Hysterectomy

Written by Debra Stang | Published on July 20, 2012
Medically Reviewed by George Krucik, MD

What Is a Hysterectomy?

A hysterectomy is a surgical procedure to remove a woman’s uterus. The uterus is also known as the womb. The uterus is located in the abdomen and is where a fetus grows during pregnancy. The uterine lining is the source of menstrual blood.

Women may need a hysterectomy for many reasons. It can be used to treat a number of chronic pain conditions, as well as certain types of cancer and infection.

Depending on your reasons for having a hysterectomy, the extent of the surgery will vary. Your doctor may recommend removing the cervix (the lower part of the uterus) and the ovaries (organs that produce estrogen and other hormones) as well.

Once you have had a hysterectomy, you will stop having periods. You will also be unable to carry a pregnancy. If your ovaries are removed, you may also go into menopause.

According to the National Institutes of Health, one in three American women will have a hysterectomy by age 60. (MedlinePlus)

Reasons for Having a Hysterectomy

There are many reasons why a doctor may suggest a hysterectomy. They include:

  • fibroids: benign tumors that grow in the uterus
  • endometriosis: a condition in which the inner lining of the uterus grows in the abdomen, causing pain and bleeding
  • uterine prolapse: when the uterus drops through the cervix and protrudes from the vagina
  • cancer of the uterus, cervix, or ovaries
  • uncontrollable vaginal bleeding
  • chronic pelvic pain
  • adenomyosis: when the inner lining of the uterus grows into the middle layer
  • pelvic inflammatory disease: a serious infection of the reproductive organs

Alternatives to Hysterectomy

According to the U.S. Department of Health and Human Services, a hysterectomy is the second most common surgical procedure performed on women in the United States. The most common is a Caesarian section. (WomensHealth.gov)

Hysterectomy is considered a safe surgery. It is effective in reducing or eliminating pelvic pain and vaginal bleeding.

Hysterectomy may not be the best option for all women. It should not be used for women who still want to have children, unless no other alternatives exist. Fortunately, many conditions that are treated with hysterectomy can also be treated in other ways. For example, hormone therapy can be used to treat endometriosis. Fibroids can be treated with other types of surgery that spare the uterus.

In some circumstances, however, hysterectomy is clearly the best option. For instance, a hysterectomy may be necessary to treat uterine or cervical cancer.

Types of Hysterectomy

There are several different types of hysterectomy.

A partial hysterectomy removes only a portion of your uterus. Your doctor may leave the cervix intact.

A total hysterectomy removes the entire uterus, including the cervix. If your cervix is removed, you will no longer need to get an annual Pap test. You should, however, continue to have regular pelvic examinations.

A hysterectomy and salpingo-oophorectomy involves removing the uterus along with one or both of your ovaries and Fallopian tubes. If both of your ovaries are removed, you will enter menopause. You may need hormone replacement therapy.

How Is a Hysterectomy Performed?

Hysterectomies can be performed in several ways. All methods require a general or regional anesthetic. A general anesthetic will put you to sleep so that you don’t feel pain. A regional anesthetic will make your body feel numb below the waistline; however, you will remain conscious. Sometimes, this type of anesthetic is combined with a sedative. This helps you feel sleepy and relaxed during surgery.

Abdominal Hysterectomy

The uterus is removed through an incision (cut) in the abdomen. The incision may be vertical (up and down) or horizontal (side to side). A horizontal incision is also called a bikini incision. Both types of incisions tend to heal well and leave little scaring.

Laparoscopic Hysterectomy

This surgery involves a tiny camera called a laparoscope. Three or four small incisions are made instead of one large incision. The uterus is cut into small pieces and removed one piece at a time. Healing time may be shorter than with abdominal surgery.

Vaginal Hysterectomy

An incision is made inside the vagina. The uterus is removed through that opening. No external cuts are made. Therefore, you will not have to worry about scars.

Laparoscopically Assisted Vaginal Hysterectomy (LAVH)

The doctor uses a laparoscope inserted through a small abdominal incision to guide the removal of the uterus through the vagina.

Risks of a Hysterectomy

Hysterectomies are performed as a routine matter. Doctors consider them quite safe. However, as with all major surgeries, there is a slight risk of an adverse reaction to the anesthetic. There is also the risk of heavy bleeding and infection around the incision site.

Other risks include injury to surrounding tissues or organs such as the:

  • bladder
  • intestines
  • blood vessels

These complications are rare. However, if they occur, you may need a second surgery to correct them.

Aftercare for a Hysterectomy

After your hysterectomy, you will be taken to a recovery room. The staff there will monitor your vital signs and give you medication for pain. After a brief period of observation, you will be taken to your hospital room. You will probably spend two to five days in the hospital. However, you will be up and walking the day after surgery.

If you’ve had a vaginal hysterectomy, your vagina will be packed with gauze to control bleeding. The doctors will remove the gauze in a few days. After that, you can expect to have bloody or brownish drainage from your vagina for about ten days. Wearing a menstrual pad can help protect your clothing.

When you return home from the hospital, continue to take frequent walks around the house. However, you should avoid any strain for four to six weeks. This includes:

  • lifting
  • bending
  • pushing, such as a vacuum cleaner
  • pulling
  • sexual intercourse

If you’ve had vaginal or laparoscopic surgery, you will probably be able to return to most regular activities within three to four weeks. If you’ve had abdominal surgery, healing will take a little longer. You should be back to normal in about four to six weeks.

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