Hysterectomy is the surgical removal of the uterus, otherwise known as the womb; sometimes the cervix and/or ovaries and fallopian tubes are also removed.
According to the Centers for Disease Control and Prevention (CDC), hysterectomy is the second most frequently performed surgical procedure, after cesarean section, for U.S. women. Approximately 600,000 hysterectomies are performed annually, and approximately 20 million American women have had a hysterectomy. During 2000-2004, rates were highest in women aged 40-44 years.
According to Our Bodies, Ourselves (as reported by the National Women’s Health Network), approximately 90 percent of hysterectomies are performed electively. For some conditions, there are nonsurgical optionsto be considered before choosing hysterectomy.
WHY MUST I HAVE A HYSTERECTOMY?
Hysterectomy is a medically necessary intervention in the case of:
- Invasive cancer of the uterus, cervix, vagina, fallopian tubes, and/or ovaries
- Unmanageable infection
- Unmanageable bleeding
- Serious complications during childbirth, such as a rupture of the uterus
The three conditions most often associated with (though not always medically necessary for) hysterectomy are uterine leiomyoma (“fibroid tumors”), endometriosis, and uterine prolapse.
WHAT ARE THE DIFFERENT TYPES OF HYSTERECTOMY AND SURGERY?
- A partial hysterectomy removes the body of the uterus while the cervix is left in place.
- A total or simple hysterectomy removes the entire uterus and cervix.
- A hysterectomy with bilateral salpingo-oophorectomy removes the uterus, cervix ovaries, and fallopian tubes.
- A radical hysterectomy removes the uterus, cervix, ovaries, fallopian tubes, and possibly upper portions of the vagina and affected lymph glands.
A hysterectomy is performed under either general or local anaesthetic.
Surgical options include abdominal hysterectomy, which is the most common approach. When performing this operation, the surgeon makes either a vertical incision from your navel to your pubic hair line or a horizontal incision directly above your pubic hairline. Although the procedure results in a longer recovery period and a more noticeable scar than the other options, it requires less skill and is usually less costly and more widely available than the other procedures.
With a vaginal hysterectomy, your uterus is removed through the vagina. One or both ovaries and fallopian tubes may also be removed during the procedure. With less postoperative pain and complications compared to other types of hysterectomy, this approach results in no visible scars and typically allows for a quicker recovery. Risks include a slight but serious risk of shortening or damaging the vagina.
With a laparoscopic-assisted vaginal hysterectomy, your uterus will also be removed through the vagina but this procedure involves three small external incisions: one in your navel, through which the laparoscope (small video camera) is inserted, and two others in your lower abdomen for the use of surgical instruments. The video camera offers the surgical team greater visibility. This procedure entails less healing time and less pain, and leaves a less noticeable scar. This surgery includes a slight risk of bladder injury and urinary tract infection.
Laparoscopic-assisted abdominal hysterectomy requires only one incision for both the laparoscope and the removal of the uterus. However, this surgery is only appropriate for a supracervical hysterectomy (where the cervix is not removed).
WHAT ARE THE RISKS?
Death due to hysterectomy is rare: less than one percent. Complications occur in three to five percent of procedures. Surgical complications may result in infection, hemorrhage during or following surgery, and/or damage to internal organs such as the urinary tract or bowel. There are other risks, including prolapse of the vagina, where the uterus, rectum, bladder, urethra, or small bowel begin to fall out of their normal positions and protrude through the vagina, and thrombosis, a type of blood clot.
Removal of the uterus and ovaries at a young age (early forties and younger) may increase your risk of heart attack. Hysterectomy has also been associated with urinary problems, sexual function problems, and hormone deficiencies.
Scar tissue, known as adhesions, may result when the surgeon removes your uterus, ovaries, or both, and your remaining organs begin to form attachments to other organs. Many types of pelvic surgery can cause adhesions; they are not the result of hysterectomies alone. Symptoms from adhesions, such as abdominal pain, usually begin within six months of hysterectomy surgery.
WHAT WILL MY RECOVERY LOOK LIKE?
If you are not menopausal and your ovaries are left in place, menstruation will end with the surgery (and you will no longer be able to get pregnant), but hormonal functions will still be present. If the ovaries are removed, your hysterectomy will jump-start menopause.
During the first week after the procedure, some light bleeding may occur and, after four to six weeks, there may also be discharge when your stitches fall out. Baths should be avoided for 10 days after the operation and, as with any other surgical procedure, strenuous physical activity is not advisable for four to six weeks. Gentle activity, such as walking when you feel ready, is encouraged. Most doctors advise against resuming penetrative sexual activity until six weeks have passed.
Generally, a woman needs five to six weeks to recover though anywhere up to 12 weeks is considered normal. Online support groups include Hyster Sisters.
For more information, the U.S. Department of Health and Human Services Office on Women’s Healthprovides this brochure.
Sources: Hysterectomy Surveillance. Centers for Disease Control and Prevention Online. 1994, 1999, 2002.
Hysterectomy Frequently Asked Questions. US Department of Health and Human Services Office on Women’s Health. 2009.