Hysterectomy: Overview

Undergoing a Hysterectomy

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A hysterectomy is the surgical removal of a woman’s uterus, commonly known as her "womb." While generally considered a very safe procedure, there are risks involved, and all women go through a recovery and healing process.

What Is a Hysterectomy?

A hysterectomy is a common surgery performed in adult women. It is usually a scheduled surgery performed as an inpatient procedure. Very rarely, a hysterectomy is performed as an emergency—often for complications related to childbirth.

During a hysterectomy, the surgeon will separate the uterus from the ligaments and tissue that hold it in place. The uterus is then removed through the vagina or through a six to eight-centimeter incision (cut) in the abdomen.

Besides the uterus, other nearby organs may also be removed during a hysterectomy, including:

The organs removed depend upon the reason for the surgery. For example, a woman who has cancer of the uterus usually has her ovaries and fallopian tubes also removed. On the other hand, a woman who has chronic bleeding problems may have only the uterus removed.

Definitions

  • Total Hysterectomy: When the cervix is removed along with the uterus
  • Supracervical/Partial Hysterectomy: When the cervix is left in place and only the uterus is removed
  • Bilateral Salpingo-Oophorectomy: When a woman's ovaries and fallopian tubes are removed

Once the surgeon has inspected the organ(s) and determined that the surgery is complete, any incisions are closed. Abdominal laparoscopic incisions (very small cuts) may be closed with absorbable sutures and sterile tape. A larger abdominal incision is often held closed with staples or sutures that are removed weeks later by the surgeon.

Various Surgical Approaches

When performing a hysterectomy, there are three different surgical approaches:

  • Vaginal: The uterus is removed through a woman's vagina
  • Abdominal: The uterus is removed through a large incision in the lower abdomen
  • Laparoscopic: The uterus is removed through multiple, tiny incisions in the lower abdomen using a laparoscope

The approach used depends on several factors, such as:

  • The reason why the surgery is being performed
  • Size, shape, and integrity of the woman's vagina and uterus
  • Surgeon training and experience
  • Whether the surgery is emergent or scheduled
  • Patient preference

Vaginal hysterectomy is generally the preferred approach while an abdominal hysterectomy is the least favorable approach. When compared to a vaginal or laparoscopic hysterectomy, an abdominal hysterectomy is associated with an increased risk of complications (e.g., infection and bleeding), as well as a longer hospital stay and recovery time. 

Contraindications

There are really no absolute contraindications to undergoing a hysterectomy, except for the fact that once a hysterectomy is performed, a woman will no longer menstruate and cannot become pregnant.

That said, there may be issues that end up being relative contraindications. For example, certain conditions may make a vaginal hysterectomy (the preferred approach) more challenging, such as: 

  • Previous cesarean section or prior abdominal surgery
  • History of an adnexal mass
  • Patients with a narrow pubic arch or poor vaginal descent

Purpose of Hysterectomy

A hysterectomy is usually performed to treat one of the below conditions: 

Once a woman has a hysterectomy, she will no longer be able to carry a child. Therefore, women in their childbearing years often attempt other less-invasive ways to treat their condition. In some instances though, as with cancer, a hysterectomy may be a woman's only treatment option.

How to Prepare

Preparing for your hysterectomy usually begins with meeting with your surgeon and anesthesia team about a week or so before your surgery.

During these appointments, the following issues will be discussed:

  • Your recovery time in the hospital
  • Potential complications
  • Your medications (which ones to continue and which ones to stop prior to surgery)
  • Instructions on what you can and cannot eat prior to surgery (and the timeline for that)
  • Arrival time for your surgery and what to wear and bring with you
  • Having a family member or friend to drive you home after your hospital stay
  • Lifestyle habits to adopt prior to your surgery (e.g., smoking cessation and daily exercise)

What to Expect on the Day of Surgery

Your hysterectomy will usually be performed under general anesthesia in the surgical ward of a hospital; although a laparoscopic hysterectomy may be performed in an outpatient surgical center.

On the day of your hysterectomy, you will be advised to wear comfortable clothes and arrive about two hours before your scheduled time.

You will also be asked to bring the following items:

  • Your insurance card
  • Your medications, including supplements, in their original bottle
  • A suitcase or bag that contains personal toiletries and clothes for leaving the hospital

Once you arrive at the hospital, you will change into a gown and relax in a preoperative room where a nurse will administer fluids and/or medications through a small needle in your arm. You will also see your surgeon and someone from the anesthesia team before going into the operating room.

Recovery

Recovery from a hysterectomy depends somewhat on the type of hysterectomy performed

While an abdominal hysterectomy generally requires a two to three-night overnight hospital stay, you may only stay one night (or even go home the same day) with a laparoscopic hysterectomy.

During your recovery, you will experience various symptoms, some of which may be temporary and last a few days to a week, like pain or constipation, and others that may last several weeks, such as vaginal bleeding and discharge.

In addition to providing you with guidance on how to best manage your symptoms, your doctor will also give you instructions on activity restrictions (e.g., sex, driving, going back to work, and more) and when to follow-up for your appointments.

Keep in mind—recovering from a hysterectomy is more than a physical process, it's also an emotional one. Women have different reactions after a hysterectomy.

Many are relieved that their symptoms are gone. Others mourn the loss of their fertility, or perhaps worry about their future, if the hysterectomy was performed to treat cancer. Symptoms of depression may also crop up during your recovery.

Long-Term Care

Undergoing a hysterectomy is a permanent decision that requires long-term care.

The long-term recovery for an abdominal hysterectomy is approximately four to six weeks. It's usually sooner for a vaginal hysterectomy and may be only a week for a laparoscopic hysterectomy. 

Even after a woman recovers physically from a hysterectomy, there are still follow-up appointments and in some cases, further procedures that need to be performed.

For example, if a woman underwent a hysterectomy for uterine cancer, she may require an additional surgery for staging purposes, like a pelvic lymph node dissection. If a woman had her ovaries removed, she will experience surgical menopause, which causes symptoms like:

Hormone replacement therapy may be recommended to ease these symptoms and also help prevent osteoporosis, which is a complication of menopause.

Other long-term lifestyle adjustments after a hysterectomy include:

  • Continuing cervical cancer screening (e.g., Pap smears and HPV tests) if your cervix remains
  • Keeping abreast of your overall health—seeing your primary care doctor for regular check-ups, eating nutritiously, maintaining a healthy weight, and exercising daily

Potential Risks

There are always potential risks associated with undergoing surgery, and a hysterectomy is no exception.

Possible, (although overall rare) complications that may arise from a hysterectomy include:

  • Infection (most common)
  • Blood clot
  • Injury to the bowel or bowel obstruction
  • Injury to an organ in the urinary tract, such as the bladder or ureter
  • Bleeding
  • Nerve injury
  • Vaginal cuff dehiscence (separation of the vagina incision or cut)
  • Fistula (when an abnormal tract forms between two tissues)

A Word From Verywell

If you are considering a hysterectomy, learning more about this type of surgery and its complex physical and emotional effects is a proactive, positive step.

For many women, their quality of life after a hysterectomy is improved. That said, deciding to undergo a hysterectomy is a personal decision—one that requires careful and thoughtful consideration.

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Article Sources
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