You are having trouble with your periods. They may be heavy, painful, or not regular, or all three. The doctor has not been able to find any serious cause. At the same time, he or she has not been able to find anything to help. If your womb is taken out - hysterectomy , the problem is solved. This is done through a cut in the tummy - an abdominal hysterectomy. At the same time, if the ovaries (the two small glands that produce the eggs) are diseased, they can be taken out as well, with the Fallopian tubes (which connect the ovaries with the womb). This is called a salpingo-oophorectomy.
Depending on the patient's condition, the particular city in Iran, the facilities available in the hospital, and the method of abdominal hysterectomy the cost of abdominal hysterectomy start from $800.
Hysterectomy may be needed if you have one of the following conditions:
Gynecologic cancer. If you have a gynecologic cancer — such as cancer of the uterus or cervix — a hysterectomy may be your best treatment option. Depending on the specific cancer you have and how advanced it is, your other options might include radiation or chemotherapy.
Fibroids. Hysterectomy is the only certain, permanent solution for fibroids — benign uterine tumors that often cause persistent bleeding, anemia, pelvic pain or bladder pressure. Nonsurgical treatments of fibroids are a possibility, depending on your discomfort level and tumor size. Many women with fibroids have minimal symptoms and require no treatment.
Endometriosis. In endometriosis, the tissue lining the inside of your uterus (endometrium) grows outside the uterus on your ovaries, fallopian tubes, or other pelvic or abdominal organs. When medication or conservative surgery doesn't improve endometriosis, you might need a hysterectomy along with removal of your ovaries and fallopian tubes (bilateral salpingo-oophorectomy).
Uterine prolapse. Descent of the uterus into your vagina can happen when the supporting ligaments and tissues weaken. Uterine prolapse can lead to urinary incontinence, pelvic pressure or difficulty with bowel movements. Hysterectomy may be necessary to achieve satisfactory repair of these conditions.
Abnormal vaginal bleeding. If your periods are heavy, irregular or prolonged each cycle, a hysterectomy may bring relief when the bleeding can't be controlled by other methods.
Chronic pelvic pain. Occasionally, surgery is a necessary last resort for women who experience chronic pelvic pain that clearly arises in the uterus. However, hysterectomy provides no relief from many forms of pelvic pain, and an unnecessary hysterectomy may create new problems. Seek careful evaluation before proceeding with such major surgery.
Hysterectomy ends your ability to become pregnant. If you think you might want to become pregnant, ask your doctor about alternatives to this surgery. In the case of cancer, hysterectomy might be the only option. But for other conditions — including fibroids, endometriosis and uterine prolapse — you may be able to try less invasive treatments first.
During hysterectomy surgery, your surgeon might also perform a related procedure that removes both of your ovaries and your fallopian tubes (bilateral salpingo-oophorectomy). You and your doctor should discuss ahead of time whether you need this procedure.
There are many reasons why the uterus would need to be removed. Some of the disorders that may be treated with a Hysterectomy are:
Constant heavy bleeding that has not been controlled by medicines or Dilatation and Curettage (D&C)
Endometriosis that causes pain or bleeding and does not respond to other treatments
Chronic pelvic pain
Prolapse uterus - a fallen (sagging) uterus
Precancerous or cancerous cells or tissue present in the uterus
Tumours in the uterus
Other ways in which the uterus may be removed are:
Vaginal Hysterectomy - Having the uterus removed through the vagina
Laparoscopic Hysterectomy through key hole incisions made in the abdomen
Hysteroscopy, Laparoscopy, Robotic Surgery may be used to:
Remove an area of endometriosis without removing the uterus
Remove tumours (fibroids) without removing the uterus
You should ask your doctor about these choices but you will find that your doctor would have chosen the method of Hysterectomy that is most appropriate for your medical condition. Please note that some techniques will not be the best option for your medical condition.
Plan for your care and recovery after the operation, especially if you are to have general anaesthesia. Ask at work for time to rest. Try to find other people to help you with your day-to-day duties.
If you are taking daily aspirin for a medical condition, ask your doctor if you need to stop taking it before your surgery.
Be sure to tell your doctor what medicines you are taking.
You may be asked to undergo Pre Anaesthetic investigations such as blood tests, ECG, Chest X-ray and also be evaluated by the anaesthetic team to assess your fitness for anaesthesia.
Follow all pre-surgery instructions that your doctor gives you.
It may usually be recommended that you eat a light meal, the night before the procedure. Do not drink coffee, tea, water or any fluid after the time that the doctor asked you to stop fluids.
You may be given a laxative to take the night before the surgery or an enema the morning before the surgery.
The IV and catheter are removed 1 or 2 days after the surgery. You may stay in the hospital about 3 to 5 days.
After you go home, get plenty of rest. Do not do any heavy lifting or otherwise strain the abdomen muscles for 4 to 6 weeks.
Follow your doctor's instructions for dealing with pain and preventing constipation.
If you were having menstrual periods before the surgery, you will no longer have them after the operation. You also cannot become pregnant. If your ovaries were removed, menopause starts right away and your doctor may prescribe hormone therapy. Be sure to discuss any concerns you have about these effects and treatment with your doctor before the surgery.
Repercussions of general anaesthesia
Most modern anaesthetics are short lasting. You should not have, or suffer from, any after- effects for more than a day after your operation. During the first 24 hours you may feel more sleepy than usual and your judgement may be impaired.
You may be recommended to have a catheter (tube) in your bladder to allow drainage of your urine. This is usually for upto 24 hours after your operation until you are easily able to walk to the toilet to empty your bladder. If you have trouble passing urine, you may need to have a catheter for a few days.
An Abdominal Hysterectomy is generally carried out through a cut that is roughly 10 cm long. This is usually made across the top of your pubic hairline, but sometimes it may run down from your belly button to your pubic hairline instead.
Stitches and dressings
Your cut will be sealed by stitches, staples, clips or glue. Glue and some stitches dissolve by themselves. Other stitches, clips or staples need to be removed. You will be given detailed information about this. Any stitches in your vagina do not require to be removed, as they are dissolvable.
Sometimes, a small tube is inserted through your lower abdominal wall to drain off any excess blood or fluid that may collect post your operation. This will be removed by a nurse after your surgery while you are still in the hospital.
You can anticipate some vaginal bleeding for one to two weeks after your operation. This is like a light period and is red or brown in colour. Some women have little or no bleeding at first, and then have a sudden flow of old blood or fluid about 10 days later. This usually stops immediately and during this period you should use sanitary towels rather than tampons as using tampons could increase the risk of infection.
Pain and discomfort
You can expect pain and uneasiness in your lower abdomen for at least the first few days after your operation. When leaving hospital, you will be provided with painkillers for the pain you are experiencing.
Following your operation your bowel may slow down for a brief time, causing air or 'wind' to be trapped. This can cause some pain or uneasiness until it is passed. Getting out of bed and walking around will provide some relief. Once bowel movements start, the trapped wind will ease.
Starting to eat and drink
After your operation, you may have a IV drip in your arm to administer fluids. When you are able to drink again, the drip will be removed. You will be offered water or a cup of tea and something light to eat.
Formation of blood clots - how to reduce the risk
There is a small possibility of formation of blood clots in the veins in your legs and pelvis (deep vein thrombosis) after any surgery. These clots can travel to the lungs (pulmonary embolism), which could be fatal. You can reduce the risk of clots by:
Starting to walk/moving about as soon as you can after your operation.
Performing exercises while you are resting, for example: pump each foot up and down briskly for 30 seconds by moving your ankle or move each foot in a circular motion for 30 seconds and bend and straighten your legs - one leg at a time, three times for each leg.
You may also be advised other methods to reduce the risk of a clot formation, particularly if you are overweight or have other health issues.
You will be given guidance and information about exercises to help you recover fast and ways to gain mobility without difficulty.
Tiredness and feeling emotional
You may feel tired than normal post-surgery as your body is using a lot of energy to heal itself. You may need to take a nap during the day for the first few days. A Hysterectomy can also be emotionally traumatic and many women during this stage feel tearful and emotional.
The cut in your abdomen (incision) may have to be reopened to stop any bleeding
Your bladder or the tubes leading to it may be injured and need surgical repair
You may develop an infection or bleeding
The incision may open
You may develop a hernia in the incision