Abdominal hysterectomy

Abdominal hysterectomy is a surgical procedure where the uterus is removed through an incision in the lower abdomen. One or both ovaries and fallopian tubes may also be removed during the procedure. Before surgery, there are two main decisions to consider about the procedure: whether the cervix should be removed and whether the ovaries and tubes should be removed. If the ovaries are removed, a woman may need to decide if she should take estrogen replacement therapy.

A standard total abdominal hysterectomy includes removal of the entire uterus and cervix. However, there are situations where the cervix is not removed which is called a subtotal hysterectomy. Subtotal hysterectomy may be considered if the woman wishes to retain the cervix or if difficulties are encountered where removal of the cervix could cause damage to the bladder or bowels. Women who have a subtotal hysterectomy should continue with routine cervical smears.

Removing the ovaries: The ovaries may be removed during hysterectomy, a procedure known as an oophorectomy. Oophorectomy is not always required; the decision depends upon several considerations.

Premenopausal women may decide to keep the ovaries to provide a continued, natural source of hormones, including estrogen, progesterone, and testosterone. These hormones are important in maintaining general health, cardiovascular health and cognition, sexual interest and preventing hot flushes and loss of bone density. On the other hand, women who have menstrual cycle-related migraines or severe premenstrual syndrome (PMS) or endometriosis may have an improvement in symptoms when hormone levels are reduced by removing the ovaries. Postmenopausal women are often advised to have their ovaries removed because of a small risk of developing ovarian cancer at some point during their lifetime. The benefits of removing or keeping ovaries should be discussed with the doctor before a decision is taken.

Removing the fallopian tubes:  Fallopian tubes serve as a conduit for the egg and sperm to meet for fertilisation. They are not known to have any role in hormone production. The finger like ends of fallopian tubes are thought to be the precursor for ovarian cancer, and the current practice is to offer removal of the fallopian tubes ( salpingectomy) during hysterectomy.