Why Do I Need a Hysterectomy?

It may be surprising that a hysterectomy is the second-most common surgical procedure among women in the United States. Cesarean birth deliveries rank as the most common. Every year, doctors perform an average of 500,000 hysterectomies due to various medical conditions that may cause women to experience severe symptoms.

According to the Centers for Disease Control and Prevention, one in three women will have a hysterectomy by the time they are 60 years old.

What is a hysterectomy?

A hysterectomy is a surgical procedure performed to remove a woman’s uterus. Women can no longer get pregnant once the uterus is removed, as this is where a baby develops. There are three different types of hysterectomies.

• Total hysterectomy: The most common type of hysterectomy; the uterus is removed in its entirety, including the cervix. The ovaries and fallopian tubes may remain or may be removed also.
• Supracervical hysterectomy: Only the upper part of the uterus is removed while the cervix is left in place. The ovaries may remain or be removed.
• Radical hysterectomy: Usually done to treat certain types of cancers. The entire uterus, cervix, tissue on both sides of the cervix and the upper part of the vagina is removed. The ovaries as well as the fallopian tubes may remain or be removed.

Hysterectomies are performed four different ways:

• Abdominal hysterectomy is performed through an incision on the abdomen that varies in size and location depending on the reason for the surgery and the size of the uterus.
• Vaginal hysterectomy is performed solely through the vagina and no incisions are made on the abdomen. Some patients are not good candidates for vaginal hysterectomy due to the size of the uterus or prior surgeries. The physician will make a determination of whether vaginal hysterectomy is a good option.
• Laparoscopic hysterectomy is a minimally invasive approach that requires several small incisions on the abdomen through which instruments can be inserted into the abdominal cavity to perform the surgery.
• Robotic surgery is an approach where the surgeon manipulates the instruments via a robotic arm inserted into the abdominal cavity versus directly moving the instruments with a traditional laparoscopic approach. This is also a minimally invasive approach requiring several small incisions on the abdomen.

The physician determines if a laparoscopic or robotic approach is used based on the reason for the hysterectomy, the patient’s history of prior surgery and physician preference.

Why may a hysterectomy be necessary?

A hysterectomy may be necessary to treat various medical conditions or problems women experience. Doctors typically try prescription medication and other treatments before moving forward with a hysterectomy. Resorting to a hysterectomy is usually out of medical necessity especially since childbirth is no longer an option after the procedure. A hysterectomy can be used to treat the following medical conditions providing relief and a better quality of life:

• Uterine fibroids are noncancerous growths found in the uterine wall that can be painful and cause long-term heavy bleeding.
• Heavy or unusual vaginal bleeding caused by infection, cancer, fibroids or changes in hormone levels.
• Uterine prolapse occurs when the uterus moves or slips from its proper place into the vagina. Uterine prolapse is the result of several births, obesity or menopause.
• Endometriosis is a condition that causes women to experience severe bleeding and pain. With endometriosis the tissue lining the uterus grows outside of the uterus in places like the ovaries, other pelvic structures or elsewhere.
• Adenomyosis is a condition where the tissue lining the cavity of the uterus grows inside the walls of the uterus. Because the tissue does not belong there, the uterine walls thicken causing heaving bleeding and pain.
• Cancer or precancer of the uterus, ovary, cervix or endometrium may require a hysterectomy

What happens after a hysterectomy?

Full recovery from a hysterectomy may take a few weeks since it is considered a major surgery. The recovery process is a little different from other procedures women undergo. Many women experience physical and emotional changes throughout recovery.

• Mesopause occurs if ovaries are removed during the hysterectomy.
• Change in sexual feelings is common especially if ovaries are removed.
• Increased risk for other health problems due to the removal of ovaries. The health concerns include bone loss, heart disease and urinary incontinence.
• Depression and a sense of loss happens. Women may grieve over the loss of fertility and the change in their body.

The key to a successful recovery is to follow your surgeon’s instructions and get plenty of rest. It is important to move around after a hysterectomy so take short walks while gradually increasing your distance every day.