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Facts About Hysterectomy Surgery



In our latest Ask the Consultant article Miss Nandita Deo, Consultant Gynaecologist talks key facts on hysterectomy.
 
What is a hysterectomy?
A hysterectomy is an operation to remove the uterus (womb). It is a common gynaecological operation, and one in five women would have had a hysterectomy by the age of 55. Following the operation, you will no longer have periods or be able to get pregnant.
 
Why is a hysterectomy done?
Hysterectomy could be offered as a treatment for: 
  • Painful, heavy or frequent periods
  • Uterine fibroids (benign growths in the womb)
  • A prolapsed womb caused by dropping of the womb
  • Cancer of the uterus, ovaries, cervix, vagina or fallopian tubes
  • Adenomyosis – caused by the lining of the womb/uterus growing in the muscles of the womb (called the myometrium)
  • Endometriosis – caused by presence of the lining of the womb in the ovaries or abdominal cavity.
 
Types of hysterectomies
There are three ways to carry out a hysterectomy:
  • Abdominal hysterectomy - the womb is removed through a cut in the tummy
  • Laparoscopic hysterectomy (keyhole surgery) - small cuts are made in the abdomen (tummy) and the womb is then removed through the vagina
  • Vaginal hysterectomy - the womb is removed through your vagina and there is no scar on the tummy.
 
There are three main types of hysterectomies:
 
Total Hysterectomy: both the body and the neck of the womb (cervix) are removed;
 
Subtotal Hysterectomy: only the body of the womb is removed and not the cervix. If a subtotal hysterectomy is performed, it is recommended that cervical smears are done regularly. If the result of the smear test is normal, it should be repeated every three years till the age of 50 and every 5 years till the age of 64 years.
 
Radical Hysterectomy: the womb and surrounding tissues are removed, including the fallopian tubes, part of the vagina, ovaries, lymph glands and fatty tissue
 
Removal of the ovaries and the fallopian tubes along with the womb is called a hysterectomy with bilateral salpingo-oophorectomy. 
 
The menopause, which normally occurs around the age of 50, may arrive a little earlier following a hysterectomy. If the ovaries are removed at the time of the hysterectomy, the female hormones are no longer produced and the woman goes through a surgical menopause. Hormone replacement therapy could be considered if there are severe menopausal symptoms. 
 
Complications of a hysterectomy
Most women will go on to have an uncomplicated operation. But, as with any major surgery, a hysterectomy has its own risks. Risks include chances of infection, bleeding which might sometimes necessitate a blood transfusion, risk of injury to adjacent organs such as bowel, bladder, ureters (tube connecting the kidney to the bladder) and thrombosis. 

What to expect after a hysterectomy
After the operation, women have a fluid drip and a urinary catheter. Pain relief is offered after the operation on a regular basis.  
 
Recovering after a hysterectomy
Women are discharged from hospital around three days after an abdominal hysterectomy. The discharge may be earlier for women who have had a vaginal hysterectomy or a laparoscopic hysterectomy. Mobilising early after a hysterectomy enhances recovery and this should be initiated as early as the day after the operation by standing up and taking short walks. Early initiation of eating and drinking improves the recovery period. It is not unusual to feel tired for many weeks after the operation. 
 
The skin wound in an open or laparoscopic hysterectomy is usually held together with stitches and occasionally with clips in an open hysterectomy. The stitches in a vaginal hysterectomy are internal and will dissolve naturally. The skin stitches heal in a week but the internal sutures take longer to dissolve.  Driving a car or swimming can resume after six weeks. Sexual intercourse can be gently resumed after six weeks.      
   
Brownish vaginal discharge can be normal unless it is smelly, heavy or itchy and may suggest an infection.  The recovery period is around 6 - 8 weeks for open hysterectomies and may be slightly shorter with vaginal and laparoscopic hysterectomies.  
 
Weight gain, excessive facial hair, depression or difficulty in making love is not a side effect of hysterectomy. Removal of the ovaries is associated with lowered androgen production, a male hormone that is a sexual stimulant. This may be associated with a loss of libido. 

Recovery is a personal experience and determined by a wide range of complex factors and some women take longer to recover. 
 
While recovering at home, women should take rest and avoid lifting weight, but also ensure that they gradually increase activity levels. Some women may experience a psychological loss of libido and may need counselling. Some women experience a sense of loss after a hysterectomy and this could be minimised by a good understanding of why the operation is being done and having explored other treatment options.

Making an appointment to see Miss Nandita Deo
Miss Deo has clinics at The Holly Private Hospital on Wednesday afternoons.

To book an appointment call our friendly Appointments Team on 020 8936 1201. 
 
References: 
www.hysterectomy-association.org.uk
www.womens-health-concern.org/help-and-advice/factsheets/hysterectomy/
www.nhs.uk
 
Date: 16/03/2018
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