A hysterectomy is a surgical procedure that involves removing the uterus. There are various types of hysterectomies depending on the surgical approach used, and what structures, other than the uterus, are impacted. Hysterectomies may be recommended for the treatment of a variety of conditions, including uterine fibroids. Some women with endometriosis receive a hysterectomy after all other efforts to control pain and endometriosis-related symptoms have failed to provide relief. However, it's important to note that at this time, there is no cure for endometriosis. Not even a complete hysterectomy can guarantee that the condition will never return.1,2
It's possible that during the procedure, not all endometriosis lesions will be removed. It's also possible for new lesions to grow in different areas after the procedure. Because of this, it has been estimated that pain returns in as many as 15% of women who undergo radical hysterectomy, where the uterus, cervix, ovaries, and other surrounding structures are removed.3 This recurrence rate increases as more structures are left in the body, such as the ovaries. A hysterectomy directly leads to infertility, which is why it is often a last line of defense against endometriosis pain and symptoms, especially in younger women who may want to have children in the future. Additionally, the removal of the uterus and the ovaries can lead to life-impacting side effects that may need to be regularly managed well after the surgery.2,3
What happens during a hysterectomy?
When a woman goes in for a hysterectomy, she will be put under general anesthesia (will be asleep). After this, the surgical procedure will begin. The approach of a hysterectomy can vary depending on a woman'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. 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. Additionally, a hysterectomy can be performed vaginally, in which the uterus is removed through the vagina.1 Each approach has its own recovery time, risks, and benefits. Your surgeon or provider will talk with you about which approach may be best for you.
In addition to the variety of approaches that can be taken, there are also different types of hysterectomies and related procedures. Some of these include:
- 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, and surrounding tissue, such as the ligaments that support the uterus, the upper part of the vagina, and nearby lymph nodes.
- 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's referred to as a bilateral oophorectomy.1,4
This is not a complete list of all of the procedures possible and structures affected during a hysterectomy. Talk with your healthcare provider or surgeon to determine which approaches are the most appropriate in your case.
What happens after a hysterectomy?
Your recovery time and post-surgical experience will depend on the approach used and what structures were impacted by the procedure. In most cases, you will need to stay in the hospital for several days until you are discharged by your healthcare team. You will most likely experience pain and discomfort. Some individuals may experience difficulties having bowel movements after the procedure, as well as experience vaginal bleeding or discharge. You will be encouraged to try to walk in the immediate days after your surgery to prevent blood clots and other potential complications. It's important to follow your provider's instructions when it comes to your recovery. It may take six weeks or more to get back to your normal activities, and 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. Notably, if your ovaries were removed during the procedure, you may experience a sudden, dramatic change in your hormone levels. This can cause a surgical menopause, with severe side effects such as hot flashes, loss of bone mineral density, vaginal dryness, decreased sex drive, and more. It may be necessary for you to take hormone-containing medications to alleviate some of these issues.3
What are the risks of a hysterectomy?
The risks that can accompany a hysterectomy vary with the procedure performed and approach taken. However, common risks of a hysterectomy include, but are not limited to:
- Heavy bleeding
- Blood clots
- Injury to surrounding structures in the pelvis, such as the bowel or bladder (which may impact their functioning)
- Pelvic pain
- Development of scar tissue that may lead to pain or other symptoms similar to those that required the procedure in the first place1,3
This is not an exhaustive list of all potential risks associated with a hysterectomy. For more information about your situation and warning signs to look for, contact your healthcare provider.