Hysterectomy
Definition
Hysterectomy is surgery to remove a womans womb (uterus). The womb is the area where a baby grows when a woman is pregnant.
Alternative Names
Vaginal hysterectomy; Abdominal hysterectomy; Supracervical hysterectomy; Radical hysterectomy; Removal of the uterus; Laparoscopic hysterectomy; Laparoscopically assisted vaginal hysterectomy; LAVH; Total laparoscopic hysterectomy; TLH; Laparoscopic supracervical hysterectomy; Robotically assisted hysterectomy
Description
During a hysterectomy,the surgeonmay remove the entire uterus or just part of it. The fallopian tubesand ovaries may also be removed.
Types of hysterectomy:
- Partial (supracervical) hysterectomy: The upper part of the uterus is removed. The cervix is left in place.
- Total hysterectomy: The entire uterus and cervix are removed.
- Radical hysterectomy: The uterus, cervixupper part of the vagina, and tissue on both sides of the cervix are removed. This is most often done if you have cancer.
Yourdoctor will help you decide which type of hysterectomy is best for you. The choice often depends on your medical history and reason for the surgery.
Why the Procedure Is Performed
There are many reasons a woman may need a hysterectomy. The procedure may be recommended if you have:
- Adenomyosis, which causes heavy, painful periods
- Cancer of the uterus, most often endometrial cancer
- Cancer of the cervix or changes in the cervix called cervical dysplasia that may lead to cancer
- Cancer of the ovary
- Long-term (chronic) pelvic pain
- Severe endometriosis that does not get better with other treatments
- Severe, long-term vaginal bleeding that is not controlled with other treatments
- Slipping of the uterus into the vagina (uterine prolapse)
- Tumors in the uterus, such as uterine fibroids
- Uncontrolled bleeding during childbirth
Hysterectomy is a major surgery. It is possible that your condition may be treated without this major surgery. Talk with your doctor or nurse about all your treatment options. Less invasive procedures include:
- Uterine artery embolization
- Endometrial ablation
- Using birth control pills
- Using pain medicines
- Using an IUD that releases the hormone progestin
- Pelvic laparoscopy
Risks
Risksof any surgery are:
- Allergic reactions to medicines
- Breathing problems
- Blood clots, which may cause death if they travel to the lungs
- Bleeding
- Infection
- Injury to nearby body areas
Risksof a hysterectomy are:
- Injury to the bladder or ureters
- Pain during sexual intercourse
- Early menopause if the ovaries are removed
- Decreased interest in sex
- Increased risk of heart disease if the ovaries are removed before menopause
Ask your doctor if taking estrogen can helplower the risk of heart disease and help menopause symptoms.
Before the Procedure
Before deciding to have a hysterectomy, ask your doctor or nurse what to expect after the procedure. Many women who have had a hysterectomy notice changes in their body and in how they feel about themselves. Talk with your doctor, nurse, family, and friends about these possible changes before you have surgery.
Tell your health care team about all the medicines you are taking. Theseinclude herbs, supplements, and other medicines you bought without a prescription.
During the days before the surgery:
- You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs like these.
- Ask your doctor which drugs you should still take on the day of your surgery.
- If you smoke, try to stop. Ask your doctor or nurse for help quitting.
On the day of your surgery:
- You will usually be asked not to drink or eat anything for 8 hours before the surgery.
- Take any medicines your doctor told you to take with a small sip of water.
- Arrive at the hospital on time.
After the Procedure
After surgery, you will be given pain medicines to relieve any discomfort.
You may also have a tube, called a catheter, inserted into your bladder to pass urine. The catheter will likely be removed before you go home.
You will be asked to get up and move around as soon as possible after surgery. This helps prevent blood clots from forming in your legs and speeds recovery.
You will be asked to get up to use the bathroom as soon as you are able. You may return to a normal diet as soon as you can without causing nausea or vomiting.
How long you stay in the hospital depends on the type of hysterectomy.
- You can likelygo home thenext day when surgeryis done through the vagina usinga laparoscope or after robotic surgery.
- When a larger surgical cut (incision) in the abdomen is made, you may need to stay in the hospital1 to2 days. You may need to stay longer if the hysterectomy is done because of cancer.
Outlook (Prognosis)
How long it takes you to recover depends on the type of hysterectomy. Average recovery times are:
- Abdominal hysterectomy: 4to 6 weeks
- Vaginal hysterectomy: 3to 4 weeks
- Robot-assisted or total laparoscopic hysterectomy: 2to 4 weeks
A hysterectomy will cause menopause if you also have your ovaries removed. Removal of the ovaries can also lead to a decreased sex drive. Your doctor may recommend estrogen replacement therapy. Discuss with your doctorthe risks and benefits of this therapy.
If the hysterectomy was done for cancer, you may need further treatment.
References
American College of Obstetricians and Gynecologists. Committee Opinion No. 444: Choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2009;114:1156-1158.
Giudice LC. Clinical practice. Endometriosis. N Engl J Med. 2010 Jun 24;362(25):2389-98.
Jones HW III. Gynecologic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery.19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 71.
Middleton LJ, Champaneria R, Daniels JP, et al. Hysterectomy, endometrial destruction, and levonorgestrel releasing intrauterine system (Mirena) for heavy menstrual bleeding: systematic review and meta-analysis of data from individual patients. BMJ. 2010;341:c3929.
National Comprehensive Cancer Network. NCCN Clinical Practice Guidelines in Oncology (NCCN Guidelines): Cervical cancer. Version 2.2013. Available at http://www.nccn.org/professionals/physician_gls/pdf/cervical.pdf.Accessed February 22, 2012.
Reviewed By: Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Bellevue, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by A.D.A.M. Health Solutions, Ebix, Inc., Editorial Team: David Zieve, MD, MHA, Bethanne Black, Stephanie Slon, and Nissi Wang.
