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Common Uterine Conditions (continued)

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What You Should Know About Hysterectomy

If you have one of the conditions previously described, your doctor may have told you that you need a hysterectomy. This section describes the different kinds of hysterectomy and some of the things you will want to consider before you make a decision about surgery.

Make sure you understand all of your treatment options and the risks and benefits of each. Then you can work with your doctor to choose the best treatment for you.

A hysterectomy may be done to relieve symptoms caused by several conditions, including:

  • Fibroids.
  • Endometriosis.
  • Hyperplasia.
  • Uterine prolapse.
  • Very heavy or irregular bleeding.

Like other operations, hysterectomy involves both risks and benefits. As with any surgery, there is some risk associated with the anesthesia and the operation itself.

After surgery, you will need to take it easy for several weeks. You will need help with household chores, shopping, and carrying things. If you have small children, you will need help caring for them.

Having a hysterectomy means that your periods will stop for good, and you will be unable to become pregnant. If your ovaries are removed, you may have symptoms associated with menopause.

If your doctor recommends that you have a hysterectomy, you will want to get as much information as possible before you make a decision. Be sure to ask the doctor about your other treatment options, including the benefits and risks of both surgical and nonsurgical alternatives to hysterectomy.

Here are some questions about hysterectomy. They can help you decide with your doctor whether a hysterectomy is the best choice for you.

1. What exactly is done during a hysterectomy?

The answer depends on which type of hysterectomy you have.

In a subtotal hysterectomy, the uterus is removed but the cervix, ovaries, and fallopian tubes are left in place.

In a total hysterectomy (also called a simple hysterectomy), the surgeon removes the uterus and cervix but leaves the ovaries and fallopian tubes.

In a hysterectomy with bilateral salpingo-oophorectomy (also called a radical hysterectomy), the uterus, cervix, ovaries, and fallopian tubes are removed.

Select for illustration on Types of Hysterectomy (20 KB).

2. Will I have a scar?

Whether or not you will have a scar and the kind of scar you will have depend on the kind of cut (incision) the doctor makes. The incision will depend on your condition and which method you choose.

In the first method, the surgeon cuts along the pubic hairline. Sometimes called a "bikini" cut, the scar may be harder to see after it heals.

Another method is to make a cut through the vagina. This method leaves no scar that can be seen. The surgeon may be able to use this method if your uterus is small or if it has slipped (prolapsed) into the vagina.

In the third method, the surgeon cuts downwards from just below the belly button to just above the pubic hairline. The cut is usually 4 to 6 inches long. This type of cut makes it easy for the surgeon to work inside the pelvis.

You should discuss these choices with your doctor and be sure that you understand them.

3. What about pain after the operation?

Your doctor can give you medicine to relieve the pain caused by surgery. Although you should rest as much as you need to, you will recover more quickly and feel better if you get a little bit of exercise each day.

4. What are the side effects of a hysterectomy?

Side effects depend on a number of things, including your age, condition, whether you are still having periods, and what type of hysterectomy you have. If you were still having periods before surgery, they will stop after the operation.

  • If your ovaries are not removed, you will continue to have hormone changes like you did with your periods, but you will not have bleeding.
  • If your ovaries are removed, you will go through changes like menopause. These might include hot flashes, vaginal dryness, night sweats, mood swings, or other symptoms.
Other side effects of hysterectomy are similar to the side effects for any type of surgery. If you work outside the home, you will need to be off for several weeks—how long depends on the type of hysterectomy you have and your doctor's orders. You will need help with routine activities such as child care, shopping, and housework. Additional side effects of surgery include:

  • Effects of anesthesia: The doctor will give you anesthesia so you will not feel pain during the operation. You may feel moody, tired, or weak for a few days after anesthesia. You also may feel a little sick to your stomach (nausea) after anesthesia. The doctor usually can give you something to help settle your stomach.
  • Infections: As with any type of operation, there is always a risk of infection. If you do get an infection, your doctor will give you medicine to treat it.
  • Too much bleeding: There is always a risk that you might bleed too much during an operation and need a transfusion. Ask your doctor if you should donate some of your own blood before the operation or if someone should give blood for you.
  • Damage to nearby organs: It is possible that during the operation a part of your body near the uterus might be damaged. Although this is unlikely, you should ask your doctor what might happen if an organ is damaged.

Studies have shown that for a small number of women, hysterectomy may be followed by one of more of the following problems: unwanted weight gain, constipation, fatigue, unexplained pelvic pain, and premature menopause, even when the ovaries are not removed.

5. If my ovaries are taken out during surgery, should I take medicine to replace the hormones the ovaries used to produce?

The ovaries produce the female hormone estrogen. Estrogen helps the body in a number of ways. For example, it helps to prevent heart disease and osteoporosis (a condition in which the bones become weak and can break easily). It also prevents vaginal dryness.

There is some concern that taking estrogen after your body stops producing it naturally might be harmful. Some research has shown that taking estrogen for many years may increase your risk for breast cancer. Also, if you had endometriosis before menopause, your endometriosis may come back if you start to take estrogen after menopause.

You should carefully consider the risks and benefits of estrogen replacement therapy. Ask your doctor to explain anything you don't understand.

6. How will I feel after a hysterectomy?

Of course, every woman has a different reaction to having this surgery. If your ovaries are removed along with your uterus, you may experience hot flashes or other menopause-like symptoms, as if you were going through "the change." Your doctor may recommend estrogen replacement therapy or other medicine to help relieve your symptoms.

You may be concerned that you won't enjoy sex after the surgery, or that your partner might not find you as appealing. Talk with other women who have had this surgery. You may be surprised to learn that they still enjoy an active and satisfying sex life after hysterectomy.

Age is an important factor in how a woman reacts emotionally to hysterectomy. This is especially true for younger women who have not started or completed their families. Sometimes doctors can find ways to help you manage your condition if you want to become pregnant before the surgery. Sometimes, a hysterectomy is needed to preserve a woman's health, and it may not be possible to delay the surgery.

If giving up the chance to become pregnant is a hard decision for you, you may want to talk with your doctor or a social worker about adoption, foster parenting, or other alternatives.

As a treatment for noncancerous uterine conditions, hysterectomy is more likely than not to improve a woman's life. In part because it means the end of painful symptoms. A few women, however, feel worse following surgery and regret their decision to have a hysterectomy.

Ask your doctor to help you sort out your options and weigh the pros and cons of this surgery as they relate to your situation. You also may want to talk this over carefully with your family or others who are close to you before making a decision.

You might want to ask your doctor or nurse about joining a support group before or after your surgery. Talking over your concerns with other women who have had this surgery can be helpful.

7. Should I get a second opinion?

Getting a second opinion from another doctor is a good way to make sure that hysterectomy is the right option for you. Don't be uncomfortable about telling your doctor you want a second opinion. Doctors expect their patients to ask for another opinion.

Many health insurance plans require that you get a second opinion before you have any surgery. Check with your insurance company to find out if they will pay for a second opinion.

If you go for a second opinion, be sure to bring your medical records from your first doctor so that the second doctor does not have to repeat tests. Be sure both doctors explain their opinions clearly to you.

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In Conclusion

Living with a noncancerous uterine condition can be painful, embarrassing, frightening, exhausting, and sometimes dangerous. There is no need for you to suffer. Treatments are available, and in many cases you need not give up your ability to become pregnant. Hysterectomy is not always the only—or even the best—option.

Deciding on the treatment that is right for you should be done in partnership with your doctor and your family. It is always a good idea to discuss your options with more than one doctor. And, it is important to let those who care about you know that you will need support and help while you are being treated.

Facts About Hysterectomy

Did you know:

  • Hysterectomy is the second most frequently performed operation for women, second only to Cesarean section.
  • Hysterectomy rates are much higher in the United States than in Norway, Sweden, or England.
  • By age 65, more than 37 percent of all women in the United States will have had a hysterectomy.
  • About 583,000 hysterectomies were performed on U.S. women in 1995.
  • U.S. women are more likely to have a hysterectomy if they live in the South or the Midwest.
  • Recent studies suggest that about 15 percent of all hysterectomies may be unnecessary.
  • Recently trained physicians are less likely to recommend a hysterectomy than ones trained earlier.
  • Nearly three-quarters of all hysterectomies are done when women are between 10 and 54 years of age.
  • Annual hospital costs for hysterectomy exceed $5 billion per year.

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Questions to Ask Your Doctor

Here is a list of questions you might want to ask your doctor. Not every question will apply to you, but the questions may help you to organize your thoughts and concerns.

  • What is the name of my condition?
  • What do you think is causing my condition?
  • Is my condition related to a disease that could be sexually transmitted? If so, what should I tell my partner? What can be done to protect me and my partner?
  • Where can I get more information about my condition?
  • What are my treatment options (hormone treatment, another kind of medicine, watchful waiting, surgery, or other alternative)?
  • Which treatment would you recommend for me? Why?
  • Is there anything I can do on my own to help lessen my symptoms?
  • Are there ways to handle my problem without having surgery or taking medicines?
  • If I need surgery, how long will it take me to recover from the operation? What limits might there be on my activities, including sex?
  • What could happen if I decide not to have surgery or other treatment, or if I want to put off treatment for a while?

No matter which treatment your doctor recommends, you should get a second opinion and find out as much as you can about:

  • How the procedure will be done or what medicines will be given.
  • How pain can be handled.
  • What the recovery period after surgery or other treatment will be like.
  • What the common side effects of the treatment are and what can be done about them.
  • Whether the treatment will affect your ability to become pregnant.

You may have thought of some other questions you want to ask. If so, you may want to make a list before you go to the doctor.

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Glossary

Abscess: An infected wound that has pus in it.

Abdomen: The part of the body below the ribs and above the pelvis.

Adhesions: Places where tissue grows together in an abnormal way; internal scar tissue.

Benign: Not cancer (noncancerous).

Bilateral salpingo-oophorectomy: The removal of both fallopian tubes and both ovaries.

Biopsy: A minor surgical procedure during which a small tissue specimen is removed and examined for the presence of disease, often cancer.

Bladder: A sac-like organ in the pelvic region where urine is stored before it leaves the body.

Cancer: A disease of the body's cells. Cells become abnormal and grow out of control. They can also spread to other parts of the body.

CAT scan: A special kind of body imaging that is processed by a computer and displayed on a screen for viewing. Also called a body section radiograph (x-ray).

Cervix: The lower, narrow end (or neck) of the uterus.

Cesarean section: Surgical delivery of a baby through an incision (cut) in the abdomen and uterus.

Chronic condition: A condition that lasts or keeps coming back over a long period of time.

Cystectomy: Surgical removal of an ovarian cyst, usually done along with laparoscopy (Also go to "Laparoscopy").

D & C (dilation and curettage): A surgical procedure that involves dilating (opening) the cervix and scraping the uterine lining (endometrium).

Dysfunctional uterine bleeding: Abnormal uterine bleeding that is not associated with a tumor, inflammation, or pregnancy.

Dysplasia: The growth of abnormal cells. Dysplasia is a precancerous condition that may or may not turn into cancer at a later time.

Electric cauterization: The destruction of tissue with a special type of electric current.

Endometrial ablation: A surgical procedure in which lasers and electrical currents are used to remove the endometrium.

Endometrial biopsy: A sample of endometrial tissue is removed and examined for abnormal cells. (Also go to "Biopsy.")

Endometriosis: A condition in which the same kind of tissue that lines the walls of the uterus grows outside the uterus in the pelvic cavity or some other area of the body.

Endometrium: The tissue that lines the inside of the uterus.

Estrogen: A hormone produced in the ovaries that affects the growth and health of female reproductive functions and organs.

Fallopian tubes: Tubes located on either side of the uterus that carry eggs from the ovary to the uterus.

Fertilization: The moment at which sperm penetrates an egg and a baby begins to grow.

Fibroids: Noncancerous growths that occur most often in the walls of the uterus.

Gonadotropin-releasing hormone (GnRH): A hormone sometimes prescribed to shrink fibroid tumors.

Hormone: A chemical produced by the body that regulates certain bodily functions. Synthetic (man-made) hormones are used in birth control pills and in medicines to treat certain conditions.

Hyperplasia: An overgrowth of the uterine lining, probably caused by excess estrogen. This is sometimes considered to be a precancerous condition, particularly in women who are near or through menopause.

Hysterectomy: Surgical removal of the uterus. Sometimes, the cervix and/or ovaries and fallopian tubes are also removed.

Hysteroscope: A thin, lighted tube that is inserted into the vagina to examine the cervix and inside of the uterus.

Intrauterine device (IUD): A device inserted by a physician in a woman's uterus to prevent pregnancy. Two types of IUDs are used in the United States. One releases a hormone and must be replaced each year. The other type is not medicated and can be left in place for up to 6 years.

Kegel exercises: Special exercises to tighten the pelvic muscles. These exercises are one method used to treat uterine prolapse and urinary incontinence (losing urine when you don't want to).

Laparoscopy: A surgical procedure that allows the doctor to look inside the pelvic cavity by inserting a tube-like instrument through a small cut in the abdomen.

Leiomyoma: The technical term for a fibroid tumor.

Ligaments: A band of tissue that can stretch and that supports other parts of the body.

Menopause: "The change"; the time when a woman stops having a period (menstruating).

Menstrual cycle: The 4-week period each month when an egg develops in the ovary, the lining of the uterus thickens, and the egg is released. If the egg is not fertilized, the cycle is completed when the lining of the uterus is shed through menstruation (a woman's "period").

Menstruation: The shedding of the lining of the uterus that occurs each month when a woman does not become pregnant. A woman's "period."

MRI (magnetic resonance imaging): An imaging technique that allows the soft tissues of the body to be seen.

Myomectomy: An operation to remove fibroid tumors.

Oophorectomy: Surgical removal of an ovary.

Ovaries: Small organs that produce hormones, such as estrogen, and eggs. One ovary is located on each side of the uterus.

PAP test: A painless procedure in which cells are removed from the cervix during a vaginal exam, placed on a slide, and examined through a microscope to look for cancer or precancerous conditions.

Pelvic inflammatory disease (PID): An infection caused by bacteria, usually from a sexually transmitted disease (go to "Sexually transmitted disease"). PID can affect the uterus, ovaries, and/or fallopian tubes. PID can cause persistent pelvic pain and, if not treated, can lead to infertility (the inability to become pregnant). Sometimes, the infection that causes PID is spread through use of an intrauterine device (go to "IUD") or during childbirth or abortion.

Progesterone: The hormone that prepares the lining of the uterus (endometrium) to receive a fertilized egg. The man-made form of this hormone may be used to treat very heavy menstrual bleeding and other conditions.

Prolapse: To fall or tilt, as a uterus or bladder might if the ligaments holding it in place become stretched.

Rectum: The bottom portion of the large intestine.

Reproductive system: The organs of the body that allow a woman to become pregnant and carry and give birth to a child. These include the uterus, fallopian tubes, ovaries, and vagina.

Sexually transmitted disease (STD): A disease that can be given from one person to another during sexual contact; for example, syphilis, gonorrhea, or AIDS.

Sonogram: An imaging procedure in which echoes from sound waves passing through tissues create pictures of structures deep within the body.

Speculum: A metal or plastic instrument the doctor inserts into the vagina to help examine the vagina and cervix.

Uterus: The organ where babies grow; the womb.

Vagina: The tube-like opening leading away from the uterus to the outside of the body.

von Willebrand Disease: A bleeding disorder that runs in families. Call the National Hemophilia Foundation 1-800-424-2634 for more information.

Watchful waiting: The doctor sees the patient regularly to keep track of the condition, talk about any changes in the condition, and make sure symptoms are being relieved.

Womb: Another name for the uterus.

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Resources for More Information

American College of Obstetricians and Gynecologists
409 12th Street, S.W.
Washington, DC 20090
(202) 638-5577
http://www.acog.com

National Women's Health Information Center
(800) 994-WOMAN
http://www.4woman.org

National Women's Health Network
514 10th Street, N.W.Suite 400
Washington, DC 20004
(202) 347-1140

National Women's Health Resource Center
5255 Loughboro Road, N.W.
Washington, DC 20016
(202) 537-4733
http://www.healthywomen.org

Endometriosis Association
8585 N. 76th Place
Milwaukee, WI 53223
(800) 992-3636
http://www.EndometriosisAssn.org

National Black Women's Health Project
1211 Connecticut Avenue, N.W. Suite 310
Washington, DC 20036
(202) 835-0117

American Society for Reproductive Medicine
1209 Montgomery Highway
Birmingham, AL 35216
(205) 978-5000
http://www.asrm.com

National Hispanic Maternal/Child Hotline
COSSMHO
1501 16th Street, N.W.
Washington, DC 20036
(800) 504-7081
http://www.cossmho.org


A Special Note: This document is about conditions of the uterus that are not cancer. To get free information about cancer of the uterus, cervix, or other parts of the body, call the Cancer Information Service at: 800-4-CANCER. This toll-free hotline is a service of the Federal Government's National Cancer Institute.


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Acknowledgments

This information was developed by the Agency for Health Care Policy and Research (AHCPR) with collaboration and support from the U.S. Public Health Service's Office on Women's Health.

We thank our colleagues within the U.S. Department of Health and Human Services for their contributions to this project. We also thank Karen Carlson, MD, of the Harvard Medical School, and Kristen Kjerulff, PhD, of the University of Maryland, Baltimore, for their technical expertise.

Copies of this and other consumer materials on common health problems are available from AHCPR. For information on available titles, or to get printed copies, call toll free: 800-358-9295 or write: Agency for Health Care Policy and Research, Publications Clearinghouse, P.O. Box 8547, Silver Spring MD 20907. Copies of many materials are also available free through InstantFAX, which operates all day every day. If you have a fax machine equipped with a touch-tone telephone, dial (301) 594-2800, push 1, and then press the start button for instructions and a list of publications.

U.S. Department of Health and Human Services
Agency for Health Care Policy and Research
2101 East Jefferson Street, Suite 501
Rockville, MD 20852

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AHCPR Publication No. 98-0003
Current as of December 1997

 


The information on this page is archived and provided for reference purposes only.

 

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