A Cleveland Clinic doctor of reproductive health reveals the details, risks and recovery for this common gynecological surgery.
“What I Wish I’d Known About a Hysterectomy”: A Patient’s Experience with an Expert Doctor’s Insight
Updated Sep. 25, 2024
Types of hysterectomies
Dr. Caponero explains the various types of hysterectomies available, each suited for different needs and conditions:
- Partial hysterectomy: involves the removal of just the upper part of the uterus.
- Total (or complete) hysterectomy: includes the removal of both the uterus and the cervix.
- Total hysterectomy with bilateral salpingo-oophorectomy: the uterus, cervix, fallopian tubes (salpingo), and ovaries (oophor) are all removed.
- Radical hysterectomy with bilateral salpingo-oophorectomy: involves removing not only the fallopian tubes and ovaries but also the upper portion of the vagina, some surrounding tissue, and lymph nodes. This type of surgery is often considered when treating cervical or uterine cancer. (It’s also important to note that the “vagina” is different from the outer parts of the female reproductive organ, which is called the “labia.”)
Reasons for a hysterectomy
Dr. Caponero outlines several reasons why a hysterectomy might be necessary for an individual. These include:
- Persistent abnormal vaginal bleeding: If other treatments can’t control abnormal vaginal bleeding, a hysterectomy might be considered.
- Severe endometriosis: This involves uterine tissue growing outside the uterus, causing significant discomfort and other complications.
- Leiomyomas or uterine fibroids: These benign tumors can grow larger, cause pain, lead to increased bleeding, and contribute to pelvic pain that isn’t relieved by other treatments.
- Uterine prolapse: This condition, where the uterus “drops” into the vaginal canal due to weakened support muscles, can result in urinary incontinence or bowel movement difficulties.
- Cancer: Cervical or uterine cancer, or even pre-cancerous conditions, often require a hysterectomy.
For Mary Catherine, her hysterectomy was prompted by uterine fibroids. Initially, her doctor opted to monitor them, but as they grew they caused painful and heavy periods that disrupted her daily life. In conversation with her doctor, it became clear that a hysterectomy was the best solution for improving her quality of life.
Benefits of a hysterectomy
“Benefits to hysterectomies include stopping bleeding associated with menses,” Dr. Caponero says. “This can significantly improve symptoms of anemia, such as fatigue, shortness of breath, and headaches, in some women.”
She adds that the procedure can also relieve pelvic pain and pressure, while lowering the risk of uterine, cervical, and ovarian cancers, depending on which organs are removed.
Mary Catherine looks back and says her decision to undergo a hysterectomy was transformative. “The relief was immediate,” this patient shares. “Before the surgery, I’d be anxious about just stepping out of my front door, terrified of unexpected and heavy bleeding … This surgery truly gave me my life back.”
Cautions for a hysterectomy
“As with any major surgery, there is a small chance that problems may occur,” Dr. Caponero points out. Some of these issues can include blood clots, severe infections, bleeding after the procedure, bowel obstructions, injuries to the urinary tract, damage to nearby organs, or complications from anesthesia.
There are a few other important factors to keep in mind:
- Onset of menopause: If the ovaries are removed along with the uterus, you’ll experience immediate menopause, no matter your age. This comes with symptoms like hot flashes, mood swings, and vaginal dryness. These symptoms may be controlled with hormone replacement therapy or other treatment as guided by a licensed physician.
- Loss of fertility: A hysterectomy ends your ability to conceive, which can be emotionally and psychologically challenging if you desire to have children.
- Recovery time: The healing process can be lengthy and painful and impact your daily activities and overall quality of life for several weeks or even months.
- Pelvic floor health: Removal of the uterus may lead to pelvic floor issues, including organ prolapse and urinary incontinence, and could also impact sexual function.
Discussing these thoroughly with your healthcare provider can help you make a decision that aligns with your health needs and life plans.
Mary Catherine’s surgery involved the removal of her ovaries due to her family’s history of ovarian cancer. This meant going through menopause earlier than expected, but she worked closely with her doctor to handle the symptoms. She reflects on the emotional journey: “I always wanted to have more children … The fibroids and heavy periods made it difficult.” Despite the challenges, she found some relief and closure after her surgery, though. “It was a bittersweet time for me,” she says.
What hurts the most after a hysterectomy?
“If a minimally invasive hysterectomy is completed with small incisions in the belly, it is common to experience gas pain, abdominal swelling, and shoulder pain for 24 to 72 hours after the surgery,” Dr. Caponero says. This discomfort comes from the carbon dioxide gas used during the procedure to give a clearer view of your internal organs. “A warm shower, heating pad, and walking may help,” she suggests.
This type of surgery, whether it’s laparoscopic, robotic, or vaginal, usually has a recovery period ranging from two to four weeks, though returning to more intense activities might take a bit longer. During this time, it’s normal to feel unusually fatigued and experience some pain at the incision sites, Dr. Caponero says.
For those undergoing open or abdominal surgery, dealing with pain at the incision site is typical, and the recovery timeline is longer—usually about six to eight weeks.
Mary Catherine, who underwent abdominal surgery due to the size of her fibroids, faced a lengthy recovery period. She says with her active lifestyle, being sidelined was especially hard. She leaned heavily on her husband and two daughters during this time. “Being a person who’s always on the move, it was really tough to be stuck at home.” Her advice? “Make sure you have a support system in place before your surgery.”
Reasons doctors might not recommend a hysterectomy
Even though complications from surgery are rare, they can be quite serious. “If you are considering a hysterectomy, it is important to find a surgeon who understands your medical history and can determine if hysterectomy is the best option for you,” Dr. Caponero advises.
Also consider that many health conditions that once required a hysterectomy can now be addressed with less invasive options. These alternatives often involve fewer risks and complications. Doctors prefer to explore these conservative methods first, especially when considering irreversible surgical procedures. For younger patients, particularly those who may want to conceive, preserving fertility and hormonal function is a priority.
When should you consider alternatives to a hysterectomy?
“It is always important to consider alternatives when deciding to have a hysterectomy,” Dr. Caponero says. “This is because a hysterectomy is only one way to treat problems involving the uterus. For certain conditions, however, hysterectomy may be the best choice.”
It’s important to work closely with your healthcare provider to explore all possible options. Understanding the alternatives specific to your condition can help you make a well-informed decision.
How to prepare for a hysterectomy
It’s important to be in the best possible health before undergoing any major surgery. Start by following your doctor’s advice closely—this includes going through all the medical evaluations, preoperative tests, and getting the green light from any specialists involved. Have an open chat with your surgeon about your surgical options, what risks are involved, and how the procedure might affect your fertility. It’s also a good idea to make some positive lifestyle changes, like quitting smoking and adjusting any medications. “By optimizing your physical health before undergoing surgery, you will optimize your post-operative outcomes,” shares Dr. Caponero.
At home, make sure you’re set up for a smooth recovery. Line up some help for the days following your surgery, whip up some meals to store in the freezer, and create a cozy spot where you can rest and recuperate. Lastly, don’t hesitate to discuss with your doctor how to manage the changes related to fertility and hormones. This conversation can help you feel more in control and prepared for what’s to come.
About the expert:
Catherine Caponero, DO, is a board-certified OB/GYN at the Cleveland Clinic. Dr. Caponero serves as a Clinical Assistant Professor of Reproductive Biology, Obstetrics, and Gynecology at the Cleveland Clinic Lerner College of Medicine of Case Western Reserve University. She specializes in gynecologic ultrasound, holding credentials from the American Institute of Ultrasound in Medicine. Additionally, she is a certified practitioner with The Menopause Society.
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Originally Published: September 25, 2024
