Hysterectomy Procedures: Types, Surgical Techniques, Recovery Times and More

What is a Hysterectomy?

Hysterectomy is the surgical removal of the uterus. Although it is the second most common surgery unique to women, choosing to undergo a hysterectomy can be a deeply personal and challenging decision. Physicians recommend the procedure after other treatment options have been discussed and are unsuccessful or are not preferred by the patient.

In this article, we will explain how hysterectomies are done and what to expect during the recovery period.

Reasons for a Hysterectomy

Common reasons women undergo a hysterectomy include:

• Endometriosis
• Heavy periods
• Uterine fibroids
• Cancer or pre-cancer of the uterus, ovaries or cervix
• Uterine prolapse
• Gender affirming surgery

Types of Hysterectomies

Total hysterectomy involves removing the uterus and cervix. A supra-cervical hysterectomy (previously described as partial), removes the uterus while leaving the cervix place. The fallopian tubes are also typically removed at the same time, and this is a separate procedure called salpingectomy. Ovaries are not removed during hysterectomy unless indicated by age or a separate problem. A hysterectomy alone does not induce menopause!

Surgical Techniques

There are different ways to perform a hysterectomy. Your surgeon will recommend a technique based on the size and shape of your uterus, the reason for your hysterectomy, and any previous deliveries/surgeries. Depending on these factors, the surgery will typically take 1-3 hours under general anesthesia (with a breathing tube).

• A vaginal hysterectomy is performed through an incision in the vagina. The uterus is removed vaginally with no abdominal incisions. This is often an option for women who have had a vaginal delivery.
• Laparoscopic hysterectomy (traditional or robotic) is the most common route performed in the US. The surgeon inserts a laparoscope (camera) through 3-4 small incisions in the abdomen. The uterus is most commonly removed through the vagina with that being the largest incision for the case (although this can vary with the size of the uterus).
• An abdominal hysterectomy requires a larger incision in the lower abdomen. It is much less common now and reserved for cases when the uterus is large or if the physician needs to examine the surrounding tissue.

Recovery

After a hysterectomy, patients will spend 6-24 hours in recovery at the hospital. They manage pain with ibuprofen, Tylenol, and a stronger narcotic pain medication. The stay may be extended based on specific circumstances, but most patients go home the same day of the procedure.

The standard recovery time is around 6 weeks. During those 6 weeks, women shouldn’t lift anything heavier than 15 pounds. They should also remain on pelvic rest for 6-8 weeks, which means no intercourse or inserting anything into the vagina. Women often feel fatigued or worn down for about a month after the procedure.

It’s important to follow recovery directions, especially lifting restrictions. Lifting restrictions are in place to prevent vaginal cuff dehiscence, which is when the vaginal incision opens. Vaginal cuff dehiscence is an emergency situation because it creates an open hole into the abdominal cavity.

Signs of overdoing it after a hysterectomy surgery include increased soreness or vaginal bleeding.

Risks and Potential Complications

Complications with this type of surgery are rare. Like any surgery, however, some risks exist.

Risks of a hysterectomy include:

• Bleeding: It’s normal to lose blood during this surgery—maybe even enough to fill a soda can.
• Infection: Antibiotics are given prior to surgery to reduce the risk of infection. It is important to monitor for fevers after surgery.
• Risk of injury to surrounding areas: There is less than a 1% chance of injury to surrounding tissue or organs.
• Complications with anesthesia: This can include postoperative nausea, developing a blood clot, and other risks that are reviewed with you by the anesthesia team.

Life after a Hysterectomy

Most women do not miss their uterus and the symptoms that lead to hysterectomy. After the initial recovery period, they are able to focus on the important things in their life, rather than bleeding and pain. If a hysterectomy was required prior to completing childbearing, this can be a significant loss for women. At Madison Women’s Health, we can connect you to mental health specialists to help you during this transition and help you navigate ways to parenthood.

Hormones & Sex

Hormone replacement is not necessary after a total hysterectomy. Women will continue to ovulate. They may even experience PMS symptoms. Menopause (cessation of ovulation) will occur in the same fashion as if they had their uterus, just without the bleeding symptoms.

After 6-8 weeks of pelvic rest, it is typically ok to have sexual intercourse after a hysterectomy if your surgeon has done an exam and given the go-ahead. A lot of research has also shown that hysterectomy does not negatively impact orgasm/sex life.

Conclusion

Even though hysterectomy is a common procedure, deciding if or when to have this surgery is a big step. Your OBGYN can help you determine if it’s the best choice for you. At Madison Women’s Health, we are on your side as you consider and prepare for the surgery — and we’re with you through recovery.

Dr. Ashley Durward has been providing healthcare to women in Madison since 2015 and joined Madison Women’s Health in 2019, specializing in high and low risk obstetrics, contraception and preconception counseling, management of abnormal uterine bleeding, pelvic floor disorders, and minimally invasive gynecologic surgery.