Hysterectomy

There are various conditions that can be treated by hysterectomy. You may need a hysterectomy if you have:

• menorrhagia – heavy or prolonged menstrual periods
• dysmenorrhoea – painful periods
• fibroids – non-cancerous tumours of the uterus
• cancer of the uterus, cervical cancer or ovarian cancer
• pelvic inflammatory disease (PID) – bacterial infection of a woman’s reproductive organs, which if not detected early can cause scarring of the uterus and fallopian tubes
• uterine prolapse – uterus drops toward or into the vagina due to weakened and damaged pelvic floor muscles or loose ligaments
• endometriosis – cells of the uterine lining (endometrial tissue) grow in other parts of the body
• adenomyosis – a form of endometriosis where the endometrial tissue extends into the muscles of the uterus.

• Hysterectomy with bilateral salpingectomy – hysterectomy with the additional removal of the fallopian tubes.
• Hysterectomy with oophorectomy – hysterectomy with the additional removal of one or both ovaries.
• Sub-total or partial hysterectomy – the body of the uterus is removed leaving the cervix (neck) in place.
• Total hysterectomy – the entire uterus including the cervix is removed, but the ovaries are left in place. In some cases the fallopian tubes and ovaries are also removed.
• Radical or Wertheim’s hysterectomy – the uterus, cervix, ovaries, fallopian tubes, upper part of the vagina (vaginal vault) and lymph nodes are removed. This type of hysterectomy may be performed when a woman has cancer of the cervix, ovaries or uterus.

A hysterectomy is a major surgical procedure performed under general anaesthesia. There are different ways a gynaecologist might perform the operation. This will be determined by the reason for performing the hysterectomy and other factors, such as the size of the uterus and the experience of the gynaecologist.

• Plus uni- or bilateral salpingectomies: hysterectomy including removal of the fallopian tube(s) (standard practice)
• Plus uni- or bilateral oophorectomies: hysterectomy including removal of one or both ovaries.
• Sub­total hysterectomy: the uterus is removed leaving the cervix behind (non-standard practice).
• Total hysterectomy: the uterus including the cervix is removed. In some cases the ovaries are also removed.
• Radical or Wertheim’s hysterectomy: the uterus, cervix, ovaries, fallopian tubes, upper part of the vagina, adjacent tissue (parametrium) and pelvic lymph nodes are removed. This type of hysterectomy may be performed when a woman has cancer of the cervix, ovaries or uterus.

There are a number of questions you may like to ask your gynaecologist when discussing the option of having a hysterectomy.

Examples include:

• what type of hysterectomy is being recommended and why?
• which method of surgery will be performed?
• what experience has the surgeon had with this procedure?
• what are the possible complications and side effects including possible impacts on sexual function?
• what is the length of recovery time in hospital and recovery period at home?
• will hormone replacement therapy (HRT) be recommended?

You may wish to bring a partner or friend to your appointment to provide support and also take notes so you have a clear record of what was discussed in your consultation.

You can also ask your gynaecologist for written information about the procedure.

Most women do not experience health problems after their hysterectomy, however some health risks can arise during or after surgery.

Surgery risks include:

• injury to neighbouring organs such as the bladder, urinary tract or bowel
• bleeding during the surgery that makes a transfusion necessary i.e. excessive loss of blood (haemorrhage)
• allergic reaction to the anaesthetic
• if undergoing a vaginal or laparoscopic hysterectomy, a need to change to abdominal incision during the surgery.

Post-operative risks include:

• difficulty urinating after surgery
• haemorrhage
• hematoma (collection of blood) at the surgical site
• blood clots
• infection.

Expected outcomes after a hysterectomy:

• menopause occurring post-operatively (if the ovaries are removed).
• sterility after surgery – you will no longer be able to have a baby.

It is important to closely follow the instructions you are given to fully prepare for your hysterectomy.

Tell your doctor before the procedure if you:

• are sensitive or allergic to any drug or substance
• are taking any medication such as aspirin or any herbal supplements
• are taking blood thinning tablets such as Warfarin
• have any health issues such as diabetes, heart valve disease or have a pacemaker.

On the day of the procedure

• Report to the hospital as outlined in your referral letters.

Following surgery, as a side effect of the general anaesthetic you may feel nauseous, and experience some abdominal discomfort and/or pain. Medication to relieve nausea and pain is available. There may also be some vaginal bleeding which should reduce after a few days.

You will be encouraged to get up and walk around on the first day following surgery to avoid constipation and gas, and to also decrease the risk of blood clots and lung infections. You can expect to be eating and drinking during this time. Following a routine hysterectomy, most women will stay in hospital between 3 to 5 days.

You will be advised to plan 4 to 6 weeks of recovery following your hysterectomy, although recovery times vary from one woman to the next and depend on the type of procedure performed. The recovery time is often shorter if a vaginal hysterectomy or LAVH has been performed, compared to an abdominal hysterectomy. The recovery time is longest following a radical hysterectomy.

Women will have different emotional responses after a hysterectomy due to the reason for their operation. For example:

• occasionally, women may feel relief that the monthly pain and inconvenience of periods are now gone and they can move forward with their life in a more positive manner
• women who have been diagnosed with cancer are frequently, and very understandably, anxious about whether the surgery will have been successful and may be concerned about the necessity of other forms of treatment aimed at preventing a recurrence.

Penetrative sex is not recommended until the top of the vagina has safely healed which is generally about 6 to 8 weeks after a hysterectomy.

During this time women and their partners may wish to focus on other activities such as the touching of outer genitals, hugs, kisses and massage.

Women that are experiencing problems with their sex life following a hysterectomy may find it helpful to speak to their gynaecologist, a psychologist, counsellor or sex therapist.

The amount of time it takes for you to get your results will differ depending on where you have the procedure done and the laboratory processing time. The specialist will write a report, which may include pictures. The pictures may be on films or on a CD.

Your doctor will need to discuss the report and results with you at your post-operative follow-up appointment, which is usually 4 to 6 weeks after the procedure.

Women who did not have their cervix removed during their hysterectomy will need to continue regular cervical screening.

Women whose cervix was removed as part of the hysterectomy should consult their gynaecologist about their individual situation and need to continue screening.

If a woman has not gone through menopause and her ovaries were removed during the hysterectomy, then hormone replacement therapy (HRT) may be recommended.

If the ovaries have not been removed, then they will continue to produce the female hormone oestrogen and hormone replacement therapy is not necessary.