Endometriosis is a medical condition in which uterine-like tissue grows outside of the uterus, forming lesions, which can cause pain, bloating, or other symptoms.1 Hysterectomy is a procedure to remove a woman’s uterus. While a hysterectomy will not cure endometriosis, for those with severe endometriosis, it may be a final choice for managing the condition*.
*Hysterectomy may not cure endometriosis. The American College of Obstetricians and Gynecologists reports that it is possible that after hysterectomy, endometriosis lesions may regrow elsewhere.
Types of hysterectomy
There are several kinds of hysterectomies that use multiple surgical approaches.2,3 Some types include:
Total Hysterectomy, where the uterus and cervix are both removed
Partial (supracervical) hysterectomy, where the upper portion of the uterus is removed, leaving the cervix intact
Radical hysterectomy, where the entire uterus, ovaries, fallopian tubes, surrounding tissue, and nearby lymph nodes are removed
Surgical approaches to hysterectomy
Hysterectomies are typically performed under general anesthesia. Most involve a hospital stay lasting a day to a week, depending on the surgical procedure performed and the patient’s personal medical situation.
Vaginal hysterectomy can be a minimally invasive surgical procedure. A surgeon makes an incision inside the vagina and surgically separates the uterus from the ovaries, fallopian tubes, and other tissues. The uterus is then removed by pulling it through the vagina.1,2 The stitches inside the vagina will dissolve and do not need to be removed.2 A vaginal hysterectomy can be performed for a number of different reasons, but is not the approach most commonly used for women with endometriosis.
In an abdominal hysterectomy, a vertical or horizontal incision is made in the lower abdomen through which the uterus is removed.4 The location of the incision depends on the surgeon’s objective for doing the procedure. According to the Mayo Clinic, most women with endometriosis have a vertical incision, from the top of the pubic bone to just below the belly button.4 This allows the surgeon to see more of the pelvic area. After an abdominal hysterectomy, you may have staples and steri-strips to help healing.
The post-op experience is different for each person, and is largely related to the nature of the procedure performed.4Rest is the key ingredient of the healing process. Some factors that can impact recovery time and experience include the extent of your procedure, side effects of anesthesia, vaginal bleeding, or discomfort from gas.
Having help at home is an important part of the recovery process. Regardless of the procedure performed, you will have some pain, restrictions on activities and exercise, and be limited in your ability to move around and care for yourself or others, at least for a few days.
General anesthesia causes drowsiness, nausea, and other side effects. You may experience moodiness, incision site pain, and abdominal soreness. Abdominal bloating and shoulder pain are common because of the carbon dioxide gas that may be used to inflate your abdomen during the procedure. Diet and exercise (such as walking, if your doctor recommends it!) can be beneficial in breaking up the trapped gas.
Restrictions on showering, swimming, sex, exercise, bending, and lifting will affect your daily life for about 6-8 weeks. You will be unable to drive while you are on pain medication and likely unable to sit comfortably.2 During recovery, your doctor may also recommend not inserting anything into your vagina and not submerging in any kind of water.5 Post-op instructions will guide you on the appropriate timeframes for resuming normal activities. A follow-up visit for evaluation will be likely scheduled sometime between 2 and 6 weeks after surgery.
To make your recovery more comfortable, prearrange for someone to help take care of you. Each person’s experience is different and listening to your body is important. Your doctor will provide guidance on good wound care. Keep your incision clean and dry. You may experience some leakage from your incision. Your doctor will likely tell you to avoid sun exposure and creams & lotions.1,4
Recovery is generally faster from a vaginal hysterectomy, because with a shorter hospital stay and an incision that is not in the abdomen, healing is quicker. Pain medication and vaginal discharge should be expected. With an abdominal hysterectomy, you may experience numbness around the incision area; your scar may be red at first, but overtime, it will fade and feel more normal.
To be more comfortable during the recovery period, try wearing loose-fitting clothing that does not bind. Bending, twisting, and sitting can be uncomfortable and should be limited in the first few weeks.
Getting back on your feet
The steps to getting back on your feet are similar to those for achieving good health5:
It can take 4-6 weeks after a vaginal hysterectomy to resume normal activities; and longer, up to 8 weeks, after an abdominal procedure. While many women are back at work in two weeks, for others, it takes longer. Just because you resume work or caring for your family doesn’t mean you are fully healed. It can take several months to feel like your old self. After the operation, you’ll need assistance with heavy lifting or deep bending for some time (as not to strain the surgical area). Many women state that walking is the best exercise for the healing process and helps your body resume normal function. Remember that if your cervix remains, your doctor may still recommend regular pap smears.
There is an emotional component to healing as well. After a hysterectomy, you will no longer be able to get pregnant. If your ovaries are also removed, you will be suddenly forced into surgical menopause. Hormones in flux or suddenly shut off can cause hot flashes, night sweats, and sudden mood swings. Don’t be alarmed if you experience sudden bouts of crying, anxiety, depression, or sadness. As you heal, try to have patience; it is normal to take time to adjust to these new feelings.
According to some patients, you may also feel happier that you are no longer suffering from the symptoms that led you to have a hysterectomy. For some, you may become pain-free and have increased sensation during sex.1
Check with your medical team if you have questions, or experience complications such as uncontrolled bleeding, infection, or severe pain.1Support groups and other resources are also available for women with endometriosis.
Vaginal Hysterectomy. Mayo Clinic website. https://www.mayoclinic.org/tests-procedures/vaginal-hysterectomy/about/pac-20384541. Accessed online September 21, 2018.
Berry, J What to expect after a vaginal hysterectomy. Reviewed March 30, 2018. https://www.medicalnewstoday.com/articles/321366.php. Accessed online September 22, 2018.
Hribar, C. Hysterectomy. Endometriosis.net website. Reviewed June 2018. https://endometriosis.net/surgery/hysterectomy/. Accessed online September 22, 2018.
Abdominal hysterectomy. Mayo Clinic Website. https://www.mayoclinic.org/tests-procedures/abdominal-hysterectomy/about/pac-20384559. Accessed online September 21, 2018.
Recovering from your hysterectomy. Dana-Farber Cancer Institute. . https://www.dana-farber.org/health-library/articles/recovering-from-your-hysterectomy/. Accessed online September 22, 2018.