Hysterectomy

Topic Overview

What is a hysterectomy?

A hysterectomy is surgery to take out your uterus. This is the organ in your lower belly where a fetus grows during pregnancy. After a hysterectomy, you won't be able to get pregnant.

Other organs might also be removed if you have severe problems such as endometriosis or cancer. These organs include the cervix, ovaries, and fallopian tubes.

Why is it done?

A hysterectomy is done to treat problems with the uterus, such as pain and heavy bleeding caused by endometriosis or uterine fibroids. It may be done to treat cancer in the uterus, cervix, or ovaries. Some people choose to have it to treat non-cancerous reproductive system conditions or as part of a gender-affirming surgery.

How is it done?

There are many different ways to do hysterectomy surgery. The most common procedures are:

Abdominal hysterectomy.

In this procedure, the doctor makes a cut in your belly. The doctor takes out the uterus through this cut.

Vaginal hysterectomy.

The doctor takes out the uterus through your vagina. The doctor makes a small cut in the vagina instead of the belly.

Laparoscopic hysterectomy.

The doctor puts a lighted tube (laparoscope) through small cuts in your belly. The doctor can see your organs with the scope. The doctor can insert surgical tools to remove the uterus through the belly or the vagina.

What can you expect as you recover from a hysterectomy?

You might go home the day of your hysterectomy or stay in the hospital for several days. Recovery can take 4 to 6 weeks. It depends on which type of surgery you have and your overall health. You will have to take it easy for a few weeks and avoid heavy lifting.

Why It Is Done

Most often, a hysterectomy is done to treat problems with the uterus. These problems include pain and heavy bleeding caused by endometriosis or uterine fibroids. The surgery may also be needed if there is cancer in the uterus, cervix, or ovaries. And it may be done as life-saving surgery if there is heavy bleeding during childbirth that can't be stopped.

In most cases, hysterectomy is an elective surgery. You can choose to have it to treat non-cancerous female reproductive system conditions that haven't improved with medical treatment. If you don't plan to get pregnant and have tried other treatment options without success, it may be a reasonable treatment choice.

Other reasons for hysterectomy include:

• Heavy menstrual bleeding.
• Pelvic organ prolapse.
• Adenomyosis.
• Chronic pelvic pain. (But surgery is done only when the pain is caused by a diagnosed condition that can be corrected with a hysterectomy.)
• A severe infection of the uterus.
• Gender-affirming surgery.

Sometimes there is a health reason to have your ovaries removed. Maybe you have a tumour on an ovary or are at high risk for breast or ovarian cancer. You may be able to choose whether to have one, both, or part of your ovaries removed based on what you prefer and your condition.

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Hysterectomy Types

There are three major types of hysterectomy. Which type you have will depend on the reason for the surgery. Your doctor will consider the size and position of your uterus and your overall health.

Total hysterectomy

This is surgery to remove the uterus and the cervix. The cervix is the lower "neck" of the uterus that opens into the vagina.

Supracervical hysterectomy

This surgery removes the uterus, but it leaves the cervix in place. It's also known as a subtotal or partial hysterectomy.

Radical hysterectomy

This removes the uterus, the cervix, part of the vagina, and some tissues around these organs. The ovaries, fallopian tubes, and nearby lymph nodes may also be removed. It may be done to treat endometriosis or cancer of the uterus, ovaries, or cervix.

Comparison of Hysterectomy Procedures

There are many ways to do the surgery. The type you have may depend on:

• Your past health.
• Other surgeries you've had.
• The size and position of your uterus.
• Your overall health.

Talk with your doctor about which type is right for you.

Abdominal surgery

This is done through a cut that the doctor makes in the lower belly. The cut is called an incision. The doctor takes out the uterus through this cut.

Vaginal surgery

This is done through the vagina. The doctor makes a small cut in the vagina. The uterus is removed through this cut.

Laparoscopic surgery

The doctor puts a lighted tube (laparoscope) through small cuts in the belly. The doctor can see your organs with the scope. The doctor inserts tools to cut the tissue that holds your uterus in place. Then the uterus is removed. It may be removed through small cuts in the belly or through the vagina.

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Risks of Hysterectomy

Hysterectomy poses some risks of major and minor complications. But most people don't have these problems after the surgery.

Your risk of problems after surgery may be higher or lower than average. This may depend in part on your overall health and how experienced the surgeon is.

Complications after the surgery include:

• Heavy blood loss.
• Bladder or bowel injury.
• Blood clot to the lung.
• Infection.

Possible ongoing problems include:

• Trouble urinating. This is more common after removal of lymph nodes, ovaries, and structures that support the uterus (radical hysterectomy).
• Weakness of the pelvic muscles and ligaments that support the vagina, bladder, and rectum.
• Early menopause if your ovaries are removed.
• Scar tissue (adhesions) in the pelvic area.

When to Call

After a hysterectomy, call your doctor or go to the emergency room if:

• You have bright red vaginal bleeding that soaks one or more pads in an hour, or you have large clots.
• You have foul-smelling discharge from your vagina.
• You are sick to your stomach or cannot keep fluids down.
• You have signs of infection, such as:
  • Increased pain, swelling, warmth, or redness.
  • Red streaks leading from the incision.
  • Pus draining from the incision.
  • A fever.
• You have pain that does not get better after you take pain medicine.
• You have loose stitches, or your incision comes open.
• You have signs of a blood clot, such as:
  • Pain in your calf, back of the knee, thigh, or groin.
  • Redness and swelling in your leg or groin.
• You have trouble passing urine or stool, especially if you have pain or swelling in your lower belly.
• You have hot flashes, sweating, flushing, or a fast or pounding heartbeat.

Your doctor will give you specific instructions after your hysterectomy. Be sure to follow them. Usually, getting some rest and following those instructions will help post-surgery problems diminish over time.

Recovery

You might go home the day of your hysterectomy or stay in the hospital for several days. Recovery can take 4 to 6 weeks. It depends on which type of surgery you have and your overall health. You won't be able to do any heavy lifting. And you will have to take it easy for a few weeks. It's common to feel more tired than usual.

After surgery, you will no longer have periods. You won't be able to get pregnant. If there's a chance that you will want to get pregnant in the future, talk to your doctor about other treatment options.

Most people can have sex without problems after they recover from surgery. But if you have your ovaries removed, you may have vaginal dryness after the surgery. It can make sex less comfortable. A vaginal lubricant, such as Astroglide or K-Y Jelly, or vaginal estrogen can help.

Your doctor will likely recommend taking hormones after your surgery if your ovaries are removed and you haven't gone through menopause. Taking out the ovaries before menopause causes a sudden drop in the hormone estrogen. This can cause menopause symptoms and raises the risk of having more fragile bones. Hormone therapy eases menopause symptoms and lowers the risk of bone loss. But it can raise the risk of some other problems. For most people, the benefits of taking hormones outweigh the risks. Talk with your doctor about the benefits and risks for you.