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The Methodist Center for Restorative Pelvic Medicine
6550 Fannin Street
Houston, TX 77030
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Estrogen Replacement Therapy/Hormone Replacement Therapy
Women generally begin to experience menopause between the ages of 45 and 54. Menopause is characterized by a number of factors but generally once a woman has stopped menstruating for at least one year, she is considered to be menopausal.
Menopause symptoms include:
- Hot flashes/flushes
- Night sweats
- Sleep disturbances
These common symptoms of menopause are the result of a drop in estrogen. Estrogen is a group of hormones found in the body. Every woman has three forms of estrogen compounds: estrone (E1), estradiol (E2) and estriol (E3).
To reduce the symptoms of menopause, doctors can administer hormone therapy. There are various hormonal treatment options available in a number of combinations. Estrogen can be taken alone or in combination with another hormone known as progesterone (progestin). These hormones acting together can help treat the symptoms of menopause. Multiple dosing regimens are used for menopausal symptoms.
Hormone therapy also comes in various forms: pills, a skin patch, gels, intrauterine device (IUD) or a vaginal ring. Each form of therapy will provide the patient with a different result depending on her needs.
A hysterectomy is surgery to remove a woman’s uterus, or womb. A womb is the area where a baby grows when a woman is pregnant. The fallopian tubes (the tubes that connect the ovaries to the uterus) and ovaries may also be removed during hysterectomy.
Alternative names for hysterectomies are:
- Vaginal hysterectomy
- Abdominal hysterectomy
- Supracervical hysterectomy
- Radical hysterectomy
- Removal of the uterus
- Laparoscopic hysterectomy
- Laparoscopically assisted vaginal hysterectomy (LAVH)
- Total laparoscopic hysterectomy (TLH)
- Laparoscopic supracervical hysterectomy
- Robotically assisted hysterectomy
Types of Hysterectomy
- Supracervical hysterectomy – The upper part of the uterus is removed. The cervix is left in place.
- Total hysterectomy –The entire uterus and cervix are removed.
- Radical hysterectomy – The uterus, upper part of the vagina, and tissue on both sides of the cervix are removed. This is most often done if you have cancer.
There are many different ways to perform a hysterectomy. The procedure may be done through a surgical incision in either the belly (abdomen) or vagina. Your doctor will help you decide which type of hysterectomy is best for you. The specific procedure depends on your medical history and reason for the surgery.
- Abdominal hysterectomy –The surgeon makes a 5- to 7-inch surgical incision in the lower part of your belly. The cut may go either up and down, or it may go across your belly, just above your pubic hair. This is called a "bikini cut."
- Vaginal hysterectomy – The surgeon makes a cut in your vagina and removes the uterus through this opening. The wound is closed with stitches.
- Laparoscopic hysterectomy – A laparoscope is a narrow tube with a tiny camera on the end. Your surgeon will make three to four small cuts in your belly. The laparoscope and other surgical instruments will be inserted through the openings. The surgeon cuts the uterus into small pieces that can be removed through these openings.
- Laparoscopy-assisted vaginal hysterectomy – The surgeon removes the uterus through a cut that is made inside your vagina. A laparoscope is used to guide the procedure.
- Robotic hysterectomy – This procedure is like laparoscopic surgery, but a special machine (robot) is used. Robotic surgery is most often used to perform a hysterectomy when a patient has cancer or is very overweight and vaginal surgery is not safe.
Why the Procedure Is Performed
There are many reasons a woman may need a hysterectomy. The procedure may be recommended if you have:
- Cancer of the uterus, most often endometrial cancer
- Cancer of the cervix or a precancerous condition of the cervix called cervical dysplasia
- Long-term (chronic) pelvic pain
- Severe endometriosis that does not get better with other treatments
- Slipping of the uterus into the vagina (uterine prolapse)
- Tumors in the uterus, such as uterine fibroids
After the Procedure
After surgery, you will be given pain medicines to relieve any discomfort. You may also have a tube, called a catheter, inserted into your bladder for one to two days to pass urine. You will be asked to get up and move around as soon as possible after surgery. This helps prevent blood clots from forming in your legs and speeds up recovery.
A hysterectomy will cause menopause if you also have your ovaries removed. Removal of the ovaries can also lead to a decreased sex drive. Your doctor may recommend estrogen hormone replacement therapy.