Hysterectomy

Hysterectomy is the second most common surgery performed with over 600,000 procedures each year in the United States. It is most commonly performed to treat uterine fibroids. A hysterectomy is the removal of a woman’s uterus and can be classified as a total hysterectomy, a subtotal also called partial hysterectomy, or a radical hysterectomy depending on her circumstances:

• Total Hysterectomy is the most common type of hysterectomy performed. The entire uterus, including the upper portion located above the fallopian tubes (fundus) and cervix, is removed but not the ovaries.
• Subtotal or Partial Hysterectomy is when the entire uterus is removed but the cervix is preserved (supracervical hysterectomy).
• Radical Hysterectomy is normally performed due to cancer. The entire uterus, cervix, and top portion of the vagina are removed, and often some tissue from the sides of the uterus along with nearby lymph nodes.
• Sometimes, one or both ovaries may be removed – oophorectomy, and/or the fallopian tubes – salpingectomy.

Why Would a Woman Undergo a Hysterectomy?

Uterine fibroids

The most prevalent reason a woman would have hysterectomy surgery is to stop the significant symptoms caused by uterine fibroids. The most common of these symptoms is heavy menstrual bleeding that can create a plethora of side effects including anemia. While fibroids are the most common root cause of heavy bleeding, it can be a result of other medical conditions.

Endometriosis

The same type of cells that make up the uterine lining can abnormally grow outside the uterus, in the pelvic area, and attach or wrap around other organs in the abdomen. These cells will bleed every month during a woman’s cycle in unison with the internal portion of the uterus. Endometriosis is often the cause of chronic pelvic pain, back pain, abnormally heavy bleeding, and infertility.

Adenomyosis

The same lining cells responsible for a woman’s period (and also endometriosis) infiltrate the muscular layer of the uterus just deep into the uterine lining. Therefore in simple terms, adenomyosis is endometriosis that involves the uterus. The layer beneath the lining, i.e. subendometrium, becomes very thick resulting in pain, heavy bleeding, infertility, and the enlargement of the uterus. This enlargement is typically diffuse but can be focal and confused with a fibroid. Adenomyosis can be treated with a non-surgical procedure called uterine artery embolization (UAE) instead of hysterectomy surgery. UAE’s success rate in adenomyosis patients is between 70-80%.

Endometrial Hyperplasia

Hyperplasia occurs when the lining of the uterus is abnormally thick and causes very heavy monthly bleeding. Endometrial hyperplasia is normally caused by an imbalance of hormones where there is an excess of estrogen and not enough progesterone. This condition tends to be more common when hormone levels are fluctuating such as during perimenopause.

Cancer

In about 10% of the cases, a hysterectomy is considered life-saving due to cancer: endometrial, ovarian, uterine, cervical, or cancer of the fallopian tubes.

How Is Hysterectomy Surgery Performed?

There are many surgical techniques used to perform a hysterectomy and the procedure and technique chosen for each patient will depend on a number of factors including patient preference, surgeon’s experience, uterine size, history of previous surgeries/presence of scar tissue.

Abdominal Hysterectomy

An abdominal hysterectomy would be used if a woman has an enlarged uterus, the surgeon is also removing the fallopian tubes and ovaries, large fibroids are present, or cancer or disease has spread to the abdominal cavity. The uterus is removed via an incision that is approximately 7 inches long traditionally located horizontally along the top of the pubic hairline. In cases of an enlarged uterus (typically above the belly button) or the presence of scar tissue, the incision is made vertically from below the navel to the pubic bone. The surgery is done under general anesthesia and requires a 2-3 night hospital stay. Recovery time is normally 6-8 weeks. An abdominal hysterectomy is often performed to address uterine fibroids.

Vaginal Hysterectomy

Vaginal hysterectomy is the only hysterectomy technique that does not require abdominal incisions. Patients suffering from uterine fibroids are rarely eligible for this approach due to the uterine enlargement the fibroids cause. The uterus is removed through the vaginal opening and sometimes is done with laparoscopic assistance. The average recovery time is 4-6 weeks.

Laparoscopic Hysterectomy

Laparoscopic hysterectomy can be performed through the abdomen or vaginally. The surgeon inserts several metal tubes into the abdomen. The surgeon then operates through these tubes with the help of a video camera attached to one of the surgical instruments – a laparoscope. The uterus may be chopped up with the use of a morcellator to allow removal from the metal tubes. Morcellation has generated a lot of concern and is very controversial due to the fear of unknowingly spreading potential cancer cells at the time of the surgery. Newer devices utilize a collection bag to prevent the intra-abdominal spill of uterine fragments. The typical recovery time is 4-6 weeks.

Robot-Assisted Hysterectomy

Robot-assisted hysterectomy is a surgical method that uses a high-powered 3D magnified view of the operating area and robotic arms to perform the hysterectomy. It is the same procedure as laparoscopic hysterectomy except robotic arms hold the surgical instruments instead of the surgeon’s hands. The cost of robot-assisted hysterectomy is significantly higher than standard laparoscopic hysterectomy. Expect a 4-6 week recovery period.

What Are The Risks Associated With a Hysterectomy?

As with any surgery, there are risks and complications that can occur. Some complications that can arise are:

• Side effects from the use of general anesthesia;
• Significant bleeding, i.e. hemorrhage, requiring a blood transfusion;
• Damage to other internal organs like the ureter, bowels, or bladder;
• Urinary leaking or abnormal communication between bowel and bladder or vagina, i.e. fistula;
• Post-surgery infection;
• Blot clots;
• Bone loss;
• Cardiovascular risks;
• Ovarian failure of the retained ovaries resulting in immediate menopause;
• Early menopause;
• Wound issues;
• Sexual dysfunction.

FAQs About Hysterectomy

1. What happens to your body after you have a hysterectomy?

If both ovaries are removed during the hysterectomy surgery, a woman’s body will enter into menopause. The loss of the ovaries results in the body’s inability to produce estrogen and all the classic symptoms of menopause will present themselves, these may include:

• Sweating at night,
• Hot flashes,
• Vaginal dryness,
• Pain during intercourse,
• Incontinence or difficulty urinating,
• Mood swings,
• Weight gain.

2. How does a woman feel after a hysterectomy?

Many women experience a sense of loss or grief after having a hysterectomy. If a woman desired to get pregnant, the hysterectomy would make that impossible and this can cause depression, sadness, or grief. Also, many women feel that their womb is what defines them as a “woman” so their sense of self-worth can be affected.

3. Will I have open space inside my abdomen after a hysterectomy?

Normally, a woman’s uterus does not occupy a great amount of room within the abdomen and after it is removed, the small and large intestines shift a bit and take up most of the newly freed space.

4. What is holding up my ovaries after a hysterectomy?

The ovaries are attached by a suspensory ligament which is connected to the pelvic wall as well as to another ligament at the top of the uterus. When the uterus is removed, the ligaments that attach the ovaries to the uterus are severed but the suspensory ligament remains intact. The surgeon may use additional measures to further secure the ovaries.

5. Will my sex life be affected after a hysterectomy?

Some women report that their sex life improved after a hysterectomy due to being relieved of heavy periods and pain, but many women report the exact opposite. These women may experience vaginal dryness as well as a loss in their desire for sex or inability to orgasm. Some types of hysterectomies change the depth or width of the vagina and can result in painful or difficult penetration during sex.

6. Can a woman have an orgasm after a hysterectomy?

Some women notice a decrease in orgasms or a decrease in the intensity of their orgasms, and in some rare cases, they are unable to reach orgasm at all following a hysterectomy. Sometimes removing the uterus will sever nerves that are instrumental for some women to climax. Also, the cervix contains nerves that can be stimulated during sex so hysterectomies that include removal of the cervix can cause changes in a woman’s ability to reach orgasm. There are cases where women experience a decrease in orgasms after a hysterectomy and the cause is unknown, but it may be tied to specific areas that require sexual stimulation, unique to her, that were affected during the surgery.

7. Can a hysterectomy cause long-term complications?

For years, the uterus was thought to exist for the sole purpose of procreation and once a woman passed that point in her life, she no longer had a use for it. Medical experts are now learning that the uterus serves other purposes beyond just nurturing a baby.

Studies done during the last few decades have connected hysterectomies with possible long-term side effects such as the increased risk of abnormal blood fat levels, osteoporosis, high blood pressure, obesity, heart disease, congestive heart failure, coronary artery disease, or plaque buildup in the arteries. Also noteworthy is that women who have had hysterectomies before age 50 seem to be more at an increased risk for future cardiovascular problems which increase the earlier the hysterectomy is done before 50.

8. Should I try to avoid having a hysterectomy?

Many experts feel that when the woman is not dealing with cancer, the least invasive method of finding the relief of symptoms is the best approach. This is particularly true with fibroids as Uterine Fibroid Embolization (UFE) has a very high success rate. With UFE, women typically get the relief of their symptoms, they avoid the significant risks and long recovery of a surgical operation, and they get to keep their uterus.

UFE Vs. Hysterectomy

If you have been suffering from uterine fibroids or adenomyosis, and your OB/GYN is recommending hysterectomy, consult an experienced Interventional Radiologist like Dr. John Lipman of Atlanta Fibroid Center® for a second opinion.

Uterine Fibroid Embolization (UFE) may be right for you. When performed by a board-certified Interventional Radiologist that specializes in UFE, this non-surgical procedure is 90% effective in treating all fibroids regardless of number and size. It allows a woman to keep her uterus while regaining her quality of life, and many patients have given birth vaginally to healthy and full-term babies after UFE.

UFE/UAE is typically performed as an outpatient procedure with 5-7 days of recovery time. To learn more about UFE/UAE and to find out if you are a candidate for this procedure, please contact Atlanta Fibroid Center® at (770) 953-2600.

Dr. John Lipman is one of the nation’s leading fibroid experts with over 9,000 UFE procedures performed. He has over 25 years of experience in helping women safely eliminate the painful and debilitating symptoms of uterine fibroids.