In the field of women’s surgery, the hysterectomy is probably one of the best-known procedures. While the name is commonly used in conversation, the different options available to women, as well as their side effects, are less familiar to many.
What is a Hysterectomy?
A hysterectomy is a surgical operation performed to remove all or part of a woman’s uterus. Depending on the reason for the surgery, other organs such as the ovaries and fallopian tubes may be removed at the same time.
Why Do Women Need Hysterectomies?
There are a number of different reasons why a doctor may recommend a hysterectomy. They include:
- Pelvic pain. If you’re suffering from severe and/or chronic pelvic pain, you may consider getting a hysterectomy. There can be a variety of reasons for pelvic pain, including pelvic inflammatory disease (PID) and endometriosis.
- Heavy bleeding. If you have unusually heavy cycles or some other cause for uterine bleeding, a hysterectomy may be an option. Some women suffer from periods that are so heavy that they strongly affect their daily activities. If medication or some other treatment doesn’t work, you may consider a hysterectomy if you’re done having children.
- Uterine prolapse. A prolapsed uterus is one that has dropped down so that it is either protruding from your cervix or feels that way. Uterine prolapse usually happens when muscles and ligaments weaken during pregnancy, and they’re unable to hold the uterus in its rightful place afterward. If other methods fail (i.e., physical therapy), a hysterectomy would be a good consideration.
- Fibroids or tumors (cancerous or non-cancerous). The final and most unwanted reason to have a hysterectomy is if fibroids or tumors (especially those that are cancerous) are found in the uterus, ovaries, or fallopian tubes. In such cases, your best chance of removing all the cancer is to have a hysterectomy.
What Types of Hysterectomy Procedures Are There?
Hysterectomies can be classified in two different ways. They can be categorized by the amount of the uterus and surrounding organs that are removed or by the surgical techniques that are used in performing the procedure. Classifications based on the amount that is removed include the following:
- Partial hysterectomy: This is a removal of a portion of the uterus.
- Complete hysterectomy: This procedure includes the removal of the uterus as well as both ovaries and the fallopian tubes. As the ovaries regulate hormones in a woman’s body, it is typically followed up with a hormone replacement protocol plan.
- Total hysterectomy: This procedure removes the complete uterus and the cervix. It can be performed abdominally or vaginally. (More on this below.)
- Subtotal hysterectomy: This is a complete removal of the uterus where the cervix is left intact.
What Kinds of Surgical Techniques are Used?
As surgical techniques continue to advance, hysterectomies become lower in risk and less invasive overall. Several different options now exist. Surgeons will choose the best option based on any risk conditions you may have and the reason for the hysterectomy, among other factors. Options include:
- Vaginal approach: If the uterus is a normal size and there is no reason to explore the surrounding area, a vaginal approach using the vNOTES procedure is less invasive. It leaves no visible scarring, and the recovery time is significantly shorter than traditional surgery.
- Robotic surgery: In the past, surgical incisions needed to be large enough to fit instruments and hands. The techniques in a robotic hysterectomy surgery allow a combination of imaging and remote operation. This means that the tools used for surgery can be much smaller and the healing due to incisions much more rapid.
- Abdominal approach: This requires an incision in the lower abdomen. It is a common approach when larger surgeries are needed or if there is a high risk of cancer.
- Laparoscopic approach: By bringing a small camera (called a “laparoscope”) into the abdomen (often through the navel), doctors can see more but work with a smaller incision. This technique can be used in both vaginal and abdominal surgeries.
What are Possible Side Effects?
Side effects for a hysterectomy will vary based on the technique and the specific organs removed. Bleeding, bruising and pain are common after any surgical procedure, and care must be taken to avoid anything strenuous until you are sufficiently healed. The time this will take will depend on your physical condition as well as the level of invasiveness of your procedure.
If you have your ovaries removed in addition to your uterus, you may have additional symptoms due to a change in your normal levels of estrogen. Hormone replacement therapy may be recommended to mitigate for this.
With all surgical procedures, there are some side effects that may come with anesthesia and/or post-surgical painkillers and antibiotics. These vary based on your body’s ability to tolerate these substances and your general health.
What are the Risks of a Hysterectomy?
Risk factors again vary due to your level of health. Coexisting conditions, from blood disorders to heart conditions to cancer, can increase the level of risk. Smoking, obesity, diabetes and other issues will also increase your overall risk. Surgical procedures can stress your heart and vascular system and cause bruising and pain during the healing process.
There is a risk of infection, of incomplete removal of cancer (if this is the reason for the procedure) and of intolerance to anesthetics or post-surgical medications. Doctors work closely with you before and after surgery to avoid these problems as much as possible and to catch them early if they do occur. If you have concerns, it is always good to speak to your provider about them before undergoing surgery.
