Life without a uterus

The womb (uterus in medical terms) is a key organ that defines women and their reproductive potential. It’s a dynamic organ that responds in a predictable manner to female hormones produced by the ovaries. As soon as reproductive maturity is achieved, the uterus always keeps itself ready in anticipation for a potential pregnancy.

If conception fails to occur, the lining of the uterus is shed away as the monthly period. In the event of a pregnancy, uterine function changes to an environment that can support the pregnancy. The monthly periods are thus postponed till after the baby is born. This cycle of events continues till the menopause, but can also be interrupted by disease processes or hysterectomy (surgical removal of the uterus).

Hysterectomy is a major surgical procedure, and has irreversible reproductive implications. Thus a decision to have one done should not be taken lightly, especially in young women in whom child-bearing is incomplete. Contemporary Gynecological practice has revolutionized treatment options for various conditions. Thus the majority of women with bleeding problems, fibroids, pelvic pain or even pregnancy related complications can be managed conservatively without resorting to a hysterectomy. Hysterectomy however still has a role in conditions like: life-threatening bleeding (where other measures have failed); cancer of the uterus and ovaries; or if conservative options for other conditions are unsatisfactory.

Women should confidently ask several questions if a hysterectomy is advised. They should be told what complications may happen, the cost, alternative treatment options (including doing nothing), and what the benefits of the hysterectomy would be. If any of the answers are unclear, a second opinion should always be sought.

Women who have had a hysterectomy don’t look any different. No one can tell that a physically normal looking woman has no uterus. A woman without a uterus will not have monthly periods and will also not need any contraception. Pap smears would no longer be needed if the cervix was also removed. Sex life is not significantly affected. But the menopause may come earlier.

Even though very rare, there is medical documentation of women becoming pregnant without a uterus! This is akin to having an ectopic pregnancy, the pregnancy in this case settling inside the abdomen. Rarely, some women are born without a uterus. This may happen for various reasons, sometimes only becoming evident when periods do not commence at puberty.

Such women are unable to carry their own pregnancies. Women without a uterus can ‘rent’ one from a friend or relative, who can then carry a pregnancy for them (called surrogacy). There has been a recent successful uterine transplantation, where a mother donated her uterus to her daughter. It remains to be seen if the transplanted uterus will carry a pregnancy.