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Hysterectomy

A hysterectomy is the surgical removal of the uterus, usually done by a gynecologist. Hysterectomy may be total (removing the body and cervix of the uterus) or partial (also called supra-cervical). In many cases, surgical removal of the ovaries (oophorectomy) is performed concurrent with a hysterectomy. The surgery is then called “total hysterectomy with bilateral salpingo-oophorectomy.” (The shorthand in the Trans community for this operation is “full hysto”.)

Women who have total abdominal hysterectomy with bilateral salpingo-oophorectomy surgeries lose most of their ability to produce the female hormones oestrogen and progesterone and subsequently enter what is known as “surgically-induced menopause” (as opposed to normal menopause, which occurs naturally in women as part of the ageing process). In women under the age of 50, hormone supplements (usually oestrogen) are often prescribed as part of hormone replacement therapy (HRT) to offset the negative effects of sudden hormonal loss (most notably an increased risk for early-onset osteoporosis). This treatment is somewhat controversial due to the known carcinogenic and coagulative properties of oestrogen; however, many physicians and patients feel the benefits outweigh the risks in women who would otherwise be “too young” to be in full-blown menopause.

Although many hysterectomies are performed via a full abdominal incision laparotomy, two common surgical approaches which are less invasive are laparoscopically (three tiny incisions are still made near the navel so that tiny cameras can be inserted to help the doctor see what ze’s doing, and the organs are then removed through those same incisions – this requires that the organs be very small either naturally or due to atrophy) or vaginally (everything is removed via the vagina and no incision is made – this works best for people who have given birth as the vaginal passage is a bit bigger). LAVH, which you may see reference to in your research, stands for Laparoscopic Assisted Vaginal Hysterectomy, in which the organs are removed via the vaginal passage but the tiny incisions are still made so that the cameras can be inserted and the doctor can see what ze’s doing. Most vaginal hysterectomies are LAVH, and LAVH is more commonly used than simple laparoscopic hysterectomy as the latter requires the organs to be quite small. Surgery with ovarian conservation is an option for the pre-menopausal patient with benign disease (non-cancer).

Indications for hysterectomy include uterine fibroids, pelvic pain (including endometriosis and adenomyosis), pelvic relaxation (or prolapse), heavy or abnormal menstrual bleeding, and cancer or pre-cancer diseases. Uterine fibroids, although a benign disease, may cause heavy menstrual flow and discomfort to some women. Many treatments are possible: Pharmaceutical (the use of NSAIDs for the pain or hormones to suppress the menstrual cycle), uterine artery embolisation, or surgical. The surgical treatment varies depending on the location of the fibroids. If the fibroids are inside the lining of the uterus, hysteroscopic removal might be an option.

Transsexuals undergoing sex reassignment surgery as part of a female-to-male (FTM) transition usually have hysterectomies and oophorectomies to remove the primary sources of female hormone production. For health reasons, some FTMs who are on T have these organs removed earlier in transition, as it reduces risk for developing ovarian cysts and other ovarian and uterine problems due to the higher levels of testosterone in their systems; some, however, wait to have a hysterectomy and oophorectomy at the same time as genital reconstruction surgery to avoid having multiple surgeries over the course of their transitions. This involves being on an operating table and under general anaesthesia for a much longer time, and as such is not as healthy or safe as having two separate operations; most people have them separately both due to this concern and financial constraints.

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