Everything you need to know about hysterectomy

Author’s Note: This article first appeared in Smart Parenting. View my other Smart Parenting articles here>>

Last year, I had to make a decision on whether I should have a hysterectomy or not. I was bleeding for more than 20 days in a month, and my doctors said it was because of the myoma (uterine fibroid) in my uterine wall being pushed out by my body.

They gave me several options on how to resolve my abnormal uterine bleeding. But my husband and I decided to go with the removal of my uterus. (Read my insights on having a hysterectomy here.)

What is a hysterectomy

Hysterectomy, as defined by the American College of Obstetricians and Gynecologists (ACOG), is the removal of a woman’s uterus and cervix (the opening of the uterus leading to the vagina).

A total or radical hysterectomy includes the removal of structures around the uterus. A subtotal or partial hysterectomy involves the removal of the uterus, but it keeps the cervix intact. It’s a procedure that is rarely performed.

How hysterectomy is performed

Once a hysterectomy is considered, a doctor will discuss whether or not the fallopian tubes and/or ovaries (total hysterectomy with bilateral salpingo-oophorectomy) should be removed with the uterus. The removal of the ovaries in hysterectomy means the patient will become menopausal if she still gets her period before surgery was done.

According to the U.K. National Health Service (NHS), there are three ways to perform a hysterectomy:

Laparoscopic hysterectomy

It is a minimally invasive surgical procedure that involves making a small incision in the belly button to insert a telescope (laparoscope) and a tiny camera to help the doctor perform the surgery. Laparoscopic hysterectomy is also more expensive.

Vaginal hysterectomy

The surgeon detaches the uterus from the ovaries, fallopian tubes, and upper vagina, as well as the blood vessels and connective tissue that support it. Vaginal hysterectomy involves a shorter time in the hospital, faster recovery, and lower cost.

Open hysterectomy

It requires an incision to be made on a woman’s abdomen, much like how a C-section is performed. Open hysterectomy is also called an abdominal hysterectomy.

Reasons a woman may need a hysterectomy

According to obstetrician-gynecologist Dr. Margaret Joyce Cristi-Limson, a hysterectomy is recommended if a woman has the following conditions:

  • uterine lesions such as myoma (although not all myoma will warrant surgery)
  • endometriosis
  • uterine prolapse
  • abnormal uterine bleeding
  • chronic pelvic pain
  • gynecologic cancer

“The approach to hysterectomy — whether open or laparoscopic or vaginal — are options to be discussed with the doctor, and whether a patient is a good candidate for such,” Dr. Cristi-Limson explained. A hysterectomy also has risks for complications, such as bleeding, infection, injury to other organs. “These will be discussed with you by the doctor so you can decide on what is the best course to take,” Dr. Cristi-Limson explained.

“There are other options that may be presented to you by your doctors when you experience conditions that may warrant a hysterectomy, but like all other medical protocols, it will depend on what your specific condition is,” Dr. Cristi-Limson explained. Some conditions may be managed medically or by other procedures that may not warrant the removal of the uterus.

My doctors and I initially opted to manage my symptoms medically because my husband and I might still want to have more children in the future. The decision to have hysterectomy became easier when several ultrasound procedures showed my cesarean scar was so thin already it may rupture during pregnancy.

What to expect after having a hysterectomy

Dr. Cristi-Limson shared it generally takes two months for a woman who had a hysterectomy to fully recover. But it will also depend if the surgery was done laparoscopically or vaginally.

Patients who go through hysterectomy should expect:

  • experience pain and/or discomfort from the incision site after the surgery
  • some vaginal spotting and discharge after the surgery. Your doctor will check the vaginal stump after a few weeks to check if it has completely healed. You cannot insert anything inside the vagina (tampon, intercourse) until six to eight weeks after the surgery.
  • stop getting their menses even if their ovaries were not removed. This does not mean that they are menopausal yet because the ovaries still continue to produce estrogen.

If the ovaries were removed during the procedure, a premenopausal patient would experience symptoms of menopause. Patients who had a hysterectomy for benign conditions will not need Pap smears anymore because the cervix has been removed.

Dr. Cristi-Limson shares her message to women who are planning to have or on the fence about whether they should get a hysterectomy, “Discuss your options thoroughly with your doctor. Performing a hysterectomy may be simple, but may be more complex (depending on the patient and the condition) and may have attendant risks that are not the same for each patient. But it still remains a good therapeutic option for many conditions.”

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