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Hysterectomy is the surgical removal of the uterus and is the second most common surgery specific to women. Deciding to have a hysterectomy can be a deeply personal and difficult choice. Doctors usually recommend the procedure after other treatment options have been explored and either failed or are not preferred by the patient.
This article will detail the hysterectomy types, how a hysterectomy is performed and what to anticipate during the recovery process.
Synopsis
What Is Hysterectomy?
A hysterectomy is a surgical operation that involves the complete or partial removal of the uterus. The uterus, also referred to as the womb, is where a fetus develops during pregnancy and where the endometrial lining, which is shed during menstruation, forms.
After undergoing a complete hysterectomy, you will no longer experience menstrual periods or be able to become pregnant.
Types of Hysterectomy
There are several types of hysterectomy, including:
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Partial (Supracervical) Hysterectomy: This procedure involves the removal of only the upper part of the uterus.
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Total Hysterectomy: This surgery removes both the uterus and the cervix.
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Radical Hysterectomy: In this procedure, the surgeon removes the uterus, cervix, and the upper part of the vagina. They may also remove the ovaries, fallopian tubes, and nearby lymph nodes.
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Total Hysterectomy with Bilateral Salpingo-Oophorectomy: This type includes the removal of one or both ovaries and fallopian tubes. A salpingo-oophorectomy can be performed during a hysterectomy.
When Is a Hysterectomy Needed?
Individuals who have a hysterectomy are unable to become pregnant and may experience early menopause. Consequently, if possible, a doctor will likely avoid recommending a hysterectomy to someone who has not yet entered menopause.
However, a doctor may suggest a hysterectomy if you are experiencing one or more of the following conditions:
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Unusually heavy vaginal bleeding
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Chronic pelvic pain
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Uterine fibroids, which are non-cancerous growths in the uterus
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Uterine prolapse, where the uterus descends toward or into the vagina
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Endometriosis, where the endometrium—the inner lining of the uterus—grows outside the uterus
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Adenomyosis, where the endometrium grows into the uterine walls
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Cancer of the uterus, cervix, ovaries, or endometrium
Hysterectomy Procedure
Let’s help you understand the hysterectomy procedure under the following sub-sections:
Preparation Before a Hysterectomy
An experienced gynaecologist in Bangalore will provide instructions on how to prepare for a hysterectomy. The specifics may vary based on the type of hysterectomy and the reason for the procedure, but common advice includes:
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Discontinue blood-thinning medications and aspirin a week before the procedure.
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Avoid smoking a few days before the procedure.
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Avoid eating and drinking for several hours before the procedure.
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Pack an overnight bag in case an extended hospital stay is recommended.
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Arrange transportation to and from the hospital.
Additionally, before the procedure, you should inform the doctor if you:
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Are you currently taking any prescription or over-the-counter medications, vitamins, or supplements
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Know or suspect you are pregnant
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Have breathing issues, such as asthma or sleep apnea
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Have any allergies to medications or anaesthetics
During the Procedure
Your surgeon will decide on the type of hysterectomy and the most suitable surgical method. You’ll be connected to monitors to track your heart rate. An intravenous (IV) line will be placed in your arm to administer medications and fluids. An anesthesiologist will provide general anaesthesia to induce sleep for the procedure.
Surgical Methods for Hysterectomy:
Your doctor might use various surgical approaches for the hysterectomy.
- Vaginal Hysterectomy
A surgeon removes the uterus through an incision at the top of your vagina. There are no abdominal incisions. Dissolvable stitches are used inside your vagina. This method has the least complications and the fastest recovery (up to four weeks). Many women head home on the same day of surgery.
- Laparoscopic-assisted Vaginal Hysterectomy (LAVH)
A laparoscope is inserted into your lower abdomen through the vaginal incision for better visualisation. The uterus is removed through the vagina, with no abdominal incisions. Most people go home on the same day, and recovery is shorter and less painful compared to an abdominal laparoscopic hysterectomy.
- Abdominal Laparoscopic hysterectomy
A laparoscope is inserted into your lower abdomen through a small incision near your belly button, with additional small incisions for surgical tools. The uterus is removed in pieces through the abdominal incisions or possibly through the vagina. Recovery is typically shorter and less painful than an abdominal hysterectomy.
- Robotic-Assisted Laparoscopic Hysterectomy
Similar to an abdominal laparoscopy but performed with robotic assistance. A laparoscope and thin surgical tools are inserted through several small incisions around your belly button. The surgeon controls the robotic arms and instruments. Recovery is comparable to that of a laparoscopic hysterectomy.
- Abdominal Hysterectomy
The uterus is removed through a 6- to 8-inch-long incision in your abdomen, made from your belly button to your pubic bone or across the top of your pubic hairline. Stitches or staples are used to close the incision. This approach is used for cancer, very enlarged uteri, or disease spread to other pelvic areas. It usually requires a longer hospital stay (two or three days) and an extended recovery time.
After the Procedure
After surgery, you may feel drowsy as the anaesthesia wears off. The doctor will administer pain relievers and monitor vital signs.
Some people may be discharged from the hospital on the same day, while others might need to stay longer. A hospital stay is more likely if the hysterectomy is part of cancer treatment.
In the weeks following the surgery, individuals may experience vaginal bleeding or spotting and mild lower abdominal pain.
Recovery from a hysterectomy takes time, often several weeks, before returning to normal activities.
During this period, getting plenty of rest and engaging in light exercise, such as walking, is crucial. However, it is important to avoid the following activities for 4–6 weeks after surgery:
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Lifting heavy objects
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Pushing or pulling objects
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Swimming
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Using tampons
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Douching
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Sexual intercourse
Conclusion
A hysterectomy is a common procedure that can alleviate symptoms from various medical conditions and, in some cases, be lifesaving. Post-surgery, you won't be able to get pregnant and may experience early menopause. However, it can help with heavy or irregular bleeding and pelvic pain.
Consult with your gynaecologist on whether a hysterectomy is beneficial for you. There are many factors to consider before deciding on this surgery.
FAQ's
Some of the factors that go into decision-making include:
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The reason for the surgery
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Whether other procedures need to be performed at the time of surgery
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History of previous surgeries
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Other medical conditions like obesity
Follow your surgeon's guidelines closely. Ensure you get ample rest, but also make sure to move around as often as possible. Start with short walks and gradually extend the distance you walk each day. Avoid lifting heavy objects until your surgeon allows you. Refrain from inserting anything into your vagina during the first 6 weeks, which includes avoiding douching, sexual activity, and tampon use.
After your recovery, continue to visit your obstetrician/gynaecologist for routine gynecologic exams and overall health care. Depending on the reason for your hysterectomy, you may still require pelvic exams and cervical cancer screenings.
Alternatives to a hysterectomy:
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Monitor the condition to see if it improves on its own
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Use medications to manage symptoms like painful periods or abnormal bleeding
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Have surgery to remove the lining of the uterus
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Use procedures to shrink or remove uterine fibroids
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Perform exercises to strengthen uterine muscles
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Use a pessary to support the uterus if you have a prolapse
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Undergo surgery for endometriosis or vaginal bleeding that doesn’t involve removing the uterus.
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