. In spite of the best efforts, many women require hysterectomy to cure their chronic pain.

Other conditions which may require a hysterectomy include drop of the bladder and rectum after childbearing.