Catherine Spader, RN
What is a hysterectomy?
A hysterectomy is the surgical removal of a woman’s uterus to treat a variety of diseases, disorders and conditions of the uterus and reproductive system. The uterus is a pear-shaped organ located in the lower abdominal (pelvic) area where a baby grows during pregnancy.
Uterus removal is a common but major surgery with significant risks and potential complications. Removing the uterus also means you will no longer be able to bear children. Your body may experience other changes as well, including early menopause if both of your ovaries are removed. You may have less invasive treatment options depending on your condition and specific circumstance, so consider getting a second opinion about your treatment options before having a hysterectomy.
Types of hysterectomy
The types of hysterectomy procedures include:
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Supracervical hysterectomy (subtotal or partial hysterectomy) is removal of part of the uterus, leaving the cervix intact.
Total hysterectomy is removal of both the uterus and the cervix.
Radical hysterectomy is an extensive surgery that includes removal of the uterus, the top of the vagina, and tissues around the cervix. Your doctor may perform a radical hysterectomy if you have cancer.
Other surgical procedures that may be performed
Your doctor may perform other procedures in addition to a hysterectomy. These include:
Oophorectomy is the removal of one or both ovaries, which are glands that produce a woman’s eggs and female hormones. Ovary removal may be necessary for certain conditions, such as cancer.
Salpingectomy is the removal of one or both fallopian tubes, which connect the ovaries to the uterus.
Why is a hysterectomy performed?
Your doctor may recommend a hysterectomy to treat a variety of diseases and conditions of the uterus and reproductive system. A hysterectomy may only be considered if other treatment options that involve less risk and fewer complications have been ineffective in treating your condition.
Ask your doctor about all of your treatment options to understand which option is best for you. Consider getting a second opinion, especially if you still want to bear children or have not yet reached menopause.
Your doctor may recommend a hysterectomy for:
Abnormal vaginal bleeding that does not get better with other treatments, such as medication or procedures that do not involve removal of the uterus
Adenomyosis, a thickening of the uterus that causes heavy, painful periods. Adenomyosis may be treated in some cases without a hysterectomy with medications and may go away on its own after menopause.
Cancer of the cervix, ovaries or uterus (often endometrial cancer). Certain cases of cervical cancer or precancerous changes of the cervix may be treated without removing the uterus.
Childbirth complications, such as uncontrolled bleeding or uterine rupture (rare)
Chronic pelvic pain that does not improve with other treatments
Endometriosis, an abnormal uterine tissue growth that causes severe menstrual pain, chronic low back and pelvic pain, and abnormal vaginal bleeding. Endometriosis can often be treated without a hysterectomy with medications or a minimally invasive laparoscopic procedure to remove the endometrial lesions.
Uterine fibroids, which are benign tumors of the uterus that can cause significant bleeding and pain. Fibroids often need no treatment or may be treated without a hysterectomy with medications or less invasive procedures, such as uterine artery embolization myomectomy.
Uterine prolapse, which is when the uterus drops or slides into the vagina. Uterine prolapse is often treated with a hysterectomy. Other treatment options include a vaginal device (pessary) that holds the uterus in place, and a surgical procedure that uses ligaments to support the uterus.
Who performs a hysterectomy?
The following specialists perform hysterectomies:
Obstetrician-gynecologists specialize in women’s reproductive health and pregnancy.
Gynecologic oncologists specialize in diagnosing, treating and preventing cancer of the female reproductive system.
General surgeons specialize in the surgical treatment of a wide variety of diseases, disorders and conditions.
How is a hysterectomy performed?
A hysterectomy can be performed as an open procedure, through the vaginal canal, or as a minimally invasive laparoscopic procedure. It is done in a hospital or surgical center.
A laparoscopic hysterectomy uses very small incisions instead of the large incision made in open surgery. Laparoscopic surgery generally entails a faster recovery time and less pain than open surgery.
Surgical approaches to a hysterectomy
A hysterectomy may be performed using one of the following approaches:
Abdominal hysterectomy (open hysterectomy) is the removal of the uterus through a five-to-seven-inch incision in the lower part of your belly. The incision may be vertical or horizontal. A horizontal incision (bikini cut) is placed very low on the abdomen so it is not easily visible.
Vaginal hysterectomy is the removal of the uterus through an incision made in the vagina. The incision is then closed with stitches until it heals.
Laparoscopic hysterectomy is the removal of the uterus through several small incisions in your abdomen. A small tube fitted with a special camera and other surgical instruments are inserted through the small incisions to remove the uterus.
Laparoscopically assisted vaginal hysterectomy (LAVH) is a vaginal hysterectomy that uses a laparoscopic camera to help your doctor see the uterus and surrounding tissues.
Robot-assisted laparoscopic hysterectomy is similar to a laparoscopic hysterectomy but includes a surgeon-controlled robotic device attached to surgical instruments and a laparoscopic camera.
Your doctor will determine which type of hysterectomy is best for you and how long you need to stay in the hospital or surgical center based on your diagnosis, age, medical history, general health, and possibly your personal preference. Learn about the different hysterectomy procedures and ask why your doctor will use a particular type of procedure for you.
Types of anesthesia that may be used
Hysterectomies are performed using either general anesthesia or a nerve block.
General anesthesia is generally a combination of intravenous (IV) medications and gases that put you in a deep sleep. You are unaware of the procedure and do not feel any pain. You may also receive a peripheral nerve block infusion in addition to general anesthesia. A peripheral nerve block infusion is an injection or continuous drip of a liquid anesthetic. The anesthetic flows through a tiny tube inserted near your surgical site to control your pain during and after surgery.
Regional anesthesia is also known as a nerve block. Regional anesthesia involves injecting an anesthetic around the nerves in the spine that transmit pain signals from the surgical area. This temporarily eliminates all pain during surgery. You will likely have sedation with regional anesthesia to keep you relaxed and comfortable.
What to expect the day of your hysterectomy
The day of your surgery, you can generally expect to:
Talk with a preoperative nurse. The nurse will perform an exam and ensure that all needed tests are in order. The nurse can also answer questions and will make sure that you understand and sign the surgical consent.
Remove all clothing and jewelry and dress in a hospital gown. It is a good idea to leave all jewelry and valuables at home or with a family member if possible. Your care team will give you blankets for modesty and warmth.
Talk with the anesthesiologist or nurse anesthetist about your medical history and the type of anesthesia you will have.
A surgical team member will start an IV.
The anesthesiologist or nurse anesthetist will start your anesthesia.
A tube will be placed in your windpipe to protect and control your breathing during general anesthesia. You will not feel or remember this or the surgery as they happen.
A team member will insert a urinary catheter into your bladder to collect urine.
The surgical team will monitor your vital signs and other critical body functions. This occurs throughout surgery and recovery until you are alert, breathing effectively, and your vital signs are stable.
What are the risks and potential complications of a hysterectomy?
As will all surgeries, a hysterectomy involves risks and the possibility of complications. Complications may become serious and life threatening in some cases. Complications can occur during surgery or recovery.
General risks of surgery
The general risks of surgery include:
Anesthesia reaction, such as an allergic reaction and problems with breathing
Bleeding or hemorrhage (heavy bleeding), which can lead to shock
Infection and septicemia, which is the spread of a local infection to the blood
Potential complications of a hysterectomy
Complications of a hysterectomy can be serious and include:
Damage to your urinary tract, bladder, rectum, or other pelvic structures during surgery, which may lead to problems, such as urinary or fecal incontinence, and require further surgical repair
Early onset of menopause if both ovaries are removed
Reducing your risk of complications
You can reduce the risk of certain complications by following your treatment plan and:
Following activity, dietary and lifestyle restrictions and recommendations before surgery and during recovery
Notifying your doctor immediately of any concerns, such as bleeding, fever, increase in pain, or wound redness, swelling or drainage
Taking your medications exactly as directed
Telling all members of your care team if you have any allergies
How do I prepare for my hysterectomy?
You are an important member of your own healthcare team. The steps you take before surgery can improve your comfort and outcome. You can prepare for a hysterectomy by:
Answering all questions about your medical history and medications you take. This includes prescriptions, over-the-counter drugs, herbal treatments, and vitamins. It is a good idea to carry a current list of your medical conditions, medications, and allergies at all times.
Getting preoperative testing as directed. Testing will vary depending on your age, health, and specific procedure. Preoperative testing may include a chest X-ray, EKG (electrocardiogram), blood tests, and other tests as needed.
Losing weight before the surgery through a healthy diet and exercise plan
Not eating or drinking just prior to surgery as directed. Your surgery may be cancelled if you eat or drink too close to the start of the procedure because you can choke on stomach contents during anesthesia.
Stopping smoking as soon as possible. Even quitting for just a few days can be beneficial and help the healing process.
Taking or stopping medications exactly as directed. For a hysterectomy, this may include not taking aspirin, ibuprofen (Advil, Motrin), and blood thinners. You may also be instructed to take a laxative to clean out your bowel the day before surgery.
Questions to ask your doctor
Facing surgery can be stressful. It is common for patients to forget some of their questions during a doctor’s office visit. You may also think of other questions after your appointment. Contact your doctor with concerns and questions before surgery and between appointments.
It is also a good idea to bring a list of questions to your preoperative appointments. Questions can include:
Why do I need a hysterectomy? Are there any other options for treating my condition?
What type of hysterectomy procedure will I need?
How long will the procedure take? When can I go home?
What kind of restrictions will I have after the surgery, and when can I return to work and other activities?
What kind of assistance will I need at home?
What medication plan should I follow before and after the surgery?
How will you manage my pain?
When should I follow up with you?
How should I contact you? Ask for numbers to call during and after regular hours.
What can I expect after my hysterectomy?
Knowing what to expect can help make your road to recovery after a hysterectomy as smooth as possible.
How long will it take to recover?
You will stay in the recovery room after surgery until you are alert, breathing effectively, and your vital signs are stable. You may have a sore throat if a tube was placed in your windpipe during surgery. This is usually temporary, but tell your care team if you are uncomfortable.
In some cases, such as after a laparoscopic supracervical hysterectomy, you may be able to go home on the same day. You may need to stay up to six days in the hospital for more extensive procedures, such as an abdominal hysterectomy.
Recovery after surgery is a gradual process. Recovery time varies depending on the specific procedure and type of anesthesia used, your general health, age, and other factors. Full recovery times range from about two to six weeks.
Will I feel pain?
Pain control is important for healing and a smooth recovery. There will be discomfort after your procedure. Your doctor and care team will manage your pain so you are comfortable and can get the rest you need. Contact your doctor if your pain gets worse or changes in any way because it can be a sign of a complication.
When should I call my doctor?
It is important to keep your follow-up appointments after your surgery. Call your doctor if you have questions or concerns between appointments. Call your doctor right away or seek immediate medical care if you have:
Change in alertness, such as passing out, unresponsiveness, or confusion
Fever. A low-grade fever (lower than 101 degrees Fahrenheit) is common for a couple of days after surgery and not necessarily a sign of a surgical infection. However, you should follow your doctor's specific instructions about when to call for a fever.
Inability to urinate or have a bowel movement
Leg pain, redness or swelling, especially in the calf, which may indicate a blood clot
Pain that is not controlled by your pain medication
Uncontrolled or heavy bleeding (hemorrhage)
Unexpected drainage, pus, redness or swelling of your incision
How might a hysterectomy affect my everyday life?A hysterectomy may cure your condition or reduce your symptoms so you can lead an active, normal life. For example, a hysterectomy may effectively treat heavy menstrual bleeding, pelvic pain, and pain with sexual intercourse. You will still need to have regular pelvic exams and possibly Pap tests after a hysterectomy.
A hysterectomy can also cause significant changes to your body that may affect your everyday life such as:
Early menopause if both of the ovaries are removed with the uterus. Symptoms of early menopause can be severe and include vaginal dryness, painful sexual intercourse, sleep problems, hot flashes, and mood swings. Early menopause may be treated with hormone replacement therapy (estrogen therapy).
Loss of childbearing ability. Some women report feeling deep sense of loss after a hysterectomy, especially if they still planned to bear children. Tell your healthcare provider if you are concerned about these feelings.
Sexual changes. Some women report painful sex or a loss of orgasm during sex after a hysterectomy. See your healthcare provider if you have pain with intercourse or are not enjoying sex the way you used to.
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- Hysterectomy. The American Congress of Obstetricians and Gynecologists.http://www.acog.org/publications/patient_education/bp008.cfm.
- Hysterectomy. Womenshealth.gov. http://www.womenshealth.gov/faq/hysterectomy.cfm.
- Pile, JC. Evaluating postoperative fever: A focused approach. Cleveland Clinic Journal of Medicine. 2006;73 (Suppl 1):S62. http://ccjm.org/content/73/Suppl_1/S62.full.pdf