Here's what you need to know about this common but major operation.
A hysterectomy is a surgical procedure to remove your uterus, or womb. It's a major operation with a significant recovery time, so it is usually only considered after exploring other less invasive treatment options.
It is a very common procedure: Nearly 500,000 women have hysterectomies in the United States each year. You are no longer able to get pregnant or have any periods after a hysterectomy.
There are different types of hysterectomies depending on the underlying reason you require the procedure. The main types of hysterectomies are:
As well as the different types of surgery, your surgeon can perform a hysterectomy in three different ways:
The type of hysterectomy and surgical procedure depend on the reason for the surgery and your personal medical history.
A hysterectomy is major surgery and usually conducted only when less invasive treatment methods have failed. Common reasons for needing a hysterectomy include:
Depending on the type of hysterectomy you need, you may experience surgical menopause.
If you have a hysterectomy, but one or both of your ovaries is left intact, you may experience menopause sooner—about a year earlier on average—than if you had not had a hysterectomy.
If you have a total hysterectomy with bilateral salpingo-oophorectomy or a radical hysterectomy where the ovaries are removed as well as the uterus, you'll experience menopause after the operation. This happens regardless of your age and is called surgical menopause.
Surgical menopause can begin hours or days after surgery, and due to the sudden onset, symptoms can be more acute than they would be during normal menopause. Your doctor will talk to you about hormone replacement therapy if this is an option.
About 13,000 new cases of cervical cancer are diagnosed each year in the U.S. Cervical cancer is often treatable, but the treatment you require depends on the type and stage of cancer you have and your individual health.
Surgery is most often one of the main treatments for cervical cancer. A simple hysterectomy is sometimes used to treat early-stage cervical cancer, particularly, stages 1A2, 1B1 and 1B2. The ovaries are usually left in place unless there is another reason to remove them.
In a case of endometriosis, tissue similar to the uterine lining grows outside the uterus in places like the ovaries, fallopian tubes, bowels and throughout the pelvis. It's a chronic, lifelong and common condition affecting more than 6.5 million women in the U.S.
Symptoms of endometriosis can be debilitating and include pain, bleeding between periods, digestive problems and infertility. A hysterectomy, with or without removal of the ovaries, is sometimes a treatment for endometriosis. However, it's not a guaranteed cure, and symptoms might return after the surgery.
Whether or not a hysterectomy might be a treatment option for endometriosis depends on the individual and the symptoms. It's a big decision, so discussing all the risks and benefits with your healthcare provider is important.
Choosing to have a hysterectomy is a significant decision. After the operation, you can no longer get pregnant, and the removal of the uterus can feel like a huge loss. However, for some women, the potential to improve symptoms can seem like a huge relief. It's essential to consider your emotions and how the surgery may make you feel.
Every woman is different, as is their medical situation. Therefore, talk to your healthcare provider about the pros and cons of a hysterectomy specifically for you. If you decide to have a hysterectomy, your doctor can provide information on how to prepare and what to expect.
Before the operation, you may be asked to:
You also usually have a preoperative assessment, which may entail a blood test, to make sure you are healthy for surgery. Your healthcare provider can give you instructions about how to prepare for your procedure. These instructions are important to follow and may include a specific time to stop eating and drinking before surgery if you are having a general anesthetic.
If you have any questions about how to prepare for a hysterectomy or are not sure about any of the instructions you have received, just speak to your clinical team. It is there to help support and guide you through the surgery.
After a hysterectomy, waking up feeling tired, uncomfortable and in some pain is completely normal. You may be given pain relief or anti-sickness medication to help.
How long you need to stay in the hospital depends on many factors, such as:
Vaginal or laparoscopic hysterectomies have shorter recovery times, and you may only need to stay in the hospital for one to four days. An abdominal hysterectomy might mean you need to stay in the hospital a little longer. Regardless of the type of surgery, you should take it easy and avoid heavy lifting for a time. It can take up to eight weeks to fully recover after having an abdominal hysterectomy.
You should be able to return to work between two and six weeks after your operation if you've had a vaginal or laparoscopic hysterectomy. You may need longer if you've had an abdominal hysterectomy. Everyone's situation is different, and your return to work depends on how you heal, your job and your life.
Some women's lives improve after their hysterectomy because they no longer need to live with symptoms such as chronic pain and heavy bleeding. For others, there can be a sense of loss that can take some time to process and accept. Occasionally, the loss can also trigger depression. If you are struggling with your feelings after a hysterectomy, reach out to your healthcare provider for support.
You need to wait around six weeks after surgery before having sex, but you may want to wait longer. Physically, your scars are healing and any vaginal discharge should have stopped by around six weeks after surgery. It's safe to have sex around four to six weeks after your hysterectomy. But when you choose to have sex after a hysterectomy is entirely your decision, depending on when you feel ready and comfortable.
Some women experience an initial loss of sexual desire after the operation. However, once fully recovered, this desire often returns. If you had your ovaries removed and began surgical menopause, the loss of libido may last longer, along with other problems such as vaginal dryness. If you find having sex difficult, ask your doctor whether hormone replacement therapy (HRT) is right for you. They can also guide you through the types of lubricants you can use and how to navigate sex through surgical menopause.
It's important to remember that although you won't need contraception to protect you from pregnancy, you can still contract sexually transmitted infections (STIs). Condoms are the only way to protect yourself from STIs, so you still need to use them when having sex with new partners or when you may be at risk of catching an STI.
There are always possible complications with any surgery, and your doctor can talk you through all of these before you decide whether to go ahead with a hysterectomy. Complications to consider are:
Every surgery carries risk, but that doesn't mean it's not safe. You can discuss the risks with your doctor, and they can explain the steps they take to minimize risks. If there is anything you feel uncomfortable about, always ask your doctor or one of your healthcare team members.
After your uterus is removed, you can no longer get pregnant or have periods. If your ovaries are removed, then you start surgical menopause. If your ovaries are not removed, you still continue to produce hormones, but menopause might start earlier than if you hadn't had a hysterectomy.
You can still have a full orgasm after a hysterectomy. For most women, the surgery does not change having an orgasm at all. Some women find sex and orgasm a better experience because they no longer have to deal with heavy bleeding and painful symptoms. Others may find their orgasm is slightly less intense due to some of the nerves connected to the cervix being disturbed, although this is very rare and the connection between the cervix and orgasm is largely not understood.
If you start menopause, you may experience problems such as vaginal dryness and loss of libido, which can affect sexual pleasure. However, many treatments, including lubricants and HRT, can help overcome these concerns.
The recovery time varies depending on the type of hysterectomy, but most people take around four to six weeks to fully recover from the surgery.
