Hysterectomy

March is Endometriosis Awareness Month. Endometriosis is a condition when the tissue lining the inside of the uterus that is usually shed during menstruation, grows outside of the uterus. Oftentimes endometriosis can be treated with hormonal birth control or surgery to remove excess uterine tissue. In some extreme cases, however, a hysterectomy is performed to treat severe symptoms of endometriosis.

What is a hysterectomy?

A hysterectomy is a surgical procedure where the uterus is removed. A hysterectomy can be done to treat uterine fibroids, a uterine prolapse where part of the uterus slides into the vagina, endometriosis as mentioned above, chronic pelvic pain, abnormal vaginal bleeding, adenomyosis (a thickening of the uterus), or uterine, ovarian or cervical cancer

What are the different types of hysterectomies?

Depending on the reason for the hysterectomy, different parts of the reproductive organs will be removed. In a supracervical hysterectomy, the upper part of the uterus is removed. A total hysterectomy removes the whole uterus and the cervix. A radical hysterectomy removes the entire uterus, the cervix, the surrounding tissue, and the top part of the vaginal canal. A radical hysterectomy is less common than the other types and is used only when cancer is being treated and removed.  

Either an open hysterectomy or a minimally invasive hysterectomy will be performed. The type of hysterectomy performed depends on the surgeon doing it, and also the reason for the surgery, as well as the patient’s overall health. There are differences in healing time, as well as how invasive the surgery is, so it is important that the type of surgery best serves the patient and their condition. An open or abdominal hysterectomy is most common and includes an incision being made across the patient’s belly. The uterus is removed through this five- to seven-inch incision. Because the patient has to be surgically cut open, they often spend a few days in the hospital afterward for recovery. There will also be a visible scar on the patient’s belly as they heal. 

What is a vaginal hysterectomy?

A minimally invasive hysterectomy has a few different approaches. One minimally invasive option is a vaginal hysterectomy. This consists of a surgeon making an incision in the vagina and removing the uterus this way. Since the incision would be inside the body, there is no visible scar left behind. A laparoscopic hysterectomy is done using a laparoscope to guide the surgeon as they perform the hysterectomy outside the body. The laparoscope has a camera on the end and is inserted into a small cut made in the belly or belly button. The surgeon is able to remove the uterus by viewing the inside of the body through this camera. Wild!

A laparoscopic-assisted vaginal hysterectomy combines the two options listed above, using the laparoscope to help remove the uterus through an incision in the vagina. Because this procedure is less invasive and doesn’t require as large of an incision, the recovery is a little less intense. A minimally invasive hysterectomy is only a good option depending on the person and severity of the condition, which is why an open hysterectomy is much more common. 

What can you expect from the recovery process?

The recovery process after a hysterectomy is similar to recovery after any major surgery. An open hysterectomy requires about four to six weeks of recovery time. The patient needs to rest, refrain from physical activity, and shouldn’t do any heavy lifting during this time. For a minimally invasive hysterectomy, recovery time is similar but lasts about three to four weeks instead. After the hysterectomy, the patient should feel relief from the symptoms associated with whatever condition prompted the surgery. 

If the ovaries are still in the body after the surgery, the patient shouldn’t experience any hormonal changes. If the ovaries are removed, however, and the patient has not experienced menopause yet, they are now in menopause. The ovaries contain the eggs that are released every month that causes menstruation, so if you no longer have ovaries, you can no longer menstruate, thus entering menopause. Because of this, the patient will likely experience symptoms associated with menopause such as mood swings, hot flashes, change in sex drive, and vaginal dryness. These symptoms can be treated with hormone replacement therapy. If the patient is under the typical age when menopause usually begins (between 45-55), their doctor will very likely have them use hormones so they are better able to navigate these changes. 

No matter the type of hysterectomy, it is recommended to wait to have sex for at least six weeks as the body heals. Some patients might notice their pelvic floor feels weaker after this surgery, which can cause less control over your bladder, as well as loss of sensation during sex. Pelvic floor exercises or even pelvic floor therapy can help with the healing process as well. Kegel exercises are a great option to strengthen the pelvic floor.

Who should consider having a hysterectomy?

A hysterectomy is not taken lightly and is performed to treat uterine fibroids, a uterine prolapse where part of the uterus slides into the vagina, endometriosis as mentioned above, chronic pelvic pain, abnormal vaginal bleeding, adenomyosis (a thickening of the uterus), or uterine, ovarian or cervical cancer. Because the uterus is removed, it is no longer possible to experience pregnancy. Despite that consideration, hysterectomies help treat a variety of serious conditions and can be life-changing in terms of pain relief and cancer removal for those experiencing any of the conditions mentioned above. 

It is important to stay on top of your reproductive health. Women and people with uteruses should visit their gynecologist on a yearly basis, receive scheduled Pap smears, as well as physical exams. If you’re experiencing any severe pain abdominal pain or abnormal bleeding, contact your doctor right away. You should not have to live in severe pain due to your reproductive organs, and this intense pain could be indicative of something much more serious. Because reproductive organs are tucked away inside of us, it is hard to know what is going on without consulting a professional. Looking after your reproductive health is just as important as maintaining your physical health overall. 

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