HYSTERECTOMY
Guide To: Surgery To Remove The Womb (Uterus)

Hysterectomies

should I have the operation?

Hysterectomies

Contents

What Is A Hysterectomy?
Are There Different Types Of Hysterectomies?
Why Is It Performed?
How Is It Performed?
How Long Does It Take To Recover After A Hysterectomy?
What Are The Risks Of The Surgery?
What Are The Side Effects Of Hysterectomies?
How Can I Avoid An Unnecessary Hysterectomy?
What Are The Alternatives?
Do I Still Need To Have Pap Tests?


Guide To Hysterectomy

How Procedure Is Performed
Side Effects
Complications
Recovery Timeline
Alternatives To Hysterectomy

What Is A Hysterectomy?

It is a surgery to remove a woman's womb (uterus). The uterus is where a baby grows during pregnancy. When it is removed a woman can no longer become pregnant and her menstrual periods stop. About 600,000 hysterectomies are performed every year in the United States (75,000 in the UK), making it the second most frequently performed surgery (after cesarean sections). In fact it is estimated that nearly one in three American women will have their womb removed by the time they reach the age of 60. The frequency at which the operation is performed has lead to considerable debate and there is growing concern that many hysterectomies performed are in fact unjustified. One recent large-scale study found that 15 percent may be unnecessary. For this reason, if you have been recommended a hysterectomy, it is always worth getting a second opinion. Research also shows that the age of your practitioner influences your chance of being recommended the surgery. Women are less likely to be told they need surgery if their gynecologist (he if she) is recently trained, than if he (tends to be male) is older and in practice longer.

Are There Different Types Of Hysterectomies?

Yes, although all surgeries involve the removal of the uterus. The different types are:
Complete or total hysterectomy: The uterus plus the cervix (opening to the vagina) is removed. This is the most common procedure.

partial, subtotal hysterectomy
Supracervical Hysterectomy

Supracervical (also called partial or subtotal) hysterectomy: Just the uterus is removed. Women who have never had an abnormal Pap test result may be candidates for this procedure as it indicates the cervix is healthy. Some doctors think this procedure is less likely to cause sexual complications later.
Radical hysterectomy: The uterus, cervix and surrounding tissues are removed. This may be necessary with certain types of female cancers.
Hysterectomy with removal or fallopian tubes and ovaries: Removal of the fallopian tubes is called a salpingectomy and removal of the ovaries is called an oophorectomy. A salpingectomy or oophorectomy can be performed alone, or with the removal of the uterus. There are two fallopian tubes and two ovaries - if just one tube or one ovary is removed, it is a unilateral procedure; if both are removed it is called a bilateral operation. Women who have both ovaries removed immediately enter premature menopause (hysterectomy induced menopause).

Why Is It Performed?

The top 3 reasons are:
1. Uterine fibroids (30 percent are performed for this reason).
2. Endometriosis (20 percent).
3. Abnormal or heavy vaginal bleeding that has no identifiable cause (20 percent).
Other reasons include:
4. Uterine prolapse (dropped womb).
5. Chronic pelvic pain, caused by conditions such as pelvic inflammatory disease (PID), and pelvic adhesions.
6. Gynecologic cancers such as cervical cancer, ovarian cancer or endometrial cancer.

How Is It Performed?

The hysterectomy procedure can be performed using a number of different methods. But basically all methods involve removing the womb either through the tummy or through the vagina. The choice of procedure will depend on your overall health, what you need to have removed and your surgeon's individual preference and experience.
Abdominal Hysterectomy: An incision about 5 to 7 inches across is made just above the pubic hair and the uterus is removed.
Vaginal Hysterectomy: A cut is made at the top of the vagina near the cervix, thorough which the uterus is taken out.
Laparoscopic Hysterectomy: 3 or 4 small cuts are made in the tummy. The surgeon inserts a small thin lighted tube with a camera on the end (laparoscope) through the incisions. He then cuts the womb into small pieces and removes them through the incisions.
Laparoscopically Assisted Vaginal Hysterectomy (LAVH): The laparoscope is used to guide the surgeon through the vagina to remove the uterus this way.
Robotic-Assisted Surgery: In a robotic assisted hysterectomy the surgeon uses a special machine (robot) to perform the surgery. The surgery procedure itself is similar to the laparoscopic hysterectomy - however the surgeon sits at a computer manipulating special wristed surgical instruments to help them overcome the limits of the human hand. Meanwhile the patient is lying on the operating table and a robotic device with arms actually carries out the surgery, directed by the surgeon from his computer. This method is usually performed if the woman has cancer or is very obese and vaginal surgery is not considered safe. One such surgery is called the da Vinci surgery or da Vinci hysterectomy.

How Long Does It Take To Recover After A Hysterectomy?

Hysterectomy recovery: Most women stay in hospital for 1 to 3 days for a vaginal procedure and up to 5 days for an abdominal operation. The stay can be longer for women recovering from cancer-related surgery. There may be some soreness around the tummy if you had an abdominal hysterectomy. You should be up and walking around by day 3, and gradually over 3 to 4 weeks you can resume normal activities like driving, exercising and working. The recovery is usually slightly faster after a vaginal hysterectomy. Most doctors advise waiting 6-8 weeks before resuming sexual activities.

What Are The Risks Of The Surgery?

Hysterectomy complications: Although a hysterectomy is considered a safe operation, it is still a major surgery and as such carries risks. These include:
• Injury to nearby organs such as the urinary tract, bladder, bowels, rectum and veins.
• Blood clots in the lungs or legs, which can be fatal.
• Infections. Nearly 40 percent of patients have post-operative infections, most can be cured with antibiotics.
• Heavy bleeding possibly requiring a transfusion (15 percent of cases).
• Reactions to the anesthesia.
• Slight fever after surgery.

When To Call The Doctor
After surgery if you experience:
• A fever of 100 F or higher, or if you have a fever which does not go away after 2 or 3 days.
• Bright red or heavy vaginal bleeding.
• Foul smelling vaginal discharge.
• Swelling or soreness in the legs.
• Breathing difficulties, coughing or chest pain.

What Are The Side Effects Of Hysterectomies?

Hysterectomy side effects: All women who undergo the procedure will:
• No longer have periods.
• No longer be able to have children.
If the ovaries are removed they will enter menopause. For reasons as yet still not understood, some women still enter premature menopause, even if their ovaries have been left intact. This can result in menopause symptoms such as:
Hot flashes - even if the ovaries have not been removed.
• Painful sexual intercourse.
Vaginal dryness (vaginal atrophy).
Low libido or loss of interest in sexual intercourse.
Heart disease in women who have had both ovaries removed is higher, unless they immediately start estrogen replacement therapy (ERT). The benefits of starting ERT if only one ovary is removed are less clear.
• Weight gain, although this is probably because the patient is less active in the post-operative recovery period. See also, weight gain and menopause.

How Can I Avoid An Unnecessary Hysterectomy?

By playing an active role in the decision process and questioning the wisdom of your doctor's verdict. If you have been advised by your doctor to undergo this surgery, it is important to ask him to discuss alternative options as well. You need to be sure they have been fully explored. If he still recommends surgery, be sure to fully discuss the possible side effects. Also if an abdominal procedure is suggested, ask why you cannot have a vaginal hysterectomy. A vaginal surgery is always preferred because it leaves no visible scar and the healing time is faster. It may not be possible if you have large fibroids which need removing. If the surgeon says you need to have both your ovaries removed, ask why and is it not possible to preserve at least one (this is important if you still wish to have children). If you are not satisfied with the answers, seek a second opinion. Your health insurance company may require this anyway.

What Are The Alternatives?

There are some clear-cut cases where a hysterectomy is definitely necessary, for example where a woman has invasive cancer or as a last resort for severe infections. In other instances the case is less clear cut, for example in the instance of large fibroids which are pressuring down on nearby organs and have not responded to hormone therapy. Or where endometriosis symptoms are severe and disabling. These are non-life threatening conditions may still be controlled by alternatives to hysterectomy (such as uterine artery embolization, endometrial ablation or hormone therapy) until you reach menopause - at which point most of these conditions clear on their own. This is particularly important for premenopausal women who still hope to have children. A hysterectomy should never be undertaken for ovarian cysts, irregular periods, menstrual cramps, uterine polyps or pelvic pain until all lower-risk alternatives have been exhausted.

Do I Still Need To Have Pap Tests?

No, not if your cervix was removed. However you should still have a regular pelvic exam and mammogram to test for breast cancer. If the cervix was not removed or your hysterectomy was for cancer, you will need to keep having your regular Pap tests. For more health questions on this and other topics see, female health questions.

  Other Useful Guides

Most Recommended Health Screenings For Women: List for all ages.
The Female Body Explained: How it works, visual guide with pictures.
Head And Face Conditions: How hysterectomies affect this area.
Abdominal Pains And Cramps: From sharp pain to persistent cramps.
Female Reproductive Disorders: Comparing gynecological symptoms.

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