A hysterectomy is an operation to remove a woman's uterus. A woman may have a hysterectomy for different reasons, including:
- Uterine fibroids that cause problems
- Uterine prolapse
- Cancer of the uterus, cervix, or ovaries
- Abnormal vaginal bleeding
- Chronic pelvic pain
- Adenomyosis, or a thickening of the uterus
Hysterectomy for noncancerous reasons is usually considered only after all other treatment approaches have been tried without success.
Depending on the reason for the hysterectomy, your doctor may choose to remove your entire uterus or only a portion.
The ovaries may also be removed -- a procedure called oophorectomy -- or may be left in place.
Surgeons use different approaches for hysterectomy depending on the reason for the hysterectomy and your overall health status.
There are two approaches to surgery – a traditional or open surgery and surgery using a minimally invasive procedure (robotic surgery) or MIP. Your doctor will ensure the surgery option he or she chooses is the best option for you.
After a hysterectomy, if the ovaries were also removed, a woman will enter menopause. If the ovaries were not removed, a woman may enter menopause at an earlier age than she would have otherwise.
Most women are told to abstain from sex and avoid lifting heavy objects for six weeks after hysterectomy.
Your physician will discuss your hysterectomy options with you if one is needed to treat your condition. Please call us with questions at (601) 936-9190 if you are experiencing any of the symptoms listed above.
Colposcopy and Cervical Biopsy
Colposcopy is a special way for your doctor to look at your vulva, vagina, and cervix . Sometimes during this procedure, your physician will take a biopsy.
Colposcopy is usually performed after certain types of abnormal Pap tests.
It can also be performed to:
- Check a sore or other problem (such as genital warts).
- Follow up on abnormal areas seen on a previous colposcopy.
- Look at the cervix for if HPV is present or if a patient shows high predisposition to HPV.
Dilation and Curettage (D&C)
Dilation and curettage (D&C) is a procedure to remove tissue from inside your uterus. Doctors perform dilation and curettage to diagnose and treat certain uterine conditions — such as heavy bleeding — or to clear the uterine lining after a miscarriage or abortion.
In a dilation and curettage — sometimes spelled “dilatation” and curettage — your doctor uses small instruments or a medication to open (dilate) your cervix — the lower, narrow part of your uterus. Your doctor then uses a surgical instrument called a curette to remove uterine tissue. Curettes used in a D&C can be sharp or use suction.
Dilation and curettage can diagnose or treat a uterine condition.
To diagnose a condition
Your doctor might recommend a D&C to diagnose a condition if:
- You have abnormal uterine bleeding
- You experience bleeding after menopause
- Your doctor discovers abnormal endometrial cells during a routine test for cervical cancer
To perform the test, your doctor collects a tissue sample from the lining of your uterus (endometrium) and sends the sample to a lab for testing. The test can check for:
- Uterine cancer
- Uterine polyps
- Endometrial hyperplasia — a precancerous condition in which the uterine lining becomes too thick
To treat a condition
When performing a therapeutic D&C, your doctor removes the entire contents of your uterus, not just a small tissue sample. Your doctor can do this to:
- Remove a molar pregnancy, in which a tumor forms instead of a normal pregnancy
- Treat excessive bleeding after delivery by clearing out any placenta that remains in the uterus
- Remove cervical or uterine polyps, which are usually benign
- Remove fibroid tumors, which are benign tumors formed on the uterine wall that sometimes bulge into the uterine cavity
- Clear out any tissue that remains in the uterus after a miscarriage or abortion to prevent infection or heavy bleeding
Your doctor may perform the D&C along with another procedure called a hysteroscopy. During a hysteroscopy, your doctor inserts a slim instrument with a light and camera on the end into your vagina, through your cervix and up into your uterus. Your doctor then views the lining of your uterus on a screen, noting any areas that look abnormal, making sure there aren’t any polyps, and taking tissue samples as needed. During hysteroscopy, your doctor can also remove uterine polyps and fibroid tumors.
Contact your doctor if you experience any of the following after a D&C:
- Bleeding that’s heavy enough that you need to change pads every hour
- Light bleeding that lasts longer than two weeks
- Cramps lasting more than 48 hours
- Pain that gets worse instead of better
- Foul-smelling discharge from the vagina
Because you’re either unconscious or sedated during D&C, you shouldn’t feel any discomfort. The procedure usually takes about 15 to 30 minutes. Your doctor will share additional information on your D&C should you need one.
Endometrial ablation is a procedure that surgically ablates or does away with the lining of your uterus to lessen menstrual flow for women who have menstrual bleeding problems, abnormal tissues such as fibroids, polyps, or cancer of the uterus.
Bleeding problems may include:
- Unusually heavy periods, sometimes defined as soaking a pad or tampon every two hours or less
- Bleeding that lasts longer than eight days
- Anemia from excessive blood loss
After an endometrial ablation, in some women, menstrual flow may stop completely. The physician inserts very thin tools into the passageway between your vagina and uterus (cervix) to complete the procedure.
There are a variety of ways to perform endometrial ablation. They might include extreme cold, heated fluids, microwave energy or high-energy radiofrequencies.
Some types of endometrial ablation can be done in your doctor’s office. Others must be performed in an operating room. Factors such as the size and condition of your uterus will help determine which endometrial ablation method is most appropriate.
Pregnancy can occur after endometrial ablation. However, these pregnancies might be higher risk to mother and baby. The pregnancy might end in miscarriage because the lining of the uterus has been damaged, or the pregnancy might occur in the fallopian tubes or cervix instead of the uterus (ectopic pregnancy).
Some types of sterilization procedures can be done at the time of endometrial ablation. If you are having endometrial ablation, long-lasting contraception or sterilization is recommended to prevent pregnancy.
Please call our offices to talk to your doctor about whether you may be a candidate for endometrial ablation at (601) 936-9190.
CONTRACEPTIVE IMPLANTATION (HRT)
Contraceptive implants are a long-term birth control option. They come in the shape of a flexible plastic rod about the size of a matchstick that is implanted under the skin of the upper arm. Often times, women choose this form of birth control because it provides a long-term result to prevent contraception.
Contraceptive implants release hormones that thicken cervical mucus and thin the lining of the uterus (endometrium). Contraceptive implants typically suppress ovulation as well.
There is only one type of contraceptive implant that is currently approved by the FDA in the United States – Nexplanon, which is radio opaque, meaning it can be seen on X-ray, which is sometimes necessary to check the location of the implant.
- Convenience – it can be removed easily upon request and will not impact your fertility.
- Uninterrupted sexual activity – implantation ensures contraception is in place without having to stop during intercourse for condoms or remember a daily pill.
- Can help with periods and endometriosis symptoms.
- Does not include estrogen.
Contraceptive implants are not for everyone. Your health care provider may discourage use of a contraceptive implant if you:
- Are allergic to any components of the implant
- Have had serious blood clots, a heart attack or a stroke
- Have hepatic tumors or liver disease
- Have known or suspected breast cancer or a history of breast cancer
- Have undiagnosed abnormal genital bleeding
Talk to your doctor to see if the contraceptive implant is the right option for you. Call to schedule an appointment at (601) 936-9190.
The Pap test checks for cervical cancer and is typically utilized at your annual exam. Pap tests are fundamental to your wellness care.
Cells scraped from the opening of the cervix are examined under a microscope. The cervix is the lower part of the uterus (womb) that opens at the top of the vagina.
You lie on a table and place your feet in stirrups. The health care provider gently places an instrument called a speculum into the vagina to open it slightly. This allows the provider to see inside the vagina and cervix.
Cells are gently scraped from the cervix area. The sample of cells is sent to a lab for examination.
Tell your provider about all the medicines you are taking. Some birth control pills that contain estrogen or progestin may affect test results.
Also tell your provider if you:
- Have had an abnormal Pap smear
- Might be pregnant
Do not do the following for 24 hours before the test:
- Douche (douching should never be done)
- Have intercourse
- Use tampons
Avoid scheduling your Pap test while you have your period (are menstruating). Blood may make the Pap test results less accurate. If you are having unexpected bleeding, do not cancel your exam. Your provider will determine if the Pap test can still be done.
Empty your bladder just before the test.
A Pap test causes little to no discomfort for most women. It can cause some discomfort, similar to menstrual cramps. You may also feel some pressure during the exam.
You may bleed a little bit after the test.
Why the Test is Performed
The Pap test is a screening test for cervical cancer. Most cervical cancers can be detected early if a woman has routine Pap tests.
Screening should start at age 21.
After the first test:
- You should have a Pap test every 3 years to check for cervical cancer.
- If you are over age 30 and you also have HPV testing done, and both the Pap test and HPV test are normal, you can be tested every 5 years (HPV is the human papillomavirus, the virus that causes genital warts and cervical cancer).
- Most women can stop having Pap tests after age 65 to 70 as long as they have had three negative tests within the past 10 years.
You may not need to have a Pap test if you have had a total hysterectomy (uterus and cervix removed) and have not had an abnormal Pap test, cervical cancer, or other pelvic cancer. Discuss this with your provider.
A normal result means there are no abnormal cells present. The Pap test is not 100% accurate. Cervical cancer may be missed in a small number of cases. Most of the time, cervical cancer develops very slowly, and follow-up Pap tests should find any changes in time for treatment.
What Abnormal Results Mean
Abnormal results are grouped as follows:
ASCUS or AGUS:
- This result means there are atypical cells, but it is uncertain or unclear what these changes mean
- The changes may be due to HPV
- They may also mean there are changes that may lead to cancer
LSIL (low-grade dysplasia) or HSIL (high-grade dysplasia):
- This means changes that may lead to cancer are present
- The risk of cervical cancer is greater with HSIL
Carcinoma in situ (CIS):
- This result most often means the abnormal changes are likely to lead to cervical cancer if not treated
Atypical squamous cells (ASC):
- Abnormal changes have been found and may be HSIL
Atypical glandular cells (AGC):
- Cell changes that may lead to cancer are seen in the upper part of the cervical canal or inside the uterus
When a Pap test shows abnormal changes, further testing or follow-up is needed. The next step depends on the results of the Pap test, your previous history of Pap tests, and risk factors you may have for cervical cancer.
For minor cell changes, doctors will recommend another Pap test in 6 to 12 months.
Follow-up testing may include:
- Colposcopy-directed biopsy
- An HPV test to check for the presence of the HPV virus types most likely to cause cancer
Make sure to schedule your Pap test during your annual exam. Please call (601) 936-9190 to schedule your appointment or if you have any questions.