Question: My gynaecologist wants to try a microwave endometrial ablation before he does a hysterectomy in order to control my heavy painful periods. What do you think about this operation?
In the last few years, doctors have tried a range of new procedures to preserve the uterus and prevent the symptoms being suffered by the woman without resorting to a hysterectomy. One of the more recent, and most successful, is the ptocedure (it isn’t really an operation as nothing is cut) known as microwave endometrial ablation (MEA).
The reason for heavy painful periods is excessive production of the lining inside the uterus (the endometrium) which is shed with every period, and comes away with some bleeding and spasms (cramps) of the muscle that forms the uterus. The procedure involves a brief general anesthetic for ten to fifteen minutes. A thin probe is introduced through the vagina and cervix into the uterus. The probe contains a microwave generator that is carefully calibrated to produce just the right amount of energy to destroy the endometrium (lining of the uterus) without damaging the wall of the uterus or surrounding organs. The probe is turned on for a few minutes and gently moved around inside the uterus to destroy all the endometrium.
MEA is normally carried out as a day surgery procedure, and the woman can go home a few hours later. There are normally some bad period-like uterine cramps for a few days, and a bloody discharge for two or three weeks, but after that, 90% of women have no periods at all, and can therefore avoid a hysterectomy.
The worst outcome is that the procedure fails and a hysterectomy is eventually necessary, but if it works, a simple procedure has replaced significant surgery. You should probably give it a try.

Question: Ten years ago I had a hysterectomy for fibroids, and my ovaries were removed. Do I need to have a Pap smear?
When a Pap smear is performed, the area examined is the cervix, and the test is primarily performed in order to find cancer of the cervix at an early stage. The cervix sits at the top of the vagina, and is the rubbery piece of tissue that forms the opening into the uterus (womb).
In a hysterectomy, the uterus and cervix are removed, but the vagina is left behind. After a hysterectomy, there is nothing left behind to perform a Pap smear on; you therefore do not require an annual trip to the doctor for this test. The one exception to this rule is those women who have had a hysterectomy because of cancer. There is a very slight risk that the cancer can spread to the top of the vagina, and so vaginal vault smears should be performed regularly in these women.
The Pap smear test is one that should be performed on all women who have ever been sexually active. A test every two years is ideal, but if there have been abnormal tests of some sort, this may be reduced to 6 or 12 months. Many other conditions other than cancer can be detected by a Pap smear. These include infections, abnormal discharges, erosions of the cervix and ulcers.

Question: I am due to have a hysterectomy because of fibroids. I want to keep my cervix, which is perfectly normal, but my gynecologist is reluctant to do this. If I have a regular Pap smear, why shouldn’t I have a sub-total hysterectomy and keep my cervix?
A sub-total hysterectomy in which the body of the uterus (the womb) is removed, but the neck of the uterus (the cervix) and the ovaries are retained is certainly an option, but it is not one that is commonly preferred.
The advantage is that you continue to have a cervix, which some experts claim is important for the full sexual satisfaction of the woman. The disadvantages are that the operation is technically more difficult, and more prone to complications, as the thick muscle of the neck of the womb must be cut through and secured, instead of the thin tissue at the top of the vagina. Your gynecologist will certainly be more experienced at doing a full hysterectomy than a partial one. As you mention, you also have the continued risk of cancer of the cervix, which can be detected early by a regular Pap smear.
My advice would be to have a full removal of your uterus and cervix (retaining one or both ovaries).