Hysterectomy

Published: May 28, 2014

So, You’re Having A Hysterectomy
What Is Hysterectomy?

Hysterectomy is the name given to the surgical procedure done to remove a woman’s uterus.  The uterus (or womb) is where a baby grows during pregnancy. It also produces a monthly menstrual period (flow).

After a woman has a hysterectomy, she can no longer have children and menstruation stops. The ovaries generally continue to produce hormones, although in some cases they may have reduced activity.

Some hysterectomies also include removal of the fallopian tubes and ovaries. The ovaries produce eggs and hormones. When the ovaries are removed, the supply of essential female hormones is greatly reduced.

Facts About Hysterectomy

  • Hysterectomy is the second most common surgical procedure performed in North America (after cesarean section).
  • About 600,000 hysterectomies are performed in women in the US each year.
  • 20% of all women have had a hysterectomy by age 40
  • More than 30% of women in US will have had a hysterectomy by the time they reach 60 years of age
  • 39% of women have had a hysterectomy by age 65

Why Do Women Have Hysterectomies?

Common reasons you might need a hysterectomy include:

  • If you have cancer of the uterus or ovaries, cervix or endometrium
  • Fibroids (non- cancerous tumors in the uterus)
  • Endometriosis (when the tissue in the uterus grows outside the uterus)
  • Abnormal bleeding or
  • Chronic pelvic pain
  • Prolapse of the uterus (the uterus slips down into the vagina)

In most cases a hysterectomy is an elective procedure which is performed to improve the quality of life to relieve heavy bleeding, pain and discomfort.  However, it may be a treatment for a number of diseases and it can save your life if you have cancer or uncontrollable bleeding.

What Should You Do If You Are Told You Need A Hysterectomy?

Hysterectomies can greatly benefit women who need them, but it is not always necessary.

You should discuss with your doctor:

  • the possible risks of surgery
  • the treatment options and risks of those treatments

You should always get a second opinion

Types of Hysterectomy

  • Partial hysterectomy (removes the body of the uterus while the cervix is left in place
  • Total (removes the whole uterus and cervix, which is the lower end of the uterus)
  • Hysterectomy with Bilateral Salpingo-Oophorectomy (removes uterus, cervix, ovaries and fallopian tubes
  • Radical (removes the uterus, cervix, ovaries, fallopian tubes and possibly upper portions of the vagina and affected lymph glands)

Hysterectomy Procedures

Your doctor will discuss the different procedures available for your hysterectomy and help you decide which is best for you.  Your options include surgery with the use of one large incision, or multiple small incisions.  Regardless, you will receive anethetics and won’t be aware during the actual procedure.

Procedures include:

  • Abdominal hysterectomy (through an abdominal incision)
  • Vaginal hysterectomy (with a vaginal incision)
  • Laparoscopic (small incisions in the abdomen which may be robotically assisted by a surgeon

Resources for Hysterectomy Information

  • www.hystersisters.com
  • www.redhotmamas.org
  • www.OBGYN.net
  • www.menopause.org
  • www.womenshealthnetwork.org

What Are The Risks of Having a Hysterectomy?

Most women don’t have a problem from the surgery, but it’s still important to understand some of the possible risks of this surgery which include:

  • Injury to nearby organs (bladder, bowel, urinary tract, rectum, or blood vessels)
  • Pain during sexual intercourse
  • Early menopause (if ovaries are removed or damaged)
  • Anesthesia problems (breathing or heart problems)
  • Blood clots in legs or lungs
  • Allergic reactions to medicines
  • Infection
  • Heavy bleeding

Hospitalization & Recovery

Hospital Recovery
You will be required to stay in the hospital for 1 to 2 days for post-surgery care. Some women, however may stay longer, often when the hysterectomy is done because of cancer.  During this time, a nurse will monitor your vital signs (blood pressure, temperature and heart rate), draw blood, help you eat, dress and take a shower the morning after surgery.  Don’t expect to be running around your hospital room!  Normal everyday activities will take more time after surgery.

It is normal for you to experience pain after your hysterectomy.  Immediately after your surgery, you will receive pain medication.  It is important to take it to prevent pain from worsening.  Controlling pain is an important part of your recovery process.

Two types of pain medications exist.  They are narcotics and non-narcotics.  Most commonly used narcotics are morphine or Demerol. These medications may cause constipation.  Your doctor may recommend that you use a stool softener. You will have excess gas as your bowels recover from the anesthesia.  You will also have an IV which will provide fluids and antibiotics.

For an abdominal hysterectomy, you will probably need a narcotic for a few days.  One effective way to control pain is with a patient controlled analgesia (PCA) pump.  It is simply a pump that allows you to deliver the pain medication yourself through an IV. By pressing a button on this pump, you can give yourself the medication.  Don’t worry, the pump has a safety timer so you won’t overdose yourself.  And, you need not to worry about becoming addicted to these medications.  It is very rare to be become addicted if you are using these medications temporarily to control pain.

If you hear some gurgling or other strange noises coming from your bowels, do not panic. They are normal!  It’s just your bowels recovering from the anesthesia.  You’ll be restricted to a clear liquid diet and limited amounts of exercise that will help get rid of your gas pain.

Hysterectomy Post-Op Points

  • Your nurse will help you get out of bed the first night and help you walk on your own four to six times a day as you begin to feel better.
  • A sanitary napkin may be necessary if you experience any vaginal bleeding after surgery.
  • Your incision will be checked every day by your nurse and he/she will change the dressing if necessary.
  • Non-absorbable staples or stitches will be removed before you go home.
  • Your doctor will help you decide when you can resume your usual diet but until then, expect to be on a liquid diet until your intestines begin to function normally.
  • Your nurse will monitor your bowel, bladder and lung function daily.

Depending on the condition at the end of your hospital stay, your nurse will discuss the possibility of receiving at-home care.  If you think you qualify for the care from a visiting nurse, discuss your options before you go home.  They’ll also go over your instructions and prescriptions for painkillers and any other medications needed.

Also, don’t forget to ask your doctor any questions you may have before going home and to ask about a follow-up appointment.  Unless you experience an emergency, your doctor will advise you to make a follow-up appointment 2 to 6 weeks after your hysterectomy.  At this visit, your doctor will explain your pathology results, and examine your incision, as well as discuss hormone therapy, and lifestyle changes.

Returning Home From A Hysterectomy

Recover time does not stop when you leave the hospital.  Complete recovery will take 4 to 8 weeks.  You will gradually be able to return to normal activities.  The first 2 to 3 weeks should be devoted to resting.  The more you rest, the faster you’ll recover.

Arrange for people to help you with household chores before you have your surgery.  And, let them help you!  Don’t do any heavy lifting or strenuous exercise and don’t rush back to work.

Take it easy.  Try to avoid climbing stairs but if you need to, go slowly.  Let someone else drive you around (if you need to leave your house) during the first week or two after surgery.

Here are some tips for a speedy recovery:

  • Drink lots of water and other clear liquids.
  • Take your pain medication.
  • You may need to use sanitary napkins (don’t use tampons).  Expect some bleeding and brownish discharge.  It may last up to five weeks.
  • Keep your incision clean.  Wash it daily with soap and water.
  • Keep your incision dry and cover it with fresh gauze.  If you shower or bathe, dry it afterwards and do not apply any creams or ointments.
  • Don’t use any tampons or douches.
  • No sexual intercourse until your doctor advises you (typically 6 weeks).  However, there is no rule for hugging and kissing.
  • Contact your doctor or go to the emergency room If you experience any of the following: fever, pain, heavy vaginal bleeding, odorous discharge, swelling in the legs, bleeding or discharge at the site of the incision; frequent or painful urination; persistent vomiting or inability to pass gas; or sudden pain in your chest

Physical and Emotional Aftermath

It’s not uncommon to feel tired and a bit irritable after your surgery.  After all, you may be experiencing pain, not sleeping as usual, and this may make you feel like an emotional rollercoaster.  If your recovery is lengthy and difficult this may affect your emotional health.

If you find you cannot pull yourself out of your high and low feelings, discuss this with your doctor.   It’s definitely a myth that hysterectomy causes depression and studies have shown that women who do suffer depression after a hysterectomy are those women who had problems before the surgery was performed.

You had (or are having) a hysterectomy to relieve unwanted symptoms of your reproductive system (heavy bleeding, fibroids, uterine prolapse, endometriosis, adenomyosis, chronic pelvic pain and/or cancer of the cervix or uterus).  These physical problems should improve but, other changes may occur.  A hysterectomy can greatly improve your quality of life but also can have long-term effects on your health, longevity and sexuality.

If you have not reached menopause yet and you have a hysterectomy with removal of your ovaries a (bilateral oophorectomy) before the age of natural menopause, expect to undergo surgical menopause. This will cause a sudden drop in estrogen and progesterone and testosterone. A drop in estrogen will cause hot flashes and night sweats and increase your risk of osteoporosis, heart disease, and vaginal dryness.  The decrease in testosterone may reduce your energy levels or sexual desire. The plummeting hormone levels, due to surgical menopause, usually cause more severe menopause symptoms than those going through natural menopause.  The experience is different, however, for everyone.

Women who have had a hysterectomy and bilateral oophorectomy may need to address the issue of hormone therapy earlier in their lives that most women.   Many women are given estrogen therapy after a hysterectomy to alleviate their menopausal symptoms like hot flashes, night sweats and vaginal dryness.

Some of the benefits associated with hormone therapy (HT) are:  fewer hot flashes, night sweats; prevention of bone loss; improved health of the vagina and urinary system.  You should not take hormone therapy (HT) if you have: a personal or family history of breast cancer, cancer of the uterus, a history of blood clots, active liver disease or vaginal bleeding.

It is also important to eat calcium rich foods and exercise.  Staying positive is one of the most important factors to consider when recovering from a hysterectomy.  In some instances, hysterectomy is a lifesaving operation and can change your life for the better.  It is our hope that you will be happy with the choices that you made whatever course of action you have taken to ensure good health.

Questions To Ask Your Doctor Before a Hysterectomy

  • Why do I need to have a hysterectomy?
  • What organ or organs will be removed and why?
  • Will my ovaries be left in place? If not, why?
  • Will my cervix be removed? If so, why?
  • Are there alternatives for me besides a hysterectomy?
  • What are the advantages, risks, benefits of each?
  • What are the physical effects of a hysterectomy? How do I deal with them?
  • What are the possible complications of this surgery?
  • Will I experience menopausal symptoms.  If so, can they be treated? What are the risks and benefits of the treatments?
  • What can I expect in the hospital, i.e., length of stay, anesthesia, etc.?
  • What kind of care will I need after my hysterectomy?
  • How soon can I go back to work?
  • When can I resume sexual activity?

Questions to Ask Your Doctor Before Leaving The Hospital

  • What restrictions are there on physical activity or diet during my recovery?
  • How do I deal with pain during recovery?
  • Do you recommend estrogen therapy if I develop menopausal symptoms? What are the different types of estrogen therapy available?
  • What are the alternatives to using hormones?
  • How can I improve my chances for a quick recovery?
  • When do I need to see you for a check up

Karen Giblin, Founder of Red Hot Mamas, Experience After An Oopherectomy 

Photo: Good Samaritan Hospital,  Baltimore, MD Red Hot Mamas program director Debbie Bena (left), with attendees (center) and Karen Giblin (right)

I was 40 years of age when I had to have a hysterectomy with removal of my ovaries (oophorectomy). The reason for my surgery was to stop abnormal and heavy bleeding and pain which was occurring during my menstrual cycles. When I first was told I needed surgery, I sought out various medical opinions and all the doctors agreed that I needed to have this surgical procedure. I had a great doctor and I was getting care at a world-renowned medical center in Connecticut.

However, in retrospect, I now know that I did not ask the enough questions while contemplating this procedure. I would have liked basic information about reasons for performing hysterectomy, types of hysterectomy procedures, what were my options, preparation before procedure performed, and issues related to stay in hospital. I did not know things like postoperative recovery time and the need for hormone therapy and its many adjustments that had to be made after surgery.

Hysterectomy was an elective surgery and my decision to have this operation was decided upon after having a series of consultations with my gynecologist; each visit about 15 minutes. After these discussions, things went pretty much in fast forward. And, before I knew it, I was in the hospital recovering from surgery. That is when suddenly I felt the impact of the surgery and I felt so ignorant that I failed to prepare myself for the recovery issues that followed – pain control issues; menopausal symptoms that suddenly appeared which were quite disconcerting for me. And, I was not armed with knowledge about treatment options to alleviate those symptoms. It became very apparent that I was not properly prepared for the surgery and the recovery period thereafter.

My immediate symptoms were troublesome and problematic affecting my quality of life – hot flashes, night sweats, heart palpitations, insomnia, fatigue and major forgetfulness. I felt as if I was lost in the Bermuda Triangle and I certainly could not find solutions for these disrupting concerns.

When returning home from the hospital, a friend drove and accompanied me to a local book store. I needed to find answers. What was happening to my body and my emotions? I was embarrassed to ask the store clerk where I could find a book on menopause. And, in 1991, there weren’t many books out there. I found one book written by Dr. Lila Nactigall.

When walking to the counter to pay for the book, my embarrassment took over, and I hid it under magazines to avoid people seeing me buying a book on menopause. At that time, menopause was a mystery to me and I did not want to openly admit to anyone that I was in the throes of it. We’ve come a long way since that time and so have I. In fact, I’ve even co- authored a book with Dr. Mary Jane Minkin, for clinicians entitled Manual of Management Counseling for the Perimenopausal and Menopausal Patient…A Clinician’s Guide. And another new book which I co-authored with Dr. Mache Seibel entitled Eat To Defeat Menopause.

I think I was blessed somehow with my experience of menopause. Being a public official, serving my third term in office (6 years) as Selectman (Town of Ridgefield, CT.), many women heard that I had a hysterectomy. They began calling me. They were breaking the silence about menopause. At first I thought it was to find out how I was feeling, but it was not.

They were calling me in quest of information about menopause – both natural and surgical menopause. I knew at that time a new direction needed to be taken in women’s healthcare as menopausal health needs of women were not being adequately addressed in the typical office visit with their gynecologists.

I thank these women for sharing intimate details about their menopause experience with me and for their willingness to discuss the positive and negative aspects about menopause. That is why I passionately embarked on developing Red Hot Mamas – to specifically help women obtain necessary information which equips them to communicate more effectively with their healthcare providers and share in decision making in efforts to optimize their health. Red Hot Mamas is designed to help women understand what to expect when menopause arrives and provide strategies to help them better manage its course. I always say, “Take charge of menopause before it takes charge of you.” As a result of our educational efforts, we are now the nation’s largest menopause education program and have worked in over 200 hospitals and physician group practices in the USA and in Canada, providing free monthly educational programs to women.

We’ve reached into every nook and cranny of the menopause world providing menopause education. Our free, monthly programs are offered at numerous sites across North America. Our website www.redhotmamas.org has received numerous health e awards and this newsletter is one more resource for women to learn and find information about menopause and their health.

We’ve paid attention to the health needs of women in the menopause transition and provided them an opportunity to gain access to important health information. And, everyone loves our name Red Hot Mamas. I’ve saved the best for last. After I had my oophorectomy in 1991, my young daughter used to say “You’re a red hot mama.” I thought this name was apropos and I named our program Red Hot Mamas Menopause Management Education Programs.

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