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(Wednesday, 3rd Sep, 2014)
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Hysterectomy

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Hysterectomy

What is a hysterectomy?

A hysterectomy is an operation in which the womb (uterus) is removed. It is one of the most frequently performed operations.

There are three types of hysterectomy a woman can have:

  • Total hysterectomy: This is the removal of the womb and cervix. It is the most common type of hysterectomy. Sometimes the fallopian tubes and ovaries are removed in addition to the uterus.
  • Sub-total hysterectomy: This is removal of the body of the womb. The cervix is left behind. This operation is now rarely carried out.
  • Radical hysterectomy: This is the removal of the uterus, cervix, a small piece of the upper part of the vagina and lymph nodes from within the pelvis. Radical hysterectomies are only performed in cases of cervical cancer.

 

When is a hysterectomy necessary?

A hysterectomy may be necessary for the following conditions:

  • Heavy periods. If a woman has unusually heavy periods which infringe upon her daily life, she may consider a hysterectomy later in life, if she has decided that she doesn't want any (more) children.
  • Fibroids. Benign tumours of fibrous and muscular tissue, which develop in the muscular wall of the womb.
  • Endometriosis. The endometrium, which is the lining of the womb, grows in other places, such as on the ovaries.
  • Prolapsed womb. The womb starts to sag downwards.
  • Cancer of the cervix (neck of the womb), cancer of the body of the womb (endometrial cancer) and sometimes for cancer of the ovary.
  • Pelvic Inflammatory Disease (PID). A condition in which the womb, fallopian tubes and ovaries are inflamed and infected.

Remember a hysterectomy is not always necessary in these conditions. Alternative treatments may be available. You should ask your doctor about other options if a hysterectomy is recommended.

What happens after the operation?

You will remain in hospital for a few days. However you will be encouraged to get mobile within the first 24 hours. You should also try to eat and drink during this time.

Once you get home recovery time varies, however it will probably take around four to six weeks. Convalescence time is usually longer for women who have had a radical hysterectomy.

This can be quite a difficult time for the woman. If the hysterectomy was carried out to treat cancer, the waiting time for results from the operation is likely to be stressful.

It can be difficult for a woman to come to terms with the loss of her womb, even where the condition being treated is benign and even if she was not planning to have any (more) children. There may be a real sense of loss or regret.

Some women may get depressed after a hysterectomy. These women should be encouraged to discuss how they are feeling with family, friends, a doctor or a support group.

On the other hand, some women may feel much happier after a hysterectomy as whatever problem necessitated the operation is now gone.

Will a hysterectomy affect my sex life?

Some women may experience some loss of sex drive (libido) after a hysterectomy, however most women do not experience a decrease in their sex-drive. In fact, many women experience an improvement in their sex life.

This is especially true if, whatever condition necessitated the operation in the first place, made sexual intercourse painful or uncomfortable.

Most women can start to have intercourse again around six weeks after their hysterectomy.

What are some of the possible complications of a hysterectomy?

When complications occur, they are usually minor. They can include:

  • Urinary infections: These are the most common type of infection after a hysterectomy. Many women have difficulty passing urine immediately after surgery. As a result a catheter (thin, plastic tube) is usually left in the bladder to drain the urine for 24 hours after the operation. This is necessary to prevent retention of urine but increases the risk of developing a urinary tract infection.
  • Bowel problems such as constipation: Almost every woman will experience some sort of bowel upset after a hysterectomy, however this is usually temporary. It is important to take simple measures to try to avoid constipation, including adequate pain relief, good fluid intake and taking stool softeners if necessary.
  • Wound infections: These may be more likely in women who are overweight. They are not usually serious and respond to simple treatment.
  • Chest infections are quite common, especially in those who have had chest problems before or who smoke.
  • Some pain and stiffness is common. While rest is essential, it is important not to lie in bed for long periods of time. Moving around is important in order to help the healing process.
  • As a result of blood loss some women may experience anaemia, which in turn aggravates feelings of fatigue. This will be monitored and treated with iron tablets if necessary.
  • Blood clots are more likely after any surgery and this is one of the main reasons that people are encouraged to get up and move around soon after surgery as immobility further increases the risk of developing blood clots. In some cases a blood-thinning medication will be given to prevent blood clots.

Are there other consequences of hysterectomy?

Women who have had a hysterectomy will no longer be able to have children, she will no longer have menstrual periods and will not need to use contraception.

If the ovaries have been removed, it is important to consider hormone replacement therapy. Women, especially younger women, who have had their ovaries surgically removed are particularly at risk of developing osteoporosis which can be prevented by taking hormone replacement therapy. Women who have had a hysterectomy will require oestrogen alone. This can be given in the form of tablets, patches or implants.

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