Hysterectomy

Hysterectomy is the surgical removal of the uterus. It’s a commonly performed procedure. If your uterus is removed, you cannot become pregnant again.

Hysterectomy, the surgical removal of the uterus, can be performed through different types of surgery. There are four main types of surgery. After a detailed examination, you and your doctor should decide which surgery is most suitable for you.

Vaginal hysterectomy – The uterus tissue is removed through an incision made in the vagina, so there is no visible incision on your abdomen. However, this method may not always be suitable. Sometimes, during vaginal hysterectomy, a camera may be inserted from the abdomen, which is called “laparoscopically assisted vaginal hysterectomy.” If this approach is used, the uterus is removed through the vagina.

What are the benefits and risks of vaginal hysterectomy? Vaginal hysterectomy generally results in fewer complications than abdominal or laparoscopic hysterectomy. The recovery time may be shorter compared to abdominal hysterectomy. However, it may not be feasible for every patient.

Laparoscopic hysterectomy – This method, also known as minimally invasive surgery, involves viewing the inside of the abdomen through a camera. To perform laparoscopic hysterectomy, the doctor inserts a camera and surgical instruments through small incisions made in the abdomen. During the surgery, the uterus is removed from the vagina.

What are the benefits and risks of laparoscopic hysterectomy? Compared to abdominal hysterectomy, there is less postoperative pain and infection with laparoscopic surgery. Hospital stay is also shorter. You can return to your normal activities earlier.

Abdominal hysterectomy – Abdomen refers to the belly. Abdominal hysterectomy involves removing the uterus through an incision made in the abdomen.

What are the benefits and risks of abdominal hysterectomy? Abdominal hysterectomy, compared to vaginal or laparoscopic hysterectomy, is associated with a higher risk of complications such as wound infection, bleeding, postoperative blood clot formation, nerve, and tissue damage. It usually requires a longer hospital stay and a longer recovery time than vaginal or laparoscopic hysterectomy. However, not every patient may be suitable for laparoscopic and vaginal hysterectomy.

Robotic hysterectomy – It’s a variation of the laparoscopic approach, where the surgical instruments used in the operation are connected to a robot controlled by the surgeon. This is called “robot-assisted laparoscopy.”

Why Is Hysterectomy Performed?

• Fibroids: Fibroids are benign tumors seen in the uterine tissue. While some cause no symptoms, others can lead to complaints such as anemia, pain, infertility, and bleeding, depending on their size and location. Fibroids are the most common reason for hysterectomy. You can read more about fibroids in my article titled ‘fibroids.’

• Endometriosis and Chronic Pelvic Pain: Some women experience constant pain in the area just below the navel. This is called “chronic pelvic pain.”

• Uterine Prolapse (Pelvic Organ Prolapse)

• Abnormal Uterine Bleeding: Some women experience excessive bleeding outside of their menstrual periods, which can lead to fatigue, anemia, and decreased quality of life. Medical treatments such as hormone-releasing intrauterine devices may be tried, and if they are not beneficial, hysterectomy may be preferred.

• Gynecologic Cancers

Are There Alternative Treatment Options If I Don’t Want to Have My Uterus Removed?

Some conditions treated with hysterectomy can also be treated in other ways. The most important point here is whether you want to conceive more.

Is It Possible to Get Pregnant After Hysterectomy?

If you have your uterus removed, you cannot become pregnant again. Unfortunately, if you have cancer or another serious problem that threatens your life and requires urgent surgery, you cannot have children after this surgery. If you want to have children and there are situations where surgery can be postponed, you should discuss this with your doctor.

Is the Uterus the Only Organ Removed During Hysterectomy?

It depends on the type of your surgery and the reason for the surgery. Other organs that may be removed along with the uterus or could be removed include:

Cervix: If you are having a vaginal hysterectomy, the cervix must be removed. If the surgery is performed abdominally or laparoscopically, the cervix may be removed or left in place. If the cervix is removed, it’s called a total hysterectomy. If the cervix is left in place, it’s called a subtotal or supracervical hysterectomy.

Ovaries and Fallopian Tubes: The ovaries have two main functions. They house the egg cells necessary for pregnancy and also play a role in the secretion of certain hormones, including estrogen and progesterone. The fallopian tubes are organs that extend between the uterus and the ovaries. They are attached to the uterine tissue and carry the egg to the uterus when ovulation occurs. In some cases, the ovaries may also be removed along with the uterus. In this case, you will enter menopause. If this happens before the age of 40, it’s called surgical menopause and leads to “early menopause.” If this occurs after the age of 40, you will enter menopause. Hormonal therapy may be necessary in cases of early menopause and menopause, so you should decide on the most suitable treatment with your doctor.

If your ovaries are not removed during surgery, you will not enter menopause, but your menstrual periods will stop.

If a hysterectomy is planned, you can ask your doctor if they plan to remove your cervix, ovaries, and fallopian tubes.

Should My Ovaries Be Removed When My Uterus Is Removed?

The decision to remove your ovaries depends on the reason for the surgery and your age. Even if you don’t want to have children, ovaries protect you from certain diseases because they secrete hormones. In premenopausal women, removal of the ovaries can lead to hot flashes, sweating, osteoporosis, decreased interest in sex, and other problems. In menopausal women, removal of the ovaries can also increase the risk of health problems such as heart disease, although research on this topic is still inconclusive, so the decision to remove or keep the ovaries should be individualized.

Is Hysterectomy a Safe Surgery?

Hysterectomy is one of the safest surgical procedures. However, it carries the risks inherent in any surgery.

These include:

• Fever and infection
• Severe bleeding during or after surgery
• Damage to the urinary tract or nearby organs
• Blood clots in the leg veins that can travel to the lungs
• Respiratory or cardiac problems related to anesthesia
• Death

Some problems related to surgery may not arise until several days, weeks, or even years after the operation. These complications are more common after abdominal hysterectomy.

Are All Women Equally at Risk for Complications?

No, some women are at greater risk of complications than others. For example, if you have an underlying medical condition, you may be at greater risk of anesthesia-related problems.

Do I Have to Stay in the Hospital After Hysterectomy?

You may need to stay in the hospital for several days after surgery. The length of your hospital stay depends on the type of hysterectomy you have, the diseases you have, and your surgery. You will be encouraged to walk as soon as possible after the surgery. Walking helps prevent blood clots in your legs. Some measures such as medication and compression stockings may also be taken to prevent blood clots.

What Can I Expect After Hysterectomy?

You may have some pain in the first few days after surgery. You may have bleeding and discharge from your vagina for several weeks. Constipation is a common problem after hysterectomy. Some women may experience temporary problems with emptying the bladder after hysterectomy. You may also encounter some psychological difficulties. Not being able to have children anymore and the cessation of menstruation can be psychologically challenging.

What Should I Pay Attention to After Surgery?

Follow your doctor’s recommendations. Make sure to rest a lot, but resting does not mean absolute bed rest. The best way to prevent clots is to move around as much as possible, so you should move as often as possible. Take short walks and gradually increase the distance you walk each day. Do not lift heavy objects until your doctor says so. Do not apply anything to the vagina for the first 6 weeks. In other words, sexual intercourse should not occur for 6 weeks, and vaginal tampons should not be used. After you have healed, you should continue with gynecological check-ups.

Should I Continue to Have Smears for Cervical Cancer Screening After Having Uterine Surgery?

Depending on the reason for the hysterectomy, you may still need cervical cancer screenings and gynecological examinations. If you have previously had surgery for cancer or precancerous conditions, you should continue to have cervical cancer screenings.