Hysterectomy is the second most common major surgery among women worldwide, after C-sections. If your doctor has recommended a hysterectomy, it may come as a surprise. However, with the right information, you can make an informed decision about whether it's necessary for your health and better understand the potential side effects.

What is Hysterectomy?

A hysterectomy is the surgical removal of the uterus and can be either a total hysterectomy (with the cervix) or a partial hysterectomy (without the cervix). In some cases, it may also involve the removal of the ovaries, fallopian tubes, and other nearby structures, especially in cases of cancer or as a preventive measure against cancer.

After hysterectomy, whether total or partial, the woman will no longer menstruate and become infertile. If the ovaries are not removed, she may continue producing hormones until natural menopause, but without the monthly bleeding. (1)

Indications

You may need a hysterectomy for one of the following reasons: (2)(3)

• Uterine fibroids: Benign growths in the uterus that may cause pain and heavy bleeding during menstruation.
• Cancer: Hysterectomy may be the most effective treatment in cases of uterine or cervical cancer. However, according to the type and stage of cancer, other treatment choices may include radiotherapy and/or chemotherapy.
• Severe or abnormal vaginal bleeding: That cannot be controlled by other non-surgical treatments.
• Endometriosis: A condition in which cells of the uterine lining begin to grow outside the uterus and cause severe pain and bleeding between periods. In severe cases, it may require a hysterectomy along with the removal of fallopian tubes and ovaries.
• Uterine prolapse: The uterus slips down into the vagina and causes urinary or bowel incontinence.
• Adenomyosis: A condition where the cells that normally line the uterus grow inside the uterine wall, causing thickening of the wall, severe pain, and heavy bleeding.
• Chronic pelvic pain: In some cases, especially when other treatments have failed, a hysterectomy may be the best option.

While many other surgical and nonsurgical treatment options are available for these problems, in some cases, the physician may decide that a hysterectomy is preferred.

At Dr. Soliman Fakeeh Hospital, our expert surgeons provide personalized medical consultations to help you find the most effective treatment for your condition. Book your appointment at our gynecology department today.

Risks

Hysterectomy is generally safe, like any surgery, complications may happen, but are typically rare and manageable, including: (3)

• Bleeding: Abnormal or excessive bleeding during or after the surgery.
• Infections: An infection may occur at the incision site or in the urinary tract, but is usually minor and treatable with antibiotics.
• Injury to adjacent organs: Such as the bladder, intestines, or adjacent blood vessels.
• Blood clots: The risk of blood clots, especially in the legs, increases after any major surgery, but precautions are always taken to avoid such risk.
• Early menopause: When the ovaries are removed, menopause starts immediately. Sometimes, even if the ovaries are not removed, they may be affected by the surgery, leading to early menopause.
• Complications with anesthesia: There is a small risk for developing complications from anesthesia, such as allergic reactions or breathing problems.

Preparations

• Discuss with your doctor what to expect after the surgery, including changes in your body.
• Be sure to inform your doctor of any medications you are taking, including over-the-counter supplements and herbs.
• You will probably need to stop taking these medications for a period before the operation, especially blood thinners.
• You’ll need to fast the night before surgery.
• You should quit smoking (if you're a smoker), as smoking can negatively impact recovery time following the surgical procedure. (4)

Surgery steps

There are 3 ways to perform hysterectomy depending on the patient’s condition and the surgical goals: (5)

• Abdominal Hysterectomy: Typically performed under general anesthesia, a large incision is made in the lower abdomen, either horizontally above the pubic bone or vertically from below the navel to above the pubic bone.
• Vaginal Hysterectomy: Performed under general, spinal, or sometimes epidural anesthesia. An incision is made in the vagina to remove the uterus. It is less invasive than the abdominal approach and offers a faster recovery time, but may not be appropriate in some cases such as when the ovaries also need to be removed.
• Laparoscopic Hysterectomy: Typically performed under general anesthesia, this method involves making small incisions in the abdomen, through which a thin camera-equipped scope is inserted to carry out the procedure. This approach allows for quicker recovery but requires a high level of surgical expertise.

Recovery

1- Recovery Period:

Initial recovery from hysterectomy takes a few days to a week, but full recovery can take between two to eight weeks, depending on the type of surgery and your health condition. (2)

2- Side Effects:

It is expected to feel some pain, abdominal swelling, and vaginal bleeding or spotting for a short time after the operation. You will need to use sanitary pads for days or even weeks after surgery. (3)

3- Tips for Recovery:

• Get enough rest, but you will need to walk around as often as you can, and gradually increase the distance each day.
• Avoid heavy lifting and strenuous physical exercise for at least 6 weeks or as recommended by your physician.
• Avoid sexual intercourse for 6 weeks or as advised by your physician depending on the type of surgery and your healing progress.
• Avoid anything in the vagina for 6 weeks, including tampons, douches, or vaginal washes.
• Follow up with your physician in the scheduled post-surgery visits for check-ups and any necessary routine tests. (1)(3)

4- Expected Changes After Surgery:

• Symptom Relief: You will be relieved from the symptoms you were having before surgery, and this can make you feel much better.
• Periods stop completely: This is due to the removal of the uterus.
• Menopause: some text
  • Removing the ovaries will immediately trigger menopause symptoms such as hot flashes and night sweats. 
  • If the ovaries are kept, menopause may start slightly earlier due to changes caused by the surgery. However, some women may not experience any change in the age of menopause onset.
• Sexual health: You can have a normal or even better sexual experience due to relief from fibroid symptoms. However, some women may note vaginal dryness or decreased libido, especially if the ovaries are removed.
• Mental health: It is common for women to feel sad or even depressed because of infertility concerns or body changes, but remind yourself of the health benefits of the surgery. Seek help if feelings of sadness become overwhelming or persistent. (2)(3)

References

1. ACOG - Hysterectomy
2. Office on Women's Health - Hysterectomy
3. Mayo Clinic - Abdominal hysterectomy
4. MedlinePlus - Hysterectomy‍
5. NHS - Hysterectomy