A hysterectomy is surgery to remove the uterus. Other organs such as the cervix, ovaries, fallopian tubes, lymph nodes and parts of the vagina may also be removed at the same time.
Why a hysterectomy is done
A hysterectomy may be done to:
- treat cancers of the female reproductive organs
- treat precancerous conditions of the cervix that have not gone away after other types of treatment
- stage cancers of the female reproductive organs to find out how far cancer has spread
- treat non-cancerous conditions of the female reproductive organs that have not responded well to other types of treatment
Types of hysterectomy
There are different types of hysterectomy. The type recommended to you as part of your cancer treatment depends on the type and size of the tumour, the stage of the cancer, your age, other treatments you’ve had and your overall health.
A total hysterectomy removes the uterus and the cervix. A total hysterectomy is also called a simple hysterectomy.
A subtotal hysterectomy removes the uterus but leaves the cervix in place.
A radical hysterectomy removes the uterus, cervix, the uppermost part of the vagina next to the cervix and the nearby ligaments that support the uterus. Nearby lymph nodes in the pelvis are often removed at the same time as part of the staging operation.
Removing the ovaries and fallopian tubes
Sometimes one or both of the ovaries and fallopian tubes are removed at the same time as a hysterectomy. The removal of the ovaries and fallopian tubes is called a salpingo-oophorectomy. A bilateral salpingo-oophorectomy (BSO) removes both ovaries and fallopian tubes. A unilateral salpingo-oophorectomy removes one ovary and one fallopian tube.
A salpingo-oophorectomy is used to treat ovarian and fallopian tube cancers and is part of a staging operation for uterine cancers.
How a hysterectomy is done
A hysterectomy is most often done in the hospital using a general anesthetic (you will be unconscious) or a spinal or epidural anesthetic (you will be awake but not able to feel the surgery). You will stay in the hospital for a few days after any type of hysterectomy. Your doctor may prescribe pain medicine and antibiotics to prevent infection.
A hysterectomy can be done using different incisions (surgical cuts):
An abdominal hysterectomy is done through a large incision in the abdomen.
A laparoscopic hysterectomy is done by laparoscopy. Laparoscopic surgery uses a thin, tube-like instrument with a light and lens (called a laparoscope). It allows the surgeon to see the organs to be removed. The laparoscope and surgical tools to remove tissue are passed through small incisions in the abdomen. The uterus is commonly removed through the vagina.
Robotic surgery can also be used to remove the uterus. It is also done by laparoscopy, but the surgeon sits at a station a short distance away from the operating table and uses a computer to move robotic arms that are connected to surgical instruments.
A vaginal hysterectomy is done through small incisions in the upper part of the vagina. The uterus is removed through the vagina. A vaginal hysterectomy may be used to treat early stage cancers of the cervix and uterus.
Women who have a vaginal hysterectomy or a laparoscopic hysterectomy generally recover more quickly and get back to their regular activities sooner than women who have an abdominal hysterectomy. Complete recovery from an abdominal hysterectomy will take 6 to 8 weeks.
To help you recover from surgery, get plenty of rest for the first 2 to 4 weeks after surgery and don’t do any heavy lifting of more than 20 pounds during the first 4 to 6 weeks after surgery.
Check with your doctor about when it’s safe for you to increase your level of activity and when you can go back to work. Your doctor will also let you know when it is safe for you to drive, do heavy or strenuous exercise, start taking baths again and have sexual intercourse.
Side effects can occur with any type of treatment, but not everyone has them or experiences them in the same way. Side effects of surgery will depend mainly on the type of hysterectomy you have and your overall health.
Short-term side effects can happen during, immediately after or a few weeks after a hysterectomy. They are usually temporary. Short-term side effects of hysterectomy include:
- bladder problems
- blood clots in the legs or in the lungs
Short-term bladder problems may include losing the feeling of having to urinate or not being able to empty the bladder completely. Some women also may develop long-term bladder problems.
Long-term side effects can develop months or years after having a hysterectomy and can last a long time. If you have a hysterectomy, you will be infertile (not able to become pregnant) because your uterus has been removed. You may also experience:
- a buildup of lymph fluid in the legs or abdomen if lymph nodes in the pelvis are removed (called lymphedema)
- weakness of the muscles and ligaments that support the vagina, bladder and rectum
- vaginal shortening (may occur after a radical hysterectomy)
- blockage of the intestine caused by bands of scar tissue (called adhesions)
- treatment-induced menopause in premenopausal women, if the ovaries have been removed
Great progress has been made
Some cancers, such as thyroid and testicular, have survival rates of over 90%. Other cancers, such as pancreatic, brain and esophageal, continue to have very low survival rates.