British women are said to experience, on average, 30 years of post-reproductive health. With or without a history of childbirth, these years can involve a number of difficult health conditions, and all too often, a lack of information on how best to deal with them.
Fortunately, great progress is being made in addressing women’s health options in later life, and it is something which is becoming a topic of national discussion. Most notably, the National Institute for Health and Care Excellence (NICE) has been asked by the Department of Health to develop a clinical guideline on diagnosis and management of the menopause. Once this guideline is published (hopefully before the close of this year) it will be in use throughout the NHS system. This guideline will be of huge assistance in ensuring both doctors and their patients are fully informed of the best options available in terms of menopause treatment.
As a clinical negligence solicitor, I have become acutely aware of the complexity of menopausal health issues and the difficulties that many women experience which impact on their day-to-day life. Hot-flushes, night sweats and mood swings can be common-place, as well as further debilitating conditions such as heavy and painful menstrual bleeding, fibroids, pelvic organ prolapse and incontinence.
Women are so often brave and silent, suffering these conditions without question, or accepting general treatments offered. All women should be advised that this is a very important time to ask questions concerning their health. Women should be made aware of the consequences, success rates and risks attached to all medical options offered by their treating doctors, and be fully comfortable with all treatment proposed.
One such treatment often offered to women both before and after menopause is womb removal, or a hysterectomy. It is estimated that one in five British women will have had a hysterectomy by the time they reach the age of 55.
A hysterectomy is a major surgery, and therefore should not necessarily be considered the first-line treatment for all adverse gynaecological symptoms.
Generally, a hysterectomy is only performed if absolutely necessary, e.g. to treat a tumour, long-term pain or excessive bleeding. A hysterectomy should therefore be reserved for women on whom more conservative treatment options have not worked, whose family is complete and who understand the risks involved with this type of major operation.
A full gynaecological and health history should be always be noted before a hysterectomy is performed. Treating doctors should make sure they are fully of informed of their patient’s childbirth history, operative history and examine any scars from previous surgeries. A full pre-operative workup is important and all necessary scans and blood tests should be performed.
Types of Hysterectomy:
- Total Hysterectomy– the womb and cervix (neck of the womb) are removed; this is the most commonly performed hysterectomy operation.
- Subtotal Hysterectomy – the main body of the womb is removed, leaving the cervix in place. This operation is less common as it does not remove the risk of cervical cancer developing at a later stage.
- Total Hysterectomy with Bilateral Salpingo-Oophorectomy – the womb, cervix, fallopian tubes (salpingectomy) and the ovaries (oophorectomy) are removed. Women who have not gone through the menopause should be particularly informed and aware of the consequences of ovary removal as this will have a huge effect on hormone balance and will fundamentally trigger immediate menopause. National guidelines now suggest that ovary removal should only take place if there is a significant risk of further problems e.g. a family history of ovarian cancer.
- Radical Hysterectomy – the womb and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue. This is generally used to treat and remove cancer if other treatments have not worked.
Ways in which a Hysterectomy is performed:
- Vaginally – the womb and neck of the womb are removed through the vagina so there is no abdominal incision. This is suitable for women who have given birth vaginally, but is generally not recommended for women who have not had children or who have undergone previous abdominal surgery.
- Abdominally – the womb and neck of the womb are removed through a cut in the abdomen. It is generally recommended if your womb is enlarged by fibroids or tumours, or if your ovaries need to be removed.
- Laparoscopically (Keyhole) – the womb and the neck of the womb are removed through several small cuts in the abdomen. This is often a preferred method of hysterectomy as it is less invasive.
Women should be completely informed of the risks attached to each particular type of hysterectomy surgery and should not be afraid to ask as many questions as necessary before surgery to ensure they fully understand the procedure they are about to undergo.
Aftercare is also extremely important in terms of wound care, monitoring of any vaginal bleeding and other general post-operative symptoms. Women should feel free to question uncomfortable post-op symptoms if they are causing concern.