What Patients Should Know About Hysterectomies

A surgeon may recommend a hysterectomy for various conditions including uterine fibroids that cause pain or heavy bleeding, unusual or heavy vaginal bleeding, uterine prolapse, endometriosis, or uterine, cervical, ovarian, or endometrial cancer.

A hysterectomy is major surgery. There may be other treatments for some of these conditions, so it is important to talk to your doctor about treatment options.

The type of hysterectomy the surgeon recommends depends on the underlying condition. A total hysterectomy removes the uterus and the cervix but not the ovaries.

In a supracervical hysterectomy, the upper part of the uterus is removed, leaving the cervix. Sometimes, a hysterectomy removes the uterus, cervix, ovaries, and fallopian tubes. In some women with cancer, the surgeon removes the surrounding tissue and lymph nodes.

Surgeons may also use a variety of methods to perform a hysterectomy. In a vaginal hysterectomy, the surgeon removes the uterus through a small cut in the vagina.

In a laparoscopic hysterectomy, the surgeon uses a thin tube with a small camera on the end and special surgical tools to remove the uterus through small cuts in the abdomen or vagina. A robotic hysterectomy is similar to a laparoscopic one, but the surgeon uses a robotic arm to remove the uterus.

Surgeons prefer vaginal or laparoscopic hysterectomies, but abdominal hysterectomies are sometimes necessary.

If the size and shape of the pelvis, uterus, or vagina make the vaginal method difficult, or if the disease has spread beyond the uterus, the surgeon may have to make a large abdominal incision to remove all of the necessary tissue.

In some cases, the patient has alternatives to a hysterectomy. For example, uterine fibroids often shrink after menopause, so some doctors suggest waiting to see if symptoms improve over time.

Exercises to strengthen the pelvic floor or a special band inserted into the vagina can effectively treat uterine prolapse, and some medications can relieve the symptoms of endometriosis. Because hysterectomies are major surgery, some doctors and patients prefer to try alternative treatments first.

In addition to alternatives to surgery, there are other surgical options to consider as well. Laparoscopic surgery to remove scar tissue and other growths can bring relief to people with endometriosis, and a dilation and curettage (commonly called a D&C) removes the lining of the uterus and can remove non-cancerous growths or polyps.

Another option is endometrial ablation, which uses heat, cold, or microwaves to destroy the uterine lining. There are a few options for fibroids, too, surgically removing or shrinking them without removing the whole uterus.

One of the critical things to consider is that a woman cannot get pregnant after having a hysterectomy. Because the uterus is removed, women also stop having periods, but if the ovaries remain intact, they will not experience symptoms of menopause right away.

If the ovaries are removed during the procedure, menopause symptoms will likely appear immediately, and the sudden drop in hormones may cause these symptoms to be more severe than had they developed naturally.

For some people, having a hysterectomy dramatically improves their quality of life, especially if the person experienced constant pain, heavy and irregular bleeding, or is at high risk for certain types of cancers.

However, the side effects of a hysterectomy are permanent and they come with risks. Depending on the type of surgery, recovery can take a long time.

All surgeries have risks, and hysterectomies are no exception. During surgery, bleeding and nerve damage may occur, as well as bowel or bladder injuries. If the surgery uncovers unexpected masses or adhesions or if excessive bleeding occurs, the surgeon may need to convert a laparoscopic procedure into an abdominal hysterectomy.

After-surgery complications include infections, bowel obstruction, and damage to the uterine vessels and ligaments.

Recovery from a laparoscopic hysterectomy usually takes about four weeks, but abdominal hysterectomy recovery can take as many as six. Light vaginal bleeding is common for a month or so.

The patient is not permitted to drive for two weeks after surgery or until they're no longer taking prescription pain medication. They must refrain from sexual intercourse and lifting anything greater than ten pounds for six weeks.

Most people can return to work between three and six weeks post-op and restart exercising in four to six weeks.