Five things you need to know about having a hysterectomy
The hysterectomy, which involves the surgical removal of the uterus, is quite a common procedure, with some 39,000 hysterectomies performed in England over 2005/06.
A hysterectomy can be a cause of anxiety for many women… Why is it necessary, what are the risks and what will happen after? Here are a few explanations to help you understand the procedure and the best way to approach it.
1. Why have a hysterectomy?
A hysterectomy is generally suggested as a last alternative and where less invasive treatment or a course of medication is inadvisable or not effective.
The main indications that a hysterectomy might be necessary are excessive or ongoing bleeding and/or pain caused by a benign tumour (fibroids, endometriosis). Hysterectomy is also a way of treating pelvic or uterine prolapses and gynaecological cancers.
A total hysterectomy is the most common and involves removing the complete uterus, including the cervix. A subtotal hysterectomy leaves the neck of the womb behind.
2. What does the hysterectomy procedure entail?
A hysterectomy is performed under either general or local anaesthetic. The uterus is separated from the surrounding tissue and taken out whole or in a few pieces. There are three methods of hysterectomy operation:
- Vaginal hysterectomy, which involves removing the uterus through a cut in the top of the vagina.
- Abdominal hysterectomy, which involves opening the base of the stomach by about 10-15cm as in caesarean sections.
- Laparoscopic hysterectomy, which involves a small camera and surgical instruments, inserted into the abdomen via three small incisions. The laparoscope can equally be helpful in a hysterectomy using the vaginal method.
The method used depends on the characteristics of the uterus, the nature of the hysterectomy, the specific expertise of the surgeon, family history and the patient’s wishes.
3. What risks are associated with having a hysterectomy?
Like any surgical procedure, a hysterectomy comes with certain risks. “Mortality is very rare, affecting less than 1 in 10,000 patients,” clarifies Prof Fernandez. Complications occur in 3 to 5% of procedures and these are typically connected to damage to surrounding organs, haemorrhages or infection. Some of these risks could include:
In practice, it is always best to seek medical advice from your doctor if you experience any pain, significant bleeding, fever, vomiting or any other anomaly following the hysterectomy operation.
4. Are there any precautions to be taken after a hysterectomy?
Generally, a woman will need 6-12 weeks off work, depending on how she experiences the operation and her recovery. The week after the procedure, some light bleeding may occur and after 4 to 6 weeks there could also be a coloured discharge, which means the stitches have naturally fallen out.
You should avoid baths for 10 days after the operation and, as with any other surgical procedure; strenuous physical activity is not advisable for 4-6 weeks after surgery. Physio exercises may be given and gentle daily walking is encouraged to keep circulation moving
Though it is sometimes recommended that you wait until your post-operative check-up, a month after the procedure, before having sexual intercourse, Prof Fernandez considers this unjustified. “Sexual activity, whether penetrative or not, can resume as soon as the patient feels ready.”
5. What are the after effects of a hysterectomy?
If the patient has already gone through the menopause before the procedure, a hysterectomy will not lead to any particular changes other than the disappearance of the initial symptoms that made the hysterectomy necessary.
If the patient was not menopausal, but the ovaries are left in place, there will be no menstruation and no possibility of becoming pregnant, but hormonal functions will still be present. If the ovaries are removed, the hysterectomy will lead to the menopause, which can eventually be treated with HRT.
“There is no reason why a hysterectomy should lead to weight gain or problems with mood swings or sexuality,” insists Prof Fernandez. The uterus and its neck do not play any role in sexuality and their removal does not alter the length of the vagina.
In most cases, there is no pressing urgency in undergoing this procedure and patients have plenty of time to discuss it with their doctor.
- Interview with Prof Hervé Fernandez, head of the gynaecology and obstetrical service, Kremlin-Bicêtre hospital, member of the French society of gynaecologists and obstetricians (CNGOF)
- The Hysterectomy Association for more useful info and a 101 Handy Hints for a Happy Hysterectomy booklet
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- Abnormal vaginal bleeding
- Cervical ectopy
- Cervical intraepithelial neoplasia (CIN)
- Ovarian cysts
- Pelvic inflammatory disease
- Polycystic ovary syndrome
- Prolapse of the uterus and vagina
- Retroverted uterus
- Uterine polyps
- Fibroids: Non-surgical treatment could be the way forward
- All about endometriosis
- What is organ prolapse?
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