Undergoing any kind of medical procedure is a big decision. Whether it’s routine or necessary to find some kind of pain or symptom relief, it can be a scary thing to consider and pursue.
While common, hysterectomy (a surgical procedure to remove the uterus), is one of those big decisions. Once you have this surgery, you aren’t able to get pregnant and you’ll no longer have a period. Hysterectomies are performed for a variety of reasons–in most cases, after pursuing other treatment options.
Why you could need a hysterectomy
A hysterectomy may be recommended to address a number of conditions–again, oftentimes after other treatment options have been explored. Those include:
- Severe endometriosis
- Persistent pelvic pain not managed by other treatments
- Uterine fibroids
- Uterine prolapse
- Chronic, excessive menstrual bleeding and pain, often unresponsive to other treatments
- Conditions that affect the lining of your uterus, like hyperplasia, recurrent uterine polyps or adenomyosis
- Cervical or uterine cancers
When considering treatment options, you and your provider should discuss the benefits of a hysterectomy alongside potential alternatives to determine what’s best for your situation.
Types of hysterectomy
Hysterectomy surgeries vary based on the structures being removed, including:
- Supracervical hysterectomy: When the uterus is removed but the cervix remains in place, it is called a supracervical hysterectomy–or sometimes a partial or subtotal hysterectomy. With this type of surgery, you’ll no longer have periods but should continue to have cervical cancer screening (pap tests) as recommended by your provider.
- Total hysterectomy: When the cervix is removed along with the uterus, it is called a total hysterectomy. In this case, you may no longer need Pap smears or other cervical cancer screening if you have a history of negative results.
- Hysterectomy with bilateral salpingectomy: This option can be total or supracervical, but includes the removal of the fallopian tubes.
- Total hysterectomy with bilateral salpingo-oophorectomy: This option removes the uterus, cervix, fallopian tubes and ovaries (oophorectomy).
- Radical hysterectomy with bilateral salpingo-oophorectomy: This type of hysterectomy is for when cancer is involved and includes the removal of the uterus, cervix, fallopian tubes, ovaries, the upper portion of the vagina and some surrounding tissue and lymph nodes.
When discussing hysterectomy, it’s important to understand the risks and benefits of the option(s) your clinician recommends. This will include a discussion of your underlying condition, future cancer risk, hormonal function, sexual and pelvic floor function, surgical complexity and recovery considerations, among other things.
How a hysterectomy is performed
Many types of hysterectomy can be performed using different surgical approaches, including:
In a vaginal hysterectomy, the uterus is removed through the vagina without external incisions. The surgeon accesses the uterus through the vaginal canal, detaches it from surrounding tissues and seals the blood vessels that were supplying it. The uterus is then carefully dissected and removed.
Vaginal hysterectomy is often chosen for cases where the uterus is normal size to address conditions like uterine prolapse or certain gynecological issues.
During laparoscopic hysterectomy, the uterus is removed with the help of a laparoscope, which is a thin, flexible tube with a video camera. Small incisions are made in the abdomen and the laparoscope and specialized surgical instruments are inserted. Manipulating these instruments from the outside, the surgeon will remove the uterus in sections through the tube or through the vagina.
Robotic surgery is another type of minimally invasive laparoscopic surgery that can be used to perform hysterectomies. In robotic surgery, the surgeon controls the robotic instruments from a console rather than directly at the bedside.
When compared to abdominal hysterectomy, both of these surgical approaches typically reduce scarring, involve shorter hospital stays, quicker recovery times and less postoperative pain. Robotic surgery can also offer improved visualization and enhanced surgical precision. Both of these surgical approaches are specialized skills and should be performed by a gynecologic surgeon with experience and a successful track record.
In an abdominal hysterectomy, the surgeon makes an incision in the abdominal wall to access and remove the uterus. The size and location of the incision depend on the specific case. Once the uterus is exposed, the blood vessels supplying it are sealed and supporting tissues are severed. The surgeon then carefully detaches the uterus from surrounding structures and lifts it out through the incision. This is a preferred option for larger uteri or more complex cases.
The decision on the surgical approach is unique to each person’s circumstances and often made collaboratively with your surgeon. Factors influencing the choice include patient preference, the underlying condition being addressed through the surgery, your current health and medical history, the complexity of the surgery and the surgeon’s experience with a particular technique. Talk about the risks, benefits and potential outcomes with your gynecologist.
When you can resume normal activity after a hysterectomy
With vaginal, traditional laparoscopic and robotic surgeries, many patients (about 85%) are able to go home the same day–and nearly all of the remaining 15% go home the next day. The hospital stay for an abdominal surgery varies, but most are two to three days. Full recovery also varies based on the surgical approach and extent of surgery, with abdominal surgical recovery taking up to four to six weeks and recovery after less invasive approaches taking from two to four weeks. Your clinician will share a complete post-operative plan of care, including pain management, wound care, follow-up appointments and gradually resuming activities.
At WHA, our OB/GYN physicians are also surgeons experienced in many surgical techniques and approaches. If you’re experiencing abnormal menstrual bleeding or have been told you might need a hysterectomy, contact one of our offices to make an appointment.