Hysterectomy is a major surgical procedure that has risks and benefits, and affects a woman's hormonal balance and overall health for the rest of her life. Because of this, hysterectomy is normally recommended as a last resort to remedy certain intractable uterine/reproductive system conditions.
Such conditions include, but are not limited to:
• Certain types of reproductive system cancers (uterine, cervical, ovarian, endometrium) or tumors.
• Severe and intractable endometriosis (growth of the uterine lining outside the uterine cavity) and/or adenomyosis (a form of endometriosis, where the uterine lining has grown into and sometimes through the uterine wall musculature), after pharmaceutical or other surgical options have been exhausted.
• Chronic pelvic pain, after pharmaceutical or other surgical options have been exhausted.
• Postpartum to remove either a severe case of placenta praevia (a placenta that has either formed over or inside the birth canal) or placenta percreta (a placenta that has grown into and through the wall of the uterus to attach itself to other organs), as well as a last resort in case of excessive obstetrical haemorrhage.
• For uterine fibroids when conservative treatment fails.
• Several forms of vaginal prolapse.
• Occasionally, women will express a desire to undergo an elective hysterectomy--that is, a hysterectomy for reasons other than the resolution of reproductive system conditions or illnesses. Some of the conditions under which a woman may request to have a hysterectomy (or have one requested for her if the woman is incapable of making the request) for non-illness reasons include:
• Prophylaxis against certain reproductive system cancers, especially if there is a strong family history of reproductive system cancers (especially breast cancer in conjunction with BRCA1 or BRCA2 mutation), or as part of recovery from such cancers.
• Part of overall gender transition for transmen.
• Severe developmental disabilities, though this treatment is controversial at best, and specific cases of sterilization due to developmental disabilities have been found by state-level Supreme Courts to violate the patient's constitutional and common law rights.
Types of hysterectomy
Hysterectomy in the literal sense of the word means merely removal of the uterus, however other organs such as ovaries, fallopian tubes and the cervix are very frequently removed as part of the surgery.
• Radical hysterectomy : complete removal of the uterus, cervix, upper vagina, and parametrium. Indicated for cancer. Lymph nodes, ovaries and fallopian tubes are also usually removed in this situation.
• Total hysterectomy : Complete removal of the uterus and cervix.
• Subtotal hysterectomy : removal of the uterus, leaving the cervix in situ.
Indications
• Leiomyomata
• Pelvic pain
• Pelvic relaxation
• Abnormal uterine bleeding
• Malignant and premalignant disease
side effects
Side effects depend on a number of things, including your age, condition, whether you are still having periods, and what type of hysterectomy you have. If you were still having periods before surgery, they will stop after the operation.
• If your ovaries are not removed, you will continue to have hormone changes like you did with your periods, but you will not have bleeding.
• If your ovaries are removed, you will go through changes like menopause. These might include hot flashes, vaginal dryness, night sweats, mood swings, or other symptoms
• Effects on social life and sexuality
Additional side effects of surgery include:
• Effects of anesthesia: The doctor will give you anesthesia so you will not feel pain during the operation. You may feel moody, tired, or weak for a few days after anesthesia. You also may feel a little sick to your stomach (nausea) after anesthesia. The doctor usually can give you something to help settle your stomach.
• Infections: As with any type of operation, there is always a risk of infection. If you do get an infection, your doctor will give you medicine to treat it.
• Too much bleeding: There is always a risk that you might bleed too much during an operation and need a transfusion. Ask your doctor if you should donate some of your own blood before the operation or if someone should give blood for you.
• Damage to nearby organs: It is possible that during the operation a part of your body near the uterus might be damaged. Although this is unlikely, you should ask your doctor what might happen if an organ is damaged.
Post-Op care
• Not necessary to leave a bladder catheter in place postoperatively
• IV fluids for the first 24 hours to ensure that the patient remains well hydrated
• Early feeding of a regular diet can stimulate the bowel and decrease the length of hospitalization*
• Deep breathing to prevent atelectasis
• Ambulation is encouraged
• Intermittent compression boots
• Adequate control of postoperative pain
• Walking and stair climbing are encouraged
• Tub baths or showers are OK
• Avoid heavy lifting (>20 pounds of weight from the floor) for 4-6 weeks to minimize stress on the healing fascia
• Vaginal intercourse is also discouraged 4-6 weeks to allow the vaginal cuff to heal completely
• Driving should be avoided until full mobility returns and opioid analgesia is no longer required
• May return to work as soon as she has regained sufficient stamina and mobility
• A prophylactic antibiotic agent should be given as a single dose 30 minutes prior to the first incision for vaginal hysterectomy
• cefazolin, cefoxitin, and cefuroxime
• Metronidazole (500 mg IV) may be used in patients with cephalosporin allergies
• Patient positioning - dorsal lithotomy
• Bimanual pelvic examination is performed
• assess uterine mobility and descent
Such conditions include, but are not limited to:
• Certain types of reproductive system cancers (uterine, cervical, ovarian, endometrium) or tumors.
• Severe and intractable endometriosis (growth of the uterine lining outside the uterine cavity) and/or adenomyosis (a form of endometriosis, where the uterine lining has grown into and sometimes through the uterine wall musculature), after pharmaceutical or other surgical options have been exhausted.
• Chronic pelvic pain, after pharmaceutical or other surgical options have been exhausted.
• Postpartum to remove either a severe case of placenta praevia (a placenta that has either formed over or inside the birth canal) or placenta percreta (a placenta that has grown into and through the wall of the uterus to attach itself to other organs), as well as a last resort in case of excessive obstetrical haemorrhage.
• For uterine fibroids when conservative treatment fails.
• Several forms of vaginal prolapse.
• Occasionally, women will express a desire to undergo an elective hysterectomy--that is, a hysterectomy for reasons other than the resolution of reproductive system conditions or illnesses. Some of the conditions under which a woman may request to have a hysterectomy (or have one requested for her if the woman is incapable of making the request) for non-illness reasons include:
• Prophylaxis against certain reproductive system cancers, especially if there is a strong family history of reproductive system cancers (especially breast cancer in conjunction with BRCA1 or BRCA2 mutation), or as part of recovery from such cancers.
• Part of overall gender transition for transmen.
• Severe developmental disabilities, though this treatment is controversial at best, and specific cases of sterilization due to developmental disabilities have been found by state-level Supreme Courts to violate the patient's constitutional and common law rights.
Types of hysterectomy
Hysterectomy in the literal sense of the word means merely removal of the uterus, however other organs such as ovaries, fallopian tubes and the cervix are very frequently removed as part of the surgery.
• Radical hysterectomy : complete removal of the uterus, cervix, upper vagina, and parametrium. Indicated for cancer. Lymph nodes, ovaries and fallopian tubes are also usually removed in this situation.
• Total hysterectomy : Complete removal of the uterus and cervix.
• Subtotal hysterectomy : removal of the uterus, leaving the cervix in situ.
Indications
• Leiomyomata
• Pelvic pain
• Pelvic relaxation
• Abnormal uterine bleeding
• Malignant and premalignant disease
side effects
Side effects depend on a number of things, including your age, condition, whether you are still having periods, and what type of hysterectomy you have. If you were still having periods before surgery, they will stop after the operation.
• If your ovaries are not removed, you will continue to have hormone changes like you did with your periods, but you will not have bleeding.
• If your ovaries are removed, you will go through changes like menopause. These might include hot flashes, vaginal dryness, night sweats, mood swings, or other symptoms
• Effects on social life and sexuality
Additional side effects of surgery include:
• Effects of anesthesia: The doctor will give you anesthesia so you will not feel pain during the operation. You may feel moody, tired, or weak for a few days after anesthesia. You also may feel a little sick to your stomach (nausea) after anesthesia. The doctor usually can give you something to help settle your stomach.
• Infections: As with any type of operation, there is always a risk of infection. If you do get an infection, your doctor will give you medicine to treat it.
• Too much bleeding: There is always a risk that you might bleed too much during an operation and need a transfusion. Ask your doctor if you should donate some of your own blood before the operation or if someone should give blood for you.
• Damage to nearby organs: It is possible that during the operation a part of your body near the uterus might be damaged. Although this is unlikely, you should ask your doctor what might happen if an organ is damaged.
Post-Op care
• Not necessary to leave a bladder catheter in place postoperatively
• IV fluids for the first 24 hours to ensure that the patient remains well hydrated
• Early feeding of a regular diet can stimulate the bowel and decrease the length of hospitalization*
• Deep breathing to prevent atelectasis
• Ambulation is encouraged
• Intermittent compression boots
• Adequate control of postoperative pain
• Walking and stair climbing are encouraged
• Tub baths or showers are OK
• Avoid heavy lifting (>20 pounds of weight from the floor) for 4-6 weeks to minimize stress on the healing fascia
• Vaginal intercourse is also discouraged 4-6 weeks to allow the vaginal cuff to heal completely
• Driving should be avoided until full mobility returns and opioid analgesia is no longer required
• May return to work as soon as she has regained sufficient stamina and mobility
• A prophylactic antibiotic agent should be given as a single dose 30 minutes prior to the first incision for vaginal hysterectomy
• cefazolin, cefoxitin, and cefuroxime
• Metronidazole (500 mg IV) may be used in patients with cephalosporin allergies
• Patient positioning - dorsal lithotomy
• Bimanual pelvic examination is performed
• assess uterine mobility and descent