American Medical Association Family Medical Guide - American Medical Association [587]
Hysterectomy
The uterus, sometimes along with the ovaries and fallopian tubes, are removed to treat several different gynecologic disorders, especially in women who are at or near menopause. Because there may be other ways of treating a particular disorder, you may want to get a second opinion from another doctor before deciding to have a hysterectomy.
In the most commonly used method of hysterectomy, the surgeon removes the uterus through an incision in the lower abdomen. Alternatively, the surgeon may make the incision at the top of the vagina and remove the uterus from below. A woman usually is given a general or spinal anesthetic for the surgery, which takes about 1 to 2 hours.
After a hysterectomy, you may experience some vaginal bleeding and discharge for a few days. Your doctor will encourage you to get out of bed and walk around a little the day after the surgery, and you can probably go home in a few days. You should be able to resume your usual activities within 6 to 8 weeks. Removal of the ovaries in a woman who has not yet reached menopause stops estrogen production and brings about early menopause. In this case, the doctor may recommend taking estrogen supplements (hormone therapy; see page 853).
Endometriosis
The lining of the uterus is called the endometrium. During each menstrual cycle, part of the endometrium thickens, becomes engorged with blood, and (if conception does not occur) sheds during menstruation. Endometriosis causes the same kind of tissue to develop in other parts of the pelvic cavity—such as on the ovaries or (less commonly) on the fallopian tubes, vagina, or intestines. The endometrial tissue can also develop on scars that have formed in the abdominal wall after surgery. Each month, these abnormal endometrial tissue fragments bleed like the lining of the uterus does during menstruation. However, because the fragments are embedded in tissue, the blood cannot escape. Instead, the blood collects in sacs (cysts), or the bleeding irritates the surrounding tissue, which responds by forming a fibrous covering around each bleeding area. Over time, scar tissue (adhesions) can develop.
In its mild form, endometriosis is common. Because endometriosis is linked to menstruation, it occurs only during a woman’s reproductive years, most often between ages 25 and 50. Endometriosis is most common in women who have not had children. After the onset of menopause, the development of the abnormal endometrial tissue subsides.
Symptoms and Diagnosis
In some cases, endometriosis causes no symptoms or only mild or unnoticeable symptoms. In most cases, symptoms include pain in the lower abdomen or lower back just before periods. Sometimes periods are irregular, with spotting before the flow begins. Intercourse may be painful. Endometriosis can cause infertility if the fallopian tubes become blocked by scarring.
The most common diagnostic procedure used to detect endometriosis is laparoscopy, an outpatient surgical procedure in which the doctor uses a lighted viewing instrument (laparoscope) to see inside the pelvic cavity.
Treatment
Mild cases of endometriosis that don’t cause symptoms do not require treatment. If symptoms are severe, doctors frequently remove the abnormal tissue during laparoscopy by cutting it out or destroying it with heat. The doctor may take a sample of tissue at this time for examination under a microscope to look for cancer cells (biopsy). Your doctor may prescribe daily treatment with hormones or hormonelike drugs for several months to suppress the growth of the abnormal tissue.
If endometriosis affects the ovaries, the treatment is the same as that for an ovarian cyst (see page 865) such as hormone therapy or surgery. In severe cases that do not respond to hormone therapy or surgical treatment, a doctor may recommend a hysterectomy (see previous page) to remove the uterus, the fallopian tubes, and the ovaries.
Endometriosis
Endometriosis