Hysterectomy

What to Expect with a Hysterectomy

A hysterectomy is a permanent and guaranteed way to treat uterine fibroids and problems including endometriosis and abnormal and heavy uterine bleeding. In addition, having a hysterectomy eliminates your risk of having cervical and uterine cancer.

A hysterectomy cannot be reversed. Once your uterus has been removed, you will no longer experience menstruation. You will also not be able to have children. If your ovaries are also removed, you will experience early onset menopause and may need hormone replacement therapy.

What are the types of hysterectomy?

There are three types of hysterectomy. Your doctor will decide which type of procedure is best, depending on your symptoms and diagnosis.

Partial hysterectomy

A partial hysterectomy is the removal of the upper part of the uterus, leaving the cervix intact.

Total hysterectomy

A total hysterectomy is the removal of the entire uterus, including the cervix. If the ovaries and fallopian tubes are also removed, the procedure is called a bilateral salpingo-oophorectomy.

Radical hysterectomy

A radical hysterectomy is the removal of the entire uterus, the fallopian tubes, the ovaries and the lymph nodes in the pelvis. You may need a radical hysterectomy to treat serious conditions like cancer.

How is a hysterectomy performed?

There are different ways to perform a hysterectomy, depending on your specific condition and medical history. Most forms take about two hours to complete. The various approaches include:

Abdominal hysterectomy

During this procedure, your uterus is removed through the abdomen.

Vaginal hysterectomy

During a vaginal hysterectomy, your uterus is removed through the vagina. This does not require an incision in the abdomen. It may not be an option if your fibroids are very large.

Laparoscopic hysterectomy

During this procedure, your surgeon makes several small incisions (about 1-inch wide) in your abdomen. Tools and cameras are then inserted through the incisions so the uterus can be removed.

Robotic-assisted hysterectomy

During a robotic-assisted hysterectomy, the surgeon makes several small incisions in the abdomen. Tools and cameras are inserted into the incisions. They are controlled by a robotic arm, which removes the uterus.

What are the risks of hysterectomy?

As with any invasive surgery that requires anesthesia, a hysterectomy comes with risks, including blood clots and injury to the bladder. If you have an abdominal hysterectomy, it is considered major surgery. You you should expect a long recovery time. Talk to your doctor about possible risks and to help decide which type of procedure is best for you.

What to Expect for Your Procedure

On the day of your surgery, take any medicines your doctor told you to take with a small sip of water and be sure to arrive at the hospital on time.

• Once you arrive at the hospital, you will be taken to a room where you will change into a hospital gown. You will then meet with your surgeon, the nurses and an anesthesiologist to ask any questions you may have about the procedure.
• The anesthesiologist will insert an intravenous (IV) line in your arm or wrist to deliver fluids and pain medicine and prep you for sedation. Once you are ready for surgery, you will be taken to the operating room.
• The surgery team will monitor your heart rate, blood pressure and breathing during your surgery. The anesthesiologist will give you general or spinal anesthesia so that you are asleep and feel no pain during the surgery.
• If you are undergoing an abdominal, a laparoscopic or a robotic-assisted hysterectomy, a nurse will sterilize the incision sites on your abdomen and the surgeon will numb the incision site or sites with a local anesthetic.
• If you are undergoing an abdominal hysterectomy, the surgeon will make either a horizontal incision at your bikini line or a vertical incision between your belly button and pubic bone.
• If you are undergoing a laparoscopic or robotic-assisted hysterectomy, the surgeon will make three small incisions in the abdomen.
• Once the uterus has been removed, the surgeon will close and cover the incisions with a dressing to keep them clean and promote healing. If you are undergoing a vaginal hysterectomy, the surgeon will remove the uterus (and ovaries and fallopian tubes if appropriate) through the vagina. He or she will then sew the top of the vagina together, leaving no external scars.

Preparing for a Hysterectomy

Before you have a hysterectomy, your doctor may order blood and imaging tests to determine the size of your uterine fibroids and to make sure you are healthy enough for surgery.

Be sure to tell your doctor about all medicines and supplements that you take. You may be asked to stop taking certain medicines before surgery, including aspirin, ibuprofen and other blood thinners.

Follow your doctor's instructions the night before the procedure. Typically, you will be asked not eat or drink after midnight and restrict certain medicines.

After Your Procedure

After your hysterectomy, you will be moved to a recovery room where a nurse will monitor your vital signs as you are waking up. You will be given pain medicine to help you feel better.

Your surgeon will talk with you to see how you are feeling and address any issues or concerns. If your surgeon ordered tests on any uterine or fibroid tissue removed during your procedure, he or she will discuss the results with you or tell you when the results will be ready.

Try to get out of bed and move around as soon as possible to speed recovery and prevent blood clots in your legs. You should also try to use the bathroom as soon as you can. If you had an abdominal hysterectomy, you may have a catheter inserted into your bladder to help you pass urine. You can eat a normal diet as long as you are not vomiting and do not feel nauseous.

What is the recovery time after a hysterectomy?

If you had a vaginal, laparoscopic or robotic-assisted hysterectomy, you can most likely go home the next day after surgery. If you had an abdominal hysterectomy, you can expect to stay in the hospital for two or more days.

Once you are home, average recovery time depends on the type of surgery you had:

• Abdominal hysterectomy: four to six weeks
• Vaginal hysterectomy: three to four weeks
• Laparoscopic or robotic-assisted hysterectomy: two to four weeks

Your ongoing recovery

Avoid sexual intercourse or lifting objects that weigh more than 20 pounds until you are fully recovered.

If your ovaries were removed during the hysterectomy, you will experience early onset menopause and likely have a reduced sex drive. This is because the ovaries make hormones responsible for sexual function. Your doctor may recommend hormone or estrogen replacement therapy to prevent bone loss and heart disease and maintain sexual health.

You will see your surgeon for a follow up appointment within four to six weeks after surgery. Be sure to tell the surgeon if you have any new symptoms such as:

• Pelvic weakness
• Vaginal dryness
• Pain during intercourse

Your doctor can recommend exercises, medicines and other therapies to help reduce these symptoms.