Hysterectomy is the surgical removal of the uterus, or womb.
Depending upon the type of procedure that is performed and the reason for the surgery, hysterectomy may also include removal of the adjacent Fallopian tubes and ovaries. Hysterectomy is the most common major surgical procedure (unrelated to pregnancy) performed on women in general. Because of the advancing development of less invasive treatment options, the incidence of hysterectomy has declined in recent years.
The following are several possible causes or reasons for hysterectomy:
Types of Hysterectomy
The types of hysterectomy include:
Surgical Techniques for Hysterectomy
A number of different procedures for hysterectomy are used. Some require standard surgical incisions while others are performed primarily via laparoscopy with small abdominal incisions for instruments.
The type of hysterectomy performed and the technique used to perform the procedure will be determined by the treating physician, based upon the patient’s particular situation.
For women who have not yet reached menopause, having a hysterectomy means that menstruation will no longer occur, nor will pregnancy be possible.
Before the Surgery
During the Surgery
After the Surgery
After the surgery, the patient will be taken to the recovery room for observation. The recovery process will vary depending on the type of procedure performed and the type of anaesthesia that is given. Once the patient’s blood pressure, pulse, and breathing are stable and the patient is alert, she will be taken to the hospital room.
Abdominal cramping may occur after the surgery. The patient may receive pain medication as needed, either by a nurse or by self-administration through a device connected to the intravenous line.
If the performed procedure was an abdominal hysterectomy, the patient may have a thin, plastic tube inserted through the nose into the stomach to remove air that is swallowed. The tube will be removed when the bowels resume normal function. The patient will not be able to eat or drink until the tube is removed.
The patient may have small to moderate amounts of vaginal drainage for several days. The nurse will check the sanitary pads periodically to monitor the amount of drainage.
Depending on the patient’s situation, liquids may be given to drink a few hours after surgery. The patient’s diet may be gradually advanced to more solid foods as tolerated.
The patient should perform coughing and deep breathing exercises as instructed by the nurse.
Women are encouraged to get up and walk within a day of the operation (within hours after a laparoscopic procedure) to reduce the possibility of developing blood clots in the legs and to speed healing overall. Pain medications are given to control pain at the incision sites. Some women experience nausea after the procedure, particularly after a general anaesthesia. Full recovery from a total abdominal hysterectomy can take 4 to 6 weeks. Recovery times are shorter for a vaginal or laparoscopic hysterectomy. Sexual intercourse can resume 4 to 6 weeks after the procedure.
Rehabilitation
Once at home, it will be important to keep the surgical area clean and dry. The doctor will give specific bathing instructions. If stitches or surgical staples are used, they will be removed during a follow-up visit, if they were not removed prior to discharge from the hospital. If adhesive strips are used, they should be kept dry and generally will fall off within a few days.
The incision and the abdominal muscles may ache, especially after long periods of standing. If a laparoscope was used, the patient may experience shoulder pain from the carbon dioxide in the abdomen. Pain relievers can be taken for soreness as recommended by the doctor. Aspirin or certain other pain medications may increase the chance of bleeding. Hence only recommended medications should be taken.
Walking and limited movement are generally encouraged, but strenuous activity should be avoided. The doctor will give instructions about when the patient can return to work and resume normal activities. It is important to avoid becoming constipated by including fiber and plenty of liquids in the diet. A mild laxative is usually recommended. If a laparoscopic procedure was performed, carbonated beverages should be avoided for one to two days after the procedure. This will help minimize the discomfort associated with the carbon dioxide gas. In addition, drinking carbonated beverages may cause nausea.
The patient should not use a douche, tampons, engage in sexual intercourse, or return to work until the doctor advises so.
The patient should look out for the following symptoms and if found, should notify the doctor immediately:
Following a hysterectomy, the doctor may give some additional or alternate instructions that may vary from patient to patient.
Risks / Complications
As with any surgical procedure, complications can occur. Some complications may include, but are not limited to, the following:
Women who have not reached menopause prior to a hysterectomy may experience menopausal symptoms such as hot flashes, mood swings, and vaginal dryness after the procedure if the ovaries are removed. Women will no longer have menstrual periods after a hysterectomy. Mood swings, depression, and feelings of loss of sexual identity may occur after hysterectomy. There may be other risks depending on the patient’s specific medical conditions.
Outlook
Hysterectomy is a common and generally very safe procedure. Most women recover fully with no complications. It is a very effective treatment for fibroid tumours, adenomyosis, and abnormal vaginal bleeding when less aggressive treatment options have not been successful. The outlook for hysterectomy when used as part of treatment for cervical or uterine cancer depends upon the exact type and stage (extent of spread) of cancer and varies according to the individual case.
A hysterectomy is surgery to take out a woman’s uterus, the organ in a woman’s belly where a baby grows during pregnancy. After a hysterectomy, you will not be able to get pregnant. Other organs might also be removed if you have severe problems such as endometriosis or cancer. These organs include the cervix (the lower part of the uterus that opens into the vagina), the ovaries (glands on both sides of the uterus that release eggs for pregnancy), and the fallopian tubes (the passageway between the uterus and the ovaries).
Whether or not the ovaries are removed will depend on your age and risk for certain types of cancer. For example, removing the ovaries lowers the risk of ovarian cancer and some types of breast cancer. But if you have your ovaries removed before the age of menopause, you will go into early menopause, and you may be more likely to get heart disease or osteoporosis. Be sure to discuss with your doctor all the benefits and risks of removing your ovaries.
Most often, hysterectomy is done to treat problems with the uterus, such as pain and heavy bleeding caused by endometriosis or fibroid tumours. The surgery may also be needed if there is cancer in the uterus, cervix, or ovaries. Some women may have the surgery during childbirth to save their lives if there is heavy bleeding that cannot be stopped. Before you choose to have a hysterectomy, consider all of your treatment options. In many cases, this surgery is a last resort after trying other treatments for the problem.
There are many different ways to do hysterectomy surgery. The type of surgery you have depends on three main things: the reason for the surgery, the size of the uterus and its position in the belly, and your overall health. The most common types are:
Feeling better after surgery takes time. Most women are in the hospital 1 or 2 days after the surgery. Some women stay in the hospital up to 4 days. When you get home, make sure you move around, but also be sure you don’t do too much. You can walk around the house and up and down stairs, but take it slow. During the first 2 weeks, it’s important to get plenty of rest. Even after you start to feel stronger, you should not lift heavy things (anything over 20 pounds). Also, you should not have sex until your doctor says it’s okay. It usually takes 4 to 8 weeks to get back to a normal routine.
You may want to have a say in this decision, or you may simply want to follow your doctor’s recommendation. Either way, this information will help you understand what your choices are so that you can talk to your doctor about them.
Your options
Key points to remember
The main reason doctors recommend removing the ovaries during hysterectomy is to lower the risk of ovarian cancer. Studies show that if you are at high risk, surgery greatly lowers your risk. If you aren’t at high risk for cancer, having your ovaries removed isn’t recommended. It’s important to know your risk for cancer when deciding whether to have your ovaries removed during your hysterectomy. Your doctor will help you find out your risk by talking to you about your medical history and your family history. Removing the ovaries if you’re at risk is a different decision than if you’re not at risk. Removing the ovaries may increase your risk of heart disease and osteoporosis. If you have your ovaries removed before menopause, you will go into early menopause. You may get hot flashes and other symptoms.
Surgery to remove the ovaries is called oophorectomy. The ovaries are an important part of the female reproductive system. They store eggs and produce sex hormones, including oestrogen. Of women who have a hysterectomy, about half of them have their ovaries removed at the same time. The main reason doctors recommend removing the ovaries along with the uterus is to reduce the risk of ovarian cancer. Studies show that if you are at high risk, surgery greatly lowers your risk.
For women at average risk-this means no personal or family history of ovarian or breast cancer-there is no clear benefit to removing the ovaries at any age. Hysterectomy itself can reduce your risk of ovarian cancer. If you have severe premenstrual syndrome (PMS), removing the ovaries can stop hormone changes. This may help you feel better. If you are at high risk for breast or ovarian cancer, having your ovaries removed can greatly lower your risk. Women at high risk for these cancers include those who:
If you don’t know if you are at high risk for breast or ovarian cancer, talk to your doctor. If your doctor thinks you could be at risk, you may want to think about gene testing.
When your ovaries are removed, you lose the oestrogen that they produce. Without oestrogen, you will go into early menopause. This can cause hot flashes and other symptoms. Having your ovaries removed before age 65 may increase your chance of getting:
Women who choose to have their ovaries removed can take oestrogen therapy. This treatment doesn’t prevent heart disease, but it helps to lower your risk of osteoporosis. If you already have bone loss, other medicines can help protect your bones.
Your doctor may recommend having your ovaries removed when you have a hysterectomy if:
Before a hysterectomy, you may have:
Your doctor may order additional tests based on your physical exam and medical history. These tests may include:
As with any surgical procedure, complications can occur. Some complications may include, but are not limited to, the following:
Women who have not reached menopause prior to a hysterectomy may experience menopausal symptoms such as hot flashes, mood swings, and vaginal dryness after the procedure if the ovaries are removed. Women will no longer have menstrual periods after a hysterectomy. Mood swings, depression, and feelings of loss of sexual identity may occur after hysterectomy. There may be other risks depending on the patient’s specific medical conditions.
It is normal to have various concerns when faced with the possibility of having a hysterectomy. A woman’s emotions are often based on her beliefs about the importance of her uterus, her fears about her health or personal relationships after a hysterectomy, and concerns about her enjoyment of sexual activities after surgery. If you are considering a hysterectomy, talk with your doctor about your specific fears and anxieties concerning the surgery.
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