Hysterectomy

Why the Procedure is Performed

There are many reasons a woman may need a hysterectomy, including:

• Adenomyosis, a condition that causes heavy, painful periods
• Cancer of the uterus, most often endometrial cancer
• Cancer of the cervix or changes in the cervix called cervical dysplasia that may lead to cancer
• Cancer of the ovary
• Long-term (chronic) pelvic pain
• Severe endometriosis that does not get better with other treatments
• Severe, long-term vaginal bleeding that is not controlled with other treatments
• Slipping of the uterus into the vagina (uterine prolapse)
• Tumors in the uterus, such as uterine fibroids
• Uncontrolled bleeding during childbirth

Hysterectomy is a major surgery. Some conditions can be treated with less invasive procedures such as:

• Uterine artery embolization
• Endometrial ablation
• Using birth control pills
• Using pain medicines
• Using an IUD (intrauterine device) that releases the hormone progestin
• Pelvic laparoscopy

Risks

Risks of any surgery are:

• Allergic reactions to medicines
• Breathing problems
• Blood clots, which may cause death if they travel to the lungs
• Bleeding
• Infection
• Injury to nearby body areas

Risks of a hysterectomy are:

• Injury to the bladder or ureters
• Pain during sexual intercourse
• Early menopause if the ovaries are removed
• Decreased interest in sex
• Increased risk of heart disease if the ovaries are removed before menopause

Before the Procedure

Before deciding to have a hysterectomy, ask your health care provider what to expect after the procedure. Many women notice changes in their body and in how they feel about themselves after a hysterectomy. Talk with provider, family, and friends about these possible changes before you have surgery.

Tell your health care team about all the medicines you are taking. These include herbs, supplements, and other medicines you bought without a prescription.

During the days before the surgery:

• You may be asked to stop taking aspirin, ibuprofen (Advil, Motrin), clopidogrel (Plavix), warfarin (Coumadin), and any other drugs like these.
• Ask your provider which drugs you should still take on the day of your surgery.
• If you smoke, try to stop. Ask your provider for help quitting.

On the day of your surgery:

• You will most often be asked not to drink or eat anything for 8 hours before the surgery.
• Take any medicines your provider told you to take with a small sip of water.
• Arrive at the hospital on time.

After the Procedure

After surgery, you will be given pain medicines.

You may also have a tube, called a catheter, inserted into your bladder to pass urine. Most of the time, the catheter is removed before leaving the hospital.

You will be asked to get up and move around as soon as possible after surgery. This helps prevent blood clots from forming in your legs and speeds recovery.

You will be asked to get up to use the bathroom as soon as you are able. You may return to a normal diet as soon as you can without causing nausea and vomiting.

How long you stay in the hospital depends on the type of hysterectomy.

• You can likely go home the next day when surgery is done through the vagina using a laparoscope or after robotic surgery.
• When a larger surgical cut (incision) in the abdomen is made, you may need to stay in the hospital 1 to 2 days. You may need to stay longer if the hysterectomy is done because of cancer.

Outlook (Prognosis)

How long it takes you to recover depends on the type of hysterectomy. Average recovery times are:

• Abdominal hysterectomy: 4 to 6 weeks
• Vaginal hysterectomy: 3 to 4 weeks
• Robot-assisted or total laparoscopic hysterectomy: 2 to 4 weeks

A hysterectomy will cause menopause if you also have your ovaries removed. Removal of the ovaries can also lead to a decreased sex drive. Your doctor may recommend estrogen replacement therapy. Discuss with your provider the risks and benefits of this therapy.

If the hysterectomy was done for cancer, you may need further treatment.

References

ACOG Committee Opinion No. 444: choosing the route of hysterectomy for benign disease. Obstet Gynecol. 2009;114(5):1156-1158. PMID: 20168127 www.ncbi.nlm.nih.gov/pubmed/20168127.

Burney RO, Giudice LC. Endometriosis. In: Jameson JL, De Groot LJ, de Kretser DM, et al, eds. Endocrinology: Adult and Pediatric. 7th ed. Philadelphia, PA: Elsevier Saunders; 2016:chap 130.

Jones HW III. Gynecologic surgery. In: Townsend CM, Beauchamp RD, Evers BM, Mattox KL, eds. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012:chap 71.

National Comprehensive Cancer Network. NCCN clinical practice guidelines in oncology (NCCN guidelines): cervical cancer. Version 1.2016. www.nccn.org/professionals/physician_gls/pdf/cervical.pdf. Accessed April 18, 2016.