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Hysterectomy: When, How and What About After?
Medically Reviewed by Charles Tatum, MD
DID YOU KNOW By age 65, more than a third of US women have had a hysterectomy. Women living in the US South or Midwest are more likely to have a hysterectomy. Hysterectomy is a descriptive term that covers a range of surgical procedures and options. At its most basic, a hysterectomy is surgery to remove a woman’s uterus. (The uterus is where a baby grows.)
“There are 3 basic types of hysterectomy,” says McLeod Gynecologist Charles Tatum, MD. “In a partial (or subtotal) hysterectomy, the upper part of the uterus is removed. In a total hysterectomy, the total uterus and the cervix are removed. A radical hysterectomy is an uncommon procedure performed when cervical cancer is detected in an early stage. Removal of the tubes and ovaries are not included in the term hysterectomy, but may be noted by the terms oophorectomy and/or salpingectomy (ovary and/or tube).
A woman and her gynecologist may choose a hysterectomy if she has:
- Fibroids, or non-cancerous growths that may cause pain or excessive bleeding.
- Endometriosis, or tissue from the uterus lining that begins growing outside the uterus. It can cause painful periods, abnormal bleeding and infertility.
- Pelvic Organ Prolapse, where the organs lose support and drop into the vagina. Prolapse causes urinary leakage or a feeling of pressure in the pelvis.
- Pelvic Pain or Abnormal Bleeding not related to the above problems.
- Cancer in the cervix, ovaries or fallopian tubes.
A surgeon can perform the hysterectomy in a variety of ways:
- Open or Abdominal hysterectomy involves an incision 6-8 inches long in the lower abdomen (bikini incision). Cancer or large fibroids may require this approach, which enables the surgeon to see the entire area clearly.
- Vaginal hysterectomy removes the uterus through the vagina, avoiding the abdominal incision. A surgeon will use this approach for early-stage cancer or pelvic organ prolapse.
- Laparoscopic Supracervical hysterectomy is performed through several small incisions in or near the navel with thin, tube-like instruments and a camera.
- Laparoscopic Assisted Vaginal Hysterectomy (LAVH) involves small incisions near the navel and removal of the organs through the vagina.
Using this approach, the fibroids are removed but fertility can be maintained. Uterine Artery embolization is a minimally invasive approach that can be effective in selective patients.
The laparoscopic approaches involve shorter hospital stays (usually 24 hours), less pain and faster recovery. Open surgery may require a 2-3 day hospital stay. Other approaches can often be done as same-day surgery.
WHAT ABOUT AFTER?
Almost all women still enjoy an active sex life after hysterectomy without interference in normal function or pleasure. For a better answer on this issue, you may want to talk with women you know who’ve had a hysterectomy.
Removal of ovaries that provide the sex hormones (estrogen, progesterone and testosterone) is not usually necessary or indicated with hysterectomy. Patients with endometriosis or strong family history of ovarian cancer may benefit from removal of the ovaries at the time of hysterectomy, but will experience a surgical menopause that may cause significant symptoms including hot flashes and vaginal dryness. These symptoms can usually be managed with either hormonal or non-hormonal therapies.
Most patients will not require Pap tests post hysterectomy for benign disease. Regular Pap tests will still be necessary for women who retain their cervix or had a hysterectomy after a cancer diagnosis.
A hysterectomy is a major surgery that can have complications such as bleeding or infection. Most patients have significant and long-term improvements in their health post-hysterectomy and rarely regret having the procedure if medically indicated. Your decision should be made in consultation with your gynecologist to understand the surgical options, alternatives, and benefits. Each woman’s choice depends on her medical history, other health conditions and reasons for the surgery.
Find a Gynecologist near you.
Sources include: McLeod Health, Centers for Disease Control & Prevention, American College of Obstetricians & Gynecologists, Society of Obstetricians & Gynaecologists of Canada, National Institutes of Health, US Department of Health & Human Services, Agency for Healthcare Research & Quality, British Medical Journal