What is a Hysterectomy?
There may be any number of reasons a person will need to one day have or consider having a hysterectomy. Here's what you need to know.
What is a Hysterectomy?
A hysterectomy is a surgical procedure that involves the removal of the uterus as well as some of the accompanying reproductive organs in certain cases.
Removal of the uterus results in the loss of one's ability to become pregnant (since the womb will be fully removed from the body) and a cessation of periods during the menstrual cycle since there will be no uterus left from which shedding endometrial tissue will need to be expelled.
Reasons Why You May Need to Have a Hysterectomy
There are a number of reasons why someone may need to have a hysterectomy. Here are the main issues this surgery can address.
Uterine fibroids
Uterine fibroids are benign growths of connective tissue and muscle from the uterine walls that can form as individual masses or in clusters, causing pain, abnormal bleeding, swelling/fullness/distention of the lower abdomen, constipation, frequent urination, and other symptoms.
Adenomyosis
This condition involves the uterine lining (endometrial tissue) growing into the walls of the uterus itself, leading to painful periods, severe pelvic pain, painful intercourse, and an enlarged uterus.
A hysterectomy fully cures adenomyosis due to the removal of the afflicted organ.
Endometriosis
Endometriosis is similar to adenomyosis in that it involves endometrial tissue, but it grows outside of the uterus entirely. It can be found on the fallopian tubes, ovaries, bladder, rectum, intestines, or anywhere else in the pelvic cavity. It may also migrate and be found on other abdominal organs as well as reach the diaphragm and lungs (known as thoracic endometriosis).
Endo can be a debilitating condition causing heavy and irregular menstrual bleeding, severe pelvic pain, pain during intercourse, pain and difficulty with both bowel movements and urination, bloating ("endo belly"), fatigue, nausea, lower back pain, infertility, and many other issues depending on where the lesions are located.
A hysterectomy is not a magical cure for endometriosis, but in many cases, it can help alleviate symptoms and provide some relief, especially alongside additional procedures such as laparoscopies with excision and ablation.
Cancer or precancerous cells in the reproductive organs or pelvic region
When precancerous cells are found in one's reproductive organs, a hysterectomy may often be a great preventative measure in ensuring that the abnormal cells do not replicate or spread further.
Additionally, when these types of cancers are found in the pelvic region, a hysterectomy will often be done in the same manner as described above for complete removal as well as various preventative purposes. It is typically performed alongside the other treatment methods in whichever way your doctor best sees benefiting your overall health and eliminating the present cancer risks.
Persistent, heavy, and/or abnormal vaginal bleeding
If you experience abnormal bleeding that is excessively heavy or persistent, a hysterectomy may be the solution to your troubles. Many doctors will recommend trying other treatment methods beforehand, such as hormonal treatment, ablation, or simply waiting it out. However, if a hysterectomy is approved as the best course of action for resolving your symptoms, it will end the bleeding and associated symptoms once the uterus has been completely removed.
Uterine prolapse
This type of prolapse occurs due to weakness in the pelvic muscles, ligaments, and connective tissues. They eventually become unable to properly keep the uterus in place—whether weakened from childbirth, obesity, age, smoking, menopause, or other issues—and it falls down into the vaginal canal. Some people experience pressure, fullness, or other unpleasant sensations when this happens, and some individuals experience no symptoms at all.
In the event of a uterine prolapse, a hysterectomy may be a suitable resolution to the problem although there are other treatment methods available for this condition before resorting to such a surgery.
Gender affirming surgical therapy
For those assigned female at birth that are taking further steps as transgender men and are able to afford such surgical procedures, a hysterectomy has become a significant component in the process for those seeking surgery for the sake of gender affirmation or in relation to gender dysphoria. In these cases, a hysterectomy is considered an essential part of one's care.
The Different Types of Hysterectomies
A hysterectomy is a procedure to remove a uterus from the human body, but there are quite a few types of hysterectomies due to the potential need for other organs or structures to be removed in the process of the surgery.
Total Hysterectomy
A total hysterectomy involves removing not only the entire uterus but also the cervix and the very upper portion of the uterus that lies above the opening to the fallopian tubes (called the "fundus"). In this procedure, the ovaries will be left behind, usually to maintain proper hormone levels and reduce the amount of stress the body will be dealing with during recovery.
Total Hysterectomy with Salpingo-Oophorectomy
This type of hysterectomy is the same as the total hysterectomy but also includes the removal of one or more ovaries and the fallopian tubes.
Radical Hysterectomy
Most commonly used when cancer is the reason behind the need for surgery, a radical hysterectomy will remove the uterus, the upper portion of the vagina, the cervix, and a significant portion of the tissue around the cervix and in the individual's pelvic cavity (as needed). The lymph nodes in the pelvic region may also be removed in serious cases.
Supracervical Hysterectomy
A supracervical hysterectomy is far less intense than the formerly mentioned options, simply removing the uterus but leaving behind the cervix and other pelvic reproductive organs.
Surgical Procedures for a Hysterectomy
There are two main methods of performing a hysterectomy: abdominally or vaginally. Some doctors may even use a combination of the two methods and adopt necessary procedures from each of these depending upon the reason for a patient needing the hysterectomy in the first place.
Abdominal Hysterectomy
This traditional method of performing a hysterectomy involves the surgeon making surgical incisions in the lower abdomen to remove the uterus and other afflicted organs. It's also associated with a longer recovery time but is the preferred method for doctors to use in the event that:
Your doctor needs to inspect the other pelvic organs and internal pelvic region for disease or other concerns
Your health has certain complications or conditions that indicate an abdominal procedure would be better suited for you (i.e., having a larger uterus than normal, abnormal uterine shape, etc.)
Vaginal Hysterectomy
With the help of ever-advancing robotic technology, it is now possible to perform a hysterectomy vaginally, resulting in quicker recovery times, lowered hospital expenses, and far less invasive means of accomplishing the ultimate goals of a hysterectomy. These vaginal hysterectomies will often be referred to as "laparoscopically assisted vaginal hysterectomies" (LAVHs) or as getting a "robotic hysterectomy."
Are There any Serious Risks Associated with a Hysterectomy?
Although technological advancements have greatly decreased the recovery time as well as the level of risk involved with having a hysterectomy, there are still a few issues that need to be monitored to avoid having them occur:
Adverse reactions to anesthesia (especially for those who haven't had prior surgeries)
Excessive amounts of bleeding
Infection (always a risk in any procedure)
Damage to other internal structures during surgery (urinary tract, bladder, intestines, rectum, and other structures in the pelvic region)
Additionally, even without the removal of one's ovaries, there is also the risk of early onset of menopause. For those who have an oophorectomy performed alongside their hysterectomy, this risk of early-onset menopause is greatly increased and hormonal replacement therapy may become necessary. If both ovaries are removed during surgery, the side effects will be quickly noticed. Your chances for heart disease and other similar conditions will also increase after losing your ovaries.
Hysterectomies also have a death rate of below 1%, so it is unlikely that such will occur with such a commonly performed procedure, but it's still a possibility as with any procedure.
How Long Does Recovery Take?
Most individuals will be required to stay in the hospital for at least 24 hours after surgery to be monitored before being allowed to return home for recovery.
In general, most hysterectomies have an average recovery time of 4 to 8 weeks with the 6-week mark being a significant milestone regarding healing, intercourse, lifting, exercise, and other activities. However, it's essential that you attend all of your post-op appointments and receive clearance from your doctor before engaging in any of these activities after surgery to avoid causing damage, impairing the healing process, or potentially causing a prolapse to occur.
The type of hysterectomy you have will determine the specifics of your recovery period, and more information on this can be found here.
Further Information
If you'd like to know even more about hysterectomies, please check out the American College of Obstetricians and Gynecologists page regarding the procedure.