What you can expect after hysterectomy
For a few days following a hysterectomy, a woman may experience vaginal bleeding, some discharge, pain and tenderness. Depending on the woman and the type of hysterectomy, she may spend anywhere from a week to more than a month recovering at home before returning to normal activity. “The body will completely heal in two months regardless of the method of hysterectomy chosen,” says Dr. Bruce McLucas, an assistant clinical professor at UCLA.
When a premenopausal woman has her ovaries removed along with her uterus, she will go into menopause right after the surgery. She may begin to have unpleasant side effects, such as hot flashes and night sweats, due to the sudden halt in estrogen production.
Many women whose ovaries are removed during hysterectomy are already in menopause and receiving hormone replacement therapy (HRT). A woman not receiving HRT who experiences unpleasant symptoms after removal of the ovaries should discuss hormone replacement with her doctor. “It’s important to understand this option,” says Dr. McLucas, “especially when surgery has caused early menopause. HRT can help with the side effects, and more importantly, HRT protects against osteoporosis.” As with any medication, there are potential risks as well as benefits to be weighed.
After a hysterectomy, a woman may feel emotionally distraught. Says Dr. McLucas, “Some women identify the uterus with childbearing and with their younger years, so it’s possible to experience a sense of loss.” Women need support and understanding from family and friends.
Some women also report feeling less sexual after hysterectomy. If this is due to hormone changes because the ovaries have been removed, HRT may help. On the other hand, notes Dr. McLucas, some women have improved sexual sensation following a hysterectomy. For example, women who have experienced pain during intercourse may find relief.
Reasons for a hysterectomy
- Heavy non-menstrual bleeding
- Uterine or cervical cancer
- Severe endometriosis
- Severe prolapse
Common types of hysterectomy
- Total hysterectomy-When uterus and cervix are removed
- Total hysterectomy with bilateral salpingo-oophorectomy-When ovaries and fallopian tubes are also removed
- Radical hysterectomy-When upper third of vagina, uterine ligaments and nearby lymph nodes also also removed
Common approaches to hysterectomy
Abdominal-uterus removed through an incision in the abdomen.
Vaginal-uterus removed through an incision inside the vagina.
L.A.V.H.-uterus removed through the vagina; requires tiny abdominal incisions for a laparoscope and other instruments.
One in three American women will eventually have a hysterectomy, making it the second most common surgery after cesarean section.
Why so common? The basic answer is that hysterectomy can cure a variety of problems to which the uterus is prone.
Most often it’s recommended for serious cases of fibroids, benign tumors that grow in the wall of the uterus. Fibroids can grow quite large, and may cause great pain and heavy bleeding.
Dealing with fibroids
Depending on the severity of the fibroids, doctors and patients may decide to try treatments other than hysterectomy. In a surgery called myomectomy, the fibroids are removed but the uterus stays in place. Drug therapy may shrink the fibroids temporarily. After menopause, fibroids may shrink without treatment. For serious cases, however, hysterectomy is often the best choice because it means a definite cure.
Heavy nonmenstrual bleeding also accounts for many hysterectomies. Usually, such bleeding is caused by abnormal growth in the lining of the uterus. Treatment with hormones may help. Dilation and curettage (D&C), in which the doctor scrapes the uterine lining, also may stop the bleeding—but often just temporarily.
A procedure called endometrial ablation may be another option in cases of heavy bleeding. The doctor inserts a thin telescope called a hysteroscope, through the vagina. A laser, small electrode or heated balloon is then used to remove the uterine lining. “Ablation may take as little as about 20 minutes, and usually it’s successful,” says Dr. Bruce McLucas of UCLA, who helped to develop the technique. If bleeding recurs, a repeat ablation or a hysterectomy may be needed.
Help for endometriosis
Hysterectomy is also used to cure severe cases of endometriosis, a common disease in which tissue shed from the uterus grows outside the uterus. Endometriosis causes pain and can lead to infertility. Drug therapy can help but may not stop pain in serious cases.
Many doctors recommend hysterectomy for severe prolapse, a sagging of the uterus into the vagina. Prolapse can occur when the ligaments that support the uterus get weak over time. The ligaments sometimes can be shortened with surgery. In other cases, the doctor may place a pessary, or support ring, around the cervix. But if the ligaments are badly damaged, hysterectomy is usually necessary.
Hysterectomy is usually required when a woman has cancer of the uterus or cervix. “The only real alternative is radiation therapy,” says Dr. Barbara Levy of the University of Washington. However, radiation therapy may not be as effective and may also involve many side effects.
If the woman with cancer is in menopause, her doctor may recommend the removal of her entire uterus (including the cervix), fallopian tubes, and ovaries to prevent spread of the cancer.
The removal of the uterus and cervix is called a total hysterectomy. When the ovaries and fallopian tubes are also removed, the procedure is a total hysterectomy with bilateral salpingo-oophorectomy. In a radical hysterectomy, the upper third of the vagina, uterine ligaments, and nearby lymph nodes are also removed.
Ways of doing hysterectomy
There are several ways of doing a hysterectomy. In an abdominal hysterectomy, an incision is made in the lower abdomen.
In vaginal hysterectomy, the incision is made in the upper end of the vagina, and the uterus is removed through the vagina. This approach generally results in fewer complications and shorter recovery time. However, the ovaries cannot always be removed vaginally, so this approach may not be an option for women with cancer. Also, women with a very narrow pelvis or with large fibroids may not be eligible for vaginal hysterectomy.
Some gynecologists are now using the laparoscope—a thin telescope inserted through the belly button—to enable a larger percentage of hysterectomies to be done by the vaginal approach. The laparoscopically assisted vaginal hysterectomy is called L.A.V.H. for short.
Although any kind of hysterectomy is major surgery, patients who have had a vaginal hysterectomy or L.A.V.H. “can often go home from the hospital sooner,” notes Dr. McLucas. “And that’s a tremendous advantage.”