A hysterectomy is a surgical procedure that removes the uterus. According to statistics, over 500,000 hysterectomies are performed in the US each year, making it the second most common surgery for women. (The most common is a cesarean section).
In this article, we’ll answer the most frequently asked questions about hysterectomies, including the different types of hysterectomies, why & how they are performed, if there are alternatives, and what you can expect during recovery from a hysterectomy.
What Is a Hysterectomy?
A hysterectomy is a surgical procedure to remove the uterus (womb) and sometimes the ovaries & fallopian tubes too. After a hysterectomy, a woman is no longer able to become pregnant.
Why Is a Hysterectomy Performed?
A hysterectomy is performed to treat conditions associated with female health and reproductive organs when other treatment options have failed to improve symptoms. The most common reasons for having a hysterectomy include, but are not limited to, the following:
- Abnormally heavy periods
- Severe pelvic pain caused by endometriosis or pelvic inflammatory disease
- Uterine prolapse
- Cancer of the cervix, ovaries, or womb
Is It Safe to Have a Hysterectomy?
Yes, hysterectomies are the second most common surgery performed on women and according to statistics they are considered safe surgical procedures. That said, just like any surgical procedure, a hysterectomy can lead to possible post-surgical issues, in particular, an abdominal hysterectomy.
Complications that could occur are:
- Blood clots
- Bleeding during or after surgery
- Bowel blockage
- Damaged urinary tract or other pelvic organs
- Respiratory or heart complications due to anesthesia
- Wound infection
Are There Any Alternatives to a Hysterectomy?
Alternatives to a hysterectomy will depend on the condition you are seeking to treat, as well as the severity of your symptoms. Pelvic physical therapy and kegel weights are often a non-surgical alternative to hysterectomies for women suffering from pelvic organ prolapse.
However, it is always best to check with your doctor before putting off a hysterectomy. Some women can manage to put up with painful symptoms and put off a hysterectomy until they have had children, while others have no choice but to treat severe symptoms with a hysterectomy.
If your healthcare provider determines that a hysterectomy might not be necessary, preliminary alternatives could include:
- Pelvic physical therapy to address pelvic floor dysfunction that might be contributing towards your symptoms.
- Waiting to see if/how your condition improves.
- Medication like birth control pills could be prescribed to manage painful periods or unusual bleeding.
- Procedures to shrink fibroids if possible.
- Using a pessary, which is a device used to support your uterus when uterine prolapse occurs.
- Surgery to treat endometriosis or vaginal bleeding that does not require a hysterectomy.
Are There Different Types of Hysterectomies?
Yes, there are three main types of hysterectomies and the organs removed during each come down to the initial reason for the procedure.
Total hysterectomy - removes the uterus and the cervix.
Supracervical hysterectomy - removes part of the uterus and the cervix is left in place.
Radical hysterectomy - removes the uterus, cervix, ovaries, fallopian tubes, and surrounding tissue.
Are the Ovaries & Fallopian Tubes Always Removed During a Hysterectomy?
When necessary, the ovaries and fallopian tubes are removed during a hysterectomy, but not always.
For example, if they have been adversely affected by endometriosis or your surgeon suspects that existing cancer could spread to the tubes or ovaries, they will be removed. And sometimes the surgeon won’t know for sure until the surgery is performed.
When just the ovaries are removed it is known as an oophorectomy, when only the fallopian tubes have been removed a salpingectomy has been performed, and when both the tubes and ovaries are taken out, the procedure is called a salpingo-oophorectomy.
What Happens When the Ovaries Are Removed During A Hysterectomy?
When the ovaries are removed during a hysterectomy, women will typically begin to experience symptoms of menopause almost immediately. These include hot flashes, mood swings, lack of libido, interrupted sleep, vaginal dryness during sex, and a higher risk of osteoporosis.
Hormone therapy is one option to counterbalance the drop in hormones during this time. Another option is a natural remedy called Chasteberry or Vitex. Used for centuries as a treatment for women’s reproductive health issues, this natural remedy is experiencing a resurgence since a Germany-based study in the 1990s revealed its benefits for treating PMS and menopausal symptoms.
How Is a Hysterectomy Performed?
A hysterectomy can be performed in three ways – vaginally, laparoscopically, or abdominally.
What Is a Vaginal Hysterectomy?
A vaginal hysterectomy is the most common way of performing a hysterectomy, but it might not be an option for everyone. During a vaginal hysterectomy, the uterus is removed via the vagina without any abdominal incisions.
What Are the Advantages of a Vaginal Hysterectomy?
A vaginal hysterectomy is typically complication-free and the recovery time is much shorter than an abdominal hysterectomy or laparoscopic hysterectomy.
What Is a Laparoscopic Hysterectomy?
A laparoscopic hysterectomy is performed by creating a few small incisions in the abdomen. A laparoscope is then inserted through one incision and surgical instruments are used via the other incisions.
The laparoscope allows the surgeon to see the pelvic organs and the surgical instruments are used to remove the uterus in small pieces via the incisions.
What Are the Advantages & Disadvantages of a Laparoscopic Hysterectomy?
The main advantage of a laparoscopic hysterectomy is that the pain during recovery is much lower than a vaginal or abdominal hysterectomy. There is also a much lower risk of infection and the time spent in the hospital is comparatively less than vaginal or abdominal procedures.
Risks involved in a laparoscopic hysterectomy include the possibility of injuring the other pelvic organs, particularly the urinary tract. This type of surgery also takes more time to perform than a vaginal hysterectomy, meaning patients can expect to be under anesthetic for longer.
What Is an Abdominal Hysterectomy?
When an abdominal hysterectomy is performed, surgeons remove the uterus via an incision made in the lower abdomen. This type of hysterectomy is often recommended when a woman’s uterus has expanded due to pelvic tumors or fibroids and cannot be removed through the vagina or small incisions made during a laparoscopic procedure. A
bdominal hysterectomies are also advised when the surgeon knows that the ovaries must also be taken out.
What Are the Advantages & Disadvantages of an Abdominal Hysterectomy?
The main advantage of abdominal hysterectomies is that they can be performed under any circumstances, even when the uterus has been enlarged by fibroids or tumors. During an abdominal hysterectomy, it is also easier for surgeons to remove the ovaries and fallopian tubes when necessary.
However, abdominal hysterectomies are also considered the riskiest of hysterectomies due to a higher possibility of complications. These include blood clots, damage to abdominal nerves & tissues, internal bleeding, and surgical wound infections.
An abdominal hysterectomy also means a longer stay in the hospital and a much longer recovery time than a laparoscopic or vaginal hysterectomy.
What Fills the Uterus Space After a Hysterectomy?
After a hysterectomy, other organs, typically the small and large intestines, will move around to fill the space where your uterus once was.
How Long Will I Stay in the Hospital After a Hysterectomy?
After a hysterectomy, most women can expect to stay in the hospital for 2-3 days after the surgery, although it can be a few days longer after an abdominal hysterectomy.
What to Expect After a Hysterectomy?
Naturally, every woman will experience some level of pain after a hysterectomy, the level of which will depend on the type of hysterectomy performed. That said, medical staff will be on hand to administer medication to manage your pain.
Additional factors to expect after a hysterectomy include the following:
- You will stay in the hospital for 2-3 days after your surgery.
- While in the hospital, you will be encouraged to walk around a few times a day to prevent blood clots.
- Bleeding and discharge from the vagina for a few weeks after your surgery is perfectly normal.
- Expect to use sanitary pads for a few weeks after surgery. Tampons are not recommended for vaginal bleeding after a hysterectomy.
- It can be painful to empty the bladder after a hysterectomy, but this is normally temporary.
- Constipation is also common after most hysterectomies.
Lastly, be prepared to have some form of emotional reaction after a hysterectomy. For some women, the emotion is a relief that their condition has been dealt with and severe symptoms are finally gone, but for others, sadness can set in due to the loss of their ability to bear children. Hormonal imbalances, due to the onset of menopause after a hysterectomy is also a factor post-hysterectomy.
Hysterectomy Recovery Tips
When recovering from a hysterectomy it’s helpful to know what to expect and what you will or will not be capable of for the first few weeks. Rest assured that although there will be some level of pain in the initial stages of recovery, you will feel better within a few weeks, and life will resume again.
The following are useful hysterectomy recovery tips to know:
- Always follow your surgeon’s instructions.
- Get plenty of rest, but try to get up and walk around a few times per day. Then slowly and gradually increase how far you walk each day.
- It’s normal to have light vaginal bleeding for up to six weeks after surgery.
- Don’t insert anything into the vagina to manage vaginal bleeding. Only sanitary pads and panty liners should be used for at least six weeks.
- It is also advisable to refrain from sex for 6-8 weeks after a hysterectomy.
- It’s okay to shower as usual and wash your incision with soap and water.
- It's also okay if the surgical strips or initial bandage come off. (They typically do this in the first week)
- Your stitches will not need to be removed. They will dissolve naturally within six weeks.
- If staples were used, they will be removed by your doctor after a few weeks.
- Don’t lift anything that weighs over 10 pounds for the first six weeks.
- Once you are no longer taking medication for pain (usually within 10-14 days), you can drive again.
- Depending on your recovery, women are typically allowed to return to work 3-6 weeks after surgery.
- After a hysterectomy, women can normally return to exercising 4-6 weeks after surgery.
When To Call Your Doctor After a Hysterectomy
If your pain noticeably increases during recovery after a hysterectomy, always check in with your doctor for guidance. Additionally, should you notice any of the below-mentioned red flags, call your healthcare provider.
- Heavy, bright red vaginal bleeding
- Redness, or swelling around the surgical incision(s)
- Increasing amounts of vaginal discharge
- A high fever (over 100 degrees Fahrenheit)
- Nausea or vomiting
- Pain or difficulty urinating
A hysterectomy is a surgical procedure that provides relief from several conditions associated with the uterus. To determine if you are a candidate for a hysterectomy, speak openly and honestly about your symptoms with your healthcare provider and have a read of our hysterectomy FAQs above.
Ensuring that you are adequately informed about the procedure, aftercare, and recovery process will allow the appropriate time for healing, both physically and emotionally, after a hysterectomy.
The American College of Obstetricians & Gynecologists – Hysterectomy - https://www.acog.org/womens-health/faqs/hysterectomy
Fibroid Treatment Collective – Fibroid Treatments - https://fibroids.com/fibroid-treatments/hysterectomy/
Mount Sinai – Hysterectomy - https://www.mountsinai.org/health-library/surgery/hysterectomy
Endometriosis Foundation of America – Is a Hysterectomy an Effective Endometriosis Treatment - https://www.endofound.org/the-experts-weigh-in-is-a-hysterectomy-an-effective-endometriosis-treatment
Mayo Clinic – Uterine Prolapse - https://www.mayoclinic.org/diseases-conditions/uterine-prolapse/diagnosis-treatment/drc-20353464