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Hysterectomy: Facts Every Woman Should Know

Approximately 600,000 hysterectomies are performed annually in the U.S., and approximately 20 million women in this country have had a hysterectomy. This makes hysterectomies one of the most common surgeries performed in the U.S. In fact, according to the Centers for Disease Control (CDC), they’re the second most frequently performed surgery, after Cesarean section, for women of reproductive age in the U.S. 

If you are one of the many women whose doctor has recommended this common procedure, read on for an overview of hysterectomy basics, including the why, what and how of these procedures.

What Is a Hysterectomy?

A hysterectomy is a surgery to remove the uterus (the womb). After a hysterectomy, a woman can no longer get pregnant and will no longer experience menstrual periods.

Why Are Hysterectomies Performed?

Hysterectomies are performed to treat a wide range of gynecologic problems, including:

• Uterine fibroids. These are benign (non-cancerous) growths in the wall of the uterus. In some women they cause pain or heavy bleeding. Uterine fibroids are the most common reason for hysterectomies.
• Endometriosis. This is a condition in which the tissue that typically lines the inside of the uterus grows outside of the uterus on the ovaries instead. It can cause severe pain and bleeding between periods.
• Uterine prolapse. This occurs when the uterus slips from its usual place down into the vagina. It is more common in women who had several vaginal births, but it can also happen after menopause or because of obesity. 
• Heavy or abnormal uterine bleeding. This can be caused by changes in hormone levels, infection, cancer or fibroids.
• Gynecologic cancer. This includes cancer of the ovary, cervix, uterus, or endometrium (the lining of the uterus).

What Are the Different Types of Hysterectomies?

• Total hysterectomy. The most common type of hysterectomy, this surgery removes the entire uterus, including the cervix. The ovaries and the fallopian tubes may or may not be removed.
• Partial hysterectomy, also called subtotal or supracervical hysterectomy. In this procedure, only the upper part of the uterus is removed. The cervix is left in place. The ovaries may or may not be removed.
• Radical hysterectomy. All of the uterus, cervix, the tissue on both sides of the cervix, and the upper part of the vagina are removed. This is often used to treat certain types of cancer, like cervical cancer. The fallopian tubes and the ovaries may or may not be removed.

Thanks to advancements in minimally invasive and laser surgeries, the number of hysterectomies performed in the U.S. has declined substantially over the last 15 years, according to researchers.

How Are These Hysterectomies Performed, and What Are the Risks?

The type of hysterectomy performed depends on the reason you’re having the surgery, your health history and other factors.

• Abdominal hysterectomy. Your doctor removes the uterus through a cut in your lower abdomen. Abdominal hysterectomy may be performed if adhesions are present or if the uterus is very large. (Adhesions are scars that band tissue together.) Abdominal hysterectomy carries a greater risk of complications, such as wound infection, bleeding, blood clots, and nerve and tissue damage, than a vaginal or laparoscopic procedure. It typically results in a longer hospital stay (three to five days) and longer recovery time (six to eight weeks). 
• Vaginal hysterectomy. The uterus is removed through the vagina. This generally causes fewer complications than abdominal or laparoscopic hysterectomy, with a shorter healing time than abdominal surgery and a faster return to normal activities. It is recommended as the first choice for hysterectomy when possible.
• Laparoscopic hysterectomy. A laparoscope is an instrument with a thin, lighted tube and a small camera that allows your doctor to see your pelvic organs. Laparoscopic surgery is when the doctor makes very small cuts to put the laparoscope and surgical tools inside of you. During a laparoscopic hysterectomy the uterus is removed in small pieces through the cuts in either your abdomen or your vagina.

Robotic hysterectomy is a type of laparoscopic surgery. Your doctor guides a robotic arm to do the surgery through small cuts in your lower abdomen.

Laparoscopic surgery usually brings about less pain, a lower risk of infection, a shorter hospital stay and possibly a quicker return to normal activities than abdominal surgery. But, laparoscopic surgery (including robotic) can take longer to perform than traditional surgery, and there’s an increased risk of injury to the urinary tract and other organs.

What Should I Expect During Recovery?

The recovery time varies, depending on the type of procedure and your overall health. You could be in the hospital for up to several days. Overall, abdominal surgery can take from four to six weeks to recover. Vaginal, laparoscopic, or robotic surgery can take from three to four weeks to recover.

Meantime, you’ll be encouraged to get up and walk around as soon as possible to minimize the risk of blood clots. You might also be given medication to help lower the clot risk and cope with pain.

After surgery, you might experience:

• Bleeding and discharge from your vagina
• Constipation 
• Short-term problems with emptying the bladder
• Emotional effects. You may feel depressed that you are no longer able to bear children; on the other hand, you may be relieved that your former symptoms are gone.

After recovery, you’ll still need to see your physician for routine gynecologic exams as well as general health care.

Moving Forward

Thanks to advancements in minimally invasive and laser surgeries, the number of hysterectomies performed in the U.S. has declined substantially over the last 15 years, according to researchers. This is good news for many women experiencing gynecologic problems.

If you are experiencing heavy or abnormal bleeding, severe pain during or between periods, or any other gynecologic problems that concern you, schedule an appointment to see your primary care physician or obstetrician/gynecologist. The sooner you are seen and diagnosed, the more treatment options you and your doctor will be able to explore.

Source: Centers for Disease Control; American College of Obstetrics and Gynecology; Gynsurgeryinfo.org; Office of Women’s Health, U.S. Department of Health and Human Services.