Description of the procedure

A hysterectomy is surgery that is performed to remove a woman's uterus. There are several different types of hysterectomy, including:

• subtotal hysterectomy, where the uterus is removed but the cervix is not
• total hysterectomy, where both the uterus and the cervix are removed
• radical hysterectomy, where the uterus, cervix, and nearby lymph nodes are removed

Doctors usually perform this procedure under general anesthesia in a hospital setting.

When should this procedure be performed?

Doctors perform this procedure only when it is medically necessary. After this procedure, a woman cannot become pregnant.

Why is this procedure performed?

A hysterectomy may be performed to treat a variety of gynecological conditions, including:

• cancer of the cervix
• cancer of the uterus
• endometriosis (a condition where parts of the uterus lining end up in other areas of the body, usually in the ovaries, fallopian tubes or pelvic area, causing pain)
• heavy bleeding (which may occur after childbirth) that other treatments do not control
• pain in the pelvis that does not go away with treatment
• uterine fibroids (non-cancerous tumours in the uterus)
• weakening of the uterus ligaments which hold the uterus in place (uterine prolapse)

Are there any risks and precautions

Certain risks are common to all surgery and every time an anesthetic is used. These include side effects of the anesthetic, breathing problems, infection, and bleeding.

There are also some risks specific to this procedure. Although it is rare, damage the bowel, bladder, or urinary tract is possible. The surgery may also damage the ovaries, which could lead to decreased levels of certain hormones. There is a rare risk that the ovaries could completely lose their ability to function, leading to early menopause.

What happens during the procedure?

The procedure takes approximately one hour. During this time, you will be asleep under a general anesthetic. In some cases doctors may use an epidural (an anesthetic in the spine) to numb the surgical area instead of putting you to sleep with general anesthetic.

If the uterus is to be removed abdominally, doctors begin the procedure by making an incision in the lower abdomen. Vaginal removal requires no incision in the abdomen because the doctor uses instruments (e.g., a laparoscope) to reach the uterus and remove it through the vagina. In this case, a cut is made in the vagina to allow the removal of the uterus.

How should I prepare for this procedure?

Before the procedure, doctors request a number of tests that provide a clearer picture of your uterus and ovaries. A pelvic exam, Pap test, and pelvic ultrasound are usually requested.

Do not eat for 8 hours before the procedure. You may continue to drink clear liquids until 2 hours before the procedure. If your doctor has recommended different times, follow the timing recommended by your doctor.

Tell your doctor or prescriber about all prescription, over-the-counter (non-prescription), and herbal medications that you are taking. Also tell them about any medication allergies and medical conditions that you may have.

Ask your doctor or pharmacist whether you need to stop taking any of your medications before the procedure.

What can I expect after the procedure?

If your surgery was done with a general anesthetic, you will be awakened in the recovery room. At this time, you will likely feel groggy, sore and possibly nauseated. An overnight stay in the hospital is common for most women.

Arrange for someone to drive you home from the hospital.

Using pain medication to control discomfort after the procedure is normal. Your doctor will likely recommend this medication for you. Resting afterwards will help speed the healing process, although you may need to take time off of work or cancel your regular activities until you recover. It usually takes four to six weeks to heal after a hysterectomy.

Sanitary pads should be used for any bleeding and discharge that you experience. This may continue for several days after surgery. Speak to your doctor immediately if you experience fever, severe bleeding, or cramps.

Sexual intercourse is not recommended for approximately six weeks to avoid infection and to help the area heal. Also avoid heavy lifting or any other strenuous activity.

Results

Results will depend on the reason for the hysterectomy. Hysterectomy can be life-saving when performed to control heavy bleeding from the uterus. It can be an effective treatment for gynecological cancers. It can also relieve the symptoms of fibroids, endometriosis, and other chronic pelvic pain problems.