What you need to know about hysterectomy

An estimated 600,000 hysterectomies are performed each year in the United States. Despite this high number of surgeries, there are common myths and misconceptions that can make it difficult for patients to understand what they need to know.

Choosing whether or not to have a hysterectomy is an especially personal decision that can significantly impact your life. If you’re considering having a hysterectomy, it’s important that you talk with your doctor about pros and cons, exactly what the procedure involves, and what to expect after surgery.

What is a hysterectomy?

A hysterectomy is a surgery to remove the uterus and cervix. During the surgery, the entire uterus — including the cervix — is removed. Afterward, the patient will no longer have a menstrual period and cannot become pregnant.

Why should I have or consider having a hysterectomy?

A hysterectomy is a definitive treatment for many noncancer ailments that affect the uterus. This means that in most cases when a hysterectomy is performed, there is no future (or further) therapy needed for the uterus. It is often the best option for a patient who has tried or considered all other options.

The most common noncancer reason for hysterectomy in the United States is uterine fibroids. However, it’s also a treatment option for:

• Heavy or unusual vaginal bleeding
• Endometriosis
• Uterine prolapse
• Adenomyosis, which is when the inner lining of the uterus breaks through the uterine wall and causes cramps, lower stomach pressure and bloating
• Cancer (or precancer) of the uterus, ovary, cervix or endometrium (the uterus lining)

What is a partial hysterectomy?

A partial hysterectomy is also called a supracervical hysterectomy. This is when only the body (corpus) of the uterus is removed and the cervix is left in place. If you keep your cervix, you will still need to have Pap smears.

How is a hysterectomy performed?

Depending on the reason for the surgery and the size of the uterus, a hysterectomy can be performed with minimally invasive techniques, which means either using small abdominal incisions (laparoscopic or robotic surgery) or no abdominal incision (vaginal surgery).

When necessary, hysterectomy is performed with open surgery, which requires a large abdominal incision. If you’ve been told that open surgery is the only option for you, it may be worth getting a second opinion. Sometimes, even in the most challenging cases — such as patients who have a large uterus, severe endometriosis or a history of multiple abdominal surgeries — an expert gynecologic surgeon at the highest level of training and experience can still perform a minimally invasive hysterectomy.

How long does it take to recover from a hysterectomy?

After a minimally invasive hysterectomy, patients can go home the same day and return to work within two weeks if their job involves a low level of physical exertion. Work that involves a high level of physical exertion would require more recovery time. With open surgery, patients stay in the hospital for about two nights and recover in about four to six weeks.

In both cases, it takes about six to eight weeks for the vagina to heal, so it’s important to abstain from sex, use of tampons or douches, and heavy lifting until cleared by a doctor.

Do my ovaries have to be removed during a hysterectomy?

The procedure to remove the ovaries is called an oophorectomy. Generally, when a hysterectomy is performed for noncancer reasons in a patient who hasn’t reached menopause or is younger than 55 years old, the ovaries should be left if they appear normal. However, every case is different.

Should my fallopian tubes be removed during a hysterectomy?

Studies show that some ovarian cancers start within the fallopian tubes. Based on this, your surgeon may recommend removal of the fallopian tubes to decrease your risk for ovarian cancer.

Will I go into menopause after a hysterectomy?

If your ovaries are not removed, you won’t go into menopause. However, if you have a hysterectomy during perimenopause (the years leading to menopause), this is when your reproductive hormones begin to decline, and it may accelerate the onset of menopause by a few months to a year.

Will my voice get deeper? Will I get facial hair or mood swings?

Your voice, hair growth and mood aren’t affected by your uterus or cervix. If you’re perimenopausal or experiencing mood swings prior to your hysterectomy, you shouldn’t expect much difference after the surgery.

Will sex feel different for me or my partner after a hysterectomy?

Surgeons make every effort to maintain the vaginal length to enjoy pleasurable intercourse. While you won’t have contractions in your uterus during orgasms anymore, you will still have orgasms. In fact, many feel that sex after a hysterectomy is better since the surgery often solves the problems that led to sex being uncomfortable in the first place, such as heavy and persistent bleeding.