What is a Hysterectomy?
A hysterectomy is a surgical procedure involving the complete or partial removal of the uterus. There are various reasons a person may elect to have this surgery, such as chronic pain, excessive menstrual bleeding, polyps, infection, urinary incontinence, or cancer. A hysterectomy removal surgery is the second most common surgery women receive. 1 in 3 women will have had a hysterectomy by age 60. Once a person has this surgery, they will no longer be able to become pregnant and they will stop having their menstrual cycle. Recovery from a hysterectomy is generally 4-6 weeks but is dependent on the type of hysterectomy surgery you have.
Why Do I Need a Hysterectomy?
There are several reasons a person might need a hysterectomy. Reasons include:
- Heavy or excessive bleeding during your menstrual cycle
- Chronic severe pain during your menstrual cycle that is unable to be managed by other treatments
- Uterine fibroids (non-cancerous tumors)
- Pelvic pain related to your uterus that is unable to be managed by other treatments
- Uterine prolapse that can lead to urinary incontinence or difficulties with bowel movements
- Cervical or uterine abnormalities that may lead to cancer
- Cervical or uterine cancer
- Issues with the uterine lining, such as hyperplasia, uterine polyps, endometriosis, or adenomyosis
What is a Hysterectomy?
There are 4 different types of hysterectomy surgeries, which include:
- Total hysterectomy. This procedure removes your uterus and cervix, but the ovaries remain.
- Supracervical hysterectomy. This procedure removes the upper part of your uterus but leaves the cervix.
- Total hysterectomy with bilateral salpingo-oophorectomy. This procedure removes the uterus, cervix, fallopian tubes, and ovaries. Removing the ovaries will begin menopausal symptoms.
- Radical hysterectomy with bilateral-salpingo-oophorectomy. This procedure removes the uterus, cervix, fallopian tubes, ovaries, the upper portion of the vagina and surrounding tissue and lymph nodes. This procedure is performed when cancer is present.
How Do I Prepare for a Hysterectomy?
Your doctor will consult with you about how to prepare for your hysterectomy and discuss any concerns you may have. Preparation may differ depending on the type of surgery and the purpose of the hysterectomy. General preparation steps include:
- Stop taking blood thinner medications and aspirin a week before surgery
- Avoid eating and drinking several hours before the surgery
- Stop smoking a few days prior to surgery
- Pack an overnight bag in case of a longer hospital stay
- Coordinate transportation to and from the hospital
Inform your doctor if:
- You have any allergies to medications or anesthesia
- You are taking any medications, vitamins, or supplements
- You might be pregnant
- You have asthma or sleep apnea
What Happens During a Hysterectomy?
During your hysterectomy, you will be under general or regional anesthesia. The procedure can last 1-3 hours. A hysterectomy can be performed in three different ways, including:
- Vaginal hysterectomy. This procedure removes the uterus through the vagina and does not require any external incisions or leave any visible scarring. It is the most recommended surgery technique for a hysterectomy.
- Abdominal hysterectomy. For this procedure, a surgeon removes the uterus through a small incision below the belly button. The recovery time is longer than a vaginal hysterectomy.
- Laparoscopic-assisted hysterectomy. This procedure uses a laparoscope (thin tube with a light and camera on the end of it) by inserting it through a small incision in the belly button. Once the uterus is located, it gets cut into tiny pieces and removed through other small incisions in the abdomen.
What Happens After a Hysterectomy?
The time you spend in the hospital after your surgery depends on the type of surgery you have. Following your surgery, your doctor will want to monitor you to make sure there are no complications, such as blood clots or bleeding. Generally, vaginal and laparoscopic hysterectomies do not require an overnight stay in the hospital. If you have an abdominal hysterectomy, you may stay a few days in the hospital to allow the doctor to monitor for complications. Your doctor will discuss post-operative care and any restrictions or concerns you may have.
Having a hysterectomy is a major surgery that involves life changes. Once you have had a hysterectomy, you will be unable to become pregnant and will no longer have a menstrual cycle. Additionally, if your ovaries are removed, you will also begin menopausal symptoms. If your ovaries remain, you may begin menopause sooner than if you still had your uterus. Many women who have hysterectomy surgery experience difficult emotions due to the major life changes the surgery brings. Make sure to consult with your healthcare provider if you notice emotional difficulties surrounding your surgery. There is an abundance of helpful resources, such as support groups, books, and mental health counseling available.
Recovery time and recovery instructions may differ depending on the type of hysterectomy surgery you had. The typical length of time one might stay in the hospital following surgery is 1-5 days. While in the hospital, your doctor will administer pain medication and monitor your vitals. It is important to get up and move around as soon as possible, to prevent blood clots.
If you have had a vaginal hysterectomy, doctors will remove the gauze used to absorb the bleeding in a few days. Once the gauze has been removed, wearing a menstrual pad can help absorb any remaining drainage. It is normal to experience some bloody or brownish drainage a few days after having the gauze removed.
Your doctor will encourage you to move around and walk as a part of your recovery. Keep in mind that there will be activities that you will want to avoid until fully recovered. Activities to avoid include:
- Lifting heavy objects
- Pushing and pulling objects, such as a vacuum cleaner
- Sexual intercourse
- Using tampons
If you have had a vaginal or laparoscopic hysterectomy, you should be able to return to most activities in 3-4 weeks. If you had an abdominal hysterectomy, recovery time is somewhat longer. You should be fully healed from your surgery within 6-8 weeks.
Side Effects and Complications
As with any surgery, there is potential for complications or side effects. Having a hysterectomy comes with potential side effects. These side effects include:
- Vaginal bleeding or spotting
- Difficulty urinating
- Digestive issues
- Damage to nerves or blood vessels surrounding the organs
- Delayed or prolonged healing
You may also begin having menopausal symptoms, which may include:
- Hot flashes
- Changes in libido (sex drive)
- Vaginal dryness
- Sleep disturbance
- Mood changes
Having a hysterectomy is generally a lower-risk surgery. However, about 5% of women do experience complications from surgery. Complications may include:
- Blood clots
- Delayed or prolonged healing
- Damage to the urinary tract
- Heavy bleeding or hemorrhaging
- Injuries to the gastrointestinal tract
- Breathing or cardiovascular complications due to the anesthesia
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