A hysterectomy is the surgical removal of a woman’s uterus. It is a major surgery that involves permanent changes to a woman’s reproductive system. As women age, they may develop various gynecological conditions that can be treated with a hysterectomy. However, the decision to undergo this surgery is a complex one for older women given the potential risks and effects on quality of life.
In this article, we will examine the key factors a 70 year old woman should consider when deciding whether to have a hysterectomy. We will look at the common indications for the surgery at this age, discuss the different types of hysterectomy procedures, review the risks and complications, and summarize the potential benefits. With this information, older women can make an informed choice about hysterectomy based on their individual circumstances and priorities.
Common reasons for hysterectomy at age 70
There are several gynecological issues that frequently prompt hysterectomy consideration in older women:
Fibroids
Uterine fibroids are non-cancerous growths that develop from the muscle tissue of the uterus. Although fibroids are most common in women in their 30s and 40s, they can still occur in older women as well. Fibroids may cause symptoms like heavy menstrual bleeding, pelvic pain and pressure, and urinary frequency. They may also contribute to reproductive problems. If medications do not adequately control fibroid symptoms, a hysterectomy may be recommended.
Endometriosis
Endometriosis occurs when tissue similar to the uterine lining grows outside of the uterus, typically on the ovaries, fallopian tubes, and pelvic structures. This displaced tissue responds to hormonal changes and can cause pelvic pain, cramping, and heavy periods. Endometriosis is often diagnosed in younger women but can sometimes affect older women too. A hysterectomy may help provide relief when other treatments fail to manage pain and other symptoms.
Uterine prolapse
Uterine prolapse is characterized by descent of the uterus from its normal position into or through the vagina. This occurs when the pelvic floor muscles and ligaments stretch and weaken. Prolapse becomes more common as women get older. For severe cases that do not respond to conservative treatments like kegel exercises and pessaries, surgical repair may be performed along with hysterectomy.
Cancer
Uterine or cervical cancers sometimes occur in older women, though less frequently than in younger women. Hysterectomy is often part of the treatment when cancer is present. Ovarian cancer may also prompt removal of the uterus. A history of reproductive cancer in the family can influence some women’s decisions for preventive hysterectomy.
Abnormal bleeding
Heavy, frequent, or irregular vaginal bleeding are all reasons an older woman might consider hysterectomy. Causes include hormone imbalance, uterine polyps, adenomyosis (uterine lining growing into muscle), and uterine cancer. When bleeding is severe enough to cause anemia or disrupt quality of life and does not respond to other interventions, a hysterectomy may be recommended.
Types of hysterectomy procedures
There are three main types of hysterectomy operations:
Partial hysterectomy
In this procedure, the uterus is removed, but the cervix is left in place. The ovaries may or may not be removed. This preserves some pelvic support but menstrual bleeding cannot continue.
Total hysterectomy
A total hysterectomy involves removal of both the uterus and the cervix. The ovaries may or may not be removed. This completely stops menstrual periods.
Radical hysterectomy
This extensive surgery removes the uterus, cervix, the upper part of the vagina, and surrounding supporting tissues. A radical hysterectomy is usually only performed for cancers when cancer has spread beyond the uterus.
The ovaries may or may not be removed during any of these hysterectomy types. Removal of ovaries (oophorectomy) eliminates the main source of estrogen and brings on surgical menopause if not already menopausal.
Hysterectomies are almost always done through an abdominal incision. However, new techniques allow for a vaginal or laparoscopic approach in some cases. Vaginal and laparoscopic hysterectomies normally involve faster recovery times but may not be appropriate for all patients.
Risks and complications
Hysterectomy is major surgery, so short-term risks must be carefully considered. Possible complications include:
- Excessive bleeding
- Infection
- Damage to nearby organs like the bladder or bowel
- Blood clots
- Negative reaction to anesthesia
For older women specifically, risks may be increased due to existing health conditions like heart disease, diabetes, or obesity. A longer hospital stay may be required for proper monitoring and recovery in high-risk patients.
Longer-term adverse effects may also occur after hysterectomy:
- Incontinence
- Loss of sexual desire/arousal
- Bowel or bladder problems
- Early onset osteoporosis (if ovaries removed)
- Depression or changes in psychological health
Hysterectomy is permanent, so women lose all possibility of future pregnancy. For women undergoing oophorectomy, menopause symptoms may be challenging if hormone therapy is not taken.
Potential benefits of hysterectomy
Despite disadvantages, hysterectomy may significantly improve quality of life when gynecologic health conditions cannot be managed successfully with more conservative treatments. Benefits may include:
- Relief from severe, chronic pelvic pain
- Resolution of abnormal vaginal bleeding
- Cure for uterine cancer in early stages
- Prevention of some hormone-responsive cancers (with ovary removal)
- No more bothersome fibroid symptoms
- Correction of uterine prolapse
- No more endometriosis-related pain and cramping
For women with severe menstruation-related symptoms, hysterectomy may remove a substantial burden and allow them to enjoy life again.
Factors to consider in decision-making
Because hysterectomy is a major, personal choice, wise decision-making requires considering:
- The individual’s symptoms, health history, examinations, and test results
- Quality of remaining life if surgery is not performed
- Type of hysterectomy recommended and reason for recommendation
- Risk factors based on age, condition, hormones, etc.
- Likelihood of risks and complications from surgery
- Expected benefits of surgery for the condition
- Possibility of managing the condition with alternative treatments instead
- Personal views on preserving the uterus and ovaries
- Options for coping with surgical menopause if ovaries will be removed
- Potential psychological effects of surgery
Older women in particular must balance alleviation of current gynecologic problems with quality of life after surgery. Non-surgical options should be exhausted before opting for the permanence of hysterectomy. Each woman’s balance of factors will be unique.
Conclusion
In summary, there are a variety of gynecologic conditions that may prompt a 70 year old woman to consider hysterectomy. The surgery can resolve issues like fibroids, prolapse, endometriosis, and cancers when more conservative measures fail. However, there are also short and long-term risks to evaluate. Wise decision-making integrates the individual’s symptoms and circumstances with the best medical advice on treating her condition. Most importantly, the patient’s goals and values must guide the ultimate choice about whether hysterectomy is the right option or not. With a thoughtful decision process, women can have peace of mind that they made the choice that is in line with their priorities for health and quality of life.