What Is a Hysterectomy?

A hysterectomy is a common surgery performed in adult women. It is usually a scheduled surgery performed as an inpatient procedure. Very rarely, a hysterectomy is performed as an emergency -often for complications related to childbirth.

During a hysterectomy, a surgeon will separate the uterus from the ligaments and tissues that hold it in place. The uterus is then removed from the body.

Other nearby organs may also be removed during a hysterectomy, including:

• Part of the vagina
• The cervix
• The fallopian tubes
• The ovaries

This decision depends on the reason for the surgery. For example, a woman who has cancer of the uterus usually has her ovaries and fallopian tubes removed along with her uterus. On the other hand, a woman who has chronic bleeding problems may have only the uterus removed.

The extent of the procedure is what defines its type:

• Total Hysterectomy: When the cervix is removed along with the uterus
• Supracervical/Partial Hysterectomy: When the cervix is left in place and only the uterus is removed
• Bilateral Salpingo-Oophorectomy: When a woman's ovaries and fallopian tubes are removed

Once the surgeon has inspected the organ(s) and determined that the surgery is complete, any incisions are closed.

Various Surgical Approaches

When performing a hysterectomy, there are three different surgical approaches that can be used:

• Vaginal: The uterus is removed through a woman's vagina.
• Abdominal: The uterus is removed through a six- to eight-centimeter incision in the abdomen, which is often held closed with staples or sutures that are removed weeks later by the surgeon.
• Laparoscopic: The uterus is removed through multiple, tiny incisions in the lower abdomen using a laparoscope. These may be closed with absorbable sutures and sterile tape.

The approach a surgeon chooses depends on several factors, such as:

• The reason why the surgery is being performed
• Size, shape, and integrity of the woman's vagina and uterus
• Whether the surgery is emergent or scheduled
• The surgeon's training and experience
• The patient's preference

Vaginal hysterectomy is generally the preferred approach while an abdominal hysterectomy is the least favored approach.

When compared to a vaginal or laparoscopic hysterectomy, an abdominal hysterectomy is associated with an increased risk of complications (e.g., infection and bleeding), as well as a longer hospital stay and recovery time. 

Contraindications

There are really no absolute contraindications to undergoing a hysterectomy. However, once a hysterectomy is performed, a woman will no longer menstruate and cannot become pregnant, which may be a deciding factor against the surgery for some.

There may be issues that end up being relative contraindications, however. For example, certain conditions may make a vaginal hysterectomy more challenging, such as: 

• Previous Cesarean section or prior abdominal surgery
• History of an adnexal mass
• Narrow pubic arch or poor vaginal descent

Purpose of Hysterectomy

A hysterectomy is usually performed to treat one of the below conditions: 

• Fibroids
• Endometriosis
• Uterine prolapse
• Chronic pelvic pain
• Abnormal uterine bleeding
• Cancer of the cervix or uterus

Once a woman has a hysterectomy, she will no longer be able to carry a child. Therefore, many women in their childbearing years attempt other less-invasive ways to treat their condition. In some instances though, as with cancer, a hysterectomy may be a woman's only treatment option.

Potential Risks

There are always potential risks associated with undergoing surgery, and a hysterectomy is no exception.

Possible (although overall rare) complications that may arise from a hysterectomy include:

• Infection (most common)
• Blood clot
• Bowel injury or bowel obstruction
• Injury to an organ in the urinary tract, such as the bladder or ureter
• Bleeding
• Nerve injury
• Vaginal cuff dehiscence (separation of the vagina incision or cut)
• Fistula (when an abnormal tract forms between two tissues)

How to Prepare

Preparing for your hysterectomy usually begins with meeting with your surgeon and anesthesia team about a week or so before your surgery.

During these appointments, the following issues will be discussed:

• Your recovery time in the hospital
• Potential complications
• Your medications (which ones to continue and/or stop prior to surgery)
• Instructions on what you can and cannot eat prior to surgery (and the timeline for that)
• Arrival time for your surgery and what to wear and bring with you
• Arranging for a ride home after your hospital stay
• Lifestyle habits to adopt prior to your surgery (e.g., smoking cessation and daily exercise)

What to Expect on the Day of Surgery

Your hysterectomy will usually be performed under general anesthesia in the surgical ward of a hospital, although a laparoscopic hysterectomy may be performed in an outpatient surgical center.

On the day of your hysterectomy, you will be advised to wear comfortable clothes and arrive about two hours before your scheduled time.

You will also be asked to bring the following items:

• Your insurance card
• Your medications, including supplements, in their original bottles
• Personal toiletries and clothes for leaving the hospital

Once you arrive at the hospital, you will change into a gown and relax in a preoperative room where a nurse will administer fluids and/or medications through a small needle in your arm. You will also see your surgeon and someone from the anesthesia team before going into the operating room.

Recovery

Recovery from a hysterectomy depends somewhat on the type of hysterectomy performed.

While an abdominal hysterectomy generally requires a two- to three-night overnight hospital stay, you may only stay one night (or even go home the same day) with a laparoscopic hysterectomy.

During your recovery, you will experience various symptoms. Some, like pain and constipation, may be temporary and last a few days to a week. Others, such as vaginal bleeding and discharge, may last several weeks.

In addition to providing you with guidance on how to best manage your symptoms, your healthcare provider will also give you instructions on activity restrictions (e.g., sex, driving, going back to work, and more) and when to come in for follow-up appointments.

Keep in mind that recovering from a hysterectomy is more than a physical process—it's also an emotional one, too.

Women have different experiences. Many are relieved that their symptoms are gone. Others mourn the loss of their fertility, or perhaps worry about their future if the hysterectomy was performed to treat cancer.Symptoms of depression may also crop up during your recovery.

It's important to lean on others for support and seek help processing these emotions, if you need it.