A hysterectomy is a surgical procedure that removes the uterus. You lose the ability to become pregnant and no longer menstruate. Reasons for this surgery include abnormal bleeding, uterine prolapse, fibroids and cancer. Recovery usually takes four to six weeks, depending on the type of surgery you have.
What is a hysterectomy?
A hysterectomy is the surgical removal of the uterus, most likely the cervix. Depending on the reason for the surgery, a hysterectomy may involve the removal of surrounding organs and tissues, such as the fallopian tubes and ovaries. The uterus is where the baby grows during pregnancy. The endothelium is the blood you shed during menstruation. You lose the ability to get pregnant and won’t get your period after a hysterectomy.
What are the different types of hysterectomy?
Your health care provider will discuss the type of hysterectomy needed, depending on your condition. This will determine if the fallopian tubes and/or ovaries need to be removed.
1. Total hysterectomy: removal of the uterus and cervix while leaving the ovaries.
supracervical hysterectomy: removal of only the upper portion of the uterus, leaving the cervix.
2. Complete hysterectomy with bilateral salpingo-oophorectomy: removal of the uterus, cervix, fallopian tubes (salpingectomy) and ovaries (oophorectomy). If you haven’t experienced menopause, having your ovaries removed will trigger menopausal symptoms.
3. Radical hysterectomy with bilateral salpingo-oophorectomy: removal of the uterus, cervix, fallopian tubes, ovaries, upper part of the vagina, some surrounding tissues and lymph nodes. This type of hysterectomy is done when you have cancer.
Why is a hysterectomy performed?
Health care providers perform hysterectomies to treat:
>> Abnormal or severe vaginal bleeding that cannot be controlled by other treatment methods.
>> Severe menstrual pain that is not controlled by other treatment methods
>> Leiomyomas or uterine fibroids (noncancerous tumors).
Increased pelvic pain associated with the uterus but not controlled by other treatments.
>> Uterine prolapse (a uterus that has “fallen” into the vaginal canal due to weak support muscles) that can lead to urinary incontinence or difficulty having a bowel movement.
>> Cervical cancer, uterine cancer, or abnormalities that may lead to cancer, to prevent cancer.
> Conditions associated with endometriosis such as hyperplasia, recurrent uterine polyps, or adenomyosis.
Risks of Hysterectomy
Most people who get a hysterectomy have no serious problems or complications from the surgery. Still, a hysterectomy is major surgery and is not without risks. Those complications include:
>> Urinary incontinence
>> Vaginal prolapse (part of the vagina coming out of the body)
>> Vaginal fistula formation (an abnormal connection that forms between the vagina and bladder or rectum)
>> Chronic pain
Other risks from hysterectomy include wound infections, blood clots, hemorrhage, and injury to surrounding organs, although these are uncommon.
How do I prepare for a hysterectomy?
Your health care provider will explain the procedure in detail, including possible complications and side effects. Talk to them about any concerns you have. You may be asked to provide blood and urine samples.
What happens during a hysterectomy?
Your health care provider will determine the type of hysterectomy you need and the best surgical method to perform the procedure. You’ll wear a hospital gown and strap it to monitors that track your heart rate. An intravenous (IV) line is placed into a vein in your arm to deliver medications and fluids.
The anesthesiologist will give you either:
general anesthesia in which you will not be awake during the procedure; or
Regional anesthesia (also called epidural or spinal anesthesia) is where medications are placed near nerves in your lower back to “block” pain while you’re awake.
There are several different surgical techniques your health care provider may use to perform a hysterectomy:
Vaginal hysterectomy:
The hysterectomy is done through an incision in the upper part of the vagina. There is no external incision.
Dissolving sutures are placed inside the vagina.
It is most commonly used for uterine prolapse and other non-malignant (or non-cancerous) conditions.
Less complications and faster recovery (up to four weeks) is the preferred method.
Patients often return home the same day of surgery.
Laparoscopic hysterectomy:
A laparoscope (a thin tube with a video camera on the end) is inserted into the lower abdomen through a small incision in the belly button.
Surgical instruments are inserted through several other small incisions.
The uterus can be removed in small pieces through incisions in the abdomen or through the vagina.
Some people go home the same day or after one night in the hospital.
Complete recovery is shorter and less painful than an abdominal hysterectomy.
Robot-assisted laparoscopic hysterectomy:
The surgeon performs the procedure with the help of a robotic machine.
A laparoscope is inserted into the abdomen so that the pelvic area can be seen.
Small, thin surgical instruments are inserted through three to five incisions around the navel. The robotic arms and instruments are controlled by the surgeon.
Recovery is similar to a laparoscopic hysterectomy.
Abdominal hysterectomy:
The uterus is removed through a six- to eight-inch incision in the abdomen.
The incision is made either from your belly button to your pubic bone, or across the top of your general hairline. The surgeon will use stitches or staples to close the incision.
Most common when you have cancer, when your uterus is enlarged, or when the disease has spread to other areas of your pelvis.
It generally requires a longer hospital stay (two or three days) and a longer recovery time.
How long does a hysterectomy take?
The process takes one to three hours. The time can vary depending on the size of the uterus, the need to remove scars from previous surgeries, and whether other tissues, such as endometrial tissue, and other organs are removed along with the uterus (such as fallopian tubes or ovaries).
What to Expect After Hysterectomy
After a hysterectomy, if the ovaries were also removed, you’ll be in menopause. If the ovaries were not removed, you may enter menopause at an earlier age than you would have otherwise.
Most people are told to abstain from sex and avoid lifting heavy objects for six weeks after hysterectomy.
After a hysterectomy, most people surveyed say they feel the operation succeeded at improving or curing their main problem (for example, pain or heavy periods).
If your ovaries were removed at the time of your hysterectomy, you may experience menopausal symptoms such as:
Hot flashes.
Vaginal dryness.
Loss of libido.
Difficulty sleeping (insomnia).
How long does it take to recover from a hysterectomy?
Most people recover from a hysterectomy in about four to six weeks. Your recovery depends on the type of hysterectomy you had and how the surgery was performed. Recovering from a vaginal and laparoscopic hysterectomy takes less time than recovering from an abdominal hysterectomy.
You should increase your activity gradually and pay attention to how you feel. If anything causes you pain, you should stop. Talk to your healthcare provider about specific instructions for recovering at home, including what medications to take.