Hysterectomy is, in fact, the medical name for the operation to remove the uterus (womb) in women. This operation may be done for the following reasons:
- Fibroids of the uterus that cause problems such as pain and bleeding.
- Prolapse (dropping) of the uterus, which makes the uterus move out of its normal position.
- Cancer of the uterus, cervix or ovaries.
- Endometriosis, a disease in which cells similar to the cells of the uterus grow in nearby tissues such as the ovaries.
- Abnormal vaginal bleeding.
- Chronic pelvic pain and inflammation.
- Thickening of the wall of the uterus. In general, except in cases of cancer, hysterectomy is recommended only when other, non-invasive treatments have not worked. After a hysterectomy, a woman can no longer become pregnant. Types of hysterectomy: depending on the condition the patient has, either the whole uterus or only part of it may be removed.
- Supracervical or subtotal hysterectomy: only the upper part of the uterus is removed and the cervix is kept.
- Total hysterectomy: the whole uterus and the cervix are removed.
3. Radical hysterectomy: the whole uterus, the tissues around the uterus, the cervix and the upper part of the vagina are removed. This type of hysterectomy is performed only when the patient is in the advanced stages
of cancer of the uterus or cervix. Hysterectomy in women of childbearing age: if the ovaries are also removed during hysterectomy in women under forty, early menopause occurs. This means that the production of sex hormones stops and, as a result, problems such as a marked loss of sex drive, vaginal dryness, hot flushes, sweating and other menopausal symptoms develop.
Women who have both ovaries removed during hysterectomy usually receive hormone replacement therapy to prevent the symptoms of early menopause caused by the stop in oestrogen production.
Different methods of hysterectomy: depending on the surgeon's experience, the reason for the operation and the patient's general physical condition, the doctor may use different methods to remove the uterus. The method used has a great effect on the healing process and on completing the recovery period. In general, there are two ways to perform a hysterectomy:
- Traditional or open surgery
- Surgery using less invasive techniques such as laparoscopy. Hysterectomy by open surgery: open hysterectomy is done through a cut in the abdomen. This method is very common, and more than half of all cases are done this way.
For an open hysterectomy, the surgeon makes a cut of 12 cm to 17 cm in the lower abdomen and then removes the uterus through
this opening. After abdominal hysterectomy, the patient usually stays in hospital under observation for two to three days.
Hysterectomy using less invasive methods (MIP): where the patient's general condition does not allow open surgery, or open surgery is not needed, doctors recommend less invasive methods, which generally have fewer complications. These methods are: – Vaginal hysterectomy (TVH): the surgeon makes a cut in the vagina and removes the uterus through this opening.
The cut is stitched after surgery and leaves no scar on the patient's body. This operation has fewer complications and is regarded as the best method with the fewest complications.
2. Laparoscopic hysterectomy: this operation is done by laparoscopy, in which surgical instruments are passed into the body through small holes made in the abdomen, using a tube and a camera with a light, and the uterus is removed.
3. Laparoscopically assisted vaginal hysterectomy: in this method, laparoscopic instruments are passed into the patient's body through the abdomen, and the surgeon removes the uterus through a cut made in the vaginal area.
Comparison of invasive and less invasive methods of hysterectomy: in general, less invasive methods have benefits over hysterectomy by open (invasive) surgery, including quicker recovery and healing, less pain, smaller scars and a lower chance of various infections.
With a less invasive method, the patient can return to normal life within three to four weeks after surgery, compared with four to six weeks after invasive treatment. The cost of hysterectomy by laparoscopy and other less invasive methods is much lower than that of open surgery. However, less invasive methods cannot be used in every case.
Scars from previous surgery, obesity, the size of the uterus and the patient's state of health can affect whether the patient is a candidate for less invasive methods. In the end, the choice of the best method, based on the patient's condition, rests with the treating doctor. Complications of hysterectomy: like other operations, hysterectomy may carry risks, including:
- Urinary incontinence
- Vaginal prolapse, in which part of the vagina moves outwards
- An abnormal connection between the vagina and the urinary or bowel passages
- Chronic pain
- Wound infections
- Blood clots
- Haemorrhage and damage to the organs and tissues around the uterus
What to expect after hysterectomy: in the first days after the operation, pain in the pelvis, abdomen and vaginal area is completely normal, and your doctor will prescribe painkillers to relieve it. In addition, loss of fluid and blood from the vagina in the first few weeks after hysterectomy is normal. Constipation is another complication; drinking plenty of fluids is recommended to prevent it.
In addition, the patient may temporarily have difficulty passing urine or controlling it, which improves over time. Emotional and psychological changes and temporary depression, caused by the disturbance in sex-hormone production after the operation, are also normal. Care after hysterectomy: following the advice below helps a great deal with recovery in the four to six weeks after hysterectomy.
1. Rest: try to rest as much as possible and avoid heavy activity. Do not drive during the recovery period.
- 2. Light exercise: in consultation with your doctor, do some light exercises designed for the recovery period after hysterectomy.
- Avoid standing for long periods
- Avoid lifting and carrying heavy objects
- Drink plenty of fluids (to prevent constipation, drink plenty of water and other fluids every day and eat fresh vegetables and fruit that contain fibre).
- Take your prescribed medicines on time.
- Avoid sexual intercourse until the recovery period is over and your doctor allows it.
Prepared by: Homa Yektapour – Education Unit
Source: Williams Obstetrics and Gynaecology
Document code: NO-BR-21