Hysterectomy

Hysterectomy is the surgical removal of the uterus. It is one of the major surgeries commonly performed in gynecology and is usually considered in the treatment of fibroids, excessive uterine bleeding resistant to treatment, endometriosis, adenomyosis, uterine prolapse, chronic pelvic pain, or certain gynecologic cancers [1][2].

After hysterectomy, the person no longer menstruates, and pregnancy is no longer possible [1][2]. Therefore, the decision for surgery should be made by considering the person’s age, desire to have children, severity of complaints, type of disease, previously tried treatments, and general health condition.

Hysterectomy is the removal of the uterus from the body using surgical methods. The scope of the surgery may vary depending on the cause of the disease. In some operations, only the uterus is removed, while in some cases, the cervix, fallopian tubes, ovaries, or surrounding tissues may also be removed [1][3].

Removal of the uterus is a permanent procedure. Therefore, hysterectomy is generally evaluated when other treatment options are insufficient, when complaints seriously affect quality of life, or in conditions such as cancer that require surgical treatment [1][2].

Why Is Hysterectomy Performed?

Hysterectomy may be performed for different medical reasons. The most common reasons are:

• Fibroids: These are benign tumors that develop in the uterus. They may cause complaints such as excessive bleeding, pain, a feeling of pressure, or frequent urination [1][2].
• Excessive uterine bleeding: Hysterectomy may be considered in cases of heavy and prolonged bleeding that cannot be controlled with medication or other treatments [2].
• Endometriosis: This is the presence of tissue similar to the inner lining of the uterus outside the uterus. It may cause severe pain and a decrease in quality of life [2].
• Adenomyosis: This occurs when tissue from the inner lining of the uterus grows into the muscular layer of the uterus. It may cause painful and heavy menstrual bleeding [2].
• Uterine prolapse: When the uterus descends toward the vagina, a feeling of pressure, urinary incontinence, or discomfort during sexual intercourse may occur [2].
• Cancer: Hysterectomy may be part of the treatment for cancers of the uterus, cervix, ovaries, or fallopian tubes [1][2].

What Are the Types of Hysterectomy?

Hysterectomy is divided into different types according to the tissues removed. Which type will be performed is determined according to the cause of the disease, the patient’s health condition, and the surgeon’s evaluation [1][3].

Total Hysterectomy

Total hysterectomy is the removal of the uterus and cervix together. It is one of the most commonly performed types of hysterectomy. It may be preferred in fibroids, abnormal bleeding, uterine prolapse, or certain types of cancer [1][3].

Partial or Subtotal Hysterectomy

Partial hysterectomy or subtotal hysterectomy is the removal of the body of the uterus while leaving the cervix in place. Since the cervix is preserved, the person should continue cervical screening as recommended by the doctor [1][2].

Radical Hysterectomy

Radical hysterectomy is a more extensive surgery usually performed in cancer treatment. The uterus, cervix, upper part of the vagina, and surrounding tissues may be removed. In some cases, lymph nodes may also be removed [1][2].

How Is Hysterectomy Performed?

Hysterectomy may be performed using open surgery, vaginal surgery, laparoscopic surgery, or robotic surgery methods. The surgical method is chosen according to the size of the uterus, type of disease, previous surgeries, suspicion of cancer, and the patient’s general condition [1][3].

Abdominal Hysterectomy

Abdominal hysterectomy is the removal of the uterus through an incision made in the abdominal area. It may be preferred when the uterus is large, when there are intra-abdominal adhesions, or when the surgeon needs to see the inside of the abdomen more broadly [3].

Vaginal Hysterectomy

Vaginal hysterectomy is the removal of the uterus through the vagina. Since no large incision is made in the abdomen, the recovery process may be shorter in suitable patients [1][2].

Laparoscopic Hysterectomy

Laparoscopic hysterectomy is performed with the help of a camera and special surgical instruments through small incisions made in the abdomen. In suitable patients, it may provide less pain and faster recovery compared with open surgery [1][3].

Robotic Hysterectomy

Robotic hysterectomy is the application of laparoscopic surgery with the help of a robotic system. It is not necessary for every patient; suitability is evaluated by the surgeon [3].

What Are the Benefits of Hysterectomy?

Hysterectomy may improve quality of life in the right patient group. It may be an effective treatment option, especially in complaints such as long-lasting heavy bleeding, anemia, pain, a feeling of pressure, or uterine prolapse [1][2].

• Bleeding complaints may end: Heavy bleeding originating from the uterus disappears after surgery.
• Pain may decrease: Pain may decrease in cases of fibroids, adenomyosis, or selected cases of endometriosis.
• The feeling of pressure may improve: Pelvic pressure complaints related to large fibroids or prolapse may be relieved.
• It may be effective in cancer treatment: In some gynecologic cancers, hysterectomy is one of the main treatment options [1][2].

What Are the Risks of Hysterectomy?

Because hysterectomy is a major surgical procedure, it carries certain risks. Risks may vary depending on the surgical method, the person’s age, additional diseases, weight, and the reason for the operation [2][3].

• Bleeding
• Infection
• Blood clot formation
• Injury to the bladder, bowel, or urinary tract
• Complications related to anesthesia
• Early menopause if the ovaries are removed
• Emotional difficulty or an adjustment period related to sexual life

Because of these risks, the purpose of the surgery, alternative treatments, organs to be removed, and the recovery process should be discussed in detail with the doctor before surgery [1][2].

Recovery Process After Hysterectomy

The recovery period after hysterectomy varies depending on the surgical method. Full recovery may take longer after open abdominal hysterectomy, while recovery may generally be shorter with vaginal or laparoscopic methods [2][3].

According to the NHS, full recovery after abdominal hysterectomy may take approximately 6-8 weeks. This period may be shorter for vaginal or laparoscopic hysterectomies [2]. During this process, it is important to avoid heavy lifting, strenuous exercise, and sexual intercourse until the doctor gives permission.

What Should Be Considered After Hysterectomy?

In the postoperative period, it is necessary to rest so the body can heal, support circulation with short walks, and follow the doctor’s recommendations. A healthcare institution should be contacted if the following symptoms occur:

• Heavy vaginal bleeding
• Foul-smelling discharge
• Fever or chills
• Severe abdominal pain
• Redness, swelling, or discharge at the wound site
• Shortness of breath, chest pain, or swelling in the leg
• Difficulty urinating or burning during urination

Life After Hysterectomy

After hysterectomy, the person no longer menstruates and cannot become pregnant [1][2]. However, if the ovaries are preserved, hormone production may continue, and the person may not enter menopause immediately. In cases where the ovaries are also removed, menopausal symptoms such as hot flashes, night sweats, sleep disturbances, and vaginal dryness may begin.

Sexual life varies from person to person. In some women, sexual life may become more comfortable because pain and bleeding complaints decrease. In some people, support may be needed due to hormonal changes, vaginal dryness, psychological effects, or the recovery process. These issues should be discussed openly with the doctor during postoperative follow-up visits.

Comments From Those Who Had Hysterectomy Surgery

Comments from people who have had hysterectomy surgery vary from person to person. Some people state that their quality of life improved after surgery because long-lasting bleeding, pain, and anemia problems improved. This relief may be especially noticeable in people whose daily life has become difficult due to fibroids, adenomyosis, or uterine prolapse.

However, some women may struggle emotionally due to the end of fertility, menopausal symptoms related to removal of the ovaries, or the postoperative recovery process. Therefore, although patient comments may provide insight, the decision for hysterectomy should be made not only based on personal experiences, but as a result of medical evaluation.

Frequently Asked Questions About Hysterectomy

References

1. American College of Obstetricians and Gynecologists (ACOG). Hysterectomy.
2. NHS. Hysterectomy.
3. Mayo Clinic. Abdominal hysterectomy.