Hysterectomy: Side Effects | Everyday Health

The fifth surgical option is an abdominal hysterectomy, the traditional approach. This procedure is the most invasive surgery with the most noticeable scar. In this procedure, the uterus is removed through a large incision in the abdomen — a horizontal cut along the bikini line, or a vertical incision if required.

Over time, any scars from a hysterectomy will usually become lighter in color, but the skin will never look exactly the same. Some women, especially women of color, are prone to keloids, a thickening of the scar tissue, Dr. Bradley says.

2. How much pain should I expect after having a hysterectomy?

Pain also depends on the hysterectomy surgical option you undergo. Most women with a laparoscopic or vaginal hysterectomy experience pain for two to three weeks. Some women have less pain after laparoscopically assisted vaginal hysterectomy than they do after a basic vaginal hysterectomy, according to a research review that appeared in The Journal of Minimally Invasive Gynecology in 2013. With abdominal hysterectomy, pain may last for three to five weeks.

The amount of pain and scarring also depends on what exactly is removed during your hysterectomy, which should be based on your reason for having the procedure, the expertise of your surgeon, and the surgical equipment available. For instance, just your uterus may be removed or your cervix may be taken out as well. Or if you have cervical cancer, for example, you might need a radical hysterectomy, which also takes out tissue on either side of the cervix and the upper part of the vagina. Each of these procedures can have a different effect after surgery when it comes to how much pain you experience.

3. What is the risk for complications after a hysterectomy?

While most women don’t have health problems during or after the surgery, risks may include:

• Injury to nearby organs
• Anesthesia problems, such as breathing or heart problems
• Blood clots in the legs or lungs
• Infection
• Heavy bleeding
• Early menopause, if the ovaries are removed
• Pain during sexual intercourse

Bradley urges women considering a hysterectomy to speak with their doctors about having the most minimally invasive procedure possible, especially those who aren’t at a healthy weight. Overweight women who have abdominal surgery for noncancerous conditions are at greater risk for bleeding and infection than women of normal weight, according to a study in the journal Human Reproduction in 2011. It was also found that underweight women had more complications with laparoscopic and abdominal surgery.

4. Should I expect menopausal symptoms after a hysterectomy?

Menopause occurs when the ovaries stop producing the hormones estrogen and progesterone, which regulate menstruation. Unless you have your ovaries removed during a hysterectomy due to a medical reason, you likely won’t enter early menopause. But while most women don’t experience early menopause after a hysterectomy, some women may, even if they keep one or both ovaries, according to a Duke University study published in the journal Obstetrics & Gynecology in December 2011. Researchers aren’t sure whether it’s the surgery itself or the underlying condition leading to a hysterectomy that brings on early menopause in some cases.

If your doctor feels you’re at risk for ovarian cancer, your ovaries may also be removed, Bradley says, although this isn’t common. And if your ovaries are removed and you were premenopausal, you will likely go into abrupt menopause. Hot flashes, night sweats, and other symptoms may result. Estrogen replacement therapy can help alleviate these hysterectomy-related issues, Bradley says. However, there’s some concern that taking estrogen could raise your breast cancer risk if you’re over 45.

5. Will I still enjoy sex after a hysterectomy?

Women often report better sex after a hysterectomy, Bradley says, because the procedure relieved pain or heavy bleeding, and because they don’t have to worry about a possible unwanted pregnancy anymore. Some women who also have their cervix removed, however, may experience a drop in testosterone and possible sexual dysfunction. Don’t hesitate to discuss the sexual side effects and risks with your doctor before moving forward with a hysterectomy.

Bradley encourages women to work with their doctors to avoid hysterectomy. But when all other treatment alternatives are exhausted, hysterectomy may help — many women are relieved to be out of pain, especially if they’re not concerned about fertility.

Removal of the Uterus Complications & Alternatives

A hysterectomy is a surgery for the removal of a woman’s uterus, also called the womb. This stops a woman’s menstrual cycle and ability to become pregnant. The surgery is more common in the U.S. than anywhere else in the world.

According to the Centers for Disease Control and Prevention, 600,000 women undergo the procedure each year and about 20 million American women have already had it done — making this surgery the second most frequently performed procedure for women in the U.S.

In some cases, this surgery is life-saving and necessary to improve a woman’s quality of life. For instance, women who have uterine cancer or painful uterine fibroids may need to have their uterus removed to improve survival or relieve painful symptoms. Others who have complications from implants such as the Essure Permanent Birth Control may be forced to remove their uterus and fallopian tubes because of extensive damage caused by metal coils in the device.

However, sometimes women have unnecessary hysterectomies that put them at increased risk for a number of other health problems. Complications include hormone imbalance and pelvic organ prolapse, a condition that leads to pelvic organs sagging into the vagina.

Some surgical techniques may put women at risk for future complications. Procedures performed with a surgical tool called a power morcellator may put women at risk for spreading undiagnosed uterine cancer in the abdominal cavity. If transvaginal mesh is used during a hysterectomy, it could erode or perforate organs, causing severe pain and requiring additional surgery.

Women with uterine fibroids, pictured above, may need a hysterectomy to alleviate pain

A study published in the American Journal of Obstetrics and Gynecology in March 2015 questioned the number of hysterectomies performed in the U. S.

For instance, a number of women had their uterus removed for abnormal uterine bleeding when there were alternative therapies that doctors could have tried before surgery.

Before a woman undergoes a hysterectomy, there are a number of factors to consider, including the type of procedure about to be performed, the surgical technique a doctor may recommend and the possible complications.

Fact

Researchers studied the medical records of more than 3,400 women and found that in roughly 1 in 5 women the surgery was unnecessary.

Hysterectomy Complications

Regardless of the type of surgery used, a hysterectomy is considered a major surgical procedure with the possibility of several complications. Major complications are rare, but serious. More experienced surgeons typically have less trouble with complications. Some complications are common, such as infections and bleeding.

Women are usually less aware of other complications, such as the threat of uterine cancer, pelvic organ prolapse or incontinence. The overall rate of these complications is about 1 percent, but some complications can be fatal.

Infection

Infections usually occur in the incision or the top of the vagina, also called the vaginal cuff. While infections usually respond to antibiotics, sometimes more surgery is needed to treat the infection. Patients typically have a 30 percent chance of infection while at the hospital, making it one of the most common complications of hysterectomies.

Pain

About 85 percent of women suffer moderate-to-severe pain after surgery that necessitates pain medication. Some women may have to take highly addictive drugs, such as morphine or fentanyl, for relief.

Blood Loss

The average blood lost during a hysterectomy is roughly the same amount as three menstrual cycles. During an abdominal hysterectomy, it is double that. Women should be aware that a blood transfusion may be necessary.

Organ Damage

The organs surrounding the uterus may be damaged during surgery. For example, the bowel, bladder and urinary tract may be injured. If the bowel is injured, it can be especially troublesome because infection sets in quickly after a bowel injury. Surgeons try to catch injuries during surgery so they can repair the damage.

Early Onset Menopause

Even if a woman retains her ovaries, menopause can come 4 to 5 years earlier in women who have had their uterus removed. Without the uterus, blood flow to the ovaries might be disrupted, preventing them from properly producing hormones.

Psychological Problems

A number of mental changes may occur after a hysterectomy. Some studies found women experience depression, anxiety and decreased sex drive after the operation. Some women may need to take medications to control the symptoms.

Increased Risk of Heart Attack and Stroke

If a woman has the procedure done before her 50s, she is at increased risk of heart attack and stroke.

Urinary or Fecal Incontinence

Frequent urination, incontinence and bowel dysfunctions can also occur, leaving a woman constipated or with fecal incontinence.

Pelvic Organ Prolapse

Without the uterus, pelvic organs may sag into the vagina, a condition known as pelvic organ prolapse. This may require more surgery to repair. Some women may have transvaginal mesh implanted to hold up sagging organs. But these implants carry complications of their own, such as organ perforation and painful sex. Women who have suffered transvaginal mesh complications have filed lawsuits against companies that made the devices.

Increased Risk of Cancer

Some studies connect hysterectomies to several cancers, including thyroid cancer, bladder cancer and renal cancer.

Risk of Spreading Uterine Cancer

Certain surgical techniques may increase the risk of spreading uterine cancer. Cancerous cells can hide in fibroids and other tissues. Without testing fibroids before surgery, it is impossible to tell if cancerous cells are present. A number of women have received surgery with a tool called a power morcellator, a drill-like device that chops up fibroids and uterus tissues into smaller pieces for easy removal but also puts them at risk for spreading of cancer cells. Some women have gone in for a routine operation and come out with stage 3 or 4 uterine cancer.

These are just some of the complications that can occur. Depending on any other health issues a woman may have, she may be at risk for additional complications.

Lawsuit Information

Over 100,000 lawsuits have been filed against transvaginal mesh manufacturers, many of which are still pending. Learn more.

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When Do Doctors Recommend Hysterectomies?

The U.S. Food and Drug Administration’s Office on Women’s Health suggests that a doctor may recommend a hysterectomy in a handful of cases. Keep in mind that there may be alternatives to this surgery even with these conditions. Women should always discuss all options with their doctors.

Uterine Fibroids

Uterine fibroids are benign, noncancerous masses of tissue that grow on the walls of the uterus. For some women, fibroids do not pose much of a problem without treatment. However, some women may suffer pain, discomfort or heavy bleeding. If there are too many fibroids to remove individually, a doctor may recommend removing the uterus. Fibroids are the most common reason women get hysterectomies.

Uterine Prolapse

After several vaginal births, a woman may suffer uterine prolapse — a condition where the uterus slips out of its usual place in the pelvic cavity and sags into the vagina. Obesity and menopause may also cause this problem. If the uterus sinks into the vagina, this can cause bowel and urinary problems, as well as pelvic pain and discomfort, so a hysterectomy may be recommended to address this.

Endometriosis and Adenomyosis

Endometriosis occurs when the lining of the uterus grows outside of the uterus. This can cause heavy periods and pain. Adenomyosis occurs when the lining of the uterus grows inside the wall of the uterus, making the wall overly thick. This causes severe pain and heavy bleeding. In both cases, a hysterectomy may be recommended or indicated.

Cancer

If cancer is present in the ovaries, uterus, cervix or lining of the uterus, a hysterectomy may be the best option for treatment.

Different Types of Hysterectomies

There are three different types of hysterectomies, depending on the amount of the uterus removed.

Total Hysterectomies

The most common type of hysterectomy, it removes the entire uterus, including the cervix. Doctors may or may not remove the fallopian tubes and ovaries as part of this procedure.

Partial Hysterectomies

Removes the upper part of the uterus and leaves the cervix in place. As with a total hysterectomy, the ovaries may or may not be removed.

Radical Hysterectomies

Most often used to treat cervical or other cancers. This procedure removes all of the uterus, the cervix and tissue surrounding the cervix, including part of the vagina. The ovaries and fallopian tubes may or may not be removed.

Some women are not counseled about the differences between total and partial hysterectomies. Doctors may remove the cervix as a precaution without informing the patient.

Sarah Salem-Robinson gives advice to women considering different types of hysterectomies.

How is a Hysterectomy Performed?

Depending on the woman’s health history and reason for surgery, a surgeon will decide on the best type of technique. Each of these has risks and benefits.

Abdominal

In this technique, doctors make a cut about 15 cm in length in the lower abdomen to reach the uterus. One of the drawbacks to this technique is lengthy recovery and a lot of blood loss, but it is the most popular technique performed in the U.S. Surgeons must cut through several layers of fat and muscle and the lining of the abdominal cavity.

Most abdominal hysterectomies are also called total abdominal hysterectomies because doctors choose to remove the cervix and the uterus. Some doctors argue that the cervix should be left in place because its removal may cause problems later on. But studies show that women who keep the cervix may still have a 20 percent chance of spotting. Because of the extensive tissue cutting involved, it takes about 6 to 8 weeks to recover.

Vaginal

Doctors access the cervix and uterus through a small cut in the vagina. After gently cutting the uterus away from surrounding tissues, the surgeon can pull the tissue out through the vagina. The top of the vagina is sutured with sutures that dissolve on their own in 4 to 6 weeks.

There is less pain and no scar on the stomach with a vaginal hysterectomy. Women also recover more quickly from this type of hysterectomy. It generally costs less to perform, but the organs are less visible and doctors may have a more difficult time seeing them during surgery.

Laparoscopic

With advances in surgical technique, many doctors are in favor of a laparoscopic approach, possibly utilizing a robot to allow the doctor to manipulate the instruments. Studies show that this approach leads to less bleeding, less pain and less risk of infection. Many doctors recommend this type of surgery to women who cannot have vaginal hysterectomies.

Doctors insert a laparoscope with a small camera at the end along with several tools through small incisions in the abdomen. Doctors use a monitor to see the inside of the pelvis and make the necessary cuts. Many surgeons use thermal energy to seal blood vessels and cut tissues.

Surgeons can then pull the uterus out of the vagina or through a small incision in the abdominal wall. Women usually recover in about 3 weeks, and patients are usually able to go home the day of surgery.

Some surgeons use a tool called a power morcellator during a laparoscopic hysterectomy. These instruments resemble drills that have long tubes with cutting blades at the end. Surgeons use these devices to chop up pieces of fibroids or chunks of the uterus and suck them out of the pelvic cavity through a small tube. But the FDA has warned that power morcellators may spread undiagnosed uterine cancer that may be hiding in fibroids or other tissues.

If you are considering having a hysterectomy, it is very important that you ask your doctor if he or she will be using a power morcellator.

Alternatives

There are a number of other treatments that may be able to address certain conditions without removing the uterus. Make sure you have an in depth conversation with your doctor about your options.

Uterine prolapse

Instead of removing the uterus, a woman may be able to do Kegel exercises and other pelvic floor therapies that strengthen the pelvic muscles.

Endometriosis

Removal of the endometrial tissue while leaving the uterus intact or oral contraceptives.

LEEP procedure

If precancerous or abnormal cells are in surface tissues or are very light, doctors may be able to do a loop electrosurgical excision procedure. LEEP removes these problematic cells.

Abnormal bleeding

Several things may cause abnormal bleeding, including hormone levels, infection, fibroids or cancer. Some treatments include dilation and curettage, where the lining and contents of the uterus are removed. Medications, hormones and IUDs may be used to treat these conditions without surgery.

Restricting blood flow

Doctors may be able to cut off the blood supply to a fibroid and stop it from growing without removing the entire uterus. Fibroids may also be removed in a procedure called a myomectomy.

As always, patients have the right to a second or third opinion. Before undergoing a major surgery like a hysterectomy, make sure to weigh all the risks and benefits and discuss them with your doctor.

Some Hysterectomies Are Unnecessary

According to some studies, hysterectomies are often overused for benign conditions that may not warrant them.

“For 81 percent of hospitals, at least half of all hysterectomies performed between 2015 and 2017 were unnecessary. 1,167 hospitals performed at least 20 unnecessary hysterectomies between 2015 and 2017, and 495 hospitals performed at least 50,” according to the Lown Institute.

Conditions where a hysterectomy might not be necessary include: Benign uterine fibroids, abnormal pelvic bleeding, pelvic pain and a painful bladder condition called interstitial cystitis.

Hysterectomy and Interstitial Cystitis

Interstitial cystitis symptoms such as pelvic pain and urinary urgency may overlap with other conditions and make IC difficult to diagnose. Because of this, women with undiagnosed IC may have unnecessary hysterectomies, according to Drs. Maurice K. Chung and Barry Jarnagin.

Hysterectomy is a major operation with several potential complications. In contrast, a patient may be able to control IC symptoms with a medication called Elmiron.

Elmiron side effects are typically mild and include: Hair loss, gastrointestinal upset and nausea. However, recent studies have linked Elmiron to a type of eye damage called pigmentary maculopathy that could lead to permanent vision loss.

Before having a hysterectomy, patients should ask their doctors to rule out IC.

Lawsuit Information

People who developed pigmentary maculopathy or other vision problems after taking Elmiron are filing lawsuits. Learn more.

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Side Effects Following a Hysterectomy

A hysterectomy is a major procedure in which a woman’s uterus is removed from the pelvis. This procedure has both physical and emotional side-effects, some of which are detailed below.

Image Credit: Fancy Studio / Shutterstock.com

Menopause

Following a hysterectomy in which the ovaries are retained, the woman can expect to enter menopause within approximately five years. This early arrival of menopause is due to a disturbance in the blood supply to the ovaries that occurs at varying degrees as a result of the procedure.

When the ovaries are removed with the uterus, the woman will experience the onset of menopause immediately afterward, since the normal ovarian function of producing female reproductive hormones has been eliminated.

Taken together, this type of early menopause that is due to the hysterectomy procedure is otherwise known as surgical menopause. Some of the primary symptoms of surgical menopause include:

• Hot flushes
• Sweating
• Vaginal dryness
• Disturbed sleep

If the woman who has undergone the hysterectomy is below the age of 40, she has entered premature menopause. Premature menopause can increase the woman’s risk of osteoporosis, Alzheimer’s disease, and heart disease as a result of the loss of the protective hormone estrogen.

In cases of premature menopause, the treating clinician may prescribe estrogen replacement therapy to alleviate the symptoms or alternative medications to prevent osteoporosis. The presence of certain coexisting medical conditions can determine which therapy is used in these cases. For example, if the woman has a history of liver disease or breast cancer, or has a strong family history of either of these conditions, hormone replacement may not be the best option.

Reduced sexual drive

Since women differ, it is not possible to predict the effect of a hysterectomy on the sexual drive of each individual woman. However, many women report increased enjoyment of sex after a hysterectomy, especially if the operation was done to relieve major bleeding or as a treatment for painful conditions of the uterus. Women who have had as many children as they desire may enjoy the freedom that comes with knowing that they can no longer become pregnant.

However, some women complain of losing interest or enjoyment during intercourse following a hysterectomy, perhaps because the uterine contractions have been lost or there is reduced cervical pressure. Vaginal dryness further complicates the problem, which can make penetration uncomfortable.

In most women, the loss of pleasure is temporary. The use of lubricant gels or hormone replacement therapy may increase their comfort level. Additionally, having an understanding partner is also important for women working through these post-surgical problems.

Hysterectomy (Uterus Removal Surgery): Side Effects,Purpose, Recovery | Yashoda HospitalsPlay

Depression

Some women might feel depressed at the thought that they have lost their uterus or that they are incapable of bearing children. Others might resent the loss of their monthly periods. Regardless of the route of the problem, a hysterectomy may precipitate depression of varying degrees.

Depressive symptoms may include a feeling of loss or of a permanent change in their perceptions of femininity or fertility, the feeling of sadness, a loss of interest in things that they enjoyed previously, and a lack of energy. These symptoms may last for many weeks or months after the surgery. Counseling, whether by a friend, doctor, or support group, can be helpful in this type of situation.

In most women, these depressive symptoms are temporary. Talking to someone who has come through a hysterectomy successfully is often helpful in preparing for the side effects.

Bowel disturbances

After a hysterectomy, some women may complain of constipation. This is usually temporary and may be prevented by increasing the amount of fiber and fruit in the diet. At first, a laxative may be helpful in order to avoid straining when defecating, which might slow down healing. Gentle abdominal pressure may also help to evacuate the bowels more easily in some cases.

Vaginal discharge

A moderate amount of vaginal discharge that is less than what occurs during a monthly period is normal for up to six weeks. However, some women may report heavy bleeding, passing clots, or having a strong-smelling discharge. These may indicate complications of some kind and should be reported to the treating clinician immediately.

Long-term health effects

The loss of ovarian function is most sudden if the ovaries are removed along with the uterus. However, even in cases where the ovaries are not removed, the blood supply to these organs is interrupted by the surgery, leading to their eventual failure to produce female hormones.

The failure to produce these hormones may increase the woman’s risk of bone loss, ischemic heart disease, and/or urinary incontinence. Incontinence is usually temporary and may be averted by regular pelvic floor exercises, which the medical team should advise before the patient is discharged. In cases of incontinence, urinary infections should be avoided by drinking plenty of water.

References

Further Reading

Hysterectomy: Surgery & Recovery

Overview

What is 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.

• A supracervical hysterectomy is the removal of the upper part of the uterus leaving the cervix behind.
• A total hysterectomy is the removal of the uterus and cervix.
• A total hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, cervix, fallopian tubes (salpingo) and ovaries (oophor). If you haven’t experienced menopause, removing the ovaries will usually start it since your body can no longer produce as much estrogen.
• A radical hysterectomy with bilateral salpingo-oophorectomy is the removal of the uterus, cervix, fallopian tubes, ovaries, the upper portion of the vagina and some surrounding tissue, and lymph nodes. A radical hysterectomy may be performed to treat cervical or uterine cancer.

Top image: Pelvic organs before hysterectomy

Bottom image: Pelvic organs after hysterectomy

Why is hysterectomy performed?

A hysterectomy may be performed to treat:

• Abnormal vaginal bleeding that is not controlled by other treatment methods.
• Severe endometriosis (uterine tissue that grows outside the uterus).
• Leiomyomas or uterine fibroids (not cancerous tumors) that have increased in size, are painful or are causing bleeding.
• Increased pelvic pain related to the uterus but not controlled by other treatment.
• Uterine prolapse (uterus that has “dropped” into the vaginal canal due to weakened support muscles) that can lead to urinary incontinence or difficulty with bowel movements.
• Cervical or uterine cancer or abnormalities that may lead to cancer for cancer prevention.

Are there alternatives to hysterectomy?

Yes. A hysterectomy is only one way to treat problems affecting the uterus. For certain conditions, however, hysterectomy may be the best choice. Please ask your healthcare provider to discuss what alternatives are available to treat your specific condition.

Procedure Details

What happens before, during, and after a hysterectomy?

Before the procedure

A healthcare provider will explain the procedure in detail, including possible complications and side effects. He or she will also answer your questions.

In addition:

• Blood and urine tests are taken.
• Hair in the abdominal and pelvic areas may be clipped.
• An intravenous (IV) line is placed in a vein in your arm to deliver medications and fluids.

During the procedure

An anesthesiologist will give you either:

• General anesthesia in which you will not be awake during the procedure; or
• Regional anesthesia (also called epidural or spinal anesthesia) in which medications are placed near the nerves in your lower back to “block” pain while you stay awake .

The surgeon removes the uterus through an incision in your abdomen or vagina. The method used during surgery depends on why you need the surgery and the results of your pelvic exam.

During a vaginal hysterectomy, some doctors use a laparoscope (a procedure called laparoscopically assisted vaginal hysterectomy or LAVH) to help them view the uterus and perform the surgery.

A laparoscope with advanced instruments can also be used to perform hysterectomy completely through tiny incisions (total or supracervical laparoscopic hysterectomy). In more difficult cases, surgeons may employ assistance of robotic instruments placed through the laparoscope to complete the laparoscopic hysterectomy (robotic-assisted laparoscopic hysterectomy).

How long does the procedure last?

The procedure lasts one to three hours. The amount of time you spend in the hospital for recovery varies, depending on the type of surgery performed.

The day of discharge

A responsible adult must drive you home the day you are discharged from the hospital.

Risks / Benefits

What are the complications of hysterectomy?

As with any surgery, there is a slight chance that problems may occur. Problems could include blood clots, severe infection, bleeding after surgery, bowel blockage, urinary tract injury, or problems related to anesthesia.

Recovery and Outlook

What should I know about recovering at home after a hysteretomy?

• You may resume your normal diet, as tolerated.
• You may take a bath or shower. Wash the incision with soap and water (the stitches do not have to be removed, as they will dissolve in about six weeks). A dressing over the incision is not necessary. If skin clips (staples) were used, they will need to be removed by your healthcare provider.
• You may use lotions and creams on the skin around the incision to relieve itching.
• Increase your activity gradually every day, when you feel capable and aren’t in pain. Completely normal activities can be resumed within four to six weeks or sooner if the procedure was performed vaginally or through the laparoscope.
• Drive when you feel capable and are no longer requiring narcotic pain medications — about two weeks after surgery.
• You can travel out of town three weeks after surgery, including air travel.
• Avoid lifting heavy objects (over 10 pounds) for at least four weeks.
• Do not douche or put anything into the vagina for four weeks.
• You may have intercourse six weeks after surgery, or as directed by your healthcare provider.
• Light swimming is permitted two weeks after surgery in a swimming pool, but avoid vigorous swimming until four weeks after surgery.
• Resume your exercise routine in four to six weeks, depending on how you feel.
• Your doctor can tell you when it’s best to go back to work. You can usually go back to work in three to six weeks, depending on the procedure.
• People who undergo a subtotal or partial hysterectomy may continue to have a light period for a year after the procedure. This happens because small amounts of the endometrial lining can remain in the cervix, causing light periods.

How will I feel after hysterectomy?

Physically

After hysterectomy, your periods will stop. Occasionally, you may feel bloated and have symptoms similar to when you were menstruating. It is normal to have light vaginal bleeding or a dark brown discharge for about four to six weeks after surgery.

You may feel discomfort at the incision site for about four weeks, and any redness, bruising or swelling will disappear in four to six weeks. Feeling burning or itching around the incision is normal. You may also experience a numb feeling around the incision and down your leg. This is normal and, if present, usually lasts about two months.

If the ovaries remain, you should not experience hormone-related effects. If the ovaries were removed with the uterus before menopause, you may experience the symptoms that often occur with menopause, such as hot flashes. Your healthcare provider may prescribe hormone replacement therapy to relieve menopausal symptoms.

Emotionally

Emotional reactions to hysterectomy vary, depending on how well you were prepared for the surgery, the reason for having it, and whether the problem has been treated.

Some women may feel a sense of loss or become depressed, but these emotional reactions are usually temporary. Other women may find that hysterectomy improves their health and well-being, and may even be a life-saving operation. Please discuss your emotional concerns with your healthcare provider.

When to Call the Doctor

When should I call my healthcare provider if I have had a hysterectomy?

Call your healthcare provider if you have:

• Bright red vaginal bleeding.
• A fever over 100°F.
• Severe nausea or vomiting.
• Difficulty urinating, burning feeling when urinating, or frequent urination.
• Increasing amount of pain.
• Increasing redness, swelling, or drainage from your incision.

Additional Details

Does hysterectomy affect sexual function?

A woman’s sexual function is usually not affected after hysterectomy, and her sexual desire should not change. Only if the ovaries were removed with the uterus prior to menopause, decreased sex drive may occur and vaginal dryness may be a problem during sex. However, estrogen therapy can relieve vaginal dryness and other hormone-related effects.

Hysterectomy Recovery: What Can You Expect?

After a hysterectomy, you will have a brief recovery time in the hospital. Your recovery time at home — before you can get back to all your regular activities — will vary depending on the procedure you had.

Abdominal hysterectomy. Most women go home 2-3 days after this surgery, but complete recovery takes from six to eight weeks. During this time, you need to rest at home. You shouldn’t do any tasks until you talk with your doctor about restrictions. Don’t do any lifting for the first two weeks. Walking is encouraged, but no heavy lifting. After 6 weeks, you can get back to your regular activities, including having sex.

Vaginal or laparoscopic assisted vaginal hysterectomy (LAVH). A vaginal hysterectomy is less surgically invasive than an abdominal procedure, and recovery can be as short as two weeks. Most women come home the same day or the next. Walking is encouraged, but not heavy lifting. You will need to abstain from sex for at least 6 weeks.

Laparoscopic supracervical hysterectomy (LSH). This procedure is the least invasive and can have a recovery period as short as six days to two weeks. Walking is encouraged, but not heavy lifting.

Robotic hysterectomy. The surgeon’s movements are mimicked by robotic arms that make small incisions to remove the uterus. Most women come home the next day. If the cervix is removed, you will have the same restrictions as you would have for an LAVH.

Call your doctor if you have any of these symptoms with any type of hysterectomy:

Your Hysterectomy Recovery

For most women, life without a uterus means relief from the symptoms that caused them to have a hysterectomy — bleeding, pelvic pain, and abdominal bloating. With relief from those symptoms, women may have better sex — with greater libido, frequency, and enjoyment.

Yet if the ovaries were removed, there are a few more challenges ahead. If you had not gone through menopause before your hysterectomy, you probably will begin having symptoms of menopause — hot flashes and mood swings. Your body is adjusting to changes in hormone levels. You may also have some changes in sexual desire and enjoyment, and vaginal dryness. Most women begin hormone replacement therapy before they leave the hospital, because bodily changes can be so drastic.

You may feel a sense of loss. You may grieve over the loss of your uterus and your ability to have children. If you had surgery because of illness or cancer, you may feel depressed. These feelings are normal. Talk to your doctor and a mental health therapist about them. Most women, however, are happy after their hysterectomy.

Treating Side Effects of Hysterectomy

If your ovaries were removed with the uterus, you may want to consider hormone replacement therapy (HRT) to ease some symptoms. Your age and medical history are factors to consider when deciding on HRT. Talk it over with your doctor. 

There are non-hormonal treatments that can help. Effexor and other SSRI antidepressants, Clonidine (a blood pressure medication), and Neurontin (prescribed for seizures and chronic pain), have been found to be effective in treating hot flashes.

Some women experience pain during intercourse after a hysterectomy. It helps to try different positions and lubricants and moisturizers (like K-Y oils or Replens). A low-dose vaginal estrogen cream, suppository or ring can also help relieve vaginal dryness.

Pelvic weakness sometimes develops after a hysterectomy. If you had some pelvic weakness before surgery, it may get worse afterward — leading to bladder or bowel problems. Kegel exercises can help strengthen pelvic muscles to help control urinary incontinence problems. For some women, corrective surgery is necessary.

Hysterectomy – Complications – NHS

As with all types of surgery, a hysterectomy can sometimes lead to complications.

Some of the possible complications are:

• general anaesthetic complications
• bleeding
• ureter damage
• bladder or bowel damage
• infection
• blood clots
• vaginal problems
• ovary failure
• early menopause

General anaesthetic

It’s very rare for serious complications to happen after having a general anaesthetic (1 in 10,000 anaesthetics given).

Serious complications can include nerve damage, allergic reaction and death.

But death is very rare – there’s a 1 in 100,000 to 1 in 200,000 chance of dying after having a general anaesthetic.

Being fit and healthy before you have an operation reduces your risk of developing complications.

Bleeding

As with all major operations, there’s a small risk of heavy bleeding (haemorrhage) after having a hysterectomy.

If you have heavy bleeding, you may need a blood transfusion.

Ureter damage

The ureter (the tube that urine is passed through) may be damaged during surgery.

This happens in around 1 in every 100 cases. It’s usually repaired during the hysterectomy.

Bladder or bowel damage

In rare cases, there’s damage to abdominal organs such as the bladder or bowel.

This can cause problems such as:

It may be possible to repair any damage during the hysterectomy. You may need a temporary catheter to drain your urine or a colostomy to collect your bowel movements.

Infection

There’s always a risk of an infection after an operation. This could be a wound infection or a urinary tract infection.

These are not usually serious and can be treated with antibiotics.

Blood clots

A blood clot, also known as a thrombosis, can form in a vein and interferes with blood circulation and the flow of oxygen around the body.

The risk of getting blood clots increases after having operations and periods of immobility.

You’ll be encouraged to start moving around as soon as possible after your operation.

You may also be given an injection of a blood-thinning medication (anticoagulant) to reduce the risk of clots.

Vaginal problems

If you have a vaginal hysterectomy, there’s a risk of problems at the top of your vagina where the cervix was removed.

This could range from slow wound healing after the operation to prolapse in later years.

Ovary failure

Even if 1 or both of your ovaries are left intact, they could fail within 5 years of having your hysterectomy.

This is because your ovaries receive some of their blood supply through the womb, which is removed during the operation.

Early menopause

If you have had your ovaries removed, you’ll usually have menopausal symptoms soon after the operation, such as:

• hot flushes
• sweating
• vaginal dryness
• disturbed sleep

This is because the menopause is triggered once you stop producing eggs from your ovaries (ovulating).

This is an important consideration if you’re under the age of 40, as early onset of the menopause can increase your risk of developing weak bones (osteoporosis).

This is because oestrogen levels decrease during the menopause.

Depending on your age and circumstances, you may need to take extra medicine to prevent osteoporosis.

Page last reviewed: 01 February 2019
Next review due: 01 February 2022

Hysterectomy – Better Health Channel

Hysterectomy is the surgical removal of the womb (uterus), with or without the cervix. The operation may also be with or without the removal of the ovaries and the fallopian tubes.

The uterus is a muscular organ of the female body, shaped like an upside-down pear. The lining of the uterus (the endometrium) thickens and, after ovulation, is ready to receive a fertilised ovum (egg). 

If the ovum is unfertilised, the lining comes away as bleeding. This is known as menstruation (period). If the ovum is fertilised, the developing baby is nurtured inside the uterus throughout the nine months of pregnancy.

If a woman has a hysterectomy, she will no longer have menstrual periods or be able to have a child, and will not need to use contraception.

Reasons for a hysterectomy

Conditions that may be treated by hysterectomy include:

• fibroids – non-cancerous growths that form within the muscular walls of the uterus, outside the uterus or within the uterine cavity
• heavy or irregular menstrual periods – however, new techniques now used to treat this include endometrial ablation (which is surgical destruction of the uterus lining) or use of a levonorgestrel-releasing inter-uterine device (IUD)
• severe period pain (dysmenorrhoea) – due to adenomyosis or severe recurrent endometriosis
• cancer of the cervix, uterus, ovaries or fallopian tubes
• endometriosis – a condition in which cells similar to those in the lining of the uterus grow in other areas of the body, especially around the ovaries and peritoneum (lining inside the abdomen) in the pelvis
• adenomyosis – a condition where endometrial-like cells grow in the muscle of the uterus
• prolapse – the uterus falls into the vagina because of loose ligaments or damage to the pelvic floor muscles, usually from childbirth
• pelvic inflammatory disease (acute or chronic PID), caused by bacterial infection, often from sexually transmitted infections (STIs).

Hysterectomy for women of childbearing age

Once a woman has had a hysterectomy of any kind, she cannot become pregnant. If the ovaries of a premenopausal woman are removed, she has had a surgical menopause. This means she will have a drop in production of the sex hormones oestrogen, progesterone and testosterone. Vaginal dryness, hot flushes, sweating and other symptoms of natural menopause may occur.

Women who undergo bilateral oophorectomy (removal of both ovaries) usually take hormone replacement therapy (also called menopause hormone therapy) ,This is also known as oestrogen replacement therapy, as usually only oestrogens are required to maintain their hormone levels and prevent the long-term risks of premature menopause.

Other roles of the uterus and ovaries

The uterus has important functions other than childbearing, including:

• sexuality – the uterus rhythmically contracts during orgasm, contributing to sensations of pleasure
• self-image – the uterus is of great psychological importance to some women for many reasons, including fertility, femininity, sexuality and body image. 

The ovaries play a major role in maintaining the female hormonal system. Their removal results in menopausal symptoms (within 24 hours, oestrogen levels fall by 50 per cent). Therefore, unless diseased, a woman’s ovaries are not usually removed during hysterectomy

Treatments other than hysterectomy

Except if a woman has cancer, doctors recommend that hysterectomy should be a procedure of last resort, when all other treatment options have failed. 

Some conditions that in the past have been treated with hysterectomy, now have alternative treatment options. These include:

• fibroids
• heavy or irregular menstrual periods
• uterine prolapse
• endometriosis.

Fibroids

Fibroids are non-cancerous growths that form within the muscular walls of the uterus. 50 to 70 per cent of women have fibroids. However, most fibroids are small, do not cause symptoms and do not require treatment. For those that do, treatment choice depends on the size, position, and symptoms caused by the fibroids.

Heavy menstrual bleeding

Heavy menstrual bleeding may be due to fibroids, adenomyosis, cancers, bleeding disorders, other medical conditions and also unknown causes. 

Alternative treatment to a hysterectomy for heavy bleeding may include:

• hormone therapies – such as progestins (progesterone-like medications), levonorgestrel -releasing IUDs, etonogestrel-releasing implants and Depo Provera
• combined oral contraceptive pill
• surgery – endometrial ablation.

Since the introduction of the levonorgestrel-releasing IUD and endometrial ablation to treat heavy or irregular periods, hysterectomy rates have reduced.

Uterine prolapse

Alternative treatment to a hysterectomy for uterine prolapse depends on the degree of prolapse, but may include:

• pelvic floor exercises
• the insertion of a pessary into the vagina to prop up the uterus
• surgical repair without hysterectomy.

Endometriosis

For endometriosis, alternative treatment to a hysterectomy may include hormonal therapies, surgical removal of areas of endometriosis, or a combination of both.

Types of hysterectomy

There are five types of hysterectomy:

• total hysterectomy – where the uterus and cervix are removed
• subtotal (partial) hysterectomy – where the uterus is removed, but the cervix is left in place. While removal of the cervix is generally advised because it is a potential cancer site, some women feel that it serves a purpose during penetrative sex. If the cervix is kept, regular cervical screening is still necessary
• hysterectomy and bilateral salpingo-oophorectomy – where the uterus, fallopian tubes and ovaries are removed. This operation is performed if the woman has cancer of the ovaries or the uterus, or for chronic pain due to recurrent pelvic infection or recurrent endometriosis
• radical hysterectomy – the most extensive version of the operation. It involves the removal of the uterus, fallopian tubes, ovaries, upper part of the vagina, and associated pelvic ligaments and lymph nodes. This is performed if the woman has cancer of the cervix, ovaries, fallopian tubes or uterus
• hysterectomy with prophylactic bilateral salpingectomy –most doctors now recommend removing the fallopian tubes at the time of hysterectomy due to research suggesting that early ‘ovarian’ cancers originate in the tubes.

Before choosing a hysterectomy

If, after talking about all the options with your doctor, you choose to have a hysterectomy, your doctor should discuss several things with you before the operation. These include:

• your medical history – as some pre-existing conditions may influence decisions on surgery and anaesthetics
• the pros and cons of abdominal (open or laparoscopic) surgery versus vaginal surgery
• your support options after surgery
• your feelings about the surgery. 

You will have a range of tests before your hysterectomy, including a complete blood-count test to check for problems such as anaemia (deficiency in red blood cells or haemoglobin).

Hysterectomy operation

The operation may be performed via an incision (cut) in your lower abdomen (abdominal hysterectomy), three to four small incisions in your abdomen (laparoscopic hysterectomy), or through your vagina (vaginal hysterectomy). 

Abdominal hysterectomy

For an abdominal hysterectomy, the surgeon usually makes a horizontal cut along your pubic hairline (your pubic hair may have been shaved around the incision). For most women, this leaves a small scar. Some women may need a vertical midline incision in the lower abdomen, especially if the hysterectomy is for a large uterine fibroid. 

An abdominal hysterectomy is generally recommended when a woman has very large fibroids or cancer.

Laparoscopic hysterectomy

For a laparoscopic hysterectomy, the surgeon inserts a telescope (laparoscope) to see your pelvic organs through a small incision in your navel, and makes another three or four small incisions through which other instruments are used. Carbon dioxide gas is used to distend (inflate) your abdomen, like a balloon, so all of your organs can be clearly seen.

The surgeon then removes the uterus, with or without fallopian tubes and ovaries, through the vagina. If the top of the vagina is sutured (stitched) through keyhole incisions, the operation is called a total laparoscopic hysterectomy. If the gynaecologist stitches the top of the vagina through the vagina, it is called a laparoscopically assisted vaginal hysterectomy.

This type of hysterectomy may be performed with the aid of a robot.

Vaginal hysterectomy

A vaginal hysterectomy is performed through an incision at the top of the vagina. It is usually performed where there is a uterine prolapse (the cervix and uterus come down into the vagina, or protrude out of the vaginal entrance). 

After a hysterectomy

Immediately after a hysterectomy operation, you can expect to:

• wake up in the recovery room
• feel some soreness around the operation site – you will be given pain-relieving medication to enable you to maintain some mobility
• experience wind pain for a few days
• have the intravenous (IV) tube removed from your arm sometime during the first few days, depending on the procedure and your condition
• have the catheter (drainage tube) removed from your bladder within 24 hours of surgery, unless your bladder was traumatised during surgery, then it will remain in longer
• be encouraged to get out of bed and go for short walks around the hospital ward as soon as possible (for this reason, adequate pain relief is very important)
• stay in hospital for two to four days, depending on the type of surgery, sometimes longer.

With good pain relief, recovery may be similar for all forms of the hysterectomy. (Although, more care is required regarding the pelvic floor, urination and bowel function after vaginal hysterectomy.)

It is important to start pelvic floor and abdominal exercises within the first few weeks after surgery. These exercises strengthen the muscles in your pelvis, and help maintain normal bladder function and vaginal muscle tone. Your doctor or physiotherapist will let you know how soon you can start these particular exercises.

Hysterectomy – potential complications

The possible complications of a hysterectomy include:

• a reaction to the anaesthetic during the operation, which may be due to allergy
• nausea and vomiting – post-anaesthetic or medication induced – for the first one to three days
• infection
• internal haemorrhage (internal bleeding)
• build-up of blood beneath the stitches (haematoma) or in the abdomen
• internal scar tissue
• blood clots (for example, thrombosis, deep vein thrombosis or pulmonary embolism)
• difficulties with urination
• injury to the bowel, bladder or ureters (tubes that carry urine from the kidneys to the bladder) – rare
• fistula (abnormal hole between internal structures, such as the bowel and vagina) – rare
• vaginal vault prolapse (when the top of the vaginal wall sags or bulges down)
• decreased sexual desire (or you may have an increase in sexual desire due to the treatment of your symptoms)
• constant pelvic pain – rare, and post-operatively usually shows improvement
• feelings of grief and loss – if not counselled appropriately before the hysterectomy.

Self-care after hysterectomy

Be guided by your doctor, but general suggestions for the four to six-week post-operative period include: 

• rest – try to rest as much as possible for at least two weeks. You should avoid driving during this time. Always rest lying down
• exercise – continue with the exercises you were shown in hospital. You should aim to go for a walk each day, unless advised otherwise by your doctor
• standing – avoid standing for more than a few minutes at a time in the early post-operative period. You can increase standing time as your recovery progresses
• lifting – avoid heavy lifting and stretching
• constipation – to avoid constipation, drink plenty of fluids and eat fresh fruits and vegetables. You may be advised to take stool softeners for the first few days
• medication – if you have been prescribed antibiotics, make sure you take the full course, even if you feel well
• sex – it is advised that you avoid vaginal sex until after the post-operative check (about four to six weeks after the operation) to make sure the vagina is fully healed. If vaginal dryness is a problem, it may be helpful to use a lubricant, or sweet almond oil or olive oil.

Long-term outlook after hysterectomy

After hysterectomy, you will no longer need contraception or have menstrual periods. If your ovaries were removed, you may experience menopause symptoms starting within a few days of your surgery. 

If you were still having periods before your hysterectomy, your doctor should discuss oestrogen replacement therapy or other options with you. How long you might need oestrogen replacement therapy will depend on your age.

Hysterectomy can be an effective treatment for gynaecological conditions such as fibroids, endometriosis and adenomyosis, though sometimes endometriosis may recur. 

If you have had a hysterectomy to treat cancer, depending on the stage of the cancer you will need to have regular check-ups to make sure you are cancer free. You may need to have a regular vault smear test – similar to a cervical screening test but involving cells from the top of your vagina instead of the cervix.

If you have had a subtotal hysterectomy (uterus removed but cervix retained) then you will need to continue having cervical screening.

Where to get help

• Your GP
• Gynaecologist
• Local women’s health centre
• Community health centre
• Family planning clinic

Removal of the uterus, or hysterectomy | Ida-Tallinna Keskhaigla

The purpose of this fact sheet is to provide the patient with information about the nature, indications and surgical methods of removing the uterus, or hysterectomy, the risks that may be associated with this operation, as well as how the removal of the uterus has on the future life of a woman.

Hysterectomy is a surgical removal of the uterus, after which it is impossible to get pregnant and give birth to a baby.

Indications for operation

Operation to remove the uterus is indicated in the following cases:

• benign tumors of the uterus;

• malignant neoplasms of the uterus, cervix or ovaries;

• severe inflammatory diseases of the female genital organs;

• profuse, frequent vaginal bleeding, refractory to treatment.

Removal of uterus

Removal of the uterus can be partial or complete. The scope of the operation is determined by the operating physician, depending on the patient’s illness and state of health.

Partial removal of the uterus, or amputation of the uterus, is the removal of the upper body of the uterus; in this case, the cervix remains.

In case of complete removal of the uterus, it is removed together with the cervix.

In malignant neoplasms, the uterus is removed along with the cervix and surrounding tissues, including the ovaries, fallopian tubes and pelvic lymph nodes.

In the case of a benign tumor, the doctor decides whether to remove the ovaries and fallopian tubes.

Before surgery

If you have a chronic medical condition (eg hypertension, cardiac arrhythmia, diabetes, asthma), the operation may be associated with an increased risk, and you should consult with an anesthesiologist before the operation.

It is important to inform the attending physician about the past illnesses and medications that you regularly take.Particular attention should be paid to anticoagulants, the intake of which for some time before the operation must be stopped or switched to another medication in order to reduce the risk of bleeding during the operation. You may also need to change your diabetes medication dose. This decision will be made by your doctor.

All medicines taken daily must be taken with you to the hospital.

Preparation for operation

Take a shower early in the morning of your surgery. To avoid complications related to anesthesia , you must not eat for at least six and do not drink for at least four hours before the operation.You should also stop smoking and chewing gum six hours before your surgery. If acidic stomach contents (undigested food or drink) enter the lungs during anesthesia, it can be life-threatening. Medicines can be taken with a little water.

In order to reduce the risk of complications, before the operation, we ask you to inform the doctor about:

• the state of their health;

• all diseases;

• constantly taken medications;

• known drug hypersensitivity.

Operation Description

The operation is performed by a gynecologist.

The uterus can be removed in three different ways:

• open abdominal surgery;

• through the vagina;

• laparoscopically.

In the case of open abdominal surgery , an incision is made longitudinally or transversely through the abdominal tissue and the uterus is removed through the incision made.In this case, it is necessary to stay in the hospital for up to five days, and after healing, a visible scar remains on the abdomen.

At operations through the vagina an incision is made and the abdominal cavity is penetrated through the vagina. The uterus is removed through a vaginal incision; after the operation, the wound is closed with sutures, there are no visible scars on the abdomen.

At laparoscopy , a small incision is made on the anterior wall of the abdomen in the navel area, the abdominal cavity is filled with carbon dioxide using a special needle, and a laparoscope is inserted into the abdominal cavity, with which it is examined.On the anterior wall of the abdomen, another 1–3 small incisions are made for inserting surgical instruments. The uterus can be removed from the abdomen in portions through small incisions in the abdomen or through the vagina. After the uterus is removed, the surgical instruments are removed, the gas is released from the abdominal cavity, and the incisions are sutured.

Benefits of laparoscopy

With laparoscopy, postoperative recovery is faster, hospital stays are shorter, and surgical trauma is reduced.Postoperative pain is also less and the risk of inflammation is lower compared to open abdominal surgery. With laparoscopy, you can return to normal physical activity after 3-4 weeks, and after open abdominal surgery after about two months.

Influence of removal of the uterus on the later life of a woman

Changes in the body after surgery largely depend on your age and the degree of removal of the uterus.

Pain is normal for several days after surgery.You will be given pain relievers to relieve pain.

Mild bleeding or dirty vaginal discharge may occur for several weeks after surgery. Constipation is common; it can be avoided with diet and intestinal softening medications. Some women may have temporary difficulty urinating or having difficulty emptying the bladder.

When recovering from surgery, it is important to follow the recommendations of your doctor.It is important to get plenty of rest and move as much as possible. Take short walks at first and gradually increase them as you feel better.

For four weeks after surgery:

Within six to eight weeks after surgery:

Some women who have undergone partial removal of the uterus and have a remaining cervix may continue to have moderate menstrual bleeding due to a small amount of uterine lining remaining on the cervix.

If you are of childbearing age and the ovaries are not removed along with the uterus, then normal hormonal regulation will remain, and your ovaries will continue to function: follicles will ripen and ovulation will occur. Often, premenstrual syndrome persists, even if menstruation is gone. Menopause will occur at a time when it could have occurred without surgery, usually around age 50.

If the uterus is removed with the ovaries before the onset of natural menopause, it will lead to a decrease in the production of female hormones and menopause, which can manifest itself in the form of unpleasant symptoms such as night sweats, hot flashes, mood swings and sleep disturbances.Over time,

may also occur

dry skin and mucous membranes and thinning of bones. If these changes worsen the quality of your life and, if your health condition allows, the doctor may prescribe you hormone replacement therapy.

Removal of the uterus from a woman during menopause does not bring significant new symptoms.

The presence of a uterus does not determine libido or interest in sexuality. Libido is determined by androgenic hormones, which are formed in the adrenal glands and in small quantities in the ovaries, so the sexuality after the removal of the uterus remains the same as it was before the operation.

Possible complications

Removal of the uterus carries a small risk of serious complications:

• profuse bleeding during surgery;

• bleeding after surgery;

• increased blood clotting and the occurrence of a blood clot;

• postoperative inflammation;

• Injury of the bladder, ureter or intestines;

• intestinal blockage;

• serious, life-threatening reaction to anesthetic drugs.

After removal of the uterus, it may develop:

• urinary incontinence;

• prolapse of the pelvic organs;

• chronic pain;

• vaginal fistula, or fistula with the bladder or intestines.

ITK1026
The information material was approved by the Health Service Quality Commission of the East Tallinn Central Hospital on March 24, 2021 (protocol No. 5-21).

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Surgical / gynecology | ChUZ “KB” Russian Railways-Medicine “Voronezh “

Laparotomy, total hysterectomy – 2nd category of complexity

In most cases, a transverse suprapubic approach (according to Pfannenstiel) is used for hysterectomy.Total hysterectomy – is a surgical intervention in which the entire uterus and the body and cervix are removed. This volume of surgery has to be resorted to when the pathology of the body and cervix is ​​combined, for example, with multiple cysts and precancerous changes in the cervix. In some cases, together with the body of the uterus, the surgeon removes the fallopian tubes, ovaries.

The decision on the amount of surgery is made by the gynecologist at the preoperative consultation.

Indications: The main indication for total hysterectomy is the combination of pathology of the body of the uterus with pathology of the cervix. 1. Malignant neoplasms of the uterus and appendages. 2. Myoma (leiomyoma, fibromyoma)

– Fibroids larger than 12 weeks of gestation.

– Rapid progressive growth of uterine fibroids.

– Multiple myomatous nodes.

– Myoma, accompanied by profuse uterine bleeding, leading to anemia.

– Myoma with questionable biopsy results (suspected malignancy).

3. Endometriosis of the uterus (adenomyosis) 3-4 degrees, not amenable to conservative treatment.

4. Recurrent endometrial hyperplasia, atypical hyperplasia.

5. Complete prolapse of the uterus. 6. Precancerous diseases of the cervix.

Surgery examination and validity of examination results: You can undergo the entire volume of preoperative examination at the Paracelsus Multidisciplinary Clinic in one day!

• – colposcopy-12 months
• – Ultrasound of the pelvic organs
• – Ultrasound of the kidneys, bladder, retroperitoneal space.
• – Ultrasound of the veins of the lower extremities – 3 months
• – Swab for flora, bacteriological culture from the cervical canal -10 days
• – oncocytology from the cervix – 6 months
• – General urine analysis-10 days,
• – Complete blood count and reticulocytes -10 days,
• – Electrocardiogram with decoding -14 days,
• – Blood for HIV, Hepatitis B, Hepatitis C, Syphilis 3 months.
• – Biochemical blood test: general, direct, indirect Bilir., Total protein, albumin, urea, glucose, creatinine, uric acid, AST, ALT, alkaline phosphatase, blood sodium and potassium, cholesterol, blood pH -10dn
• – Coagulogram – 10days
• – Blood group and Rh factor
• – Fluorography – 6 months.
• – Mammography -24 months (after 36 years), 12 months (after 50 years)
• – Consultation of a therapist, anesthesiologist and other specialists according to indications.

Other examinations can be added according to indications.

Anesthesia: These operations are performed under spinal anesthesia or under endotracheal anesthesia. The method of pain relief is chosen jointly by the anesthesiologist and the surgeon, of course, taking into account the wishes of the patient.

Contraindications:

Planned intervention is not performed for clinically significant bleeding disorders, acute infections, decompensated somatic diseases (hypertension, unstable angina pectoris, severe diabetes mellitus, severe anemia).

Sexual life after hysterectomy. One of the most important questions of interest to patients before planning a hysterectomy is the effect of the operation on their sexual life. Surgeons suggest abstaining from sexual activity for at least 6 to 8 weeks after hysterectomy. After this time, intercourse should not cause pain or discomfort. Sexual activity after hysterectomy has been extensively studied. It has been proven that hysterectomy does not lead to significant changes in sex drive or the ability to enjoy sex.Most women who have a healthy sex life can return to their pre-operative level of activity. Some women become more interested in sex after surgery, especially those with clinical manifestations of uterine disease. Studies have shown that the ability to have an orgasm during intercourse does not change after surgery. Women should not be afraid to remove the uterus and ignore the doctor’s orders. In some cases, this is the only option not only to get rid of the disease, but also to save lives.