Understanding the physical changes that may come with a hysterectomy can help manage your expectations. Here are five questions to ask your doctor.
A hysterectomy is a common gynecological surgery, yet the facts about this procedure aren’t always clearly communicated. In an American Urogynecologic Society survey of more than 1,200 women, 30 percent of the respondents didn’t know that removing the uterus stops menstruation, and 13 percent mistakenly thought a woman could still get pregnant after a hysterectomy.
Before you decide to have a hysterectomy, it’s important to know how your body will change after the procedure. Here are five common questions to ask your doctor — the exact answers will depend on the kind of surgery you and your doctor decide is the best treatment for you.
1. Will I have a scar after a hysterectomy?
Not necessarily, says Linda Bradley, MD, vice chair of obstetrics and gynecology at the Cleveland Clinic in Ohio. Four of the five hysterectomy surgical options available are minimally invasive. These include:
- Vaginal hysterectomy: This is the most minimally invasive surgery, with the uterus taken out through the vagina. There is no visible scarring.
- Laparoscopic supracervical hysterectomy: Three to four small incisions are made in the abdomen in this surgical procedure. Through them, the doctor inserts a thin, lighted tube with a camera (laparoscope) to see inside your pelvis; the uterus is sectioned into small pieces that are removed through the incisions.
- Laparoscopically assisted vaginal hysterectomy: This procedure requires small abdominal incisions and a vaginal incision. A laparoscope and other surgical tools are inserted in the abdominal incisions, and the uterus is removed through the vagina.
- Robotic-assisted hysterectomy: This type of hysterectomy procedure, performed with the aid of a computer and robotics, involves small abdominal incisions.
The fifth surgical option is an abdominal hysterectomy, the traditional approach. This procedure is the most invasive surgery with the most noticeable scar. In this procedure, the uterus is removed through a large incision in the abdomen — a horizontal cut along the bikini line, or a vertical incision if required.
Over time, any scars from a hysterectomy will usually become lighter in color, but the skin will never look exactly the same. Some women, especially women of color, are prone to keloids, a thickening of the scar tissue, Dr. Bradley says.
2. How much pain should I expect after having a hysterectomy?
Pain also depends on the hysterectomy surgical option you undergo. Most women with a laparoscopic or vaginal hysterectomy experience pain for two to three weeks. Some women have less pain after laparoscopically assisted vaginal hysterectomy than they do after a basic vaginal hysterectomy, according to a research review that appeared in The Journal of Minimally Invasive Gynecology in 2013. With abdominal hysterectomy, pain may last for three to five weeks.
The amount of pain and scarring also depends on what exactly is removed during your hysterectomy, which should be based on your reason for having the procedure, the expertise of your surgeon, and the surgical equipment available. For instance, just your uterus may be removed or your cervix may be taken out as well. Or if you have cervical cancer, for example, you might need a radical hysterectomy, which also takes out tissue on either side of the cervix and the upper part of the vagina. Each of these procedures can have a different effect after surgery when it comes to how much pain you experience.
3. What is the risk for complications after a hysterectomy?
While most women don’t have health problems during or after the surgery, risks may include:
- Injury to nearby organs
- Anesthesia problems, such as breathing or heart problems
- Blood clots in the legs or lungs
- Heavy bleeding
- Early menopause, if the ovaries are removed
- Pain during sexual intercourse
Bradley urges women considering a hysterectomy to speak with their doctors about having the most minimally invasive procedure possible, especially those who aren’t at a healthy weight. Overweight women who have abdominal surgery for noncancerous conditions are at greater risk for bleeding and infection than women of normal weight, according to a study in the journal Human Reproduction in 2011. It was also found that underweight women had more complications with laparoscopic and abdominal surgery.
4. Should I expect menopausal symptoms after a hysterectomy?
Menopause occurs when the ovaries stop producing the hormones estrogen and progesterone, which regulate menstruation. Unless you have your ovaries removed during a hysterectomy due to a medical reason, you likely won’t enter early menopause. But while most women don’t experience early menopause after a hysterectomy, some women may, even if they keep one or both ovaries, according to a Duke University study published in the journal Obstetrics & Gynecology in December 2011. Researchers aren’t sure whether it’s the surgery itself or the underlying condition leading to a hysterectomy that brings on early menopause in some cases.
If your doctor feels you’re at risk for ovarian cancer, your ovaries may also be removed, Bradley says, although this isn’t common. And if your ovaries are removed and you were premenopausal, you will likely go into abrupt menopause. Hot flashes, night sweats, and other symptoms may result. Estrogen replacement therapy can help alleviate these hysterectomy-related issues, Bradley says. However, there’s some concern that taking estrogen could raise your breast cancer risk if you’re over 45.
5. Will I still enjoy sex after a hysterectomy?
Women often report better sex after a hysterectomy, Bradley says, because the procedure relieved pain or heavy bleeding, and because they don’t have to worry about a possible unwanted pregnancy anymore. Some women who also have their cervix removed, however, may experience a drop in testosteroneand possible sexual dysfunction. Don’t hesitate to discuss the sexual side effects and risks with your doctor before moving forward with a hysterectomy.
Bradley encourages women to work with their doctors to avoid hysterectomy. But when all other treatment alternatives are exhausted, hysterectomy may help — many women are relieved to be out of pain, especially if they’re not concerned about fertility.