Hysterectomy

What is a hysterectomy?

A hysterectomy is the surgical removal of your uterus and, most likely, your cervix. Depending on the reason for the surgery, a hysterectomy may involve removing surrounding organs and tissues, like your fallopian tubes and ovaries.

You won’t be able to get pregnant and you won’t get your menstrual period after a hysterectomy.

What are the different kinds of hysterectomy?

Your healthcare provider will discuss which type of hysterectomy you need, depending on your condition. This will determine if they’ll also need to remove your fallopian tubes and/or ovaries.

The different types of hysterectomy surgeries are:

• Total hysterectomy: Removing your uterus and cervix but leaving your ovaries. Because you still have your ovaries, you won’t enter menopause immediately after surgery.
• Supracervical hysterectomy: Removing just the upper part of your uterus while leaving your cervix. You may also have your fallopian tubes and ovaries removed at the same time. Because you still have your cervix, you’ll still need Pap smears.
• Total hysterectomy with bilateral salpingo-oophorectomy: Removing your uterus, cervix, fallopian tubes (salpingectomy) and ovaries (oophorectomy). Removing your ovaries will start menopause immediately (if you haven’t already completed it).
• Radical hysterectomy with bilateral salpingo-oophorectomy: The removal of your uterus, cervix, fallopian tubes, ovaries, the upper portion of your vagina, and some surrounding tissue and lymph nodes. Providers use this type most commonly when cancer is involved. You’ll enter menopause after this type because you won’t have ovaries anymore.

What does a hysterectomy treat?

Healthcare providers often suggest alternative treatments before recommending a hysterectomy. This mostly depends on the reason for needing a hysterectomy. Sometimes, those treatments don’t help, or surgery is the only option to treat the condition.

Surgeons perform hysterectomies to treat:

• Abnormal or heavy vaginal bleeding.
• Severe pelvic pain.
• Uterine fibroids and other noncancerous tumors.
• Severe endometriosis.
• Uterine prolapse that can lead to urinary incontinence or fecal incontinence.
• Cervical, ovarian or uterine cancer.
• Conditions with the lining of your uterus, like hyperplasia or adenomyosis.
• Serious complications of childbirth like uterine rupture.

Many people have a hysterectomy to prevent cancer. For people at high risk for certain types of cancer, removing the uterus (and/or surrounding reproductive organs) can reduce the chances of developing cancer.

How common is it to get a hysterectomy?

Approximately 600,000 females get hysterectomies in the United States each year.

How do I prepare for a hysterectomy?

A healthcare provider will explain the procedure in detail, including possible complications and side effects. Talk to them about any concerns you have about the surgery and the recovery process. You may need to provide blood and urine samples to make sure you’re healthy enough for surgery.

A hysterectomy may not involve a hospital stay, depending on what type you have and the surgical approach your surgeon uses. Be sure to discuss what support you’ll need in the early days of your recovery so you can plan for help.

What happens during a hysterectomy?

Your healthcare provider will determine the type of hysterectomy you need and the best surgical method to perform that procedure. You’ll change into a hospital gown and get hooked up to monitors that track your heart rate. A healthcare provider will place an intravenous (IV) line in a vein in your arm to deliver medications and fluids.

An anesthesiologist will give you either:

• General anesthesia, which will put you to sleep for the procedure.
• Regional anesthesia (also called epidural or spinal anesthesia), which involves putting medication near the nerves in your lower back to “block” pain while you stay awake. This is less common.

Surgical methods for hysterectomy

There are several different surgical approaches your healthcare provider may use to perform a hysterectomy.

Vaginal hysterectomy

• A surgeon removes your uterus through an incision at the top of your vagina. There are no incisions on your abdomen.
• They use dissolvable stitches inside your vagina.
• Fewest complications and fastest recovery (up to four weeks).
• People often go home on the same day of surgery (outpatient).

Vaginal laparoscopic hysterectomy

• A surgeon inserts a laparoscope (a thin tube with a video camera on the end) into your lower abdomen through the vaginal incision. This allows improved visualization of the pelvic structures.
• Your surgeon removes your uterus through your vagina.
• There are no abdominal incisions.
• People often go home on the same day of surgery.
• Full recovery is shorter and less painful than an abdominal laparoscopic hysterectomy.

Abdominal laparoscopic hysterectomy

• A surgeon inserts the laparoscope into your lower abdomen through a small incision near your belly button.
• They insert surgical tools through several other small incisions on your abdomen.
• Your surgeon removes your uterus in small pieces through the abdominal incisions (or possibly through your vagina).
• Some people go home the same day or after one night in the hospital.
• Full recovery is shorter and less painful than an abdominal hysterectomy.

Robotic-assisted laparoscopic hysterectomy

• Similar to an abdominal laparoscopy, but your surgeon performs the procedure with the help of a robotic machine.
• Your surgeon inserts a laparoscope through abdomen incisions. They insert small, thin surgical tools through three to five other small incisions around your belly button. The surgeon controls robotic arms and instruments.
• The recovery is like a laparoscopic hysterectomy.

Abdominal hysterectomy

• Your uterus is removed through a 6- to 8-inch-long incision in your abdomen.
• The incision is made either from your belly button to your pubic bone or across the top of your public hairline. The surgeon will use stitches or staples to close the incision.
• Surgeons may use this type when cancer is involved, when the uterus is very enlarged or when disease spreads to other pelvic areas.
• It generally requires a longer hospital stay (two or three days) and a longer recovery time.

How long does a hysterectomy take?

The procedure lasts one to three hours. The time can vary depending on:

• The size of your uterus.
• Whether you have scar tissue from past surgeries.
• Whether your surgeon needs to remove endometriosis or other organs (like your fallopian tubes or ovaries).

How painful is a hysterectomy?

Anesthesia will keep you from feeling pain during the surgery. But you can expect soreness and discomfort for a few weeks. Your surgeon will discuss your options for pain relief during recovery. This could involve prescription pain medication or over-the-counter (OTC) pain medicines like NSAIDs (non-steroidal anti-inflammatory drugs) or acetaminophen.

What are the most common side effects of a hysterectomy?

Some of the most common side effects of a hysterectomy are:

• Vaginal bleeding and drainage (can last up to six weeks).
• Soreness or irritation at the incision sites.
• Difficulty peeing or pooping in the days following surgery.
• Fatigue and tiredness from surgery.

If your healthcare provider removes your ovaries at the time of your hysterectomy, and you haven’t already gone through menopause, you may experience symptoms of menopause, such as:

• Hot flashes.
• Vaginal dryness.
• Loss of libido.
• Difficulty sleeping (insomnia).

Your surgeon will discuss treatment options to avoid the side effects of menopause if they remove your ovaries. This could include hormone replacement therapy (HRT) to relieve your symptoms.

What happens after a hysterectomy?

The amount of time you spend in the hospital following a hysterectomy varies depending on what kind of surgery you had. Your healthcare provider may want to monitor you and ensure there aren’t any signs of complications. You’ll walk around as soon as possible after your surgery to prevent blood clots in your legs.

If you had an abdominal hysterectomy, you might stay in the hospital for a few days. Vaginal and laparoscopic hysterectomies are less invasive and typically don’t require an overnight stay in the hospital.

Your healthcare provider will go over recovery instructions, including restrictions to your day-to-day activities. Be sure to discuss any concerns you have about your recovery or the procedure before you go home.

How long do you have to be on bed rest after a hysterectomy?

You typically don’t need to be on bed rest after a hysterectomy. In fact, your provider will want you to walk around as soon as you’re able to.

What happens to your body after a hysterectomy?

The types of changes you can expect to your body depend on what kind of hysterectomy you have. If your provider removes your ovaries, you can expect to enter menopause right away. In addition to the usual side effects of surgery, you may also have symptoms of menopause. Talk to your healthcare provider about ways to minimize symptoms of menopause.

If your provider keeps your ovaries, you won’t enter menopause. In this case, you’ll still lose the ability to get pregnant, but your ovaries will continue to make hormones. You’ll enter menopause at a more typical age (around 51).

As with any major surgery, recovery and rest is crucial. Allow yourself time to heal. Your body has been through a lot, so prioritize rest and relaxation for at least the first two weeks.

What are the advantages of having a hysterectomy?

Having a hysterectomy can help you live a more enjoyable life, especially if you have constant pelvic pain or heavy and irregular bleeding. If you’re at a higher risk of uterine cancer, a hysterectomy can lower this risk. Having your cervix removed means you may not need pap smears any longer. Having your fallopian tubes removed reduces the risk of ovarian cancer even if your ovaries aren’t removed.

What are the disadvantages of having a hysterectomy?

A hysterectomy is a major surgery with a long recovery. It comes with risks and side effects and is permanent. Depending on the type of surgery you have, you can go into menopause or experience symptoms of menopause immediately after. You also won’t be able to become pregnant after any type of hysterectomy.

What are the complications of a hysterectomy?

As with any surgery, there’s a slight chance that problems may occur, including:

• Blood clots.
• Severe infection.
• Bleeding.
• Injury to your urinary tract, bowel or other nearby organs.
• Complications from anesthesia.

How long does it take to recover from a hysterectomy?

Most people recover from a hysterectomy in about four to six weeks. Your recovery depends on the type of hysterectomy you had and the method your surgeon used. Recovering from a vaginal and laparoscopic hysterectomy takes less time than recovering from an abdominal hysterectomy.

You should increase your activity gradually and pay attention to how you feel. If anything causes you pain, you should stop. Talk to your healthcare provider about specific instructions for recovering at home, including what medications to take.

What should I know about recovering from a hysterectomy at home?

Vaginal and laparoscopic recoveries take about two to four weeks. It may take up to six weeks to recover from abdominal hysterectomy. In most cases, you’ll receive papers with instructions that specify what activities you can and can’t do and for how long.

Talk to your healthcare provider before going home to make sure you know how to best care for yourself.

Common instructions after a hysterectomy

Some things you can expect after surgery include:

• You can experience light vaginal bleeding or dark brown discharge for up to six weeks. Use only a light panty liner or sanitary pad to catch the discharge (no tampons).
• Don’t lift heavy objects (over 10 pounds) for at least four to six weeks.
• Don’t put anything into your vagina for four to six weeks, or as directed by your healthcare provider.
• Don’t have sex for six weeks after surgery.
• Don’t take a bath or swim in a pool for at least six weeks.
• If your surgeon used surgical strips on abdominal incisions, they should fall off on their own within two weeks. Any internal stitches should dissolve on their own in a few weeks. You may take a shower during this time. Wash your incision with soap and water and pat it dry. A bandage over the incision isn’t necessary.
• If your surgeon used staples, they’ll remove them at your follow-up appointment. You may need to wait to shower and use a protective/waterproof covering for several weeks.
• You can drive about two weeks after abdominal surgery or when you’re no longer taking narcotics for pain. If you had a vaginal or laparoscopic hysterectomy, you might begin driving within a few days.
• Resume your exercise routine in four to six weeks, depending on how you feel. You should build up your activity gradually and not jump right into your previous activity levels.
• You can usually go back to work in two to six weeks, depending on what kind of work you do.

How will I feel after a hysterectomy?

It’s normal to feel slightly different physically and emotionally after a hysterectomy, especially during your recovery.

Physically

After a hysterectomy, your periods will stop. Occasionally, you may feel bloated and have symptoms similar to when you were menstruating.

You may feel discomfort at abdominal incision sites for about four weeks, and any redness, bruising or swelling will disappear in four to six weeks. Feeling burning or itching around the incisions is normal. You may also experience a numb feeling around the incisions or down your leg. This is normal and, if present, usually lasts about two months.

It’s normal to have scarring from the surgery, both internally and externally. Abdominal laparoscopic surgeries will cause smaller, less visible scars as opposed to abdominal hysterectomies, which will be larger.

People who undergo supracervical hysterectomy may continue to have light periods for a year after the procedure. This happens because small amounts of the endometrial lining can remain in your cervix, causing light periods.

Emotionally

Emotional reactions to a hysterectomy vary and can depend on how well you were mentally prepared for the surgery and the reason for having it.

You may feel a sense of loss, but these emotional reactions are usually temporary. Others may find that a hysterectomy improves their health and well-being and may even be a life-saving operation. Please discuss your emotional concerns with your healthcare provider and see if they recommend counseling or a support group to help you cope.

Do I still need a Pap test if I have had a hysterectomy?

This depends on if your surgeon removed your cervix and why you had the hysterectomy. If you still have a cervix, you should continue to get Pap smears to screen for cervical cancer. If you don’t have a cervix, you may not need a Pap test.

When should I see my healthcare provider if I had a hysterectomy?

Call your healthcare provider if you have:

• Bright red vaginal bleeding.
• A fever over 100 degrees Fahrenheit (37.77 degrees Celsius).
• Severe nausea or vomiting.
• Difficulty peeing, a burning feeling when you pee or frequent urination.
• Increasing redness, swelling or drainage from your incision.
• Increasing amounts of pain. (Pain gets worse instead of better.)

Does a hysterectomy affect my sex life?

A hysterectomy shouldn’t affect your sexual function. If you enter menopause as a result of a hysterectomy, you could have symptoms like low sex drive and vaginal dryness. Let your healthcare provider know if you experience uncomfortable side effects of menopause so they can recommend a treatment.

What fills the empty space after a hysterectomy?

After you have a hysterectomy, your other organs move to fill the space. Your small and large intestines mainly fill the space once occupied by your uterus.

What are alternatives to a hysterectomy?

Your healthcare provider will work with you to develop the best treatment plan for your symptoms or condition. When a hysterectomy isn’t medically necessary, some alternatives to try could be:

• Watching and waiting to see if the condition improves.
• Taking medications such as birth control pills to manage painful periods or abnormal bleeding.
• Surgery to remove the lining of your uterus.
• Having procedures to shrink or remove uterine fibroids.
• Performing exercises for uterine prolapse that help improve the muscles in your uterus.
• Using a pessary to “prop up” your uterus if you have a uterine prolapse.
• Undergoing surgery to treat endometriosis or vaginal bleeding that doesn’t involve removing your uterus.

How do you sit on the toilet after a hysterectomy?

Sitting on the toilet after a hysterectomy may be a little uncomfortable, especially if you had an abdominal hysterectomy. Supporting your belly and abdomen can help you feel a little better when you sit down. It may feel a little better to lean forward into a pillow when you sit on the toilet. This may take pressure off your abdomen (it takes more work to sit up straight).

Some people find squatting to be painful, so if you can adjust your toilet to be higher, that could be an option. If you can’t do this, sit down slowly and gently while you try to position yourself.

Can I get a flat tummy after a hysterectomy?

It’s very normal to experience bloating or gassiness after a hysterectomy. It can take several weeks for the puffiness and swelling in your belly to go down. Talk to your healthcare provider about ways to reduce your discomfort. Performing certain exercises and applying a warm compress may help.