A hysterectomy is a surgery to remove all or part of the uterus, and may be indicated in the treatment of uterine fibroids, endometriosis, chronic pelvic pain, uterine or cervical cancer, or abnormal vaginal bleeding that does not improve with other treatments.

Depending on the condition being treated, your doctor may also recommend removal of one or both of the ovaries (called an oophorectomy), the fallopian tubes, or parts of the surrounding tissue.

Recovery time varies depending on the type of surgery and the extent of the condition, and may last anywhere from three to eight weeks.

Indications for surgery

A hysterectomy may be recommended for the following reasons:

Uterine fibroids or prolapse;
Chronic pelvic pain;
Endometriosis and adenomyosis;
Benign ovarian tumors or endometrial hyperplasia;
Cancer of the uterus, cervix, endometrium, or ovaries;
Pelvic inflammatory disease (PID);
Uterine rupture or perforation;
Pelvic congestion syndrome.

In addition, a hysterectomy may be indicated in the case of complicated septic abortion, gestational trophoblastic disease, or placenta accreta.

A hysterectomy may also be indicated in cases of abnormal uterine bleeding when other treatment options have proven ineffective at controlling the bleeding.

The type of hysterectomy performed will depend on the condition being treated, and may involve the removal of all or part of the uterus, ovaries, and fallopian tubes.

Types of hysterectomy

Different types of hysterectomy may be indicated in different situations, depending on the objectives of the surgery and what needs to be removed:

Total hysterectomy: consists of the removal of the whole uterus, including the cervix;
Partial hysterectomy: involves the removal of the body of the uterus while leaving the cervix intact;
Radical hysterectomy: more common in cases of advanced stage cancer, this involves the removal of the uterus, cervix, upper portion of the vagina, and part of the surrounding tissues.

In some cases, such as severe endometriosis or advanced cancer, it may also be necessary to remove the fallopian tubes and the ovaries.

How to prepare

In preparing for a hysterectomy it is important to discuss any questions you may have about the surgery with your doctor, including what techniques will be used and what recovery will look like. You should also inform your doctor of any allergies or health problems you may have.

You should also let your doctor know about any medications, vitamins, supplements, or natural remedies you may be taking. In some cases, doctors will recommend stopping the use of anticoagulants a few days before surgery in order to avoid heavy bleeding.

Patients must be fasting for at least eight hours prior to surgery. It is also recommended to avoid smoking and drinking alcohol prior to a hysterectomy.

It is important to complete all exams ordered by your doctor and bring the results with you on the day of surgery. These may include a preop risk assessment, blood tests, and imaging tests, such as pelvic ultrasound, MRI, and a CT scan of the abdomen and pelvis.

Surgical procedure

A hysterectomy is done in the hospital under general anesthesia and is performed by a gynecological surgeon. The procedure typically lasts about 1 to 2 hours.

Hysterectomy may be performed using different surgical techniques, including:

1. Abdominal hysterectomy

An abdominal hysterectomy is done through an incision in the abdomen, which can be vertical (from the navel to the pelvic region) or horizontal (similar to a c-section).

This technique is typically used for the removal of tumors, as it provides better visualization and makes it easier to identify the affected organs and tissues.

Abdominal hysterectomy, also called total abdominal hysterectomy, usually requires a hospital stay of around four days as well as a six week recovery period.

2. Vaginal hysterectomy

A vaginal hysterectomy is performed through an incision in the vagina to allow for removal of the uterus. This technique typically involves a 1 to 2 day hospital stay with recovery lasting about 2 to 3 weeks.

This method may not be recommended in the case of an enlarged uterus.

3. Laparoscopic hysterectomy

Laparoscopic hysterectomy involves small incisions in the umbilicus (navel) or the vagina in order to introduce a laparoscope (tiny camera) and other surgical instruments.

A laparoscopic hysterectomy also involves a hospital stay of 1 to 2 days and a faster recovery than with abdominal hysterectomy (about 2 to 3 weeks).

4. Robotic hysterectomy

Robotic hysterectomy is done by specialized machines through small incisions in the umbilicus or the vagina. Length of hospitalization and recovery time are the same as with laparoscopic hysterectomy.

Recovering from surgery

Care instructions following a hysterectomy include:

Rest, avoiding heavy lifting and high impact activities for at least three months;
Avoid having sex for about six weeks or as recommended by your doctor;
Take short walks around the house throughout the day to improve circulation and prevent blood clots.

It is common to experience vaginal bleeding during the first few days following a hysterectomy. It is important to take all medications as prescribed and at the correct times. These medications may include analgesics (pain relievers) and anti-inflammatories for pain control and antibiotics to help prevent infection.

Body changes after surgery

Following a hysterectomy, a woman or person assigned female at birth (AFAB) will no longer menstruate and cannot become pregnant. A normal sex life is still possible, however, as libido and the ability to have sex remain.

Ovulation after hysterectomy

If the uterus is removed but the ovaries remain, you will continue to ovulate. In this case the egg will be released into the peritoneal cavity, where it will be reabsorbed by the body.

If the ovaries are removed along with the uterus, ovulation will no longer occur. This can lead to symptoms of menopause such as hot flashes, decreased libido, vaginal dryness, insomnia, and irritability.

Possible complications

The main risks involved with hysterectomy are hemorrhage (heavy bleeding), localized infection of the incisional area, thrombosis (blood clots), pelvic abscess, urinary tract infection (UTI), damage to the nerves or the blood vessels, and damage to organs close to the uterus, such as the bowel and bladder.

Allergic reaction to the anesthetic used during surgery is also possible, as it is with any surgery utilizing anesthesia.

Warning signs

It is important to seek urgent medical attention for any ot the following symptoms:

Persistent fever higher than 100.4ºF (38ºC);
Frequent vomiting;
Severe abdominal pain that does not improve with the use of anti-inflammatories or analgesics as prescribed by your doctor;
Redness, bleeding, pus, or foul-smelling discharge in the area of the incision;
Vaginal bleeding that is heavier than a normal period.

You should also seek urgent medical attention if you experience shortness of breath, chest pain, leg pain or swelling, or skin that is pale, blue-tinged, and cold to the touch.

These symptoms can be a sign of surgical complications and require urgent treatment in the Emergency Department to avoid further complications.