A hysterectomy-induced menopause, instant or otherwise, is not to blame for all of the problems women encounter after surgery. But there is no doubt that the surgery can bring on very serious physical and psychological problems for which we have no clear-cut medical explanation.

Understanding Hysterectomy
Strictly speaking, hysterectomy means removal of the uterus. Not the ovaries and fallopian tubes. Just the uterus. When the ovaries and tubes also are removed in the course of surgery, the procedure is properly described as a hysterectomy and bilateral salpingo-oopherectomy.

The Three Approaches To Hysterectomy

1. Abdominal Hysterectomy
2. Vaginal Hysterectomy
3. Laparoscopic-assisted Vaginal Hysterectomy

Abdominal Hysterectomy
Abdominal hysterectomy is the most common surgical approach to hysterectomy, and is done through an incision in the abdomen. The main reason why hysterectomy is such simple surgery is that, internally, all women are built the same way. In every women body the uterus is supported by the same ligaments and served by the same blood supply. Hysterectomy involves detaching the uterus from the ligaments that support it and the blood vessels that supply it.

COMPLICATIONS: If surgeons do their jobs carefully and meticulously, few women should suffer complications of hysterectomy. But there are several pitfalls. These include adhesions; injury to the bowel, bladder, orureter; postoperative bleeding, and wound dehiscence.

Vaginal Hysterectomy
About 20 percent of all hysterectomies are vaginal procedures. Instead of opening the abdomen, the surgeon approaches the uterus through the vagina, detaches it, and pulls it out. Vaginal hysterectomy usually is reserved for women with uterine prolapse-a uterus that has lost its muscular supports and began to sag.

COMPLICATIONS: Although vaginal hysterectomies are generally regarded as less dangerous than abdominal hysterectomies, they present their own set of risks and complications, including fever and infection, bladder injury, and adhesions.

Laparoscopic-Assisted Vaginal Hysterectomy
This new approach to hysterectomy involves the use of a viewing device called a laparoscope. The illustration shows how the laparoscope is inserted via a tiny abdominal incision near the belly button. Other surgical instruments are inserted through similarly small incisions. The big advantage of laparoscopic surgery of any type is that a small incision means a shorter hospital stay - only one or two days - less pain, and more rapid recuperation.

Because laparoscopic surgery involves so much less physical strain than conventional surgery, it has become very popular. Unfortunately, however, not all surgeons are as proficient as they should be before attempting the procedure. Some are operating on patients with no more training than merely having watched a film on laparoscopic surgery. This is a scary situation.

COMPLICATIONS: While laparoscopic-assisted vaginal hysterectomy is so new that we have no meaningful statistics on the rate of complications, there is no reason to believe that the complications would be any different from those that occur with other types of hysterectomy The greatest threat is posed by inexperienced physicians who attempt the procedure without adequate training. The concern is that the availability of the procedure will lead to an increased number of unnecessary or unjustified hysterectomies. Can it be too long before we start to hear that women are being urged to have hysterectomies during their lunch hour?