5 Things to Know About Hysterectomy

Hysterectomy is one of the most common gynecological procedures performed today. The surgery to remove the uterus can treat many common gynecologic complaints and it’s a popular procedure for women of all ages.

However, there are many misconceptions that may cause some confusion or anxiety about the procedure. University Hospitals OB/GYN physician Michael Baldonieri, MD, says it’s important to have the facts when considering a hysterectomy so you can make the best decision for yourself.

Here are five things you should know about hysterectomies.

1. Hysterectomies can treat a wide range of conditions, from abnormal bleeding and pelvic pain to cancer.

The most common reason for a hysterectomy is abnormal bleeding. This can include issues like heavy menstrual bleeding, irregular cycles and bleeding in between periods. Other reasons for hysterectomy include:

• Chronic pelvic pain, including severe menstrual pain and pain caused by conditions like endometriosis.
• Abnormal pap smears: If a woman has a history of abnormal pap tests, she may opt to minimize her future risk by having a hysterectomy.
• Structural problems of the uterus: This can include things like fibroids and uterine prolapse.
• Precancerous changes and cancer: This includes women with precancerous conditions such as endometrial hyperplasia, as well as endometrial, uterine and cervical cancers.

2. Hysterectomy type and method are chosen based on an individual patient’s needs and preferences.

Hysterectomy procedures vary widely, both in what organs are removed and the methods by which they are removed. Types of hysterectomy surgery include:

• Total hysterectomy: The uterus and the cervix are removed; this is the most common type of hysterectomy surgery.
• Partial/supracervical hysterectomy: The uterus is removed but the cervix is left in place.
• Radical hysterectomy: The tissue surrounding the cervix and the upper portion of the vagina are also removed.
• Hysterectomy with salpingectomy: The uterus, cervix and fallopian tubes are removed.
• Hysterectomy with salpingo-oophorectomy: Uterus, cervix, fallopian tubes and ovaries are removed.

Hysterectomy methods include open hysterectomy (one large incision on the belly), laparoscopic hysterectomy (4–5 small incisions), robotic-assisted laparoscopic hysterectomy and vaginal hysterectomy, in which the uterus is removed through the vagina without the need for incisions.

Several factors go into determining which surgery type and method is best for each candidate. These include:

• Childbirth history, including whether deliveries have been vaginal or C-section.
• Patient’s age and whether they have entered menopause.
• Reason for the surgery and severity of the symptoms.
• History of previous belly surgeries.
• Patient’s anatomy.
• Size of the uterus.
• Patient and provider preference.

3. A hysterectomy does not mean automatic menopause.

One of the main concerns for younger patients is whether they will enter premature menopause after a hysterectomy. The determining factor of menopause is activity of the ovaries, so as long as the patient keeps at least one ovary, she will most likely have enough hormones to not go into surgically-induced menopause after her hysterectomy.

Dr. Baldonieri says that it’s relatively rare to remove the ovaries during a hysterectomy if the woman is pre-menopausal, usually only in cases of severe endometriosis or if cancer is present.

4. In most cases, side effects from a hysterectomy are minimal.

Dr. Baldonieri says after an initial recovery period of 4-6 weeks, depending on the procedure, side effects from a hysterectomy are usually mild if the ovaries have been left in place.

There may be some symptoms such as hot flashes in the first few weeks after surgery, but those generally go away as your hormones regulate. Other side effects that women are often concerned about – such as sex drive and weight gain – are typically not seen in most women who retain at least one ovary. And because you no longer have periods after a hysterectomy, problems with menstrual pain and bleeding go away.

“Overall, the relief from symptoms that most women experience far outweighs any temporary side effects,” says Dr. Baldonieri.

5. For women not ready for a hysterectomy, there are less-invasive options.

For previous generations, hysterectomy was often the only option for women seeking relief from abnormal bleeding, pelvic pain and other symptoms. But today, there are many other treatments that can either replace hysterectomy or act as a bridge to improve a patient’s quality of life until she and her provider decide it’s time for a hysterectomy, says Dr. Baldonieri.

Treatments include oral medications, birth control pills and hormonal intrauterine devices (IUDs), and minor surgical procedures such as uterine ablation. This procedure is done under sedation and is used to treat heavy menstrual bleeding. During ablation, a thin tube is inserted through the cervix into the uterus, where energy is used to destroy the lining of the uterus and convert it to scar tissue. This minimizes bleeding with periods, and in some cases stops it completely.

“While hysterectomy is an option for women who no longer want to get pregnant, there are usually less invasive options we can try first, and they can be very effective at managing symptoms,” says Dr. Baldonieri.

When To Seek Help

Dr. Baldonieri says if you are experiencing symptoms such as heavy or unusual bleeding or severe pelvic pain that are interfering with your life, make an appointment with your provider to discuss your options.

“Once we pinpoint the cause we can work together to understand your goals of treatment and find a solution that works best for your unique needs,” he says.

Related Links

The women’s health experts at University Hospitals are experienced in treating the full range of gynecologic conditions, including both medical management as well as minimally invasive surgical treatment options such as hysterectomy and uterine ablation.