What are the major side effects of a total hysterectomy. Why might someone need this procedure. How does a hysterectomy impact a person’s life. What are the alternatives to hysterectomy for various conditions. How common is hysterectomy in the United States. What should patients expect after undergoing a hysterectomy.

Understanding Total Hysterectomy: A Common Surgical Procedure

A total hysterectomy is a surgical procedure that involves the removal of the uterus, and in some cases, the fallopian tubes and ovaries. It’s a significant operation that can have far-reaching effects on a person’s health and well-being. In the United States, hysterectomy is the second most common surgery performed on women, following cesarean delivery, with nearly 600,000 procedures conducted annually.

The decision to undergo a hysterectomy is not taken lightly, and it’s essential to understand the reasons, potential side effects, and alternatives before proceeding. This comprehensive guide will explore various aspects of total hysterectomy, providing valuable insights for those considering or scheduled for this procedure.

Common Reasons for Undergoing a Total Hysterectomy

There are several medical conditions that may necessitate a hysterectomy. Understanding these reasons can help patients make informed decisions about their healthcare. Here are some of the most common indications for a total hysterectomy:

Uterine Fibroids

Uterine fibroids are non-cancerous growths that develop in the uterus. They can cause heavy bleeding, pain, and abdominal distension. In some cases, fibroids may affect fertility. While medications and less invasive procedures like myomectomy are often tried first, a hysterectomy may be recommended if these treatments prove ineffective or if fibroids continue to regrow and produce symptoms.

Gynecological Cancers

Approximately 10% of all hysterectomies are performed due to cancer. This may include cancers of the uterus, ovary, cervix, or endometrium. The decision to perform a hysterectomy in cancer cases depends on the type and stage of cancer, as well as the patient’s overall health. In some instances, a hysterectomy may be recommended for precancerous conditions or as a diagnostic tool when cancer is suspected.

Endometriosis

Endometriosis occurs when tissue similar to the uterine lining grows outside the uterus. This condition can cause severe pain, irregular periods, and infertility. While hormone therapy and surgical removal of endometrial tissue are usually attempted first, a hysterectomy may be considered if these treatments fail to provide relief.

Adenomyosis

Adenomyosis is a condition where the uterine lining grows into the muscle of the uterus, causing the uterine wall to thicken. This can lead to pain and heavy bleeding. Although adenomyosis often resolves after menopause, a hysterectomy may be recommended for severe cases that don’t respond to hormone therapies or pain medication.

Pelvic Inflammatory Disease (PID)

PID is a bacterial infection that can cause severe pelvic pain. While early detection usually allows for treatment with antibiotics, advanced cases that have damaged the uterus may require a hysterectomy.

Uterine Prolapse

Uterine prolapse occurs when the uterus slips from its normal position and descends into the vagina. This condition is more common in individuals who have had multiple vaginal births, those with obesity, or those who have gone through menopause. Severe cases of uterine prolapse that don’t respond to conservative treatments may necessitate a hysterectomy.

Side Effects and Potential Risks of Total Hysterectomy

While a hysterectomy can provide relief from various gynecological conditions, it’s important to be aware of the potential side effects and risks associated with the procedure. These can vary depending on the type of hysterectomy performed and individual factors.

Immediate Post-Operative Effects

• Pain and discomfort at the incision site
• Vaginal bleeding and discharge
• Fatigue
• Constipation
• Urinary retention or incontinence

Long-Term Effects

• Cessation of menstrual periods
• Inability to become pregnant
• Hormonal changes (if ovaries are removed)
• Potential for early onset of menopause
• Changes in sexual function or libido
• Increased risk of osteoporosis and heart disease (if ovaries are removed before natural menopause)

Potential Complications

• Infection
• Excessive bleeding
• Damage to surrounding organs (bladder, bowel, ureters)
• Blood clots
• Adverse reaction to anesthesia
• Pelvic floor weakness

Is a hysterectomy always the best option? While a hysterectomy can effectively treat many gynecological conditions, it’s not always the first or only choice. Depending on the specific condition and its severity, alternatives such as medication, hormone therapy, or less invasive surgical procedures may be considered. It’s crucial to discuss all available options with a healthcare provider to determine the most appropriate treatment approach.

Preparing for a Total Hysterectomy: What to Expect

Proper preparation can help ensure a smoother surgery and recovery process. Here are some key steps to take when preparing for a total hysterectomy:

1. Undergo pre-operative tests and evaluations as recommended by your healthcare provider.
2. Discuss any medications you’re currently taking and whether they need to be adjusted before surgery.
3. Stop smoking and limit alcohol consumption to promote better healing.
4. Arrange for help at home during your recovery period.
5. Prepare your home environment for your return, ensuring easy access to necessities.
6. Follow any fasting or bowel preparation instructions provided by your surgeon.
7. Pack a hospital bag with comfortable clothing and personal items.

How long does recovery from a total hysterectomy typically take? Recovery time can vary depending on the type of hysterectomy performed and individual factors. Generally, patients can expect to stay in the hospital for 1-3 days following the procedure. Full recovery may take 4-6 weeks for abdominal hysterectomy, or 3-4 weeks for vaginal or laparoscopic hysterectomy. However, it’s important to follow your doctor’s specific instructions and avoid strenuous activities until cleared to do so.

Life After Hysterectomy: Adjusting to Changes

Undergoing a total hysterectomy can bring about significant changes in a person’s life. It’s important to be prepared for these changes and to have support systems in place. Here are some aspects of life that may be affected after a hysterectomy:

Hormonal Changes

If the ovaries are removed along with the uterus (a procedure known as oophorectomy), you will experience immediate menopause. This can lead to symptoms such as hot flashes, night sweats, and mood changes. Hormone replacement therapy may be recommended to manage these symptoms.

Emotional and Psychological Impact

Some individuals may experience feelings of loss or sadness after a hysterectomy, particularly if they had hoped to have children. It’s important to acknowledge these feelings and seek support if needed, whether through counseling or support groups.

Sexual Function

While many people report improved sexual function after a hysterectomy due to relief from pain or heavy bleeding, others may experience changes in sensation or libido. Open communication with partners and healthcare providers is crucial in addressing any concerns.

Bone and Heart Health

If the ovaries are removed before natural menopause, there may be an increased risk of osteoporosis and heart disease. Regular exercise, a healthy diet, and potentially hormone therapy can help mitigate these risks.

How can one maintain optimal health after a hysterectomy? Maintaining a healthy lifestyle is crucial after a hysterectomy. This includes regular exercise, a balanced diet rich in calcium and vitamin D, stress management techniques, and regular check-ups with your healthcare provider. If hormone replacement therapy is recommended, it’s important to follow the prescribed regimen and discuss any concerns with your doctor.

Alternatives to Hysterectomy: Exploring Other Options

While a hysterectomy may be necessary in some cases, there are often alternative treatments available depending on the underlying condition. It’s important to discuss these options with your healthcare provider to determine the most appropriate course of action. Some alternatives to hysterectomy include:

Medication and Hormone Therapy

For conditions such as endometriosis, adenomyosis, or heavy menstrual bleeding, hormonal treatments like birth control pills or progesterone therapy may be effective. Non-hormonal medications like tranexamic acid can also help manage heavy bleeding.

Minimally Invasive Procedures

• Endometrial ablation: A procedure that destroys the uterine lining to reduce or stop menstrual flow.
• Uterine artery embolization: A technique used to shrink fibroids by cutting off their blood supply.
• Myomectomy: Surgical removal of fibroids while leaving the uterus intact.
• Hysteroscopy: A procedure to remove polyps or small fibroids through the cervix.

Pelvic Floor Exercises

For mild cases of uterine prolapse, pelvic floor exercises (Kegels) may help strengthen the supporting muscles and improve symptoms.

Watchful Waiting

In some cases, particularly for conditions that may improve with time (such as fibroids after menopause), your doctor may recommend monitoring the condition closely without immediate intervention.

What factors should be considered when choosing between a hysterectomy and alternative treatments? The decision between a hysterectomy and alternative treatments depends on various factors, including the severity of symptoms, the underlying condition, age, desire for future pregnancies, and overall health. It’s crucial to have a thorough discussion with your healthcare provider about the benefits and risks of each option, as well as your personal preferences and goals.

Hysterectomy as Part of Gender-Affirming Care

It’s important to note that hysterectomy can also be a part of gender-affirming care for transgender and non-binary individuals. For those assigned female at birth who are transitioning or who identify as male or non-binary, a hysterectomy may be an important step in aligning their physical body with their gender identity.

Considerations for Gender-Affirming Hysterectomy

• The decision to undergo a hysterectomy should be made in consultation with healthcare providers experienced in transgender health.
• Hormone therapy and its effects on reproductive organs should be discussed.
• The impact on fertility and future reproductive options should be carefully considered.
• Psychological support and counseling may be beneficial before and after the procedure.

How does a hysterectomy fit into the broader spectrum of gender-affirming surgeries? A hysterectomy is often one of several procedures that may be part of gender-affirming care. It may be performed alongside other surgeries such as oophorectomy (removal of ovaries) or top surgery (chest masculinization). The specific combination of procedures will depend on the individual’s goals and medical considerations. It’s crucial to work with a team of healthcare providers who are knowledgeable about transgender health to create a comprehensive care plan.

The Future of Hysterectomy: Advances in Surgical Techniques

As medical technology continues to advance, new surgical techniques for hysterectomy are being developed and refined. These innovations aim to improve outcomes, reduce recovery time, and minimize potential complications. Some of the recent advancements in hysterectomy procedures include:

Robotic-Assisted Laparoscopic Hysterectomy

This technique uses robotic arms controlled by a surgeon to perform the hysterectomy through small incisions. It offers increased precision and may be particularly beneficial for complex cases.

Single-Incision Laparoscopic Hysterectomy

This minimally invasive approach uses a single small incision, typically in the navel, to perform the hysterectomy. It may result in less postoperative pain and improved cosmetic outcomes.

Natural Orifice Transluminal Endoscopic Surgery (NOTES)

This experimental technique involves performing the hysterectomy through natural body openings, eliminating the need for external incisions. While still in development, it holds promise for even less invasive surgery in the future.

Improved Tissue Sealing and Cutting Devices

Advancements in surgical instruments allow for more precise cutting and sealing of blood vessels, potentially reducing blood loss and operating time.

How might these advancements impact the future of hysterectomy procedures? As these new techniques continue to evolve and become more widely available, they may offer patients more options for less invasive surgery with potentially faster recovery times and fewer complications. However, it’s important to note that the best surgical approach will still depend on individual factors such as the reason for the hysterectomy, overall health, and surgeon expertise. Patients should discuss the available options with their healthcare provider to determine the most appropriate approach for their specific situation.

In conclusion, a total hysterectomy is a major surgical procedure that can significantly impact a person’s life. While it can provide relief from various gynecological conditions, it’s crucial to understand the potential side effects, risks, and alternatives before making a decision. By working closely with healthcare providers, considering all available options, and preparing adequately for the procedure and recovery, patients can navigate the hysterectomy process with confidence and make informed choices about their health.

Considerations and What to Expect

People may have a hysterectomy due to health conditions like fibroids, endometriosis, or cancer. It may also be part of gender-affirming care.

A hysterectomy is a surgery to remove your uterus. Sometimes, doctors will also remove your fallopian tubes and ovaries during a hysterectomy. After a hysterectomy, you won’t have periods and won’t be able to get pregnant.

A hysterectomy is the second most common surgery performed on women in the United States after cesarean delivery. Each year, nearly 600,000 hysterectomies are done. There are many reasons your doctor may recommend a hysterectomy. Read on to learn more about why you might need a hysterectomy and what risks are involved.

Uterine fibroids are noncancerous growths that form in the uterus. They’re one of the most common reasons for a hysterectomy.

Fibroids can cause heavy bleeding, pain, or stomach distention. They may also affect fertility.

Your doctor may first recommend medications, such as oral birth control pills, or other less-invasive procedures, such as a myomectomy, to treat fibroids. A myomectomy removes only the fibroids and leaves the uterus intact.

If other measures aren’t effective or fibroids continue to regrow and produce symptoms, a hysterectomy may be an option.

Cancer is the reason for about 10 percent of all hysterectomies.

Your doctor may recommend a hysterectomy if you have cancer of the:

• uterus
• ovary
• cervix
• endometrium

Your treatment approach will depend on the type of cancer you have, how advanced it is, and your overall health. Other options may include chemotherapy and radiation.

Sometimes, doctors recommend surgery if you have precancerous conditions or if they suspect cancer. In some cases, removing the uterus may be a safer way to diagnose cancer than through a biopsy on an intact uterus.

You may also opt to have a hysterectomy to reduce your risk of developing cancer in the future if you have Lynch syndrome. This is an inherited condition that can increase your risk of colon, uterine, and other cancers.

If you test positive for the BRCA gene, you don’t necessarily need a hysterectomy. People with this gene may have an increased risk for ovarian and breast cancers, so doctors may just recommend the removal of ovaries and fallopian tubes.

Endometriosis is a condition where tissue that normally lines the uterus grows outside of it. Endometriosis can cause extreme pain and irregular periods. It can also lead to infertility.

Doctors usually recommend hormone therapy or medical procedures to remove endometrial tissue before a hysterectomy.

A hysterectomy can often reduce or eliminate symptoms from endometriosis, but it’s still possible for endometriosis to recur following hysterectomy. It’s important to discuss the pros and cons of this treatment option with your doctor before having surgery.

Adenomyosis happens when the lining of the uterus grows into the muscle of the uterus. This causes the uterine wall to thicken, which leads to pain and heavy bleeding.

This condition often goes away after menopause, but if your symptoms are severe, you may require treatment sooner.

Hormone therapies and pain medication are usually tried first. If they don’t work, a hysterectomy may be an option.

Pelvic Inflammatory disease (PID) is a bacterial infection that can lead to severe pelvic pain.

When found early, PID can usually be treated with antibiotics. But it can damage the uterus if it spreads.

Your doctor may recommend a hysterectomy if you have severe PID.

Hyperplasia means the lining of your uterus is too thick. This condition may be caused by having too much estrogen.

In some cases, hyperplasia can lead to uterine cancer.

Hyperplasia can cause heavy, irregular menstrual bleeding.

Typically, treatment options include different types of hormone therapies. If your hyperplasia is severe or your doctor suspects it may develop into cancer, they may recommend a hysterectomy.

You might benefit from a hysterectomy if you regularly experience heavy or irregular menstrual bleeding.

Irregular bleeding can be caused by:

• fibroids
• infection
• hormone changes
• cancer
• other conditions

It can be accompanied by stomach cramps and pain.

Removing the uterus is sometimes the only way to find relief from heavy bleeding. Other treatments, such as hormone therapy, are usually tried first.

Uterine prolapse happens when your uterus slips from its usual place and falls into the vagina. This condition is more common in those who’ve had multiple vaginal births. It can also affect people with obesity or who have gone through menopause.

Common symptoms with uterine prolapse are:

• pelvic pressure
• urinary issues
• bowel problems

Treatment options often depend on how severe the prolapse is. Certain exercises and devices can be used at home. In some cases, doctors can repair the weakened pelvic tissues with minimally invasive surgery.

If these measures don’t work or aren’t good options, a hysterectomy may be the treatment of choice.

Sometimes, a hysterectomy is performed within 24 hours after vaginal or cesarean delivery. Certain complications, such as severe bleeding, may mean your doctor has to take out your uterus.

This outcome is very rare, but it can be lifesaving.

Placenta accreta happens during pregnancy when the placenta grows too deeply into the uterine wall. This condition can be very serious, but it often doesn’t cause symptoms.

In almost all cases of placenta accreta, the doctor will perform a cesarean delivery followed by a hysterectomy to prevent blood loss that happens when the placenta separates.

A transgender person may choose to have a hysterectomy. They may decide to only remove the uterus or to remove the uterus and ovaries.

Your doctor can help walk you through the different procedures and possible complications.

Some insurance providers will cover gender affirming hysterectomies. If you have insurance, it’s a good idea to review your policy and confirm your coverage with your provider. They can help you understand if and when hysterectomies are covered.

There are several types of hysterectomy. The type your doctor recommends will depend a lot on the reason you’re having a hysterectomy.

Types of hysterectomy include:

• Partial hysterectomy. With this type, a portion of your uterus is removed, and your cervix, ovaries, and fallopian tubes are left intact.
• Total hysterectomy. Your doctor will remove your entire uterus and your cervix. They may also remove your fallopian tube while leaving your ovaries intact. Removing your fallopian tubes and cervix may reduce your risk for certain cancers.
• Hysterectomy and salpingo-oophorectomy. With this procedure, your doctor will remove your uterus and one or both ovaries along with your fallopian tubes. You may require hormone treatment following this type of hysterectomy.

In addition to different types of hysterectomy, there are also different surgical procedures or methods to remove the uterus. The actual procedure your doctor recommends will depend on your reason for having a hysterectomy.

Your doctor might go through your abdomen or your vagina to get to your uterus. The procedure can be done as a laparoscopic, robotic, or open surgery. If you have open surgery, your doctor may do either a vertical or a horizontal incision.

Discuss all of your surgical options with your doctor ahead of time. Depending on the type of surgery, you may have an increased risk of some side effects or complications.

While a hysterectomy is considered one of the safest surgeries, there are risks involved with any procedure.

Potential side effects or complications may include:

• infection
• heavy bleeding during or after the procedure
• injury to other organs
• blood clots
• breathing or heart complications from anesthesia
• bowel blockage
• trouble urinating
• death

Serious complications are more common in abdominal hysterectomies compared to other, less invasive types. Remember, after a hysterectomy, you won’t get your period again.

Some people experience a loss of interest in sex or become depressed after a hysterectomy. Talk with your doctor or healthcare professional if this happens to you.

If you have your ovaries removed as part of the procedure and you haven’t gone through menopause yet, the surgery could cause you to experience menopause symptoms, such as:

• hot flashes
• vaginal dryness
• mood swings

Ovary removal also puts you at risk for developing other medical conditions like bone loss, heart disease, and urinary incontinence.

A hysterectomy can improve your quality of life.

For people living with fibroids, adenomyosis, endometriosis, or abnormal periods, a hysterectomy can help reduce or eliminate chronic pain. It can also help avoid unexpected and heavy bleeding.

For people having the surgery due to cancer, hysterectomy can be an important part of your treatment plan.

Talk with your doctor about how a hysterectomy might improve your symptoms or quality of life.

Having a hysterectomy is a big decision. It’s a major surgery that can change your body forever. You cannot become pregnant following a hysterectomy. You may also go into early menopause.

You might want to ask your doctor the following questions before considering a hysterectomy:

• Do I need a hysterectomy? Why?
• What are the benefits and downsides of having a hysterectomy for my particular condition?
• What other options are available?
• If I don’t have a hysterectomy, what will happen?
• How can a hysterectomy relieve my symptoms?
• What kind of hysterectomy will I have?
• What are the symptoms of menopause?
• Will I need medications after surgery?
• What changes to my mood will it have?
• What will my recovery be like?

If you need a hysterectomy but still want to have children, make sure you discuss your options with a healthcare professional. Adoption and surrogacy are two potential options you may consider.

A hysterectomy is a common procedure that can improve symptoms caused by many different medical conditions. In some cases, the surgery can be lifesaving.

You won’t be able to get pregnant following the surgery and you may go into early menopause. But, the procedure can relieve heavy or irregular bleeding and pelvic pain.

Talk with your doctor if you think you might benefit from having a hysterectomy. There are lots of factors to consider before deciding to have this surgery.

Recovery and long term impact

During recovery from hysterectomy a person may experience pain, bleeding, and constipation. There may also be menopause-type symptoms, such as hot flashes. However, the side effects can depend on the type of procedure and reason for surgery.

A hysterectomy is a surgery that removes the uterus. According to the American College of Obstetricians and Gynecologists (ACOG), a doctor may recommend a hysterectomy if a person has:

• endometriosis
• uterine fibroids
• gynecologic cancer
• abnormal bleeding
• chronic pain in the pelvis

A doctor may also perform a hysterectomy for pelvic organ prolapse, and genetic diseases that make some cancer more likely, such as Lynch syndrome.

In this article, we focus on hysterectomies for gynecological reasons and explain:

• types of hysterectomy
• side effects of each one
• potential risks and complications
• questions to ask a doctor

Share on PinterestWearing loose clothing and keeping the surgical area clean and dry can aid recovery after a hysterectomy.

According to ACOG, there are three broad types of hysterectomy:

• Total hysterectomy: This surgery involves the complete removal of the uterus and cervix.
• Supracervical hysterectomy: During this procedure, surgeons remove the uterus but not the cervix. A doctor may also refer to this procedure as a subtotal or partial hysterectomy.
• Radical hysterectomy: This surgery removes the uterus, cervix, and surrounding support tissue. Doctors often recommend this type of hysterectomy for people with cancer.

Additionally, a hysterectomy with oophorectomy is when surgeons remove the uterus and one or both ovaries during the same surgery.

A hysterectomy with salpingo-oophorectomy involves removing the fallopian tubes.

Also, surgeons can perform a hysterectomy in several different ways. They may remove the organs through the abdomen, or they may remove them through the vagina.

A laparoscopic-assisted hysterectomy involves a surgeon performing part of the surgery through the abdomen but removing the uterus through the vagina, combining both approaches.

It is common for people to experience pain, bleeding, vaginal discharge, and constipation after a hysterectomy. Pain medication and using sanitary pads can help with these side effects.

What other short-term side effects a person may experience depend on the type of hysterectomy they have.

Hysterectomy without oophorectomy

A hysterectomy that does not involve ovary removal may still affect the ovaries.

According to a 2020 review, research studies have found some evidence suggesting that some hysterectomies that spare the ovaries may speed up the onset of menopause.

A small, older study from 2006 found that hysterectomies may affect blood supply to the ovaries, which is one theory for why this could happen.

However, the evidence for this is still very mixed and dependent on the type of hysterectomy and what organs and surrounding tissues the surgeon removes.

Scientists are still investigating the long-term effects of hysterectomies and need to do further studies on the impact hysterectomies on ovarian function.

Hysterectomy with oophorectomy

If a person has undergone a hysterectomy with oophorectomy, this means they no longer have ovaries.

The ovaries produce the hormone estrogen. Without these organs, a person who had not undergone menopause already will experience menopause symptoms.

These side effects of hysterectomy with oophorectomy include:

• hot flashes
• night sweats
• vaginal dryness
• difficulty sleeping
• mood swings and irritability
• weight gain
• hair loss
• dry skin
• incontinence
• loss of bone density
• rapid heartbeat

The duration of these symptoms will vary from person to person. Due to the sudden drop in estrogen, people who have had an oophorectomy may experience exaggerated symptoms.

A doctor can prescribe hormone replacement therapy (HRT) to reduce menopause symptoms for people who are premenopausal.

According to the Office on Women’s Health, it typically takes 3–4 weeks to recover from a vaginal or laparoscopic hysterectomy.

It may take 4–6 weeks to recover from an abdominal hysterectomy.

A person’s age and overall health also influence their recovery time.

The Dana-Farber Cancer Institute say that after a hysterectomy, an individual:

• cannot drive for 2 weeks
• cannot lift objects heavier than a bag of groceries for 6 weeks
• may experience fatigue for the first 6 weeks
• may see spotting and vaginal discharge for 8 weeks
• cannot insert anything into the vagina for 8 weeks

A person can aid their recovery by:

• doing light exercise, such as walking
• getting plenty of rest
• keeping any surgical incisions clean and dry
• avoiding tight clothing
• checking incisions regularly for signs of infection
• avoiding water directly hitting an incision in the shower
• gently cleaning the area
• taking prescribed medications correctly

A person will typically stay in the hospital for 1–2 days following the procedure before returning home to recover. This time can vary depending on the type of hysterectomy. Abdominal surgery may require a stay of 2–3 days.

If someone has a hysterectomy due to cancer, they may need to stay for longer.

According to ACOG, the risks of an abdominal hysterectomy include:

• infection
• wound bleeding
• blood clots
• nerve or tissue damage

Vaginal or laparoscopic hysterectomies typically have a lower risk for complications. However, any type of hysterectomy can potentially cause these problems.

According to a 2018 study, having a hysterectomy before 35 years of age also increases a person’s risk factor for several medical conditions, including:

• 14% increased risk of lipid abnormalities
• 13% increased risk of high blood pressure
• 18% increased risk of obesity
• 33% increased risk of coronary artery disease
• 4.6-fold increased risk of congestive heart failure
• 2.5-fold increased risk of coronary artery disease

In addition to physical changes, a person who undergoes a hysterectomy may also experience changes in their mental health.

Hysterectomies mean a person can no longer get pregnant. For some, this causes grief and sadness, particularly if they had hoped to have more children.

A person will also not have periods anymore, which can make a female feel they have lost part of their identity or womanhood.

For others, losing their periods can be a relief. If someone has a painful or difficult health condition, their symptoms may improve, along with their quality of life.

People who do not want children may also feel relieved that they cannot become pregnant.

A study of females who underwent hysterectomies without ovary removal from 1980–2002 found that they had a 6.6% higher risk for new depression diagnoses and a 4.7% higher risk for anxiety diagnoses in the 20 years following their surgery.

The researchers are not sure why this occurred, so scientists need to carry out more research to understand this trend.

Hysterectomies are not reversible, so it is a good idea for people to ask for as much information as they need to feel confident with their decision.

Questions to ask could include:

• Will the procedure cure a condition or just treat the symptoms?
• Are there any alternatives to a hysterectomy that may help with symptoms?
• Will natural menopause improve the symptoms, and, if so, is a hysterectomy necessary?
• Could symptoms return after the procedure, and if so, what happens then?
• Is there a way to preserve eggs if I want a child in the future, via a surrogate, for example?
• What type of hysterectomy would you recommend?
• Will you remove the cervix, fallopian tubes, or surrounding tissue?
• What can I expect during and after the procedure?

According to Dana-Farber Cancer Institute, a person should contact their doctor or healthcare provider if they experience any of the following symptoms after their surgery:

• heavy vaginal bleeding that soaks a pad in less than 1 hour
• foul vaginal odor
• changes in urinary frequency or inability to urinate
• fever at or above 100. 4^oF
• continuous constipation
• diarrhea
• vomiting or nausea
• swelling, pain, or tenderness around the incision
• any openings at the incision site
• chest pains or trouble breathing
• severe pain that does not improve with pain relief

Short-term hysterectomy side effects can include pain, bleeding, discharge, and constipation. A person may also temporarily experience menopause-like symptoms, such as hot flashes. These will resolve as a person recovers.

In the long term, a person may feel a sense of loss or sadness, or possibly relief following the procedure. People who have also had ovaries removed will experience menopause and may benefit from HRT.

Hysterectomies have some risks, and they also mean a person cannot become pregnant. The individual can talk to their doctor about all their options before undergoing surgery.

Total or subtotal hysterectomy: time to dispel the myths?

At present, the development of innovative methods for the treatment of pathology of the female reproductive system has not led to a sharp decrease in the frequency of hysterectomy, which is still one of the most frequently performed operations in gynecology. The active introduction of minimally invasive methods of surgical treatment has led to the fact that the question of choosing a method of surgical access is practically no longer controversial, while the question of the advisability of preserving or removing the cervix during hysterectomy remains relevant. An in-depth analysis of the literature and the results of our own research allow us to state that the advantages of subtotal hysterectomy over total hysterectomy in terms of a low risk of subsequent prolapse and improvement in sexual function is an established myth that has no evidence-based medicine. Apparently, the only indication for performing subtotal hysterectomy remains the need to preserve the cervical stump when performing sacrocervicopexy, since the proportion of cervical erosion in patients with a preserved cervix is ​​​​less, in general, if necessary, subtotal hysterectomy can be performed only in specially selected patients without cervical pathology uterus and deep infiltrative endometriosis.

Hysterectomy is currently one of the most frequently performed operations in gynecology. Innovative methods of treating the pathology of the female reproductive system did not lead to the expected sharp decrease in the frequency of performing this type of surgical intervention. According to the literature, more than 1 million such operations are performed per year in various countries. For example, more than 550,000 hysterectomies are performed per year in the United States, about 100,000 in the UK, 60,000 in France, and 30,000 in Australia. The progressive development of minimally invasive surgical techniques has made this operation safer for patients. Currently, preference is given to laparoscopic access [1-14].

The most common indication for hysterectomy, according to many studies, is uterine fibroids. Approximately 40% of all hysterectomies are believed to be performed for uterine fibroids and its complications [6–7]. In English-speaking countries, indications for hysterectomy are formulated in a peculiar way, and about a third of all hysterectomies are performed for “dysfunctional or abnormal uterine bleeding. ” Endometriosis and ovarian neoplasms are the third most common reason for hysterectomy in the US.

If the question of choosing a surgical approach is no longer controversial [15, 16], then the question of choosing the extent of the operation is still relevant. The expediency of preserving the cervix is ​​also solved ambiguously [11, 14, 17, 18]. For a number of decades, the issue of removing or preserving the cervix has been discussed primarily from oncological positions. The desire for unreasonable preservation of the cervix during hysterectomy often leads to the fact that the pathologically altered cervix is ​​not removed during surgery. Subsequently, there is a risk of developing precancerous and cancerous diseases of the cervical stump. Irregular monitoring of women after supravaginal amputation of the uterus in the late postoperative period can lead to delayed diagnosis and treatment of the developed pathology of the cervical stump [4, 19-22].

According to J. Hannoun-Levi et al. [23], the number of patients with cervical stump carcinoma was 1.2–6.6% of the total number of patients with cervical cancer. It should be noted that the risk of cancer in the cervical stump is 5-10 times higher than in the vaginal stump, especially in women over 50 years of age. According to studies by domestic authors, the risk of developing cervical cancer after supravaginal amputation of the uterus varies within 0.5–1.5% [20] . However, oncological risks are not the main problem of the cervix preserved at the first operation. Perhaps that is why the national traditions of performing certain volumes of surgery vary greatly and depend on the surgical school. The advantages of supravaginal amputation of the uterus usually include the preservation of the supporting ligamentous apparatus of the uterus, a lower frequency and severity of urodynamic and sexual dysfunction [24–27]. In English-speaking countries, there has been a trend in recent years towards the exclusive use of total hysterectomy. So, according to H. Hasson [27], if in the USA up to 1940, 95% of performed hysterectomies were subtotal, in 1975 the proportion of subtotal hysterectomies was only 5%. The main reason for refusing to perform subtotal hysterectomy in those years was the high incidence of cancer in the cervical stump (5-7%). In the UK in 1992, out of 2000 hysterectomies, only 0.7% were subtotal. At the same time, most operations were performed for benign pathology of the uterus, not accompanied by changes in the cervix.

An analysis of data on thousands of subtotal hysterectomies conducted in the 60s showed that the incidence of carcinomas in the cervical stump ranges from 0.3 to 1.9%. In women diagnosed with cancer of the cervical stump, the indication for supravaginal amputation of the uterus in most cases was fibroids [20, 23, 27, 28].

Important in the problem of preventing cancer in the stump of the cervix is ​​the preoperative diagnosis of the state of the cervix. Back in 1993, W. van Wijngaarden [28] showed that if a patient had normal cytological smears before subtotal hysterectomy, then the probability of developing cervical cancer later is less than 0.3%. D. Vale et al. [22] showed on a large material that the frequency of atypical changes in cytological smears after total hysterectomy was 0.13%. In the Scandinavian countries in the 80s, some researchers believed that the risk of developing malignant changes in the cervical stump could be reduced by prophylactic coagulation of the cervical canal. The frequency of carcinoma after this procedure in studies by P. Kikku [29] was 0.11%, while without prophylactic coagulation this figure was 0.4-1.9%. According to a number of authors [30—35], the hysterectomy technique developed by Kurt Semm makes it possible to reduce the likelihood of developing pathological processes in the cervical stump due to circular resection of the endocervix. Interestingly, after this operation, dysplasia was detected in 11.5% of patients. It is noteworthy that in all observations before the operation, the cervix was considered healthy, all women had normal smears-imprints.

Therefore, intraoperative destruction of the mucous membrane of the cervical canal by electrocoagulation, as well as with the help of special instruments, does not guarantee complete destruction of the epithelium and does not exclude the possibility of developing cancer after surgery. In addition, the literature describes a large number of observations of the development of various benign pathologies in the stump of the cervix, requiring further surgical treatment.

H. Hasson [27] in the analysis of 216 extirpations of the stump of the cervix noted that in 74% of patients the indication for surgery was chronic cervicitis, in 9% – hyperplastic processes, 9% – leukoplakia, 3% – polyp of the cervical canal, 2% – leiomyoma, 2% of others – dysplasia, 1% – endometriosis. According to van Evert et al. [14], in the long-term period after laparoscopic supravaginal amputation of the uterus, cervical pathology was diagnosed in 12 (6. 3%) patients, of which extirpation of the cervical stump was required in 4 (2.1%) patients.

Often causes considerable difficulty in deciding the extent of hysterectomy in patients with internal endometriosis due to the inability to exclude the presence of endometrioid heterotopia in the cervix. IN AND. Kulakov et al. [19, 36] based on the experience of surgical treatment of the stump of the cervix, it is believed that in case of adenomyosis, it is advisable to perform hysterectomy. According to the same authors, all patients with endometriosis of the stump were previously operated on for suspected uterine fibroids. The presence of endometriosis was revealed only by histological examination of macropreparations.

According to M. Nisolle [13], careful selection of patients with benign uterine pathology is required for subtotal hysterectomy, which involves the exclusion of any cervical pathology and deep endometriosis.

One of the reasons for refusing to perform a total laparoscopic hysterectomy is the greater technical complexity of the operation and, accordingly, a higher risk of intra- and early postoperative complications. J. van Evert et al. [14] evaluated the experience of 192 subtotal and 198 total laparoscopic hysterectomies performed over 10 years from 1998 to 2007. The authors noted early postoperative complications in 3% of patients who underwent subtotal hysterectomy and in 12% of patients who underwent total laparoscopic hysterectomy, in while long-term negative results of treatment (genital prolapse, repeated operations) were more often observed after subtotal hysterectomy than after total: 15% versus 3%. The data of J. Scott and H. Sharp [21] on the number of complications such as infectious inflammation, bleeding, injuries of neighboring organs also do not confirm the advantages of subtotal laparoscopic hysterectomy over total.

Even if we omit the fact of the possible risk of developing background precancerous and cancerous diseases of the cervical stump, it is worth noting that, according to a number of authors, from 17 to 38% of patients who underwent subtotal hysterectomy present various complaints directly related to the presence of the cervical stump due to the occurrence of various inflammatory diseases of the cervix, violations of sexual and urinary function, the extirpation of the cervical stump after subtotal hysterectomy is associated with the highest risk of complications, especially if the first operation was performed by laparotomy access. These problems are associated with a massive adhesive process and a violation of the anatomical location of organs and tissues in the abdominal cavity [5–7, 37, 38].

The traditional argument in favor of performing a subtotal hysterectomy is the alleged decrease in the frequency of prolapse after this operation. Note that even V.I. Kulakov et al. [19, 36] pointed out that this fact is not confirmed by the results of studies and largely depends on the undiagnosed pathology of the pelvic floor prior to hysterectomy. The point of view about the decrease in the frequency of prolapse after subtotal hysterectomy is not confirmed by foreign authors [17]. For example, A. Lethaby (2006) [39] did not confirm the improvement of sexual function, as well as the function of the bladder and rectum compared with abdominal total hysterectomy. In a recent work by N. Pouwels et al. [40] also did not confirm the data on the improvement of sexual function as a result of the subtotal volume of the operation. D. Rahn et al. [41] in a study on cadavers demonstrated the same degree of fixation of the vaginal dome after abdominal total and subtotal hysterectomy. Moreover, N. Gimbel et al. [26] point to clear advantages of total hysterectomy over subtotal hysterectomy, both in terms of sexual function, delayed prolapse of the vaginal stump or cervix, and sexual comfort.

Given that, according to modern data, the overall level of complications of these operations is the same (17% for subtotal hysterectomy, 15% for total) and only early postoperative (bleeding, fever, infection, hematoma of the fornix) complications are more common with total hysterectomy, than with subtotal hysterectomy (3% versus 12%), it is safe to talk about myths regarding the “benefit” of subtotal hysterectomy [14]. Late postoperative complications (problems with the cervical stump, the need for extirpation of the stump, dyspareunia, pain, etc.) are significantly more likely to accompany subtotal hysterectomy (15% versus 3%). That is, the traditionally indicated advantages of the subtotal volume of surgery over total evidence-based studies are not confirmed [13, 14].

When analyzing sexual function after surgery, it turned out that the only predictor of deterioration in sexual function after surgery for both the patient and her partner was a negative sexual experience before the intervention. The scope of the operation, total or subtotal hysterectomy, did not affect sexual function [19, 40, 42].

Thus, at present, it can be stated with certainty that the advantage of subtotal hysterectomy over total hysterectomy, which consists in a low risk of subsequent prolapse and improvement in sexual function, is an established myth that is not supported by evidence-based medicine [40, 42]. The undoubted advantage of subtotal laparoscopic hysterectomy is the ease of its implementation [43]. Apparently, the only indication for subtotal hysterectomy remains the need to preserve the cervical stump when performing sacrocervicopexy, since the proportion of cervical erosion in patients with preserved cervix is ​​less [13]. In general, we believe, one should agree with the statement that subtotal hysterectomy can be performed only for specially selected patients without precancerous pathology of the cervix and endometrium, as well as deep infiltrative endometriosis.

Hysterectomy (removal of the uterus) by vaginal access inexpensively near the house – inpatient operations

In our Paracelsus Medical Center, gynecological surgeons are skilled in performing any type of hysterectomy. At the preoperative appointment, the surgeon-gynecologist will select the most appropriate method for performing the operation, taking into account all the factors individually for each patient.

Vaginal hysterectomy

Vaginal access is a surgical intervention in which all manipulations are carried out through incisions in the woman’s vagina.

Total hysterectomy

This is an operation that removes the entire uterus, body and cervix. It is necessary to resort to this volume of surgical intervention in case of prolapse of internal genital organs, as well as a combination of pathology of the body and cervix, 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 extent of surgery is made by the surgeon-gynecologist at the preoperative consultation.

Indications: The main indication for total hysterectomy by vaginal access is uterine prolapse in combination with pathology of the body and cervix.

1. Complete and incomplete prolapse of the uterus and vaginal walls.2. Myoma (leiomyoma, fibromyoma) Myoma of small size.

Rapid progressive growth of uterine fibroids.

Multiple myoma nodes.

Myoma, accompanied by profuse uterine bleeding, leading to anemia. Myoma with questionable biopsy results (suspicion of malignancy).

3. Endometriosis of the uterus (adenomyosis) grade 3-4, not amenable to conservative treatment.
4. Recurrent endometrial hyperplasia, atypical hyperplasia.
5. Precancerous diseases of the cervix.

Examination for surgical intervention and validity of the results of the examination: You can undergo the entire scope of the preoperative examination at Our Medical Center Paracel in one day!

colposcopy-12 months

Ultrasound of the pelvic organs

Ultrasound of the kidneys, bladder, retroperitoneum.

Ultrasound of the veins of the lower extremities – 3 months

Flora smear, bacteriological culture from the cervical canal – 10 days

Oncocytology from the cervix – 6 months

Electrocardiogram with decoding -14d,

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 -10 days

Coagulogram – 10 days

Blood type and Rh factor

Fluorography – 6 months

Mammography -24 months (after 36 years), 12 months (after 50 years)

Consultation of a general practitioner, anesthesiologist and other specialists according to indications. Other examinations may be added according to indications.

Pain relief for hysterectomy:

These operations are performed under spinal anesthesia or endotracheal anesthesia.