Hysterectomy is a surgery performed to surgically remove a woman’s uterus (the womb), the organ where the baby grows when a woman is pregnant. In this surgery the whole uterus is removed and the doctor could also decide to remove the ovaries and fallopian tubes if it is felt necessary. A woman cannot become pregnant and will no longer have menstrual periods post hysterectomy. The woman could have symptoms of a menopause if both ovaries are removed and you would do well to discuss with your doctor about the risks and benefits of removing your ovaries.

Why would I need a hysterectomy?

A hysterectomy may be necessary if you have:

  • Uterine fibroids. These are non-cancerous growths in the walls of the uterus or womb. They cause pain and heavy bleeding in some women.
  • Heavy / unusual vaginal bleeding. These could be because of changes in hormone levels, infection, cancer or fibroids.
  • Uterine prolapse. In this condition the uterus slips from its initial position down into the vagina. Seen in women who have had several vaginal births, uterine prolapse can also happen after menopause or due to obesity. This could lead to urinary and bowel issues and undue pressure on the pelvic.
  • Endometriosis. Endometriosis is a condition where the tissue that usually lines the uterus grows outside the uterus or on the ovaries. This causes pain and bleeding in-between periods.
  • Adenomyosis. Here the tissue that lines the uterus grows inside the walls of the uterus where it should not be. Due to this the uterine walls thicken causing severe pain and heavy bleeding.
  • Cancer (or pre-cancer) of the uterus, ovary, cervix, or the uterus lining (endometrium).

Are there alternatives to hysterectomy?

Hysterectomy is major surgery and one must evaluate thoroughly before deciding on it. In some cases a hysterectomy could be the best option medically such as with heavy bleeding or certain types of cancer. But the patient could try on other treatments first too including:
Wait-and-watch

Kegel exercises (Pelvic floor exercises especially for Prolapse)
Medication for birth control, such as the pill, vaginal ring or a hormonal Intra Uterine Device (IUD), MIRENA IUD.
Vaginal pessary, a rubber or plastic donut-shaped object used (in cases of uterine prolapse).

Different types of hysterectomies

  • In the case of partial, subtotal or supracervical hysterectomy only the upper part of the uterus is removed while the cervix is left as is. The ovaries may or may not be removed.
  • In the case of a radical hysterectomy the uterus, cervix, the tissue on both sides of the cervix and the upper part of the vagina are removed. A radical hysterectomy is often conducted to treat certain cancers including cervical cancer. The ovaries and fallopian tubes may or may not be removed.
  • In a total hysterectomy the uterus including the cervix are removed while the fallopian tubes and ovaries may or may not be removed. This is the most common type of hysterectomy.

Does hysterectomy lead to a menopause?

Women who have a hysterectomy will cease to have their period. The possibilities of other symptoms of menopause post hysterectomy depend on whether your ovaries are removed during the surgery. If your ovaries are retained, there should be no other menopausal symptoms but you may have symptoms if you are younger than the average age for menopause – usually 51 years.

Once the uterus is removed you no longer get your periods and also cannot get pregnant. But it is possible that the ovaries still produce hormones which means you might not have other signs of menopause. Hot flashes are a possible symptom considering that the surgery could have blocked the flow of blood to ovaries thus preventing the ovaries from releasing oestrogen.

Hysterectomy procedure

A hysterectomy can be performed in several ways and this depends on the reason for the surgery, your condition and health. The various procedures include:

  • Abdominal hysterectomy where the doctor makes a cut to remove the uterus in your lower abdomen.
  • Vaginal hysterectomy where a small cut is made in the vagina.
  • Laparoscopic hysterectomy where an instrument called the laparoscope a thin tube with a light and camera allows the doctor to see all pelvic organs. Here, the doctor makes small cuts to insert the laparoscope and surgical tools inside of you. In a laparoscopic hysterectomy the uterus is removed through small cuts made in the abdomen or vagina.

Recovering after a hysterectomy

Recovering from a hysterectomy does takes time. Most women are advised to stay in the hospital for 3 to 4 days post surgery though the doctor usually has you get up and move around as soon as possible after surgery including using the bathroom on your own. However you would probably have to use a thin tube called catheter to pass urine for one or two days post your surgery. Plenty of rest is advised and you are not to lift water/ heavy objects for four to six weeks. Post this period, you should be able to take a tub bath and resume sexual activity.

What changes could I expect after a hysterectomy?

Hysterectomy is a major surgery, so recovery takes a few weeks. However the most significant change for you is better quality of life with relief from the symptoms that led to the surgery.

Changes you may experience after a hysterectomy include:

  • Menopause. Your periods would have stopped and if your ovaries are removed you may have other symptoms of menopause.
  • Change in sexual feelings. Some women experience vaginal dryness or have less interest
    in sex after a hysterectomy especially if ovaries are removed.
  • Risk for other health problems. In case both ovaries are removed you may be at a higher risk for certain conditions such as bone loss, heart disease, and urinary incontinence (uncontrolled leakage of urine). Your doctor will advise you on addressing these aspects.
  • Sense of loss. It is possible that women get depressed over the loss of fertility or change in their bodies. Your doctor would advise you on how to manage these things and get back to living life to the fullest and doing things that you once enjoyed.

What impact would hysterectomy have on my sex life?

If you have had a normal sex life prior to your surgery in all possibility, you should be able to get back to it without any issues. In fact, women report an improved sex life post hysterectomy because they have relief from pain/ heavy vaginal bleeding.

If your hysterectomy leads to symptoms of menopause you could experience vaginal dryness or a reduced interest in sex. You could use a water-based lubricant to address this. Do discuss with your doctor on how to best address this issue.

Do I still need to have Pap Smear tests post-surgery?

Maybe. You would need regular Pap Smear tests to screen for cervical cancer if your cervix is not removed or you’ve had a hysterectomy because of cancer / pre-cancer.