Hysterectomy, Life After the Surgery

 

…to Be or not to Be, that is the question…

 

 

 

 

 

 

Surgical removal of the uterus

A hysterectomy is major operation to remove a woman’s uterus. It is carried out to treat various problems associated with periods, pelvic pain, tumours and other related conditions. The problem you are experiencing will determine what type of operation is required and whether the fallopian tubes, ovaries, and cervix will also be removed.

Before you decide what to do, it is important that you understand why your doctor has suggested this surgery and what your options are. If you are still having your periods, this surgery will stop them and you will no longer be able to get pregnant.

Since this is a major operation, your doctor may suggest other medical treatments that should be tried first. You may also decide not to go ahead with the operation and live with the problem, but sometimes, there is no alternative. Some conditions which have no alternatives might include cancer, unbearable pain and bleeding.

As mentioned before, a hysterectomy is an operation to remove the uterus. Sometimes, other organs that surround the uterus are also removed to properly treat your condition. These organs include the cervix, the fallopian tubes and the ovaries.

 

Your medical history and the reason for the operation will shape the doctor’s decision as to which type of hysterectomy is best for you:

 A’ complete or total’  removes the uterus, including the cervix. The name is confusing because it does not remove “everything”. In fact, the ovaries and fallopian tubes remain. This is the most common type.

A’ partial or subtotal’  only removes the upper part of the uterus and leaves the cervix and other organs in place.

 A ‘radical’  removes the uterus, the cervix, the upper part of the vagina, supporting tissues and usually the pelvic lymph nodes. This operation is usually performed to treat cancer.

 

In addition to the hysterectomy, you may need to have one or both ovaries removed. This is called a salpingo-oophorectomy. It involves removing the fallopian tube and ovary on one side (unilateral) or both sides (bilateral) of the uterus. This is done mostly in cases of cancer, infection or adhesions. In general, the ovaries and fallopian tubes are left in place unless something is wrong with them. Discuss your options with your doctor.

 

What Will Happen After The Operation?

After the operation, you will need to stay a few days in the hospital to recover. The time spent depends on the type of operation you had and your progress.Your doctor might prescribe antibiotics to prevent infections, as well as pain medication. Complete recovery from abdominal surgery usually takes 6-8 weeks. During this time, you can slowly increase the level of your activities – but don’t overdo it!

Listen to your body and do everything in moderation.

Get plenty of rest and avoid lifting during the first two weeks. You can then begin to do light chores, some driving, and even return to work as long as your job does not involve too much physical activity. Once the bleeding, pain and abdominal pressure have stopped, you can resume normal activities. Around the sixth week following the operation, you can take baths and resume sexual activity, but demanding exercises should be put off until 3 months after your operation.

Women who have had a vaginal surgery generally recover more quickly and are able to resume their activities earlier than women who have undergone an abdominal hysterectomy.

 

What Will Change?

If a woman hasn’t already been through menopause, her periods will stop after the procedure. She can no longer get pregnant. If the ovaries are removed, she might go through distressing menopausal symptoms (hot flashes, mood swings, sleep disturbance, vaginal dryness etc). This may cause more severe symptoms than a natural menopause.

Some women have also reported a decrease in sexual pleasure with the removal of the cervix but this has not been scientifically proven. In fact, most women report either an increase in sexual pleasure or no change at all.

 

Call your doctor or go directly to hospital if you have:

• Heavy vaginal bleeding
• Fever: temperature of 38º Celsius (101º Fahrenheit) or higher
• Severe vaginal, abdominal, leg or chest pain
• Wound draining, discharge, opening, inflammation or swelling
• Persistent nausea and vomiting
• A swollen abdomen or if you are no longer able to pass gas
• Shortness of breath
• Any urinary incontinence (urine leaking or dripping) or painful urination

 

NOTE:

A hysterectomy is a major decision that you should take after careful consultation with your doctor. You should understand the reason for the operation, the benefits and risks and the alternatives to a hysterectomy. If you are unsure, discuss the issue with your doctor or obtain a second opinion.

Non-elective reasons:

• Invasive cancer of the reproductive system including the uterus, cervix, ovaries, fallopian tubes, vagina
• Severe infection (PID) that does not respond to treatment.
• Severe and uncontrollable uterine bleeding.
• Serious complications during childbirth such as a ruptured uterus.  

 

Elective reasons:

• Uterine prolapse
• Endometriosis
• Fibroid tumors
• Severe pelvic infections
• Some cases of hyperplasia

 All of the above reasons for elective hysterectomy are based on your personal medical condition.

 

Surgical Hysterectomy Alternatives

• Myomectomy
• Endometrial ablation
• Uterine artery embalization
• Uterine balloon therapy
• Adhesiolysis

Hormonal Pharmacological  Alternatives

• GnRH agonists with add-back therapy
• Oral contraceptives
• Androgens
• RU-486
• Gestrinone

Non-Hormonal Pharmacological  Alternatives

• NSAIDs – Non-Steroidal Anti-Inflammatory Drugs

Other Options

• Observation

 

Endometriosis:  Surgical  Alternatives

• Excision of endometrial ablation
• Resection of cul-de-sac obliteration
• Nerve blocks
• Uterosacral nerve ablation

Hormonal Pharmacological  Alternatives

• GnRH agonists with add-back therapy
• Danazol
• Progestins
• Oral Contraceptives
• Tamoxifen
• RU-486

Non-Hormonal Pharmacological Alternatives

• NSAIDs
• Analgesics
• Anxiolytics

Other Options

• Observation
• Biofeedback
• Acupuncture
• Hypnosis Lifestyle changes – diet and exercise

 

Uterine Prolapse: Surgical  Alternatives

• Anterior or posterior colporrhaphy
• Laparoscopic or vaginal suspension

Hormonal Pharmacological Hysterectomy Alternatives

• Estrogen

Non-Hormonal Pharmacological Hysterectomy Alternatives

• None

Other Options

• Observation
• Kegels
• Pessaries
• Electrical stimulation
• Urethral beads
• Periurethral injections of GAX, collagen, fat, silicon

Abnormal Uterine Bleeding:  Surgical Alternatives

• D & C
• Endometrial ablation

Hormonal Pharmacological  Alternatives

• Progestins
• Estrogen
• Oral contraceptives
• Danazol
• Prostaglandin inhibitors
• GnRH agonists
• Antifibrinolytic agents
• Luteinizing hormone agonists

Non-Hormonal Pharmacological  Alternatives

• None

Other Options

• Observation
• Antidepressants

Chronic Pelvic Pain:  Surgical  Alternatives

• Adhesiolysis
• Nerve blocks
• Denervation procedure
• Uterosacral nerve ablation

Hormonal Pharmacological  Alternatives

• Danazol
• GnRH agonists with add-back therapy
• Oral Contraceptives
• Medroxyprogesterone acetate

Non-Hormonal Pharmacological Alternatives

• NSAIDs
• Analgesics
• Nerve blocks
• Narcotics

 

Other Options

• Observation
• Counseling
• Biofeedback
• Relaxation
• Trigger point injections
• Acupuncture
• Psychotropic drugs
• Antidepressants
• Physical therapy

 

Before choosing hysterectomy you should carefully explore hysterectomy alternatives that may be available to you so that you make an informed decision about what is best for you. Many times, conditions for which your healthcare provider suggests hysterectomy are successfully treated with alternatives to hysterectomy that include less invasive surgeries, pharmacological treatments, and observation.

Sadly, many physicians see the uterus only necessary for women wishing to have children. This often leaves women alone to explore potential alternatives to hysterectomy. Today, many insurance providers require a second opinion prior to approval of hysterectomy in an effort to reduce the number of unnecessary hysterectomies. If your doctor insists on hysterectomy and it is not for a life-threatening situation, seek another opinion and explore your options before making your decision.

Because hysterectomy has such long-term effects on a woman’s health, longevity, and sexuality it is vital that women understand all possible consequences. You must understand when hysterectomy is elective and when it is necessary to save your life.

  

RELATED LINKS:

WCH: http://www.womenshealthmatters.ca/index.cfm

Source of Information:  

 www.about.com 

For more information about the SOGC, read our booklet:   What You Should Know About the SOGC

Wikipedia Definition:   http://en.wikipedia.org/wiki/Hysterectomy

Frequently Asked Questions, WomensHealth.gov:  http://www.womenshealth.gov/faq/hysterectomy.cfm

Medicine.net:  http://www.medicinenet.com/hysterectomy/article.htm

 

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