A hysterectomy is the removal of the uterus – a surgical procedure performed on about half a million women in the US every year. Your gynecologist can recommend a hysterectomy as a treatment for some types of cancer and reproductive health issues unique to women. Regardless of the reason for the surgery, having to undergo a hysterectomy can cause anxiety. At All Women’s Care in Los Angeles, we perform various types of hysterectomies and prepare our clients for the procedure. The preparation involves educating you about the procedure, how it is done, the recovery time, and how your life changes after the procedure. We will prepare you to ensure that you are equipped with the relevant information, based on which you can make a final decision.
Overview of Hysterectomy
A hysterectomy is a surgical procedure involving the removal of the uterus and sometimes the cervix, fallopian tubes, and the ovaries. A hysterectomy is necessary for dealing with problems such as:
Fibroids are benign tumors that develop in the wall of the uterus, either as one or many. Fibroids can result in heavy menstrual periods, rectal pressure, bladder pressure, and enlarged abdomen. For some women, fibroids do not cause any symptoms, and they can live with them. However, some may cause:
- Heavy bleeding (which increases the risk for anemia)
- Painful sex
- Lower back pain
- Infertility (though rare)
- Complications during pregnancy and delivery
A hysterectomy is an option for the permanent treatment of fibroids. It is especially conducted on women who are not near or approaching menopause, do not want kids, and the fibroids are large and cause heavy periods.
Heavy Vaginal Bleeding
Heavy bleeding or abnormal vaginal bleeding can occur due to cancer of the uterus, cervix or ovaries, renal problems polyps, fibroids, and low platelet count. Heavy bleeding includes symptoms such as:
- Periods that occur less than 21 days apart
- Heavy period (you soak a tampon in about two hours)
- A period that lasts longer than seven days
- Spotting between period
- Bleeding after sex
Hysterectomy for heavy or abnormal vaginal bleeding is usually a last resort treatment option or the only option if the bleeding results from cancer or very large fibroids.
Uterine prolapse is the protrusion of the uterus in the vagina due to the weakening of the muscles and ligaments that provide support to the uterus. A prolapsed uterus can result in discomfort during sex, urinary incontinence, and urine retention, problems when having a bowel movement and a feeling of heaviness in your pelvic region.
A hysterectomy is one of the treatment options for uterine prolapse considered when other treatment options are ineffective or inapplicable.
Endometriosis is a common condition that results from the growth of uterine tissue outside the uterus. The tissue commonly grows on ovaries, fallopian tubes and the outer surface of the uterus. Endometriosis can result in serious pain during periods, chronic lower back pain, and painful sex, bleeding, and spotting between your periods, infertility, and digestive problems. Endometriosis is diagnosed through a pelvic exam or ultrasound.
Where endometriosis causes severe symptoms, your doctor will recommend surgery. The surgical procedure depends on the area of tissue growth and your response to other treatment options.
Usually, a hysterectomy is the last option, and it provides relief from the intolerable symptoms of the condition, but not a permanent cure. To increase the chances of success, the doctor might recommend the removal of the ovaries.
Adenomyosis is a condition where the uterine lining grows into the muscular tissue of the uterus resulting in painful, prolonged, and heavy periods and chronic pelvic pain. The condition can occur independently or together with endometriosis. Adenomyosis usually resolves on itself after menopause. However, your doctor may recommend a hysterectomy where other treatment options have not worked, and you are experiencing severe pain.
A hysterectomy is a common treatment option for cervical, ovarian, and uterine cancers. Hysterectomy is ideal for stage 1 and stage 2A cancers. Depending on the stage, you will either get a radical or simple hysterectomy. The procedure reduces the chances of cancer recurring or spreading to the nearby tissues.
Severe Pelvic Inflammatory Disease (PID)
PID is a bacterial infection on the female pelvic organs that can result in severe pain. Sexually transmitted infections such as gonorrhea and chlamydia increase the risks of developing PID> when the disease does not respond to treatment, or it results in excessive pain, your doctor might recommend a hysterectomy to remove the affected tissue.
Complications During Childbirth
Complications such as uterine rupture or excessive hemorrhage may necessitate the removal of the uterus to save the woman’s life.
The doctor can perform one of three types of hysterectomy procedures based on the extent of tissues or organs removed. They include:
1. Total hysterectomy
A total hysterectomy is a procedure involving the removal of the entire uterus, the cervix and the surrounding tissue including the fallopian tubes and the ovaries. The procedure is common for people with cancer, pelvic prolapse fibroids, and abnormal vaginal bleeding.
2. Partial hysterectomy
A partial involves the removal of the top part of the uterus. The cervix and other organs remain intact.
3. Radical hysterectomy
Radical hysterectomy involves the removal of the uterus, cervix, fallopian tubes, the upper part of the vagina ovaries and lymph nodes surrounding the area. Radical hysterectomy is common for cancer treatment.
Hysterectomy, regardless of the type, can be performed using a variety of techniques. The choice of the technique to use depends on the skill and experience of the surgeon, your health, and the reason for the hysterectomy. The techniques are:
1. Abdominal Hysterectomy
An abdominal hysterectomy involves the removal of the uterus through an incision on the abdominal wall. The procedure is similar to a C-section, although the incision is smaller. Doctors use the procedure for women with a larger uterus, or when the doctor wants to examine the surrounding tissues for the disease.
The incision is made vertically from the navel or horizontally along the upper part of the pubic hairline. The technique has the longest recovery time and exposes you to several risks, including:
- Infection at the point of incision
- Blood clots
- Urinary retention
- Damage to other organs such as the bladder, ureter, and the intestines during the surgery
2. Vaginal Hysterectomy
A vaginal hysterectomy is a minimally invasive procedure that involves the removal of the vagina through the vaginal opening. A vaginal hysterectomy will be used when treating uterine prolapse or in repairing the tissues of the vagina.
Vaginal hysterectomy does not involve making any incisions; therefore, it has the lowest pain level and quicker recovery.
Doctors use this technique for women who have had a vaginal birth, have a small uterus, and have never suffered pelvic inflammatory disease.
The procedure involves detachment of the uterus from any connective tissues, the fallopian tubes, and upper vagina. The doctor may also cut up the uterus in smaller parts to facilitate removal.
3. Laparoscopic Hysterectomy
Laparoscopic hysterectomy is another minimally invasive procedure that involves the insertion of a laparoscope through an incision on your belly button. The doctor will then make small incisions in the abdomen to facilitate the entry of surgical tools. The uterus will then be removed through the vagina or the laparoscope tube. The procedure leaves small scars on the abdomen but has a shorter recovery period.
4. Robot-Assisted Hysterectomy
A robotic hysterectomy involves the use of 3-D technology and miniature instruments to perform the procedure. The robot arms are inserted into your abdomen through the small incisions.
Preparing for a Hysterectomy
Anxiety before a hysterectomy is common. You can relax when preparing for the procedure if you know what to expect.
Your doctor will conduct a variety of tests to check your overall health. He or she will collect your medical history, allergies, major illnesses, and past surgeries. You should inform your doctor about any sensitivities or issues you have with your health. In addition, you should inform your doctor about the medications you have had or those you are currently using.
After the surgery, you will need to rest for recovery. Therefore, you have to plan your work and where you will be staying. Ensure that you have a person to help you with lifting heavy objects (heavy lifting can cause post-surgical complications).
Ask your doctor about the procedure he or she will be performing. Ensure that you are familiar with all the options and make an informed decision. Seek clarification about issues that are unclear to you before you go for surgery.
Ask for time off work. The leave period should align with the time during which you will be recovering from your surgery. You can continue working until the day of the procedure. However, you may need time off to heal. The recovery period and time off work will depend on the nature of the procedure and your recovery pace.
Before the procedure, maintain a healthy diet with all the necessary nutrients. A healthy diet will prepare your body for the procedure and improve your immunity, which shortens the recovery time. In addition, you should be adequately hydrated
Stop or reduce smoking as it affects the healing process. Smoking naturally slows down the immune system.
If you have any medical conditions, you should ensure that they are well checked and managed to prevent complications during surgery.
Plan on how you will pay for the procedure beforehand, in most cases, your health insurance will cover the costs of the procedure, particularly if your doctor recommends it as a medically necessary procedure. If you are not covered by insurance, the costs of the hysterectomy can range between $10,000 and $20,000. The costs may be higher depending on the facility you choose and the surgical procedure the doctor uses. You will also have to pay the doctor’s fee. Talk with your doctor to determine whether they offer discounts and the terms of payment.
Before the surgery, you should not take solids or liquids the night before your surgery. You are advised to fast for at least 8 hours before surgery. On the day before your surgery, your doctor will conduct additional urine and blood tests, x-rays, and an EKG. These tests check your overall health and ability to go through the surgery.
Relax before the procedure to prevent the release of stress hormones. Stress hormones could weaken your immunity. Carry your medical records with you as they might serve as reference points for hospital staff.
During the surgery, you will be put under anesthesia to numb or put you to sleep. Most hysterectomies (regardless of the technique take an average of two hours to complete. The length of the surgery depends on factors such as the size of your uterus and additional procedures that the doctor will perform.
After surgery, you begin the recovery process. Recovery involves a few hours or days in the observation room to gauge your response to the surgery. You will stay in the hospital until the anesthesia wears off and your vitals are normal. Generally, doctors prefer to keep you longer for observation to ensure that any post-surgical complications are caught early.
Recovering After a Hysterectomy
Recovering after a hysterectomy takes considerable time – about two to six weeks depending on the procedure. At the hospital, recovery will include wearing off of the anesthesia and general guidelines on how to care for yourself. Your doctor will also encourage you to walk, cough, or breathe deeply, which helps prevent complications.
You will have to abstain from sex for at least six weeks to allow healing. Before you resume your sex life, you may experience anxiety and doubt. Your libido is subject to change over time and can be affected by a hysterectomy. In general, many women experienced an increase in their sex drive and response. However, you need to use a water-soluble lubricant to avoid irritation and facilitate healing.
Some of the care tips you can implement during recovery include:
- Perform simple walking exercises to reduce the risk of developing blood clots and in facilitating faster healing
- Avoid lifting heavy objects
- Attend follow up appointments with your doctor to monitor healing
- Get enough rest
- Maintain a healthy diet for energy and faster healing. Include fiber and increase your water intake to reduce and manage constipation
When you notice any of the following symptoms during the recovery, contact your doctor immediately:
- Severe pain
- Redness and discharge at the point of incision
- Trouble urinating
- Difficulty when having a bowel movement
- Chest pains and shortness of breath
- Unusual vaginal discharge
- Heavy bleeding
Living with a Hysterectomy
Your life will change after a hysterectomy. Relief from your symptoms is the major and most noticeable change you will experience. The changes in your life include both physical and emotional.
Emotionally, you might experience feelings of loss, especially if menstruation and childbirth are a big part of your identity as a woman. If you experience such symptoms, talk to a therapist or a close friend who will help you navigate through these emotions.
Where children are a big part of your future, and a hysterectomy is unavoidable, you can explore various parenting options such as surrogacy and adoption.
If you still want to have your biological children, discuss with your doctor about alternative treatments to hysterectomy, their possible side effects, complications, and the consequences of each choice. Navigating through the feelings associated with a hysterectomy can be overwhelming for most women. It is advisable to find an active support group with women who have undergone a hysterectomy. Your partner can join you if he or she is also experiencing feelings of loss after the procedure.
You will also need to get regular PAP smears if your cervix was not removed or the hysterectomy was necessary for the treatment of cancer. Where your ovaries were not removed, you may experience hot flashes, PMS, and premenstrual dysphoric disorder. You are also likely to experience menopause sooner.
If your ovaries were removed during the procedure, you would experience symptoms of menopause in the days after the procedure. Some of these symptoms include:
- Vaginal dryness
- Hot flashes
- Mood changes including anxiety and depression
- Weight gain around the abdomen
- Dry skin
- Hair loss
- Increased risk of developing urinary tract infections and urinary incontinence
These symptoms are usually sudden and intense due to the abrupt decline in estrogen. In normal menopause, the ovaries gradually reduce the amount of estrogen produced, which gives the body time to adjust and lessens the intensity of menopausal symptoms. Your doctor may recommend hormone replacement therapy to help manage the condition.
Risks of a Hysterectomy
Like all surgeries, a hysterectomy exposes you to several risks. The risks and complications arising from a hysterectomy are rare but may need surgery to correct them. These include:
- Reaction to anesthesia
- Infection at the sites of incision
- Injury to the neighboring organs including the bowel, bladder, and ureter
- Nerve damage
- Increased risks of contracting urinary tract infections
- Ovary failure
- Increased risk of pelvic organ prolapse
- Death (very rare)
To prevent these complications, you should maintain a healthy diet and lead a healthy life before the surgery. You should also go to a surgeon who has experience in conducting hysterectomies.
You may get ovarian cancer even after a hysterectomy, especially if your ovaries were left in place. In addition, if the doctor cuts up your uterus or fibroids during a vaginal hysterectomy, then the risk of cancer spreading increases. Fibroids are non-cancerous growths, which may sometimes have cancer cells in them. The doctor cannot check them for cancer until they are removed and tested; therefore, cutting them up before removal is risky.
Alternatives to a Hysterectomy
A hysterectomy results in the permanent loss of your uterus. It is a major procedure, which should not be the first alternative. Get a second opinion from other doctors to determine whether you really need the hysterectomy. For example, sometimes, menopause can help relieve the symptoms you are currently experiencing for conditions such as fibroids and heavy or abnormal vaginal bleeding.
Such an alternative enables you to deal with the problem without giving up your uterus. Here are other alternatives based on the underlying reason for the hysterectomy.
1. For fibroids
Fibroids are usually not cancerous. They can be treated with a variety of options before settling for a hysterectomy. These treatment options include:
- Watchful waiting, which involves monitoring the status of the fibroids and conducting other treatment procedures if a problem develops.
- Myomectomy which involves the removal of the fibroids while leaving the uterus intact
- Uterine fibroid embolization which cuts off the supply of blood to the fibroids
- Management of fibroids using hormonal therapy and non-steroidal anti-inflammatory medications
2. For excessive vaginal bleeding
- Management with birth control procedures such as oral contraceptives and IUDs
- Endometrial ablation, which involves the removal of the interior lining of the uterus. This procedure results in the permanent loss of fertility.
- Dilation and curettage to remove the uterine lining that builds up before a period. The procedure is repeated every cycle and does not affect fertility
3. For Uterine Prolapse
- Use of a vaginal pessary
- Self-care procedures such as Kegel exercises
- Surgery to repair the weakened connective tissues in the pelvis
4. For endometriosis
- Pain medication
- Hormone therapy
- Surgery to remove the endometrial growth
5. For Chronic Pelvic Pain
- Birth control pills to stop ovulation
- Non-steroidal anti-inflammatory drugs
- Physical therapy
- Injections to the painful areas to reduce pain
- Antibiotics for bacterial infections such as pelvic inflammatory disease
A hysterectomy is a surgical procedure that results in the permanent loss of your uterus, which is a major procedure that requires careful consideration. While it is a generally safe method, it still poses the risks associated with all surgeries. However, hysterectomy can provide permanent relief to your symptoms and could be the only choice for some conditions such as cancer. At All Women’s Care, we strive to help women in Los Angeles to get relief from symptoms such as fibroids, endometriosis, cancer, and other conditions that could require a hysterectomy. We use up-to-date technology in conducting the diagnosis and treatment for the best results. In addition, we provide all the relevant information about hysterectomies, including the positive and the negative, and leave the final decision to you. If you are considering a hysterectomy or would like to have a second opinion, contact us at 213-250-9461.