Love, Life, and Your Health: Helpful Things to Know If You're Considering A Hysterectomy

Hysterectomy is the surgical removal of the uterus. It ends menstruation and the ability to become pregnant. Depending on the reason for the surgery, a hysterectomy may also involve the removal of other organs and tissues, such as the ovaries and/or fallopian tubes.

Your health care provider might recommend a hysterectomy if you have

·         Fibroids. Many hysterectomies are done to permanently treat these benign tumors in your uterus that can cause persistent bleeding, anemia, pelvic pain, and pain during intercourse and bladder pressure. For large fibroids, you might need surgery that removes your uterus through an incision in your lower abdomen (abdominal hysterectomy).

·         Endometriosis. This occurs when the tissue lining your uterus (endometrium) grows outside the uterus, involving the ovaries, fallopian tubes or other organs. Most women with endometriosis have a laparoscopic or robotic hysterectomy or abdominal hysterectomy, but sometimes a vaginal hysterectomy is possible.

·         Adenomyosis. This occurs when the tissue that normally lines the uterus grows into the uterine wall. An enlarged uterus and painful, heavy periods result.

·         Gynecological cancer. If you have cancer of the uterus, cervix, endometrium or ovaries, or precancerous changes, your doctor might recommend a hysterectomy. Most often, treatment for ovarian cancer involves an abdominal hysterectomy, but sometimes vaginal hysterectomy is appropriate for women with cervical or endometrial cancer.

·         Uterine prolapse. When pelvic supporting tissues and ligaments weaken or stretch out, the uterus can sag into the vagina, causing urine leakage, pelvic pressure or difficulty with bowel movements. Removing the uterus and repairing supportive tissues might relieve those symptoms.

·         Abnormal uterine bleeding. When medication or a less invasive surgical procedure doesn't control irregular, heavy or very long periods, hysterectomy may be needed.

·         Chronic pelvic pain. If your pain is clearly caused by a uterine condition, hysterectomy might help, but only as a last resort. Chronic pelvic pain can have several causes, so an accurate diagnosis of the cause is critical before having a hysterectomy.

Types of Hysterectomy

• Partial Hysterectomy – removes the body of the uterus while the cervix is left in place.
• Total or Simple Hysterectomy – removes the entire uterus and cervix.
• Hysterectomy with Bilateral Salpingo-Oophorectomy – removes the uterus, cervix, and fallopian tubes.
• Radical Hysterectomy – removes the uterus, cervix, ovaries, fallopian tubes and possible upper portions of the vagina and affected lymph glands.

Are there alternatives to hysterectomy?

Depending on your condition, you may want to try other options first that do not involve surgery or to “watch and wait” to see if your condition improves on its own (American College of Obstetricians and Gynecologists, 2018). Some women wait to have a hysterectomy until after they have completed their families. If you choose another option besides hysterectomy, keep in mind that you may need additional treatment later.

Risks

Although vaginal hysterectomy is generally safe, any surgery has risks. Risks of vaginal hysterectomy include:

• ·               Heavy bleeding
• ·               Blood clots in the legs or lungs
• ·               Infection
• ·               Damage to surrounding organs
• ·               Adverse reaction to anesthetic

Severe endometriosis or scar tissue (pelvic adhesions) might force your surgeon to switch from vaginal hysterectomy to laparoscopic or abdominal hysterectomy during the surgery.

Except in cases of suspected uterine cancer, the surgeon might cut an enlarged uterus into smaller pieces and remove it in sections (morcellation).

What should I expect after having a hysterectomy?

According to the American College of Obstetricians and Gynecologists, 2018, you can expect to have some pain for the first few days after the surgery. You will be given medication to relieve pain. You will have bleeding and discharge from your vagina for several weeks. Sanitary pads can be used after the surgery. Constipation is common after most hysterectomies.

Some women have temporary problems with emptying the bladder after a hysterectomy. Other effects may be emotional. It is not uncommon to have an emotional response to hysterectomy. You may feel depressed that you are no longer able to bear children, or you may be relieved that your former symptoms are gone

What are some important things I should know about recovery?

Follow your health care professional's instructions. Be sure to get plenty of rest, but you also need to move around as often as you can.

• ·        Take short walks and gradually increase the distance you walk every day.
• ·        You should not lift heavy objects until your doctor says you can.
• ·        Do not put anything in your vagina during the first 6 weeks. That includes douching, having sex, and using tampons

After you recover, you should continue to see your health care professional for routine gynecologic exams and general health care. Depending on the reason for your hysterectomy, you still may need pelvic exams and cervical cancer.

References:

American College of Obstetricians and Gynecologists. (2018, October). Hysterectomy. Retrieved from https://www.acog.org/Patients/FAQs/Hysterectomy?

Cleveland Clinic. (2018, June 25). Hysterectomy. Retrieved from https://my.clevelandclinic.org/health/treatments/4852-hysterectomy

National Women’s Health Network (NWHN). (2016, November 28). Hysterectomy. Retrieved from https://www.nwhn.org/hysterectomy/

Mayo Clinic. (2018, December 13). Vaginal hysterectomy. Retrieved from https://www.mayoclinic.org/tests-procedures/vaginal-hysterectomy/about/pac-20384541