Hysterectomy Overview - Patient Education
A hysterectomy, which is the second most common operation for women after cesarean section delivery, involves removal of the uterus or womb. This is distinct from whether or not the ovaries are removed. Approximately 600,000 hysterectomies are performed annually in the United States. Read more in this patient education guide.
Indications for a hysterectomy include:
- Symptomatic uterine fibroids/growths (bleeding, pain, pressure)
- Cancer of cervix, uterus, and ovaries
- Endometriosis (uncontrolled by medication)
- Abnormal vaginal bleeding
- Adenomyosis (uterine thickening)
- Uterine prolapse
There are three types of hysterectomies:
Partial hysterectomy: the upper portion of the uterus is removed but the cervix is left inside (also known as subtotal or supracervical)
Total hysterectomy: the entire uterus with cervix is removed (most common type)
Radical hysterectomy: the entire uterus with cervix is removed, along with the upper part of the vagina and adjacent tissue (usually done for treatment of uterine cancer)
*Removal of the ovaries and tubes along with the uterus is called “hysterectomy with bilateral salpingo- oophorectomy” (TAHBSO) and is often performed together.
Procedure Types
There are three approaches to a hysterectomy which are dependent upon the size of the uterus, history of prior surgery, uterine mobility, the skill of the surgeon, as well as the pathological indication of the surgery. The approaches are:
Abdominal: an incision is made through the abdomen (either up and down from the navel to the pubic bone) or horizontally, just above the pubic bone; requires the longest hospitalization (3-7 days) and longest recovery (6-8 weeks)
Benefits include:
- Provides the largest opening for enlarged uterus/tumors
- Best exposure for cancer surgery and viewing adjacent organs
Risks include:
- Increased future possibility for incisional hernia
- Bleeding
- Infection
Vaginal: cervix and uterus are removed through the vagina; usually reserved for uterine prolapse (where the uterus is coming down the birth canal and is visible or felt through the labia); not recommended if there is an enlarged uterus (with fibroids), scar tissue from prior surgery or endometriosis, or lack of uterine descent or mobility
Benefits include:
- Less invasive
- Less costly
- Recovery time is shortened.
Risks include:
- Possible damage to bladder, bowel and ureters
- Infection
Laparoscopic: air inflates the abdomen for improved visibility and a lit telescope like instrument (laparoscope) attached to a video camera is inserted through the belly button so that the procedure can be viewed on a monitor; the uterus is removed with additional instruments which are inserted through two or three additional small incisions; cervix is often left in place for future support; contradictions include endometriosis, fibroid tumors, and cancer
Benefits include:
- The ability to maintaining a higher level of sexual arousal
- Decreased risk of future pelvic floor prolapse
- Faster recovery
- Smaller scar than total abdominal hysterectomy
Risks include:
- Increased exposure to anesthesia
- Possibility of increased blood loss
- Infection
- Possible damage to adjacent organs
A hybrid approach to hysterectomy is the Laparoscopic Assisted Abdominal Hysterectomy (LAVH). Here, a laparoscopic procedure is performed, the organs are well visualized and appropriate incisions are made, but the uterus is removed vaginally instead of abdominally. The benefits of this procedure are a lower risk of damage to surrounding structures than with a vaginal hysterectomy and good visualization, which is not obtained through a vaginal hysterectomy alone.
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Doctors Who Treat The Need For Hysterectomy
The two main types of doctors that perform a hysterectomy are:
- Gynecologists - specialize in the female reproductive tract (both medically and surgically)
- General Surgeons - perform surgery for the treatment of problems in body parts/organs
Depending on the indication for the hysterectomy, additional specialists are added to the team. Those listed in our patient education guide include:
- Urologist — A doctor who specializes in the medical and surgical treatment of the urinary tract.
- Gynecological Oncologist — A doctor who treats gynecological cancers, and has more extensive surgical training for radical procedures.
- Psychologist — A healthcare specialist who provides therapy and counseling in order to devise techniques for controlling stress or mood problems.
- Psychiatrist — A medical doctor who focuses on health and disorders of the mind and mood. This doctor may prescribe medications in addition to psychotherapy.
- Nurse Practitioner — A nurse who focuses on prevention, wellness and education of patients about health and health choices.
- Nutritionist — A professional who formulates diet plans for both the healthy and compromised individual, as well as advising which vitamins and supplements would promote good health.
How to Prepare for Your Hysterectomy Doctor Visit
Before surgery for any type of hysterectomy is scheduled, a complete physical examination is performed as well as a thorough review of the following areas listed in this patient education guide:
- History of previous surgery
- History of previous medical problems
- History of allergies
If there are significant medical problems, you will be asked to see a family doctor for medical clearance – an authorization by the physician that you are physically able to tolerate the surgery and anesthesia.
The indication for surgery and type of surgery will be discussed thoroughly, along with benefits, risks, and any concerns expressed by the patient.
Depending on your insurance coverage, you may need to obtain a second opinion or a pre-surgical approval by the insurance company.
Pre-surgery preparation includes the following steps:
- Smoking cessation for 6-8 weeks prior to surgery, as wound healing is hindered by smoking
- Discontinuation of aspirin or other blood clotting medications for 10-14 days prior to surgery if possible to decrease excess bleeding risks
- No eating or drinking from midnight on prior to the day of surgery
- In some cases, only clear liquids for 1-3 days prior to surgery and laxatives to clean out the colon
Questions to Ask Your Doctor About Hysterectomy
From your initial diagnosis throughout your treatment and care, you will have questions about your hysterectomy. This patient education guide lists helpful questions for you and your doctor to discuss so you can make informed decisions about your condition.
Question About My Diagnosis
- Is there a risk that I have cancer?
- What is the difference between a myomectomy and hysterectomy?
- If I am already in menopause, does the ovary still perform a function?
- Why do you feel that I need a hysterectomy?
- Is there a website or forum that discusses the diagnosis in more detail?
- How common is my problem?
- Can there be any other conditions that mimic my diagnosis?
- Are there other medical conditions associated with my problem?
Questions About My Treatment
- What type of hysterectomy do you advise for me? Why?
- What surgical approach are you planning? Why?
- Will you be taking out my ovaries?
- Is there something that I can take to prevent instant menopause?
- Are there treatments that I can have instead?
- Are there procedures that we can try first?
- Is there medication to shrink down fibroids?
- What type of anesthesia would I have?
Questions About My Lifestyle & Family
- Will having this surgery diminish my sex drive?
- When can I resume intercourse?
- Will I need a private duty nurse when I go home?
- When can I start exercising?
- Are there exercises that could improve my condition?
- When can I return to work?
- When can I drive again?
Common Tests or Labs to Diagnose Need for Hysterectomy
There are several tests and labs used to make a hysterectomy diagnosis and monitor your ongoing condition.This patient education guide lists the most common tests and labs ordered, why you need them, and what they can tell you about your condition.
| Test |
Why Test? |
What Happens? |
Normal Result |
|
CBC (complete blood count)
|
Tests for Anemia
|
After a tourniquet is applied to the upper arm, the skin is swabbed with alcohol and a needle punctures the skin. Blood is then drawn into a syringe for analysis
|
- White Blood Cells = 4.5-11
- Red Blood Cells (female) = 4.1-5.1
- Hemoglobin (female) = 12-16
- Hematocrit (female) = 36-46%
|
|
Clotting Studies
|
To ensure that no excess bleeding will occur
|
The needle is removed and a pressure bandage is applied to the puncture site.
|
- Prothrombin Time: 10-12 seconds
- Partial Thromboplastin Time (PTT): 30-45 seconds
- International Normalized Ratio (INR):1-2
|
|
Ultrasound
|
Visualizes structural abnormalities in uterus, cervix, ovaries, and surrounding structures
|
After lying down on the table, the technician/doctor places clear water-based gel on your stomach and pelvic area. A hand-held probe is then moved back and forth over the area, transmitting sound waves. The echoes of these waves create an image on a computer monitor.
When a transvaginal ultrasound is performed, you lie on the exam table with knees bent and feet in stirrups. A covered probe is lubricated and placed in the vagina. The probe emits sound waves and the echoes create an image on a computer monitor.
|
No masses, strictures, obstructions, or compromise to blood flow of pelvic organs
|
|
Colonoscopy
|
Looks for growths, tumors, ulcers, and strictures of the large intestine
|
After lying on an exam table, sedation is given by IV in your arm.
The doctor then passes a long, flexible scope with light attached to a video monitor up through your rectum to view the entire large intestine. When done, the instrument is removed and you are awakened.
|
No growths, ulcers, tumors, or strictures seen
|
|
Intravenous Pyelogram (IVP)
|
Images the urinary tract system
|
After lying on an exam table, a dye is injected into an arm vein. A series of x-ray images are then taken over specific intervals of time.
|
No masses, strictures, or obstructions of the urinary bladder, ureters, or urethra. Bladder empties at the appropriate time.
|
|
Papanicolaou test (Pap smear)
|
Screens for changes in cervical and vaginal cells (cancer and types of infection)
|
You will lie down on the exam table with bent knees and heels in stirrups. A speculum (clamp) is inserted into the vaginal vault and opened to reveal cervical visibility. This may cause some pressure. A soft brush or spatula is used to scrape some cells from the cervix at the exterior and just inside the opening of the cervix. This specimen is then sent to the laboratory for analysis.
|
No cancer cells, abnormal bacteria, fungus, or other organisms atypical of environment.
|
Common Medications and Treatments for Hysterectomy
A determination will be made regarding they type of hysterectomy surgery needed and as to whether or not the ovaries need to be removed and whether the cervix needs to be removed depending on the test results (possibility of cancer). Read more about treatments in this patient education guide.
If a hysterectomy is done for the indication of cancer, a further tumor workup is justified with possible chemotherapy and radiation therapy (pending pathology results).
| Treatment |
How It's Done |
Benefit |
|
Chemotherapy
|
Drugs can be given orally or through an intravenous (IV) line which is inserted into an arm vein with an IV bottle attachment having a sugar and water solution.
The protocol for duration and frequency of treatment is dependent upon the particular drug combination, extent of cancer and facility that is administering the drugs.
|
Drugs destroy tumors and cancer cells
(Often combined with radiation therapy)
|
|
Radiation Therapy
|
After lying down on an exam table, a machine suspended over your body sends out high-energy radiation beams to the localized area where the cancer is located.
|
Adjuvant therapy- postoperative treatment to prevent cancer recurrence
Treatment of returning cancer
|
|
Epidural
|
You are placed on the exam table/bed in a fetal position with knees to the chest and the back curled out. The back is prepped with antiseptics and then local anesthetic is used to numb the skin over the site for the epidural.
A needle is carefully inserted into the space above the spinal cord and a thin catheter is threaded through this needle into the epidural space.
The needle is then removed and a small pressure bandage is applied to cover the injection site. Pain medication is given through the catheter (and can be attached to a pump with a button to press for more pain relief as needed.
|
Helps provide comfort.
Recover faster and decrease complications by getting you mobile in less time.
Steroid injection through an epidural line relieves pain and helps a patient recuperate with exercise and rehab.
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