A hysterectomy is a surgical procedure that involves removing the uterus. There are different types of hysterectomies depending on the approach used and what structures other than the uterus are impacted.
Hysterectomies may be used to treat a variety of conditions, including uterine fibroids. Some people with endometriosis receive a hysterectomy after all other efforts to control pain and endometriosis-related symptoms have failed to provide relief. However, it is important to note that at this time, there is no cure for endometriosis. Not even a complete hysterectomy can guarantee the condition will never return.1,2
It possible that not all endometriosis lesions will be removed during the procedure. It is also possible for new lesions to grow in different areas after the procedure. It has been estimated that pain returns in as many as 15 percent of people who undergo a radical hysterectomy. This is where the uterus, cervix, ovaries, and other surrounding structures are removed.3
This rate increases as more structures are left in the body, such as the ovaries. A hysterectomy directly leads to infertility. This is why it is often a last line of defense against endometriosis pain and symptoms, especially in younger people who may want to have children in the future. The removal of the uterus and the ovaries may also lead to life-impacting side effects that need to be regularly managed well after the surgery.2,3
How does a hysterectomy help manage endometriosis?
The approach of a hysterectomy can vary depending on a person's specific situation and what structures are being removed or treated. Hysterectomies can be performed laparoscopically through a small incision in the abdomen. This minimally invasive technique often leads to the fewest complications and shortest recovery time.1
Hysterectomies can also be performed during a laparotomy, in which a large incision is made in the abdomen. The recovery time for a laparotomy is much longer than a laparoscopic procedure. A hysterectomy can be also performed vaginally, in which the uterus is removed through the vagina.1
A hysterectomy is done under general anesthesia, which means the person undergoing the surgery is asleep. Each approach has its own recovery time, risks, and benefits. Your surgeon or doctor will talk with you about which approach may be right for you.
There are also different types of hysterectomies and related procedures. Some of these include:1,4
- Supracervical hysterectomy – The upper body of the uterus is removed and the cervix remains in place. Also called a partial or subtotal hysterectomy.
- Total hysterectomy – The whole uterus and the cervix are removed.
- Radical hysterectomy – The entire uterus is removed, along with the ovaries and fallopian tubes. Surrounding tissue, such as the ligaments that support the uterus, the upper part of the vagina, and nearby lymph nodes are also removed.
- Salpingo-Oophorectomy – When both ovaries and both fallopian tubes are removed.
- Salpingectomy – When both fallopian tubes are removed.
- Oophorectomy – When an ovary is removed. If both are removed, it is a bilateral oophorectomy.
This is not a complete list of all of the possible procedures and structures affected during a hysterectomy. Talk with your doctor about what approach is right for you.
What happens after a hysterectomy?
Your recovery time and experience after surgery will depend on the approach used and what structures were impacted. In most cases, you will need to stay in the hospital for several days. You will most likely experience pain and discomfort. Some people have trouble with bowel movements after the procedure, as well as vaginal bleeding or discharge.1,3
You will be encouraged to try to walk in the days after your surgery to prevent blood clots and other complications. It is important to follow your doctor's recovery instructions. It may take 6 weeks or more to get back to your normal activities. You may be prohibited from lifting anything or physically exerting yourself. You may need to have a caregiver help you at home when you first leave the hospital.1,3
Depending on the nature of the procedure, you may experience some life-altering effects. If your ovaries were removed during the procedure, you may experience a sudden, dramatic change in your hormone levels. This can cause surgical menopause. Side effects include hot flashes, loss of bone mineral density, vaginal dryness, decreased sex drive, and more. You may need to take medicines that contain hormones to reduce some of these issues.3
What are the possible side effects of a hysterectomy?
The risks of a hysterectomy vary with the procedure performed and approach taken. However, common risks include:
- Heavy bleeding
- Blood clots
- Injury to surrounding structures in the pelvis, such as the bowel or bladder
- Pelvic pain
- Development of scar tissue, which can create similar symptoms as before the procedure
These are not all the possible side effects of a hysterectomy. Talk to your doctor about what to expect or if you experience any changes that concern you during treatment with a hysterectomy.