Risks of a hysterectomy

A hysterectomy used to be the first choice when it came to the treatment of problem periods - but the number of hysterectomies being performed is on the decline.

It's estimated that around 55,000 hysterectomies are still performed in the UK every year.

Typically, hysterectomies are used to treat heavy periods, fibroids and to manage symptoms of endometriosis. For some women, they are necessary to treat cancer, but this is a rare reason for hysterectomy.

Most of these operations will go smoothly.

However, there are risks associated with this surgery, and women should carefully weigh up their options, and also look at alternatives to hysterectomy before making their choice.

A good gynaecologist will be happy to go through the pros and cons of each procedure.  

What are the risks of a hysterectomy?

• Bleeding. Haemorrhaging is a risk (albeit small) of any major operation like a hysterectomy. A blood transfusion may be required if this happens during the operation.
• Damage to the urinary system. In around one per cent of cases, surgery damages the ureter. Occasionally, the bladder or is affected, which may lead to complications such as infection, incontinence and a frequent need to urinate.
• Infection. Post-operative infections are always a risk after an operation. Antibiotics are usually used to treat them.
• Thrombosis. Because a hysterectomy is a serious operation that causes you to remain immobile, there’s always a risk a blood may block blood circulation – which is known as thrombosis. Moving around and anticoagulant drugs can help reduce this risk.
• Vaginal issues. A hysterectomy that removes the top of the vagina may heighten the risk of prolapse.
• Problems with the ovaries. Not every hysterectomy removes the ovaries (oophorectomy). However, even if you opt to keep your ovaries they may stop functioning within five years after a hysterectomy. This will mean an earlier menopause, which can increase your risk of osteoporosis.
• Early menopause. Menopausal symptoms are usually triggered when the ovaries stop functioning or after an oophorectomy. Symptoms can include, anxiety, insomnia, hot flushes and night sweats.

Dangers of a general anaesthetic

Having a General Anaesthetic is not risk-free. Serious problems occur in around one in every ten thousand anaesthetics. This may include:

• Allergic reaction

• Nerve damage

• Death

Statistics show there’s a small risk of death during a General Anaesthetic - to put this in perspective, the risk is between one in one hundred thousand to one in two hundred thousand. Your risk rate may go up if you’re overweight or have underlying health problems. 

Are there alternatives to hysterectomy?

Women who wish to avoid hysterectomy but solve the issue of heavy, painful periods may like to consider fibroid removal using myomectomy and ablation. These used to done under General Anaesthetic, but the latest and safest techniques mean you can walk in to a clinic to have these done – and walk out again in the same day – no anaesthetic required.

Mr Francis Gardner is Consultant Gynaecologist and Clinical Director of Gynaecology at Queen Alexandra Hospital Portsmouth and is in private practice in Harley Street. He says: “Ambulatory gynaecology – also known as ‘Office Gynaecology’ has many advantages over a hysterectomy and is a far less invasive.”

He explains: “Use of these techniques can mean women can avoid the risk of a GA (general anaesthetic), along with a reduction in surgical complications. Using oral pain relief a few hours before the operation along with a local anesthetic means that patients experience little discomfort. In one study, which asked patients who’d had office gynaecology procedures to score any pain or discomfort out of 10, the average rating was just 2.4.”

Less risk of infection with office gynaecology

Apart from low levels of discomfort, office gynaecology has other obvious advantages. “There is also less chance of acquiring an infection,” points out Mr Gardner. “The operation can be completed in minutes, allowing the patient to walk out of the clinic. This, in turn, reduces the problems of thrombosis as the patient is not having to spend long periods of time recovering in bed.”

“A hysteroscopy - where the lining of the womb (uterus) can be assessed by direct visualisation with a telescope (hysteroscope) and a small camera – can identify whether there are fibroids and polyps. These can be removed either during this assessment, or at another appointment using the MyoSure system. This is a special telescope which allows a piece of equipment to be passed through it which treats the fibroids and polyps without any cuts or scars.”

The safest ablation?

This in its self, can help with problems associated with fibroids, such as heavy bleeding. However, fibroids can re-grow. If women have completed their families, an endometrial ablation with the NovaSure can be offered.

Mr Gardner says: “An endometrial ablation is an alternative to hysterectomy that works by treating just the womb lining rather than removing the whole womb. There are many different ways of performing this, including using laser energy, microwave energy, hot water and a heated cutting wire. However, the leading ablation is NovaSure Endometrial Ablation which uses a rapid delivery (Maximum 120 seconds) of controlled radio frequency energy with a measured scientific endpoint to ensure safe and reliable ablation.”

“Once any fibroids have been removed, the NovaSure ablation offers very rapid treatment. It takes an average of 90 seconds to perform the procedure. It can be done at any point in the menstrual cycle. Post procedure pain is minimised because the inflammatory products of the ablation are evacuated during the procedure.”