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What happens to hysterectomy?

Benefits and Risk General Considerations

A hysterectomy may be life-saving in the case of cancer. It can relieve the symptoms of bleeding or discomfort related to fibroids, severe endometriosis or uterine prolepses. On the other hand, for these non-cancerous conditions, you may prefer to seek alternatives to surgery for these symptoms or other problems related to the uterus and pelvic organs.

Symptoms like pelvic pain or unusual bleeding may not necessarily be related to the uterus. An accurate diagnosis will help you to determine the potential benefits and risks of a hysterectomy.

The risks of hysterectomy include the risks of any major operation, although its surgical risks are among the lowest of any major operation.

Hysterectomy patients may have a fever during recovery, and some may develop a mild bladder infection or wound infection. If an infection occurs, it can usually be treated with antibiotics. Less often, women may require a blood transfusion before surgery because of anemia or during surgery for blood loss. Complications related to anesthesia might also occur, especially for women who smoke, are obese, or have serious heart or lung disease.

As with any major abdominal or pelvic operation, serious complications such as blood clots, severe infection, adhesions, postoperative [after surgery] hemorrhage, bowel obstruction or injury to the urinary tract can happen. Rarely, even death can occur.

In addition to the direct surgical risks, there may be longer-term physical and psychological effects, potentially including depression and loss of sexual pleasure. If the ovaries are removed along with the uterus prior to menopause [change of life], there is an increased risk of osteoporosis and heart disease as well. These will be discussed later along with possible treatments.

In making a decision, you should also consider that a hysterectomy is not reversible. After a hysterectomy, you will no longer be able to bear children and you will no longer menstruate. You need to think about the impact these changes would have on you.

Talk about your concerns with your doctor or a counselor and your partner. You may want to bring your partner to your doctor's office to discuss concerns before having the operation.

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Removal of Tubes and Ovaries

Should your ovaries be removed along with your uterus if you have a hysterectomy?

If you have a diagnosis of uterine cancer, the ovaries should be removed because the hormones they secrete may encourage the growth of the cancer. They also may have to be removed in severe endometriosis because they produce the hormones that are responsible for endometriosis.

The fallopian tubes are generally removed when the ovaries are removed because they are attached to the uterus and their sole purpose is to serve as a passageway between the ovaries and the uterus.

In cases other than uterine cancer or endometriosis, there is controversy among doctors about the advantages and disadvantages of removing ovaries and tubes as part of a hysterectomy.

Some doctors believe that healthy ovaries should be removed as part of a hysterectomy in women who are close to menopause or later, when the ovaries' function normally fades. It is done as a preventive measure to reduce the risks of developing ovarian cancer. This is because ovarian cancer is very difficult to detect at an early enough stage for it to be curable.

Other doctors disagree because this cancer is rare and because removing the ovaries does not always guarantee women will not develop ovarian cancer. [Rarely, the cells that cause ovarian cancer can be present in the body even after the ovaries are removed.] In addition, ovaries produce several hormones which are beneficial to women. They protect against serious common diseases such as heart disease and osteoporosis and contribute to sexual pleasure.

As a woman ages, the ovaries gradually reduce their production of hormones, but even after menopause they produce small amounts of hormones. Removing the ovaries causes menopause to occur more abruptly. The symptoms of menopause include hot flashes, night sweats, insomnia, fatigue, depression and vaginal dryness.

After ovaries are removed or when menopause occurs, hormone replacement therapy often helps reduce the risks of osteoporosis, and reduce menopausal symptoms like hot flashes and vaginal dryness. It may also contribute to sexual pleasure. However, there are some women who cannot be placed on hormone replacement therapy. For example, some women with liver disease or a history of hormone-dependent tumors, such as breast cancer, may not be able to take these hormones.

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Sexuality

Every person reacts differently, and reactions are a combination of emotional and physical responses. We still have much to learn about the effects of hysterectomy on sexual function.

Some women say they enjoy sex more after a hysterectomy, particularly if they had a lot of bleeding and pain beforehand. Some women feel more relaxed not worrying about getting pregnant.

Some women who have hysterectomies experience lower sexual enjoyment. There may be a number of reasons for this which is only partially understood.

For some women, uterine contractions and pressure against the cervix add to sexual pleasure. Others may feel less pleasure or reduced desire due to loss of certain hormones if ovaries were removed. Loss of hormones can cause vaginal dryness and make sex uncomfortable. Hormone replacement therapy may relieve some of these symptoms. A vaginal gel or lubricant can reduce vaginal dryness. For some women, reduction in sexual pleasure is temporary while they and their partners adjust. Because sexual feelings are so individual, it may be difficult to predict exactly how a hysterectomy will affect your feelings.

Emotional Effects

Some women report having a strong emotional reaction, or feeling down, after a hysterectomy. Most feel better after a few weeks, but some women do feel depressed for a long time. Other women experience a feeling of relief after a hysterectomy.

No longer being able to bear children can cause emotional problems for some women. Some women feel changed or feel they have suffered a loss. Talking things over with your doctor, your partner, a friend or a counselor often helps. It may help to talk with a friend or another woman who has had a hysterectomy before and after your operation.

Alternatives

“Alternatives to hysterectomy have their own benefits and risks. A myomectomy for fibroids, for example, is more localized surgery and does not involve removal of the uterus. However, like hysterectomy, it does involve general anesthesia and is a major operation. A myomectomy is a more difficult operation to perform than a hysterectomy, and there may be increased risk of bleeding and infection. With this procedure, tumors may remain or return which may lead to further surgery in the future, sometimes a hysterectomy. ”

“Laparoscopy is a common procedure which enables the physician to visualize and treat a number of gynecologic conditions such as endometriosis through one or more minute incisions in the abdomen. It usually requires one day surgery and general anesthesia. Laser therapy or microsurgical techniques can be used with laparoscopy. ”

“Each drug therapy has its own side effects and you should review these with your physician. Some therapies are more experimental and their benefits and risks may not be as well understood. You need to carefully review with your doctor what is known about any therapy you choose. ”

“Or you may choose to simply bear with your symptoms for awhile and see what happens over time since the bleeding and discomfort related to endometriosis or fibroids may diminish as a woman enters menopause. ”

“In considering a hysterectomy, you may wish to get a second opinion. A second opinion means that a second doctor will review your medical history, examine you and advise you as to whether he or she agrees with your primary doctor's treatment recommendation. It is an opportunity for you to discuss your condition with another expert. Many health insurance plans require and pay for a second opinion before any major surgery. Second opinions are common; getting one doesn't mean you are being disloyal to your first doctor. If you don't know another doctor to ask for a second opinion, your insurance company or the county medical society can give you the names of appropriate doctors in your area. It is best to request a doctor who is board certified in obstetrics and gynecology. ”

“Finally, because every woman is unique and because a hysterectomy was recommended to you because of your individual needs, it is important that you discuss your personal risks and benefits with your doctor before deciding whether to have a hysterectomy. As with other surgery, different doctors make different judgments about when to recommend this operation. ”

Different Types of Hysterectomies

All hysterectomies are major operations involving removal of at least the uterus. Some types of hysterectomies involve removing other organs as well. It is important to talk with your doctor about the kind of hysterectomy recommended for you.

Subtotal Hysterectomy

In this operation, only the upper part of the uterus is removed, but the cervix is not. Tubes and ovaries may or may not be removed. This procedure is always done through the abdomen. Leaving the cervix may help with later sexual enjoyment. After this operation, a woman still needs to have regular Pap smears to prevent cervical cancer.

Total Hysterectomy

This operation involves removing both the body of the uterus and the cervix, which is the lower part of the uterus. Hysterectomy can sometimes be done through the vagina [vaginal hysterectomy] at other times; a surgical incision in the lower belly [abdominal hysterectomy] is preferable. For example, if you have large fibroid tumors, it is difficult to safely remove the uterus through the vagina.

Vaginal hysterectomy, when it can safely be performed, generally involves fewer complications, a shorter recovery period and no visible scar. "Complete hysterectomy" is a common non-medical term that usually means a total hysterectomy plus removal of the ovaries and fallopian tubes.

Radical Hysterectomy

This procedure is reserved for serious disease such as cancer. The entire uterus and usually both tubes and ovaries as well as the pelvic lymph nodes are removed through the abdomen. Since cancer is unpredictable, other organs or parts of other systems are sometimes removed as well.