A Hysterectomy is the surgical removal of the uterus. Other associated organs such as the fallopian tubes, ovaries and cervix may be removed at the same time, depending on the type of hysterectomy being performed. This results in a woman being no longer able to menstruate or conceive and bare children following the procedure.

Hysterectomy is one of the most common forms of elective surgery for women in Australia. Most are performed to treat conditions such as fibroids (growths which form in the uterus), heavy bleeding, pelvic inflammatory disease, adenomyosis, endometrioses, uterine prolapse or gynaecological cancers. Treatment of these conditions vary, and some more conservative treatments may be offered which may eliminate the need for a hysterectomy.

There are four different types of hysterectomy:

• Sub-total or Partial hysterectomy
• Hysterectomy with ovarian conservation
• Hysterectomy with oophorectomy
• Radical or Wertheim’s hysterectomy

Sub-total/Partial Hysterectomy:

This involves the removal of a woman’s fallopian tubes as well as the upper two-thirds of the uterus, while preserving the cervix.

Hysterectomy with ovarian conservation:

This involves the removal of a woman’s fallopian tubes, uterus and cervix while preserving the ovaries. This is sometimes called a total hysterectomy.

Hysterectomy with oophorectomy:

This involves the removal of the fallopian tubes, uterus and cervix as well as one or both sets of ovaries.

Radical or Wertheim’s Hysterectomy:

This involves the removal of fallopian tubes, uterus, cervix, ovaries, nearby lymph nodes and the upper portion of the vagina. This kind of hysterectomy is used in the treatment of some gynaecological cancers.

What you need to know about Hysterectomy

Hysterectomy is major surgery and is generally not considered as first-line treatment for heavy menstrual bleeding. Hysterectomies are generally prescribed for women when other forms of treatment haven’t been successful. Its important to learn about the risks involved and to be aware of any conservative alternatives you may be able to try before resorting to a hysterectomy.

Making the decision to have a hysterectomy can be a difficult and emotional process, as having the procedure will mean a woman no longer menstruate and therefore no longer conceive children. For some women, the removal of the chance of pregnancy and the cessation of periods will bring relief. For others it’s a sad time as they come to terms with the end of their reproductive abilities.

Benefits and Risks involved when keeping your ovaries

Some gynaecologists will recommend ovary removal during your hysterectomy to prevent the possibility of developing ovarian cancer, others will recommend leaving them intact. The side effects of ovarian removal can be significant, as the ovaries produce sex hormones called androgens including testosterone, which are important for maintaining strong bones and muscles, a good protein balance, sexual desire and libido, and general wellbeing. The ovaries produce 35% of a woman’s testosterone production – and surgical removal of ovaries has been associated with cases of significant deterioration in libido and sexual desire, especially in younger women.

Ovaries also turn testosterone into oestrogen, therefore removing a woman’s ovaries results in a reduction in hormone production, which may bring on instant menopause – referred to as ‘surgical menopause’. The drop in hormone levels can cause menopause-like symptoms – hot flushes, night sweating, vaginal dryness and an increased risk of osteoporosis and heart disease. It’s important to note however that some women who retain their ovaries during a hysterectomy still experience menopause earlier than expected.

Hysterectomy methods – abdominal, laparoscopic or vaginal

Hysterectomies can be performed in three different ways, via the abdomen, vagina, or with a laparoscope. The reason for the procedure, the woman’s physical characteristics, any previous surgeries as well as the surgeons skills and preference will help your medical team determine which method is best for you.

Abdominal Hysterectomy

You will be given a general anaesthetic, which means you will be asleep for for the procedure. Usually a transverse (across) incision is made low down on the abdomen, often referred to as a ‘bikini line’ incision, but a vertical cut may also be used depending on the size of your uterus. The uterus and any other organs will b removed through the incision, and then the wound closed – either with dissolvable sutures or staples which will need to be removed within 7 days. The procedure generally takes about one hour.

Vaginal Hysterectomy

You will be given a general anaesthetic, and an incision is made in the upper internal portion of the vagina and the uterus removed though the vagina. This method can result in less pain and recovery time, a shorter hospital stay and no visible scar. Vaginal hysterectomies are sometimes preferred over abdominal hysterectomies where possible. The procedure generally takes about one hour.

Laparoscopic Hysterectomy

You will be given a general anaesthetic and a small incision is made in your abdomen to allow for a keyhole telescope (laparoscope) to see your pelvic organs. Another 3 or 4 small incisions are made through which other instruments are used and carbon dioxide gas is inserted to inflate your abdomen so that your surgeon can see all of your organs clearly. Your uterus with or without fallopian tubes and ovaries, is then removed through your vagina. Sometimes doctors may fit a small tube into one of the wounds to drain some blood stained fluids, and this will be removed the next day. The procedure generally takes between one and two hours.

Risks & Complications

As with all major surgeries there are risks involved, such as reactions to anaesthetic, blood clots in the legs or lungs, wound infection, or respiratory tract infections. The most common complications following a hysterectomy are fever or infection.

The risks specific to an abdominal hysterectomy include excessive bleeding, damage to the bladder or ureters - the tubes which run from the bladder to the kidneys - or injury to the bowel or associated blood vessels. Abdominal hysterectomies may carry a lesser chance of damage to the urinary tract and blood vessels, but the disadvantage is that this method is generally more painful, with a longer recovery time.

For women who have undergone a vaginal hysterectomy, there may be an increased risk of vaginal vault prolapse. This occurs when the top of the vagina drops down as a result of the support structures being removed or reduced. Some specialists believe that by retaining the cervix if possible, the vaginal support it provides may prevent prolapse, however more research is needed to confirm.

Side Effects

There are some side effects following a hysterectomy, which may include:

• Painful gas/wind: This will gradually pass, but if it is bothering you, speak with your doctor to discuss treatment and/or medication.
• Brownish-red vaginal discharge: You will notice a discharge for about 4 weeks after surgery. Sanitary pads may be used during this time. The discharge shouldn’t be foul smelling or contain any pus, which may indicate an infection. Speak with your doctor if this occurs or if you are unsure.
• Surgical Menopause: Women who have had their ovaries removed during their hysterectomy will generally experience menopausal symptoms after 3 or 4 days following surgery.
• Body weight: some women put on weight following a hysterectomy, due to the post-operative physical restrictions. Women who eat a balanced healthy diet and watch their calorie intake while they are resting and being inactive should not put on any weight.
• Sexual effects: Depending on the type of hysterectomy, women may notice a difference in how they respond to sex after the procedure. Some women indicate that the sensation of orgasms changes, due to the lack of uterine contractions which are present during orgasm. Some women find sex to more pleasurable and enjoyable following a hysterectomy. Experts agree this is due many factors, such as the removal of worry about falling pregnant, or knowing the discomfort from heavy menstruation is no longer an issue.
• Emotional + psychological effects: It is not uncommon for women to experience a sense of sadness or loss following a hysterectomy. Pre-menopausal women or women of child-bearing age who are required to undergo a hysterectomy may feel sadness that a milestone has arrived too early, and they cannot have children anymore. These emotional burdens can progress to clinical depression if not reported to a doctor and handled accordingly. Always seek help if you are struggling with any emotional symptoms, as doctors may not only be able to provide treatment, but direct you to support groups, which can be of great help to many women.

Recovery

How long you will spend in hospital will depend on what type of hysterectomy is performed, and whether there were any post-operative complications. Generally for an uncomplicated abdominal hysterectomy the hospital recovery time is around 5 - 7 days, and 3 – 4 days for uncomplicated vaginal or laparoscopic hysterectomies.

It is important that you do not put anything into your vagina for at least the first six weeks – including douches, tampons, or having sex.

As with all major surgeries, some women may feel nauseas as a side effect of the anesthetic. Following the procedure some pain and discomfort may be experienced, and your healthcare providers will discuss pain and nausea medication and treatments with you. Vaginal bleeding is also common but should reduce over the first few days. Women who have undergone a hysterectomy are encourage to get up and gently move and walk around if they can on the first day after surgery – to avoid constipation and gas and the decrease the risk of blood clots and respiratory infections.

You will need to be well prepared for your at-home recovery, and women require complete rest for at least the first few days after they leave hospital. After this rest period you will be able to start moving around and do very light duties – but it’s important that you avoid standing for long periods of time and ensure you sit and lie down as often as possible.

After around 3 – 4 weeks you may start to increase physical activity, but it is still advised to avoid heavy lifting and prolonged standing. This allows the tissues to heal correctly, which may avoid future damage. As a general guide, women should not lift more than around 4kgs - which is the approximate weight of a full kettle of water - during this time. For a period of 6 – 8 weeks your body is recovering, and you should not carry any heavy items – such as grocery bags – or undertake any physically demanding household tasks during this recovery.

This article provides general information only, and should never replace professional advice. Always seek guidance from your GP, gynaecologist or relevant healthcare provider.