What happens after a hysterectomy with ovaries kept? Explore the common symptoms, alternative treatments, and essential considerations to ensure a smooth recovery.

Hysterectomy: An Overview

A hysterectomy is a surgical procedure that removes a woman’s uterus, also known as the womb. During this operation, the doctor may also remove the fallopian tubes and ovaries. After a hysterectomy, the patient will no longer menstruate or be able to become pregnant.

Symptoms After Hysterectomy with Ovaries Kept

When the ovaries are kept during a hysterectomy, the patient may still experience certain symptoms. These can include:

• Menopausal symptoms, such as hot flashes, mood changes, and vaginal dryness, as the ovaries may still produce reduced levels of hormones.
• Pelvic pain or discomfort, as the remaining pelvic structures adjust to the absence of the uterus.
• Incontinence or changes in bladder function, as the pelvic floor muscles may be affected by the surgery.
• Decreased sexual function, due to changes in hormone levels and pelvic anatomy.

Reasons for Hysterectomy

A hysterectomy may be recommended for various medical conditions, including:

1. Uterine fibroids: Noncancerous growths in the uterine wall that can cause pain, heavy bleeding, or other symptoms.
2. Heavy or abnormal vaginal bleeding: Changes in hormone levels, infection, cancer, or fibroids can lead to excessive or prolonged bleeding.
3. Uterine prolapse: When the uterus slips from its normal position and protrudes into the vagina, often due to multiple childbirths or aging.
4. Endometriosis: A condition where the tissue that normally lines the inside of the uterus grows outside of the uterus, causing pain and bleeding.
5. Adenomyosis: When the uterine lining grows into the uterine muscle, leading to thickening of the uterine walls and heavy bleeding.
6. Uterine, ovarian, cervical, or endometrial cancer: In some cases, a hysterectomy may be the best treatment option for certain types of cancer.

Alternatives to Hysterectomy

In some cases, there may be alternatives to hysterectomy that can address the underlying condition without the need for surgery. These options may include:

• Watchful waiting: Monitoring the condition, such as uterine fibroids, which may shrink after menopause.
• Kegel exercises: Strengthening the pelvic floor muscles to help with uterine prolapse.
• Medication: Hormonal treatments or pain relievers to manage endometriosis, heavy bleeding, or other symptoms.
• Vaginal pessary: A device inserted into the vagina to support the uterus and prevent prolapse.
• Smaller surgical procedures: Less invasive options, such as laparoscopic surgery to treat endometriosis or stop heavy bleeding.

Preparing for a Hysterectomy

Before undergoing a hysterectomy, it’s important to have a thorough discussion with your healthcare provider. Topics to discuss may include:

• Your specific medical condition and the reasons for the recommended hysterectomy.
• The potential risks and benefits of the procedure, including the impact on your overall health and well-being.
• The option to keep or remove your ovaries, and the potential impact on your hormonal balance.
• Alternative treatment options that may be available to you.
• The expected recovery timeline and any lifestyle changes you may need to make.

Navigating the Recovery Process

After a hysterectomy, the recovery process can vary depending on the type of surgery and your individual health. It’s common to experience some of the following during the recovery period:

• Pelvic pain or discomfort, which can be managed with medication and rest.
• Fatigue and the need for a gradual return to normal activities.
• Changes in bowel and bladder function, which may require some adjustments.
• Emotional adjustments, as the body and mind adapt to the changes brought about by the surgery.

Your healthcare team will provide guidance and support throughout the recovery process to ensure a smooth transition.

Embracing the New Normal

After a hysterectomy with ovaries kept, it’s important to be patient and kind to yourself as you navigate the physical and emotional changes. Regular check-ups with your healthcare provider, as well as open communication about any concerns or symptoms, can help ensure a successful recovery and adjustment to your new normal.

Hysterectomy | Office on Women’s Health

A hysterectomy is a surgery to remove a woman’s uterus (also known as the womb). The uterus is where a baby grows when a woman is pregnant. During the surgery the whole uterus is usually removed. Your doctor may also remove your fallopian tubes and ovaries. After a hysterectomy, you no longer have menstrual periods and cannot become pregnant.

What happens during a hysterectomy?

Hysterectomy is a surgery to remove a woman’s uterus (her womb). The whole uterus is usually removed. Your doctor also may remove your fallopian tubes and ovaries.

Talk to your doctor before your surgery to discuss your options. For example, if both ovaries are removed, you will have symptoms of menopause. Ask your doctor about the risks and benefits of removing your ovaries. You may also be able to try an alternative to hysterectomy, such as medicine or another type of treatment, first.

Why would I need a hysterectomy?

You may need a hysterectomy if you have one of the following:¹

• Uterine fibroids.  Uterine fibroids are noncancerous growths in the wall of the uterus. In some women they cause pain or heavy bleeding.
• Heavy or unusual vaginal bleeding. Changes in hormone levels, infection, cancer, or fibroids can cause heavy, prolonged bleeding.
• Uterine prolapse. This is when the uterus slips from its usual place down into the vagina. This is more common in women who had several vaginal births, but it can also happen after menopause or because of obesity. Prolapse can lead to urinary and bowel problems and pelvic pressure.
• Endometriosis. Endometriosis happens when the tissue that normally lines the uterus grows outside of the uterus on the ovaries where it doesn’t belong. This can cause severe pain and bleeding between periods.
• Adenomyosis. In this condition the tissue that lines the uterus grows inside the walls of the uterus where it doesn’t belong. The uterine walls thicken and cause severe pain and heavy bleeding.
• Cancer (or precancer) of the uterus, ovary, cervix, or endometrium (the lining of the uterus). Hysterectomy may be the best option if you have cancer in one of these areas. Other treatment options may include chemotherapy and radiation. Your doctor will talk with you about the type of cancer you have and how advanced it is. Learn more about treatment options for these cancers at the National Cancer Institute.

Keep in mind that there may be alternative ways to treat your health problem without having a hysterectomy. Hysterectomy is a major surgery. Talk with your doctor about all of your treatment options.

What are some alternatives to hysterectomy?

Hysterectomy is major surgery. Sometimes a hysterectomy may be medically necessary, such as with prolonged heavy bleeding or certain types of cancer. But sometimes you can try other treatments first. These include:

• Watchful waiting. You and your doctor may wish to wait if you have uterine fibroids, which tend to shrink after menopause.
• Exercises. For uterine prolapse, you can try Kegel exercises (squeezing the pelvic floor muscles). Kegel exercises help restore tone to the muscles holding the uterus in place.
• Medicine. Your doctor may give you medicine to help with endometriosis. Over-the-counter pain medicines taken during your period also may help with pain and bleeding. Hormonal birth control, such as the pill, shot, or vaginal ring, or a hormonal intrauterine device (IUD) may help with irregular or heavy vaginal bleeding or periods that last longer than usual.
• Vaginal pessary (for uterine prolapse). A pessary is a rubber or plastic donut-shaped object, similar to a diaphragm used for birth control. The pessary is inserted into the vagina to hold the uterus in place. Uterine prolapse happens when the uterus drops or “falls out” because it loses support after childbirth or pelvic surgery. 
• Surgery. You and your doctor may choose to try a surgery that involves smaller or fewer cuts than hysterectomy. The smaller cuts may help you heal faster with less scarring. Depending on your symptoms, these options may include:
  • Surgery to treat endometriosis. Laparoscopic surgery uses a thin, lighted tube with a small camera. The doctor puts the camera and surgery tools into your pelvic area through very small cuts. This surgery can remove scar tissue or growths from endometriosis without harming the surrounding healthy organs such as ovaries. You may still get pregnant after this surgery.
  • Surgery to help stop heavy or long-term vaginal bleeding.
    • Dilation and curettage (D&C) removes the lining of the uterus that builds up every month before your period. Often, a hysteroscopy is done at the same time. Your doctor inserts the hysteroscope (a thin telescope) into your uterus to see the inside of the uterine cavity. D&C may also remove noncancerous growths or polyps from the uterus. After the D&C, a new uterine lining will build up during your next menstrual cycle as usual. You may still get pregnant after this surgery.
    • Endometrial ablation destroys the lining of the uterus permanently. Depending on the size and condition of your uterus, your doctor may use tools that freeze, heat, or use microwave energy to destroy the uterine lining. This surgery should not be used if you still want to become pregnant or if you have gone through menopause.
  • Surgery to remove uterine fibroids without removing the uterus. This is called a myomectomy. Depending on the location of your fibroids, the myomectomy can be done through the pelvic area or through the vagina and cervix. You may be able to get pregnant after this surgery. If your doctor recommends this surgery, ask your doctor if a power morecellator will be used. The FDA has warned against the use of power morcellators for most women.
  • Surgery to shrink fibroids without removing the uterus. This is called myolysis. The surgeon heats the fibroids, which causes them to shrink and die. Myolysis may be done laparoscopically (through very small cuts in the pelvic area). You may still get pregnant after myolysis.
• Treatments to shrink fibroids without surgery. These treatments include uterine artery embolization (UAE) and magnetic resonance (MR)-guided focused ultrasound (MR[f]US). UAE puts tiny plastic or gel particles into the vessels supplying blood to the fibroid. Once the blood supply is blocked, the fibroid shrinks and dies. MR(f)US sends ultrasound waves to the fibroids that heat and shrink the fibroids. After UAE or MR(f)US, you will not be able to get pregnant.

How common are hysterectomies?

Each year in the United States, nearly 500,000 women get hysterectomies.² A hysterectomy is the second most common surgery among women in the United States. The most common surgery in women is childbirth by cesarean delivery (C-section).

What are the different types of hysterectomies?

• A total hysterectomy removes all of the uterus, including the cervix.  The ovaries and the fallopian tubes may or may not be removed. This is the most common type of hysterectomy.
• A partial, also called subtotal or supracervical, hysterectomy removes just the upper part of the uterus. The cervix is left in place. The ovaries may or may not be removed.
• A radical hysterectomy removes all of the uterus, cervix, the tissue on both sides of the cervix, and the upper part of the vagina. A radical hysterectomy is most often used to treat certain types of cancer, such as cervical cancer. The fallopian tubes and the ovaries may or may not be removed.

Will the doctor remove my ovaries during the hysterectomy?

Whether your ovaries are removed during the hysterectomy may depend on the reason for your hysterectomy.

Ovaries may be removed during hysterectomy to lower the risk for ovarian cancer. However, women who have not yet gone through menopause also lose the protection of estrogen, which helps protect women from conditions such as heart disease and osteoporosis.  

Recent studies suggest that removing only the fallopian tubes but keeping the ovaries may help lower the risk for the most common type of ovarian cancer, which is believed to start in the fallopian tubes.³

The decision to keep or remove your ovaries is one you can make after talking about the risks and benefits with your doctor.

Will the hysterectomy cause me to enter menopause?

All women who have a hysterectomy will stop getting their period. Whether you will have other symptoms of menopause after a hysterectomy depends on whether your doctor removes your ovaries during the surgery.

If you keep your ovaries during the hysterectomy, you should not have other menopausal symptoms right away. But you may have symptoms a few years younger than the average age for menopause (52 years).

Because your uterus is removed, you no longer have periods and cannot get pregnant. But your ovaries might still make hormones, so you might not have other signs of menopause. You may have hot flashes, a symptom of menopause, because the surgery may have blocked blood flow to the ovaries. This can prevent the ovaries from releasing estrogen.

If both ovaries are removed during the hysterectomy, you will no longer have periods and you may have other menopausal symptoms right away. Because your hormone levels drop quickly without ovaries, your symptoms may be stronger than with natural menopause. Ask your doctor about ways to manage your symptoms.

How is a hysterectomy performed?

A hysterectomy can be done in several different ways. It will depend on your health history and the reason for your surgery. Talk to your doctor about the different options:

• Abdominal hysterectomy. Your doctor makes a cut, usually in your lower abdomen.
• Vaginal hysterectomy. This is done through a small cut in the vagina.
• Laparoscopic hysterectomy. A laparoscope is an instrument with a thin, lighted tube and a small camera that allows your doctor to see your pelvic organs. Laparoscopic surgery is when the doctor makes very small cuts to put the laparoscope and surgical tools inside of you. During a laparoscopic hysterectomy the uterus is removed through the small cuts made in either your abdomen or your vagina.
• Robotic surgery. Your doctor guides a robotic arm to do the surgery through small cuts in your lower abdomen, like a laparoscopic hysterectomy.

How long does it take to recover from a hysterectomy?

Recovering from a hysterectomy takes time. Most women stay in the hospital one to two days after surgery. Some doctors may send you home the same day of your surgery. Some women stay in the hospital longer, often when the hysterectomy is done because of cancer.

Your doctor will likely have you get up and move around as soon as possible after your hysterectomy. This includes going to the bathroom on your own. However, you may have to pee through a thin tube called a catheter for one or two days after your surgery.

The time it takes for you to return to normal activities depends on the type of surgery:

• Abdominal surgery can take from four to six weeks to recover.
• Vaginal, laparoscopic, or robotic surgery can take from three to four weeks to recover.

You should get plenty of rest and not lift heavy objects for four to six weeks after surgery. At that time, you should be able to take tub baths and resume sexual intercourse. How long it takes for you to recover will depend on your surgery and your health before the surgery. Talk to your doctor.

What changes can I expect after a hysterectomy?

Hysterectomy is a major surgery, so recovery can take a few weeks. But for most women, the biggest change is a better quality of life. You should have relief from the symptoms that made the surgery necessary.

Other changes that you may experience after a hysterectomy include:

• Menopause. You will no longer have periods. If your ovaries are removed during the hysterectomy, you may have other menopause symptoms.
• Change in sexual feelings. Some women have vaginal dryness or less interest in sex after a hysterectomy, especially if the ovaries are removed.
• Increased risk for other health problems. If both ovaries are removed, this may put you at higher risk for certain conditions such as: bone loss, heart disease, and urinary incontinence (leaking of urine). Talk to your doctor about how to prevent these problems.
• Sense of loss. Some women may feel grief or depression over the loss of fertility or the change in their bodies. Talk to your doctor if you have symptoms of depression, including feelings of sadness, a loss of interest in food or things you once enjoyed, or less energy, that last longer than a few weeks after your surgery.

Will my sex life change after a hysterectomy?

It might. If you had a good sex life before your hysterectomy, you should be able to return to it without any problems after recovery. Many women report a better sex life after hysterectomy because of relief from pain or heavy vaginal bleeding.

If your hysterectomy causes you to have symptoms of menopause, you may experience vaginal dryness or a lack of interest in sex. Using a water-based lubricant can help with dryness. Talk to your partner and try to allow more time to get aroused during sex. Talk with your doctor and get more tips in our Menopause and sexuality section.

I’ve had a hysterectomy. Do I still need to have Pap tests?

Maybe. You will still need regular Pap tests (or Pap smear) to screen for cervical cancer if you:

• Did not have your cervix removed
• Had a hysterectomy because of cancer or precancer

Ask your doctor what is best for you and how often you should have Pap tests.

Did we answer your question about hysterectomies?

For more information about hysterectomy, call the OWH Helpline at 1-800-994-9662 or contact the following organizations:

• Agency for Healthcare Research and Quality (AHRQ), HHS
  Phone Number: 301-427-1364
• National Cancer Institute (NCI)
  Phone Number: 800-422-6237
• Division of Reproductive Health, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention (CDC), HHS
  Phone Number: 800-323-4636
• American College of Obstetricians and Gynecologists (ACOG)
  Phone Number: 202-638-5577
• American College of Surgeons (ACS)
  Phone Number: 800-621-4111

Sources

1. American College of Obstetricians and Gynecologists. (2015). Hysterectomy.
2. CDC. (2010). National Hospital Discharge Survey. Procedures by selected patient characteristics – Number by procedure category and age.
3. American College of Obstetricians and Gynecologists. (2013). Growing Acceptance of Removing Fallopian Tubes But Keeping Ovaries to Lower Ovarian Cancer Risk.

The Office on Women’s Health is grateful for the medical review by:

• Sarah M. Temkin, M.D., F.A.C.O.G., Community Oncology and Prevention Trials Research Group, Division of Cancer Prevention, National Cancer Institute
• Kimberly Kho, M.D., M.P.H., Assistant Professor, Department of Obstetrics and Gynecology, Director, Southwestern Center for Minimally Invasive Surgery, Gynecology, University of Texas Southwestern Medical Center

All material contained on these pages are free of copyright restrictions and maybe copied, reproduced, or duplicated without permission of the Office on Women’s Health in the U. S. Department of Health and Human Services. Citation of the source is appreciated.

Page last updated:
December 29, 2022

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.

How to recognize posthysterectomy syndrome | Directory of medical laboratory Optimum (Sochi, Adler)

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4. Posthysterectomy syndrome

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Post-hysterectomy syndrome is a complex of symptoms characterized by metabolic and psychovegetative disorders. It develops after the removal of the uterus (hysterectomy) with the preservation of 1 or 2 ovaries. PHES seriously reduces the quality of life of the patient, negatively affects the ability to work and health.

Causes of development

After hysterectomy functional activity of the ovaries is disturbed. Branches of the uterine arteries are excluded from their blood supply. The architectonics of the blood vessels of the ovaries changes, intraovarian blood supply worsens, stagnant processes occur, and anovulatory cycles become more frequent. Ovarian ischemia provokes the acceleration of various degenerative conditions, the extinction of ovulation and the synthesis of hormones. Against this background, hypoestrogenism develops, which is manifested by pronounced psycho-emotional and vegetative-vascular disorders.

Symptoms and first signs

Neurovegetative symptoms manifest as poor heat tolerance, tachycardia at rest, increased sensitivity to low temperatures, chills, sleep disturbances, numbness of the extremities, periodic hot flashes, vestibular syndrome, increased sweating, tissue swelling , arterial hypertension.

Psychoemotional manifestations of are expressed in the form of an astheno-depressive disorder (fatigue, decreased performance, weakness, painful sensitivity to light or sound, weakness, bad mood, lack of joy). There is also emotional lability, increased tearfulness. A woman is worried about a feeling of anxiety, an unreasonable fear of sudden death.

Impaired reproductive function during childbearing years is often regarded as aging and loss of femininity. A woman perceives herself as inferior. Depression accompanies 40% of patients.

Diagnostic methods

To determine the severity of clinical manifestations, the Kupperman menopausal index is used. This test is based on the analysis of metabolic, vegetative and psycho-emotional disorders. The woman is offered to answer 30 questions that have 4 possible answers. Points are given depending on how severe the symptoms are, then they are summed up and evaluated.

To determine the functional activity of the ovaries, as well as to make a further prognosis, experts examine the level of estradiol, follicle-stimulating and luteinizing hormones in dynamics.

To determine the structural changes in the ovaries, to assess the characteristics of intraovarian blood flow after removal of the uterus, ultrasound with Dopplerography is prescribed. The study indicates a cystic transformation of the ovaries, which were preserved after the operation, and in the intraovarian blood flow, the rate of microcirculation slows down, there is venous congestion.

With persistent PHES (symptoms bother more than a year after surgery), the volume of the ovaries decreases, the follicular reserve is depleted, and the echogenicity of the stroma increases. With transient PGES (symptoms bother 1-12 months), ovarian function is restored over time.

Treatment

Therapy depends on the severity of clinical symptoms. With mild and moderate degree of PGES, sedatives, antidepressants, and tranquilizers are prescribed. To improve the processes of microcirculation in the pelvic organs and eliminate congestion, physiotherapy is carried out, for example, electrophoresis.

In more severe cases, hormone replacement therapy (HRT) is added. Additionally, they control the rheological properties of blood, indicators of fluidity and coagulability, and prevent the formation of blood clots with the help of venoprotectors and antiplatelet agents.

Hysterectomy – City Hospital No. 40

Operation hysterectomy – removal of the uterus with a neck

The name of the operation hysterectomy comes from the Latin hystera – uterus, ectomia – removal, in other words, it is a surgical operation to remove the uterus. To date, hysterectomy is the most common gynecological operation, both in Russia and abroad, ranking second among gynecological operations after operations on the uterine appendages.

Indications for hysterectomy

Indications for hysterectomy are: tumor diseases of the uterus, such as uterine fibroids in case of large nodes or their rapid growth, compression of adjacent organs, the presence of uterine bleeding caused by fibroids. Hysterectomy is also performed:

• in cases of uterine prolapse or prolapse,
• in case of adenomyosis leading to bleeding and anemia of the patient,
• in the presence of malignant neoplasms of the ovaries and uterus,
• Malignant neoplasms of the cervix,
• inflammatory diseases of the uterus and appendages

The decision on the methods of treatment of the above diseases is made by the doctor, taking into account the age of the patient, the implementation of reproductive plans, concomitant gynecological and somatic diseases. If in the surgical treatment of women under 40 years of age preference is given to organ-preserving operations aimed at restoring and preserving reproductive functions, then in patients of the older age group with realized generative function, radical hysterectomy is more often performed.

Often the question arises of the advisability of preserving or removing the cervix from the position of oncological alertness (the risk of oncological diseases in other parts of the reproductive system).

There are three types of hysterectomy: supravaginal amputation of the uterus or subtotal hysterectomy (preserving the cervix), hysterectomy or total hysterectomy (removal of the body of the uterus along with its cervix) and radical hysterectomy (with removal of the fallopian tubes and ovaries). All of these options refer to radical operations, that is, to a surgical intervention that leads to a complete cure for the patient.

Subtotal hysterectomy

Subtotal hysterectomy is performed for diseases such as uterine fibroids in women under 50 years of age, prolapse of the pelvic organs during sacrocervicopexy, and benign ovarian tumors. This type of operation allows you to save the cervix, which has a beneficial effect on the postoperative period, allowing the patient to have a full sexual life. However, the risk of developing cervical cancer remains.

In the case of supravaginal amputation of the uterus, the risk of malignant tumors of the cervix ranges from 0. 5 to 1%. In the vast majority of cases, diseases of the cervix after subtotal hysterectomy are found in patients who, at the time of surgical treatment, already had some of its changes. It is now known that in patients who do not have pathological changes in smears for oncocytology taken before surgical treatment, the risk of developing cervical cancer in the future is less than 0.3%. Therefore, an important stage before surgical treatment is the clinical and laboratory examination of patients.

Total hysterectomy (hysterectomy)

Total hysterectomy is by far the most common type of this type of operation. Indications for it are most often: uterine fibroids in women over 45 years of age, with changes in the cervix according to colposcopy, detection of human papillomavirus in the study of PCR, with a combination of uterine fibroids with adenomyosis, with prolapse of the pelvic organs during vaginal hysterectomy followed by plasty of the walls of the vagina. At the very initial stages of cancer of the body and cervix, a panhysterectomy is performed, that is, a total hysterectomy with appendages on both sides.

Radical hysterectomy

In cases where it is necessary to quickly reach menopause, a radical hysterectomy with removal of the ovaries and fallopian tubes (or salpingo-oophorectomy) is performed. The main reason for such a radical decision is the increased risk of subsequent development of ovarian cancer. The final decision is made by the doctor after analyzing all the factors, such as: the age of the patient, the disease, the suspicion of malignancy of the formation. Radical hysterectomy is performed in the following cases: uterine fibroids in a woman in perimenopause, that is, a period close to menopause, when leaving the ovaries is impractical. Also, radical hysterectomy is performed for ovarian tumors in women of late reproductive age, with the very initial stages of cancer of the body and cervix.

Hysterectomy and types of operations

Removal of the uterus can be performed by three different approaches: laparoscopic, laparotomic and vaginal (vaginal). Depending on the access, the general health of the patient, the optimal type of anesthesia is selected.

Laparotomic hysterectomy

If the operation is performed by laparotomy, the surgeon makes a lower median or transverse incision of the abdominal wall 10-20 cm. The uterus is fixed and removed from the abdominal cavity through the wound. The ligamentous apparatus that holds the uterus, blood vessels of the uterus and appendages is crossed, if their removal is planned.

In the case of subtotal hysterectomy (supravaginal amputation of the uterus), the body of the uterus is cut off by the surgeon from the cervix, followed by the formation of a stump. During the extirpation of the uterus, the latter is cut off from the underlying formations, with the formation of a vaginal stump. The disadvantages of laparotomic hysterectomy are the high invasiveness of the operation, as a result of which the recovery period and the length of stay in the hospital increase.

Hysterectomy performed by laparotomy is more difficult for patients to tolerate, in patients in the postoperative period there is a greater intensity of pain, which requires the use of analgesics in comparison with women who underwent surgery by vaginal or laparoscopic access.

Vaginal or vaginal hysterectomy

Vaginal (Vaginal) hysterectomy is performed by the surgeon through an incision in the upper third of the vagina. Therefore, after such an operation, there is no scar on the anterior abdominal wall. Removal of the uterus through the vagina has such obvious advantages as less blood loss compared to abdominal hysterectomy, better patient well-being after surgery, a short rehabilitation period, and a quick return of the patient to normal activity. However, for this operation, the necessary conditions are sufficient mobility and moderate size of the uterus, sufficient vaginal capacity. Due to the low visibility, the risk of damage to adjacent organs increases.

Laparoscopic hysterectomy

Laparoscopic hysterectomy is by far the most technologically advanced method. In Russia, the first laparoscopic hysterectomy was performed in 1991 by H. Reich, the surgeon who is the author of this operation. When removing the uterus through laparoscopic access, through the navel or 2 cm above it, a 10 mm trocar for the laparoscope is inserted, two trocars d = 8 mm and one trocar d = 5 mm for operating instruments are also inserted in the right and left iliac regions and above the womb. At the beginning of the operation, using a special camera (laparoscope), an examination of the abdominal organs (stomach, liver, intestinal loops, peritoneum, omentum) is performed, which makes it possible to identify concomitant diseases, if any. Next, the pelvic organs are examined and the necessary manipulations are performed – ligation (ligation) and the intersection of the vessels supplying the uterus, the intersection of the ligamentous apparatus of the uterus. Through an incision in the upper wall of the vagina, it is possible to extract the entire organ. Or after its preliminary slicing (in the case of a large size of the uterus).

In addition to the advantages similar to those of vaginal hysterectomy (low surgical trauma, low blood loss, short recovery period, cosmetic effect, etc.), laparoscopic hysterectomy has additional advantages, such as a tenfold magnification with optical instruments , which allows better visualization of the anatomy and, most importantly, the pathology of the pelvic and abdominal organs.

This approach allows for complete hemostasis, which makes the amount of blood loss minimal and reduces the risk of infectious complications. Also, when performing laparoscopic hysterectomy, it is possible to obtain video documentation. The disadvantages of laparoscopic hysterectomy include the high cost of equipment purchased by the hospital, which leads to an increase in the cost of the operation.

Robot-assisted hysterectomy

Robot-assisted hysterectomy is performed using the Da Vinci robot system. As with laparoscopy, trocars are installed in the abdominal cavity, to which special manipulators of the Da Vinci Si HD robot are attached. Instruments are attached to them and then installed in the abdominal cavity, which the surgeon controls using the robot console, being away from the operating table. The steps of the operation are the same as for laparoscopy.

Da Vinci robot can perform operations such as:

• subtotal hysterectomy,
• total hysterectomy,
• radical hysterectomy,
• as well as an extended hysterectomy, that is, a hysterectomy with the removal of lymph nodes, performed for cancer of the body and cervix.

After a robot-assisted hysterectomy, the patient is allowed to drink, roll over in bed, and get up on the day of the operation. The advantages of robot-assisted operations are:

• less blood loss,
• shorter downtime, even compared to laparoscopic surgery,
• less injury,
• greater radicalism of the operation (this is especially true for operations with cancer of the cervix and body of the uterus, thanks to the 3D image of the optical system).

Preparing for uterine hysterectomy

When preparing for surgery, you must first visit the selection committee at the gynecology department to determine the indications and the date of the operation. Then undergo an examination (the list of necessary tests is on the website). For hospitalization, it is recommended to have compression stockings or bandages with you to prevent thromboembolic complications, as well as 5 syringes of Clexane 0.4 for subcutaneous injection. On the appointed day, the patient is admitted to the department, preoperative preparation is carried out, and the next day, surgery is performed. Special preparation before the operation at home is not required.

After hysterectomy

In the postoperative period after laparotomic hysterectomy, the sutures are removed on the 8th day, discharge from the hospital is made on the 6-8th day after the operation. A mandatory recommendation after this type of surgery is to limit physical activity for 3 months.

After vaginal hysterectomy (vaginal) and laparoscopic surgery already on the first day of the postoperative period in the evening it is allowed to drink liquid, turn and sit up in bed, get up. The next day you are allowed to get up, walk and eat. Extract is carried out on the 3-6th day of the postoperative period.

During the first two weeks after surgery, patients are advised to take a shower and then treat the wounds. The need to limit physical activity in this category of patients is present during the first 2-3 weeks of the postoperative period, after which it is possible to return to normal activity. A month later, the department performs a control examination with the results of histology and subsequent recommendations.

Consequences of hysterectomy

Long-term results of hysterectomy were analyzed, which showed that the general well-being and quality of life of patients after removal of the uterus does not depend on the volume of the operation, but on the general condition and the presence of concomitant diseases before surgical treatment.