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Hysterectomy FAQ

 

What is a hysterectomy?

Hysterectomy is the surgical removal of the uterus or womb. This can be performed through the abdominal wall, through the vagina (if the fibroids are small) or by laparoscope (a small tube inserted near the belly button) or hysteroscope (a small tube is inserted through the vagina).

The cervix can also be removed and some surgeons remove the ovaries as well, although this is not part of the fibroid treatment and is controversial.

 

How many are performed?

Over 75,000 hysterectomies are performed in the UK each year. 60% of these are for fibroids. There have been recent calls in the medical press to reduce the number of hysterectomies, as less invasive treatments are available.

 

What happens?

The abdominal approach is usually used for the treatment of fibroids. An incision is made in the abdomen and through the muscle. The uterus is removed.

There is considerable pain after the operation normally lasting from 3 to 10 days.

The operation is associated with heavy haemorrhaging requiring blood transfusions. A high fever occurs in a large proportion of patients.

 

How long would I stay in hospital?

The normal stay in hospital is between 5 days and 2 weeks.

 

How long does it take to recover?

Hysterectomy is very invasive surgery. There is danger of a hernia (protrusion of a portion of organ or tissue) if there is any lifting or stretching of the abdomen. For this reason women must not even lift a kettle or drive a car for at least 6 weeks.

Hormone replacement will probably be required if the uterus is removed. If the ovaries are also removed it will normally be given afterwards.

Return to work is normally between 2 and 3 months, depending on the nature of the work. Full recovery may take longer.

 

What care will I need?

Most women will need considerable care at home for at least 6 weeks, because they will not be able to lift or stretch or drive. This means another member of the family or a friend will need to look after them.

 

Success rate

Hysterectomy is very successful at removing all symptoms associated with fibroids. There is no re-growth of the fibroids.

It can also protect against cancer of the uterus, and cervix if this is removed and ovaries if they are removed. However, NICE guidelines state that healthy ovaries should not be removed.

 

Side effects and safety

The most serious side effects arise because hysterectomy is such an invasive procedure. Urinary tract infection (from the bladder to the kidneys) occurs in 3.3% to 25% of women and wound infections in 25%.

Deep vein thrombosis (DVT) occurs in approximately 15-18% of patients having gynae surgery. This is a serious complication where a blood clot occurs in the leg (usually) due to the surgery and subsequent inactivity. This blood clot can move to the heart and lungs causing a potentially fatal pulmonary embolism.

Surgical damage can occur to the bladder (1.1-1.7%) resulting in incontinence in some. It can also occur in the urinary tract (0.1-1.7%) and the bowel (gut) (0.5-5%). This kind of damage can have long-term side effects. Surgical damage to the bowel can lead to serious infection.

There can also be surgical damage to the nerves supplying the vagina, which will effect the woman's enjoyment of sex considerably.

The overall surgical complication rate is 9-16%.

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Long term side effects

Menopause occurs 5 years earlier after hysterectomy. Women are infertile and will not have periods.

Normally women will have hormone replacement therapy, as early menopause leads to a higher incidence of heart disease, osteoporosis and bowel cancer.

As a result of changes in hormone levels and early menopause enjoyment of sex and sex drive can be adversely affected.

 

Effect on fertility

Women are infertile after hysterectomy.

 

Effect on sex

Sexual dysfunction is a serious long-term side effect of hysterectomy that is usually not mentioned to women and there is also very little research on it. This affects not only the woman's enjoyment and desire for sex, but can also challenge and put a strain on marriages and personal relationships.

If women have been suffering from menorrhagia, vaginal dryness and general illness before hysterectomy, the relief of these symptoms and improvement in general health is likely to enhance their desire for and enjoyment of sex. The loss of the fear of becoming pregnant and lack of periods may have the same effect.

However, hysterectomy is also a direct cause of sexual dysfunction -

  • The uterus and cervix are involved in the female orgasm and have rhythmic muscle contractions during it. Removal of the uterus and sometimes the cervix as well can result in a lessening of the sensation of an orgasm, which is quite noticeable in some women. The pressure effects and orientation of these organs are also lost when they are removed which adversely affects the orgasm
  • The vagina is likely to become narrower and shorter after hysterectomy. This can make sex painful and full penetration difficult
  • Surgical damage of the nerves, particularly to the vagina can result in loss of sensation
  • Surgical damage to the bladder and intestine can result in incontinence, which can have an effect on sex
  • Changes in hormone levels and early onset of menopause can lead to loss of libido (sexual desire), vaginal dryness and difficulty achieving an orgasm. If the ovaries are also removed then the loss of testosterone will lead to a reduction is sex drive
  • Some women feel that they are no longer feminine after hysterectomy and this can have psychological effects on their self-esteem and desire for sex.

 

Effect on mood and depression

There is considerable evidence that some women feel very depressed after hysterectomy. This may be due to the changes in hormone levels, the psychological feeling of loss of femininity or on-going illness. It can be very debilitating to those suffering from it.

 

Questions to ask your doctor

  • How long will I be in hospital?
  • How will I feel immediately after the procedure?
  • How much pain will I suffer?
  • How much support will I need at home?
  • How long will my partner have to take off work to look after me?
  • What will I be able to do after the procedure?
  • When can I return to work?
  • How long will it take until I feel completely better?
  • What are the short-term side effects?
  • What are the long-term side effects?
  • What could go wrong?
  • Will it have any effect on my sex life?
  • Will I be able to become pregnant?
  • How will it affect my periods and menopause?
  • Will I need HRT?

 

Further Information

For more information please contact the Hysterectomy Association.

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