Each year, more than 600,000 women in this country undergo a hysterectomy. This is the second among most commonly performed surgeries in the United States. One-fourth of the female population will have this procedure before they turn 60 years of age. The majority of these surgeries are performed on women between the ages of 40 to 55.

A hysterectomy should be the last resort when non surgical therapies are not helping the symptoms. Uterine leiomyoma, or fibroid tumors, is one of the most common causes of hysterectomies. Irregular heavy menstrual bleeding and severe cramping are also common reasons observed in women under 40 years of age.

What Is a Hysterectomy?

Even though it is the second most common major surgery, there are risks.  A hysterectomy only involves removing the uterus and many times the cervix.  The ovaries and fallopian tubes are a separate procedure that can be done at the same time as a hysterectomy in many cases.  Most people are in the hospital anywhere from 3 hours to 2 days after surgery.  Now a days, the majority of women go home the next day, less than 24 hours.   This surgery is considered an option when all other treatment methods have been exhausted.

  • During a supracervial hysterectomy, the surgeon removes the top part of the uterus, but they keep the cervix in place.
  • Total hysterectomies remove the entire uterus and cervix.
  • A radical hysterectomy removes the top part of the vagina as well as the uterus and cervix.

Radical procedures are typically done when cancer is present.

Types Of Hysterectomy

  • Total Abdominal Hysterectomy used to be the standard method for this surgery, but the recovery times are greater as well as the pain and complications. Typically, a bikini-line incision is made above the pubic bone, which leaves a rather large scar. When the ovaries and cervix are removed during the procedure, it is called a bilateral salpingo-oophorectomy. However, in recent years, two less-invasive procedures have been developed to minimize both scarring and healing time.
  • Vaginal Hysterectomy: A vaginal type hysterectomy requires inserting a small hole into the top of the vagina. The uterus and cervix are separated from the vaginal tissue and removed. This procedure is not performed if there is cancer or there are large fibroid tumors.
  • Laparoscopic Hysterectomy: During a laparoscopic hysterectomy, the surgeon makes tiny incisions in the abdomen and vagina. In similar fashion to the vaginal hysterectomy, the uterus and cervix are removed through the incision. The only difference is a miniature camera is inserted into the abdomen to view other organs during the surgery.  2 or 3 additional laparoscopic instruments are inserted through tiny incisions and the sugery is performed with these instruments while watching with the camera.. Recovery times are much less than those who undergo a total abdominal hysterectomy.
  • Robotic Laparoscopic Hysterectomy:  This surgery is the most advance type of laparoscopic hysterectomy and allows the surgeon to have better visualization and dexterity during the surgery.  Robotic hysterectomy also allows patients who have more difficult anatomy that would otherwise have to be cut open for an abdominal surgery, now have option of having a minimally invasive procedure with less pain, less bleeding, less complications, and a faster recovery.  A robotic laparoscopic hysterectomy are available to almost all patients in the United States, however, they might need to travel to a different hospital or city in some cases if they live in a small town.

Who Needs A Hysterectomy?

Numerous minimally invasive surgical techniques should have been explored and discussed before considering a hysterectomy. The benefits must outweigh the risks for a doctor to recommend such a procedure. However, it is not surprising that very often women quickly look to a hysterectomy to resolve problems like heavy menstrual bleeding.

For most, other techniques have failed and required them to take more serious steps to resolve their issues. Many women have fibroid tumors that cause severe bleeding, pain, and heavy periods. Here are some other reasons to have a hysterectomy:

  • Uterine prolapse: Numerous women experience a prolapse after delivering a child vaginally.  As time goes by the uterus drops out of its normal position and down into the vagina. Urinary issues, bowel problems, and pelvic pressure is often problematic. Chronic heavy lifting, constipation, obesity or menopause can also worsen or cause this condition.
  • Endometriosis: Tissues that normally grow inside the uterus begin growing on the outside of the uterus in the pelvic cavity and on other organs, namely the ovaries and tubes. There is often intense pain and pelvic pressure during menses and intercourse associated with this condition.
  • Adenomyosis: Severe cramping is associated with adenomyosis. When endometrial glands grow inside the uterine walls, where it doesn’t belong, it causes severe cramping during menses. This results in heavy bleeding and intense cramps and typically starts when a woman is in her 30s.
  • Cancer: Female cancer can involve the uterus, cervix, ovaries, fallopian tubes, vagina, and surrounding tissues. Without annual exams and pap smears it is often hard to detect until the cancer is advanced. After a hysterectomy, chemotherapy and radiation will be used to ensure no cancerous cells are left behind.

Risks Involved In A Hysterectomy

Undergoing a hysterectomy is a major surgery, the benefits can be many, and fortunately the recovery does not have to be difficult as it was years ago. The quality of life improvements are worth the risks to many women. However, some women experience the following problems after this surgery:

  • Menopause:  Although periods will be a thing of the past, if your ovaries are removed during the surgery, you will have menopause symptoms.  These include hot flashes, night sweats, vaginal dryness, weight gain, and irritability.  Talk your doctor how to prevent or minimize these symptoms.
  • Sexual Differences: Some women experience vaginal dryness or become less interested in sex after this surgery. This is definitely the case when the ovaries are removed.
  • Increased risk for health problems: When both ovaries are removed, in general patients are at a higher risk for urinary incontinence, bone loss, and heart disease.
  • Depression: Some women go through depression and hormonal changes after they have lost their reproductive organs. The loss of fertility can be a big problem for some women.  Feelings of sadness, less energy, and loss of interest in food and enjoyable activities are signs of depression.  On the other hand, many women who have been struggling with various symptoms for a long time are very happy after a hysterectomy.  Be sure to talk with your doctor if any of these symptoms happen to you.

Recovery

Recovering from any major surgery takes time. Though the hospital stay may be anywhere from several hours to 3 days, recovery really takes place at home.  Most women complain of fatigue as the most difficult aspect of recovery.   When the procedure was done due to cancer, recovery times may be much longer.

It is important to move around as much as possible. A catheter will be used for at least a few hours after the procedure. It can take four to six weeks to recover from abdominal surgery, while vaginal, laparoscopic and robotic surgery can take from one to four weeks on average.  No sexual intercourse for at least four to eight weeks depending on the type of hysterectomy.  Showering is ok immediately, but wait on tub baths until at least a month has passed. Recovery times will depend on the specific surgery and the overall health of the patient.

hysterectomy graphic
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Alternatives To A Hysterectomy

Many people try these methods before the hysterectomy surgery:

  • Using medication and waiting until menopause: Fibroids shrink by 30% after menopause.
  • Exercises: Kegel exercises work great for a prolapse as they help to restore muscle tone and can improve prolapse symptoms.
  • Dilation and curettage (D&C): This procedure scrapes the lining of the uterus to help reduce heavy bleeding. It can also remove noncancerous growths or polyps from the uterus.
  • Endometrial Ablation:  This seals the lining of the uterus to stop heavy bleeding and works very well in most cases.  For women less than 40 years old this usually only lasts for several years.
  • Myomectomy: Removing fibroids without a hysterectomy.
  • Surgery For Endometriosis: A doctor can remove the abnormal tissue growths and improve painful symptoms, usually to assist in the patient keeping her uterus for future pregnancies.

Final Thoughts

A hysterectomy is a major surgical procedure that should come as a last resort. It can have extended recovery times and lifelong changes.  Most of the time women find their quality of life dramatically improves, but there are risks to surgery.   It is important to explore non-surgical options before undergoing a hysterectomy.

If you are suffering from any of these symptoms, seeing a doctor sooner rather than later is advisable. Have you had a hysterectomy? Share your experiences below.

Images: 1, 2.

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