What are the common side effects of a total hysterectomy. How long does recovery typically take after the procedure. What are the potential long-term impacts of a hysterectomy on a woman’s health. How can patients manage post-operative symptoms and ensure a smooth recovery.

Understanding the Different Types of Hysterectomy Procedures

A hysterectomy is a surgical procedure that involves the removal of the uterus. There are several types of hysterectomy procedures, each with its own set of potential side effects and recovery considerations:

• Total hysterectomy: Complete removal of the uterus and cervix
• Supracervical hysterectomy: Removal of the uterus while preserving the cervix
• Radical hysterectomy: Removal of the uterus, cervix, and surrounding support tissue
• Hysterectomy with oophorectomy: Removal of the uterus and one or both ovaries
• Hysterectomy with salpingo-oophorectomy: Removal of the uterus, fallopian tubes, and ovaries

The choice of procedure depends on the underlying medical condition and individual patient factors. Understanding the specific type of hysterectomy performed is crucial for anticipating potential side effects and planning for recovery.

Immediate Post-Operative Side Effects and Recovery

In the days and weeks following a total hysterectomy, patients may experience a range of side effects as their body heals from the surgery. What are the most common immediate post-operative symptoms? These typically include:

• Pain and discomfort around the incision site
• Vaginal bleeding and discharge
• Constipation
• Fatigue
• Difficulty urinating

Managing these symptoms is an important part of the recovery process. Pain medication, proper wound care, and following post-operative instructions from your healthcare provider can help alleviate discomfort and promote healing.

Recovery Timeline and Expectations

How long does it typically take to recover from a total hysterectomy? The recovery timeline can vary depending on the surgical approach and individual factors, but generally:

• Vaginal or laparoscopic hysterectomy: 3-4 weeks for initial recovery
• Abdominal hysterectomy: 4-6 weeks for initial recovery

During this time, patients are advised to limit certain activities to promote healing. This includes:

1. Avoiding driving for 2 weeks
2. Refraining from lifting heavy objects (more than a bag of groceries) for 6 weeks
3. Expecting fatigue for the first 6 weeks
4. Being prepared for spotting and vaginal discharge for up to 8 weeks
5. Avoiding inserting anything into the vagina for 8 weeks

It’s important to note that full recovery and return to all normal activities may take several months. Patients should work closely with their healthcare providers to determine when it’s safe to resume specific activities.

Long-Term Effects of Hysterectomy on Hormonal Balance

The long-term effects of a hysterectomy on hormonal balance can vary depending on whether the ovaries are removed during the procedure. What happens when the ovaries are preserved? Even when the ovaries are left intact, some studies suggest that a hysterectomy may potentially accelerate the onset of menopause.

A 2020 review of research studies found evidence indicating that some hysterectomies that spare the ovaries may lead to earlier menopause. One theory, proposed in a small 2006 study, suggests that hysterectomies might affect blood supply to the ovaries, potentially impacting their function. However, it’s important to note that the evidence is mixed and depends on various factors, including the type of hysterectomy performed and the extent of tissue removal.

Hysterectomy with Oophorectomy: Induced Menopause

When a hysterectomy includes the removal of both ovaries (bilateral oophorectomy), it results in immediate surgical menopause. What are the symptoms of surgically-induced menopause? These can include:

• Hot flashes and night sweats
• Vaginal dryness
• Sleep disturbances
• Mood swings and irritability
• Weight gain
• Hair loss
• Dry skin
• Urinary incontinence
• Loss of bone density
• Rapid heartbeat

The sudden drop in estrogen levels following oophorectomy can lead to more intense menopausal symptoms compared to natural menopause. How can these symptoms be managed? Hormone replacement therapy (HRT) is often recommended for premenopausal women who undergo oophorectomy to alleviate symptoms and reduce long-term health risks associated with estrogen deficiency.

Potential Risks and Complications of Total Hysterectomy

While hysterectomy is generally considered a safe procedure, it is still major surgery and carries potential risks and complications. What are the most common risks associated with a total hysterectomy?

• Infection at the incision site or in the pelvic area
• Excessive bleeding
• Damage to surrounding organs (bladder, bowel, ureters)
• Blood clots
• Adverse reactions to anesthesia
• Pelvic floor weakness leading to prolapse
• Changes in sexual function or sensation

It’s crucial for patients to discuss these potential risks with their healthcare provider before surgery and to be aware of signs that may indicate complications during recovery. Prompt reporting of any unusual symptoms can help ensure timely treatment and prevent more serious issues.

Impact of Hysterectomy on Sexual Health and Function

The effect of a hysterectomy on sexual health and function is a common concern for many patients. How does a total hysterectomy impact sexual experiences? The impact can vary widely among individuals, but some potential changes may include:

• Altered sensations during intercourse due to the removal of the cervix
• Changes in orgasm intensity or frequency
• Vaginal dryness, especially if the ovaries are removed
• Reduced libido, which may be related to hormonal changes
• Potential improvement in sexual function for those who previously experienced pain or heavy bleeding

It’s important to note that many women report no negative impact on their sexual function following a hysterectomy, and some even experience improvements. Open communication with healthcare providers and partners can help address any concerns and find solutions to potential issues.

Strategies for Maintaining Sexual Health Post-Hysterectomy

What can be done to maintain or improve sexual health after a hysterectomy? Consider the following strategies:

1. Allow adequate time for healing before resuming sexual activity
2. Use lubricants to address vaginal dryness
3. Engage in pelvic floor exercises to improve muscle tone and sensation
4. Explore different sexual positions that may be more comfortable
5. Consider hormone therapy if menopausal symptoms are impacting sexual function
6. Seek counseling or sex therapy if psychological factors are affecting sexual well-being

By proactively addressing sexual health concerns, many women can maintain a satisfying sex life following a hysterectomy.

Long-Term Health Considerations After Hysterectomy

While a hysterectomy can resolve many gynecological issues, it’s important to be aware of potential long-term health considerations. What are some of the key health factors to monitor after a hysterectomy?

• Bone health: Especially important if ovaries were removed, as estrogen plays a crucial role in maintaining bone density
• Cardiovascular health: Some studies suggest an increased risk of heart disease in women who have had a hysterectomy, particularly if ovaries were removed at a young age
• Pelvic floor strength: Changes in pelvic floor support can lead to issues like prolapse or incontinence
• Mental health: Hormonal changes and the emotional impact of the surgery can affect mood and mental well-being
• Weight management: Hormonal shifts may influence metabolism and weight

Regular check-ups, a healthy lifestyle, and open communication with healthcare providers are essential for managing these long-term health considerations effectively.

Strategies for Optimizing Recovery and Long-Term Health

Recovering from a total hysterectomy and maintaining long-term health requires a proactive approach. What are some effective strategies for optimizing recovery and overall well-being after a hysterectomy?

1. Follow post-operative instructions carefully, including wound care and activity restrictions
2. Engage in gentle, approved exercises to promote healing and maintain strength
3. Maintain a balanced, nutrient-rich diet to support healing and overall health
4. Stay hydrated to aid in recovery and manage constipation
5. Practice stress-reduction techniques, such as meditation or deep breathing exercises
6. Attend all follow-up appointments and openly discuss any concerns with healthcare providers
7. Consider joining support groups or seeking counseling to address emotional aspects of recovery
8. Gradually return to normal activities as advised by your healthcare team
9. Continue routine health screenings, including bone density tests and cardiovascular check-ups
10. Explore hormone replacement therapy options if experiencing significant menopausal symptoms

By implementing these strategies and working closely with healthcare providers, patients can navigate the recovery process more smoothly and set the foundation for long-term health and well-being after a hysterectomy.

Addressing Emotional and Psychological Aspects of Hysterectomy

The emotional and psychological impact of a hysterectomy can be significant and varies greatly among individuals. How can patients address the emotional aspects of undergoing this procedure? Consider the following approaches:

• Acknowledge and validate your feelings about the surgery and its effects
• Seek support from loved ones, support groups, or professional counselors
• Educate yourself about the procedure and its effects to alleviate fears and uncertainties
• Practice self-care and engage in activities that promote emotional well-being
• Be patient with yourself during the recovery process, both physically and emotionally
• Explore mindfulness techniques to manage stress and anxiety
• Consider journaling as a way to process your thoughts and feelings

It’s important to recognize that emotional reactions to a hysterectomy are normal and can range from relief to grief. Some women may experience a sense of loss related to fertility or perceived femininity, while others may feel empowered by the resolution of chronic health issues. What strategies can help in coping with these emotions?

1. Open communication with partners, family, and friends about your experiences and needs
2. Joining support groups or online communities of women who have undergone hysterectomies
3. Setting realistic expectations for recovery and allowing yourself time to adjust
4. Focusing on the positive aspects of the surgery, such as improved quality of life
5. Exploring new interests or hobbies during recovery to maintain a positive outlook

By addressing both the physical and emotional aspects of recovery, patients can work towards a more holistic healing process following a hysterectomy.

Navigating Lifestyle Changes After Hysterectomy

A hysterectomy often necessitates certain lifestyle changes, both in the short term during recovery and potentially in the long term. What are some key lifestyle considerations for women who have undergone a hysterectomy?

Short-Term Lifestyle Adjustments

• Modifying your home environment to accommodate recovery needs
• Planning for assistance with daily tasks during the initial recovery period
• Adapting work schedules or responsibilities as needed
• Adjusting exercise routines to gentler, approved activities
• Making dietary changes to support healing and manage constipation

Long-Term Lifestyle Considerations

How might life change in the long term after a hysterectomy? Consider the following aspects:

1. Fertility and family planning: For women who haven’t completed their families, exploring alternative options like adoption or surrogacy if desired
2. Hormone management: Potentially incorporating hormone replacement therapy or natural alternatives into your health routine
3. Exercise and physical activity: Focusing on exercises that support pelvic floor health and overall well-being
4. Nutrition: Emphasizing a diet that supports bone health, especially if at risk for osteoporosis
5. Sexual health: Adapting to changes in sexual function and exploring ways to maintain intimacy
6. Regular health screenings: Incorporating new health checks into your routine, such as bone density scans
7. Stress management: Developing ongoing strategies to manage stress and promote emotional well-being

By proactively addressing these lifestyle factors, women can adapt to life after a hysterectomy more effectively and maintain overall health and well-being.

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.

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.

procedure, recovery after surgery and consequences for the woman

10/16/2016

Contents

• Purpose of hysterectomy
• Indications for surgery
• Preparation
• Contraindications
• Procedure
• Rehabilitation
• Benefits of contacting MEDSI

Removal of the uterus (hysterectomy) is one of the most frequently performed operations in gynecology. Intervention is a real test for a woman. Not surprisingly, patients experience not only the fear of the operation itself, but also depression and vulnerability, confusion and inferiority. We will try to answer all the questions that women have. We will understand how the removal of the uterus is carried out, and how life can change after such an intervention.

Purpose of hysterectomy

Surgery is performed when other treatments have failed or are inappropriate. Emergency interventions often help save the patient’s life.

Interestingly, in a number of European countries and the United States, the operation is common among women after 40–45 years of age. This is due to the fact that it makes it possible to reduce the risks of developing fibroids and tissue growth, if any, and also avoids the appearance of malignant tumors.

Indications for surgery

Hysterectomy is performed in the following pathological conditions and diseases:

• Uterine cancer. After surgery, chemotherapy and radiation therapy are also carried out
• Multiple nodules of fibroids
• Internal bleeding with risk of anemia and other life-threatening conditions
• Acute pain syndrome
• Vaginal bleeding
• Growth of uterine lining tissue in ovaries and fallopian tubes

Preparation

Before the removal of the uterus, the woman undergoes a comprehensive examination. It allows you to assess the patient’s health status and identify possible contraindications.

The following diagnostic tests are usually performed:

• Pelvic ultrasound or MRI with contrast agent
• Vaginal swab
• Endometrial biopsy

The so-called hospital complex is obligatory.

It includes:

• general and biochemical blood test
• urinalysis
• blood test for group and Rh factor, as well as infections, clotting disorders, HIV and other diseases
• fluorography
• ECG

The patient consults with a gynecologist, internist and anesthetist.

Important! If temporary (relative) contraindications to the intervention are identified, the necessary treatment is carried out. If, for example, infectious diseases are detected, the doctor prescribes antibiotics and anti-inflammatory drugs. It is very important to achieve complete recovery or remission. Otherwise, there will be a high risk of surgical and postoperative complications. In addition, existing diseases negatively affect the rehabilitation process, lengthening it.

If a cervicalectomy or other operation is performed to remove a malignant tumor, hormonal and other drugs are prescribed. They help stop tumor growth. The therapy can make it possible to reduce the size of the formation, which will positively affect the course of the intervention, reducing tissue trauma.

Contraindications

Surgery to remove the uterus is not performed if there are the following contraindications:

• low blood clotting
• arterial hypertension
• acute infectious diseases (including small pelvis)
• angina pectoris
• anemia
• diabetes mellitus
• liver failure
• kidney failure
• allergic reactions to anesthetics

Important! There are both absolute and relative contraindications to intervention. In this case, the doctor makes the final decision on the operation. If necessary, the patient is consulted by specialists of narrow profiles.

Procedure

Hysterectomy of the uterus (including appendages) is performed under general anesthesia. The intervention usually takes 1-1.5 hours.

3 methods are used to access organs:

• Laparoscopic. The intervention is carried out through punctures in the area of ​​the abdominal wall. The technique allows to reduce tissue injuries and shorten the rehabilitation period. Usually only 4 small punctures and a specialized tool are required. It is inserted into the cervical canal. First, the ligaments of the uterus are excised, and then it is removed. After that, the walls of the vagina are coagulated and sutured
• Abdominal. This operation is traditional and the most traumatic. It requires a large incision in the abdominal wall. Mandatory for standard intervention is the fixation of intestinal loops. This avoids damage to them. The cervix is ​​cut off in the inner zone of the pharynx. After that, her stump and vaginal vaults are sutured. Then drain pipes are installed. They are removed after a few days
• Transvaginal. Access is provided through an incision in the vaginal area. After that, the surgeon peels off the bladder. Then the vessels and fallopian tubes, as well as ligaments, are separated and cut. After that, the uterus is cut off. The stumps of the pipes are sewn together

There are also 3 types of hysterectomy.

Radical

It involves the removal of the uterus, fallopian tubes, ovaries, regional lymph nodes and fatty tissue. The operation is performed for endometriosis and cancer.

Total

This hysterectomy involves the removal of the uterus with the cervix and appendages. It is prescribed for oncological diseases. The technique allows to reduce the risks of the spread of the tumor process. It is often combined with other methods of cancer therapy (chemotherapy, etc. ). Total hysterectomy can also be performed in emergency situations.

Subtotal

The cervix is ​​not removed during this operation. This intervention eliminates the risk of damage to the ureters and large vessels. It is prescribed for adhesions, pelvic endometriosis and some other pathologies.

Rehabilitation

Recovery after a hysterectomy is a lengthy process. Conventionally, rehabilitation is divided into 2 periods:

1. Early. 3-4 days after the intervention, the woman is under the control of medical personnel. The therapy is aimed at eliminating pain, preventing bleeding, restoring the body, reducing the risk of developing anemia and inflammation. The doctor also monitors the work of the intestines, the condition of the suture and the amount of discharge from the genitals. To remove fluid from the body, a urinary catheter is installed on the first day. During this time, the patient only drinks and does not eat anything. Then, low-fat broths and yogurts are gradually introduced into the diet. Eat light foods that are quickly digested. Chocolate, cabbage, legumes, corn are completely excluded, i.e. products that can cause increased gas formation and constipation. A woman should eat in small portions and at least 4-5 times a day
2. Late. With the classical method of the operation, it lasts about 1.5 months, with laparoscopic – no more than 30 days. The late rehabilitation period begins after discharge from the hospital. At this time, a woman should be attentive to her health and direct all actions towards its full recovery

There are certain recommendations that the patient should follow during rehabilitation:

• Mandatory intake of medicines prescribed by the doctor. Painkillers, anti-inflammatory, hormonal, enzymatic and general tonic agents are usually recommended
• Restriction of physical activity. It is especially important to avoid excessive pressure on the muscles of the abdomen and pelvic floor
• Do simple exercises (if recommended by a doctor)
• Refusal of sexual life. Return to it is carried out with caution. If a woman experiences discomfort, you need to contact a gynecologist. Perhaps it will prolong the period of sexual dormancy
• Healthy eating. Even after discharge from the clinic, you need to adhere to the correct diet with the restriction of alcohol, pastries, fatty foods, smoked meats, marinades
• Proper drinking regimen. A woman should drink about 1.5-2 liters of water per day. This will allow the natural detoxification of the body

Of course, the main consequence of the removal of the uterus is that the woman loses her childbearing function. Otherwise, life can remain as fulfilling as it was before.

Over time, the menstrual cycle is restored, the level of hormones returns to normal. After the removal of the uterus, even the libido can remain the same. At the same time, the ability to lead an active sex life fully returns.

Benefits of contacting MEDSI

• Experienced doctors. Our specialists are not only professionally trained to solve women’s problems, but also provide patients with an attentive and delicate approach
• Comprehensive surveys. They are carried out using modern equipment and ensure the accuracy of diagnosis and the identification of all pathologies
• Possibilities of using sparing techniques for hysterectomy of the uterus and ovaries. Operations are performed using minimally invasive methods, which increases their safety and shortens the rehabilitation period
• New high-tech equipment. It minimizes the risk of bleeding and the occurrence of complications and relapses
• Comfortable hospital stay before and after hysterectomy
• Outpatient rehabilitation and monitoring facilities

To clarify information or make an appointment, just call +7 (812) 336-33-33. Our specialist will answer all questions. Recording is also possible through the SmartMed application.

Do not delay treatment, see a doctor right now:

• Gastroenterologist appointment
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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 Russian 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 performing 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 a preserved cervix is ​​less [13].