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What Is a Hysterectomy?
A hysterectomy is a surgical operation to remove the uterus, which is the hollow, pear-shaped organ in the lower abdomen where a fetus develops and grows. A hysterectomy is usually performed to treat a health condition when other therapies — such as medication, hormone treatments, or less-invasive surgical procedures — have been unsuccessful in completely alleviating symptoms like bleeding and pain.
In some cases a hysterectomy may be necessary to save a person’s life (for example, to stop life-threatening bleeding after the birth of a baby) or to help prevent the spread of certain gynecological cancers.
There are three types of hysterectomy, and they each remove different parts of the reproductive system.
- Total Hysterectomy This is the removal of the entire uterus, including the cervix (the lower narrower portion of the uterus).
- Supracervical (aka Subtotal or Partial) Hysterectomy This is the removal of the upper part of the uterus. The cervix is left in place.
- Radical Hysterectomy This is a total hysterectomy that also involves removing surrounding tissues around the uterus, called the parametrium. This procedure is usually reserved for cases where cancer is present.
During these procedures, one or both of the ovaries may also be removed, which is known as an oophorectomy. The surgical removal of the fallopian tubes is called a salpingectomy. When both are removed, it’s called a salpingo-oophorectomy.
There are several medical reasons why a woman would consider having her uterus removed. It’s typically done as an elective surgery rather than a life-saving one.
Uterine Fibroids
Fibroids are benign (noncancerous) tumors that grow in the wall of the uterus. They can be as small as an apple seed or as large as a grapefruit.
Fibroids don’t always cause symptoms. When they do, they can cause heavy menstrual bleeding, prolonged menstrual periods (lasting more than a week), pelvic pain, lower back pain, or painful intercourse. While symptoms often respond to medication or nonsurgical treatment, sometimes the symptoms are severe enough to warrant hysterectomy, which is the only permanent solution for uterine fibroids.
Endometriosis
Endometriosis is a disease in which the uterine lining grows outside of the uterus, causing painful menstrual cramps, chronic pain in the lower back and pelvis, intestinal pain, bleeding or spotting between periods, and infertility. Most often endometriosis is found on the ovaries, fallopian tubes, and the peritoneum (pelvic sidewall).
Hormone therapy, pain medication, and minimally invasive procedures may be performed to treat this condition. But when those options fail to keep the disease at bay, a hysterectomy may be performed.
Pelvic Organ Prolapse
Pregnancy, childbirth, and aging can weaken or stretch a person’s pelvic supporting tissues and ligaments. In some cases, the uterus can lower or sag into the vagina. Women with this condition may experience pelvic pressure, urinary incontinence, or difficulty making a bowel movement. Hysterectomy may be recommended for this condition.
Abnormal Uterine Bleeding
Heavy bleeding during your period is one example of abnormal uterine bleeding. Other instances include bleeding and spotting between periods, bleeding or spotting after sex, menstrual cycles that last longer than 38 days or shorter than 24 days, and bleeding after menopause.
Benign growths in the uterus — either polyps or fibroids — are common causes of abnormal uterine bleeding. Medication and surgical procedures like endometrial ablation or uterine artery embolization are common treatments, but a person may opt for a hysterectomy as a solution.
Chronic Pelvic Pain
Chronic pelvic pain typically lasts six months or longer. Most chronic pelvic pain can be attributed to endometriosis. Other conditions that can lead to chronic pelvic pain include fibroids, ovarian cysts, irritable bowel syndrome, and interstitial cystitis (painful bladder syndrome).
Depending on the condition, treatment for pelvic pain can include medication, physical therapy, biofeedback, or minimally invasive procedures like trigger point injections or peripheral nerve blocks. As a last resort, hysterectomy may be suggested for chronic pelvic pain that hasn’t responded to any other treatment.
Adenomyosis
Adenomyosis is a condition in which the tissue that lines the uterus grows inside the walls of the uterus, where it doesn’t belong. The displaced tissue continues to act normally — thickening, breaking down, and bleeding — during each menstrual cycle. The condition sometimes results in an enlarged uterus and painful, heavy periods. This usually resolves after menopause. Doctors treat it the same way they treat endometriosis, and hysterectomy may be recommended.
Gynecologic Cancers
Hysterectomies are routinely performed to treat gynecologic cancer. Hysterectomy is the main treatment for endometrial cancer, which is the most common type. Physicians consider the surgery the best treatment option in many cases.
Treatment for ovarian cancer usually involves a combination of surgery and chemotherapy. The surgery may involve hysterectomy, especially if the cancer is advanced. Hysterectomy is also a common treatment for invasive cervical cancers.
There are several approaches to the surgery, and the type of procedure your doctor will perform will often depend on your particular medical situation. Each option involves unique risks and benefits, and recovery time can vary for the different methods.
Abdominal Hysterectomy
This type of surgery removes the uterus through a cut in the abdomen, which is known as an open procedure. It typically involves a hospital stay of (at most) two to three nights. Full abdominal surgery may be recommended over less-invasive options if you have an enlarged uterus, large fibroids, endometriosis, or cancer or if you need your ovaries and fallopian tubes removed.
Vaginal Hysterectomy
In this procedure, the uterus is removed through the vagina, so no abdominal incision is made. Vaginal hysterectomy generally involves the least postsurgery pain and leaves no visible scarring. It’s typically the preferred method for treating uterine prolapse (when the uterus falls down into the vagina due to weakened muscles and other pelvic tissues). But because of the size and position of the vagina, vaginal hysterectomy may not be an option.
Laparoscopic Hysterectomy
During this procedure, the surgeon makes a few small incisions in the lower abdomen. Then a laparoscope — a thin tube that contains a video camera — is inserted in one of these incisions. The laparoscope allows the surgeon to see your pelvic organs, and surgical tools are inserted through the other incisions. The uterus can then be removed in small pieces through the incisions, through a larger incision made in the abdomen, or through the vagina.
It’s important to take care of your health before surgery to keep you strong for the procedure and to help shorten recovery time. Take walks, work out, do yoga, and eat a healthy diet. Also make sure you have clothes that will be suitable for your recovery, such as yoga pants or pajamas that are comfortable and easy to get on and off.
If you have kids, schedule childcare during your recovery. You will be unable to lift, drive, or carry children for a while following a hysterectomy.
If you’re also having your ovaries removed, it will immediately put you into menopause. Before the surgery takes place, learn about common menopausal symptoms and explore options for managing them, such as using fans, cooling sheets, and cool packs for hot flashes.
Prior to the procedure, you will be given an intravenous (IV) line in your arm or hand to provide fluids and medications. You will also likely be given general anesthesia to help numb any pain. You will be asleep and unaware of what’s happening during the surgical procedure. Once it’s completed, any incisions will be closed with stitches, staples, or surgical glue.
When you return to the recovery room, you will be given medicine for pain. You will have some bleeding from the vagina that will necessitate sanitary pads. You will also be provided liquids or light meals to help give your digestive system an opportunity to return to normal.
As with any type of surgery, some complications may occur. Risks associated with hysterectomy include:
- Blood clots
- Infection
- Excessive bleeding
- Adverse reaction to anesthesia
- Damage to the urinary tract, rectum, or other pelvic structures
- Early menopause
How long it takes to bounce back from surgery will depend on the type of surgery you receive. Following abdominal hysterectomy, you may need to stay in the hospital for a day or two — sometimes a bit longer. If a woman has a laparoscopic hysterectomy, she can often go home the same day. You can expect some pain for the first few days, but medication should help.
Keep any incisions clean, and pat (don’t rub) them dry. You can shower immediately, but you may need to wait four weeks before taking a bath. Clean the incision daily with warm water and gentle soap. Your healthcare provider should give you specific instructions for incision care if you have one.
Avoid lifting any objects that weigh more than 20 pounds for six weeks after surgery. Generally, you should avoid vaginal intercourse, or putting anything in your vagina (including tampons), for eight weeks after a hysterectomy.
The Takeaway
- A hysterectomy is the surgical removal of the uterus. It is performed to treat health conditions like uterine fibroids, endometriosis, or chronic pelvic pain when other treatments have not been successful.
- Hysterectomy is typically the treatment of choice for people with gynecologic cancers, such as endometrial, ovarian, or cervical cancers.
- There are different types of hysterectomy surgeries, and some are more invasive than others. The choice a doctor makes depends largely on individual medical needs.
- If you experience severe symptoms following the procedure, such as excessive bleeding or prolonged pelvic pain, seek immediate medical attention.
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