Hysterectomy is a surgical procedure of removing the whole uterus (a body part where implantation and development of the fetus occurs) or an affected part of the uterus from women’s body. Rarely this may also include removal of ovaries (produces an egg) and fallopian tubes (where sperm and egg unites and travels to the uterus).

Thus, women cannot get her periods after the procedure and cannot conceive. It is the second most common surgery in the field of Obstetrics and Gynecology, next to Caesarean section.

What are the types of hysterectomy?

• Supra-cervical (subtotal) Hysterectomy: In this type, only the upper part of the uterus is removed keeping the cervix in place.
• Total Hysterectomy: The whole uterus along with the cervix is removed.
• Radical Hysterectomy: The whole uterus along with both sides of the cervix and some part of vagina removed.

When is the Hysterectomy needed?

Hysterectomy can be a last option to many common problems like mass (fibroids) in the uterus, excessive uterine bleeding (AUB), painful periods (endometriosis, adenomyosis) and certain infections. Hysterectomy may be needed in the following cases:

• Tumor(s) in the uterus, cervix, ovary in the endometrium: Hysterectomy is chosen as a last option to treat the above mentioned cancers when other treatment options (like loop electrosurgical excision procedure (LEEP) to remove the cancerous cells, radio therapy or chemotherapy) fail.
• To treat fibroid, when other treatment options including medications and procedures to remove fibroids, fail to respond positively.
• To relieve the symptoms of Endometriosis including severe pain and bleeding during periods, lower back pain and pain in the pelvis, pain during or after sex, bleeding between periods, and other symptoms. Hysterectomy is usually needed when medication or less invasive surgery does not work out.
• To treat prolapse of the uterus when vaginal pessary and other treatments do not work.
• To treat adenomyosis that causes unbearable pain. Hysterectomy is preferred when other treatments have not helped at all.
• To treat chronic pelvic pain as a last resort but unfortunately it does not help with all forms of pelvic pain.
• To cure abnormal vaginal bleeding permanently, when medications like hormones, birth control pills, and non-steroidal anti-inflammatory drugs (NSAIDs) do not work.

There are minimally invasive techniques available for treating some of these conditions.  It is always better to look for other ways to treat your underlying gynaecological problem without having a hysterectomy. Discuss the pros and cons of the hysterectomy with your doctor before taking a final decision.

What to expect in a Hysterectomy surgery?

Before the Hysterectomy:

• The patient may have to undergo several tests to detect cancer, which often alters the approach to surgery. These tests may include:

o Pap test to check for abnormal cells in the cervical area.

o Endometrial biopsy (sample cells from uterus lining are examined) to check for cancerous cells.

o Ultrasound of the pelvic region to see abnormal signs and symptoms in the pelvic area.

• Vaginal area may be cleaned to avoid infection.
• Patient may be given an antibiotic via intravenous to avoid any risk of post-surgical infection.

During the Hysterectomy:

1. Patient is usually anesthetized using general anaesthesia.

2. The actual procedure may last for about one to two hours.

3. Procedure involves emptying the urinary bladder with a urinary catheter.

4. Surgeon may make an incision in the lower abdomen, which may be vertical or horizontal.

5. Doctor may choose the appropriate incision type based on the cause of hysterectomy, uterus size and presence of scars on the abdomen etc.

6. Depending on the clinical history of the patient and the reason of the surgery, the doctor may choose any of the following methods to perform the surgery:

• Abdominal Hysterectomy – The procedure is performed by making 5 to 7 inch cut in the lower abdomen.
• Vaginal Hysterectomy – It involves making an incision in the vagina to operate.
• Laparoscopic Hysterectomy –It involves surgery using laparoscope (thin tube equipped with a camera) by making 3 to 4 incisions in the abdomen.
• Laparoscopically Assisted Vaginal Hysterectomy (LAVH) – It is the procedure of removing the affected uterus through the vagina and the procedure is guided by laparoscope.
• Robotic-assisted Hysterectomy –Involves removal of the uterus using robot through small incisions in the abdomen.

After the Hysterectomy:

• The patient may have to take certain pain killers and antibiotics to avoid infection.
• The patient may have to stay in the hospital for one to two days, if everything goes normal and as expected.
• Hospital stay can be longer for women having cancer as a reason of their hysterectomy.
• Patient may have to use sanitary pads as there might be vaginal bleeding after the surgery.
• If necessary, the patient may have to get treatment for scars after the surgery.

How much time will it take for recovery?

• In case of laparoscopic or vaginal hysterectomy, it may take 3 to 4 weeks to get completely recovered.
• In case of abdominal hysterectomy, recovery usually takes quite longer ie. four to six weeks.
• Patient may not allowed lifting heavy objects and rigorous activity at least for six weeks after the surgery.
• It is recommended to take plenty of rest; normal routine can be resumed after six weeks of the surgery.

What are the risks of hysterectomy?

Hysterectomy when done immediately or delayed comes with its share of issues, some of which are:

• Injury to nearby organs
• Early menopause
• Infections
• Blood clots
• Excessive bleeding
• Allergic reactions to medications
• Cost of the operation
• The risk of anaesthesia and its side effects
• Hospital stay
• Loss of work days
• Adhesions and its effects.
• Painful sex

What can be done to avoid Hysterectomy?

With changing lifestyles and health habits like sedentary desk online jobs, fatty diet intake, stress, lack of exercise etc. some diseases like fibroids, endometriosis have become common in the present day. Another reason which makes a woman vulnerable to such conditions is postponing pregnancy beyond 30 years of age. Thankfully, the advanced technology helps to pick up some conditions in the early stage itself, reducing the risk of treatment. Patient needs to be vigilant and see a doctor immediately, if there are any gynaecological problems, so that they are treated at an early stage, and thereby avoid hysterectomy.

However, lately the number of hysterectomies has been on the rise worldwide. Alongside, interestingly people have also started realising the importance of retaining the uterus. Avoiding hysterectomies helps women to lead a normal life by restoring hormonal action.