What is a hysterectomy?
A hysterectomy is the surgical removal of the uterus and often the cervix. Depending on the reason for the procedure, it may also include the removal of nearby organs and tissues, such as the fallopian tubes and ovaries.
You cannot conceive or menstruate after a hysterectomy, but the procedure can help you find relief from pain and other symptoms that lower your quality of life. Having a hysterectomy can be a major decision, and your women’s health provider will help you weigh the pros and cons, so you feel confident in your treatment decision.
Types of hysterectomy
Depending on your diagnosis, your provider may suggest removing the ovaries and fallopian tubes as well as the uterus as part of your hysterectomy.
The different types of hysterectomy surgeries are:
- Hysterectomy with or without removal of fallopian tubes or ovaries: A surgeon removes the upper part of the uterus. Your cervix, which connects the vagina to the lower part of the uterus, remains in place. This procedure is also called a subtotal or supracervical hysterectomy.
- Total hysterectomy: In a total hysterectomy, the surgeon removes your uterus and cervix. A total hysterectomy is also called a complete or simple hysterectomy. It is the most common type of surgery for removing the uterus.
Why might I need hysterectomy surgery?
A hysterectomy is used to treat many women’s health conditions, including:
- Endometriosis
- Gynecologic cancers, including cervical, ovarian, endometrium and uterine cancers
- Menorrhagia or heavy bleeding
- Severe pelvic pain or pain with periods
- Uterine prolapse that can lead to urinary incontinence or fecal incontinence
- Uterine fibroids or other noncancerous tumors
- Conditions affecting the lining of your uterus, such as hyperplasia or adenomyosis
Many women have a hysterectomy to prevent cancer. For those at high risk of certain types of cancer, removing the uterus and surrounding reproductive organs can significantly lower the risk of developing the disease.
How to prepare for hysterectomy surgery
Taking steps to improve your health in the weeks leading up to your procedure will ease your recovery. Steps to take include:
- Eating a healthy diet
- Exercising regularly
- Getting plenty of sleep
- Quitting smoking
- Optimizing and managing any existing chronic conditions
Your surgeon will discuss the approach they will take to perform your hysterectomy and will provide detailed instructions to follow about whether or when to stop taking medications. An anesthesiologist will explain your sedation options.
You will also need to find someone to drive you to and from the hospital on the day of your hysterectomy.
The hysterectomy procedure
Hysterectomy is a safe, common procedure. Depending on your overall health and reason for surgery, your experience will be unique to you.
Before the procedure
Your care team will tell you when to arrive for your procedure. When you arrive, you will meet with members of your surgery team. This is a good time to ask any remaining questions you have.
If you expect to stay at the hospital after your procedure, bring clothing, toiletries and a book or other item to make your stay more comfortable.
During the procedure
Just before your procedure, you will receive anesthesia. Your anesthesiologist will use general anesthesia, which allows you to remain unconscious throughout the procedure, or regional anesthesia that numbs your abdomen and legs.
Based on your specific needs, your surgeon will remove your uterus using one of the following methods:
- Abdominal hysterectomy: During an abdominal (open) hysterectomy, the surgeon makes an incision in the abdomen, either horizontally just above the pubic bone or vertically up to or beyond the belly button, depending on the reason for surgery and size of the pathology. This method is often used when cancer is present, the uterus is enlarged, or the disease has spread to other pelvic areas.
- Laparoscopic hysterectomy: In many cases, a hysterectomy can be performed using minimally invasive techniques. A laparoscopic hysterectomy involves several small incisions in the abdomen rather than one large incision. The surgeon inserts an endoscope (a thin video camera) through one incision, allowing visualization of the pelvic organs on a monitor. The abdomen is inflated with gas to create space for the procedure, and small surgical tools are used in the other incisions to remove the uterus intact or in sections.
- Robotic hysterectomy: A robotic hysterectomy is another minimally invasive option, where the surgeon uses a robotic device to assist in the removal of the uterus through small abdominal incisions.
- Vaginal hysterectomy: A vaginal hysterectomy is the least invasive method for removing the uterus, as it involves an incision at the top of the vagina without any abdominal incisions. Many patients can go home the same day as the surgery, and full recovery typically takes less time and involves less pain compared to an abdominal laparoscopic hysterectomy.
After the procedure
With a minimally invasive hysterectomy, you return home within 24 hours. An open procedure may require you to stay in the hospital. Whichever procedure you have, your care team will encourage you to start walking as soon as possible to reduce your risk of blood clots.
Full recovery can take up to two months.
As you recover, avoid sex after your procedure. You may resume sexual activity when it feels comfortable and safe for you. Additionally, do not lift heavy objects for a few weeks while your body heals.
Hysterectomy side effects and risks
Hysterectomy is considered a very safe procedure, and the risk of complications is low.
Some common risks include:
- Vaginal bleeding and drainage, which can last up to six weeks
- Soreness, irritation or pain at the incision sites
- Difficulty urinating or having bowel movements in the days following surgery
- Fatigue and tiredness due to the procedure
If your healthcare provider removes your ovaries during the hysterectomy and you have not yet gone through menopause, you may experience menopausal symptoms such as hot flashes, vaginal dryness, loss of libido, and insomnia. Your OBGYN will discuss treatment options to manage these symptoms, which may include hormone replacement therapy (HRT).
Recovery
Recovery from vaginal and laparoscopic hysterectomies typically takes two to four weeks, while abdominal hysterectomies may require up to six weeks. You'll receive instructions on post-operative care, including activity restrictions.
Instructions after a hysterectomy may include:
- Expect light vaginal bleeding or dark brown discharge for up to six weeks; use light panty liners or sanitary pads (no tampons).
- Avoid lifting heavy objects (over 10 pounds) for at least four to six weeks.
- Refrain from inserting anything into the vagina as directed by your healthcare provider.
- Avoid baths or swimming for at least six weeks.
If surgical strips were used on abdominal incisions, they should fall off within two weeks, and internal stitches will dissolve on their own. You can shower during this time, washing the incision with soap and water and patting it dry; a bandage is not necessary. If staples were used, they'll be removed at your follow-up appointment, and you may need to wait to shower while using a protective covering.
You can usually drive about two weeks after abdominal surgery or once you're no longer taking narcotics. For vaginal or laparoscopic hysterectomies, you may resume driving within a few days. Gradually return to exercise in four to six weeks, and plan to return to work in two to six weeks, depending on your job.