Hysterectomy is the second-most common surgical procedure for women in the United States, behind only cesarean sections.
A hysterectomy is a medical term for surgically removing the uterus. Around 600,000 people get hysterectomies each year.
We asked Enes Taylan, M.D., an OB/GYN specialist at Sanford Aberdeen Clinic, to explain more about this common surgery and why it is sometimes the best option in preserving your health.
Why would someone need a hysterectomy?
The most common reason to get a hysterectomy in the United States is fibroids, a condition of non-cancerous growths that develop in the uterus and are made of muscle and fibrous tissue. These fibroids can be linked to heavy or painful periods, body pains, frequent need to urinate, constipation, and pain or discomfort during sex.
Other common causes:
- Endometriosis. A condition where cells grow outside of the uterus and attach to other organs. This can cause chronic pelvic pain, pain during sex, and prolonged or heavy bleeding.
- Abnormal uterine bleeding. This is an over-thickening of the lining of the uterus.
- Cancer. A patient has cervical, ovarian, or endometrial cancer.
- Uterine prolapse. This is when the uterus drops down into the vagina.
- Chronic pelvic conditions. This may include pelvic pain, or pelvic inflammatory disease.
- Adenomyosis. The lining of the uterus grows into the muscle wall of the uterus.
“If we’re dealing with gynecological cancer in the uterus, the uterus usually needs to be removed,” Dr. Taylan said. “But with benign conditions, a lot of the time before deciding on a hysterectomy we will try medical alternatives. When they do not succeed, we have to move forward with a hysterectomy.”
What are the different kinds of hysterectomies?
Hysterectomies are done as traditional or open surgeries that require an abdominal incision, and laparoscopic hysterectomies, which are done using a small camera with surgical instruments that make minimally invasive incisions.
These laparoscopic incisions are made in the abdominal wall or in the vaginal wall. Those going through the vaginal wall are referred to as vNOTES, or vaginal natural orifice transluminal endoscopic surgery.
“Most hysterectomies done in the United States now are done laparoscopically,” Dr. Taylan said. “The minimally invasive approach heals faster, and patients can return to a normal life more quickly.”
Hysterectomies are defined by what is removed. They include:
- Total hysterectomy. Your provider removes the whole uterus including the cervix and the fallopian tubes, leaving the ovaries. It’s the most common type of hysterectomy.
- Hysterectomy with salpingo-oophorectomy. Your provider removes one or both ovaries, and the fallopian tubes, along with the uterus.
- Radical hysterectomy. Your provider removes the uterus, cervix, and the top part of the vagina. The pelvic lymph nodes may also be removed. Some cases of cancer call for this surgery.
- Supracervical hysterectomy (partial or subtotal hysterectomy). Your provider removes the body of the uterus. The cervix is left whole.
What are the risks of a hysterectomy?
Some possible complications include:
- Bleeding
- Injury to the tubes that carry urine from the kidneys to the bladder (ureters) and bladder
- Infection
- Injury to the bowel or other intestinal organs
- Trouble with urination or urinary incontinence
You will no longer have a period after a hysterectomy, and you will not be able to get pregnant. If the ovaries are removed before you reach menopause, you may have menopausal symptoms after their removal. This includes hot flashes, mood swings, and vaginal dryness.
You may also experience depression and feel a loss of sexual identity after a hysterectomy.
You may have other risks based on your condition. Be sure to discuss any concerns with your health care provider before the procedure.
Potential ill-effects can sometimes be avoided if the ovaries remain. Removing ovaries brings on immediate menopause if you haven’t completed it before your hysterectomy. During menopause, and afterward, women do not produce estrogen at the same level they did before. Estrogen can help protect women from conditions like heart disease and osteoporosis. Studies also suggest keeping the ovaries may also reduce the risk of certain types of cancer.
How long does it take to heal after a hysterectomy?
Some hysterectomies can be done minimally invasively as same-day procedures. However, you can expect to stay in the hospital one or two days after a vaginal or laparoscopic hysterectomy, and longer after an abdominal hysterectomy.
When you return home, you will need some additional time to rest and recover. Most women recover three to four weeks after a laparoscopic or vaginal hysterectomy. It may take four to six weeks to recover from an abdominal hysterectomy.
You may have some bleeding or discharge after your surgery. You should not take a tub bath, douche, have sex, or put anything into your vagina for six weeks after your surgery.
“Everyone is different but if it’s a minimally invasive surgery, it’s usually closer to four weeks than six weeks,” Dr. Taylan said. “Some people even feel like they’ve recovered after two or three weeks.”
Patients will often ask about how a hysterectomy would affect their sex life.
“I will tell them as long as the recovery process goes well and vaginal stitches are healed, a hysterectomy will not affect your sex life,” Dr. Taylan said.
Post-surgery discomforts accompany the procedure but are most times manageable. If you do experience any of the possible side effects after your procedure, reach out to your women’s health provider to discuss options.
“There is still going to be some pain after the surgery, but it can be relieved with pain medications,” Dr. Taylan said. “Sometimes patients might experience constipation or difficulty emptying their bladders, but those problems also can be easily resolved with diet, exercise, and certain medications. And most of the time our patients recover well by the six weeks after the surgery.”
Seeking care
Ultimately, if you think you might need a hysterectomy, there are doctors at Sanford Health who can help you. Your OB/GYN or your primary care provider can help you sort through treatment options that are both safe and effective for you.
Learn more
- HRT for menopause symptoms: What to ask your doctor
- The impact of uterine fibroids on women’s health
- Preventing osteoporosis after menopause
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Posted In Aberdeen, Gynecology, Menopause Care, Women's
