Hysterectomy

What is a hysterectomy?

A hysterectomy is a procedure in which a woman’s uterus is surgically removed from the body. The uterus or the womb is a muscular sac that carries the baby, nourishes it, and helps it to grow until the time the baby is born.

The lining inside the uterus is known as the uterine lining and is responsible for the menstruation process. A hysterectomy is done for several reasons such as cancer, uterine prolapse, fibroids, chronic pain, abnormal bleeding, and other underlying diseases.

Once you do a hysterectomy, you will stop menstruating and will lose the ability to become pregnant.

A hysterectomy surgery involves certain risks and side effects and since the patient loses her capability to become pregnant or menstruate normally, the doctor will do adequate tests and prescribe medications or alternative treatments before doing a hysterectomy. A hysterectomy is only done when no other treatment choices are available for curing the disease.

Types of hysterectomy

A hysterectomy can be partial or total depending on the reason for the surgery.

• Supracervical hysterectomy – Here, the upper portion of the uterus is removed. The cervix is left intact.

• Total hysterectomy – This surgery removes the entire uterus and the cervix.

• Hysterectomy and bilateral salpingo-oophorectomy – In  total hysterectomy, the surgeon removes the uterus, cervix along with the fallopian tubes (salpingo) and the ovaries (oophor). This is mainly done after menopause when the patient is no longer menstruating.

• Radial hysterectomy – This surgery is done along with bilateral salpingo-oophorectomy. Here, the uterus, fallopian tubes, cervix, ovaries along with lymph nodes, the upper part of the vagina, and surrounding vaginal tissues are removed. This is done mainly to treat uterine or cervical cancers.

Preparation

Before you undergo a hysterectomy surgery, it is best to be prepared and gather all the information and details about the procedure. Here is a checklist.

• Gather information about the surgery – Talk to your doctor or medical counselor and gather all information you need about the surgery. Learn about the pros and cons and the side effects of the surgery. If you have any questions, do not hesitate, and ask your doctor or the surgeon who will be performing the surgery. If you are anxious, talk to your medical supervisor or the doctor and clear your doubts.

• Learn about your medications – Follow up with your doctor days before the surgery and learn about your medication routine and the instructions to follow before the surgery. Ask your doctor which medicines you should discontinue or continue taking before the surgery. If you are taking any medications, supplements, or herbal remedies, inform your doctor and the medical supervisor. Do not change the medication routine and follow your doctor’s instructions properly to avoid complications after the surgery.

• Make arrangements for your hospital stay – Your doctor will give you suggestions about the hospital where he/she will perform the surgery. If you have any suggestions, be open and talk to your doctor. Choose a location that is nearer to your residence and does not take too much time for you to travel back home after the surgery.

• Make arrangements for care at home – After the surgery, you will need proper rest. Your activities will be restricted and you will need assistance at home. Make arrangements for help at home who can assist you in your day-to-day activities and medical care.

Tests to be done:

A doctor will perform certain tests to verify whether you need a hysterectomy or not.

• Pap smear – This test is also known as a Pap test and is done on women suffering from cervical cancer.

• Endometrial biopsy – This is done on patients suffering from endometriosis or endometrial cancer.

• Pelvic ultrasound – It will visualize all the pelvic organs like the ovary and determine whether the patient has any ovarian cysts, fibroids, endometrial polyps, etc.

• Routine tests – The doctor will ask you to do a routine urine test and some blood tests to evaluate your overall health.

• General health checkups.

Before the surgery

The day you undergo the surgery, your medical supervisor will explain the procedure in detail. You will be advised to follow certain preparatory measures such as:

• Stop smoking or drinking alcohol a few days before the surgery.

• Eat healthy foods.

• Do light exercises to keep your body fit.

• If you are overweight, doctors may recommend to lose some weight before the surgery.

• On the morning of the surgery, you will be asked to bathe properly with soap and water and thoroughly wash your private parts to prevent any infection.

• Vaginal douching may be used to thoroughly cleanse your vaginal area to reduce the risks of any infection.

• An enema may be administered to clear your bowels.

• You will be put on an IV (intravenous fluids) before the surgery.

Procedures

There are different procedures to do a hysterectomy depending on the type of the medical condition and the overall health of the patient.

Open hysterectomy surgery

Abdominal hysterectomy is done as open surgery. It is an invasive surgery and is the most common procedure to do a hysterectomy surgery.

In this procedure, a 5 to 7 inches incision is done either across the abdomen above your bikini lining or vertically just below the belly button to the bikini line from which the womb is cut and removed. After the womb has been removed, the incision is stitched back.

The surgery is done under general anesthesia and the patient needs to stay in the hospital post-surgery for a few days until she is fit to go home. The surgery will leave a visible scar on the abdomen.

This surgery is mostly done if the patient has large pelvic tumors, fibroids, or the ovaries need to be removed.

Minimally invasive surgeries

• Vaginal hysterectomy – A vaginal hysterectomy is done to remove the uterus and the cervix. It is mainly done in case of heavy menstruation or fibroids. It can be done under general anesthesia or localized anesthesia depending on the patient and the doctor performing the surgery. The surgery normally takes around 45 minutes. The surgeon will make a cut along your cervix above the vagina to remove the uterus and the cervix. The supportive ligaments are then stitched back to prevent prolapse. After the surgery, the surgeon will insert gauze to control bleeding. After a few days, the gauze will be removed. Patients may, however, experience vaginal bleeding or brownish discharge for a few days and have to wear sanitary napkins to control the discharge. Vaginal hysterectomy is less invasive than abdominal hysterectomy and recovery are much faster compared to open surgery.

• Laparoscopic hysterectomy – Another name for laparoscopic surgery is keyhole surgery. A laparoscope that has a small video camera and a light attached to it is inserted through the small incision hole that helps the surgeon to see the organs and the tissues surrounding the reproductive organs. The surgeon makes small incisions in the vagina or the abdomen through which he/she inserts the laparoscope. The surgeon then removes parts of the reproductive organs like the cervix, womb, ovaries, etc. The surgery is done under general anesthesia.

• Laparoscopically-assisted vaginal hysterectomy (LAVH) – An LAVH is done to remove the reproductive organs through the vagina. It is normally not done on patients suffering from advanced cancer. The surgeon makes small cuts in the abdominal wall through which the laparoscope and other surgical devices are inserted. The surgeon cuts the organs like the fallopian tubes, cervix, or ovaries that are to be removed and detaches them  from the ligaments holding them. The detached organ/s are then removed from the vaginal incision.

• Robot-assisted laparoscopic hysterectomy – This is quite similar to laparoscopic hysterectomy; however, the only difference is that the surgeon uses robotic assistance that controls some devices that help the surgeon to remove the reproductive organs. The surgeon makes some incisions in your abdomen through which the surgical instruments remove the organs. The surgeon sees and conducts the entire procedure through a 3D screen.

When should you go for a hysterectomy surgery?

A hysterectomy is generally done for the following reasons.

• Gynecologic cancers like cervical or uterine cancers – If a patient is suffering from gynecological cancers like cervical or uterine cancers and have exhausted all other treatment options like radiation, chemotherapy, etc., then hysterectomy is the only treatment.

• Uterine fibroids – Also known as leiomyoma are benign non-cancerous tumors that can cause pelvic pain and persistent bleeding, anemia, and pressure on the bladder. Treatment depends on the stage of the disease and the size of the tumors. Some fibroids do not have any symptoms and may not need any treatment as well. If the fibroids are painful and the symptoms cannot be cured by medication or other treatments, then hysterectomy is the only possible treatment for the disease.

• Endometriosis – Endometriosis is a condition when the uterine tissues (endometrium) that grow inside the lining of the uterus start developing outside the uterus and spreads to the fallopian tubes, ovaries, and other abdominal organs. In such cases, your doctor may suggest a hysterectomy. The surgeon may perform bilateral salpingo-oophorectomy. However, it is done only when no other treatment or medications are working to treat the symptoms.

• Severe pelvic pain – If a patient is experiencing chronic pelvic pain related to the uterus, a doctor may perform a hysterectomy. However, it is best to seek proper medical intervention and diagnosis before undergoing a hysterectomy for pelvic pain.

• Abnormal vaginal bleeding – For patients who have abnormal and severe vaginal bleeding during each menstrual cycle, doctors may prescribe a hysterectomy. This is only done when no other treatment can cure the problem.

• Uterine prolapse – This happens when the uterine and vaginal muscles become weak and the uterus drops down to the vagina. This can hinder bowel movements, cause pelvic pressure and urinary incontinence.

• Adenomyosis – In this condition, the endometrium or the inner lining of the uterus penetrates the uterus wall or the myometrium and thickens the uterus. This can cause severe cramps during menstruation, heavy bleeding during periods, bloating, etc. The pain may be localized or can be felt in all parts of the uterus. Doctors may perform a hysterectomy to treat the condition.

Surgery options

Patients can undergo a hysterectomy surgery in a specialized clinic or a public or private hospital. Each facility whether it is a small clinic or a multi-specialty hospital has its own merits and drawbacks.

Small clinics

Pros

• More cost-effective than big private hospitals

• More personalized care due to fewer patients

• Do not have to wait for paperwork and other formalities unlike bigger hospitals

Cons

• Limited access to specialized equipment highly-trained doctors

• Lack of adequate staff and aftercare facilities post-surgery

• Local clinics may not be equipped to handle emergencies

Hospitals

Pros

• More experience in handling traumatic situations and emergencies

• Access to the best doctors and facilities

• Safer environment to carry out invasive procedures

Cons

• There is a significant price variance in big hospitals due to underlying costs and additional charges

• Patients may have to wait for hours or days to book an appointment with their doctors.

• Less personalized care compared to local clinics

• Patients may have to travel long distances to get a consultation

Cost of hysterectomy

The average hysterectomy cost in India depends on various factors such as:

• The city you are residing in where you are going to have your surgery. Some cities like Kolkata or If you are travelling to a different city, the cost will be even more. You have to consider your hotel stay not only for you but also for your spouse or the person/s accompanying you and also the daily travel expenditure for consultations.

• The charges are less in smaller clinics compared to big hospitals. The cost of the procedure is less in Government hospitals.

• Doctor’s remuneration.

• Post-operative care. You have to appoint nurses or caregivers at home especially if you are living alone or do not have anyone to help you with your household chores and cooking.

• The type of procedure.

• Whether insurance coverage is available for the surgery.

Post-operative care and things to keep in mind

Post-surgery, you have to remain in the recovery room for a few hours until the doctors and medical team decide to transfer you to a general bed.

During this time, the medical team will monitor your recovery and progress, check your vital signs, and signs of pain or other symptoms. You will be given medications for pain relief and to prevent infections. Doctors and nurses will encourage you to resume walking after the surgery.

Here are some post-operative tips to remember after surgery:

• You have to stay in the hospital for two or three days or more depending on the type of hysterectomy procedure and your recovery process.

• You will have menstrual bleeding and vaginal discharge after the surgery. You have to wear sanitary napkins for a few days or weeks. If you have persistent heavy bleeding, consult your doctor immediately.

• Once you are back home, take ample rest.

• Resume normal activities 4-6 weeks after the surgery. In vaginal or laparoscopic surgeries, the healing is faster.

• Avoid lifting heavy objects.

• Try to stay active but avoid strenuous activities.

• Avoid sex for few weeks.

• At home follow your normal diet.

• After two weeks, you can do light swimming as per the recommendation of the doctor.

• You can start light exercises after four or six weeks depending on your recovery and the hysterectomy procedure.

• Consult your doctor before going back to work.

• Some women may feel distressed or depressed after the hysterectomy surgery. Consult your doctor or a counselor, if you are feeling overwhelmed.

Risks and side effects

After a hysterectomy surgery, some patients may experience certain side effects both physically and emotionally. The hysterectomy procedure especially abdominal hysterectomy which is an open surgery is susceptible to certain risks. Laparoscopic surgery has a low rate of risks post-surgery.

Physical side effects:

• Bleeding from the wound site

• Blood clots

• Itching or burning sensation on the wound site

• Inflammation or redness

• Infection in and around the surgical site

• Damage of nerves or tissues

• Insomnia

• Hot flashes

• Dryness in the vagina

• Night sweats

• Painful sex

• Reduced urge for sex

Risks for medical conditions like:

• High blood pressure

• Increase in weight leading to obesity

• High risk of coronary artery disease

• Increased risk for heart failure

• Pelvic organ prolapses

There is a high risk of pelvic organ prolapses after a hysterectomy. Since there is no connection between the vagina and the other reproductive organs like the cervix or the uterus, the vagina itself may prolapse and protrude out.

There can be prolapse of other organs like the bladder or the bowel due to lack of support from the pelvic ligaments and may cause urinary problems. Doctors may recommend Kegel exercises or pelvic floor exercises to strengthen the pelvic muscles.

Mental side effects

Besides the impact on physical health, hysterectomy may affect the mental health of a person as well. Since a woman can no longer be pregnant or have normal periods, they may feel that they have lost their identity or traits of womanhood. For some women who had painful periods, not having menstruation may be a relief. However, for others, menstruation and motherhood are related to femininity and this may cause depression, sadness, mood swings, and anxiety.

Best option

Laparoscopic surgery is minimally invasive and the recovery rate is also higher. Patients have fewer side effects and can resume normal work after proper rest and care at home. Bangalore is the home for some of the best OB/GYN doctors and A-rated hospitals that can perform hysterectomy surgeries in a safe and secure environment. At goficure, our dedicated medical coordinator will assist you throughout your journey from booking consultations, pre-surgery medical diagnosis, finding the best doctor, hospital care, insurance coverage, and post-surgery care as well. Our medical coordinator will also assist you in booking follow-up appointments for smooth recovery and healing.

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