SURGICAL PROCEDURES
Hysterectomy
A hysterectomy procedure is a surgical operation performed to remove the uterus (or womb).
The procedure is a very common surgery around the world and about one in five women will undergo a hysterectomy procedure by the age of 55. However, the number of hysterectomies are going down because of new treatments available to manage conditions that previously could only be cured with a hysterectomy.
Hysterectomy interview with Patricia Ntuli on SA FM radio.
FAQs
What are the conditions that may require a hysterectomy?
- Cancer of the womb or ovaries or cervix will almost certainly need a hysterectomy
- Abnormal uterine bleeding such as irregular bleeding or very heavy menstrual bleeding that we fail to cure with other methods such as tablets, ablation.
- Adenomyosis or endometriosis of the womb when the cells from the lining of the womb (endometrium) grow inside of the tummy and cause enormous pains during the menstrual periods as well as very heavy bleeding
- Large uterine fibroids (more than 12 weeks) or fibroids that cause pain and bleeding. Fibroids are growth usually non-cancerous on the uterus. They are very common and in a majority of women do not cause any symptoms, but when women start experiencing pain or bleeding Dr Novikova will suggest treatment. Usually, she can remove fibroids and the hysterectomy is unnecessary. A hysterectomy may be the safest option for women who do not plan to have more children and have very large fibroids. After assessing each case the doctor will discuss all the options available and recommend the most appropriate one in my opinion.
How is the procedure conducted?
There are three approaches to performing a hysterectomy procedure such as an abdominal (Caesarean type, up and down cut on the tummy), laparoscopic (or keyhole surgery involving a 1 cm cut in the belly button and three 0.5 cm cuts on the sides of the tummy) or vaginal (when there is no cut on the tummy at all and the whole operation is done through the vagina). The choice of hysterectomy procedures (abdominal, laparoscopic or vaginal) depends on the actual problem, size of the uterus, ability to move the uterus, other conditions that the woman may have and her medical condition overall. Dr Novikova can only advise on the type of procedure that is possible in your case after examining you and reviewing all the relevant tests results. Laparoscopic and vaginal hysterectomies do have the advantage of a quicker recovery.
Are the ovaries removed during hysterectomy?
No, usually ovaries are not removed unless they have abnormalities. Nowadays, removing the tubes during the procedure is a common practice as it prevents ovarian cancer in the future and it does not have any negative implications.
What are the risks of hysterectomy?
As with any surgical procedure, a hysterectomy can be complicated by infection, fever, bleeding during and after surgery, injury to bladder, ureter, bowel and large vessels, blood clots in legs and lungs, breathing, heart problems related to anaesthesia and even death. Your risk of hysterectomy depends on the reason for the procedure, your other medical problems, your previous surgery as well as your weight.
What are the measures to prevent the complications of a hysterectomy?
Every woman undergoing this procedure receives an antibiotic. Just the cut is made to prevent infection, has compression stocking and calf compressors as well as a medication to thin the blood after surgery to prevent clots. Women are monitored closely during and after surgery. Any individual risk is discussed before the surgery and dealt with appropriately.
What are the long-term consequences of a hysterectomy procedure?
After the hysterectomy procedure has been conducted you will not have periods and you will not be able to fall pregnant.
What is important during the recovery period?
You should rest initially and increase your physical activity gradually. You can walk the following day after a hysterectomy procedure, but should avoid heavy lifting and heavy physical activity for 4-6 weeks. You should also avoid having sex and inserting anything in the vagina for 6 weeks after the hysterectomy procedure.
Do women develop menopause after having hysterectomy?
No, this procedure does not lead to menopause unless the ovaries are removed
Does sexual satisfaction change following this procedure?
Women do not need a uterus to experience an orgasm so sexual satisfaction generally does not change. Some women may find more pleasure in sex because their symptoms of pain or bleeding are gone, others may develop problems because of vaginal dryness especially if the ovaries are removed. Whatever the issue is, I will discuss it with you prior to the operation and we can manage it afterwards.
What are the alternatives to hysterectomy?
There are a number of alternatives to this procedure depending on what the reason for the hysterectomy is. For example, abnormal uterine bleeding and adenomyosis can be treated with hormonal tablets (pill or other hormonal tablets), or tablets that decrease blood flow or endometrial ablation (destruction of the lining of the womb with high temperature).
Uterine fibroids can also be treated with all the above and an embolization procedure.
Cancer generally requires hysterectomy with minimal alternatives.
How long will you be in hospital after the procedure?
You usually come to the hospital on the day of surgery and go home the following day after a laparoscopic or vaginal hysterectomy procedure and in 2-3 days after an abdominal hysterectomy procedure.
How long is the recovery?
It usually takes up to 6 weeks to fully recover from surgery, however, the recovery is much quicker after laparoscopic and vaginal hysterectomy. Women usually experience some pain, which is controlled with tablets. Constipation is common. Some women have difficulties passing urine, which is usually a temporary concern after a hysterectomy procedure.