Hysterectomy

What is a hysterectomy?

Hysterectomy is surgery to remove the uterus. Your healthcare provider may also remove one or both ovaries, and the fallopian tubes. In some cases, other parts of the reproductive system may be removed.

The types of hysterectomy include:

• Total hysterectomy. Your provider removes the whole uterus including the cervix. But not the fallopian tubes or ovaries. It’s the most common type of hysterectomy.

• Hysterectomy with salpingo-oophorectomy. Your provider removes one or both ovaries, and the fallopian tubes, along with the uterus.

• Radical hysterectomy. Your provider removes the uterus, cervix, and the top part of the vagina. The pelvic lymph nodes may also be removed. Some cases of cancer call for this surgery.

• Supracervical hysterectomy (partial or subtotal hysterectomy). Your provider removes the body of the uterus. The cervix is left whole.

Hysterectomy methods include:

• Abdominal hysterectomy. Your healthcare provider makes a large incision in your belly and removes the uterus. They use this method to remove the fallopian tubes. This is done when the uterus is enlarged, or when disease has spread to the pelvic cavity, as in endometriosis or cancer. The incision can be made from the navel down to the pubic bone. Or along the top of the pubic hairline.

• Vaginal hysterectomy. In this method, your provider removes the uterus through the vaginal opening. It’s most often used for uterine prolapse. Or when vaginal repairs are needed. You will not need an incision. This means there is no visible scarring.

• Laparoscopic-assisted hysterectomy.  Your provider uses a laparoscope for this method. This is a thin, flexible tube with a video camera. They insert thin tubes through tiny incisions in the belly near the navel. Your provider removes the uterus in sections. This is done through the laparoscope tube or through the vagina. A form of laparoscopic hysterectomy uses a robot to assist.

Your healthcare provider will decide the best method based on your situation.

If you have not yet reached menopause, having a hysterectomy means you will no longer have a period. You will also not be able to get pregnant.

Why might I need a hysterectomy?

You may need a hysterectomy for:

• Fibroids. These are noncancerous tumors.

• Endometriosis. A condition in which endometrial cells grow outside of the uterus. They attach themselves to other organs in the pelvic cavity. This causes chronic pelvic pain, pain during sex, and prolonged or heavy bleeding.

• Abnormal uterine bleeding. This may be because of endometrial hyperplasia. This is an overthickening of the uterine lining that may cause abnormal bleeding.

• Cancer. You have cervical, ovarian, or endometrial cancer.

• Organ interference. The uterus or a growth interferes with the bladder or intestines.

• Uterine prolapse. This is when the uterus drops down into the vagina.

• Chronic pelvic conditions. This may include pelvic pain, or pelvic inflammatory disease.

Your healthcare provider may have other reasons to recommend a hysterectomy.

What are the risks of a hysterectomy?

Some possible complications include:

• Bleeding

• Injury to the tubes that carry urine from the kidneys to the bladder (ureters) and bladder

• Infection

• Injury to the bowel or other intestinal organs

• Trouble with urination or urinary incontinence

You may have menopausal symptoms if you have not reached menopause before a hysterectomy . This includes hot flashes, mood swings, and vaginal dryness. You will no longer have a period after a hysterectomy.

You may also have mood swings, depression, and feel a loss of sexual identity after hysterectomy.

You may have other risks based on your condition. Be sure to discuss any concerns with your healthcare provider before the procedure.

How do I get ready for a hysterectomy?

• Your healthcare provider will explain the procedure to you and you can ask questions.

• You will be asked to sign a consent form that gives permission to do the procedure. Read the form carefully and ask questions if something is not clear.

• Your healthcare provider will review your health history and do a complete physical exam to be sure you are in good health before having the procedure. You may have blood tests or other diagnostic tests.

• You will be asked to fast for 8 hours before the procedure, generally after midnight.

• Tell your healthcare provider if you are pregnant or think you could be.

• Tell your healthcare provider if you are sensitive to or are allergic to any medicines, iodine, latex, tape, or anesthesia.

• Tell your healthcare provider of all medicines (prescription and over-the-counter) and herbal supplements that you are taking.

• Tell your healthcare provider if you have a history of bleeding disorders. Or if you are taking any blood-thinning medicines (anticoagulants), aspirin, or other medicines that affect blood clotting. You may be told to stop these medicines before the procedure.

• Your provider will tell you how to cleanse your bowels before the operation.

• Don't douche or use tampons on the day of the procedure.

• Your provider will give you a sedative before you are taken to the operating room. You will be asleep for the procedure.

• You may be given an antibiotic to take the day before the procedure.

• Arrange for someone to help around the house for a week or two after you go home.

• Follow any other instructions your provider gives you to get ready.

What happens during a hysterectomy?

You will likely need to stay in the hospital for a hysterectomy. Procedures may vary based on your condition and your healthcare provider's practices.

The procedure will vary based on the method used.

Generally, a hysterectomy follows this process:

• You will need to remove any jewelry or other objects that may interfere with the procedure.

• You will need to remove clothing and put on a hospital gown.

• If there is too much hair at the surgical site, it may be shaved off.

• An intravenous (IV) line will be put in your arm or hand.

• You will be positioned on the operating table on your back. For a vaginal procedure, your feet will be placed in stirrups.

• The anesthesiologist or nurse anesthetist will watch your heart rate, blood pressure, breathing, and blood oxygen level during the procedure.

• Your provider will insert a thin, narrow tube (catheter) into your bladder to drain urine.

Abdominal hysterectomy

• The skin over the surgical site will be cleaned with an antiseptic solution.

• Your provider will make an incision from the navel to the pubic bone. Or across the lower belly. The surgeon will discuss which incision is best for you.

• After the incision has been made through the layers of skin, muscle, and other tissue, the healthcare provider will check the organs and other structures in the belly and pelvis.

• Your provider will carefully cut away the tissues connecting the uterus to blood vessels and other structures in the pelvis.

• Your provider will remove your uterus, along with any other structures. These include the ovaries, fallopian tubes, and cervix, as needed.

• They will close the incision with surgical stitches or staples.

Vaginal hysterectomy

• The lower belly and perineum will be cleaned with an antiseptic solution. The rectum may be packed with an antiseptic-soaked sponge.

• Your provider will insert a speculum into your vagina to spread the walls of the vagina apart to show the cervix.

• Your provider will make an incision inside the vagina, near the cervix.

• Your provider will carefully cut away the tissues connecting the uterus to blood vessels and other structures in the pelvis.

• Your provider will remove the uterus through the vagina. They will also remove excess vaginal tissue or other tissue or structures if needed.

• Your provider will use stitches to close the opening into the peritoneal cavity created.

Laparoscopic-assisted hysterectomy

• The skin over the surgical site will be cleaned with an antiseptic solution.

• Your healthcare provider will make a small incision in the belly near the navel. They will inflate the belly with a gas. This lets the surgeon easily see the uterus and surrounding organs. Your provider may make more incisions in the belly for other surgical tools.

• The operating table will be tilted so that your head is lower than your feet. This helps to move the other abdominal organs and structures out of the surgical field. It makes room for the laparoscopic surgical instruments.

• Your provider will insert the laparoscope through the incision and examine the abdominal cavity. They will remove the tissues surrounding the uterus.

• Your provider will then remove the uterus through the vagina or through the laparoscope. They may also remove other organs or structures, such as the ovaries or fallopian tubes, as needed.

• Your provider will remove the laparoscope and close the incisions when the procedure is done.

After the procedure, all methods

• Your provider will send the uterus and any other organs or tissues removed to the lab for study.

• Your provider will use stitches or surgical staples to close any skin incision(s).

• Your provider will put on a sterile bandage, dressing, or adhesive strips to skin incisions. They will apply a sanitary pad to the perineal area. This is to absorb any drainage from the vagina.

What happens after a hysterectomy?

In the hospital

After the procedure, you will be taken to the recovery room. Your recovery will vary based on the type of procedure done and the type of anesthesia used. You will be taken to your hospital room once your blood pressure, pulse, and breathing are stable and you are alert.

You may have abdominal cramping after the surgery. You may get pain medicine as needed. This will be done either by a nurse or by giving it to yourself through a device connected to your IV.

If you had an abdominal hysterectomy, you may have a thin, plastic tube put through your nose into your stomach. This is to remove air that you swallow. The tube will be removed when your bowels go back to normal. You will not be able to eat or drink until the tube is removed.

You may have small to moderate amounts of vaginal drainage for several days. The nurse will check the sanitary pads to keep an eye on the amount of drainage.

You will be urged to get out of bed within a few hours after a vaginal procedure. Or by the next day after an abdominal procedure. You will also be taught to do coughing and deep breathing exercises.

You may be given liquids to drink a few hours after surgery based on your situation. You will gradually be able to eat more solid foods as you can handle them.

Arrange for a follow-up visit with your healthcare provider, usually a few weeks after the procedure.

At home

It's important to keep the incision clean and dry once you are home. Your healthcare provider will give you specific bathing instructions. If you went home with stitches or surgical staples, your provider will remove them during a follow-up office visit. If your provider used adhesive strips, keep them dry. They should fall off on their own within a few days.

The incision and the abdominal muscles may ache. This is especially true after long periods of standing. You may have shoulder pain from the gas used to inflate your belly if a laparoscope was used. Take a pain reliever as recommended by your healthcare provider. Aspirin or certain other pain medicines may increase the chance of bleeding. Be sure to take only recommended medicines.

You will be able to walk and have limited movement, but stay away from strenuous activity. Your healthcare provider will tell you when you can go back to work and other normal activities.

Include fiber and plenty of liquids to prevent constipation. Your healthcare provider may recommend a mild laxative.

If you had a laparoscopic procedure, do not drink carbonated drinks for 1 to 2 days after the procedure. This will help reduce the discomfort from the gas. These drinks may also cause nausea.

Don't use a douche, tampons, have sex, or return to work until your healthcare provider says it’s OK.

Tell your healthcare provider if you have any of the following:

• Fever or chills

• Redness, swelling, or bleeding or other drainage from the incision site(s)

• Increased pain around the incision site(s)

• Abdominal pain, cramping, or swelling

• Increased vaginal bleeding or other drainage

• Leg pain

Your healthcare provider may give you other instructions after a hysterectomy based on your situation.

Next steps

Before you agree to the test or procedure make sure you know:

• The name of the test or procedure

• The reason you are having the test or procedure

• What results to expect and what they mean

• The risks and benefits of the test or procedure

• What the possible side effects or complications are

• When and where you are to have the test or procedure

• Who will do the test or procedure and what that person’s qualifications are

• What would happen if you did not have the test or procedure

• Any alternative tests or procedures to think about

• When and how you will get the results

• Who to call after the test or procedure if you have questions or problems

• How much you will have to pay for the test or procedure